Midwife Licensure Exam Health Assessment — Health History & Physical Examination TechniquesCheat Sheet
One-page cheat sheet for Midwife Licensure Exam Health Assessment — Health History & Physical Examination Techniques. Every formula, definition, and key fact you need for this chapter, condensed to a single printable page. Designed for the final review session before the Midwife Licensure Exam 2026.
Exam context
For the Midwife Licensure Examination, Professional Regulation Commission (PRC) — Board of Midwifery tests Health Assessment under a "Core" label, with Health History & Physical Examination Techniques in the 1st slot across 2 chapters. Midwife Licensure Exam candidates must clear the 75% weighted average cut on the 2026 paper, which draws about a meaningful share of Health Assessment questions. Date to watch: April and November 2026 (expected).
Health History & Physical Examination Techniques - Cheat Sheet
Your final 30-minute rapid-fire reference for mastering health assessment fundamentals. All formulas, vital sign norms, IPPA technique sequences, interview structures, and high-yield NLE facts condensed into one exam-ready guide.
Sections
Section Title
Assessment Types & Data Classification
Important Facts
- Subjective data = only the client can provide; objective data = nurse observes/measures
- Database foundation: accurate assessment = valid nursing diagnoses = effective interventions
- Assessment is the first step of the nursing process (Assessment → Diagnosis → Planning → Implementation → Evaluation)
- Must differentiate between actual problems (present now) and potential/risk problems (may develop)
Key Definitions
Term
Subjective Data (Symptoms/Covert)
Example
Patient reports 'sharp, stabbing chest pain for 2 hours.'
Definition
Information stated by the client only — pain, nausea, dizziness, fatigue; cannot be observed or verified by the nurse.
Term
Objective Data (Signs/Overt)
Example
BP 140/90, temperature 38.5°C, audible crackles in bilateral lung bases.
Definition
Measurable, observable information gathered by the nurse through examination — vital signs, physical findings, lab results.
Term
Initial/Comprehensive Assessment
Example
Detailed assessment of a newly admitted patient covering all body systems and detailed health history.
Definition
Complete head-to-toe health history and physical examination performed on admission or initial client contact.
Term
Focused/Problem-Oriented Assessment
Example
Respiratory system focus for a client with dyspnea; cardiovascular focus for chest pain.
Definition
Targeted evaluation of a specific complaint or body system related to the client's chief concern.
Term
Emergency Assessment
Example
Immediate assessment of an accident victim before transport to hospital.
Definition
Rapid evaluation using ABC (Airway, Breathing, Circulation) priority in acute/critical situations.
Term
Ongoing/Time-Lapsed Assessment
Example
Vital signs rechecked every 4 hours post-op; neurological checks after head injury.
Definition
Reassessment performed at intervals to monitor status changes, response to treatment, or progression of illness.
Diagrams To Know
- Nursing Process cycle showing assessment as first step
- Data classification hierarchy: Subjective vs Objective
Section Title
Health History Interview Structure & Communication
Important Facts
- Interview has 4 phases: Preparatory → Introductory → Working (body) → Closing
- OLD CARTS: Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity — use for any symptom analysis
- PQRST (alternative): Provocation/Palliation, Quality, Region/Radiation, Severity, Timing — especially for pain assessment
- Always use OPEN-ENDED questions first to gather rich data; use CLOSED-ENDED to verify facts
- Non-therapeutic blocks: leading questions, 'why' questions sounding accusatory, false reassurance, subject-changing, medical jargon
- In Philippine context: respect for elders (use 'po'/'opo'), family involvement in decisions, hiya (shame/reticence) affects disclosure — especially sexual/mental health
- Never rush; inadequate time = incomplete history + loss of rapport
- Ensure privacy, adequate lighting, minimal noise, comfortable temperature
- Explain purpose and obtain informed consent before proceeding with exam
Key Definitions
Term
Chief Complaint (CC)
Example
'I've had a bad headache for 3 days' or 'My leg is swollen.'
Definition
The reason for seeking care, stated in the client's own words, usually brief (typically 1–3 sentences).
Term
History of Present Illness (HPI)
Example
Uses OLD CARTS or PQRST mnemonics to describe onset, location, duration, character, aggravating/relieving factors, timing, severity.
Definition
Systematic, detailed analysis of the chief complaint using chronological narrative and symptom characteristics.
Term
Open-Ended Question
Example
'Tell me about your usual daily diet' or 'How has this pain affected your daily life?'
