NR 509 midterm Exam Latest 2023 with 100% Verified
Questions and Answers
Focused Assessment - ANSWER -Addresses focused concerns or symptoms
-Used for established clients during routine or urgent care visits
-Health history and physical exams are focused on the problem
-Includes:
• brief history of the present illness
• only the system related to the problem in the review of systems
Comprehensive Assessment - ANSWER -Used for new clients
-Provides personalized information about the client
-Strengthens the clinician-client relationship
-Provides a baseline for future assessments
-Provides an opportunity for health promotion education and counseling
-Includes:
• extended history of the present illness
• at least two areas of past medical history, family history, and social history
• at least 10 systems in the review of systems
Subjective data - ANSWER includes symptoms that the client describes such as a
sore throat, headache, or pain. It also includes the client's feelings, perceptions, and
concerns
Information obtained from the client during any part of the health history
Examples of Subjective Data:
-Lower back pain
-Fatigue
-Stomach cramps
-Immunization history
Objective data - ANSWER includes the physical examination findings or signs
observed
All physical examinations, laboratory information, and test data
Examples of Objective Data:
-Heart rate
-Blood pressure
-Lung sounds
-Wound appearance
-Ambulation description
-Weight
Clinical Encounter Sequence (detailed) - ANSWER Initiate Encounter
-Review the clinical record
,-Ensure the client is comfortable
-Clarify the goals/agenda for the encounter; balance provider and client goals
-Establish rapport
-Identify the client's preferred title, name, and gender pronouns
-Use "people first" language (i.e., a person with hearing loss, a person who uses a
wheelchair)
Gather Information
-ID the client's chief complaint or reason for seeking care
-Invite the client's story using an open-ended approach
-Gather information about the client's perspective of the illness using the mnemonic
FIFE
-Conduct the health history interview
-Gather information about past medical history, medications and allergies, family
history, personal and social history, and ROS
Perform the Physical Exam
-Conduct the exam based on the information obtained from the health history
-Maintain client's comfort and privacy throughout the exam
Explain and Plan
-Assess and respond to the client's needs for information
-Negotiate and make decisions together
-Utilize teach-back to ensure the client understands the plan
Close the Encounter
-Leave time for the client to ask questions
-Summarize the plans for future evaluation, treatments, and follow up
The general sequence of a clinical encounter is to: - ANSWER -initiate the
encounter
-gather information
-perform a physical exam
-develop a shared plan
-close the encounter
FIFE mnemonic - ANSWER Feelings
Ideas
Function
Expectations
-A mnemonic for the patient's perspective on the illness
• The patient's Feelings, including fears or concerns, about the problem
• The patient's Ideas about the nature and the cause of the problem
• The effect of the problem on the patient's life and Function
• The patient's Expectations of the disease, of the clinician, or of health care, often
based on prior personal or family experiences
Basic interviewing techniques - ANSWER -active listening
-empathy
,-guided questioning
-validating
-empowerment
-partnering
-transitioning
-reassuring
-summarizing
-nonverbal communication
active listening - ANSWER closely attending to what the client is communicating,
connecting to the client's emotional state, and using verbal and nonverbal skills to
encourage the client to expand on their feelings and concerns.
empathy - ANSWER identifying with the client and feeling their pain as one's own,
then responding to them in a supportive manner.
guided questioning - ANSWER -Guided questions help to elicit more information,
while still showing a continued interest in the client's feelings and story.
-Some techniques of guided questioning include moving from open-ended to more
focused questions; clarifying what the client means; encouraging with continuers
such as "go on"; using a series of questions one at a time; and using questions that
require a graded response (i.e., how many stairs can you climb before feeling short
of breath?).
validating - ANSWER affirming the legitimacy of the client's emotional experience.
-Examples: "That must have been a difficult experience. It's very common to feel the
way you are feeling."
empowerment - ANSWER Empowering clients to ask questions and express their
concerns increases the chances that they will adopt your advice, make lifestyle
changes, or take medications as prescribed.
partnering - ANSWER involves expressing commitment to an ongoing relationship
with the clients to build rapport
transitioning - ANSWER Transitions can be used to inform the client that the
direction of the interview is changing.
reassuring - ANSWER Reassurance is an appropriate way to help the client feel
that problems have been fully understood and are being addressed.
summarizing - ANSWER Giving a summary of the client's story during the interview
helps to communicate that they have been carefully listening.
nonverbal communication - ANSWER includes eye contact, facial expression,
posture, head position, and movement such as shaking or nodding, interpersonal
distance, and placement of the arms or legs (i.e., crossed, neutral, or open).
