Midwife Licensure Exam Health Assessment — Health History & Physical Examination TechniquesExam Answer Templates

Marks

1

Topic

Physical Examination Techniques — IPPA

Difficulty

easy

Template Id

T1

Examiner Tip

This is a classic 'trick' NLE item. Examiners specifically test whether you know the abdominal exception. Simply writing 'IAPA' with the reason earns full marks quickly — do not overthink this.

Model Answer

The correct sequence for abdominal examination is Inspection → Auscultation → Percussion → Palpation (IAPA). This order is used to prevent alteration of bowel sounds before they are assessed.

Question Type

very_short_answer

Answer Structure

• State the correct sequence with arrows: Inspection → Auscultation → Percussion → Palpation [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing the standard IPPA sequence instead of the abdominal IAPA sequence
• Listing only 3 of 4 techniques
• Correct techniques but in wrong order

Key Phrases To Include

• Inspection → Auscultation → Percussion → Palpation
• IAPA
• bowel sounds
• abdomen

Marks

2

Topic

Purpose and Types of Assessment

Difficulty

easy

Template Id

T2

Examiner Tip

Examiners award one mark per category. Give the synonym (symptom/covert; sign/overt) alongside the definition — it shows depth and protects you if the examiner's rubric uses a slightly different primary term.

Model Answer

Subjective data (also called symptoms or covert data) refers to information reported by the client that cannot be observed or measured by the nurse, such as pain, dizziness, or nausea. Objective data (also called signs or overt data) refers to information that can be directly observed, measured, or verified by the nurse, such as blood pressure, temperature, a visible rash, or an audible wheeze.

Question Type

short_answer

Answer Structure

• Sentence 1: Define subjective data with an example [1 mark]
• Sentence 2: Define objective data with an example [1 mark]

Scoring Breakdown

Common Mark Deductions

• Defining one type correctly but omitting an example
• Confusing subjective with objective (e.g., calling pain objective)
• Using lay language instead of clinical terms (e.g., 'what the patient feels' without further explanation)

Key Phrases To Include

• reported by the client
• cannot be measured or observed by the nurse
• symptoms / covert data
• observed or measured by the nurse
• signs / overt data

Marks

2

Topic

General Survey and Vital Signs

Difficulty

easy

Template Id

T3

Examiner Tip

Memorize all five values with their units as one complete set. NLE frequently uses vital sign ranges as single-best-answer distractors — knowing exact numbers protects you from nearly correct but wrong options.

Model Answer

Normal adult vital sign ranges are: (1) Temperature: 36.5–37.5 °C (oral); (2) Pulse: 60–100 beats/min, regular; (3) Respirations: 12–20 breaths/min, regular and unlabored; (4) Blood pressure: below 120/80 mmHg (normal); and (5) Oxygen saturation (SpO2): 95–100% on room air.

Question Type

short_answer

Answer Structure

• List all five vital signs with correct values and units — examiners typically award 0.5 marks per correct vital sign when grading holistically for a 2-mark question, or may award 1 mark for 3 correct and 1 mark for all 5 correct.

Scoring Breakdown

Common Mark Deductions

• Omitting units (°C, mmHg, beats/min)
• Writing incorrect ranges (e.g., RR 16–20 instead of 12–20)
• Forgetting SpO2 as the fifth vital sign

Key Phrases To Include

• 36.5–37.5 °C
• 60–100 beats/min
• 12–20 breaths/min
• below 120/80 mmHg
• 95–100% on room air

Marks

2

Topic

Physical Examination Techniques — Palpation

Difficulty

easy

Template Id

T4

Examiner Tip

The 'why' earns the second mark. NLE items frequently require rationale, not just identification. A complete answer always pairs what with why.

Model Answer

The dorsum (back) of the hand is best used to assess skin temperature. This is because the skin over the dorsum is thinner and contains more temperature-sensitive nerve receptors, making it more sensitive to heat and cold compared to the palmar surface or fingertips.