Definition
Question that cannot be answered with 'yes' or 'no'; encourages the client to provide narrative, detailed information.
Term
Closed-Ended Question
Example
'Do you take your medication every day?' or 'Are you allergic to penicillin?'
Definition
Question requiring a specific, brief answer (usually yes/no or a single fact); used to verify or obtain specific data.
Term
Therapeutic Communication
Example
Using silence, paraphrasing, and non-judgmental responses to help the client feel heard and safe.
Definition
Purposeful, client-centered interaction using active listening, reflection, clarification, and empathy to build trust.
Diagrams To Know
- Four phases of the interview process
- OLD CARTS mnemonic for symptom analysis
- PQRST mnemonic for pain assessment
- Therapeutic vs non-therapeutic communication techniques
Section Title
Components of Complete Health History
Important Facts
- Health history order: CC → HPI (using OLD CARTS/PQRST) → Past History → Family History → ROS → Lifestyle/Psychosocial
- ROS is SUBJECTIVE only — documents what the client reports, not what you observe
- Allergies must include type of reaction (rash, anaphylaxis, GI upset) not just 'allergic to'
- Drug allergies supersede drug benefits — always clarify reaction type; 'upset stomach' ≠ true allergy
- Immunization history important: DPT, Polio, BCG (Philippines routine schedule), tetanus status for wound assessment
- Medications: ask about prescription, OTC, herbal, and traditional remedies — all can interact
- Family history: ask specifically about 'cancer, heart disease, diabetes, high blood pressure, stroke' — common hereditary conditions
- Genogram: simple tool showing family structure and disease distribution across generations
Key Definitions
Term
Biographic Data
Example
Maria Santos, 45 years old, female, widowed, elementary school teacher, Catholic.
Definition
Demographic information: name, age, sex, address, civil status, occupation, religion (if relevant to care).
Term
Past Health History
Example
Measles at age 6, appendectomy 2015, DPT vaccination complete, NKDA (no known drug allergies).
Definition
Record of childhood illnesses, adult illnesses, injuries, surgeries, hospitalizations, immunization status, and allergies.
Term
Family Health History
Example
Mother: Type 2 diabetes; Father: hypertension; Brother: asthma. Grandfather (maternal side): coronary artery disease.
Definition
Information on heritable and communicable diseases in immediate and extended family; often presented as a genogram.
Term
Review of Systems (ROS)
Example
General: 'Any recent weight loss?' HEENT: 'Vision changes?' CV: 'Chest pain or palpitations?' Respiratory: 'Cough or shortness of breath?'
Definition
Systematic, head-to-toe series of targeted questions about each body system to identify symptoms the client has not mentioned.
Term
Lifestyle & Psychosocial Data
Example
Works 8 hours daily, exercises 3×/week, sleeps 6–7 hours nightly, occasional wine, denies smoking, married with 2 children.
Definition
Information about diet, physical activity, sleep patterns, substance use (tobacco, alcohol, drugs), occupation, coping mechanisms, stress, and functional patterns.
Diagrams To Know
- Complete health history component sequence
- Genogram format for family health history
- ROS template (questions by body system)
Formulas
Formula
BMI = Weight (kg) / Height (m)²
Meaning
Weight in kilograms divided by height in meters squared; metric standard for body mass assessment.
Watch Out
Must convert imperial to metric first (1 kg = 2.2 lb; 1 m = 39.37 inches or 3.28 feet); easy to confuse numerator/denominator.
When To Use
Every initial assessment; use to categorize nutrition status as part of general survey.