Managing Challenging Situations: Silent Clients - ANSWER -Clients may be quiet
to collect thoughts, remember details, or decide if they trust the provider
, -Become comfortable with periods of silence
-Acknowledge that the client is quiet and ask what they are thinking about or if
something has upset them
Managing Challenging Situations: Talkative Clients - ANSWER -Talkative clients
should be allowed to talk for several minutes at the beginning of the interview
-Focus on what seems to be most important to the client
-Offer a summary of the main concerns and suggest a focus on one problem or ask
the client to identify their priority concern for the day
Managing Challenging Situations: Clients with Altered Cognition - ANSWER -
Clients with conditions such as dementia or mental health illness may not be able to
provide their history
-Obtain information from family members or caregivers
-Some clients may be able to provide a history, but cannot make their own health
decisions
Managing Challenging Situations: Angry Clients - ANSWER -Clients may direct
anger toward the provider even if their anger is related to being ill, suffering a loss, or
feeling overwhelmed and not in control
-Acknowledge clients' anger and frustration, but avoid reinforcing criticism of other
providers or the clinical setting
-Alert security staff for clients who are overly disruptive or out of control
-Remain calm and avoid being confrontational
Comprehensive health history - ANSWER Chief Complaint
History of Present Illness
Past Medical History
Medications and Allergies
Family History
Personal and Social History
Review of Systems
History of present illness - ANSWER use OLDCARTS
Past medical history - ANSWER -Childhood Illnesses: Inquire about childhood
illnesses such as measles, chickenpox, or scarlet fever and chronic childhood
illnesses such as diabetes or asthma.
-Adult Illnesses: Inquire about illnesses such as diabetes, hypertension, or asthma
and hospitalizations.
-Surgical: Document dates, indications, and types of surgical procedures.
-Obstetric/Gynecologic: Document number of pregnancies (gravida), number of
deliveries (para-term, preterm, abortions, and living children), menstrual history,
methods of contraception, and sexual function.
-Psychiatric: Document diagnoses, hospitalizations, treatments, and the time frame.
-Health Maintenance: Document immunizations and screening tests such as pap
smears, mammograms, or colonoscopies. Include the results and dates of screening
tests.
Questions and Answers
Focused Assessment - ANSWER -Addresses focused concerns or symptoms
-Used for established clients during routine or urgent care visits
-Health history and physical exams are focused on the problem
-Includes:
• brief history of the present illness
• only the system related to the problem in the review of systems
Comprehensive Assessment - ANSWER -Used for new clients
-Provides personalized information about the client
-Strengthens the clinician-client relationship
-Provides a baseline for future assessments
-Provides an opportunity for health promotion education and counseling
-Includes:
• extended history of the present illness
• at least two areas of past medical history, family history, and social history
• at least 10 systems in the review of systems
Subjective data - ANSWER includes symptoms that the client describes such as a
sore throat, headache, or pain. It also includes the client's feelings, perceptions, and
concerns
Information obtained from the client during any part of the health history
Examples of Subjective Data:
-Lower back pain
-Fatigue
-Stomach cramps
-Immunization history
Objective data - ANSWER includes the physical examination findings or signs
observed
All physical examinations, laboratory information, and test data
Examples of Objective Data:
-Heart rate
-Blood pressure
-Lung sounds
-Wound appearance
-Ambulation description
-Weight
Clinical Encounter Sequence (detailed) - ANSWER Initiate Encounter
-Review the clinical record
,-Ensure the client is comfortable
-Clarify the goals/agenda for the encounter; balance provider and client goals
-Establish rapport
-Identify the client's preferred title, name, and gender pronouns
-Use "people first" language (i.e., a person with hearing loss, a person who uses a
wheelchair)
Gather Information
-ID the client's chief complaint or reason for seeking care
-Invite the client's story using an open-ended approach
-Gather information about the client's perspective of the illness using the mnemonic
FIFE
-Conduct the health history interview
-Gather information about past medical history, medications and allergies, family
history, personal and social history, and ROS
Perform the Physical Exam
-Conduct the exam based on the information obtained from the health history
-Maintain client's comfort and privacy throughout the exam
Explain and Plan
-Assess and respond to the client's needs for information
-Negotiate and make decisions together
-Utilize teach-back to ensure the client understands the plan
Close the Encounter
-Leave time for the client to ask questions
-Summarize the plans for future evaluation, treatments, and follow up
The general sequence of a clinical encounter is to: - ANSWER -initiate the
encounter
-gather information
-perform a physical exam
-develop a shared plan
-close the encounter
FIFE mnemonic - ANSWER Feelings
Ideas
Function
Expectations
-A mnemonic for the patient's perspective on the illness
• The patient's Feelings, including fears or concerns, about the problem
• The patient's Ideas about the nature and the cause of the problem
• The effect of the problem on the patient's life and Function
• The patient's Expectations of the disease, of the clinician, or of health care, often
based on prior personal or family experiences
Basic interviewing techniques - ANSWER -active listening
-empathy
,-guided questioning
-validating
-empowerment
-partnering
-transitioning
-reassuring
-summarizing
-nonverbal communication
active listening - ANSWER closely attending to what the client is communicating,
connecting to the client's emotional state, and using verbal and nonverbal skills to
encourage the client to expand on their feelings and concerns.
