NURS 190 PHYSICAL ASSESSMENT FINAL EXAM 2
LATEST VERSIONS REAL EXAM 2026 UPDATED
1. Pt with malignant melanoma; risk factors; what will the skin look like? ABCDE
➢ ABCDE of Melanoma
• Asymmetry
• Border Irregularity
• Color Variation
• Diameter Greater than 6mm
• Evolving Changes
➢ Risk Factors
• Sun sensitivity, difficulty tanning, hx of prolonged sun exposure, use of tanning booths, occupational
exposure to chemicals like tar and radiation
➢ QUIZ QUESTION: Nevi this big and has color variation should be alerted for? – Malignant Melanoma
2. How to assess for central cyanosis?
➢ Look at patient’s oral mucosa
➢ QUIZ QUESTION: How to assess central cyanosis? – check the oral mucosa
3. Contact dermatitis
➢ Inflammation of the skin due to an allergy to a substance that comes into contact with the skin
➢ Redness, hives, vesicles or scales accompanied by intense itching
4. 3 Tineas; signs and symptom
➢ Tinea Corporis – fungal infection of the body
➢ Tinea Capitis – fungal infection of the scalp
• Need to further assess the cause of pruritus of the scalp because this can be due to lice
➢ Tinea Pedis – fungal infection of the feet (athlete’s foot)
5. COPD, configuration of chest
➢ Barrel chest; AP:T diameter is equal
➢ QUIZ QUESTION: Expected finding with patient with COPD?
• Barrel chest
• Kyphosis
• Hollow Clavicle
• Protruding Sternum → angle of Louie
6. Scoliosis, kyphosis, lordosis, torticollis
➢ Scoliosis – lateral curvature and rotation of the thoracic and lumbar spine (S back); most common in female
➢ Kyphosis – exaggerated posterior curvature of the thoracic spine (hunchback); associated with aging.
➢ Lordosis – exaggerated curvature of the lumbar spine (swayback); compensation for pregnancy, obesity, and
skeletal changes.
➢ Torticollis – muscle spasm by spinal accessory nerve, causing lateral flexion contracture of neck muscle
7. Physiological changes in older adult for all the systems discussed
➢ Skin, Hair, and Nails
• Decreased elasticity, sebum production, perspiration, and melanin
• Increased sensitivity to light
• Nails become thicker, and more brittle
➢ Head, Neck and Lymphatics
• Loss of subcutaneous fat in the face
• Decreased reproductive hormone
• Hair change, tooth loss, limited ROM
• Complaints of tired or weak feeling due to thyroid dysfunction
➢ Eye
• Decreased vision acuity
• Presbyopia – age-related near vision difficulty
• Cataract – thickened yellow lens; decreased lens clarity
• Macular Degeneration – loss of central vision
➢ Ears, Nose, Mouth and Throat
• Loss of hearing frequency
• Gradual hearing loss (presbycusis)
,• Chelitis (angular stomatitis)
• Decreased sense of taste and smell, saliva production,
• Receding gum, tooth loss
, ➢ Respiratory
• Decreased respiratory efficiency, cough ability
• Changes in breath depth
• Increased RR, effect of infection
➢ Breast and Axillae
• Limited ROM for examinations
• Modification of BSE
• Changes in breast tissue composition
• Gynecomastia in males
• Increased breast cancer risk with aging
➢ Cardiovascular
• Loss of ventricular compliance and vascular rigidity
• Conduction system loses automaticity
➢ Peripheral Vascular
• Increased BP
• Decreased pulse with irregularities
• Enlarged calf vessel
8. Different types of color – jaundice, pallor etc; What requires immediate intervention
➢ Cyanosis – mottled blue color in skin (REQUIRES IMMEDIATE INTERVENTION)
