NSG6020 Advanced Health and Physical Assessment 1

South University Online

FINAL HEAD TO TOE PHYSICAL EXAM DEMONSTRATION

 General tips: Do not disrobe patients for any part of exam; we will assume this
has been done. You will need a stethoscope, cotton ball (or other soft object),
penlight or small flash light. Great if you have a reflex hammer no problem if
you do not; use side of hand or stethoscope if you do not have one.

 No need to state what you are doing during the exam unless indicated in the
particular section below. If filming exam place web cam or video camera far
enough away to keep patient and examiner in full view of camera; take a few
test videos and review them to make sure we will be able to see you performing
the aspects of the exam.

 You may look at your note cards or look away from the exam (to view a note
board) briefly during the exam. The video cannot be stopped more than once
during the exam. You do have the option of submitting the exam in two parts.
The video or live exam cannot be longer than 30 minutes; time your practice
sessions.

 Most of all, relax and do not stress- stress will decrease your ability to recall the
steps in the exam. Remember- you all know these steps, if you have been
practicing regularly you should have no trouble performing them for the final
exam 

Physical Exam Checklist Pass / Fail

Student Name: Date: Tester: Done Comments

Introduction: (Total: 2 pts)
1. Establishes contract to perform assessment (1pt)
(Introduce yourself to patient)
2. Washes hands (1pt)
(Use waterless hand sanitizer or state “I just washed my hands”)

Stand in Front of Patient: Patient sitting, with legs dangling

Skin (General survey): (Total: 1 pt)
1. Inspects: overall skin color: (pink, cyanotic, jaundice, pale, pigmentation & uniformity)
(1pt)
(Generally look over skin as you do each part of the exam so we can tell that you
performed this part- knowing that in a real exam the patient would be disrobed)

(During the exam, examine skin condition with corresponding regional examination.
Assumption: Aspects of Health history & General Survey complete, including general
appearance, LOC, mood and affect, mobility, speech, measurements, VS, etc. Report
any significant health history issues – especially as might affect physical exam – to the
tester:
CMA/8_11 (Adapted from Jarvis, C. (2012). Physical examination and health assessment. (6th ed.).
Philadelphia: Saunders)
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South University Online

Only state major issues i.e. if there is a significant physical

deformity/disorder/disease that would limit the exam such as inability to stand
due to severe lumbar disc disease, otherwise assume we are aware of all previous
subjective findings and health history, in other words not need to state.)

Head and Face (Total: 9 pts)

1. Inspects and palpates scalp, hair, and cranium (1 pt)
2. Inspects: Asks the patient: wrinkle forehead, close eyes against resistance, puff cheeks,
clench teeth; inspect for symmetry (4 pts)
3. Palpates Temporal artery (1 pt)
4. Palpates TMJ as the pt. opens and closes their mouth, move jaw side-to-side (1 pt)
5. Has the patient clench their teeth while trying to separate the jaw by pushing down on
the chin (1 pt)
(You may need to ask them to do this part unless they know to do it when you touch
the sides of their face from your practice sessions)
6. Palpates sinuses (cheekbones [maxillary], under eyebrows [frontal]) (1 pt)
Eyes (Total: 7 pts)
1. Tests visual acuity: Snellen test (or explains) (1 pt)
(You may state that they have been tested and have 20/20 vision left eye, right eye
and both eyes)
2. Tests confrontation (1 pt)
3. Tests extraocular muscles: performs the six cardinal positions of gaze (1 pt)
(May need to tell patient to follow your finger with their eyes only)
4. Inspects: structures, conjunctiva, sclera, cornea, irides (1 pt)
5. Tests corneal light reflex (1 pt)
(Will need flashlight or pen light for steps 5 and 6)
6. Tests pupils: size, response to light, and accommodation. (PERRLA) (2 pt)
Ears (Total: 3 pts)
1. Inspects external ear: position, alignment, skin condition, & auditory meatus (1 pt)
2. Palpate: Moves auricle and pushes tragus for tenderness (1 pt)
3. Tests Hearing: performs Whisper test (1 pt)
(May state this was previously tested and what results were i.e. state “Forced
whisper hearing test passed bilaterally at 5 feet”
Nose (Total: 2 pts)
1. Inspects external nose: symmetry, position, proportion, lesions. (1 pt)
2. Tests the patency of each nostril. (1 pt)
(May state that nostrils are patent bilaterally)
Mouth and Throat (Total: 5 pts)
1. Inspects: Using a penlight (without tongue blade), inspect the buccal mucosa, teeth &
gums, tongue, floor of mouth, palate, tonsils (if present) (2 pts)
(Do not remove dentures if present; in a real clinical exam you would but please do
not for this exam)

