NURSING NR 509 APEA EXAM 2024 WOMENS S HEALTH EXAM QUESTION AND CORRECT DETAILED ANSWER AND
RATIO
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Introduction - CORRECT ANSWER- , my name is
, I will be doing your exam today. I'll begin with inspecting your face. I'll note that I don't see any discolorations or lesions & the head is midline & symmetrical.
Lymph nodes - CORRECT ANSWER-Next, I'll palpate the lymph nodes. I'll begin with the preauricular lymph nodes, right in front of the ear, and postauricular, right behind the ear. Then I will palpate her occipital lymph nodes in the back of the head. And then I'm gonna move forward and palpate the tonsillar lymph nodes. Come under the jawline, the submandibular lymph nodes, and the submental. Now I will go to the anterior cervical lymph nodes, and the posterior cervical lymph nodes.
And I will end with the supraclavicular lymph nodes right about the clavicles. I do not feel any enlargement, and they are equal bilaterally.
Face - CORRECT ANSWER-I'm testing trigeminal nerve, which is cranial nerve # 5. Palpating over the masseter muscle as the pt clenches the jaw. I don't feel any distortions & my pt has great strength. Now, I'm testing the sensory portion of the trigeminal nerve. I'll ask my pt to close your eyes & let me know where you feel my touch. (>> Forehead, right cheek, left cheek, chin, nose)
Next, I'll test the facial nerve, which is cranial nerve # 7. I'm going to ask you to do some facial expressions. I'm going to have you smile, next, frown for me. Now raise your eyebrows & puff up your cheeks, pucker your lips. I notice all expressions have bilateral symmetry.
Ears - CORRECT ANSWER-Now, I'm going to inspect the ears. I'm looking for nodules or skin lesions. They're both symmetrical, no nodules or skin lesions are noted. I'm going to look inside the ear canal with the otoscope. I see that the external auditory canal is clear, there's no swelling, redness, drainage or cerumen. The tympanic membrane is pearly gray & there is no effusion in the middle ear. I'll do the other ear. Looking into the external auditory canal. I see there is no swelling, redness, drainage, or cerumen. Pt's tympanic membrane is pearly gray & there's no effusion in the middle ear. Next, I'm going to palpate pinna for any nodules or tenderness. Now the tragus. No nodules or tenderness are noted.
Acustic nerve CN8 - CORRECT ANSWER-I will be testing your acoustic nerve, which is cranial nerve # 8, which is hearing. I'll be performing a whisper test. I want you to cover one of your ears & I will stand behind you, cover my mouth & whisper 3 words & I want you to repeat them
to me (1, 2, 3) & let's do the other side (4, 5, 6). Hearing is intact bilaterally.
Eyes - CORRECT ANSWER-I'm going to assess the pt's eyes. I'm going to look at the conjunctiva. I notice that they're pink & clear, no drainage or lesions & the sclera is white & clear. I'm going to test cranial nerve # 2, the optic nerve, covering central vision. Using the Snellen eye pocket chart, I'm going to stand 6 ft away & ask the pt to cover 1 eye & read the lowest line possible (LTFPH). Repeat with the other eye. Now with both eyes. The pt has normal vision, 20/20 in the L eye, R eye, & both eyes.
Cranial nerve 2 - CORRECT ANSWER-I'll continue with cranial nerve # 2, the optic nerve, this time assessing peripheral vision. Please stand, so we can be at the same eye level. I'm going to ask the pt to look straight ahead & not move their head ((hands right above shoulders, move hands in "come" motion)) Can you see my hands now? >> Let me know when you do>> I'm going to cover above, ((w/hands on either side of face, move hands)) Do you see them now? >> Let me know when you do>> Now from below ((hands on pt sides, bring hands upward)) Do you see them now? >> Let me know when you do. The pt's peripheral vision is normal. Again, I'm checking cranial nerve # 2, the optic nerve for pupil response to light. I'm using the ophthalmoscope head & turning on my light. Please look at my nose. I notice that the pupil constricts. I will check the other eye. The pupils are about 2-3 mm's & both respond to light equally.
Cranial nerves 3,4,&6 - CORRECT ANSWER-Next, I'm going to be checking cranial nerves # 3, the ocular motor, cranial nerve # 4, the trochlear, & cranial nerve # 6, the abducens. I will choose an H pattern to assess the extraocular muscles of the eye. If you'll follow my finger, with your eyes only. All EOMs are intact equally.
Nose - CORRECT ANSWER-I'm going to inspect the nose. I see that it's midline, there's no obstruction, fracture or swelling. I'll begin by inserting the speculum of the otoscope inside the nose. I see pink & moist turbinates & the septum is midline, straight & there's no deviation. On the other side, I see a straight septum, the turbinates are pink & moist. There's no swelling or bogginess.
