NR668 / NR 668 CEA Final Exam 2026 | Clinical Evaluation and Assessment | Chamberlain University | Questions & Correct Answers with Detailed Rationales | Guaranteed Pass | Advanced Health Assessment & APRN Prep PDF

INSTANT PDF DOWNLOAD — This is the comprehensive Final Exam preparation guide for NR668 / NR 668 - Clinical Evaluation and Assessment (CEA) (2026) at Chamberlain University, featuring questions and correct answers with detailed rationales. Designed for advanced practice nursing students (NP, CNS, CNM, CRNA), this resource consolidates the critical clinical evaluation and assessment concepts required to master the NR668 CEA Final Exam and excel in advanced health assessment coursework and clinical practice. The guide is meticulously aligned with Chamberlain University curriculum, APRN consensus model competencies, and current evidence-based advanced health assessment standards. This verified resource provides comprehensive coverage of key NR668 Clinical Evaluation and Assessment Final Exam topics, including: Advanced Health History Taking (comprehensive vs focused history, chief concern (patient's own words, duration, severity), history of present illness (HPI)—OLDCARTS (Onset (when did it start, sudden vs gradual), Location (where exactly, does it radiate), Duration (constant vs intermittent, how long does each episode last), Characteristics (sharp, dull, burning, stabbing, throbbing, pressure, crushing, tearing, squeezing, aching, gnawing, cramping, colicky, electric shock, pins/needles, tingling), Aggravating factors (what makes it worse—movement, position, activity, eating, breathing, palpation, stress), Relieving factors (what makes it better—rest, medication, position, heat, ice, distraction), Timing (time of day, relationship to meals, sleep, activity, menstrual cycle), Severity (0-10 scale, mild/moderate/severe, impact on function, acceptable level for patient), Associated symptoms (other symptoms that occur with or around the same time), Pertinent positives and negatives (symptoms present that support differential diagnosis, symptoms absent that would be expected if a specific condition were present), past medical history (childhood illnesses, adult illnesses (chronic diseases—hypertension, diabetes, heart disease, stroke, COPD, asthma, kidney disease, liver disease, thyroid disease, autoimmune disorders, cancer), psychiatric history (depression, anxiety, bipolar, PTSD, schizophrenia, eating disorders, substance use disorders, suicide attempts, self-harm, hospitalizations, outpatient treatment), surgeries (dates, indications, complications, anesthesia complications), hospitalizations (dates, reasons, outcomes), injuries (dates, mechanisms, sequelae), transfusions (dates, products, reactions), immunizations (status for age: influenza, Tdap/Td, MMR, varicella, hepatitis B, HPV, pneumococcal (PCV13, PPSV23), meningococcal, zoster (shingles), COVID-19, RSV (older adults, pregnant), rotavirus (children), Hib (children), polio (children)), pregnancy history (gravida/para (GTPAL: Gravida (number of pregnancies), Term (number of term deliveries ≥37 weeks), Preterm (number of preterm deliveries 20-36 6/7 weeks), Abortions (spontaneous or induced abortions 20 weeks), Living (number of living children), menstrual history (menarche age, last menstrual period (LMP), cycle length and regularity, duration of flow, amount, dysmenorrhea, intermenstrual bleeding, postmenopausal bleeding, date of menopause, menopausal symptoms), contraceptive history, sexual history (sexually active, number of partners, condom use, other contraception, STI history, sexual function (desire, arousal, orgasm, pain—dyspareunia), sexual orientation, gender identity, intimate partner violence screening), family history (first-degree relatives (parents, siblings, children) and second-degree relatives (grandparents, aunts, uncles), age and health status, age and cause of death, specific conditions (hypertension, heart disease (early onset 55 male, 65 female), stroke, diabetes, cancer (type, age of onset—breast, ovarian, colon, prostate, pancreatic, melanoma, lung, leukemia/lymphoma), hyperlipidemia, thyroid disease, autoimmune disorders (lupus, RA, MS), kidney disease, dementia/Alzheimer's, seizure disorder, psychiatric disorders, substance use disorders, genetic disorders (cystic fibrosis, Huntington's, sickle