CMA/8_11 (Adapted from Jarvis, C. (2012). Physical examination and health assessment. (6th ed.).
Philadelphia: Saunders)
 NSG6020 Advanced Health and Physical Assessment 3
South University Online

2. Inspects: Asks the patient to open mouth and say “ahhh”, inspect the uvula and soft
palate (rise midline) (1 pt)
3. Explains how to test the gag reflex (1 pt)
4. Inspects: Asks the pt. to stick out their tongue: (check that it is midline and without
tremors), note any breath odor (1 pt)

Neck (Total: 9 pts)

1. Inspects the neck: symmetry, lumps, pulsations (1 pt)
2. Palpates lymph nodes (2 pts)
3. Inspects and palpates the carotid pulse, one side at a time (1 pt)
4. Auscultates carotid for bruits (at least one location each side) (1 pt)
5. Palpates the trachea for location (midline) (1 pt)
6. Tests ROM of neck: forward/backward, ear-to shoulder, chin side-to-side (1 pt)
7. Tests: muscle strength against resistance (head forward & backward
head turned to each side, and shoulder shrug) (2 pts)
(Will need to ask pt. to shrug shoulders)

Move to back of patient (Patient remains sitting)

Neck (Total: 1 pt)
1. Palpates thyroid gland, posterior approach (1 pt)

Thorax and Lungs: Posterior and Lateral (Total: 6 pts)

1. Inspects the posterior chest: configuration of thoracic cage, skin characteristics,
symmetry of shoulders and muscles (1 pt)
2. Palpates: lumps, masses, tenderness; and spinal processes: tenderness, alignment (1 pt)
3. Percusses: costovertebral angle (CVA),( note any tenderness) (1 pt)
4. Auscultates breath sounds: upper & lower lobes at 5 levels AND lateral lobes, compare
side-to-side (3pts)

Move to front of patient (Patient remains sitting)

Thorax, Lungs, apical pulse: Anterior (Total: 4 pts)
1. Inspects: respirations and skin characteristics. (1 pt)
2. Auscultates breath sounds at 5 levels & compares sides (2 pts)
3. Auscultates cardiac base: Has patient lean forward, exhale, and listens for murmur (1
pt)
Upper Extremities (Total: 8 pts)
1. Inspects hands and nails: (skin), lesions, nail shape and contour, consistency, color (1
pt)
2. Palpates: joints in wrists and hands, assess cap refill (1 pt)
3. Palpates: Skin temperature (dorsum of hand: warm/cool/dry/clammy) and skin turgor

CMA/8_11 (Adapted from Jarvis, C. (2012). Physical examination and health assessment. (6th ed.).
Philadelphia: Saunders)
 NSG6020 Advanced Health and Physical Assessment 4
South University Online

(1 pt)
4. Palpates: radial and brachial pulses, and epitrochlear lymph nodes (1 pt)
5. Tests: ROM of shoulders (Forward flexion, hyperextension, internal rotation,
abduction, adduction, external rotation); and arms (Pronation/supination,
Flexion/extension) (1 pt) (Will need to ask patient to perform these motions)
6. Test muscle strength: arms Flexion/extension (1 pt)
7. Tests ROM wrists and hands (hand up/down, bend fingers/extend, ulnar deviation,
spread fingers, make fist, touch thumb to base of little finger) (1 pt)
8. Tests muscle strength: wrists (extension and flexion against resistance) and hand
grasps bilaterally (1 pt)
(Will need to ask patient to flex and extend wrists and grasp your fingers to test
strengths)

Assist Patient to Lay Down (HOB up 30-45 degrees – or flat, if tolerated):

Neck vessels: (1 pt)
1. Inspect each side of neck for jugular venous pulse, with patient’s head turned to
opposite side. (With visible pulsation, distinguishes between jugular and carotid
pulsations; Raise HOB if Jugular pulsation to note angle pulsations stop) (1 pt)
Heart (Total: 9 pts)
1. Inspects the precordium for pulsations and heave (lift). (1 pt)
(Do not remove or open shirt for this part of the exam, we will assume you are
checking for this as you look at chest)
2. Palpates: anterior chest: note any abnormal thrill and if the apical impulse is detectable:
note the location. (1 pt)
3. Auscultates: the apical rate and rhythm (15-sec count). (1 pt)
4. Auscultates: (with diaphragm) to identify S1 and S2 at the following sites: (5 pts)
 Aortic: 2nd RICS
 Pulmonic: 2nd LICS
 Tricuspid: 4th LICS
 Mitral: 5th LICS, midclavicular line
Repeats with Bell of stethoscope to assess for abnormal heart sounds
5. Asks patient to lean slightly on left side: Auscultates: with bell of stethoscope at apex
(1 pt)