Next, I'll palpate the pt's sinuses beginning with the frontal sinuses. Let me know if you feel any tenderness. The maxillary sinuses, tenderness? No tenderness noted.
Mouth - CORRECT ANSWER-Now, I'm going to inspect the throat & mouth. The lips, I see they are pink & moist. Can you open your mouth? I don't see any signs of decay or cracks in the teeth. The gums look pink & there is no redness or swelling. The buccal mucosa on both sides is moist & pink. Upper hard & soft palates are intact, pink & moist. The tongue is smooth, pink & moist. If you'll lift your tongue up, please. I don't see any nodules or drainage & it's pink & moist on the floor of the mouth. Now I'll look at the posterior pharynx & it's pink & there is no post nasal drainage. ((Grade tonsils if present, +1 normal or +2 mid-line, bilateral))
Cranial nerve 9, 10 & 12 - CORRECT ANSWER-Cranial nerve # 9 the glossopharyngeal, which is the gag reflex & I won't not be testing for that. I'll check cranial nerve # 10, which is the vagus nerve. I'll have the pt go ahead & open your mouth again ((w/my light shining in pt mouth)) & say "ahhh" The uvula rises symmetrically with phonation.
Then we have cranial nerve #12, the hypoglossal. I'll have you stick your tongue out & move it side to side.
Next, I'm palpating the TMJ. I'm palpating both sides. Please open your mouth & close. Do you have any tenderness? I don't feel any subluxation, crepitus, clicking, or tenderness.
Neck and Throat - CORRECT ANSWER-There are no deformities in the neck & it's symmetrical. Next, I'll palpate the trachea; it's midline. Now, I'll palpate the thyroid gland. by finding the cricoid process. With one hand in the suprasternal notch, right here, with the other hand.And I will put my fingers on either side, between those two points, landmarks, and I'm actually gonna retract a little bit on one side and ask her to swallow. And I'm feeling the thyroid as it rises for size in any nodules. And now, when we retract on the opposite side, and ask her to swallow. No nodules noted.
Throat - CORRECT ANSWER-I'm palpating the carotid arteries, they're normal & bounding. I'll auscultate the carotid arteries, checking for bruits bilaterally. Take a breath in. Hold it. Breathe. Take a breath in. Hold it. Breathe.
Neck ROM - CORRECT ANSWER-I'm checking ROM of the neck. Please flex your neck by taking your chin down to your chest. Now straighten
your neck & look up to the ceiling, extension, now look forward. I want you to look over your R shoulder, rotation. Now your L shoulder, rotation. I want you to do a flexion to the side, ear to your shoulder, lateral flexion. Other side, lateral flexion. They're all intact equally.
Next, I'll test cranial nerve # 11, which is the spinal accessory nerve. I'm going to put resistance on your shoulders & please shrug them. They are equal & intact.
Heart/Chest - CORRECT ANSWER-(Have patient sitting) I'm going to assess your heart sounds ((5 areas, diaphragm->bell)). I'll start with the aortic valve (2nd IS, R sternal border). Pulmonic valve (2nd IS, L sternal border). Erb's point (3rd IS, L sternal border). Tricuspid (4th IS, L sternal border) & mitral (midclavicular line, 5th IS). I'm inspecting the anterior chest & there aren't any obvious deformities in symmetry.
I'll auscultate the lung sounds in the anterior lung fields (x6 areas). Normal breaths in & out through your mouth. Breath sounds are clear. I'll proceed to the posterior chest (auscultate 8 areas). Normal breaths in & out through your mouth.
Upper extremities - CORRECT ANSWER-I'm checking the upper extremities. Inspecting the joints of the hands. If you'll extend your hands out. Don't see redness, swelling or deformities of the finger joints. I'm checking for cap refill (1 finger ea. hand). Nail bed turns pink in less than 3 secs, bilaterally. Next, I'll check the radial pulses bilaterally, if you'll just face your palms inward please. They're equal, 2+ bilaterally. I'm going to assess hand grips. If you'll grip my hands tight, strength is 5/5.
ROM Upper extremities - CORRECT ANSWER-Now I'm going to assess pt's ROM (1 side/Immersion). I'll begin by assessing passive ROM of the elbow. Flexion & extension. I would do the same on the other side. I'm now going to check the strength of the biceps & triceps. Please, flex your elbows & push against my hands. Now, pull back towards you.
Biceps & triceps strength is 5/5. Next, I'm going to assess passive ROM of the shoulder. Flexion, extension, internal rotation, external rotation. Abduction & adduction.
