Health Assessment Test 1 Study Guide Q's

Describe five methods of complementary interventions.

1) Acupuncture 2) Therapeutic touch 3) Meditation 4) Hypnosis 5) Biofeedback

Special considerations when interviewing an older adult.

1) Always address by proper sirname (Mr. or Mrs. ___) 2) Avoid "elderspeak" 3) Adjust pace of the interview 4) Consider any physical limitations

List at least 5 names for various folk healers and the culture they represent.

1) Curandero(ra) - Hispanic 2) Hougan (voodoo priest) - Blacks 3) Shaman - American Indian 4) Acupuncturists - Asian 5) Braucher - Amish

Response to someone who has spoken to you in a sexually aggressive way.

"I am uncomfortable with the way you are speaking to me, please stop."

List the basic characteristics of culture.

(1) learned from birth through the processes of language acquisition and socialization; (2) shared by all members of the same cultural group; (3) adapted to specific conditions related to environmental and technical factors and to the availability of natural resources; and (4) dynamic and ever changing.

Describe 4 sources of error that may occur when using the 24-hour diet recall.

(1) the individual or family member may not be able to recall the type or amount of food eaten; (2) intake within the last 24 hours may be atypical of usual intake; (3) the individual or family member may alter the truth for a variety of reasons; and (4) snack items and use of gravies, sauces, and condiments may be underreported.

Describe the points to consider in preparing the physical setting for the interview.

1) Ensuring privacy is very important - this means finding a private room in a hospital, clinic, or home, and if it is not possible, behind curtains or some kind of partition for "psychological privacy". This also extends to limiting people in the room, or making sure the client is comfortable with answering openly and honestly if there is someone present. 2) Refuse interruptions or let the client know beforehand if one is expected. 3) One also needs to take into consideration the physical environment, meaning: • Quiet setting • Removing distractions • Enough lighting • Comfortable room temperature • Personal space; keeping a comfortable distance between yourself and client • "Equal status seating," meaning remaining at eye level or in a position where the client is not looking up to you, even if he or she is bedridden.

List the 9 types of responses examiners use during the interview and examples of each.

1) Facilitation - Nodding "yes" 2) Silence - waiting for response with interruption or moving on 3) Reflection - summarizing something client just said. 4) Empathy - "this situation must be very hard for you right now" 5) Clarification - "Breathing becomes difficult when you run, but not when walking, is that correct?" 6) Confrontation - "You say you would like to lose weight but refuse to go to change your current lifestyle, is that correct?" 7) Interpretation - "It seems every time you come in due to migraines, you are also under extreme pressure at home." 8) Explanation - "You must not consume any alcohol while on this medication or else you will experience extreme side effects." 9) Summary - Review important parts of the interview. Client should have time and space to make corrections/clarifications.

Ten traps of interviewing. Provide examples.

1) False assurance/reassurance - "Don't worry, everything will be fine." 2) Giving unwanted advice - "If I were you, I would follow the doctor's recommendation no matter what." 3) Using authority - "Your health provider knows best" 4) Using avoidance language - "Your loved one has now gone to a better place." 5) Distancing - "There is an unusual growth on the left lung." 6) Using professional jargon - "It seems you've been experiencing angina pectoris" 7) Leading or biased questions - "You haven't been drinking, have you?" 8) Talking too much - talking and explaining more than listening to the client 9) Interrupting - cutting the client off and continuing his or her sentence 10) Why Questions - "Why did you wait so long before seeking medical attention?"

List 7 nonverbal behaviors made by an examiner.

1) Physical appearance 2) Posture 3) Gestures 4) Facial expression 5) Eye contact 6) Tone of voice 7) Touch

List the pros and cons of note-taking during the interview.

1) Pros • Being able to record important details • Not having to rely solely on memory • Organizing information for formal documentation 2) Cons • Breaks eye contact with client • Impedes ability to take notice clients nonverbal behavior • Shifts your attention away from the person, making him or her feel less important • Client may feel uncomfortable or threatened when he or she is disclosing sensitive info while you are recording • Impedes client's ability to talk at a natural pace to ensure you get everything down

Describe the items included in a functional assessment.

1) Self-Esteem, Self-Concept. 2) Activity/Exercise. 3) Sleep/Rest. 4) Nutrition/Elimination. 5) Interpersonal Relationships/Resources. 6) Spiritual Resources. 7) Coping and Stress Management. 8) Personal Habits. 9) Alcohol 10) Illicit or Street Drugs. 11) Environment/Hazards. 12) Intimate Partner Violence. 13) Occupational Health.

