NSG555 / NSG 555 Exam 2: Nurse Practitioners in Primary Care I | Complete Guide with Questions and Verified Answers | (Latest 2026/2027 Update) All Modules Covered | 100% Correct | Grade A - Wilkes

NSG555 / NSG 555 Exam 2: Nurse Practitioners in Primary Care I | Complete Guide with Questions and Verified Answers | (Latest 2026/2027 Update) All Modules Covered | 100% Correct | Grade A - Wilkes Skin inspection and palpation includes assessment for: A. Color, uniformity, and symmetry B. Skin lesions C. Skin temperature D. All of the above D. All of the above An ABNORMAL angle between the nail base and the nail is called clubbing and may indicate which of the following conditions? A. Poor hygiene B. Dehydration C. Cardiopulmonary disorder D. Skin cancer C. Cardiopulmonary disorder Which are the best places to check the skin for tenting, which is a sign of dehydration? A. Top of the hand and foot B. Neck and top of the head C. Shoulder and thigh D. Forearm and sternum D. Forearm and sternum Which of the following is considered an ABNORMAL finding in an older adult? A. Malignant melanoma B. Cherry angioma C. Seborrheic keratoses D. Lentigines A. Malignant melanoma The ABCD rule of melanoma includes: A. Asymmetry of shape B. Border irregularity and color variation C. Diameter larger than the eraser of a pencil D. All of the above D. All of the above What is the correct order for abdominal assessment? A. Inspection, palpation, auscultation, percussion B. Inspection, auscultation, percussion, palpation C. Auscultation, inspection, palpation, percussion D. Palpation, inspection, auscultation, percussion B. Inspection, auscultation, percussion, palpation How often should normal bowel sounds be heard in each quadrant of the abdomen? A. 5-35 times per minute B. Less than 5 times per minute C. 15-20 times per minute D. 20-40 times per minute A. 5-35 times per minute Which of the following is an important part of performing an abdominal assessment? A. Completing the assessment as quickly as possible B. Stopping the assessment if the patient has any tenderness C. Explaining each step of the assessment to the patient D. Having the patient talk when auscultating for bowel sounds C. Explaining each step of the assessment to the patient What should you do if a patient is ticklish when you are palpating the abdomen? A. Distract the patient by talking to him or her. B. Do not palpate the abdomen in the upper quadrants. C. Do only deep palpation of all four quadrants. D. Place your hand over the patient's hand during palpation. D. Place your hand over the patient's hand during palpation. Moderate and deep palpation of the abdomen: A. May cause tenderness B. Should not detect masses C. Should never be done over a surgical incision D. All of the above D. All of the above A nurse is palpating the breasts of a patient. Which of the following are important aspects of proper palpation of the breasts? A. Using finger pads to palpate B. Using a consistent pattern C. Making small circles at each part of the breast and gliding from place to place D. All of the above D. All of the above What is the most important information to document if a mass is palpated in the breast or axilla? A. Color and tenderness of surrounding tissue B. Shape, tenderness, mobility, and size of the breasts C. Consistency, borders, mobility, location, size, shape, tenderness, and retraction of the mass D. Characteristics of the nipple and lymph nodes C. Consistency, borders, mobility, location, size, shape, tenderness, and retraction of the mass What are the five danger signs to watch for when assessing nipples? A. Shape, tenderness, size, inversion, and mobility B. Discharge, depression, discoloration, dermatologic changes, and deviation C. Lymph nodes, breast size, symmetry, tail of Spence, and color D. Rash, nodules, warmth, redness, and pain B. Discharge, depression, discoloration, dermatologic changes, and deviation Which of the following statements is the most complete description of the tail of Spence? A. Breast tissue that extends into the axilla B. A common place to find breast lumps C. Not included in a breast exam D. Both A and B D. Both A and B When assessing the breasts, which of the following is considered normal? A. Long-standing, unchanging nevi B. Reddened Montgomery glands C. Peau d'orange skin texture D. Nipples that are not symmetrical A. Long-standing, unchanging nevi Which of the following indicates normal respiratory function? A. Symmetrical chest expansion B. Nasal flaring C. Use of accessory muscles D. Lip pursing A. Symmetrical chest expansion When palpating the thorax, which of the following would be an abnormal finding? A. Tenderness B. Pulsations C. Masses D. All of the above D. All of the above When percussing the thorax, which of the following would be a normal finding? A. Dullness over the lung fields B. Resonance over the lung fields C. Dullness over the ribs, heart, and diaphragm D. Both B and C D. Both B and C Normal breath sounds include: A. Vesicular sounds B. Rhonchi C. Wheezes D. Crackles A. Vesicular