Common Values
Value
36.5–37.5°C (average 37°C / 98.6°F)
Symbol
T
Quantity
Normal Adult Temperature (Oral)
Value
60–100 beats per minute (regular)
Symbol
P
Quantity
Normal Adult Pulse
Value
12–20 breaths per minute
Symbol
RR
Quantity
Normal Adult Respirations
Value
<120/80 mmHg (systolic/diastolic)
Symbol
BP
Quantity
Normal Adult Blood Pressure
Value
95–100%
Symbol
SpO₂
Quantity
Normal SpO₂ (Room Air)
Value
18.5–24.9 kg/m²
Symbol
BMI
Quantity
Normal BMI Range
Value
+0.5°C above oral
Symbol
ΔT(rectal)
Quantity
Rectal Temperature Elevation
Value
–0.5°C below oral
Symbol
ΔT(axillary)
Quantity
Axillary Temperature Decrease
Section Title
General Survey & Vital Signs
Important Facts
- General survey components: appearance (age, hygiene, distress signs) → body structure/nutrition → mobility → behavior/mental status
- BMI categories: Underweight <18.5, Normal 18.5–24.9, Overweight 25–29.9, Obese ≥30 kg/m²
- Adult vital sign norms (memorize exactly): Temp 36.5–37.5°C oral (avg 37°C); Pulse 60–100/min regular; RR 12–20/min; BP <120/80 mmHg (normal), 120–129 systolic + <80 diastolic = elevated
- SpO₂: 95–100% on room air is normal; <90% indicates hypoxemia
- Temperature sites & variations: Oral (baseline ~37°C); Rectal +0.5°C higher; Axillary –0.5°C lower; Tympanic ±0.5°C accuracy varies
- Pulse: assess rate, rhythm, and amplitude; palpate radial (most common), carotid, apical, dorsalis pedis, or other sites per protocol
- Respirations: count for 60 seconds; note rate, depth (shallow/deep), and effort (labored/unlabored); abnormal patterns: bradypnea (<12), tachypnea (>20), dyspnea (difficult breathing)
- Blood pressure: systolic = pressure during ventricular contraction; diastolic = pressure during ventricular relaxation; take bilaterally, upper arm at heart level, use correct cuff size
- Pain assessment: use 0–10 numeric scale (adult), Wong-Baker FACES (children), FLACC (non-verbal), or descriptive scale per facility protocol
- Anthropometric baseline essential: weight, height, BMI, skinfold measurements (if indicated) for nutritional status
Key Definitions
Term
General Survey
Example
Apparent age, hygiene/grooming, signs of distress, body symmetry, gait, level of consciousness, mood, affect.
Definition
Overall first impression of the client's physical appearance, body structure, mobility, and behavior; begins the moment you see the client.
Term
Vital Signs
Example
T 37.2°C, P 78/min regular, RR 16/min, BP 118/76 mmHg, SpO₂ 97% RA, Pain 0/10.
Definition
Objective measurements of basic physiologic functions: temperature, pulse, respirations, blood pressure, and pain ('fifth vital sign').
Diagrams To Know
- BMI classification chart
- Vital signs normal ranges (adult)
- General survey observation checklist
Common Values
Value
~1 cm into tissues
Symbol
Palpation₍light₎
Quantity
Light Palpation Depth
Value
~4 cm into tissues
Symbol
Palpation₍deep₎
Quantity
Deep Palpation Depth
Section Title
Physical Examination Techniques (IPPA)
Important Facts
- IPPA SEQUENCE FOR ALL REGIONS EXCEPT ABDOMEN: Inspection → Palpation → Percussion → Auscultation
- IPPA SEQUENCE FOR ABDOMEN ONLY: Inspection → Auscultation → Percussion → Palpation (to avoid altering bowel sounds)
- Hand use by part: Fingertips/pads = fine touch, texture, pulses, edema; Dorsum (back) = temperature; Ulnar edge/palmar surface = vibration (fremitus); Grasping fingers = mass position/consistency
- ALWAYS warm hands before palpating; ALWAYS palpate tender areas LAST to avoid guarding
- Light palpation BEFORE deep palpation; never palpate or percuss abdomen first (alters bowel sounds)
- Percussion sounds in order of density: Tympany (air-filled, loud) → Resonance (air-filled lung, normal) → Hyperresonance (abnormal, emphysema/pneumothorax) → Dullness (dense organ) → Flatness (bone/muscle, softest)
- Resonance over lung is NORMAL; dullness over lung is ABNORMAL (consolidation, effusion, atelectasis)
- Hyperresonance is abnormal in adults (emphysema, pneumothorax, asthma); resonance expected
- Stethoscope: Diaphragm (flat side) = high-pitched sounds (breath, heart S1/S2, bowel); Bell (cup side) = low-pitched (S3, S4, murmurs, bruits)
- Always apply bell lightly; never listen through clothing; warm stethoscope first; eliminate background noise
- Inspection begins during interview and continues throughout entire exam
- Compare bilateral regions for symmetry; asymmetry may indicate pathology
Key Definitions
Term
Inspection
Example
Observing skin color and turgor, noting bilateral symmetry of chest wall, identifying position of surgical incision.
Definition
Deliberate, systematic visual observation (and occasionally olfactory/auditory) of the client to note color, size, shape, symmetry, position, movement, and lesions.
