| Course | NSG 121 Health Assessment |
|---|---|
| Unit | Unit 4 |
| Paper type | Landmark and positioning guide |
| Length | About 910 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 121 Unit 4
Counted From Bone: A Landmark and Positioning Guide for Heart, Lung, and Abdominal Sites, With the Pairs Students Most Often Confuse
Student Name
Department of Nursing, Herzing University
NSG 121: Health Assessment
Instructor Name
February 5, 2026
Counted From Bone: A Landmark and Positioning Guide for Heart, Lung, and Abdominal Sites, With the Pairs Students Most Often Confuse
How to Use This Guide
Each entry names a site, the landmark it is counted or traced from, the position of the person when it is examined, and the terms used to record what is heard or felt. No site is located by a loose direction such as "lower left chest." The landmark descriptions follow the course text (Jarvis, 2020) and Bickley et al. (2021).
The Starting Landmark: The Sternal Angle
Site: the angle of Louis, the ridge where the manubrium meets the body of the sternum. Landmark: found by sliding a fingertip down from the suprasternal notch about 5 cm until a horizontal bony ridge is felt. Position: sitting or lying, either works. Why it matters: the second rib joins the sternum at this ridge, so the space directly below it is the second intercostal space. Every other chest site in this guide is counted downward from here. Counting from the bottom of the ribcage is unreliable because the lower ribs are hard to feel and the twelfth rib does not reach the front.
Cardiac Listening Sites
Aortic area: second intercostal space at the right sternal border, found by moving from the sternal angle one finger width to the right and into the space below the second rib. Pulmonic area: the same space on the left sternal border. Erb's point: third intercostal space at the left sternal border, counted one space below the pulmonic area. Tricuspid area: fourth or fifth intercostal space at the lower left sternal border. Mitral area: on the left midclavicular line in the fifth intercostal space, found by counting down from the second space and then moving out along that space to a vertical line dropped from the middle of the clavicle.
Position: sitting and supine for all five. Two positions change what is heard. Turning the person partly onto the left side, the left lateral decubitus position, brings the apex of the heart closer to the chest wall and makes low-pitched sounds at the mitral area easier to hear with the bell. Having the person sit up, lean forward, and breathe out brings the base of the heart closer and makes soft high-pitched sounds at the aortic and pulmonic areas easier to hear with the diaphragm. Terms used in the record: S1, S2, rate and rhythm, and, if present, extra sounds or murmurs described by timing, location, and pitch.
Point of Maximal Impulse
Site: where the apex of the heart taps the chest wall. Landmark: usually in the fifth intercostal space at or just inside the left midclavicular line, located by the same count as the mitral area. Position: supine; if it cannot be felt, the left lateral position moves it toward the chest wall but also shifts it outward, so a location found that way is recorded with the position. Terms: location by space and line, diameter in centimeters (usually no larger than a coin, 1 to 2.5 cm), and whether the tap is brief or sustained.
Lung Landmarks
Anterior: the upper edge of each lung sits about 2 to 4 cm above the inner third of the clavicle. The lower edge crosses the sixth rib at the midclavicular line, counted from the sternal angle. Lateral: the lower edge crosses the eighth rib at the midaxillary line. Posterior: the vertebra prominens, the most prominent spinous process at the base of the neck when the head is bent forward, is C7; counting down, the lower edge of the lungs sits near T10 on expiration and moves down on deep inspiration. The scapulae are not landmarks for counting, since their position changes with the arms.
Position: sitting, arms crossed in front to move the scapulae outward for the posterior chest. Terms: breath sounds as vesicular, bronchovesicular, or bronchial by location; added sounds as crackles or wheezes; percussion notes as resonant, dull, or hyperresonant.
Abdominal Sites
Quadrants: two imaginary lines crossing at the umbilicus, one vertical along the midline from sternum to pubic bone and one horizontal. Liver span: at the right midclavicular line, percussed downward from a resonant area of the chest until the note turns dull (the upper edge), and upward from the abdomen until it turns dull (the lower edge); the distance between is the span, usually 6 to 12 cm. McBurney's point: one third of the way along a line from the right anterior superior iliac spine to the umbilicus.
Position: supine, knees slightly bent, arms at the sides, to relax the abdominal muscles. Terms: bowel sounds described by presence and character; percussion notes as tympanic or dull; findings on palpation by quadrant, depth, and tenderness.
Sites Commonly Confused
Pulmonic area and Erb's point: both are at the left sternal border and only one space apart. They are told apart by counting from the sternal angle every time, not by estimating.
Mitral area and the point of maximal impulse: they are often the same place, but in a person with an enlarged heart the impulse moves outward and down, while the mitral listening area is still defined by the count. Recording both separately is what reveals the difference.
