Clinical assessment scores worksheet with answers

Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury opens the eyes when spoken to, talks in sentences but is confused and shows as the best motor response: moves a hand to the site of pressure (localises). Find the Glasgow Coma Scale total GCS = E + V + M.

Practice exercise (made-up values, not clinical guidance). An adult weighs 62 kg and is 193 cm tall. Find the body mass index BMI = weight (kg)/height (m)². Round to one decimal place.

Practice exercise (made-up values, not clinical guidance). A practice patient after a head injury opens the eyes only to pressure (a painful stimulus), makes no sounds and shows as the best motor response: extension of the arms and legs (abnormal extension). Work out the GCS and classify the head injury by it. Click your answer.

1. 1mild
2. 2moderate
3. 3severe

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: yes; secondary diagnosis: no; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: no; gait: weak; mental status: overestimates or forgets limits. Find the Morse total MFS.

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: slightly limited; moisture: very moist; activity: bedfast; mobility: completely immobile; nutrition: very poor; friction and shear: problem. Use the bands 19–23 not at risk, 15–18 mild, 13–14 moderate, 10–12 high and 9 or below very high. Click the risk level.

1. 1not at risk
2. 2mild risk
3. 3moderate risk
4. 4high risk
5. 5very high risk

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: no; ambulatory aid: none, bed rest or nurse assists; IV therapy or saline lock: no; gait: normal, bed rest or wheelchair; mental status: knows own limits. Using the cut-offs 0–24 low, 25–44 moderate and 45 or more high, click the fall-risk level.

1. 1low risk
2. 2moderate risk
3. 3high risk