Term
Palpation
Example
Feeling for enlarged lymph nodes, assessing skin temperature, detecting abdominal masses or organ enlargement.
Definition
Use of touch to assess texture, temperature, moisture, turgor, pulsations, masses, tenderness, organ size, and consistency.
Term
Percussion
Example
Tapping the chest to detect hyperinflation; tapping the abdomen to assess for free fluid; tapping over liver to estimate size.
Definition
Striking body surface to produce sounds that reveal density of underlying tissue; helps identify organ borders and pathology.
Term
Auscultation
Example
Listening for normal S1/S2 heart sounds, bilateral breath sounds, bowel sounds after abdominal surgery, carotid bruits.
Definition
Listening to body sounds (usually with a stethoscope) to assess heart sounds, breath sounds, bowel motility, and vascular flow.
Term
Light Palpation
Example
Initial abdominal exam to identify superficial masses, tender areas, or skin texture changes before deep palpation.
Definition
Gentle palpation using fingertip pressure about 1 cm in depth; used first to assess surface characteristics and tenderness.
Term
Deep Palpation
Example
Palpating liver edge, spleen, kidneys, or assessing for rebound tenderness (sign of peritoneal irritation).
Definition
Firm palpation pressing approximately 4 cm into tissues; used after light palpation to assess organs, deep masses, and rebound tenderness.
Diagrams To Know
- IPPA sequence for non-abdominal regions
- IPPA sequence for abdominal region (different order)
- Percussion sound spectrum by tissue density
- Hand parts and what they assess
- Stethoscope diaphragm vs bell use
Section Title
Percussion Sounds & Clinical Significance
Important Facts
- Resonance over lung = NORMAL; dullness or hyperresonance over lung = ABNORMAL
- Dullness over lung field suggests: consolidation (pneumonia), pleural effusion, atelectasis, or mass
- Hyperresonance over lung suggests: emphysema, pneumothorax, acute asthma, or air trapping
- Tympany expected over stomach/gas-filled bowel; ABNORMAL if heard over lung (hollow lung artifact)
- Percussion sounds in order of loudness/pitch: Hyperresonance (loudest) → Resonance → Dullness → Flatness (quietest)
- Percussion sounds related to tissue density: More air = louder/higher; More solid = softer/lower
- To percuss properly: use indirect (mediate) method — place left hand flat on client's chest, strike left middle finger with right middle finger; listen to resulting sound
Key Definitions
Term
Tympany
Example
Normal over epigastric area (stomach) and lower left abdomen (colon with gas); indicates hollow air-filled space.
Definition
Loud, drum-like, high-pitched percussion sound heard over air-filled organs (stomach, gas-filled bowel loops).
Term
Resonance
Example
Expected over all lung fields during chest percussion; indicates healthy, aerated lung tissue.
Definition
Low-pitched, hollow, clear percussion sound heard over normal air-filled lung tissue; NORMAL finding over lungs.
Term
Hyperresonance
Example
Heard over hyperinflated lungs in COPD or pneumothorax; abnormal finding requiring follow-up.
Definition
Booming, extremely low-pitched, louder-than-normal percussion sound; ABNORMAL in adults; indicates trapped air (emphysema, pneumothorax, asthma exacerbation).
Term
Dullness
Example
Normal over liver (RUQ), spleen (LUQ), or full bladder (suprapubic); ABNORMAL over lung field (suggests consolidation, pleural effusion, or atelectasis).
Definition
Medium-pitched, thud-like percussion sound heard over solid/dense organs (liver, spleen, heart, full bladder) or abnormal lung consolidation.
Term
Flatness
Example
Heard over bones, solid muscle mass, or large pleural effusion; indicates complete absence of air.
Definition
Soft, very short, barely audible percussion sound heard over very dense tissue (bone, muscle, fluid); least resonant sound.