Cerebellar Function - CORRECT ANSWER-I'm going to assess cerebellar coordination with rapid alternating movements. If you'll take your thumb & touch your index finger, middle, & 4th & 5th finger & repeat. It's performed well & is well coordinated. Next, I'll do the rapid movements of the pt's hands. Palms down on your thighs & then up & then down & alternate & increase the speed. It is normal & well- coordinated.
Tendon reflexes - CORRECT ANSWER-Next, I'll assess the deep tendon reflexes (1 side/Immersion). I'll start with the bicep tendon,So I will support her arm on my arm, and then I'm placing my thumb on the medial aspect of the antecubital fossa, and I will strike my thumbnail with the pointy end of the hammer. And as you can see, she contracted her bicep tendon very well. Now I'm checking her patellar reflex with the flat end of the hammer. And she had a good response. And I'll come around and do her Achilles. I'll ask her to relax her foot, then I'll dorsiflex the foot a little bit, and tap with the flat end. And you notice she had a little bit of pronation there.
Abdomen - CORRECT ANSWER-I'll have the pt lie down for the abdominal exam. I'm observing the abdomen for its contours & symmetry & there are no distortions. I'll auscultate the bowel sounds in all 4 quads. Bowel sounds are present in all 4 quadrants.
I'll auscultate for bruits. I'll begin with the aortic, right below the xiphoid process. Midline. The L renal, which is above & lateral to L of umbilicus. The R renal to the R & above umbilicus. The iliac, to the L & below umbilicus & the R iliac, which is to the R & below umbilicus. I don't hear any bruits.
Abdominal percussion - CORRECT ANSWER-I'm going to percuss in all 4 quads. I'm percussing for tympany, dullness, or flatness. All areas are normal. Next, I'm palpating all 4 quads for tenderness & masses. No masses are noted.
Palpation - CORRECT ANSWER-Now I'm going to palpate the liver and the spleen. Beginning with the liver. I'm gonna place my left hand underneath and I'm looking at the midclavicular line on the right.
And I'm placing my palm upward right at the edge of the costovertebral angle, and I'm asking her to take a deep breath in. And as she does so, I'm pressing deeper and upward, and I might feel the lower edge of the liver.
Spleen - CORRECT ANSWER-Now for her spleen I'd like her to adjust herself and come over towards me laterally.
And I'm gonna put my left hand back here. And right below the costovertebral angle I'm gonna put my right hand. And as she breathes in, once again pushing upward and downward. And I do not feel the edge of the spleen which is actually normal.
Blumberg sign - CORRECT ANSWER-Now I'm gonna assess the Blumberg sign. I will take my hand vertically 90 degrees and I will press down into the abdomen. And when I release, if she feels any pain on the rebound, that would be a positive Blumberg sign.
Lower extremities - CORRECT ANSWER-Now I'm going to assess the lower extremities. I'm inspecting for lesions or edema. I don't see any. I'm going to do ROM of the hip, I'll flex the knee & in turn flex the hip. Then I'm going go into abduction ( take the leg out toward the side) & adduction ( the the leg and cross over the midline). Next is internal rotation & external rotation.
Now I'm going to assess ROM of the knee, flexion & extension. Next, I'm assessing knees strength. Flex your knees, please. I'm going to place my hands on top & ask my pt to push up towards them. Now push back. Strength is 5/5 & equal.
Ankle ROM - CORRECT ANSWER-I'm going to do the ROM of the ankle. Supporting the ankle, dorsiflexion, plantar flexion, & rotation. I'll also assess ankle strength. Point your toes up dorsiflex with resistance. Now point your toes down plantar flexion with resistance. Strength is 5/5 & equal bilaterally. Now I'll assess the dorsalis pedis pulses. They are 2+ & equal.
Spinal exam - CORRECT ANSWER-Now I'll have you stand up for the spine exam. I'm going to inspect & palpate along both sides of the spine for any expected curvatures, alignment & tenderness. I'm going to do ROM of the spine. I'm going to ask you to bend over & touch your toes. Now straighten back up & extend backwards. Straighten back up & do a lateral flexion to one side & then the other. Now rotation to the R & to the L. There is good, active ROM.
Romberg - CORRECT ANSWER-Next, I'll assess for the Romberg & I'll have you just stand with your arms down by your side. Close your eyes for about 20 sec's, I'm looking for any swaying. There is none & I would note a negative Romberg. Now I'll assess your gait & ask you to take a few steps forward. Turn around & a few steps more. There is a steady & even gait. This concludes my physical exam. [Show Less]