Question Type

short_answer

Answer Structure

• Sentence 1: Name the correct part of the hand (dorsum) [1 mark]
• Sentence 2: Explain WHY — thinner skin, more temperature-sensitive receptors [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating 'fingertips' instead of dorsum — fingertips are used for texture and pulses, not temperature
• Giving the correct part without any rationale
• Confusing dorsum with palmar surface

Key Phrases To Include

• dorsum of the hand
• back of the hand
• thinner skin
• temperature-sensitive
• more sensitive to heat and cold

Marks

3

Topic

Health History Interview — Phases

Difficulty

medium

Template Id

T5

Examiner Tip

Use a numbered list format. Examiners count items — if you write four numbered points with clear phase names and at least one action per phase, you protect all 3 marks. Never describe phases in a single undifferentiated paragraph.

Model Answer

The four phases of the health history interview are: (1) Preparatory/Pre-interaction Phase — the nurse reviews available records, ensures privacy, and prepares the environment before meeting the client. (2) Introductory/Opening Phase — the nurse establishes rapport, introduces herself, explains the purpose of the interview, and obtains consent. (3) Working/Body Phase — the nurse actively collects subjective data through effective questioning and therapeutic communication. (4) Closing/Termination Phase — the nurse summarizes the findings, allows the client to add any information, and explains the next steps in care.

Question Type

short_answer

Answer Structure

• Name and describe Phase 1: Preparatory/Pre-interaction [0.75 mark]
• Name and describe Phase 2: Introductory/Opening [0.75 mark]
• Name and describe Phase 3: Working/Body [0.75 mark]
• Name and describe Phase 4: Closing/Termination [0.75 mark]
• Note: Examiners typically award 3 marks holistically across all four phases — partial credit for partially correct descriptions.

Scoring Breakdown

Common Mark Deductions

• Listing only phase names without descriptions
• Confusing the order of phases (e.g., placing 'closing' as phase 3)
• Describing only 3 of 4 phases
• Vague descriptions that do not specify what the nurse does in each phase

Key Phrases To Include

• preparatory / pre-interaction
• introductory / opening
• working / body phase
• closing / termination
• rapport
• consent
• data collection
• summarize

Marks

3

Topic

Physical Examination Techniques — Percussion

Difficulty

medium

Template Id

T6

Examiner Tip

This is a high-frequency NLE topic. Memorize the five sounds in order from least dense to most dense tissue: Tympany → Resonance → Hyperresonance (abnormal) → Dullness → Flatness. Clinical examples (emphysema, pleural effusion) earn the 3rd mark.

Model Answer

The five percussion sounds and their associated tissue types are: (1) Tympany — loud, drum-like sound heard over air-filled organs such as the stomach or gas-filled intestines. (2) Resonance — low-pitched, hollow sound heard over normal, air-filled lung tissue. (3) Hyperresonance — booming sound, louder than resonance, heard over hyperinflated lungs (e.g., emphysema or pneumothorax) — abnormal in adults. (4) Dullness — medium-pitched, thud-like sound heard over dense organs such as the liver, spleen, or a full bladder; dullness over a lung field is abnormal and suggests consolidation or pleural effusion. (5) Flatness — soft, very short sound heard over extremely dense tissue such as bone or muscle.

Question Type

short_answer

Answer Structure

• List all 5 sounds with quality description and associated tissue/organ [1 mark per 2 sounds, approximately]
• Marks are typically awarded holistically: 1 mark for any 2 sounds correct, 2 marks for any 4 sounds correct, 3 marks for all 5 sounds with correct tissue associations

Scoring Breakdown

Common Mark Deductions

• Describing only 3 of 5 sounds
• Associating dullness with normal lung tissue (it is abnormal there)
• Confusing hyperresonance with resonance
• Omitting the clinical significance of abnormal sounds

Key Phrases To Include

• tympany — air-filled organs
• resonance — normal lung
• hyperresonance — emphysema / pneumothorax
• dullness — liver, spleen, consolidation
• flatness — bone, muscle

Marks

3

Topic

Health History — HPI and Symptom Analysis

Difficulty

medium

Template Id

T7

Examiner Tip

Case-based questions expect application, not just recall. Mention the client's own words ('walking worsens it') under Aggravating factors to show you read the scenario carefully — examiners reward clinical integration.