sounds When auscultating the lungs, it is important to: A. Compare each side bilaterally. B. Note abnormal sounds. C. Ask the patient to take slow, deep breaths. D. All of the above. D. All of the above A patient has edema and redness of the skin surrounding the nail on his right index finger. Which data elicited from his history best explains this condition? A. He has a family history of fungal infections of the nails B. There has been a scabies outbreak among his family C. He has a new full-time job as a dishwasher at a restaurant D. He recently had several warts removed from each of his hands C. He has a new full-time job as a dishwasher at a restaurant When examining a 16-yeard-old male patient, the nurse note multiple pustules and comedones on the face. The nurse recognizes that increased activity of which cells or glands produce these manifestations A. Epidermal cells B. Eccrine glands C. Apocrine glands D. Sebaceous Glands D. Sebaceous glands A patient with darkly pigmented skin has been admitted to the hospital with hepatitis. How does the nurse assess for jaundice in this patient? A. Inspect the color of the sclera B. Inspect the genitalia for color C. Blanch the fingernails D. Jaundice cannot be assessed in patients with darkly pigmented skin A. Inspect the color of the sclera A patient has multiple solid, red, raised lesions on her legs and groin that she describes as "itchy insect bites." How does the nurse document these lesions? A. Wheals B. Bulla C. Tumors D. Plaques A. Wheals The nurse observes multiple red circular lesions with central clearing that are scattered all over the abdomen and thorax. How does the nurse document the shape and pattern of these lesions? A. Gyrate and linear B. Annular and generalized C. Iris and discrete D. Oval and clustered B. Annular and generalized Which disorder is an example of a vascular lesion? A. Dermatofibroma B. Vitiligo C. Sebaceous cyst D. Port wine stain D. Port wine stain A 60-year-old male patient states that he has a sore above his lip that has not healed and is getting bigger. The nurse observes a red scaly patch with an ulcerated center and sharp margins. These findings are commonly associated with which malignancy? A. Kaposi's sarcoma B. Malignant melanoma C. Basal cell carcinoma D. Squamous cell carcinoma D. Squamous cell carcinoma A 48-year-old woman asks the nurse how to best protect herself from excessive sun exposure while at the beach. Which response would be most appropriate? A. "Limit your time in the sun to 5 minutes every hour." B. "Wear a wet suit that covers your arms and legs." C. "Apply a waterproof sunscreen (SPF 15 or higher) to exposed skin surfaces; reapply at least every 2 hours." D. "Apply sunscreen with a minimum SPF 50 to all skin surfaces before leaving for the beach; this will provide all day coverage." C. "Apply a waterproof sunscreen (SPF 15 or higher) to exposed skin surfaces; reapply at least every 2 hours." The nurse is performing a skin assessment on a patient in pain. Which skin layer contains sensory fibers that react to touch, pain, and temperature? A. The dermis B. The epidermis C. The hypodermis D. The subcutaneous tissue A. The dermis The nurse is performing a skin assessment and finds that the patient has milia. In which age group would this be an expected finding? A. Newborns B. Young children C. Adolescents D. Older adults A. Newborns A patient is concerned because the dermatologist diagnosed macules all over the skin. The patient asks the nurse what could be causing this? The nurse's best response is: A. "You have an infection and will need an antibiotic." B. "Macules need to be watched closely for signs of skin cancer." C. "Macules are warts and should be removed." D. "Macules are freckles are considered normal on the skin." D. "Macules are freckles are considered normal on the skin." The nurse is assessing an African-American patient for cyanosis. Cyanosis in dark pigmented skin appears as a(n): A. deeper tone of brown or purple. B. cluster of dark spots over the skin surface. C. yellowish-green skin. D. Ashen gray color to the skin. D. Ashen gray color to the skin. The nurse is assessing a patient for nail clubbing. Where should the nurse focus the exam? A. The thickness of the nail B. The color of the nail C. The width of the nail base D. The angle of the nail base D. The angle of the nail base A patient comes to the clinic for a skin check. Which finding by the nurse indicates a need to further investigate a lesion? A. The lesion bleeds easily when it is touched. B. The lesion is dark brown. C. The lesion is slightly raised and circumscribed. D. The lesion has been present for 20 years. A. The lesion bleeds easily when it is touched. The nurse is performing a skin check on a patient. In which age group is seborrheic keratosis an expected finding? A. Newborns B. Older adults C. Adolescents D. Young children B. Older Adults The nurse is teaching a parent about risk factors associated with the skin for their school-age child. What would the nurse include as the most