cell, hemophilia, Marfan, Ehlers-Danlos, polycystic kidney disease), sudden cardiac death 50 years, clotting disorders (DVT/PE, Factor V Leiden, prothrombin mutation), consanguinity), social history (occupation (exposures—chemicals, toxins, radiation, asbestos, silica, coal dust, pesticides, heavy metals, solvents, noise, vibration, repetitive motion, lifting, prolonged standing/sitting, shift work, stress, job satisfaction), living situation (housing type, homeless, unsafe housing, environmental exposures (mold, lead, radon, asbestos, secondhand smoke, poor air quality, contaminated water), household members (ages, health conditions, smokers), marital status, partner/spouse, children, dependents, support system (family, friends, community, church, support groups), education level (highest grade completed, literacy, health literacy), financial status (employment, income, insurance, food security, medication affordability, transportation access, ability to afford copays/deductibles, medical debt), military history (branch, years of service, deployments, combat exposure, exposures (Agent Orange, burn pits, depleted uranium, Gulf War illness, blast injury, TBI), VA benefits, service-connected disability), spiritual/religious beliefs (importance in healthcare, practices, dietary restrictions, blood transfusion beliefs, organ donation, advance care planning, end-of-life wishes, chaplain access), advance directives (living will, durable power of attorney for healthcare, DNR/POLST, organ donor status, discussion with family, copy in medical record), functional assessment (ADLs (Activities of Daily Living)—bathing, dressing, toileting, transferring, continence, feeding; IADLs (Instrumental ADLs)—meal preparation, shopping, housekeeping, laundry, managing finances, managing medications, using telephone/technology, transportation; physical function (gait, balance, mobility, falls history, use of assistive devices (cane, walker, wheelchair, scooter), ability to climb stairs, ability to perform job/household duties, exercise (type, frequency, duration, intensity), limitations due to pain, weakness, shortness of breath, fatigue, dizziness), driving status (valid license, driving at night, accidents, near misses, tickets, medical conditions affecting driving (seizure disorder, syncope, dementia, vision impairment, stroke with hemiparesis, sleep apnea with excessive daytime somnolence, uncontrolled diabetes with hypoglycemia unawareness, heart failure with dyspnea at rest, arrhythmias, recent MI, pacemaker/ICD—state laws vary on reporting requirements), safety (falls risk, home hazards (loose rugs, poor lighting, no handrails, cluttered pathways, pets underfoot, electrical cords, slippery floors, uneven surfaces, stairs without handrails, no grab bars in bathroom, high bed, lack of assistive devices), elder abuse (physical, emotional, sexual, neglect, financial exploitation), domestic violence, intimate partner violence (IPV) screening (routine screening of all women of childbearing age, ask in private, validated tools (HITS, STaT, AAS), resources (hotline ), mandatory reporting laws vary by state for IPV), substance use (alcohol—CAGE questionnaire (Cut down, Annoyed, Guilty, Eye-opener), AUDIT-C (3 questions), quantity/frequency (number of drinks per day/week, heavy drinking (7 drinks/week women, 14 men, 4 per occasion women, 5 men), binge drinking (4+ women, 5+ men within 2 hours), withdrawal symptoms, previous treatment, detox, rehab, AA/NA attendance, current sobriety date; tobacco (cigarettes (pack-years: packs per day × years smoked, 20 pack-years significant for lung cancer screening), electronic cigarettes/vaping (nicotine concentration, frequency), smokeless tobacco (chewing tobacco, snuff, snus), cigars, pipe, age started, quit attempts, previous cessation methods (nicotine replacement (patch, gum, lozenge, inhaler, nasal spray), bupropion, varenicline), motivation to quit (stage of change: precontemplation, contemplation, preparation, action, maintenance), nicotine withdrawal symptoms (craving, irritability, anxiety, depression, difficulty concentrating, insomnia, increased appetite, weight gain), secondhand smoke exposure (household members, workplace, children exposure); illicit drugs (marijuana/cannabis (frequency, quantity, method (smoked, vaped, edible, oil, tincture), age started, medical marijuana card, CBD