| Course | NR 306 Health Assessment |
|---|---|
| Week | 7 |
| Paper type | Neurological examination write-up |
| Length | About 1,240 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 306 Week 7
Neurological Assessment Write-Up: A 58-Year-Old Court Stenographer Who Wakes With a Tingling Right Hand
Student Name
College of Nursing, Chamberlain University
NR 306: Health Assessment
Instructor Name
Month Day, Year
Neurological Assessment Write-Up: A 58-Year-Old Court Stenographer Who Wakes With a Tingling Right Hand
Setting and Method
Mrs. O. is a 58-year-old court stenographer who types on a stenotype machine for up to six hours a day. For about three months she has woken two or three nights a week with tingling in her right thumb, index and middle fingers, which goes away when she shakes her hand. She is right-handed, takes levothyroxine, and has no weakness, headaches, dizziness or falls. She was examined at 1600 in the skills laboratory and gave verbal consent at 1555.
Every entry below has three parts: the test, how it was done, and what she did. Strength is graded on the 0 to 5 scale, and reflexes on the 0 to 4+ scale, where 2+ is average (Jarvis & Eckhardt, 2024). Sensory tests were done with her eyes closed unless stated. Left and right are written in the same entry.
Mental Status
Taken from the history and the examination as a whole: alert; knew her name, the building, the date and why she had come; dressed neatly; speech fluent, clear and well organized; followed three-step commands without repetition; recalled the examiner's name at the end of the session; described her work and symptoms in a logical sequence with dates.
Formal screening: not done; the course did not require a scored cognitive screen for a well adult, and nothing in the conversation suggested one was needed. Nasreddine et al. (2005) developed the Montreal Cognitive Assessment as a brief screen for mild cognitive impairment, and it would be the instrument to use if a concern arose.
Cranial Nerves
I (olfactory): eyes closed, one nostril occluded; identified coffee and orange peel through each nostril.
II (optic): read the 20/20 line on a near card at 14 inches with reading glasses, each eye; visual fields by confrontation full in all four quadrants, each eye.
III, IV, VI (oculomotor, trochlear, abducens): pupils 4 millimeters, equal, constricting to 2 millimeters to direct and consensual light and on accommodation; no ptosis; followed the examiner's finger through six cardinal positions with parallel movement and no nystagmus.
V (trigeminal): clenched teeth with masseter and temporalis muscles firm and equal on palpation; identified cotton wisp and sharp end of a broken tongue blade on the forehead, cheek and jaw, equal on both sides.
VII (facial): raised eyebrows, closed eyes tightly against resistance, smiled, puffed cheeks and showed teeth; all equal on both sides.
VIII (acoustic): repeated whispered three-item combinations correctly with each ear at arm's length.
IX, X (glossopharyngeal, vagus): said ah; soft palate and uvula rose in the midline; voice clear; gag reflex not tested.
XI (spinal accessory): shrugged shoulders and turned the head against the examiner's hand; strength 5 of 5, equal.
XII (hypoglossal): protruded the tongue in the midline; pushed it into each cheek against the examiner's finger; equal strength; no fasciculations.
Motor
Bulk (inspection, both sides together): symmetric in the shoulders, arms, forearms, thighs and calves. Thenar eminence (the fleshy pad at the base of the thumb) full and equal on both hands.
Tone (passive movement of the elbows, wrists and knees): normal resistance, no rigidity or catching, both sides.
Strength against the examiner's resistance, 0 to 5 scale: every group tested scored 5 on the right and 5 on the left. Groups tested: shoulder abduction; flexion and extension at the elbow; wrist extension; grip; spreading the fingers; lifting the thumb at a right angle to the palm; hip flexion; knee extension; and pulling the foot up and pushing it down at the ankle.
Pronator drift (arms out, palms up, eyes closed, 20 seconds): no drift of either arm.
Sensory
Light touch (cotton wisp), eyes closed, compared side to side: felt equally on both hands and forearms, both feet and legs, except the tip of the right index finger, which she described as "there, but softer than the left."
Sharp and dull (broken tongue blade), eyes closed: correctly identified 10 of 10 on each hand, including the right index fingertip, and on both feet.
Two-point discrimination (paper clip opened to two points), fingertips: distinguished two points at 4 millimeters on the left index fingertip and at 6 millimeters on the right index fingertip; 4 millimeters on both little fingers.
Vibration (128-hertz tuning fork), eyes closed: felt at the distal joint of both thumbs and both great toes, stopping at the same time as the examiner's own sensation.
Position sense (examiner moved the distal joint of the great toe and index finger up or down), eyes closed: correct on 5 of 5 trials at each site.
Stereognosis (object in the hand), eyes closed: identified a coin, a key and a paper clip with each hand.
Graphesthesia (number traced on the palm), eyes closed: identified 3, 7 and 8 on each palm.
Provocation tests at the wrist: tapping over the front of the right wrist, over the carpal tunnel, produced tingling into the right index and middle fingers; the same on the left produced nothing. Holding both wrists fully flexed, backs of the hands together, for 60 seconds produced tingling in the right thumb and index finger at about 40 seconds; the left produced nothing.
Reflexes
0 to 4+ scale, right and left: biceps 2+, 2+; triceps 2+, 2+; brachioradialis 2+, 2+; patellar 2+, 2+; Achilles 1+, 1+ (both increased to 2+ with reinforcement by clasping her hands and pulling).
Plantar response (stroked lateral sole with the end of a reflex hammer handle): toes curled down on both feet.
