NR 509 Midterm Study Guide

 


14 July 2024

NR 509 Midterm Study Guide
General Study Tips and Recommendations

 	
Focus and Repetition: Topics and content on guides are intended to focus student attention when reading/studying. Some topics may be repeated in multiple chapters to reinforce learning.
 	
Depth of Understanding: Multiple test items are derived from the same topic areas to encourage deeper comprehension. Students must have a broad understanding of the content and not simply memorize passages in textbooks or articles.
 	
Key Information: Information in red letters in the chapters, as well as tables and appendices at the end of the chapters, may include test items.
 	
Cognitive Levels: Exam questions represent various levels of cognitive learning. Students are expected to analyze, synthesize, and evaluate patient scenarios to answer questions effectively.
 	
Reading Strategy: Read all of the answers BEFORE reading the stem of the question. This helps focus on the key content and avoids distractions by extraneous information.
 	
Techniques of Examination and Recording Findings: Be familiar with these sections for all body system chapters in the textbook.

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Chapter 1: Approach to the Clinical Encounter

 	
The Interviewing Process

 	
Stages of the Interview

 	
Initiating the Encounter: Set the stage, adjust the environment, review the clinical record, set your agenda, greet the patient, establish rapport, identify patient title/pronouns.
 	
Gathering Information: Chief complaint, establish agenda, invite patient’s story, gather information about the patient’s perspective (FIFE: Feelings, Ideas, Effect on function, Experience), identify and respond to emotional cues, explore biomedical perspective, gather background information.
 	
Performing the Physical Examination
 	
Explaining and Planning: Assess and respond to the patient’s need for information, establish shared understanding, verify patient understanding, negotiate the plan of action with shared decision-making.
 	
Closing the Encounter: Allow time for final questions, follow-up plans, self-reflection.




 	
Interviewing Techniques

 	
Gather information about the patient’s understanding of illness (FIFE).
 	
Respond to emotional cues (Name, Understand, Respect, Support, Explore).
 	
Gather information by exploring the biomedical perspective.
 	
Gather important background information and context (Medical, family, and personal/social history).


 	
Setting the Stage for the Examination

 	
Set the stage, adjust the environment, review the clinical record, set your agenda, greet the patient, establish rapport, identify patient name and gender pronoun.



Chapter 2: Interviewing, Communication, and Interpersonal Skills

 	
Fundamentals of Skilled Interviewing
 	
Verbal and Nonverbal Communication
 	
Challenging Patient Situations and Behaviors

Chapter 3: Health History

 	
Focused and Comprehensive Health Histories
 	
Determining the Scope of the Patient Assessment
 	
The Seven Attributes of a Patient’s Principal Symptoms

 	
Location, quality, quantity and severity, timing, onset, duration, frequency, setting, aggravating and relieving factors, associated manifestations.


 	
Subjective vs. Objective Data

 	
Subjective: What the patient tells you (medical history).
 	
Objective: What is observed (labs).


 	
Modifying the Clinical Interview for Various Clinical Settings

Chapter 4: Physical Examination

 	
Determining the Scope of the Physical Examination
 	
Techniques of Examination (Note: Be familiar with specific techniques in body system chapters)
 	
Head-to-Toe Physical Assessment
 	
Examining the Patient from the Right Side: Advantages include more reliable estimates of jugular venous pressure, more comfortable palpation of the apical impulse, more frequently palpable right kidney, and examining tables accommodating right-handed approach.
 	
Elevating the Head of the Examining Table: Adjust to see jugular venous pulsations. For cardiovascular examination, ask the patient to roll partly onto the left side to listen at the apex for S3 or mitral stenosis. For aortic regurgitation, the patient should sit, lean forward, and exhale.

Chapter 5: Clinical Reasoning, Assessment, and Plan

 	
The Clinical Reasoning Process
 	
The Problem List: List the most active and serious problems first, record their date of onset. Separate lists for active and inactive problems or one list in order of priority.
 	
The Differential Diagnosis (DDx) List
 	
The Summary Statement
 	
Assessment (Medical Diagnoses)
 	
Planning (Treatment and Interventions)

Chapter 6: Integumentary Assessment

 	
Normal vs. Abnormal Findings and Interpretation
 	
Common Skin Conditions

 	
Melanoma, Primary and Secondary Skin Lesion Nomenclature, Psoriasis, Tinea, Pityriasis Rosea, Lyme Disease, Acne, Systemic Lupus Erythematosus, Herpes Zoster, Cellulitis.



Chapter 7: Evaluating Clinical Evidence

 	
Using Elements of the Physical Examination as Diagnostic Tests
 	
Evaluating Diagnostic Tests
 	
Critically Appraising Clinical Evidence
 	
Communicating Clinical Evidence to Patients

 	
Five As (ask, advise, assess, assist, and arrange).
 	
FRAMES (feedback about personal risk, responsibility of patient, advice to change, empathetic style, promote self-efficacy).



Chapter 8: General Survey, Vital Signs, and Pain

 	
General Survey
 	
Vital Signs
 	
Classifying Normal and Abnormal Blood Pressures
 	
Acute and Chronic Pain
 	
Exploring Weight Loss (Including Anorexia Nervosa and Bulimia Nervosa)

Chapter 9: Cognition, Behavior, and Mental Status

 	
Techniques of Examination
 	
Speech Patterns (Including Aphasia)
 	
Assessing Abstract Thinking
 	
Mental Status Examination
 	
Screening for Depression
 	
Screening for Substance Abuse
 	
Hallucinations and Illusions

Chapter 10: Skin, Hair, and Nails

 	
Techniques of Examination
 	
Anatomy
 	
Skin Lesion Morphology
 	
Melanoma Risk Factors
 	
Health Promotion and Skin Cancer Screening
 	
Herpes Zoster

Chapter 11: Head and Neck

 	
Techniques of Examination
 	
Anatomy
 	
Lymph Node Assessment
 	
Thyroid Assessment
 	
Screening for Thyroid Cancer

Chapter 12: Eyes

 	
Techniques of Examination
 	
Anatomy
 	
Visual Acuity Assessment (Snellen)
 	
Visual Fields Assessment
 	
Extraocular Muscle Assessment (And Associated Cranial Nerves)
 	
Ophthalmoscopic (Funduscopic) Examination and Common Findings
 	
Nystagmus