use, cannabis use disorder (CUD) screening (CUDIT-R), cannabinoid hyperemesis syndrome (cyclic vomiting relieved by hot showers/baths), cannabis withdrawal (irritability, anxiety, insomnia, decreased appetite, craving); stimulants (cocaine, crack cocaine, methamphetamine, amphetamine, MDMA/Ecstasy)—frequency, route (intranasal, smoked, IV, oral), last use, withdrawal (crash (hypersomnia, hyperphagia, depression, anergia), craving, no life-threatening withdrawal), complications (cardiovascular (MI, stroke, hypertension, cardiomyopathy, aortic dissection), neurological (seizure, intracranial hemorrhage, movement disorders), psychiatric (psychosis, paranoia, aggression, anxiety, depression), infectious (HIV, hepatitis B/C, endocarditis, cellulitis, abscesses, necrotizing fasciitis from IV use), dental (meth mouth—severe caries, tooth loss, gum disease), hyperthermia, rhabdomyolysis, renal failure); opioids (heroin, prescription opioids (oxycodone, hydrocodone, morphine, hydromorphone, fentanyl, methadone, buprenorphine), frequency, route (IV, intranasal, smoked, oral, transdermal), last use, opioid use disorder screening (CAGE-AID, OWLS, NIDA Quick Screen), withdrawal symptoms (not life-threatening but severe—yawning, rhinorrhea, lacrimation, piloerection (gooseflesh), mydriasis, muscle aches, bone pain, abdominal cramps, nausea, vomiting, diarrhea, tachycardia, hypertension, tachypnea, fever, diaphoresis, insomnia, anxiety, craving), onset depends on half-life (heroin 6-12 hours, short-acting prescription opioids 8-24 hours, methadone 24-72 hours), treatment: methadone (opioid agonist, daily dosing at federally regulated clinic), buprenorphine (partial agonist, office-based prescribing with DATA waiver (X-waiver eliminated 2023, any DEA-registered provider with Schedule III authority can prescribe buprenorphine for OUD, but still need specialized training and notification to DEA), formulations (Subutex—buprenorphine alone, Suboxone—buprenorphine/naloxone (naloxone added to deter IV misuse, minimal oral/sublingual bioavailability), Sublocade (monthly extended-release injection), Brixadi (weekly/monthly injection)), precipitated withdrawal risk if buprenorphine given too soon after last full opioid agonist use (must be in moderate withdrawal (COWS score 12) before first dose), naltrexone (opioid antagonist, must be opioid-free 7-10 days before starting to avoid precipitated withdrawal, oral daily or extended-release injection (Vivitrol monthly)), opioid overdose reversal (naloxone (Narcan)—intranasal or IM, onset 2-3 minutes, duration 30-90 minutes (shorter than most opioids, may need repeat doses), risk of precipitated withdrawal in opioid-dependent individuals, layperson administration legal with standing orders in most states, co-prescribing naloxone recommended for all patients on chronic opioids 50 MME/day, history of overdose, concurrent benzodiazepine use, substance use disorder); benzodiazepines (prescribed (alprazolam, clonazepam, lorazepam, diazepam, temazepam, chlordiazepoxide, clorazepate, oxazepam, estazolam, flurazepam, quazepam) and illicit (sometimes combined with opioids—high risk of fatal overdose), dependence, tolerance, withdrawal (potentially life-threatening—seizures, delirium tremens-like state, autonomic instability), cannot discontinue abruptly (taper over weeks to months under medical supervision, may require inpatient detoxification, substitute long-acting benzodiazepine (diazepam, chlordiazepoxide, phenobarbital) for short-acting, adjunctive anticonvulsants (valproate, carbamazepine, gabapentin, pregabalin), withdrawal symptoms (anxiety, insomnia, tremors, palpitations, diaphoresis, nausea, vomiting, abdominal cramps, muscle twitching, hyperreflexia, photophobia, hyperacusis, paresthesias, derealization, depersonalization, psychosis, seizures (grand mal), delirium), benzodiazepine withdrawal can be fatal (unlike opioid withdrawal), flumazenil (benzodiazepine antagonist) rarely used for withdrawal (can precipitate seizures in dependent individuals), reversal of benzodiazepine overdose (flumazenil, use with caution in patients with chronic benzodiazepine use due to seizure risk), sedative-hypnotic use disorder (zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), barbiturates, carisoprodol (Soma), meprobamate, methaqualone (Quaalude), gamma-hydroxybutyrate (GHB) (also used