Coordination and Gait
Rapid alternating movements (palm and back of the hand on the thigh, 10 seconds): smooth and rhythmic on both sides.
Finger to nose (eyes open, then closed): accurate and smooth on both sides.
Heel to shin (lying): heel ran straight down each shin without wavering.
Gait: walked 6 meters across the room and back with an even stride and arm swing; walked heel to toe along a straight line; walked on heels and on toes.
Romberg (feet together, arms at the sides, eyes closed, 30 seconds): stood without swaying.
Summary and Reflection
Mental status, cranial nerves I to XII, motor, reflexes, coordination and gait were symmetric and within the expected range. The only asymmetry was in the right hand: light touch softer at the right index fingertip, two-point discrimination at 6 millimeters on the right index fingertip against 4 on the left, and tingling reproduced in the lateral three fingers of the right hand by tapping over the wrist and by holding it flexed. Thumb strength and thenar bulk were equal. No condition was named, and Mrs. O. was encouraged to raise the night tingling with her primary care provider.
On my unit, a neurological check means pupils, grips and orientation, and I record them several times a shift. This examination showed me how much that check misses. Grip strength was equal, but the hand findings came from tests I rarely use: two-point discrimination and the wrist provocation tests. Bickley et al. (2021) organize the neurologic examination around the question of where a problem is located, and the only way to answer that for Mrs. O. was to test each modality at each site and compare the two hands in the same entry.
References
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.
Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
The Chamberlain NR 306 Week 7 instructions
The Week 7 assignment asks for a complete neurological examination of a volunteer. Expect the template to include mental status, cranial nerves I to XII, motor bulk, tone and strength, sensory modalities, reflexes and plantar response, coordination, gait and balance, with a summary and reflection. For each entry, give the test, how it was done and the response. Grade strength on the 0 to 5 scale and reflexes on the 0 to 4+ scale. Note whether the person's eyes were closed for sensory tests. Test both sides and record each. Describe gait instead of calling it steady. Name any test you did not perform and why, since this region is where unrecorded shortcuts show most.
Inside the NR 306 Week 7 example
The write-up opens with Mrs. O., six hours a day on a stenotype and three months of nighttime tingling in her right thumb, index and middle fingers. The method states the three-part rule and both scales from Jarvis and Eckhardt (2024). Mental status is described, with the MoCA by Nasreddine et al. (2005) named as not required. Each cranial nerve is listed with its task and result. Motor entries cover bulk, tone, strength by group and pronator drift. Sensory entries test light touch, sharp and dull, two-point discrimination, vibration, position, stereognosis and graphesthesia, then two wrist provocation tests. Reflexes, coordination, gait and Romberg follow. The summary names the single asymmetry.
NR 306 Week 7 rubric: what full points look like
Neurological rubrics commonly reward complete coverage of all components, the test named for each finding, use of grading scales, bilateral comparison, accurate sensory technique and a summary without diagnosis. Naming the test carries the most weight, so intact never appears alone. Coverage scores when every cranial nerve and sensory modality is recorded. Scales earn credit when strength and reflexes are graded, including reinforcement for the Achilles reflexes. Bilateral comparison is graded on measurements for both sides, as with two-point discrimination. Stating that eyes were closed protects sensory findings. Reporting the hand asymmetry without naming a nerve problem fits the course scope. Reflection on how bedside neuro checks miss these findings shows insight.
Common NR 306 Week 7 mistakes, and how to avoid them
Marks leak first from a nerve reported without its test. Next is a missing grade, normal where a score was expected. Sensory tests without noting eyes closed, one side tested and both claimed, gait labeled steady, mental status skipped, coordination tasks merged and cranial nerve I omitted all cost points. Any test you did not perform must be named. Most sections expect all twelve cranial nerves. Without a reflex hammer, use what your section permits and say so. More testing than you do at work is expected; that is the point of the course. Send the volunteer's history with your test results, and the neurological record can be written test by test.
Get a NR 306 Week 7 example written to your instructions
Send the Week 7 instructions and the neurological form your section uses, and a custom example is written into it with every test named and answered, returned inside 24 to 48 hours. The first one is free. Whoever let you tap their tendons and close their eyes for you did so under an arrangement that remains theirs and yours.
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NR 306 Week 7 questions, answered
Do I have to test all twelve cranial nerves?
Test whatever the form lists, and most classroom forms list all of them. The first is the usual problem, since it needs something with a smell, and the honest entry is to name it as not tested with the reason. Several others are already covered by the head and neck examination, so the work is smaller than the list looks, and the record simply has to say which task produced each answer.
I do not own a reflex hammer. What then?
Name the substitute you used, or name the row as not performed. Sections vary in what they supply and what they expect at home, and either answer is acceptable when it is written down. What is not acceptable is a set of graded reflexes in a document where no hammer or equivalent existed, because a grade implies a technique and the technique implies a tool.
This is more testing than I ever do at work. Is that expected?
Yes, and it is the point of placing the region here. Very little of a full neurological battery appears on an ordinary medical or surgical round, which is exactly why the course makes you run it once with nothing prompting you to. The write-up is evidence that you reached tests no complaint sent you toward, and that is what the row is worth.
Where can I find a free NR 306 Week 7 sample paper?
The complete Week 7 neurological write-up on Mrs. O., with all twelve cranial nerves, graded strength and reflexes and the right-hand findings, appears in full on this page.
What asymmetry does the NR 306 Week 7 example find?
Softer light touch at the right index fingertip, two-point discrimination at 6 millimeters on the right index finger against 4 on the left, and tingling on tapping the front of the right wrist.