common cause of skin lesions for this age group? A. Changes in skin turgor and skin tone B. Skin inflammation from sebaceous gland activity C. Communicable disease and bacterial infection D. Maturation of melanocytes, causing changes in skin color C. Communicable disease and bacterial infection The nurse is assessing a patient's skin turgor. Skin turgor is assessed by: A. auscultating the skin to note the presence of motility sounds. B. stretching the skin and observing for a degree of flexibility. C. pressing on the skin and observing the depression. D. pinching the skin and watching the skin return to place. D. pinching the skin and watching the skin return to place. The nurse knows that the functions of the skin include which of the following? (Select all that apply.) Select all that apply. A. Protection B. Sensory output C. Production of vitamin D D. Temperature regulation E. Sensory input F. Production of vitamin C A. Protection C. Production of Vitamin D E. Sensory Input D. Temperature Regulation A patient reports severe abdominal pain and pain in the right shoulder that gets worse after eating fried foods. What question does the nurse ask to gather more data about the possibility of cholelithiasis? A. "Has your abdomen been distended?" B. "Have you experienced fever, chills, or sweating?" C. "Have you vomited up any blood in the last 24 hours?" D. "Has the color of your urine or stools changed?" D. "Has the color of your urine or stools changed?" The nurse is interviewing a patient with a history of flank pain, fever, and chills. Which examination technique is most appropriate for this patient? A. Percussion over the costovertebral angle B. Deep palpation of the lower abdomen C. Palpation of the kidney for contour D. Auscultation of the lower quadrants of the abdomen A. Percussion over the costovertebral angle A patient reports a gnawing, burning pain in the mid-epigastric area that is aggravated by bending over or lying down. Which additional question does the nurse ask as part of a symptom analysis? A. "Do you have a family history of this type of pain?" B. "How long ago did you eat?" C. "Is the pain worse after eating or when your stomach is empty?" D. "Have you noticed any yellow coloring in your eyes or on your skin?" C. "Is the pain worse after eating or when your stomach is empty?" Which organ is the nurse assessing during palpation of the right upper quadrant of the abdomen? A. Liver and gallbladder B. Stomach and spleen C. Uterus, if enlarged, and right ovary D. Right ureter and ascending colon A. Liver and gallbladder Using deep palpation of a patient's epigastrium, a nurse feels a rhythmic pulsation of the aorta. Based on this finding, what is the nurse's most appropriate response? A. Auscultate this area using the bell of the stethoscope B. Percuss the area for tone C. Document this is an expected finding D. Ask the patient if there is pain in this area C. Document this is an expected finding When assessing an adult's liver, the nurse percusses the lower border and finds it to be 5 cm below the costal margin. What is the nurse's appropriate action at this time? A. Document this as an expected finding for this adult B. Palpate the upper liver border on deep inspiration C. Palpate the gallbladder for tenderness D. Use the hooking technique to palpate the lower border of the liver B. Palpate the upper liver border on deep inspiration Which is an abnormal sound the nurse would detect when auscultating the abdomen using the bell of the stethoscope? A. High-pitched gurgles B. Borborygmi C. Venous hum D. Absent bowel sounds D. Absent bowel sounds Which technique does the nurse use to palpate a patient's abdomen? A. Asks the patient to breathe slowly through the mouth B. Uses the heel of the hand to perform deep palpation C. Uses the left hand to lift the rib cage away from the abdominal organs D. Uses the pads of the fingertips to depress the abdomen D. Uses the pads of the fingertips to depress the abdomen A nurse inspects the abdomen for skin color, surface characteristics, and surface movement. What part of the abdominal assessment does the nurse perform next? A. Palpate lightly for tenderness and muscle tone B. Auscultate for bowel sounds C. Palpate deeply for masses or aortic pulsation D. Percuss for tones B. Auscultate for bowel sounds A patient reports having abdominal fullness and having vomited several times yesterday and today. What question is appropriate for the nurse to ask in response to this information? A. "Has there been a change in the amount of the distention?" B. "Did you have heartburn before the vomiting?" C. What did the vomitus look like?" D. "Have you noticed a change in the color of your urine or stools?" C. What did the vomitus look like?" The nurse is preparing to perform an abdominal assessment. In which position should the patient be placed for abdominal assessment? A. Sitting upright on the examination table B. In a left lateral position C. Supine D. In a high-Fowler's position C. Supine In which patient would a pulsation within the