NR 509 MIDTERM EXAM STUDY GUIDE
● Chapter 1
Basic and Advanced Interviewing Techniques
Basic maximize patient's comfort, avoid unnecessary changes in position, enhance
clinical efficiency, move head to toe, examine the patient from their right side
Active listening, empathic responses, guided questioning, nonverbal
communication, validation, reassurance, partnering, summarization, transitions,
empowering the patient
Active Listening- closely attending to what the patient is communicating,
connecting to the patient’s emotional state and using verbal and nonverbal skills to
encourage the patient to expand on his or her feelings and concerns.
Empathic Responses-the capacity to identify with the patient and feel the patient’s
pain as your own, then respond in a supportive manner.
Guided Questioning- show your sustained interest in the patient’s feelings and
deepest disclosures and allows the interviewer to facilitate full communication, in
the patient’s own words, without interruption.
Non-verbal- includes eye contact, facial expression, posture, head position and
movement such as shaking or nodding, interpersonal distance, and placement of
the arms or legs-crossed, neutral, or open.
Validation- helps to affirm the legitimacy of the patient’s emotional experience.
Reassurance- an appropriate way to help the patient feel that problems have been
fully understood and are being addressed.
Partnering- building rapport with patients, express your commitment to an ongoing
relationship.
Summarization- giving a capsule summary of the patient’s story during the course
of the interview to communicate that you have been listening carefully.
Transitions- inform your patient when you are changing directions during the
interview.
,Empowering the Patient- empower the patient to ask questions, express their
concerns, and probe your recommendations in order to encourage them to adopt
your advice, make lifestyle changes, or take medications as prescribed.
Advanced: Determine scope of assessment: Focused vs. Comprehensive: pg5
Comprehensive: Used for patients you are seeing for the first time in the office or
hospital. Includes all the elements of the health history and complete physical
examination. A source fundamental and personalized knowledge about the patient,
strengthens the clinician-patient relationship.
● Is appropriate for new patients in the office or
hospital
● Provides fundamental and personalized knowledge
about the patient
● Strengthens the clinician–patient relationship
● Helps identify or rule out physical causes related
to patient concerns
● Provides a baseline for future assessments
● Creates a platform for health promotion through
education and counseling
● Develops proficiency in the essential skills of
physical examination
Flexible Focused or problem-oriented assessment: For patients you know well
returning for routine care, or those with specific “urgent care” concerns like sore
throat or knee pain. You will adjust the scope of your history and physical
examination to the situation at hand, keeping several factors in mind: the
magnitude and severity of the patient’s problems; the need for thoroughness; the
clinical setting—inpatient or outpatient, primary or subspecialty care; and the time
available.
● Is appropriate for established patients, especially
during routine or urgent care visits
● Addresses focused concerns or symptoms
● Assesses symptoms restricted to a specific body
system
, ● Applies examination methods relevant to assessing
the concern or problem as thoroughly and carefully as
possible
Tangential lighting: JVD, thyroid gland, and apical impulse of heart.
Components of the Health History Jenna/Ashley
Initial information
Identifying data and source of the history; reliability
Identifying data- age, gender, occupation, marital status
Source of history- usually patient. Can be: a family member or friend, letter of
referral, or clinical record.
Reliability- Varies according to the patient’s memory, trust, and mood.
Chief Complaint
Chief Complaint- Make every attempt to quote the patient’s own words.
Present Illness
Complete, clear and chronological description of the problem prompting the
patient visit
Onset, setting in which it occurred, manifestations and any treatments
Should include 7 attributes of a symptom:
● Location
● Quality
● Quantity or severity
● Timing, onset, duration, frequency
● Setting in which it occurs
● Aggravating or relieving factors
● Associated manifestations
-Differential diagnosis is derived from the “pertinent positives” and “pertinent
negatives” when doing Review of Systems that are relevant to the chief complaint.
A list of potential causes for the patients problems.
-Present illness should reveal patient’s responses to his or her symptoms and what
effect this has on their life.
-Each symptom needs its own paragraph and a full description.
, -Medication should be documented, name, dose, route, and frequency. Home
remedies, non-prescriptions drugs, vitamins, minerals or herbal supplements, oral
contraceptives, or borrowed medications.
-Allergies-foods, insects, or environmental, including specific reaction
Tobacco use, including the type. If someone has quit, note for how long
-Alcohol and drug use should always be investigated and is often pertinent to the
Presenting Illness.
Past history
-Childhood Illness: measles, rubella, mumps, whooping cough, chickenpox,
rheumatic fever, scarlet fever, and polio. Also include any chronic childhood
illness
-Adult illnesses: Provide information in each of the 4 areas:
● Medical: diabetes, hypertension, hepatitis, asthma
and HIV; hospitalizations; number and gender of sexual
partners; and risk taking sexual practices.
● Surgical: dates, indications, and types of operations
● Obstetric/gynecologic: Obstetric history, menstrual
history, methods of contraception, and sexual function.
● Psychiatric: Illness and time frame, diagnoses,
hospitalizations, and treatments.
-Health Maintenance: Find out if they are up to date on immunizations and
screening tests. Review Tb tests, pap smears, mammograms, stool tests for occult
blood, colonoscopy, cholesterol levels etc..
Family history
Outlines or diagrams age and health, or age and cause of death, of siblings, parents,
and grandparents
Documents presence or absence of specific illnesses in family, such as
hypertension, coronary artery disease, elevated cholesterol levels, stroke, diabetes,
thyroid or renal disease, arthritis, tuberculosis, asthma or lung disease, headache,
seizure disorder, mental illness, suicide, substance abuse, and allergies, and
symptoms reported by patient.