Model Answer

The nurse uses the OLD CARTS mnemonic to systematically assess the client's chest pain: O — Onset: 'When exactly did the chest pain start? Did it come on suddenly or gradually?' L — Location: 'Where exactly is the pain? Does it radiate anywhere, such as to your left arm or jaw?' D — Duration: 'How long does each episode of pain last? Is it continuous or intermittent?' C — Character: 'Can you describe the pain? Is it sharp, dull, crushing, burning, or pressure-like?' A — Aggravating factors: 'What makes the pain worse? Is it activity, breathing, or eating?' (Client already states: walking worsens it.) R — Relieving factors: 'What makes the pain better? Does rest, position change, or medication help?' T — Timing: 'Does the pain occur at rest, with exertion, or at a specific time of day?' S — Severity: 'On a scale of 0 to 10, with 0 being no pain and 10 being the worst pain imaginable, how would you rate your pain right now and at its worst?'

Question Type

case_study

Answer Structure

• State the mnemonic expansion: OLD CARTS [0.5 mark]
• Apply at least 6–8 components with sample assessment questions for each [2.5 marks, distributed across correct components]

Scoring Breakdown

Common Mark Deductions

• Expanding only 4–5 letters of OLD CARTS instead of all 8
• Listing the letters without applying them to the scenario
• Forgetting to use a validated pain scale for Severity
• Not integrating the client's given information (walking worsens it) into the Aggravating component

Key Phrases To Include

• OLD CARTS
• Onset, Location, Duration, Character, Aggravating, Relieving, Timing, Severity
• 0–10 numeric pain scale
• aggravating factor: walking
• systematic symptom analysis

Marks

2

Topic

Physical Examination Techniques — Auscultation

Difficulty

easy

Template Id

T8

Examiner Tip

Memory trick: Diaphragm = D = Dominant, loud (high-pitched). Bell = B = Bass, soft (low-pitched). Examiners frequently ask for examples — list at least two sounds per side.

Model Answer

Auscultation is a physical examination technique that involves listening to body sounds, typically using a stethoscope. The diaphragm (flat side) of the stethoscope transmits high-pitched sounds such as normal breath sounds, bowel sounds, and S1/S2 heart sounds; it is pressed firmly against the skin. The bell (cup side) transmits low-pitched sounds such as S3 and S4 extra heart sounds, murmurs, and bruits; it is placed lightly against the skin.

Question Type

short_answer

Answer Structure

• Sentence 1: Define auscultation [0.5 mark]
• Sentence 2: Describe the diaphragm — high-pitched sounds, examples, firm pressure [0.75 mark]
• Sentence 3: Describe the bell — low-pitched sounds, examples, light pressure [0.75 mark]

Scoring Breakdown

Common Mark Deductions

• Reversing the diaphragm and bell functions
• Omitting the pressure application difference (firm vs. light)
• Not giving examples of sounds for each side

Key Phrases To Include

• diaphragm — high-pitched sounds
• bell — low-pitched sounds
• S1/S2 — diaphragm
• S3, S4, murmurs — bell
• pressed firmly / applied lightly

Marks

3

Topic

Physical Examination Techniques — Palpation

Difficulty

medium

Template Id

T9

Examiner Tip

Depth values (1 cm and 4 cm) are specific, testable facts. Including them differentiates a complete answer from a vague one. The rationale is worth a full mark — never omit it in a 3-mark question.

Model Answer

Light palpation involves applying gentle pressure to a depth of approximately 1 cm and is used to assess surface characteristics such as texture, skin temperature, moisture, superficial tenderness, and muscle guarding. Deep palpation applies pressure to a depth of approximately 4 cm and is used to assess deeper organs, masses, and organ size. The correct sequence is to always perform light palpation first, followed by deep palpation. The rationale is that beginning with light palpation allows the nurse to identify superficial tenderness and muscle guarding, which can alert her to areas of pathology before applying deeper pressure. Palpating deeply over a tender area first may cause involuntary guarding or rebound tenderness, obscuring true findings. Additionally, tender areas should always be palpated last, regardless of the technique used.

