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Download NUR509 MIDTERM TESTED EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS A+ VERIFIED and more Exams Advanced Education in PDF only on Docsity!
Interviewing techniques - correct answers-ADAPTIVE QUESTIONING(GUIDED), FOCUS QUESTIONS, ECHOING, summarization, transitions, partnering and validation Setting the stage for the examination - correct answers-intiate the session, gather info, physical examin, explan and plan, close the session Patient-centered medical care - correct answers-patient experssions, emotions, perceptions, feelings, attitudes towards disease focus The FIFE model - correct answers-FEELINGS, IDEAS, FUNCTIONAL EFFECT AND EXPECTATIONS(PATIENTS PERSPECTIVE) ¢ silent patient - correct answers-allow for reflection Talkative - correct answers-allow to talk 5-10 min then redirect, don't show impatience Comp health history - correct answers-CC,HPI,PMI,Family history, ROS and personal/social history Focused - correct answers-established patients with specific concerns, ER visits, CC,HPI, pertinent PMH, and ROS Determining the scope of the patient assessment - correct answers-FOCUSED OR COMPREHENSIVE The seven attributes of a patient's principal symptoms - correct answers-OLDCARTS Subjective versus objective data - correct answers-Subjective what the patient reports/says Determining the scope of the physical examination if it needs to be - correct answers-comprehensive or focused The clinical reasoning process - correct answers-gather initial patient info, health history and physical exam, organize them to represent a problem, genertate a hypothesis with the differential diagnosis, test hypotheses until diagnosis is selected, plan the diagnostic and treatment strategy The problem list - correct answers-summarizes all related problems that support a differential diagnosis with the most serious/active firsts The differential diagnosis (DDx) list - correct answers-list of possible diagnoses supported by the problem list The summary statement - correct answers-includes chief compliant, pertinent parts of hx, physical exam and lab data, no more than 2-3 sentences, demonstrates clinical reasoning skills, Assessment (medical diagnoses) - correct answers-includes all abnormal and unexpected findings, known diagnoses and new/undiagnosed symptoms and signs, chief compliant at top and includes significant social factors that impact health such as food and housing insecurity Planning (treatment and interventions) - correct answers-what you want the patient to take or do with education Using elements of the physical examination as diagnostic tests - correct answers-key elements of HPI, ¢ Evaluating diagnostic tests - correct answers-validity and sensitivity and specificity Sensitivity - correct answers-probability that a person with disease has a positive test Specificity - correct answers-probability that a nondisease person has a negative test (including aphasia) - correct answers-Blocking (sudden interruption midsentence) Circumstantiality - correct answers-unnecessary detail, indirection, delay in reaching a point Clanging - correct answers-Word association based on sound not meaning( Rhymying) Confabulation - correct answers-fabricating facts or events Derailment (loose association) - correct answers-Shifting topics Echolali - correct answers-: Repeating others Flight of Ideas - correct answers-accelerated speech with topic changes Incoherence - correct answers-Incomprehensible and illogical Neologisms - correct answers-invented words Perseveration - correct answers-repertition of word or ideas Broca aphasia - correct answers-Expressive aphasia, able to comprehend, unable to speak Wernicke aphasia - correct answers-receptive aphasia unable to comprehend but able to speak Mood is - correct answers-chronic/sustained Affect is - correct answers-acute/ variable Percussion of organ involves - correct answers-striking the middle finger of one hand against the middle finger of the other. 