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Head-to-Toe Assessment Exam Questions And Answers A+ Graded
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Head-to-Toe Assessment Exam Questions AndAnswers A+ Graded
How do you document a patient's mental status? -ANSWER MS: "Patient alert and
oriented x3" or "Patient alert and oriented to person, place, and time."
What are you assessing for skin & nails? -ANSWER Skin: temp; color; moisture; lesions;
turgor; presence/absence of jaundice, pallor, or cyanosis.
Nails: capillary refill, smoothness/quality
How do you document normal and slow capillary refill? -ANSWER Normal: "cap refill <3
sec"
Slow: "Prolonged/delayed cap refill >3"
How do you chart normal findings for skin & nails assessment? - ANSWER Skin/Nails:
"Skin pink (or other), warm, dry w/o jaundice, pallor, cyanosis and no lesions noted. Skin
turgor brisk < 2 sec under right clavicle."
How would you assess for pretibial edema? - ANSWER Press and hold gently on the
shins for 5 seconds. Release and observe for pitting.
What are you looking for and how would you document your findings for normal mucous
membranes? -ANSWER Looking for color, moisture, presence/absence of lesions.
MM: "Oral mucosa pink, moist without lesions."
What are you testing and how do you document your findings for normal eyes?
-ANSWER Testing for PERRLA and red light reflex.
Eyes: "PERRLA bilaterally with red reflex present bilaterally."
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