Question Type

short_answer

Answer Structure

• Define light palpation with depth (1 cm) and purpose [1 mark]
• Define deep palpation with depth (4 cm) and purpose [1 mark]
• State correct sequence (light before deep) with rationale; add 'tender areas last' rule [1 mark]

Scoring Breakdown

Common Mark Deductions

• Omitting the approximate depth values
• Stating the correct sequence without providing rationale
• Forgetting the rule about palpating tender areas last

Key Phrases To Include

• light palpation — 1 cm depth
• deep palpation — 4 cm depth
• light palpation first
• prevent guarding
• tender areas last
• surface characteristics
• organs and masses

Marks

1

Topic

Health History — Components

Difficulty

easy

Template Id

T10

Examiner Tip

This is a pure recall item. Use the numbered list format and aim to write all 7 components. Even for 1 mark, showing completeness reflects clinical mastery.

Model Answer

A complete nursing health history includes: (1) Biographic data, (2) Chief complaint, (3) History of present illness (HPI), (4) Past health history, (5) Family health history, (6) Review of systems (ROS), and (7) Lifestyle and psychosocial data.

Question Type

very_short_answer

Answer Structure

• List all 7 components — 1 mark for listing at least 5 components correctly

Scoring Breakdown

Common Mark Deductions

• Listing fewer than 5 components
• Including 'physical examination findings' — these are not part of the health history (they are objective data, not history)

Key Phrases To Include

• biographic data
• chief complaint
• history of present illness
• past health history
• family health history
• review of systems
• lifestyle / psychosocial data

Marks

5

Topic

Comprehensive Health Assessment — Integration

Difficulty

hard

Template Id

T11

Examiner Tip

For 5-mark long-answer questions, use bold section headings (I. Health History, II. Vital Signs, III. Physical Examination, IV. Documentation). This structure immediately signals organization and makes the examiner's marking fast and favorable. Mention RA 9173 at least once — it is a reliable mark-earner in Philippine nursing board exams.

Model Answer

A comprehensive nursing health assessment for this client involves two major components: the health history interview and the physical examination. I. Health History Interview Before beginning, I will review available records, ensure privacy by closing curtains and limiting visitors, and prepare a quiet, well-lit environment. I will introduce myself by name and designation, explain the purpose of the interview, and obtain the client's consent, respecting her right to information under RA 9173 (Philippine Nursing Act of 2002). I will be sensitive to cultural factors common in the Philippine setting, such as hiya (reticence), the presence of family members, and the use of respectful language ('po' and 'opo'), especially since she is an elder. I will collect the following components systematically: 1. Biographic data — name, age, civil status, address, religion, occupation. 2. Chief complaint — in her own words: 'weakness and difficulty breathing for two days.' 3. History of present illness — using OLD CARTS (Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity) and PQRST for her dyspnea. 4. Past health history — previous illnesses, hospitalizations, surgeries, allergies, and current medications. 5. Family health history — heritable conditions such as hypertension, diabetes, or heart disease. 6. Review of systems — head-to-toe subjective questioning of each body system. 7. Lifestyle and psychosocial data — diet, activity level, smoking, alcohol use, coping, and support systems. II. General Survey and Vital Signs I will begin with a general survey upon first contact, noting her overall appearance, level of distress, hygiene, level of consciousness, posture, and any signs of respiratory distress (e.g., use of accessory muscles, cyanosis). I will measure and record: - Temperature: normal range 36.5–37.5 °C - Pulse: normal range 60–100 beats/min - Respirations: normal range 12–20 breaths/min (note rate, rhythm, and depth given her dyspnea) - Blood pressure: normal below 120/80 mmHg - SpO2: normal 95–100% on room air - Pain scale: 0–10 (as the fifth vital sign) - BMI: weight (kg) / height (m²); normal 18.5–24.9 kg/m² III. Physical Examination — IPPA Sequence For all body regions except the abdomen, I follow Inspection → Palpation → Percussion → Auscultation. For the abdomen, I follow Inspection → Auscultation → Percussion → Palpation to avoid altering bowel sounds. - Inspection: assess color, symmetry, respiratory effort, chest wall movement. - Palpation: use dorsum for skin temperature, fingertips for texture and tenderness; light palpation before deep palpation; palpate tender areas last. - Percussion: percuss lung fields — resonance over normal lung; dullness may indicate consolidation or pleural effusion relevant to her dyspnea. - Auscultation: use diaphragm for high-pitched breath sounds (S1/S2, crackles, wheeze); use bell for low-pitched sounds (S3, murmurs) if cardiac cause is suspected. IV. Documentation All findings will be recorded accurately, promptly, and objectively using the institutional format, with measurable descriptors. I will maintain confidentiality consistent with the Code of Ethics for Registered Nurses and RA 9173. Findings will serve as the baseline database to formulate nursing diagnoses and develop the nursing care plan.