Diagrams To Know
- Percussion sound spectrum by tissue type
- Percussion findings: normal vs abnormal by region
- Clinical significance of percussion sounds in lungs and abdomen
Section Title
Client Preparation, Positioning & Environment
Important Facts
- Always explain procedures to reduce anxiety and obtain informed consent before exam
- Environment essentials: Privacy (closed door/curtain) → Warm room temperature → Adequate lighting → Minimal noise → Equipment within reach
- Position matches body region: Fowler's for head/neck/thorax/heart; Supine for abdomen/anterior chest; Dorsal recumbent for relaxed abdomen; Sims' for rectum; Lithotomy for pelvic/vaginal; Standing for gait/balance
- Always consider client tolerance: reposition frequently for frail/dyspneic clients; never force uncomfortable positions
- Drape appropriately: expose only the region being examined; maintain dignity by covering other areas
- Have client void before abdominal examination to ensure bladder emptiness and avoid discomfort/false findings
- Equipment ready: stethoscope, sphygmomanometer, penlight, thermometer, tape measure, reflex hammer, tuning fork, otoscope, ophthalmoscope, gloves, lubricant
- Standard precautions: hand hygiene before/after contact, gloves for body fluid contact or non-intact skin, proper disposal of sharps/biohazards
- Warm equipment (stethoscope, hands) before contact with client
- Assess pain continuously; stop or modify exam if client shows distress
Key Definitions
Term
Fowler's Position
Example
Client seated upright on examination table for inspection and palpation of chest, heart, lungs, and neck.
Definition
Semi-upright sitting position (45–60° angle); used for head, neck, thorax, heart, and upper extremities examination.
Term
Supine Position
Example
Client lies flat for abdominal palpation, percussion, and auscultation; provides access to entire abdomen.
Definition
Flat on back, legs extended; used for abdominal and anterior chest examination.
Term
Dorsal Recumbent Position
Example
Alternative supine position for anxious or older clients; easier on spine and allows better muscle relaxation.
Definition
Flat on back with knees bent and feet flat on surface; relaxes abdominal muscles for a more comfortable abdominal exam.
Term
Sims' Position
Example
Client positioned on left side to access rectum and lower GI tract for digital rectal exam.
Definition
Left side-lying with left leg extended, right knee bent; used for rectal examination.
Term
Lithotomy Position
Example
Gynecological exam positioning; client draped appropriately for privacy and dignity.
Definition
Flat on back, knees bent and legs elevated in stirrups; used for female pelvic and vaginal examination.
Term
Standing Position
Example
Observe walking pattern, test balance (Romberg), assess spinal curvature and range of motion.
Definition
Upright; used to assess gait, balance, spine alignment, and musculoskeletal function.
Diagrams To Know
- Client positioning by examination type
- Proper draping techniques by position
- Equipment setup and checklist
Section Title
Documentation, Legal, & Safety Standards
Important Facts
- Document findings promptly, accurately, and objectively; avoid charting interpretations as observations
- Use precise, measurable descriptions: '2 cm × 3 cm firm, nontender, mobile mass in right axilla' instead of 'lump in armpit'
- Use institutionally approved documentation format: Narrative, SOAP (Subjective-Objective-Assessment-Plan), Focus/DAR (Data-Action-Response), or electronic health record protocol
- All documentation must comply with RA 9173 and institutional policy; records are legal documents
- Maintain client confidentiality per Data Privacy Act of 2012 and nursing ethics; do not share health information without consent
- Hand hygiene: perform before and after client contact, before sterile procedures, after contact with body fluids or contaminated surfaces, and after removing gloves
- Standard precautions apply to all clients: treat all blood, body fluids, secretions as potentially infectious
- Use gloves when: contact with blood, body fluids, non-intact skin anticipated; change gloves between clients; hand hygiene after glove removal
- Proper sharps disposal: use designated sharps container, never recap needles, never break needles by hand
- Maintain dignity: appropriate draping, privacy, respect for cultural beliefs, explain procedures
- Report findings promptly to supervisor or physician if abnormal or urgent
Key Definitions
Term
Objective Documentation
Example
Instead of 'looks sick,' write 'appears anxious, BP 150/95, skin cool and diaphoretic, respirations 22/min labored.'
Definition
Recording only what was directly observed/measured by the nurse, using precise, measurable descriptions without interpretation.
Term
RA 9173 (Philippine Nursing Act of 2002)
Example
Nurses must follow standards of care, document accurately, maintain client confidentiality, and comply with Code of Ethics for Registered Nurses.
Definition
Philippine law regulating nursing practice, licensure, professional standards, and scope of practice; nurses must maintain confidentiality and accurate records.
Term
Code of Ethics for Registered Nurses (Philippines)
Example
Nurses must treat all clients with respect, maintain privacy of health information, practice within scope, and seek supervision when needed.
Definition
Professional ethical standards for Filipino nurses emphasizing respect for human dignity, confidentiality, competence, accountability, and professional integrity.
