NR 631 MAIN EXAMINATION SET QUESTIONS AND
SOLUTIONS GRADED A+
✔✔The Seven Attributes of a Symptom - ✔✔Location
Quality
Quantity or Severity
Timing
Setting in which it occurs
Remitting or exacerbating factors
Associated manifestations
✔✔Past Medical History - ✔✔Includes all medical problems of the patient whether they
are currently active or remote. It should include the child illnesses, adult illnesses in for
areas; medical, surgical, psychiatric, OB/GYN this is also where you ask for information
regarding the patient's immunizations, and age-appropriate preventative measures such
as colonoscopy, and mammography
Includes general state of health
Childhood illnesses (EX. Chicken pox, rubella)
Medical Illnesses (ex, HTN, HLD, DM)
Surgical PMH (ex. Appendectomy)
OB/GYN PMH (ex. C-section, GPTAL)
Psych PMH (ex. Depression, anxiety, SI/HI)
Health Maintenance (ex. Immunizations, screening tests)
Allergies
Medication HX
Family History
Personal and Social History
Sexual Orientation and Gender Identity (pg. 91-92)
Alcohol History (CAGE Questionnaire) (Pg. 94)
Tobacco Use History (Pack years)
Illicit Drug Use History
Sexual History
Spiritual History
✔✔Family History - ✔✔Be aware of family patterns of disease track gina grams for
family hx
Ask: "Who do you live with?" great for elder patients who are high risk for alls
Includes nontraditional families
List or diagram (genogram) the age, health, or age at death of each immediate relative
(parents, grandparents, siblings, children, and grandchildren
Ask of any have: HTN, coronary artery disease, stroke, diabetes, thyroid or kidney
disease,, arthritis, TB, asthma or lung disease, seizure disorder, mental illness, suicide,
substance abuse. Ask if any have breast, ovarian, colon or prostate cancer.
Look for drug abuse, alcohol abuse, domestic violence
✔✔Personal and Social History - ✔✔1. Personal status
,2. Diet
3. Habits: caffeine, tobacco, alcohol, drug
4. Health maintenance activities
5. Use of complimentary or alternative therapies
6. Living conditions
7. Exercise
8. Sleep
9. Occupation
10. Travel
11. Military Service
✔✔Environmental Hazards - ✔✔Work
Personal safety/risks -seat belts, helmets
Guns in the home
Elderly - throw rugs, stairs, handrails *Functional Assessment must be done
o (assess the ability to perform ADL and IADL)
✔✔Special Considerations - ✔✔Interpreters
Other individuals in the room
Disabled patient or those with special assistive devices
"Shopping list" of problems may have multiple appointments
✔✔Review of Systems (ROS) - ✔✔· The review of systems questions may uncover
problems or symptoms that you or the patient may have overlooked, particularly in
areas unrelated to the HPI. This is an inquiry method called scanning, and when you
ask the patient questions regarding dysfunctions in different organ systems. These yes
/no questions should come at the end of the interview
· It is helpful to prepare the patient by saying, "the next part of the history may feel like a
lot of questions, but it is important to make sure we have not missed anything."
· Think about asking series of questions going from head to toe, keep your technique
flexible, remember these are yes no questions.
· Documented with "Denies"
✔✔GENERAL - ✔✔Changes in weight
Fatigue and weakness
Fever, chills, and night sweats
✔✔Skin - ✔✔Rashes, lesion or moles
✔✔HEENT - ✔✔Head nose, ears and throat
Runny nose, plugged ears, sore throat or ringing in the ears?
✔✔Neck - ✔✔Masses, pain stiffness?
✔✔Breasts - ✔✔Discharge?
, ✔✔Respiratory - ✔✔Wheezing, crackles?
✔✔Cardiac - ✔✔SOB, arms or legs swell?
✔✔GI - ✔✔N/v, constipation?
✔✔PV - ✔✔Hot and cold to extremities
✔✔Urinary - ✔✔Frequency, hematuria?
✔✔GU - ✔✔Rashes, lesion or moles, discharge or pain?
✔✔MSK - ✔✔Muscle pain or brushing?
✔✔Psych - ✔✔Suicidal ideations homicidal ideation, depression?
✔✔Neuro - ✔✔Numbness and tingling, are you able to ambulate?
✔✔Heme - ✔✔Hematemesis, blood in stool, CBC?
✔✔Endo - ✔✔Sensitivity to heat, hair loss
✔✔Concluding Question - ✔✔At the conclusion of the Health History interview it is
IMPORTANT to ask patient:
o "Is there anything else that you think would be helpful for me to know?"
If several problems are mentioned, ask: "What problems concern you most?"
✔✔Physical Examination - ✔✔Be sure to wash your hands before examining the
patient!