Question Type

long_answer

Answer Structure

• Introduction: Mention the two major components — health history and physical examination [0.5 mark]
• Health history interview: Phases, cultural sensitivity (hiya, RA 9173), all 7 components [1.5 marks]
• General survey and vital signs with correct normal ranges and units [1 mark]
• Physical examination: IPPA sequence (including abdominal exception), correct hand parts for palpation, percussion sounds, diaphragm/bell distinction [1.5 marks]
• Documentation: Objective recording, RA 9173, nursing process application [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Describing physical examination without specifying IPPA sequence
• Omitting the abdominal IAPA exception
• Not mentioning RA 9173 or documentation standards
• Listing vital signs without correct values or units
• Ignoring cultural considerations specific to Filipino clients
• Writing a disorganized essay without headings or logical structure — examiners cannot identify components to award marks

Key Phrases To Include

• health history interview
• OLD CARTS / PQRST
• IPPA sequence
• abdominal exception — IAPA
• dorsum for temperature
• light before deep palpation
• tender areas last
• diaphragm — high-pitched
• bell — low-pitched
• resonance vs. dullness
• RA 9173
• hiya / cultural sensitivity
• 36.5–37.5 °C, 60–100/min, 12–20/min, <120/80 mmHg, 95–100%

Marks

2

Topic

Physical Examination Techniques — Inspection

Difficulty

easy

Template Id

T12

Examiner Tip

Including 'bilateral comparison' and 'adequate lighting' as conditions for effective inspection shows clinical depth beyond simple memorization — this earns the second mark even if your list of characteristics is short.

Model Answer

Inspection is a deliberate, systematic physical examination technique that involves careful visual (and sometimes olfactory and auditory) observation of the client. During inspection, the nurse assesses: color, size, shape, symmetry, position, movement, texture, presence of lesions or discharge, and any abnormal odors. Adequate lighting, appropriate exposure, and bilateral comparison are essential for effective inspection. Inspection begins at the moment of first contact during the interview and continues throughout the entire examination.

Question Type

short_answer

Answer Structure

• Sentence 1: Define inspection — deliberate, systematic visual observation [1 mark]
• Sentence 2: List at least 4 characteristics assessed + essential conditions (lighting, bilateral comparison) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Defining inspection too vaguely as 'just looking at the patient'
• Not listing specific characteristics assessed
• Omitting the importance of adequate lighting or bilateral comparison

Key Phrases To Include

• deliberate and systematic
• visual observation
• color, size, shape, symmetry
• good lighting
• bilateral comparison
• first technique in IPPA

Marks

1

Topic

Physical Examination Techniques — IPPA Abdominal Exception

Difficulty

easy

Template Id

T13

Examiner Tip

The key word is 'alter.' Always pair the sequence rule with the physiological rationale — this is what separates a 1-mark answer from a 0-mark answer on this item.

Model Answer

The nurse auscultates the abdomen before percussion and palpation because percussion and palpation can stimulate or alter bowel sounds, producing artificially increased or decreased sounds. Auscultating first ensures that bowel sounds are assessed in their natural, undisturbed state, yielding accurate and reliable findings.