Anterior and posterior lower lung edges: students often expect them at the same level. The lower edge is higher in front (sixth rib) than at the back (near T10), so percussion on the back finds lung well below where the front suggests (McGee, 2018).
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. (2020). Physical examination & health assessment (8th ed.). Elsevier.
McGee, S. (2018). Evidence-based physical diagnosis (4th ed.). Elsevier.
NSG 121 Unit 4 instructions, in plain terms
Unit 4 asks you to write a guide to anatomical landmarks and positioning for physical examination. Expect to explain how to use the guide, name each site with its landmark, position and common errors, and address sites students confuse. Many versions ask whether to use anatomical terms or plain words, whether every entry needs a position and whether diagrams are allowed. Check your section's expectations. Use anatomical terms with plain explanations. Counting from a bony landmark, such as the sternal angle, makes sites reproducible. Position matters, since the point of maximal impulse is easier to find with the person leaning left. Commonly confused pairs are where the guide adds most value. Diagrams, if allowed, should be labeled clearly.
How the NSG 121 Unit 4 example is put together
The guide opens with how each entry is built, so the reader knows what to expect. The sternal angle section comes first because most chest sites are counted from it. Cardiac sites follow in a consistent format: site, landmark, how to count, position and error. The point of maximal impulse gets its own entry because it varies with body type and position. Lung landmarks cover anterior and posterior borders and fissures. Abdominal entries describe quadrants and regions. The confused sites section puts similar sites side by side with how to tell them apart. Each entry is short enough to use at the bedside, and every landmark is anchored to bone rather than to soft tissue that moves.
Where the points sit in the NSG 121 Unit 4 rubric
Herzing's rubric for a landmark guide usually covers accuracy of landmarks, clarity of counting methods, positioning, attention to common errors, organization and sources. A wrong intercostal space or line would send a student to the wrong site, so accuracy is checked entry by entry. Counting criteria reward clear steps from bone. Positioning points go to positions that make sites easier to find, such as leaning left for the apex. Error criteria look for confused pairs explained side by side. Organization earns credit for a consistent format. Labeled diagrams, where allowed, are credited. Plain explanations beside anatomical terms help new students. The guide's landmark counts follow the chest and abdomen chapters of the Bates' Guide.
NSG 121 Unit 4 help: mistakes that cost points
Landmark guides in Unit 4 commonly lose points through wrong intercostal spaces, such as placing the aortic area at the third space. Another frequent problem is landmarks anchored to soft tissue, such as the nipple, which varies between people. Students often leave out positioning. Commonly confused sites are not addressed. Lung borders are described only anteriorly, missing the posterior counts from the scapula and spinous processes. Abdominal quadrants are drawn without the midline and umbilical lines explained. Diagrams are unlabeled. Terms are used without plain explanations. Finally, anchor every site to bone, because graders reward a guide that produces the same site for every examiner and every patient.
Get a NSG 121 Unit 4 example written to your instructions
Send the Unit 4 instructions and the rubric from your NSG 121 classroom, with the regions the guide has to cover. We write a custom example that reaches every site from a landmark, records the position inside each entry, keeps the required terminology beside its location and separates the confusable pairs. First custom sample free, returned in 24 to 48 hours.
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NSG 121 Unit 4 questions, answered
Should the guide use anatomical terms or plain words?
Anatomical terms throughout, with a plain gloss only where your instructions ask for one. This unit is examining precision, and a substituted everyday word reads as an approximation even when the site is right. If a term is new to you, write it in full the first time and keep it consistent, since drifting between two words for one site costs marks.
Do I need to include positions for every entry?
Include them wherever the position changes what is found, which is more entries than most drafts assume. Where a position genuinely makes no difference, say so briefly rather than leaving the field empty, since a reader cannot tell an omission from a judgment. Your text will usually indicate which entries depend on how the person is placed.
Can I use diagrams instead of written landmarks?
Diagrams help, and many sections welcome them, but they do not replace the written description. A label on a figure does not show that you can state where a site is counted from, which is the thing being assessed. Include the figure if your instructions allow it, cite it properly, and keep the full description in the entry.
Where can I find a free NSG 121 Unit 4 sample paper?
The complete NSG 121 Unit 4 landmark guide is posted here free, every heart, lung and abdominal site counted from bone with confused pairs explained. A guide for other body systems can be prepared on request.
How do you find the sternal angle?
Run your fingers down from the notch at the top of the sternum until you feel a ridge where the manubrium joins the body of the sternum. The second rib attaches there, which this sample uses to count down to each heart site.