NURS 6013 EXAM 1 QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED
A+||BRAND NEW
modules 1-4 - ANSWER-
social determinants of health - ANSWER-economic stability, neighborhood and physical
environment, education, food, community and social context, health care system
when to do complete/comprehensive H & P - ANSWER-o complete H & P
- new pt, physical, complex CC
- physical may not have an HPI
comprehensive H&P - ANSWER--PMH
-family history
-psychosocial history
-14 point review of systems
complete PE
changes only slightly based on risks
when to do focused/episodic - ANSWER-- established pt w a simple CC
- complete HPI
what to include in focused H&P - ANSWER-pertinent aspects of:
-PMH
,-family history
-psychosocial history
-relevant other (GYN, etc)
-pertinent ROS
focused PE
requires the provider to discern what is/isn't relevant
SOAP - ANSWER-S: subjective
O: objective
A: assessment
P: plan
E: Evaluation
S - ANSWER-subjective:
o identifying info
o CC
o HPI
- 7 dimensions
- informs ROS
o History
- PMH
- family history
- psychosocial history
o ROS
- symptom analysis
- informs physical exam
,O - ANSWER-objective:
- VS
- physical exam: exam findings
A - ANSWER-assessment (diagnoses)
step 1 - ANSWER-chart review
-ID pt specific risks
-review problem list
-previous notes
-needed health maintenance
-labs
-pathology
-imaging, tests, consults
-look at trends (VS, labs, chronic disease control)
-formulate differentials
-formulate agenda based on what you know so far
S: identifying info - ANSWER--name
-age
-gender/orientation
-occupation
-interpreter use
-accompanied by whom, who is giving info
-referred by whom
-reliability "patient is a good historian"
S: Chief complaint - ANSWER--in patient's words
, -why pt is seeking care- not a diagnosis
-CC on intake may be different than what pt reveals to PCP
S: HPI - ANSWER--chronological description of presenting illness based on CC
-may include pt risk factors
-pertinent positives and negatives
-pneumonics (table 2-2)
-choose appropriate method based on presentation
S: HPI must include - ANSWER--location
-quality
-severity
-duration and timing
-context
-modifying factors
-associated S/S
HPI in chronic diseases - ANSWER--HPI: status of illness/control
-onset
-think about systems affected and review those systems
-meds, allergies, habits pertinent to the illness
-focus on response to treatment/functional capacity, self management, quality of life
S: PMH - ANSWER--current and past med problems unrelated to CC
-med/surg/ob/psych and dates
-hospitalizations, childhood illness, injuries, surgeries, immunizations, allergies (seasonal, food,
latex, metals)
-meds (rx and otc): each med needs a diagnosis/problem identifies, note drug allergies (or
NKDA) w description of reaction (angioedema, hives, nausea)
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED
A+||BRAND NEW
modules 1-4 - ANSWER-
social determinants of health - ANSWER-economic stability, neighborhood and physical
environment, education, food, community and social context, health care system
when to do complete/comprehensive H & P - ANSWER-o complete H & P
- new pt, physical, complex CC
- physical may not have an HPI
comprehensive H&P - ANSWER--PMH
-family history
-psychosocial history
-14 point review of systems
complete PE
changes only slightly based on risks
when to do focused/episodic - ANSWER-- established pt w a simple CC
- complete HPI
what to include in focused H&P - ANSWER-pertinent aspects of:
-PMH
,-family history
-psychosocial history
-relevant other (GYN, etc)
-pertinent ROS
focused PE
requires the provider to discern what is/isn't relevant
SOAP - ANSWER-S: subjective
O: objective
A: assessment
P: plan
E: Evaluation
S - ANSWER-subjective:
o identifying info
o CC
o HPI
- 7 dimensions
- informs ROS
o History
- PMH
- family history
- psychosocial history
o ROS
- symptom analysis
- informs physical exam
,O - ANSWER-objective:
- VS
- physical exam: exam findings
A - ANSWER-assessment (diagnoses)
step 1 - ANSWER-chart review
-ID pt specific risks
-review problem list
-previous notes
-needed health maintenance
-labs
-pathology
-imaging, tests, consults
-look at trends (VS, labs, chronic disease control)
-formulate differentials
-formulate agenda based on what you know so far
S: identifying info - ANSWER--name
-age
-gender/orientation
-occupation
-interpreter use
-accompanied by whom, who is giving info
-referred by whom
-reliability "patient is a good historian"
S: Chief complaint - ANSWER--in patient's words
, -why pt is seeking care- not a diagnosis
-CC on intake may be different than what pt reveals to PCP
S: HPI - ANSWER--chronological description of presenting illness based on CC
-may include pt risk factors
-pertinent positives and negatives
-pneumonics (table 2-2)
-choose appropriate method based on presentation
S: HPI must include - ANSWER--location
-quality
-severity
-duration and timing
-context
-modifying factors
-associated S/S
HPI in chronic diseases - ANSWER--HPI: status of illness/control
-onset
-think about systems affected and review those systems
-meds, allergies, habits pertinent to the illness
-focus on response to treatment/functional capacity, self management, quality of life
S: PMH - ANSWER--current and past med problems unrelated to CC
-med/surg/ob/psych and dates
-hospitalizations, childhood illness, injuries, surgeries, immunizations, allergies (seasonal, food,
latex, metals)
-meds (rx and otc): each med needs a diagnosis/problem identifies, note drug allergies (or
NKDA) w description of reaction (angioedema, hives, nausea)