epigastric area be considered a normal finding during inspection? A. An elderly patient B. A very thin patient C. An obese patient D. A patient with ascites B. A very thin patient The nurse is percussing a patient's abdomen and hears tympany. Which anatomic features explain the finding of tympany with stomach percussion? A. The stomach is a muscular organ. B. The stomach is hollow. C. The stomach is flask-shaped. D. The stomach secretes digestive enzymes. B. The stomach is hollow. The student nurse is studying the liver. The primary function of the liver is to: A. absorb most nutrients. B. metabolize nutrients. C. produce red blood cells for circulation. D. store vitamin C. B. metabolize nutrients. The nurse auscultates the abdomen to gain information regarding: A. the perfusion of the mesentery. B. the peristaltic activity of the intestinal tract. C. the production of erythrocytes by the spleen. D. the metabolic activity of the liver. B. the peristaltic activity of the intestinal tract. The nurse notes a black umbilicus on a 5-day-old infant. What does this finding indicate? A. The infant may have a feeding problem. B. The infant has hepatitis. C. The umbilicus is infected. D. This is a normal finding. D. This is a normal finding. The nurse is assessing a patient's abdomen and suspects ascites. Which technique is used to confirm the presence of abdominal ascites? A. Percussion of dullness over dependent areas of the abdomen B. Auscultation of fluid movement within the abdominal cavity C. Palpation of rebound tenderness D. Palpation of pitting edema of the abdomen A. Percussion of dullness over dependent areas of the abdomen The nurse includes questions about chest pain as part of an abdominal history because myocardial pain can be: A. caused by esophageal herniation or rupture. B. associated with ulcer disease. C. related to congenital abdominal defects. D. perceived as esophageal and stomach pain. D. perceived as esophageal and stomach pain. The nurse should auscultate the abdomen for at least __________________ before documenting an absence of bowel sounds. A. several minutes B. 30 seconds C. 1 hour D. 5 to 15 seconds A. several minutes The nurse is performing an abdominal assessment. Which sequence of assessment techniques is used? A. Inspection, auscultation, percussion, and palpation B. Auscultation, inspection, palpation, and percussion C. Inspection, auscultation, palpation, and percussion D. Palpation, inspection, auscultation, and percussion C. Inspection, auscultation, palpation, and percussion The nurse calculates the body mass index of a patient at 31.8. What is the most appropriate action of the nurse? A. Refer the patient for behavioral interventions for weight loss B. Estimate body fat using tricep skin fold measurement C. Calculate the percent o change in weight since the last visit D. Calculate grams of fat that patient consumed daily A. Refer the patient for behavioral interventions for weight loss A man weights 265 pounds and is 6 feet 4 inches tall. Based on these data, how does the nurse classify his weight? A. Overweight B. Class One Obesity C. Class Two Obesity D. Class Three Obesity B. Class One Obesity An older woman is 5ft 2in tall and weighs 100 pounds. To best understand her dietary intake, which question is most appropriate? A. "Who prepares your meals on a daily basis?" B. "What are your favorite foods?" C. "How do you get to the grocery store each week?" D. "What you eat on a typical day?" D. "What you eat on a typical day?" Why does the nurse ask about medications taken as part o nutritional assessment? A. Medications must be taken with food to avoid irritation to the gastrointestinal system B. Actions of many drugs require adjustments to the diet C. The absorption and bio availability of some medications affected by food D. Some medications taste bad and may interfere with appetite C. The absorption and bio availability of some medications affected by food A patient report "a lot" of unintentional weight loss over the past 4 months. The nurse measures his height and weight (5ft, 11 in, 170 pound) and determines that his body mass index is 22.7. Which action is most appropriate to better evaluate his recent weight loss? A. Calculate his desirable body weight B. Ask, "What is your usual body weight?" C. Record what he ate in the last 24 hours D. Determine his hip-to-waist ratio B. Ask, "What is your usual body weight?" The nurse is assessing a patient's nutritional status and suspects the patient needs more macronutrients. Which of the following are considered macronutrients? A. Minerals B. Water C. Fats D. Vitamins C. Fats The nurse is teaching a patient the importance of protein for healing. Which foods should the nurse include in the teaching plan? A. Cereal B. Bread C. Oatmeal D. Fish D. Fish The nurse is assessing a patient's dietary intake to help the patient lose weight. What is the easiest way to assess the patient's normal dietary intake? A. Asking the patient to do a 24-hour dietary recall B. Comparing the recommended dietary allowances to