Position HOB flat (Check patient comfort/tolerance)

Abdomen and hips (Total: 8 pts)
(Do not remove clothing for this section, we will assume that you have done so)
1. Inspects: contour, symmetry, skin characteristics, umbilicus, and pulsations. (1 pt)
2. Auscultates bowel sounds in all four (4) quadrants starting with the RLQ > RUQ>
LUQ> LLQ (1 pt)
3. Auscultates for vascular sounds over the aorta (with bell of stethoscope) (1 pt)
4. Percusses: Three spots in each of the four (4) quadrants in zig-zag pattern. (1 pt)
5. Palpates: light palpation in all four (4) quadrants. (1 pt)
CMA/8_11 (Adapted from Jarvis, C. (2012). Physical examination and health assessment. (6th ed.).
Philadelphia: Saunders)
 NSG6020 Advanced Health and Physical Assessment 5
South University Online

6. Performs abdominal exam in correct order (1 pt)

7. Tests: ROM of hip (straight leg flexion, adduction/adduction, internal/external rotation –
with knee bent) (2 pts)
8. Test strength of hip by applying resistance to straight leg flexion & abduction) (1 pt)

Lower Extremities (Total: 10 pts)

1. Inspects: symmetry, skin characteristics, and hair distribution.(1 pt)
2. Palpates pulses (for presence and characteristics): popliteal, posterior tibia, and
dorsalis pedis arteries. (3 pts)
3. Palpates for temperature and edema (foot and lower leg) (1 pt)
4. Tests ROM and strength against resistance: ankles (Dorsiflexion/plantar flexion plus
with resistance; inversion/eversion,) and toes (curl and straighten) (2 pts)
5. Inspects Toes: separate and inspect. Tests capillary refill bilaterally (1 pt)
6. Tests cerebellar function: Has patient run heel down shin (1 pt)
7. Tests Babinski reflex (1 pt)

Patient Sitting, legs dangling: (note strength at getting from lying to

sitting position; assist if needed)
M/S/Neuro (Total: 7 points)
1. Tests muscle strength of knees with ROM: (extension/flexion and against resistance)
(1 point)
2. Tests deep tendon reflex of patella (1 pt)
(May use stethoscope or side of hand if no reflex hammer- tap gently just to
show us that you know how to do this)
3. Tests light sensation in selected areas on face, forearms, hands, lower legs, and feet:
(i.e. with cotton ball or other soft small object) (1 pt)
4. Tests superficial pain discrimination (Sharp/Dull) to hands, lower legs (1 pt)
(No need to fully perform- just state that you have done this and it is normal)
5. Tests stereognosis (both hands) (1 pt)
6. Tests position sense (one hand, middle digit) (1 pt)
7. Tests rapid alternating hand movements (cerebellar) (1 pt)

Patient Standing:
Neurologic/Gross Motor (Total: 8 pts)
1. Asks the pt. to walk across the room, turn (1 pt)
2. Asks the pt. to walk back toward you heel-to-toe, then (1 pt)
3. Asks the pt. to walk on their toes for a few steps, then (1 pt)
4. Asks the pt to walk on their heels for a few steps. (1 pt)
5. Assesses the Romberg sign (assess for 20 seconds *standing by pt. for safety-
If you patient is unsteady do not attempt, just state that this was performed) (2
pts)

CMA/8_11 (Adapted from Jarvis, C. (2012). Physical examination and health assessment. (6th ed.).
Philadelphia: Saunders)
 NSG6020 Advanced Health and Physical Assessment 6
South University Online

6. Tests ROM of spine: bend forward, bend side-to-side, twist side-to-side (1 pt)
7. Tests shallow knee bend (each leg, holding onto exam table) (1 pt)
8. Thank patient for the exam.

Total:
(To “PASS” student must score 80 points or higher out of 100 points)

CMA/8_11 (Adapted from Jarvis, C. (2012). Physical examination and health assessment. (6th ed.).
Philadelphia: Saunders)