as date rape drug, club drug), withdrawal similar to benzodiazepines, can be life-threatening); hallucinogens (LSD, psilocybin (magic mushrooms), mescaline (peyote), DMT/ayahuasca, ketamine, phencyclidine (PCP), MDMA (ecstasy/molly) (also stimulant and entactogen), salvia divinorum, synthetic cannabinoids (K2, Spice), synthetic cathinones (bath salts)), inhalants (volatile hydrocarbons (glues, spray paints, gasoline, lighter fluid, nail polish remover, markers, correction fluid, cleaning fluids, butane, propane, nitrous oxide (whippets), amyl nitrite (poppers), alkyl nitrites, anesthetics (ether, chloroform, halothane)), side effects (sudden sniffing death syndrome (cardiac arrhythmia), hypoxia, asphyxia, aspiration, bronchospasm, laryngospasm, seizures, coma, hepatotoxicity, nephrotoxicity, peripheral neuropathy, cerebellar degeneration, cognitive impairment, leukoencephalopathy, bone marrow suppression, aplastic anemia), withdrawal (not well-defined, may include anxiety, irritability, depression, insomnia, tremor, nausea, headache, craving), caffeine (daily intake (coffee, tea, soda, energy drinks, pre-workout supplements, caffeine pills), withdrawal (headache, fatigue, irritability, dysphoria, nausea, muscle pain/stiffness, difficulty concentrating, flu-like symptoms, onset 12-24 hours after last dose, peak 24-51 hours, duration 2-9 days, gradual taper to avoid), medical cannabis (certifying condition (chronic pain, nausea/vomiting from chemotherapy, muscle spasticity from MS, seizure disorders (Dravet, Lennox-Gastaut), PTSD, cachexia/wasting syndrome, Crohn's disease, Parkinson's disease, Huntington's disease, ALS, glaucoma, terminal illness), dosing (CBD:THC ratio, route (oral oil/tincture, capsule, edible, vaporized, smoked, topical, suppository), duration of use, adverse effects (dizziness, drowsiness, dry mouth, increased appetite, weight gain, diarrhea, fatigue, impaired memory and concentration, anxiety, paranoia, hallucinations (high THC strains), cannabinoid hyperemesis syndrome (cyclic vomiting, abdominal pain, compulsive hot bathing), interactions with CYP450 (CBD inhibits CYP2C19, CYP3A4, CYP1A2, CYP2D6, CYP2B6, CYP2C9, may increase levels of warfarin (INR monitoring required), clopidogrel, diazepam, lamotrigine, valproate, phenytoin, carbamazepine, oxcarbazepine, SSRIs/SNRIs, TCAs, antipsychotics, benzodiazepines, statins (simvastatin, atorvastatin), calcium channel blockers, beta-blockers, cyclosporine, tacrolimus, sildenafil, tadalafil, oral contraceptives, antiretrovirals, protease inhibitors, NNRTIs, integrase inhibitors), monitoring (LFTs, INR for warfarin, therapeutic drug levels for anticonvulsants), nutrition (diet history (24-hour recall, food frequency, typical meals, snacks, portion sizes, dietary patterns (Mediterranean, DASH, vegetarian, vegan, keto, low-carb, paleo, intermittent fasting, gluten-free, dairy-free, low-FODMAP, low-residue), food allergies (peanuts, tree nuts, milk, eggs, wheat, soy, fish, shellfish, sesame, sulfites, dyes, preservatives, lactose intolerance, celiac disease, gluten sensitivity), food preferences and aversions, cultural/religious dietary restrictions (kosher, halal, vegetarian/vegan for religious reasons (Hindu, Buddhist, Seventh-day Adventist), fasting periods (Ramadan, Yom Kippur, Lent), special diets (dysphagia (mechanical soft, pureed, thickened liquids), bariatric surgery (post-op diet progression, vitamin supplementation), diabetes (carb counting, consistent carbohydrate meal plan, insulin-to-carb ratio), hypertension (DASH diet, low sodium mg/day), heart failure (fluid restriction 1.5-2 L/day, sodium restriction), chronic kidney disease (protein restriction, potassium restriction, phosphorus restriction), liver disease (low sodium, fluid restriction, protein management for hepatic encephalopathy), malnutrition risk (unintentional weight loss (5% in 1 month or 10% in 6 months), decreased oral intake, muscle wasting, low albumin/prealbumin, chewing/swallowing problems, nausea/vomiting, diarrhea, constipation, early satiety, anorexia, food insecurity, ability to prepare meals, access to grocery store/transportation, cooking facilities, food assistance (SNAP, WIC, Meals on Wheels, food pantries)), physical activity (type (aerobic, resistance, flexibility, balance), frequency (days per week), duration (minutes per session), intensity (light, moderate (brisk walking, dancing, gardening, cycling 10 mph, water aerobics), vigorous (running, swimming laps, cycling 10 mph, HIIT, jumping rope, heavy lifting, competitive sports), sedentary time (hours per day sitting at work, commuting, watching TV, using computer/phone), barriers (pain, fatigue, shortness of breath, weakness, joint problems, fear of falling, lack of time, lack of motivation, lack of facilities/equipment, unsafe neighborhood, weather, caregiving responsibilities), readiness to change (precontemplation, contemplation, preparation, action, maintenance, relapse), exercise prescription (150 minutes moderate or 75 minutes vigorous aerobic per week + 2 days strength training + 2-3 days flexibility + balance exercises for older adults), precautions (uncontrolled hypertension, unstable angina, uncontrolled arrhythmias, severe aortic stenosis, uncontrolled heart failure, acute myocarditis/pericarditis, severe pulmonary hypertension, recent pulmonary embolism/DVT, uncontrolled diabetes with frequent hypoglycemia or severe hyperglycemia, proliferative retinopathy, severe autonomic neuropathy, foot ulcers, acute illness/infection, fever, electrolyte abnormalities, severe anemia, untreated symptomatic hernia, musculoskeletal injury, pregnancy (avoid supine position after first trimester, avoid activities with risk of abdominal trauma or falls), activity counseling (start low and go slow, gradual progression, warm-up/cool-down, hydration, appropriate footwear/clothing, safety precautions), sleep (typical bedtime and wake time, total sleep duration (adults need 7-9 hours), sleep latency (time to fall asleep), nighttime awakenings (number, duration, reason—bathroom, pain, anxiety, nightmares, hot flashes, restless legs, breathing, coughing, caregiver responsibilities), early morning awakening (unable to fall back asleep, associated with depression), daytime naps (frequency, duration, effect on nighttime sleep), sleep quality (refreshed vs unrefreshed), snoring (loudness, frequency, positional, witnessed apnea (stop breathing, gasping, choking), witnessed by bed partner, Epworth Sleepiness Scale (score 10 indicates excessive daytime sleepiness), STOP-BANG questionnaire for OSA (Snoring, Tiredness, Observed apnea, high blood Pressure, BMI 35, Age 50, Neck circumference 17 inches male/16 female, Gender male—score 0-2 low risk, 3-4 intermediate, 5-8 high risk for OSA), restless legs syndrome (urge to move legs, worse at rest/bedtime, relieved by movement, worse in evening/night, causes: iron deficiency (check ferritin, transferrin saturation), pregnancy, renal failure, peripheral neuropathy, medications (antidepressants (SSRIs, SNRIs, TCAs, mirtazapine), antipsychotics (especially olanzapine, risperidone, quetiapine), antihistamines (diphenhydramine, hydroxyzine), dopamine antagonists (metoclopramide, prochlorperazine), lithium, caffeine, nicotine, alcohol withdrawal), treatment: treat underlying cause, iron supplementation if ferritin 75 mcg/L, non-pharmacologic (avoid triggers, massage, heat/cold, moderate exercise, good sleep hygiene), pharmacologic (alpha-2-delta ligands—gabapentin enacarbil (Horizant), pregabalin (Lyrica) first-line; dopamine agonists (pramipexole, ropinirole)—risk of augmentation (worsening of symptoms earlier in day, increased severity, shorter latency after starting medication), benzodiazepines (clonazepam) for sleep disturbance but risk of dependence, opioids for refractory RLS (low-dose tramadol, methadone) after specialist consultation), circadian rhythm disorders (delayed sleep phase (late bedtime, late wake time), advanced sleep phase (early bedtime, early wake time—older adults), shift work disorder, irregular sleep-wake rhythm, jet lag disorder), insomnia disorder (difficulty falling asleep, staying asleep, or early morning awakening with daytime consequences (fatigue, mood disturbance, cognitive impairment, impaired function), duration (3 months acute, ≥3 months chronic), frequency (≥3 nights per week), diagnostic criteria (DSM-5-TR), sleep hygiene (consistent bedtime/wake time, no caffeine after noon, no alcohol near bedtime, no large meals before bed, regular exercise (but not within 2-3 hours of bedtime), comfortable sleep environment (dark, quiet, cool), no electronics in bedroom (blue light suppresses melatonin), reserve bed for sleep and sex only, wind-down