the USDA MyPlate C. Comparing established eating habits with Dietary Reference Intakes D. Asking the nurse to fill out a food plan A. Asking the patient to do a 24-hour dietary recall The nurse suspects that the patient is suffering from malnutrition. Which laboratory test indicates a patient's protein calorie status? A. Lipid profile B. Hemoglobin and hematocrit C. Serum albumin D. Serum glucose levels C. Serum albumin The nurse is teaching adult male healthy eating guidelines. How many servings of dairy should the nurse recommend for this patient? A. 3 to 5 B. 5 to 6 C. 2 to 3 D. 0 to 2 C. 2 to 3 The nurse is assessing an elderly patient's risk of nutritional deficiency. An important risk factor for nutritional deficiency in the elderly is: A. decreased activities of daily living. B. an allergy to shellfish. C. increased blood pressure. D. exercise pattern. A. decreased activities of daily living In which age group is skipping meals most commonly seen? A. School-age children B. Older adults C. Adults D. Adolescents D. Adolescents According to the food plan, what represents one serving from the bread, cereal, and grain products group? A. 1 cup cooked rice B. 1 slice of bread C. 1 hamburger bun D. 6 soda crackers B. 1 slice of bread The nurse is working with a patient to develop a nutritional plan for a patient newly diagnosed with diabetes. The nurse assesses what the patient's food preferences are because: A. life expectancy can be predicted based on food preferences. B. food preferences and dislikes have a strong influence on what a person eats. C. food preferences can indicate a chronic disease that the nurse may be unaware of. D. a list of food preferences will help identify individuals who will not comply with special diets. B. food preferences and dislikes have a strong influence on what a person eats. The school nurse is assessing the nutritional status of a healthy adolescent. Which assessment will the nurse include in this assessment? (Select all that apply.) Select all that apply. A. Body mass index (BMI) B. Dietary assessment C. Clinical evaluation of diet D. Biochemical tests results E. Anthropometrics A. BMI B. Dietary Assessment C. Clinical Evaluation of diet E. Anthropometrics A nurse suspects a viral infection or upper respiratory allergies when the patient describes the sputum as being which color? A. Green B. Clear C. Yellow D. Pink tinged B. Clear During inspection of the respiratory system the nurse documents which findings as abnormal A. Skin color consistent with patient's race B. 1:2 ratio of anteroposterior to lateral diameter C. Respiratory rate of 20 breaths per minute D. Patient leaning forward with arms braced on knees D. Patient leaning forward with arms braced on knees A patient has an infection of the terminal bronchioles and alveoli that involves the right lower lobe of the lung. Which abnormal findings are expected? A. Dyspnea with diminished breath sounds bilaterally B. Asymmetric chest expansion and rhonchi on the right side C. Fever and tachypnea with crackles over the right lower lobe D. Prolonged expiration with an occasional wheeze in the right lower lobe C. Fever and tachypnea with crackles over the right lower lobe On auscultation of a patient's lungs, the nurse hears a low-pitched, coarse, loud, and low snoring sound. Which term does the nurse use to document this finding? A. Rhonchi B. Wheeze C. Crackles D. Pleural friction rub A. Rhonchi A nurse finds the patient's AP diameter of the chest to be the same as the lateral diameter. Based on this finding, what additional data would the nurse anticipate? A. Bronchial breath sounds in the posterior thorax B. Decrease in respiratory rate C. Decreased breath sounds on auscultation D. Complaint of sharp chest pain on inspiration C. Decreased breath sounds on auscultation How does the nurse palpate the chest or tenderness, bulges, and symmetry? A. Uses the fist of the dominant hand to gently tap the anterior, lateral, and posterior chest, comparing one side with another B. Uses the ulnar surface of one hand to palpate the anterior, posterior, and lateral chest, comparing one side with another C. Uses the tips of the fingers to palpate the skin over the chest and the alignment of vertebrae D. Uses the palmar surface of fingers of both hands to feel the texture of the skin over the chest and the alignment of vertebrae D. Uses the palmar surface of fingers of both hands to feel the texture of the skin over the chest and the alignment of vertebrae Which breath sounds are expected over the posterior chest of an adult A. Vesicular B. Bronchovesicular C. Bronchial D. Bronchoalveolar A. Vesicular Narrowing of the bronchi creates which adventitious sound? A. Wheeze B. Crackles C. Rhonchi D. Pleural friction rub A. Wheeze A nurse is auscultating the lungs of a healthy female patient and hears crackles on inspiration. What action can the use take to ensure this is an accurate finding A. Make sure the bell of the stethoscope is used rather than the diaphragm B. Ask the patient to cough then repeat the