Diagrams To Know
- Documentation standards and requirements
- Hand hygiene protocol steps
- Standard precautions checklist
Section Title
NLE High-Yield Concepts — Mnemonics & Quick Recall
Important Facts
- IPPA order is IPPA for lungs/heart/extremities; IAAP (different order) for abdomen to preserve bowel sounds
- Subjective = client states (symptom); Objective = nurse observes/measures (sign)
- General survey begins at first visual contact; continues throughout entire exam
- Hand parts: fingertips for texture/pulses; dorsum for temperature; ulnar edge for vibration (fremitus)
- Vital signs: T 36.5–37.5°C, P 60–100/min, RR 12–20/min, BP <120/80 mmHg, SpO₂ 95–100%, Pain 0–10
- BMI normal range: 18.5–24.9 kg/m² (easy to confuse with weight/height ratio — it's weight divided by height squared)
- Percussion: NORMAL lung = resonance; ABNORMAL lung = dullness (consolidation) or hyperresonance (air trapping)
- Stethoscope: diaphragm for high sounds, bell for low sounds; warm it and apply to bare skin
- Assessment → Diagnosis → Planning → Implementation → Evaluation (nursing process order)
- Cultural sensitivity in Philippines: use honorific 'po/opo' with elders, involve family, recognize hiya affecting health disclosure
- RA 9173 compliance: accurate documentation, client confidentiality, scope of practice, Code of Ethics
Key Definitions
Term
OLD CARTS
Example
Chest pain analysis: Onset (sudden at 2 PM) → Location (central chest) → Duration (30 min) → Character (sharp, pressure) → Aggravating (deep breath) → Relieving (rest) → Timing (intermittent) → Severity (7/10).
Definition
Mnemonic for systematic symptom analysis: Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity.
Term
PQRST
Example
Pain provoked by (activity/food?), Quality (sharp/dull/aching?), Region (where located and does it radiate?), Severity (1–10 scale), Timing (constant/intermittent/nighttime?).
Definition
Alternative mnemonic for pain/symptom analysis: Provocation/Palliation, Quality, Region/Radiation, Severity, Timing.
Term
ABC Priority
Example
Accident victim: check for patent airway, assess respiratory effort, assess heart rate/BP; manage life threats before detailed exam.
Definition
Emergency assessment sequence: Airway → Breathing → Circulation; prioritizes life-threatening conditions in acute situations.
Diagrams To Know
- OLD CARTS breakdown with clinical example
- PQRST breakdown with clinical example
- ABC emergency assessment priority sequence
Must Remember
- IPPA ORDER differs by region: Inspection → Palpation → Percussion → Auscultation for lungs/heart/neck/extremities; BUT Inspection → Auscultation → Percussion → Palpation for ABDOMEN ONLY (to preserve bowel sounds).
- SUBJECTIVE = client states (symptom); OBJECTIVE = nurse observes/measures (sign) — this distinction appears in nearly every NLE exam question about data collection.
- VITAL SIGNS normal ranges (adult): Temperature 36.5–37.5°C oral, Pulse 60–100/min, Respirations 12–20/min, Blood Pressure <120/80 mmHg, SpO₂ 95–100%, Pain 0–10 — must memorize exactly; 1°C or 5 bpm off changes answers.
- BMI FORMULA = Weight (kg) ÷ Height (m)² with normal range 18.5–24.9 kg/m² — commonly asked; easy to miscalculate if not converting imperial correctly.
- PERCUSSION SOUNDS mapped to tissue density: Hyperresonance (abnormal lung) → Resonance (normal lung) → Dullness (solid organ) → Flatness (bone); DULLNESS OVER LUNG FIELD = ABNORMAL (consolidation/effusion/atelectasis).
- PALPATION TECHNIQUE: Warm hands first, LIGHT palpation (1 cm depth) BEFORE deep palpation (4 cm depth), palpate TENDER AREAS LAST to avoid guarding — failing to follow this order gives false findings.
- STETHOSCOPE PARTS: Diaphragm (flat, high-pitched sounds: breath, normal heart sounds S1/S2, bowel) vs Bell (cup, low-pitched sounds: murmurs, S3/S4, bruits) — applied lightly; never listen through clothing.
- HEALTH HISTORY COMPONENTS in order: Biographic data → Chief Complaint → History of Present Illness (using OLD CARTS/PQRST) → Past Health History → Family History → Review of Systems (ROS is subjective only) → Lifestyle/Psychosocial — missing even one is incomplete assessment.