➢ Pallor – loss of skin color due to the absence of oxygen
➢ Uremia – pale yellow tone due to urinary retention
➢ Erythema – redness of the skin due to increase visibility of the oxyhemoglobin
➢ Jaundice – yellow undertone due to increase bilirubin in the blood
➢ QUIZ QUESTION: CYANOSIS is a priority because it indicates hypoxemia
9. How to assess jaundice, central cyanosis?
➢ Look for discoloration with the patient’s oral mucosa, then conjunctiva next
10. How to assess temperature
➢ Use the dorsal surface of the hand and feel for the temp
➢ QUIZ QUESTION: If assessing for temperature, use the DORSAL surface of the hand
11. Sxs of infection; patient suspecting with infection
➢ Older patient with pneumonia will present CONFUSION
➢ QUIZ QUESTION: patient suspected of fungal infection? – have you taken antibiotics recently
12. Assessing for pain; expected findings with acute pain /chronic pain
➢ Self-reported pain from patient is the most accurate assessment of pain
➢ QUIZ QUESTION: Best way to assess for pain is SELF-REPORTED pain from patient
13. Cranial nerves I, II, III,IV, VI; how to assess the different cranial nerves?
➢ CN I: Olfactory – smell
• Assessment: have the patient close their eyes, obstruct one nare then make patient sniff a common
substance, and then do the other nare
• Anosmia – inability to detect odor
• Unilateral or bilateral anosmia
➢ CN II: Optic – sight
• Assessment: Snelling and Rosenbaum
• Optic atrophy, papilledema, amblyopia, field defects
➢ CN III: Oculomotor – eyelids and pupil
• Direct Constriction – shine light directly to the pupil; failure of the pupil to constrict shows defect in the
direct pupillary response; defect in CN III
• Consensual Constriction – simultaneous constriction of the pupil that is not illuminated.
• 6 Cardinal Fields of Gaze – evaluates the movement of the eyes
o Nystagmus – weakness of the extraocular muscles; repetitive uncontrolled eye movements
o Looking up and down without moving the head
• Confrontational Test – tests peripheral vision by covering one eye together with patient; examiner moves
finger in peripheral field
• ABNORMAL: can’t move eye upward, and downward
• Diplopia, ptosis, dilated pupils, inability to focus on close objects
LATEST VERSIONS REAL EXAM 2026 UPDATED
1. Pt with malignant melanoma; risk factors; what will the skin look like? ABCDE
➢ ABCDE of Melanoma
• Asymmetry
• Border Irregularity
• Color Variation
• Diameter Greater than 6mm
• Evolving Changes
➢ Risk Factors
• Sun sensitivity, difficulty tanning, hx of prolonged sun exposure, use of tanning booths, occupational
exposure to chemicals like tar and radiation
➢ QUIZ QUESTION: Nevi this big and has color variation should be alerted for? – Malignant Melanoma
2. How to assess for central cyanosis?
➢ Look at patient’s oral mucosa
➢ QUIZ QUESTION: How to assess central cyanosis? – check the oral mucosa
3. Contact dermatitis
➢ Inflammation of the skin due to an allergy to a substance that comes into contact with the skin
➢ Redness, hives, vesicles or scales accompanied by intense itching
4. 3 Tineas; signs and symptom
➢ Tinea Corporis – fungal infection of the body
➢ Tinea Capitis – fungal infection of the scalp
• Need to further assess the cause of pruritus of the scalp because this can be due to lice
➢ Tinea Pedis – fungal infection of the feet (athlete’s foot)
5. COPD, configuration of chest
➢ Barrel chest; AP:T diameter is equal
➢ QUIZ QUESTION: Expected finding with patient with COPD?
• Barrel chest
• Kyphosis
• Hollow Clavicle
• Protruding Sternum → angle of Louie
6. Scoliosis, kyphosis, lordosis, torticollis
➢ Scoliosis – lateral curvature and rotation of the thoracic and lumbar spine (S back); most common in female
➢ Kyphosis – exaggerated posterior curvature of the thoracic spine (hunchback); associated with aging.
➢ Lordosis – exaggerated curvature of the lumbar spine (swayback); compensation for pregnancy, obesity, and
skeletal changes.