auscultation C. Ask the patient not to talk while the nurse is listening to the lungs D. Change the patient's position B. Ask the patient to cough then repeat the auscultation A nurse in the emergency department is assessing a patient with a moderate left pneumothorax. What does this nurse expect to find during the respiratory examination? A. Increased fremitus over the left chest B. Tracheal deviation to the left side C. Crepitus on the left chest during palpation D. Distant to absent breath sounds over the left chest D. Distant to absent breath sounds over the left chest The student nurse is reviewing the pathophysiology of inspiration. The primary muscles of inspiration are the diaphragm and the ____________. A. scalene muscles B. abdominal muscle C. pectoral muscles D. external intercostal muscles D. external intercostal muscles A patient complains to the nurse of coughing up green phlegm and is having difficulty breathing at rest. The nurse suspects: A. bacterial pneumonia. B. a viral infection. C. tuberculosis. D. pulmonary edema. A. bacterial pneumonia. The nurse assesses a patient who has a costal angle greater than 90 degrees. What is the most likely cause of this finding? A. Infant respiratory distress syndrome B. Pneumothorax C. Chronic obstructive pulmonary disease D. Atelectasis C. Chronic obstructive pulmonary disease The nurse auscultates prolonged expiration with expiratory wheezing and diminished breath sounds while assessing a patient. What does the nurse suspect? A. Tuberculosis B. Asthma C. Pneumonia D. Croup B. Asthma The nurse is palpating a patient's chest wall. What can be accomplished with palpation of the chest? A. Identification of lung sounds B. Assessment of equal chest expansion C. Approximation of lung size D. Determination of oxygenation B. Assessment of equal chest expansion The nurse percusses a patient's chest and feels dullness. The nurse suspects which diagnosis? A. Pneumonia B. Chronic obstructive pulmonary disease (COPD) C. Bronchiectasis D. Emphysema A. Pneumonia A nurse hears inspiratory and expiratory wheezes bilaterally. What is the meaning of this finding? A. Narrowed airways B. Fluid in the alveoli C. Consolidation in alveoli D. Sputum in the bronchi A. Narrowed airways A nurse hears bronchovesicular sounds in the posterior chest on either side of the spine. This finding indicates: A. a normal finding. B. pleural effusion. C. lung cancer. D. pneumonia. A. a normal finding. The examiner notes a diaphragmatic excursion of 4 cm on the right side and 8 cm on the left side. What do these findings mean? A. This is a normal finding because the right lung is larger than the left lung. B. The patient may have a pleural effusion. C. The patient may have a pneumothorax. D. Asymmetric findings are common in well-conditioned adults. B. The patient may have a pleural effusion. During an assessment, the nurse knows that expected assessment findings in the normal adult lung include the presence of what? (Select all that apply.) Select all that apply. A. Expansion muffled voice sounds B. Absent voice sounds and hyper resonant percussion tones C. Muffled voice sounds and symmetric tactile fremitus D. Symmetric chest E. Increased tactile fremitus and dull percussion tones F. Adventitious sounds and limited chest expansion G. Resonant percussion tones -Symmetric chest expansion -Resonant percussion tones -Vesicular breath sounds over peripheral lung fields -muffled voice sounds -no adventitious sounds Barriers to effective communication (5) 1) Filtering 2) Selective perception 3) Emotional influence 4) Language barrier 5) Language of nursing Barrier: Selective perception Occurs on receiver side as they interpret a message according to their own experiences, interests, values, motivations, and expectations → Nursing care: ask our clients, "what is your understanding of what I said?" and ask them to repeat it back Barrier: Filtering Occurs on the sender side as they manipulate the message/information in order to make it more favorable to the receiver → The sender tends to say what they believe the receiver wants to hear rather than providing/saying the entire truth → Goal: avoid conflict or elicit a behavior Barrier: Emotional influence The receiver's or sender's emotional state can influence the delivery or impact of a message for that person → Can affect objective reasoning → Nursing care: important to assess emotional state Barrier: Language barrier Type 1: True language barrier (i.e., speaks exclusively Mandarin) Type 2: vocabulary barrier (slang, regional, etc vs literal meaning) Barrier: Language of nursing (jargon & health literacy) The vocation-specific vocabulary/language of healthcare may be unfamiliar to patients → Nursing care: use plain talk, assess learning, use teachback Health literacy definition "The skills, knowledge, motivation and capacity of a person to access, understand, appraise and apply information to make effective decision about health and health care and take appropriate action" Signs of health literacy (5) 1) Understand & perform