QUESTION No 1  A 17-year-old male presents with a complaint of a red, itchy rash over his torso and back x 1 week, which is keeping him up at night. He denies sick exposures or a recent visit to wooded areas. He denies other symptoms, significant history, or allergies.

1-In order of importance, describe three (3) questions that you would like to ask this patient and give a brief explanation of why?

2- From the information provided, list your differential diagnoses in the order of “most likely” to “possible but unlikely.”


An 89-year-old female complains of a “stabbing chest pain” and points to the area just below her scapula at the right mid-clavicular line. She states that she had an upper respiratory infection last week that “just seems to hang on.” She has no other complaints.

1- In order of importance, describe three (3) questions that you would like to ask this patient and give a brief explanation of why.

2- Which lab or imaging tests would you order for this patient? Why?


NURS 518 reviews principles of physical examination and introduces concepts and principles on which the clinical nurse practitioner role is based. These include advanced physical examination techniques, clinical decision-making principles, communication, client education and documentation.

Course Goals

At the end of this course, the student should be able to:

  1. complete a comprehensive physical examination of an adult client, including appropriate psychosocial, developmental and cultural elements;
  2. complete a focused physical examination of an adult client based on priority presenting symptoms including appropriate psychosocial, developmental and cultural elements;
  3. identify and interpret both normal and abnormal physical assessment finding;
  4. use appropriate interviewing techniques to complete a comprehensive health history
  5. synthesize health assessment information to diagnose health risks and states of health/illness;
  6. formulate preliminary differential diagnoses through the integration of client information;
  7. articulate the fundamental principles of health promotion and prevention as they relate to their individual clients, client groups, and /or the population as a whole;
  8. apply epidemiologic principles in the process of clinical decision making;
  9. apply evidenced based decision making principles to the ordering and interpretation of lab and diagnostic testing;
  10. discuss the approach to the client when conferring a diagnosis with sensitivity to the patient experience and within the philosophy of client-centered care;
  11. explore patient experiences of illness and integrate this knowledge into the context of client-centered care;
  12. explore elements within family culture and personal experiences that affect change -behaviours and outcomes in health care;
  13. communicate effectively in order to support, educate, coach and counsel clients;
  14. appropriately complete consultations/referrals for clients to other health-care providers;
  15. appropriately document clinical data, assessment findings, and differential diagnoses;
  16. explore the legalities of documentation and professional liability as they pertain to nurse practitioner practice;
  17. adhere to federal and provincial/territorial legislation, policies and standards related to privacy, documentation and information management; and
  18. practice (in the student role) in accordance with federal and provincial/territorial legislation, professional and ethical standards, and policy relevant to nurse practitioner practice.

Course Materials


Registration in this course includes an electronic textbook. For more information on electronic textbooks, please refer to our eText Initiative site.

Bickley, L. S, Szilagyi, P. G., & Hoffman, R. M. (Eds). (2020). Bates’ guide to physical examination and history-taking (13th ed.). Wolters Kluwer.

Online Materials

Bickley, L. (2013). Bates’ visual guide to physical examination (5th ed.). Philadelphia, PA: Wolters Kluwer.

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