empathy - ANSWER identifying with the client and feeling their pain as one's own,
then responding to them in a supportive manner.
guided questioning - ANSWER -Guided questions help to elicit more information,
while still showing a continued interest in the client's feelings and story.
-Some techniques of guided questioning include moving from open-ended to more
focused questions; clarifying what the client means; encouraging with continuers
such as "go on"; using a series of questions one at a time; and using questions that
require a graded response (i.e., how many stairs can you climb before feeling short
of breath?).
validating - ANSWER affirming the legitimacy of the client's emotional experience.
-Examples: "That must have been a difficult experience. It's very common to feel the
way you are feeling."
empowerment - ANSWER Empowering clients to ask questions and express their
concerns increases the chances that they will adopt your advice, make lifestyle
changes, or take medications as prescribed.
partnering - ANSWER involves expressing commitment to an ongoing relationship
with the clients to build rapport
transitioning - ANSWER Transitions can be used to inform the client that the
direction of the interview is changing.
reassuring - ANSWER Reassurance is an appropriate way to help the client feel
that problems have been fully understood and are being addressed.
summarizing - ANSWER Giving a summary of the client's story during the interview
helps to communicate that they have been carefully listening.
nonverbal communication - ANSWER includes eye contact, facial expression,
posture, head position, and movement such as shaking or nodding, interpersonal
distance, and placement of the arms or legs (i.e., crossed, neutral, or open).
Managing Challenging Situations: Silent Clients - ANSWER -Clients may be quiet
to collect thoughts, remember details, or decide if they trust the provider
, -Become comfortable with periods of silence
-Acknowledge that the client is quiet and ask what they are thinking about or if
something has upset them
Managing Challenging Situations: Talkative Clients - ANSWER -Talkative clients
should be allowed to talk for several minutes at the beginning of the interview
-Focus on what seems to be most important to the client
-Offer a summary of the main concerns and suggest a focus on one problem or ask
the client to identify their priority concern for the day
Managing Challenging Situations: Clients with Altered Cognition - ANSWER -
Clients with conditions such as dementia or mental health illness may not be able to
provide their history
-Obtain information from family members or caregivers
-Some clients may be able to provide a history, but cannot make their own health
decisions
Managing Challenging Situations: Angry Clients - ANSWER -Clients may direct
anger toward the provider even if their anger is related to being ill, suffering a loss, or
feeling overwhelmed and not in control
-Acknowledge clients' anger and frustration, but avoid reinforcing criticism of other
providers or the clinical setting
-Alert security staff for clients who are overly disruptive or out of control
-Remain calm and avoid being confrontational
Comprehensive health history - ANSWER Chief Complaint
History of Present Illness
Past Medical History
Medications and Allergies
Family History
Personal and Social History
Review of Systems
History of present illness - ANSWER use OLDCARTS
Past medical history - ANSWER -Childhood Illnesses: Inquire about childhood
illnesses such as measles, chickenpox, or scarlet fever and chronic childhood
illnesses such as diabetes or asthma.
-Adult Illnesses: Inquire about illnesses such as diabetes, hypertension, or asthma
and hospitalizations.
-Surgical: Document dates, indications, and types of surgical procedures.
-Obstetric/Gynecologic: Document number of pregnancies (gravida), number of
deliveries (para-term, preterm, abortions, and living children), menstrual history,
methods of contraception, and sexual function.
-Psychiatric: Document diagnoses, hospitalizations, treatments, and the time frame.
-Health Maintenance: Document immunizations and screening tests such as pap
smears, mammograms, or colonoscopies. Include the results and dates of screening
tests.