Question Type

very_short_answer

Answer Structure

• State the reason: percussion/palpation alter bowel sounds, so auscultation must come first [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating the correct sequence without explaining WHY
• Saying only 'to avoid pain' without mentioning alteration of bowel sounds

Key Phrases To Include

• alter bowel sounds
• stimulate bowel sounds
• accurate assessment
• auscultate first

Marks

3

Topic

Health History Interview — Therapeutic Communication and Cultural Sensitivity

Difficulty

hard

Template Id

T14

Examiner Tip

PRC Board exams frequently include scenario-based items with Philippine cultural context. Using the specific term 'hiya' signals cultural competence and earns immediate recognition. Always tie your answer back to RA 9173 or the Code of Ethics for Registered Nurses in scenario questions involving professional practice.

Model Answer

The client's hesitation and averted gaze are consistent with hiya — a Filipino cultural value involving a sense of shame or reticence, particularly around sensitive topics such as sexual health. The nurse should respond therapeutically in the following ways: 1. Acknowledge and normalize: The nurse can briefly normalize the topic by saying, 'I understand these questions may feel uncomfortable. Your answers will help us give you the best care, and everything you share is confidential.' This reduces shame without being dismissive. 2. Ensure privacy: Confirm that the room is private and that no family members are present for sensitive questioning, since Filipino clients may be reluctant to disclose in front of family due to hiya. 3. Use therapeutic silence and non-verbal support: Allow comfortable silence after questions, maintain a neutral, non-judgmental facial expression, and avoid maintaining intense eye contact, which can feel confrontational in Filipino culture. 4. Use open-ended questions in Filipino/local language if possible: 'Maari mo bang ibahagi ang iyong kalusugan?' (Can you share about your health?) — this conveys respect and reduces power distance between nurse and client. 5. Avoid non-therapeutic techniques: Do not use leading questions, show shock or disapproval, change the subject abruptly, or give false reassurance ('Don't worry, it's nothing serious'). The nurse's role is to build trust and maintain a therapeutic relationship. The client's dignity and autonomy must be respected throughout, consistent with the Code of Ethics for Registered Nurses under RA 9173.

Question Type

case_study

Answer Structure

• Identify the cultural concept: hiya [0.5 mark]
• Describe 2–3 specific therapeutic communication strategies [1.5 marks]
• Mention privacy/family dynamics in Philippine context [0.5 mark]
• Reference Code of Ethics / RA 9173 or professional nursing standards [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Not identifying hiya as the cultural factor
• Describing generic communication strategies without adapting to the Philippine/Filipino context
• Suggesting the nurse ignore the sensitive topic entirely
• Omitting the mention of privacy or family dynamics

Key Phrases To Include

• hiya
• cultural sensitivity
• therapeutic communication
• non-judgmental
• privacy
• confidentiality
• open-ended questions
• avoid non-therapeutic techniques
• RA 9173 / Code of Ethics

Marks

2

Topic

General Survey — Anthropometric Measurements

Difficulty

medium

Template Id

T15

Examiner Tip

Always show your work step-by-step for numerical items — even if your final answer is wrong, partial marks may be awarded for correct formula and setup. Always include kg/m² as the unit and state the classification category.

Model Answer

BMI = Weight (kg) / Height (m²) BMI = 80 kg / (1.70 m)² BMI = 80 / 2.89 BMI = 27.7 kg/m² Interpretation: A BMI of 27.7 kg/m² falls in the Overweight category (BMI 25.0–29.9 kg/m²). The normal BMI range is 18.5–24.9 kg/m². The nurse should include nutritional assessment and counseling on healthy weight management as part of this client's care plan.

Question Type

numerical

Answer Structure

• Write the BMI formula [0.5 mark]
• Substitute values and calculate correctly: 80 / (1.70)² = 80 / 2.89 = 27.7 kg/m² [1 mark]
• Correct interpretation with normal range stated [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Using cm instead of meters in the formula (common arithmetic error)
• Calculating correctly but omitting the units (kg/m²)
• Correct BMI value but wrong interpretation (e.g., calling 27.7 'obese')
• Not stating the normal BMI range in the interpretation

Key Phrases To Include

• BMI = weight (kg) / height (m²)
• 27.7 kg/m²
• overweight
• normal range 18.5–24.9 kg/m²