Reflect on your approach to the patient, adjust the lighting and environment, check your
equipment, make sure the patient is comfortable, use standard and universal
precautions
Approach the patient from the RIGHT (point of reference)
Examine the patient in a gown
o Inspection, Palpation, Percussion, Auscultation
Be systematic - "head-to-toe"
Avoid frequent position changes (especially if elderly)
Explain what you are going to before you do it
o "I am going to listen to your heart"
Prepare patient for invasive exams: pelvic, rectal
General Survey
Vitals
Skin
SOLUTIONS GRADED A+
✔✔The Seven Attributes of a Symptom - ✔✔Location
Quality
Quantity or Severity
Timing
Setting in which it occurs
Remitting or exacerbating factors
Associated manifestations
✔✔Past Medical History - ✔✔Includes all medical problems of the patient whether they
are currently active or remote. It should include the child illnesses, adult illnesses in for
areas; medical, surgical, psychiatric, OB/GYN this is also where you ask for information
regarding the patient's immunizations, and age-appropriate preventative measures such
as colonoscopy, and mammography
Includes general state of health
Childhood illnesses (EX. Chicken pox, rubella)
Medical Illnesses (ex, HTN, HLD, DM)
Surgical PMH (ex. Appendectomy)
OB/GYN PMH (ex. C-section, GPTAL)
Psych PMH (ex. Depression, anxiety, SI/HI)
Health Maintenance (ex. Immunizations, screening tests)
Allergies
Medication HX
Family History
Personal and Social History
Sexual Orientation and Gender Identity (pg. 91-92)
Alcohol History (CAGE Questionnaire) (Pg. 94)
Tobacco Use History (Pack years)
Illicit Drug Use History
Sexual History
Spiritual History
✔✔Family History - ✔✔Be aware of family patterns of disease track gina grams for
family hx
Ask: "Who do you live with?" great for elder patients who are high risk for alls
Includes nontraditional families
List or diagram (genogram) the age, health, or age at death of each immediate relative
(parents, grandparents, siblings, children, and grandchildren
Ask of any have: HTN, coronary artery disease, stroke, diabetes, thyroid or kidney
disease,, arthritis, TB, asthma or lung disease, seizure disorder, mental illness, suicide,
substance abuse. Ask if any have breast, ovarian, colon or prostate cancer.
Look for drug abuse, alcohol abuse, domestic violence
✔✔Personal and Social History - ✔✔1. Personal status
,2. Diet
3. Habits: caffeine, tobacco, alcohol, drug
4. Health maintenance activities
5. Use of complimentary or alternative therapies
6. Living conditions
7. Exercise
8. Sleep
9. Occupation
10. Travel
11. Military Service
✔✔Environmental Hazards - ✔✔Work
Personal safety/risks -seat belts, helmets
Guns in the home
Elderly - throw rugs, stairs, handrails *Functional Assessment must be done
o (assess the ability to perform ADL and IADL)
✔✔Special Considerations - ✔✔Interpreters
Other individuals in the room
Disabled patient or those with special assistive devices
"Shopping list" of problems may have multiple appointments
✔✔Review of Systems (ROS) - ✔✔· The review of systems questions may uncover
problems or symptoms that you or the patient may have overlooked, particularly in
areas unrelated to the HPI. This is an inquiry method called scanning, and when you
ask the patient questions regarding dysfunctions in different organ systems. These yes
/no questions should come at the end of the interview
· It is helpful to prepare the patient by saying, "the next part of the history may feel like a
lot of questions, but it is important to make sure we have not missed anything."
· Think about asking series of questions going from head to toe, keep your technique
flexible, remember these are yes no questions.
· Documented with "Denies"
✔✔GENERAL - ✔✔Changes in weight
Fatigue and weakness
Fever, chills, and night sweats
✔✔Skin - ✔✔Rashes, lesion or moles
✔✔HEENT - ✔✔Head nose, ears and throat
Runny nose, plugged ears, sore throat or ringing in the ears?
✔✔Neck - ✔✔Masses, pain stiffness?
✔✔Breasts - ✔✔Discharge?
, ✔✔Respiratory - ✔✔Wheezing, crackles?
✔✔Cardiac - ✔✔SOB, arms or legs swell?
✔✔GI - ✔✔N/v, constipation?
✔✔PV - ✔✔Hot and cold to extremities
✔✔Urinary - ✔✔Frequency, hematuria?
✔✔GU - ✔✔Rashes, lesion or moles, discharge or pain?
✔✔MSK - ✔✔Muscle pain or brushing?
✔✔Psych - ✔✔Suicidal ideations homicidal ideation, depression?
✔✔Neuro - ✔✔Numbness and tingling, are you able to ambulate?
✔✔Heme - ✔✔Hematemesis, blood in stool, CBC?
✔✔Endo - ✔✔Sensitivity to heat, hair loss
✔✔Concluding Question - ✔✔At the conclusion of the Health History interview it is
IMPORTANT to ask patient:
o "Is there anything else that you think would be helpful for me to know?"
If several problems are mentioned, ask: "What problems concern you most?"
✔✔Physical Examination - ✔✔Be sure to wash your hands before examining the
patient!
Reflect on your approach to the patient, adjust the lighting and environment, check your
equipment, make sure the patient is comfortable, use standard and universal
precautions
Approach the patient from the RIGHT (point of reference)
Examine the patient in a gown
o Inspection, Palpation, Percussion, Auscultation
Be systematic - "head-to-toe"
Avoid frequent position changes (especially if elderly)
Explain what you are going to before you do it
o "I am going to listen to your heart"
Prepare patient for invasive exams: pelvic, rectal
General Survey
Vitals
Skin
