ANCC PMHNP EXAM PREP CHPT 6 Advanced Health and Physical Assessment (Physical, Neurological, Laboratory, Immunizations)
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ANCC PMHNP PREP CHPT 6 Advanced Health
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ANCC PMHNP PREP CHPT 6 Advanced Health
PHYSICAL EXAM
Reasons to be familiar with the physical exam in psychiatry: Ans- To be able to detect underlying
medical problems
To be familiar with a screening neurological exam and to be able to rule out neurological problems that
may manifest as symptoms of a psychiatric problem
To be abl...
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ANCC PMHNP EXAM PREP CHPT 6
Advanced Health and Physical
Assessment (Physical, Neurological,
Laboratory, Immunizations)
PHYSICAL EXAM
Reasons to be familiar with the physical exam in psychiatry: Ans- To be able to detect underlying
medical problems
To be familiar with a screening neurological exam and to be able to rule out neurological problems that
may manifest as symptoms of a psychiatric problem
To be able to differentiate normal and abnormal signs and symptoms
To know when to refer
NEUROLOGICAL EXAM
Reflexes (biceps, triceps, brachioradialis, patellar, Achilles, plantar) Ans- Grade reflexes and note
symmetry between right and left sides.
A positive Babinski (fanning of toes and dorsiflexion of the great toe) is normal ininfants up to age 2
years.
NEUROLOGICAL EXAM
Cranial nerves (mnemonic italicized in parentheses)
(On Old Olympus Towering Top, A Finn And German Viewed Some Hops) Ans- Olfactory: 1st (On)
* Test sense of smell and ensure patency of the nasal passages.
,* Have the client close eyes and test each nostril separately while other is occluded, asking the client to
identify familiar odors.
Optic: 2nd (Old)
* Test vision using Snellen chart or other suitable chart depending on the client's acuity and ability to
cooperate.
* Examine the inner aspect of the eyes with the ophthalmoscope.
* Test peripheral vision using the confrontation test.
Oculomotor: 3rd (Olympus')
* This is the motor nerve to the five extrinsic eye muscles. Test together with cranial nerve 4 (trochlear)
and cranial nerve 6 (abducens; see below).
* Test the extraocular movements (EOMs).
* Check the equality of pupils, their reaction to light, and their ability to accommodate.
* Test the corneal light reflex (when shining a light at the bridge of the nose, the light should appear
symmetrically in both eyes).
Trochlear: 4th (Towering)
* Use the same process as cranial nerve 3 (oculomotor) and cranial nerve 6 (abducens).
Trigeminal: 5th (Motor division; Top)
* Palpate the masseter muscles with the fingertips while the client clenches his or her teeth.
* Look for disparity in tension between the two muscles, which can indicate paralysis on the weak side.
* Look for tremor of the lips, involuntary chewing movements, and spasm of the masticatory muscles.
Trigeminal: 5th (Sensory division)
* Test tactile perception of the facial skin by touching with a wisp of cotton.
* Test corneal reflex with wisp of cotton.
* Test superficial pain of the skin and mucosa with pinpricks.
* Test the sense of touch in the oral mucosa.
,Abducens: 6th (A)
* Use the same process as for cranial nerves 3 (oculomotor) and 4 (trochlear).
Facial: 7th (Motor division; Finn)
* Inspect the face in repose for evidence of flaccid paralysis.
* Test by asking the client to elevate eyebrows, wrinkle forehead, close eyes, frown, smile, and puff
cheeks.
Facial: 7th (Sensory division)
* Test taste for sugar, vinegar, and salt.
Acoustic: 8th (And)
* Check hearing with the audiometer or by the whisper test.
* Check for hearing loss using the Weber and the Rinne tests.
Glossopharyngeal: 9th (German)
* Test together with cranial nerve 10 (vagus; see below).
Vagus: 10th (Viewed)
* Test for elevation of the uvula by having the client open his or her mouth and say "ah."
* Test the gag reflex by touching the back of throat with a tongue blade.
Accessory spinal: 11th (Some)
* Test the strength of the sternocleidomastoid and trapezius muscles against resistance of your hands.
Hypoglossal: 12th (Hops)
* Look for tremors and other involuntary movement when the client
protrudes his or her tongue.
, NEUROLOGICAL EXAM
Coordination and fine-motor skills Ans- * Equilibrium: Check by administering the Romberg test: have
the client stand up straight with feet together, arms by sides, and eyes closed. Only slight swaying would
be normal, and the client will be able to sustain this pose for approximately 5 seconds. More than slight
swaying suggests cerebellar ataxia or vestibular dysfunction.
* Diadochokinesia: Ability to perform rapid alternating movements (such as patting knees alternating
palm and back of hands, touching thumb to each finger); the client should be able to smoothly execute
these movements and maintain the rhythm.
*Dyssynergia: Finger-to-nose test, heel-to-knee test
* Handwriting
* Gait: Observe client walking.
NEUROLOGICAL EXAM
Sensory functions Ans- * Pain: Check sensation to pain with pinprick, and compare on each side of body.
* Temperature: Check temperature if sensation to pain is abnormal.
* Superficial touch: Test with wisp of cotton.
* Two-point discrimination: Apply pins to skin simultaneously; ask the client if he or she feels one or two
pinpricks.
* Stereognosis: Tests the ability to distinguish forms by placing objects in the client's hands while his or
her eyes are closed.
* Graphesthesia: Tests the ability to identify figures, letters, or words by tracing the figure on the skin of
the palm of the hand.
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