List 5 points to consider when using an interpreter.

1) Use a trained interpreter who knows medical terminology. 2) Avoid interpreters from a rival tribe, state, region, or nation 3) Be aware of gender differences between interpreter and client; same gender usually preferred. 4) Be aware of age differences between interpreter and client; older interpreter usually preferred. 5) Be aware of socioeconomic differences between interpreter and client.

The steps of the diagnostic reasoning process are listed below. Consider the clinical example given for "cue recognition," and fill in the remaining diagnostic reasoning steps. 1. Cue recognition 2. Hypothesis formulation 3. Data gathering for hypothesis testing 4. Hypothesis evaluation

1. AJ is a 62-year-old man, appears pale, diaphoretic, and anxious 2. AJ may be experiencing chest pains 3. run auscultating tests, take vital signs, check pulses, ask questions related to chest pain 4. evaluate data collected during tests to determine where AJ is experiencing chest pains

List and define the critical characteristics used to explore each symptom the patient identifies.

1. Location - ask the patient to point to the specific location of the symptom 2. Character or quality - describing the symptom 3. Quantity or severity - quantify the severity of the sign or symptom 4. Timing - when did it begin, how long does it last, how often does it occur 5. Setting - where was the patient when they experienced the symptom 6. Aggravating or relieving factors - what worsens, induces, and relieves the pain 7. Associated factors - are there associating factors to the primary symptom 8. Patient's perception - what does the symptom mean for the patient, how has it affected their daily functioning.

Define the elements of the health history: reason for seeking care; present health state or present illness; past history, family history; review of systems; functional patterns of living.

1. Reason for seeking care - brief, spontaneous statement in the person's own words that describes the reason for the visit. 2. Present health state - For the well person, this is a short statement about the general state of health. For the ill person, this section is a chronologic record of the reason for seeking care, from the time the symptom first started until now. 3. Past history - Past health events are important because they may have residual effects on the current health state. 4. Family History - an accurate family history highlights diseases and conditions for which a particular patient may be at increased risk. 5. Review of systems - The purposes of this section are (1) to evaluate the past and present health state of each body system, (2) to double-check in case any significant data were omitted in the Present Illness section, and (3) to evaluate health promotion practices. 6. Functional patterns of living - Functional assessment measures a person's self-care ability in the areas of general physical health or absence of illness

Describe how you would validate the following data. 1. Mr. Quinn tells you his weight this morning on the clinic scale was 165 lb. 2. The primary counselor tells you Ellen is depressed and angry about being admitted to residential treatment in the clinic. 3. When auscultating the heart, you hear a blowing, swooshing sound between the first and second heart sounds.

1. Weighing Mr. Quin again on another scale 2. Ask specific questions related to the youth's behaviors to validate depression and anger. Or ask the youth how she feels directly 3. Listen again, run an EKG, and ask for a second opinion

Define a pedigree or genogram.

A pedigree or genogram is a graphic family tree that uses symbols to depict the gender, relationship, and age of immediate blood relatives in at least three generations such as parents, grandparents, and siblings.

Contrast the use and settings for the following alcohol screening tools: AUDIT; AUDIT-C; CAGE questionnaire.

AUDIT - covers alcohol consumption, drinking behaviors, or dependency. AUDIT-C - is a shorter form that is helpful for acute and critical care units. The AUDIT-C is a valid screening test for heavy drinking and/or active alcohol abuse CAGE - works well in primary care settings; it takes less than 1 minute to complete and the 4 straightforward yes/no questions are easy for clinicians to remember. The CAGE tests for lifetime alcohol abuse and/or dependence but does not distinguish past problem drinking from active present drinking; less effective with women and minority groups

What proportion of Americans ages 12 and older report being current alcohol drinkers? And report being binge drinkers (≥5 drinks/occasion)?

About 52.1% of Americans ages 12 and up report being alcohol drinkers, and almost 40% report being binge drinkers.

State 3 clinical laboratory findings that are used to detect or monitor alcohol use.

Appearance - unsteady gait, incoordination Behavior - impaired social or occupational functioning

How would you modify interview for someone hearing-impaired?

Ask the client their preferred method of communication, make sure their hearing aid is properly adjusted, include a sign-language interpreter when conducting a complete history interview. If they prefer lip reading, speak slowly and use appropriate hand gestures. Make sure the client understands the questions.

State convenient ways to assess a person's recent memory within the context of the initial health history.

By the 24-hour diet recall or by asking the time the person arrived at the agency.

Describe the rationale and components of cultural care.