65 year old retired pilot visits the clinic because of a recurrent headach and dizziness for the last 2 weeks with occasional numbness, which should be the systems examined in the clinicians focused assessment? - correct answers-nervous What does validity measure? - correct answers-true state of affairs 25 year old patient is doing a stress test, her HR shows 25 each time what would the practitioner question? - correct answers-validity Patient states he is always hungry and tired and that his feet feel funny, what type of assessment should be done? - correct answers-Head to toe 51year old male who is moderatly overweight stats that he is having chest pain after tennis with his friend, later in the day a 29 year old reports that her chest feels hot and tight and she can get stressed out, the provider recommends an immediate evaluation for the professor and not the college student why? - correct answers-Positive predictive value of an observation is higher in a group with a higher prevalance of disease if 3 sets of test strips show negative ph and another 3 set show higher ph and they were bought more recently what is true? - correct answers-the test strips demonstrate high intraobserver reliability Positive predictive value - correct answers-150divided by(150+150) this is the positive predictive value Negative predictive value - correct answers-85 divided by (85+15) this is the negative predictive value 58year old carpenter presents for physical, the practitioner notes there is a systolic murmur on auscultation of the aorta. Why does she not conclude the patient has aortic stenosis? - correct answers- Systolic murmurs have high sensitivity but low specificity for aortic stenosis Melanoma risk factors - correct answers-lighter skin, sun exposure Most common skin cancer - correct answers-basal cell carcinoma (pink patch/papule non healing and pearly appearance. 2nd most common skin cancer is - correct answers-squamous cell carcinoma( Smooth/firm border) 3rd most common skin cancer - correct answers-melanoma Health promotion and skin cancer screening - correct answers-every patient especially those over 50 Herpes zoster - correct answers-vesicles (fluid filled), erythematous, dermatoma usually unilateral Lymph node assessment: submental, submandibular, preauricular, posterior auricular, tonsillar, occipital, anteriari and posterior cervical,supraclavicular - correct answers-submental, submandibular, preauricular, posterior auricular, tonsillar, occipital, anterior and posterior cervical,supraclavicular Thyroid assessment: - correct answers-look for goiter, temp intolerance, weight changes, dry skin, tachy/bradycardia, palpitations. Screening for thyroid cancer: - correct answers-radiation exposure, 1st degree relative with thyraid cancer and being female Visual acuity assessment: 20/100 - correct answers-person can read at 20 feet what everyone else can read at 100ft Visual fields assessment cnll - correct answers-central/peripheral vision, pupillary response is cn Il, Myopia - correct answers-nearsighted, hyperopia=farsighted, presbyopia= age related farsighted Extraocular muscle assessment (and associated cranial nerves) - correct answers-CNIIl,IV,VI Ophthalmoscopic (funduscopic) examination and common findings: - correct answers-red reflex Nystagmus: - correct answers-involuntary, jerking movements of the eyes Glaucoma: leading cause of blindness, cause cataracts - correct answers-gradual peripheral vision lass, optic cup increases in size and pallor. Risk factors for glaucoma are= >65, African American, diabetes, myopia, ocular hypertension Macular degeneration: - correct answers-leading cause of poor central vision, age related, dry atrophic(common),wet exudatie/neovascular Drusen bodies - correct answers-cellular debris, hard=sharply defined ; soft= confluent,altered pigmentation Legally blind - correct answers-20/200 Red reflexes an be caused by - correct answers-catartcs, vitreous, artificial eye, retinoblastoma Papilledema - correct answers-optic nerve head swelling which may represent increased iCP Screening for hearing loss: establish timeline, acute hearing loss is no known cause - correct answers- immediate ENT referral Presbycusis - correct answers-age related, higher frequency first Conductive - correct answers-external and middle ear Sensorineural - correct answers-internal ear and neural involvement 3 tonsil grading - correct answers-up to 75% airway occluded (not normal) 4 tonsil grading - correct answers-More than 75% of airway occluded, almost touching(abnormal) © Techniques of examination (including percussion) - correct answers-Inspect, palpation (chest expansion, crepitus, fremitus(normal vibrations). Percussion;tympanic, hyper resonant, dull, auscultate=breath sounds Bronchophy is positive if abnormally loud when they say 99 respiratory distress - correct answers-increased work of breathing; a sensation of shortness of breath lung sounds - correct answers-lung sounds are referenced as crackles (rales), wheezes (rhonchi), and stridor « Asthma. - correct answers-retraction of muscles if severe, hyperresonance on percussion, wheezing, coug common withthick mucoid