● Chapter 1
Basic and Advanced Interviewing Techniques
Basic maximize patient's comfort, avoid unnecessary changes in position, enhance
clinical efficiency, move head to toe, examine the patient from their right side
Active listening, empathic responses, guided questioning, nonverbal
communication, validation, reassurance, partnering, summarization, transitions,
empowering the patient
Active Listening- closely attending to what the patient is communicating,
connecting to the patient’s emotional state and using verbal and nonverbal skills to
encourage the patient to expand on his or her feelings and concerns.
Empathic Responses-the capacity to identify with the patient and feel the patient’s
pain as your own, then respond in a supportive manner.
Guided Questioning- show your sustained interest in the patient’s feelings and
deepest disclosures and allows the interviewer to facilitate full communication, in
the patient’s own words, without interruption.
Non-verbal- includes eye contact, facial expression, posture, head position and
movement such as shaking or nodding, interpersonal distance, and placement of
the arms or legs-crossed, neutral, or open.
Validation- helps to affirm the legitimacy of the patient’s emotional experience.
Reassurance- an appropriate way to help the patient feel that problems have been
fully understood and are being addressed.
Partnering- building rapport with patients, express your commitment to an ongoing
relationship.
Summarization- giving a capsule summary of the patient’s story during the course
of the interview to communicate that you have been listening carefully.
Transitions- inform your patient when you are changing directions during the
interview.
,Empowering the Patient- empower the patient to ask questions, express their
concerns, and probe your recommendations in order to encourage them to adopt
your advice, make lifestyle changes, or take medications as prescribed.
Advanced: Determine scope of assessment: Focused vs. Comprehensive: pg5
Comprehensive: Used for patients you are seeing for the first time in the office or
hospital. Includes all the elements of the health history and complete physical
examination. A source fundamental and personalized knowledge about the patient,
strengthens the clinician-patient relationship.
● Is appropriate for new patients in the office or
hospital
● Provides fundamental and personalized knowledge
about the patient
● Strengthens the clinician–patient relationship
● Helps identify or rule out physical causes related
to patient concerns
● Provides a baseline for future assessments
● Creates a platform for health promotion through
education and counseling
● Develops proficiency in the essential skills of
physical examination
Flexible Focused or problem-oriented assessment: For patients you know well
returning for routine care, or those with specific “urgent care” concerns like sore
throat or knee pain. You will adjust the scope of your history and physical
examination to the situation at hand, keeping several factors in mind: the
magnitude and severity of the patient’s problems; the need for thoroughness; the
clinical setting—inpatient or outpatient, primary or subspecialty care; and the time
available.
● Is appropriate for established patients, especially
during routine or urgent care visits
● Addresses focused concerns or symptoms
● Assesses symptoms restricted to a specific body
system
, ● Applies examination methods relevant to assessing
the concern or problem as thoroughly and carefully as
possible
Tangential lighting: JVD, thyroid gland, and apical impulse of heart.
Components of the Health History Jenna/Ashley
Initial information
Identifying data and source of the history; reliability
Identifying data- age, gender, occupation, marital status
Source of history- usually patient. Can be: a family member or friend, letter of
referral, or clinical record.
Reliability- Varies according to the patient’s memory, trust, and mood.
Chief Complaint
Chief Complaint- Make every attempt to quote the patient’s own words.
Present Illness
Complete, clear and chronological description of the problem prompting the
patient visit
Onset, setting in which it occurred, manifestations and any treatments
Should include 7 attributes of a symptom:
● Location
● Quality
● Quantity or severity
● Timing, onset, duration, frequency
● Setting in which it occurs
● Aggravating or relieving factors
● Associated manifestations
-Differential diagnosis is derived from the “pertinent positives” and “pertinent
negatives” when doing Review of Systems that are relevant to the chief complaint.
A list of potential causes for the patients problems.
-Present illness should reveal patient’s responses to his or her symptoms and what
effect this has on their life.
-Each symptom needs its own paragraph and a full description.
, -Medication should be documented, name, dose, route, and frequency. Home
remedies, non-prescriptions drugs, vitamins, minerals or herbal supplements, oral
contraceptives, or borrowed medications.
-Allergies-foods, insects, or environmental, including specific reaction
Tobacco use, including the type. If someone has quit, note for how long
-Alcohol and drug use should always be investigated and is often pertinent to the
Presenting Illness.
Past history
-Childhood Illness: measles, rubella, mumps, whooping cough, chickenpox,
rheumatic fever, scarlet fever, and polio. Also include any chronic childhood
illness
-Adult illnesses: Provide information in each of the 4 areas:
● Medical: diabetes, hypertension, hepatitis, asthma
and HIV; hospitalizations; number and gender of sexual
partners; and risk taking sexual practices.
● Surgical: dates, indications, and types of operations
● Obstetric/gynecologic: Obstetric history, menstrual
history, methods of contraception, and sexual function.
● Psychiatric: Illness and time frame, diagnoses,
hospitalizations, and treatments.
-Health Maintenance: Find out if they are up to date on immunizations and
screening tests. Review Tb tests, pap smears, mammograms, stool tests for occult
blood, colonoscopy, cholesterol levels etc..
Family history
Outlines or diagrams age and health, or age and cause of death, of siblings, parents,
and grandparents
Documents presence or absence of specific illnesses in family, such as
hypertension, coronary artery disease, elevated cholesterol levels, stroke, diabetes,
thyroid or renal disease, arthritis, tuberculosis, asthma or lung disease, headache,
seizure disorder, mental illness, suicide, substance abuse, and allergies, and
symptoms reported by patient.