self-care instructions, including complex regimens 2) Plan & carry out healthy lifestyle changes 3) Demonstrate good decision making wrt health 4) Know when and how to access healthcare 5) Spread knowledge r/t health to their community Effects of low health literacy (3) 1) Less likely to engage in screenings & prevention 2) Less likely to manage/control chronic disease 3) More likely to experience poor health outcomes (including hospitalization & death) Phases of disaster management (4) 1) Prevention and mitigation 2) Preparedness 3) Response 4) Recovery Disaster mgmt: Prevention and mitigation Done before disaster Components: - Establish objectives - Risk assessment - Risk prevention & mitigation Disaster mgmt: Preparedness Planning. Done before disaster Components: - Emergency access & evacuation routes - Emergency team & - Emergency response equipment Disaster mgmt: Response Goal: save lives & property Done during disaster Components: _ Rescue, relief, & salvage - Immediate damage assessment - Immediate protection of damaged heritage Disaster mgmt: Recovery Done after disaster Components: - Detailed damage assessment - Treatment (restoration, retrofitting, repair) - Recovery & rehabilitation Host-Agent-Environment model wrt disasters Host: those who are harmed by the disaster What makes someone variable? → SDOH, health status, mobility, psychological factors Agent: what causes the disaster (ex: hurricane or terrorism) Environment: physical space where the agent causes disaster (ex: Nola or NYC) → Affects our preparedness plans (such as fire insurance or earthquake-safe homes in Cali) Multiple vs mass casualty Multiple casualty: 2-99 victims Mass casualty: 100+ victims Mass casualty triage Core question: who most urgently needs care? Goal: prioritize use of personnel, resources, & time → Focus is to do the most good for the most people (utilitarian), rather than to do the most good you can for each person, regardless of the cost to others Triage level of prevention? Secondary START (simple triage and rapid treatment) Triage system designed to allow personnel with limited medical knowledge and skill to triage victims in 60 seconds or less per victim → Priority may change according to available resources, # of personnel, # of patients, weather/environment, method of transportation, and distance to trauma center) What are the levels of START? (4) RED-Priority 1: immediate: life will likely be saved by immediate transportation YELLOW-Priority 2: delayed: less severe injuries than priority 1 GREEN-Priority 3: minimal: minor injuries not requiring urgent care BLACK-Priority 4: expectant: the deceased, those who are beyond help, or those whose care will take more time or What is family nursing? (3) Individual in a family → Family as a client → Family as a system What is a family? In short: whatever the patient says it is Universal family characteristics (5) 1) Every family is a small social system 2) Family life cycle 3) Family culture 4) Family structure 5) Family function Family characteristics: Family culture Shared... - Values and experiences - Roles (assigned parts people play in daily activities) - Distribution of power ... Collected over time Family characteristics: Structure & function Structure can vary pretty widely (nuclear vs extended, single vs double parent, etc) Function: provides affection, security, identity, affiliation, socialization, and control Family characteristics: Family life cycle Expansion (adding members) vs contraction (losing members) over time Family development tasks: where we are in the life cycle (young children vs older folks) Family characteristics: Every family is a small social system Family unit is independent, has boundaries, is adaptive, is goal-oriented Family health practice guidelines (5) 1) Work with the family collectively 2) Start where the family is currently 3) Adapt nursing interventions to the family 4) Recognize the validity of family structural variations 5) Emphasize strengths in the family Characteristics of a healthy family (6) 1) Facilitative interaction exists among family members 2) Individual member development is enhanced 3) Role relationships are structured effectively 4) Active attempts are made to cope with problems 5) There is a healthy home environment & lifestyle 6) Regular links with the broader community are established Family health assessment data collection categories (12) 1) Demographics (who is part of this unit?) 2) Physical environment 3) Psychological & spiritual environment 4) Structure/roles 5) Functions 6) Values & beliefs 7) Communication patterns 8) Decision-making patterns 9) Problem-solving patterns 10) Coping patterns 11) Health behaviors 12) Social & cultural patterns → Assess strengths, stresses, and resources for each (just have a general idea of these...) The home health visit (5) 1) Focus on family as a unit 2) Ask goal-oriented questions 3) Collect data over time 4) Look at both quantitative and qualitative 5) Use your professional judgement → This is a privilege! Process of making a home health visit (5) 1) Build rapport: can still get assessment data 2) Use acute observational skills: look for consistency b/t pt report and observed data 3) Help family focus on/move toward goal: point out positives! 