secreations. * Pneumonia - correct answers-Retraction of muscles if severe, dullnes on percussion, crackles on auscultation, Chronic obstructive pulmonary disease (COPD): - correct answers-retraction of muscles if severe, hyperresonance on percussion, wheezing, coug common withthick mucoid secreations atelectasis - correct answers-collapsed lung; incomplete expansion of alveoli © Screening for cardiovascular (CV) risk factors: - correct answers-BMI >25, smoking, inactive, diet high in fat and sodium, total cholesteroal >200, BP>120>80, fasting glucose >100, African American, family history, AFIB cardiovascular disease - correct answers-a disease of the heart and blood vessels Lipid screening - correct answers-Onset 18-35/45yo screen if at increased risk of heart disease. Males >35yo and Females >45yo Heart rhythms and sounds: Split S1 - correct answers-individual closing of mitral and tricuspid Split 2 - correct answers-individual closing of aortic and pulmonic, $3 heart sound - correct answers-Increased ventricular filling pressure (e.g., mitral regurgitation, HF), common in dilated ventricles S4 - correct answers-an abnormal heart sound detected late in diastole as resistance is met to blood entering either ventricle during atrial contraction; most often caused by hypertrophy of the ventricle jugular venous pressure - correct answers-The indirectly observed pressure over the venous system via visualization of the internal jugular vein carotid arteries - correct answers-the major arteries that carry blood upward to the head Murmurs - correct answers-abnormal heart sounds Congestive heart failure (CHF); left sided - correct answers-dry(backs up into lungs=crackles) Right sided heart failure - correct answers-moist backs up into the body =edema and jvd © Heart valve pathology: mitral stenosis - correct answers-opening snap Right lymphatic duct drains right side of head, neck, thorax rue - correct answers-right side of head, neck, thorax rue Thoracic duct drains - correct answers-everything except for right side of head,neck,thorax and rue What percentage of mood disorders make up all mental health disorders? - correct answers-25% What is considered to be a patient identifier for mental health screening? - correct answers-substance abuse Hallucinations may occur in which type of patients? - correct answers-delirium,dementia,ptsd,and schizophrenia what is the difference between illusions and hallucinations - correct answers-illusions involve irrational fear or perceptions, hallucinations show things that are not real what is a benign skin lesion? - correct answers-seborrheic keratosis What percent of melanoma is intitially noticed by patients and then brought to the attention of their physcian? - correct answers-50% Acne vulgaris - correct answers-associatied with blocked sebaceous glands,stress,humidity, and heavy sweating Cherry angiomas - correct answers-benign and may increase with size and aging Alopecia areata is? - correct answers-patchy hair loss without associaited skin changes Hypothyroidism symptoms - correct answers-dry skin, myexedema, alopecia of the eyebrows, temp regulation and brittle nails hirutism may appear in some women with - correct answers-pcos JVD is a hallmark sign of? - correct answers-Heart Failure myopia - correct answers-near-sightedness, blurred distance presbyopia - correct answers-aging vision hyperopia - correct answers-farsighted cant see things up clase what causes gradual vision loss? - correct answers-cataracts,glaucoma and macular degeneration what causes flashing lights or floaters? - correct answers-retinal detachment A vibrating tuning fork placed on the head sets the bone of the skull into vibration and stimulates the - correct answers-cochlea Weber test - correct answers-placing tuning fork on top of head Rinne test - correct answers-hearing acuity test performed with a vibrating tuning fork that is first placed on the mastoid process and then in front of the external auditory canal to test bone and air conduction What often accompanies tinnitus? - correct answers-vertigo Can acid reflux cause hoarseness through damage to the laryngeal area? - correct answers-yes Acti sunlight on lower lip ic Cheilitis is a precancerous condition that results from - correct answers-excessive expasure to Pink frothy sputum indicates - correct answers-Congestive Heart Failure AND Pulmonary Edema (life- threatening) What type of consolidatin or sound is associated with pneumonia? - correct answers-dullness Correct order of lung exam is? - correct answers-Inspect,palpate, percussion and auscultation 
