NR 509 / NR509 Midterm Study Guide: Advanced Physical Assessment
Latest Update 2026/2027 | Chamberlain University
Comprehensive Review for Midterm Examination
========================================
SECTION 1: THE COMPREHENSIVE HEALTH HISTORY AND INTERVIEWING
Components of the Health History
Chief Complaint (CC): The patient's primary reason for seeking care, documented in their own
words.
History of Present Illness (HPI): The detailed exploration of the CC.
Past Medical/Surgical History (PMH/PSH): Chronic illnesses, hospitalizations, surgeries, and
childhood illnesses.
Family History (FH): Age and health/status of first-degree relatives; genetic predispositions (e.g.,
cancer, diabetes, heart disease).
Social History (SH): Occupation, living situation, diet, exercise, tobacco/alcohol/drug use, sexual
history, travel.
Review of Systems (ROS): A systematic checklist of symptoms across all body systems to ensure
nothing is missed.
Clinical Pearl: Mnemonic for HPI - OLDCARTS
Onset: When did it start? (Acute vs. insidious)
Location: Where is it? Does it radiate?
Duration: How long does it last? Constant or intermittent?
Character: Describe the sensation (sharp, dull, burning, pressure).
Aggravating factors: What makes it worse? (Movement, eating, position)
Relieving factors: What makes it better? (Rest, medications, position)
Timing: When does it occur? (Morning, night, after meals)
,Severity: On a scale of 0-10, how severe?
Therapeutic Communication Techniques
Use: Active listening, open-ended questions ("Tell me more about..."), reflection ("It sounds like
you are worried"), clarification, summarization, empathy, silence.
Avoid: Leading questions ("You don't smoke, do you?"), medical jargon, false reassurance
("Don't worry, it's nothing"), interrupting, "why" questions (can sound judgmental).
Health History Modifications by Population
Pediatric: Birth history (gestational age, complications), feeding history, developmental
milestones, immunizations, school performance.
Geriatric: Functional assessment (ADLs/IADLs), falls history, polypharmacy (medication
reconciliation), cognitive screening, advance directives.
Pregnant: LMP (to calculate EDD), obstetric history (GTPAL), previous complications.
LGBTQ+: Use preferred pronouns, ask anatomy-based screening questions ("Do you have a
cervix?" instead of "Are you a woman?"), discuss gender-affirming care and hormone therapy.
Sensitive Topics Screening
Sexual History (5 Ps): Partners, Practices, Protection from STIs, Past history of STIs, Pregnancy
intention.
Substance Use: CAGE (Cut down, Annoyed, Guilty, Eye-opener); CRAFFT for adolescents.
Intimate Partner Violence: HITS (Hurt, Insult, Threaten, Scream) or STaT tool; routine screening
for women of childbearing age.
Mental Health: PHQ-2/PHQ-9 for depression; GAD-7 for anxiety.
Cultural Considerations
Health Literacy: Use the Teach-Back method ("Can you explain to me how you will take this
medication?") to assess understanding.
Language: Always use a certified medical interpreter, never family members or children.
Spiritual Assessment: FICA (Faith, Importance, Community, Address in care).
, Functional Assessment
ADLs (Basic): Bathing, dressing, toileting, transferring, continence, feeding.
IADLs (Complex): Shopping, cooking, housekeeping, managing finances, medication
management, using telephone.
========================================
SECTION 2: APPROACH TO PHYSICAL ASSESSMENT AND GENERAL SURVEY
Four Techniques of Examination (Order is Critical!)
Inspection: Always first. Observe for color, shape, symmetry, movement.
Palpation: Light then deep. Assess temperature, moisture, texture, tenderness, masses.
Percussion: Tapping to assess underlying structures. Exception: Auscultate the abdomen before
percussing.
Auscultation: Listening to sounds produced by the body.
Diaphragm: High-pitched sounds (breath sounds, bowel sounds, normal S1/S2).
Bell: Low-pitched sounds (bruits, extra heart sounds S3/S4, murmurs).
Common Error to Avoid: Never percuss or palpate the abdomen before auscultating, as this can
alter bowel sounds.
Vital Signs Reference Table
Vital Sign
Normal Adult Range
Equipment/Notes
Temperature 36.0°C - 38.0°C (96.8°F - 100.4°F) Oral, Tympanic, Temporal, Rectal (highest)
Pulse (HR) 60 - 100 bpm Assess rate, rhythm, amplitude (0-3+)
Respirations 12 - 20 breaths/min Assess rate, rhythm, depth, effort before telling patient
Latest Update 2026/2027 | Chamberlain University
Comprehensive Review for Midterm Examination
========================================
SECTION 1: THE COMPREHENSIVE HEALTH HISTORY AND INTERVIEWING
Components of the Health History
Chief Complaint (CC): The patient's primary reason for seeking care, documented in their own
words.