- GENERAL SURVEY observed AT FIRST CONTACT: Physical appearance (age, hygiene, distress), Body structure/nutrition (stature, symmetry, BMI), Mobility (gait, ROM), Behavior (LOC, mood, affect, speech) — this is objective data foundation.
- RA 9173 COMPLIANCE & DOCUMENTATION: Record objectively without interpretation, maintain confidentiality per Data Privacy Act, use precise measurable descriptions, document promptly, comply with Code of Ethics for Registered Nurses — legal liability if not followed.
Last Minute Tips
- When you see 'IPPA' in an NLE question, ALWAYS check the body region: if it says 'abdomen,' the order is DIFFERENT (I→A→P→P, not I→P→P→A). This single mistake costs points on nearly every assessment exam.
- Memorize vital sign normal ranges EXACTLY as given (36.5–37.5°C, 60–100/min, 12–20/min, <120/80 mmHg, 95–100% SpO₂) — exam questions use these precise cutoffs; being off by 1 unit gives a wrong answer.
- In Philippine context, NLE questions about client interviews will ask about cultural sensitivity — remember hiya (shame affecting disclosure), use of 'po/opo' with elders, family involvement in decisions. Questions about Filipino clients emphasize respect and family-centered care.
- Percussion sound questions are HIGH-YIELD: If dullness is heard over the lung field, it is ALWAYS abnormal (consolidation, effusion, atelectasis) — this is tested repeatedly. Resonance = normal lung; anything else = pathology.
- Never confuse 'sign' (objective: BP 140/90, crackles) with 'symptom' (subjective: 'I feel dizzy'); NLE asks 'What is a sign of...' vs 'What is a symptom of...' — answering wrong loses points on nursing diagnosis selection.
Comparison Tables
Rows
Values
- Inspection → Palpation → Percussion → Auscultation
- No risk of altering sounds; palpation/percussion does not interfere with findings
Property
Lungs, Heart, Neck, Extremities
Values
- Inspection → Auscultation → Percussion → Palpation
- Palpating or percussing first can distort bowel sounds; must listen before manipulating
Property
Abdomen
Columns
- Examination Region
- Sequence
- Rationale
Table Title
IPPA Sequence: Regular Regions vs Abdomen
Rows
Values
- Booming/Very low
- ABNORMAL in adults
- Emphysema, pneumothorax, asthma (trapped air)
Property
Hyperresonance
Values
- Low/Hollow
- Normal lung fields (anterior, posterior, lateral thorax)
- Dullness/hyperresonance over lungs = abnormal
Property
Resonance
Values
- Medium/Thud-like
- Over liver (RUQ), spleen (LUQ), heart, full bladder
- Over lung = consolidation, effusion, atelectasis; over abdomen = fluid/solid
Property
Dullness
Values
- Loud/Drum-like
- Over stomach, gas-filled bowel (epigastric, lower left)
- Over lung = abnormal; indicates air-filled space
Property
Tympany
Values
- Soft/Barely audible
- Over bone, muscle, large effusion
- Indicates very dense tissue; least resonant
Property
Flatness
Columns
- Sound
- Pitch/Volume
- Normal Location
- Abnormal Finding
Table Title
Percussion Sounds & Clinical Significance
Rows
Values
- 36.5–37.5°C (oral)
- Hypothermia <36.5°C (exposure, shock, sepsis)
- Fever/Hyperthermia >37.5°C (infection, inflammation, MI)
Property
Temperature
Values
- 60–100 bpm, regular
- Bradycardia <60 (athletes, heart block, vagal stimulation)
- Tachycardia >100 (pain, fever, anemia, hyperthyroidism, exercise)
Property
Pulse (Rate)
Values
- 12–20 breaths/min
- Bradypnea <12 (opioids, CNS depression, hypothermia)
- Tachypnea >20 (fever, pain, hypoxia, anxiety, metabolic acidosis)
Property
Respirations
Values
- <120/80 mmHg (normal); 120–129/<80 (elevated)
- Hypotension <90 systolic (shock, dehydration, bleeding)
- Hypertension ≥130/80 (chronic HTN, stress, pain, CAD risk)
Property
Blood Pressure
Values
- 95–100%
- Hypoxemia <90% (respiratory/cardiac disease, anemia)
- >100% impossible without supplemental oxygen
Property
SpO₂ (Room Air)
Columns
- Vital Sign
- Normal Range (Adult)
- Below Normal (Hypo-)
- Above Normal (Hyper-)
Table Title
Vital Signs: Normal Adult Values & Abnormalities
Rows
Values
- Cannot be answered 'yes/no'; requires narrative response
- START the interview; gather rich subjective data; explore feelings/experiences
- 'Tell me about your headache.' 'How has this affected your daily life?' 'Describe your diet.'