4) Review important points 5) Plan for next visit: increases follow-through Conceptual frameworks (3) Interactional framework Structural-functional framework Developmental framework Family assessment methods (2) Ecomap Genomap Structural-functional framework Family = one social system relating to other social systems in the external environment Indication: Family is having a hard time functioning in the community Developmental framework Indication: Great to use when you're in the middle of life phase changes Examination of members' changing roles and tasks in each progressive life-cycle Interactional framework Family = a singular unit of interacting personalities Indication: looking at problems within family function → Emphasis on communication, roles, conflict, coping patterns, and decision-making processes → This framework neglects the family's external environment Ecomap Family unit in center, connected to resources. Helps illustrate access, etc Framework: Structural-functional * Needs to be readable Genomap A family-tree style map of relationships between and among generations Simple assessment of Framework: Interactional or developmental Characteristics of vulnerable populations Heightened risk of adverse outcomes (mortality rates, life expectancy, access to care, quality of care, quality of life) → Overlapping vulnerabilities intensify risk of negative outcome → Note about "vulnerability": need to talk about root causes and disparities, Models and theories of vulnerability: Flaskerud & Winslow's vulnerable populations conceptual model Focuses on how the availability of resources and exposure to risk factors can influence health status 3 Interconnected components: Relative risk, resource availability (economic, social, etc) & health status (M&M) Feedback loops: Increase in morbidity and mortality → Increase the need for resource availability (such as access to health care) → Deplete the actual resources available in the community → Includes policy analysis Models and theories of vulnerability: Behavioral model for vulnerable populations (3) Looks at interplay between... Category 1: Predisposing factors → demographics, SDOH, health beliefs, social structures, childhood characteristics (ACEs) Category 2: Enabling factors → personal, family, & community resources Category 3: Perceived health needs → health behaviors, population health conditions/outcomes Models and theories of vulnerability: Framework for studying vulnerability hypothesis (4) 1) Macro- & micro-perspectives 2) Direct link between community resources (food, exercise, etc) → individual resources 3) Differential vulnerability hypothesis 4) Social vs human capital Models and theories of vulnerability: Differential vulnerability hypothesis Negative or stressful events hurt some folks more than others Models and theories of vulnerability: Human vs social capital Human capital: the investments we make in people--individual capabilities & skills (job training, income, housing availability, education) Social capital: the investments we make in social ties--marital status, family structure, & membership in organizations (easy to overlook, but what we rely on in emergencies) Socioeconomic gradient Study in England that identified a direct correlation between life expectancy and SES Solution-based nursing (6) 1) The person is the focus 2) Emphasis on strengths 3) Resilience is equally important as vulnerability 4) No only focused on illness care 5) Proactive, not reactive approach 6) Move beyond individual focus to examine unjust societal & cultural factors Levels of addressing health disparities (3) 1) Upstream (improve community conditions) 2) Midstream (social workers, community needs) 3) Downstream (medical interventions, clinical care) Factors that increase health vulnerability in children (3) 1) Rapid growth and development: eg, prenatal development) 2) Differences in physiology: I&O, metabolism, surface area 3) Differences in behavior: closer to ground, less varied diet, high risk behavior Where can lead be coming from? Environment: water, soil, air Household: toys, jewelry, ceramic, paint (#1 source of exposure = houses built 1978) Indoor asthma triggers (6) 1) Secondhand smoke 2) Mold 3) Dust mites in bedding, soft fabric 4) Pets: keep outside or dust 5) Pests: bugs & rodents; disease-carriers 6) Volatile organic compounds (ex, perfume) Minimizing indoor asthma triggers (6) 1) Smoke outside 2) Eliminate moisture to prevent mold 3) Keep house clean, especially bedding 4) Pest management 5) Lock up/eliminate chemicals * Be able to explain strategies in a paragraph Integrated pest management 1) Dry out the pests 2) Starve out the pests 3) Keep them out 4) Proper use of at least toxic pesticide needed (lock it up, store safely) Poster presentations → Be able to relate 1 to SDOH, role of nursing, & epidemiology