History of Present Illness (HPI): The detailed exploration of the CC.
Past Medical/Surgical History (PMH/PSH): Chronic illnesses, hospitalizations, surgeries, and
childhood illnesses.
Family History (FH): Age and health/status of first-degree relatives; genetic predispositions (e.g.,
cancer, diabetes, heart disease).
Social History (SH): Occupation, living situation, diet, exercise, tobacco/alcohol/drug use, sexual
history, travel.
Review of Systems (ROS): A systematic checklist of symptoms across all body systems to ensure
nothing is missed.
Clinical Pearl: Mnemonic for HPI - OLDCARTS
Onset: When did it start? (Acute vs. insidious)
Location: Where is it? Does it radiate?
Duration: How long does it last? Constant or intermittent?
Character: Describe the sensation (sharp, dull, burning, pressure).
Aggravating factors: What makes it worse? (Movement, eating, position)
Relieving factors: What makes it better? (Rest, medications, position)
Timing: When does it occur? (Morning, night, after meals)
,Severity: On a scale of 0-10, how severe?
Therapeutic Communication Techniques
Use: Active listening, open-ended questions ("Tell me more about..."), reflection ("It sounds like
you are worried"), clarification, summarization, empathy, silence.
Avoid: Leading questions ("You don't smoke, do you?"), medical jargon, false reassurance
("Don't worry, it's nothing"), interrupting, "why" questions (can sound judgmental).
Health History Modifications by Population
Pediatric: Birth history (gestational age, complications), feeding history, developmental
milestones, immunizations, school performance.
Geriatric: Functional assessment (ADLs/IADLs), falls history, polypharmacy (medication
reconciliation), cognitive screening, advance directives.
Pregnant: LMP (to calculate EDD), obstetric history (GTPAL), previous complications.
LGBTQ+: Use preferred pronouns, ask anatomy-based screening questions ("Do you have a
cervix?" instead of "Are you a woman?"), discuss gender-affirming care and hormone therapy.
Sensitive Topics Screening
Sexual History (5 Ps): Partners, Practices, Protection from STIs, Past history of STIs, Pregnancy
intention.
Substance Use: CAGE (Cut down, Annoyed, Guilty, Eye-opener); CRAFFT for adolescents.
Intimate Partner Violence: HITS (Hurt, Insult, Threaten, Scream) or STaT tool; routine screening
for women of childbearing age.
Mental Health: PHQ-2/PHQ-9 for depression; GAD-7 for anxiety.
Cultural Considerations
Health Literacy: Use the Teach-Back method ("Can you explain to me how you will take this
medication?") to assess understanding.
Language: Always use a certified medical interpreter, never family members or children.
Spiritual Assessment: FICA (Faith, Importance, Community, Address in care).
, Functional Assessment
ADLs (Basic): Bathing, dressing, toileting, transferring, continence, feeding.
IADLs (Complex): Shopping, cooking, housekeeping, managing finances, medication
management, using telephone.
========================================
SECTION 2: APPROACH TO PHYSICAL ASSESSMENT AND GENERAL SURVEY
Four Techniques of Examination (Order is Critical!)
Inspection: Always first. Observe for color, shape, symmetry, movement.
Palpation: Light then deep. Assess temperature, moisture, texture, tenderness, masses.
Percussion: Tapping to assess underlying structures. Exception: Auscultate the abdomen before
percussing.
Auscultation: Listening to sounds produced by the body.
Diaphragm: High-pitched sounds (breath sounds, bowel sounds, normal S1/S2).
Bell: Low-pitched sounds (bruits, extra heart sounds S3/S4, murmurs).
Common Error to Avoid: Never percuss or palpate the abdomen before auscultating, as this can
alter bowel sounds.
Vital Signs Reference Table
Vital Sign
Normal Adult Range
Equipment/Notes
Temperature 36.0°C - 38.0°C (96.8°F - 100.4°F) Oral, Tympanic, Temporal, Rectal (highest)
Pulse (HR) 60 - 100 bpm Assess rate, rhythm, amplitude (0-3+)
Respirations 12 - 20 breaths/min Assess rate, rhythm, depth, effort before telling patient