➢ Torticollis – muscle spasm by spinal accessory nerve, causing lateral flexion contracture of neck muscle
7. Physiological changes in older adult for all the systems discussed
➢ Skin, Hair, and Nails
• Decreased elasticity, sebum production, perspiration, and melanin
• Increased sensitivity to light
• Nails become thicker, and more brittle
➢ Head, Neck and Lymphatics
• Loss of subcutaneous fat in the face
• Decreased reproductive hormone
• Hair change, tooth loss, limited ROM
• Complaints of tired or weak feeling due to thyroid dysfunction
➢ Eye
• Decreased vision acuity
• Presbyopia – age-related near vision difficulty
• Cataract – thickened yellow lens; decreased lens clarity
• Macular Degeneration – loss of central vision
➢ Ears, Nose, Mouth and Throat
• Loss of hearing frequency
• Gradual hearing loss (presbycusis)
,• Chelitis (angular stomatitis)
• Decreased sense of taste and smell, saliva production,
• Receding gum, tooth loss
, ➢ Respiratory
• Decreased respiratory efficiency, cough ability
• Changes in breath depth
• Increased RR, effect of infection
➢ Breast and Axillae
• Limited ROM for examinations
• Modification of BSE
• Changes in breast tissue composition
• Gynecomastia in males
• Increased breast cancer risk with aging
➢ Cardiovascular
• Loss of ventricular compliance and vascular rigidity
• Conduction system loses automaticity
➢ Peripheral Vascular
• Increased BP
• Decreased pulse with irregularities
• Enlarged calf vessel
8. Different types of color – jaundice, pallor etc; What requires immediate intervention
➢ Cyanosis – mottled blue color in skin (REQUIRES IMMEDIATE INTERVENTION)
➢ Pallor – loss of skin color due to the absence of oxygen
➢ Uremia – pale yellow tone due to urinary retention
➢ Erythema – redness of the skin due to increase visibility of the oxyhemoglobin
➢ Jaundice – yellow undertone due to increase bilirubin in the blood
➢ QUIZ QUESTION: CYANOSIS is a priority because it indicates hypoxemia
9. How to assess jaundice, central cyanosis?
➢ Look for discoloration with the patient’s oral mucosa, then conjunctiva next
10. How to assess temperature
➢ Use the dorsal surface of the hand and feel for the temp
➢ QUIZ QUESTION: If assessing for temperature, use the DORSAL surface of the hand
11. Sxs of infection; patient suspecting with infection
➢ Older patient with pneumonia will present CONFUSION
➢ QUIZ QUESTION: patient suspected of fungal infection? – have you taken antibiotics recently
12. Assessing for pain; expected findings with acute pain /chronic pain
➢ Self-reported pain from patient is the most accurate assessment of pain
➢ QUIZ QUESTION: Best way to assess for pain is SELF-REPORTED pain from patient
13. Cranial nerves I, II, III,IV, VI; how to assess the different cranial nerves?
➢ CN I: Olfactory – smell
• Assessment: have the patient close their eyes, obstruct one nare then make patient sniff a common
substance, and then do the other nare
• Anosmia – inability to detect odor
• Unilateral or bilateral anosmia
➢ CN II: Optic – sight
• Assessment: Snelling and Rosenbaum
• Optic atrophy, papilledema, amblyopia, field defects
➢ CN III: Oculomotor – eyelids and pupil
• Direct Constriction – shine light directly to the pupil; failure of the pupil to constrict shows defect in the
direct pupillary response; defect in CN III
• Consensual Constriction – simultaneous constriction of the pupil that is not illuminated.
• 6 Cardinal Fields of Gaze – evaluates the movement of the eyes
o Nystagmus – weakness of the extraocular muscles; repetitive uncontrolled eye movements
o Looking up and down without moving the head
• Confrontational Test – tests peripheral vision by covering one eye together with patient; examiner moves
finger in peripheral field
• ABNORMAL: can’t move eye upward, and downward
• Diplopia, ptosis, dilated pupils, inability to focus on close objects