routine (30-60 minutes before bed), avoid clock-watching), cognitive behavioral therapy for insomnia (CBT-I) first-line (stimulus control (go to bed only when sleepy, get out of bed if unable to sleep after 20-30 minutes, return when sleepy, wake at same time regardless of sleep duration, no daytime napping), sleep restriction (limit time in bed to actual sleep time, then gradually increase as sleep efficiency improves), cognitive restructuring (address unhelpful beliefs about sleep), relaxation training (progressive muscle relaxation, guided imagery, deep breathing, biofeedback, mindfulness meditation), sleep hygiene education, paradoxical intention (try to stay awake to reduce performance anxiety), pharmacologic for insomnia (short-term only, avoid in chronic insomnia unless CBT-I not available/effective—benzodiazepine receptor agonists (zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata), triazolam (Halcion), temazepam (Restoril), flurazepam (Dalmane), quazepam (Doral), estazolam (Prosom), doxepin (low dose 3-6 mg for sleep maintenance—only FDA-approved for sleep maintenance, not sleep onset), ramelteon (melatonin receptor agonist—sleep onset), suvorexant (orexin receptor antagonist—sleep onset/maintenance), lemborexant (orexin receptor antagonist—sleep onset/maintenance), daridorexant (orexin receptor antagonist—sleep onset/maintenance), melatonin (over-the-counter, 0.5-5 mg, not FDA-regulated, variable potency, short-term use), trazodone (25-100 mg off-label, common for insomnia in depression, risk of priapism, daytime sedation), mirtazapine (7.5-15 mg off-label, significant weight gain, sedation), amitriptyline (10-50 mg off-label, anticholinergic, cardiac risk in overdose, not first-line), gabapentin (300-1200 mg off-label for insomnia, especially with RLS or pain), quetiapine (12.5-100 mg off-label for insomnia, weight gain, metabolic syndrome, tardive dyskinesia risk, not first-line), diphenhydramine (Benadryl, Unisom) over-the-counter, anticholinergic, cognitive impairment, fall risk in elderly, tolerance develops quickly, avoid chronic use), REM sleep behavior disorder (loss of atonia during REM, acting out dreams (punching, kicking, shouting, jumping out of bed), associated with alpha-synucleinopathies (Parkinson's, dementia with Lewy bodies, multiple system atrophy), can precede Parkinson's by decades, clonazepam effective but may worsen OSA, melatonin 3-12 mg, safety precautions (remove sharp objects, padding floor, lower bed, lock windows, sleep alone), polysomnography recommended for diagnosis, treat underlying synucleinopathy), narcolepsy (type 1 with cataplexy (loss of muscle tone triggered by emotion—laughter, surprise, anger, excitement), type 2 without cataplexy, excessive daytime sleepiness (ESS 10, multiple sleep latency test (MSLT) mean sleep latency 8 minutes with ≥2 sleep-onset REM periods (SOREMPs), cataplexy (sudden bilateral loss of muscle tone without LOC, typically brief seconds to minutes, triggered by strong emotion, preserved consciousness, can be partial (facial droop, head drop, slurred speech, jaw weakness, knee buckling, arm weakness) or complete (collapse), status cataplecticus (recurrent cataplexy lasting hours), treatment: sodium oxybate (Xyrem, Xywav) (GHB, central nervous system depressant, taken at bedtime and middle of night, highly controlled, effective for EDS and cataplexy), modafinil/armodafinil (wake-promoting, first-line for EDS), pitolisant (histamine H3 antagonist/inverse agonist, for EDS and cataplexy), solriamfetol (dopamine/norepinephrine reuptake inhibitor, for EDS), venlafaxine, fluoxetine, clomipramine for cataplexy), hypersomnia (excessive daytime sleepiness not due to sleep disordered breathing, narcolepsy, or insufficient sleep, MSLT mean sleep latency 8 minutes but 2 SOREMPs, treatment: modafinil, armodafinil, methylphenidate, dextroamphetamine, solriamfetol, pitolisant), parasomnias (sleepwalking (somnambulism), sleep terrors (pavor nocturnus), confusional arousals, sleep-related eating disorder, sleep-related sexual behavior (sexsomnia), sleep-related groaning (catathrenia), sleep-related hallucinations (hypnagogic at sleep onset, hypnopompic on awakening), sleep paralysis (inability to move at sleep onset or upon awakening, may be associated with narcolepsy, normal variant in general population, lasting seconds to minutes, can