Property
Open-Ended
Values
- Answered 'yes/no' or with specific facts; brief answer
- VERIFY specific facts; focus discussion; obtain baseline data quickly
- 'Do you take your medication daily?' 'Are you allergic to penicillin?' 'Do you smoke?'
Property
Closed-Ended
Columns
- Question Type
- Structure
- When to Use
- Example
Table Title
Open-Ended vs Closed-Ended Questions
Rows
Values
- Upright, 45–60° angle
- Head, neck, thorax, heart, lungs, upper extremities
- Natural, comfortable for most clients
Property
Fowler's / Semi-Fowler's
Values
- Flat on back, legs extended
- Abdomen, anterior chest, extremities
- May cause back discomfort; use small pillow under knees if tolerated
Property
Supine
Values
- Flat on back, knees bent, feet flat
- Relaxed abdominal examination
- Easier on lower back; relaxes abdominal muscles; preferred for anxious clients
Property
Dorsal Recumbent
Values
- Left side, left leg extended, right knee bent
- Rectum, lower GI, perineal area
- Exposes rectal area; dignity maintained with draping
Property
Sims' (Left side-lying)
Values
- Flat on back, knees flexed, legs in stirrups
- Female pelvic and vaginal examination
- Uncomfortable/embarrassing; explain purpose, maintain privacy, use curtain, minimize time
Property
Lithotomy
Values
- Upright, feet together or shoulder-width apart
- Gait, balance, musculoskeletal alignment, spine
- Test balance (Romberg), assess spinal curves, observe natural posture
Property
Standing
Columns
- Position Name
- Body Placement
- Regions Examined
- Client Comfort Notes
Table Title
Physical Examination Positions & Regions
Rows
Values
- Highest discriminatory touch
- Texture, consistency, fine detail, pulses, edema, masses
- Detecting lymph node enlargement, assessing skin turgor, feeling pulse amplitude
Property
Fingertips/Pads
Values
- Temperature-sensitive (thinner skin)
- Skin temperature, temperature differences between areas
- Comparing skin temperature bilaterally, detecting fever by touch
Property
Dorsum (Back of Hand)
Values
- Detects vibration
- Tactile fremitus (chest vibration from lung sounds), vibration sensation
- Assessing chest wall vibration during speech/cough (pneumonia vs normal)
Property
Ulnar Edge / Palmar Surface
Values
- Bimanual control
- Position, movement, mobility of masses or organs
- Assessing kidney mobility, evaluating mass size/fixation, palpating thyroid
Property
Grasping Fingers
Columns
- Hand Part
- Sensitivity
- What It Assesses
- Clinical Example
Table Title
Hand Parts Used in Palpation & What They Assess
Rows
Values
- Question suggests the answer the nurse expects
- Biases client response; gets 'yes' answer without genuine information
- 'You don't drink alcohol, do you?' (suggests no; client may agree falsely)
Property
Leading Questions
Values
- 'Why did you...?' phrasing sounds judgmental
- Client feels blamed; becomes defensive; closes off communication
- 'Why didn't you take your medication?' (sounds accusatory; client clams up)
Property
Accusatory 'Why' Questions
Values
- Minimizing client concern without basis
- Client feels unheard; trust erodes; real fears not addressed
- 'Don't worry, you'll be fine' (without assessment; may not be true)
Property
False Reassurance
Values
- Abruptly shifting topic away from client concern
- Client feels dismissed; important data lost; rapport broken
- Client mentions anxiety; nurse says 'Let's check your blood pressure' (avoids anxiety)
Property
Subject-Changing
Values
- Using complex medical terminology with client
- Client does not understand; embarrassed to ask; gives vague 'yes' answers
- 'Do you have dyspnea?' instead of 'Are you short of breath?'
Property
Medical Jargon
Columns
- Block
- Definition
- Why It's Problematic
- Example to Avoid
Table Title
Common Non-Therapeutic Communication Blocks
Ready to practise for the Midwife Licensure Exam 2026?
Super Tutor's AI review plan adapts to your weak areas and builds a weekly practice schedule around your target Midwife Licensure Exam exam date.