NR 509 Immersion weekend Questions
and Answers with Complete Solutions
Abdomen Correct Answer- I'll have the patient lie down for the abdominal exam.
[BLANK_AUDIO] I will expose her abdomen. [BLANK_AUDIO] And I am obs
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NR 509 Immersion weekend Questions
and Answers with Complete Solutions
Abdomen Correct Answer- I'll have the patient lie down for the abdominal exam.
[BLANK_AUDIO] I will expose her abdomen. [BLANK_AUDIO] And I am observing the abdomen
for its contours and symmetry, and there is no distortions. Now I will auscultate her bowel
sounds in all four quadrants.
[BLANK_AUDIO] Bowel sounds are present in all four quadrants. Now I will auscultate for any
bruits. I will begin with the aortic area, which is right below the xiphoid process.
[BLANK_AUDIO] Midline. [BLANK_AUDIO] Next I will do the left renal, which is above and lateral
to the left, the umbilicus. The right renal is to the right and above the umbilicus.
The iliac, to the left and below the umbilicus. [BLANK_AUDIO] And the right iliac, which is to the
right and below the umbilicus. And I do not hear any bruits. Now I'm going to percuss in all four
quadrants. I'm percussing for any tympany, dullness, or flatness. [BLANK_AUDIO] And it's
normal.
Next I'm gonna palpate in all four quadrants for tenderness and any masses. [BLANK_AUDIO]
And that feels normal, I do not feel any masses. 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. [BLANK_AUDIO] 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. 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.
Acoustic Nerve Correct Answer- No. Thank you, next I will be testing her acoustic nerve, which
is cranial nerve number eight, and that is her hearing. So I will be performing a whisper test, so
I'm gonna ask Sarah to cover one of her ears. And then I will stand behind her, cover my mouth,
and whisper three words.
One, two, three. And let's do the other side. Four, five, six. And her hearing is intact bilaterally.
Crainial Nerves Correct Answer- Next, I will test the trigeminal nerve, which is cranial nerve
number five. It has a motor component, and I will palpate over the masseter muscle as she
clenches her jaw. And I don't feel any distortions, and she has great strength. Next, I will test
the sensory portion of the trigeminal nerve.
And I'll ask Sarah to close her eyes, and let me know where she feels my touch. Forehead, right
cheek, left cheek, chin, nose. Next, I will test her facial nerve, which is cranial nerve number
seven. And I'm gonna ask her to do some facial expressions. And I'll ask for her to begin with a
smile, and I know that is symmetrical.
Next, frown for me. OK. Now raise your eyebrows and go ahead and puff up your cheeks, and
you notice they're equal bilaterally. And now I want you to pucker your lips, very tight pucker.
So that looks good. Thank you, Sarah. [BLANK_AUDIO]
Ear Correct Answer- Now, I'm gonna inspect Sarah's ears, and I'm looking for any nodules or any
skin lesions. Lets look at your other ear, Sarah, and they look nice. And now I'm going to also
note that they're symmetrical, and I'm now going to look inside her ear canal with the
otoscope. I'm gonna pull her ear up and back, and as I look in, I see that the external auditory
canal is clear, there's no swelling or redness or drainage or cerumen.
The tympanic membrane is pearly gray, and there is no effusion in the middle ear. I will do the
same for her left ear, pull the ear up and back, looking into the external auditory canal. I see
there is no cerumen, there's no swelling or redness, there is no drainage.Her tympanic membrane is pearly grey, and there's no fluid in the external auditory canal. So
you have very normal eardrums and ears. Now I'm going to palpate Sarah's pinna,
[BLANK_AUDIO] For any nodules or tenderness, any tenderness, Sarah? No. And now her
tragus, in front of the ear, any tenderness?
eyes Correct Answer- now I will check cranial nerve number two, the optic nerve again, covers
peripheral vision.
So I would like Sarah to stand up so we will be at the same eye level. And I'm gonna ask her to
look straight ahead and not move her head, and first of all, do you see my hands now? No. Let
me know when you do. Yes. And then I'm going to cover above, do you see them now?
No. Let me know when you do. Yes. Now come from below, do you see them now? No. Let me
know when you do. Yes. OK, thank you, and you can have a seat. Her peripheral vision is
normal. Now I'm going to continue and check cranial nerve number two again, the optic nerve,
for her pupil response to light.
And I'm using the ophthalmoscope head and turning on my light. And I'm gonna ask Sarah to
just stare at my nose. Now I'm gonna come from the side with my light source, and I notice that
the pupil constricts, and then I will check the right eye as well. And her pupils are about two to
three millimeters, and they respond to light equally.
Now I'm gonna be checking cranial nerves number three, which is the ocular motor, cranial
nerve number four, which is the trochlear, and cranial nerve number six, which is the abducens.
And in doing so, I will choose a star or an H pattern, and this is checking the extraocular muscles
of the eye.
So if you will follow my finger, Sarah, with your eyes only. [BLANK_AUDIO] Thank you, and all
EOMs are intact equally.
Eyes Correct Answer- Now I'm going to assess Sarah's eyes, and first I'm gonna look at her
conjuctiva. I notice that they're pink and clear, no drainage or lesions.
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