be terrifying, treatment: reassurance, improve sleep hygiene, treat underlying narcolepsy if present, selective serotonin reuptake inhibitors (SSRIs) for frequent episodes), Advanced Physical Examination Techniques (inspection, palpation (light (1 cm depth), deep (4-5 cm depth), bimanual, ballottement), percussion (direct, indirect/blunt, auscultatory, interpretation (tympany—air/gas, hyperresonance—hyperinflated lung, resonance—normal lung, dullness—fluid/solid organ/consolidation/tumor, flatness—bone/muscle)), auscultation (diaphragm (high-pitched sounds—heart S1/S2, breath sounds, bowel sounds, bruits), bell (low-pitched sounds—heart S3/S4, vascular sounds, diastolic murmurs of mitral/tricuspid stenosis, carotid bruits), olfaction (odor—fruity breath (DKA), fetor hepaticus (liver failure), uremic fetor (renal failure), foul sputum (lung abscess, bronchiectasis), purulent/draining wound infection, stool (melena, C. diff, malabsorption), urine (maple syrup urine disease, phenylketonuria), vaginal discharge (bacterial vaginosis—fishy odor, trichomoniasis—foul)), general survey (apparent age vs stated age, level of consciousness (alert, lethargic (drowsy, falls asleep without stimulation), obtunded (difficult to arouse, responds to tactile/verbal stimulation with groaning/mumbling, drift back to sleep), stupor (responds only to painful stimulation, minimal movement), coma (unarousable, no response to pain, no sleep-wake cycles), acute mental status change (delirium vs dementia), distress (pain, respiratory, cardiovascular, psychological, no acute distress), body habitus (asthenic (thin, slender, long extremities), athletic (muscular), pyknic (stocky, round, thick trunk), cachectic (severe wasting, malnutrition, chronic disease, cancer, AIDS, COPD, heart failure, renal failure, malabsorption), obesity (BMI 30-34.9 class I, 35-39.9 class II, ≥40 class III (severe/extreme), central obesity (waist circumference 40 inches male, 35 inches female—metabolic syndrome risk), underweight (BMI 18.5—malnutrition, eating disorder, malabsorption, hyperthyroidism, malignancy, chronic infection, dementia, neglect), developmental delay (gross motor, fine motor, speech/language, cognitive, social/emotional), gait (normal, antalgic (painful—limp, shortened stance phase on affected side), Trendelenburg (pelvis drops to contralateral side during stance phase on affected side—gluteus medius weakness, hip pathology), steppage (foot drop—high stepping to clear toes, peroneal nerve palsy, L5 radiculopathy, CMT), ataxic (wide-based, uncoordinated, staggering—cerebellar disease, sensory ataxia (loss of proprioception—foot slaps, patient watches feet, worsens with eyes closed, Romberg positive), vestibular ataxia (vertigo, nausea, nystagmus), parkinsonian (shuffling, reduced arm swing, en bloc turning, festination (accelerating forward), freezing, retropulsion), hemiparetic (circumduction of affected leg, arm held flexed/adducted/internal rotation—stroke, unilateral upper motor neuron lesion), spastic (scissoring (legs cross due to adductor spasticity), toe walking, bilateral—cerebral palsy, spinal cord injury, multiple sclerosis), waddling (pelvic drop bilaterally with wide base, trunk lurches—proximal muscle weakness (muscular dystrophy, myopathy, hip dislocation, pregnancy), propulsive (leaning forward, difficulty stopping—parkinsonism), cautious (elderly, fear of falling, decreased balance, slow, short steps, wide base, may use assistive device), choreiform (irregular, jerky, flowing movements—Huntington's, tardive dyskinesia, Sydenham's chorea, drug-induced (levodopa, oral contraceptives, anticonvulsants, antipsychotics, lithium, stimulants), dystonic (sustained twisting postures, abnormal positioning—limb, neck (torticollis), face (blepharospasm), trunk—idiopathic, drug-induced (antipsychotics—acute dystonia, tardive dystonia), psychogenic (variable, distractible, inconsistent, sudden onset, paroxysmal, improves with distraction or hypnosis, entrainment, associated psychiatric comorbidities), antalgic, functional, assistive devices (cane (held on contralateral side, advanced with weak leg, advanced to replace stance phase on affected side), walker (standard (pick-up), rolling (wheeled) with or without wheels, platform (forearm support), posterior (rollator with seat), knee walker (non-weight bearing lower leg injury), crutches (axillary (2-3 finger widths below axilla to avoid brachial plexus compression), forearm (Lofstrand, Canadian—cuff around forearm), platform (forearm trough for non-weight bearing due to wrist/hand pathology)), wheelchair (manual (self-propelled, lightweight, rigid or folding frame, quick-release wheels, anti-tippers), power (joystick, sip-and-puff, head control, chin control, tongue control—for severe upper extremity weakness/paralysis, spinal cord injury, ALS, muscular dystrophy, MS, cerebral palsy), transport (lightweight, small wheels, pushed by caregiver), bariatric (extra-wide, heavy-duty frame, larger wheels, reinforced), positioning (footrests, armrests, headrest, lateral supports, seat cushion (pressure redistribution—foam, gel, alternating air, Roho (air-filled cells), Jay (gel/foam/fluid combination), back support (custom-molded, tension-adjustable, reclining, tilt-in-space (pressure relief, posture, comfort)), safety (wheel locks engaged when transferring, removing footrests, lap tray, seat belt, tilt-in-space for pressure relief every 15-30 minutes), hygiene (moisture-wicking fabric, incontinence pad, pressure injury assessment), propulsion (handrims, power-assist wheels, SmartDrive (push-assisted power), Alber E-motion (power assist when pushing handrims), transmission), maintenance (tire pressure (pneumatic tires 60-120 psi), spoke tension, bearings, brake adjustment, upholstery condition, frame integrity, battery charge for power chair, charger compatibility, emergency battery disconnect), prescription (evaluation by physical therapist or ATP (assistive technology professional), seating clinic (physiatrist, PT, OT, ATP, equipment vendor, wheelchair user), insurance (Medicare Part B (requires in-person evaluation by physician/PT/OT, face-to-face encounter, written order, medical necessity documentation—can't perform ADLs/IADLs with current equipment, home assessment for accessibility (door width 32 inches, ramps, thresholds, turning radius 60 inches, counters/sinks lowered, roll-under sink, stove/oven accessible, front-loading appliances, closet rod height, shelf depth, electrical outlets reachable, light switches reachable, thermostat reachable, call bell/emergency system reachable, floor transitions (carpet to tile, threshold height), floor surface (smooth, level, non-slip), obstacles (throw rugs, cords, furniture, clutter, pet bowls/toys, plant stands), door handles (lever style vs round knob, height, ease of use), wheelchair lift (vertical platform lift for steps/porch, requires landing space, permit, maintenance, annual inspection), ramp (slope 1:12 (1 inch rise per foot of ramp length, max slope 8.3%), width 36 inches minimum, landings every 30 feet, handrails both sides if rise 6 inches or run 72 inches, edge protection, non-slip surface, snow/ice removal, portable ramps for single step or van), van conversion (full-size or minivan, lowered floor, ramp or lift, raised roof, lowered entry step, kneeling suspension, automatic door openers, manual or power ramp (fold-out or deployable from under floor), 6-point or 4-point tiedown system for wheelchair (track-mounted or floor-mounted retractors, tension indicators, straps with quick-release buckles, shoulder harness, lap belt, docking system (automatic lock)), driver assessment (rehabilitation driving specialist, vehicle modifications (hand controls, left-foot accelerator pedal, steering spinner knob (tri-pin, palm grip, saddle grip, t-handle, push-pull, right-angle, underhand), reduced-effort steering (power steering, servo steering), power brakes, pedal extensions, electronic driving aids (touch pad, joystick, voice control, head array, sip-and-puff, chin control, tongue control), adaptive seating (lateral supports, hip belt, chest harness, headrest support, anterior tilt for hip extension, pommel for adduction/spasticity), funding (Medicare (wheelchair base, not vehicle modifications), Medicaid (some states cover vehicle modifications through waiver programs), vocational rehabilitation (if employment-related), Department of Veterans Affairs (for veterans with service-connected disability), private insurance (variable), grants (paralyzed veterans of America (PVA), Christopher and Dana Reeve Foundation, National Spinal Cord Injury Association, Challenged Athletes Foundation, Help Hope Live, GoFundMe)), height (standing height