Because immigration occurs at high levels and immigrants with limited English proficiency (LEP) have particular needs, the Office of Minority Health published the National Standards for Culturally and Linguistically Appropriate Services in Health Care. • EFFECTIVE CARE results in positive outcomes and satisfaction for the patient. • RESPECTFUL CARE takes into consideration the values, preferences, and expressed needs of the patient. • CULTURAL AND LINGUISTIC COMPETENCE is a set of congruent behaviors, attitudes, and policies that come together in a system among professionals that enables work in cross-cultural situations

List the effects of alcohol on 4 traumatic or disease conditions.

Breast Cancer - up to 1 alcoholic drink per day increases risk of breast cancer 4%, more than 3 per day can increase risk by up to 40-50% Liver Cirrhosis - alcohol abuse is the number one cause for this disorder Hypertension - moderate drinking leads to hypertension by stimulating the nervous system, which can later cause cardiomyopathy Atrial Fibrillation - moderate to heavy drinking increases risk of atrial fibrillation in people over 55yrs old with cardiovascular disease and diabetes

Discuss bruising in children and how it relates to their development level.

Bruising is not typical in infants under 9months old if they are not yes "cruising", usually bruising in infants younger than 9 months, should alert you to possible abusive mechanisms to the injury or an underlying medical illness. Children who are walking bruise on bony prominences on the front of their body (atypical places include butt, hands, feet, and abdomen). With children younger 4, bruising on torso, ears, and neck as well as any bruising on pre-cruising infants correlates with abuse.

Discuss some of the long-term consequences of child maltreatment.

Child maltreatment shown to be a predictor of negative health outcomes for children that can persist into adulthood (e.g., mental health issues, incidence of suicide attempts, substance abuse, and the risk of perpetrating abuse as an adult). It has also shown to be a predicator of youth violence.

Identify the most common mental health problems that result from intimate partner violence.

Depression, suicidality, posttraumatic stress disorder (PTSD) symptoms, and problems with substance abuse.

Define the hot and cold theory of health and illness, and relate this to different types of foods and illnesses.

Hot/cold theory is an explanatory model with origins in the ancient Greek humoral theory. Beverages, foods, herbs, medicines, and diseases are classified as hot or cold according to their perceived effects on the body, not on their physical characteristics. Illnesses believed to be caused by cold entering the body include earache, chest cramps, paralysis, gastrointestinal discomfort, rheumatism, and tuberculosis. Among illnesses believed to be caused by overheating are abscessed teeth, sore throats, rashes, and kidney disorders.

Describe the role that cultural heritage and values may play in an individual's nutritional intake.

Immigrants commonly maintain traditional eating customs long after the language and manner of dress of an adopted country become routine. Occupation, class, religion, gender, and health awareness also have a great bearing on eating customs. Cultural food preferences are often interrelated with religious dietary beliefs and practices. Other issues are fasting and other religious observations that may limit a person's food or liquid intake during specified times

Discuss the rationale for obtaining a family history.

In the age of genomics an accurate family history highlights diseases and conditions for which a particular patient may be at increased risk.

Open-ended vs Closed questions: explain the purpose of each during an interview.

Open-ended questions: asks for longer narrative information; unbiased; leaves the person free to answer in any way. These are good to use to begin the interview or to gain more information when a new topic is brought up during the interview. Closed questions: questions that ask for specific information and elicit a short, one- or two- word answer, a "yes" or "no," or a forced choice. These are good to ask when filling in details that might have been missed in the clients' narrative. They are good to speed up the interview.

Define optimal nutritional status.

Optimal nutritional status is achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands caused by growth, pregnancy, or illness

Describe the unique nutritional needs for various developmental periods throughout the life cycle.

Infants & Children: Breastfeeding is recommended for full-term infants for the first year of life because breast milk is ideally formulated to promote normal infant growth and development and natural immunity. Because cow's milk may cause gastrointestinal (GI) and kidney problems and is a poor source of iron and vitamins C and E, it is not recommended for infants until 1 year of age; fat (calories and essential fatty acids) is required for proper growth and central nervous system development. Adolescents: Caloric and protein requirements increase to meet this demand, and because of bone growth and increasing muscle mass (and in girls the onset of menarche), calcium and iron requirements also increase. Pregnancy: To support the synthesis of maternal and fetal tissues, sufficient calories, protein, vitamins, and minerals must be consumed during pregnancy. In particular, iron, folate, and zinc are essential for fetal growth, and vitamin and mineral supplements are often required. Adulthood: During adulthood growth and nutrient needs stabilize; the adult years are an important time for education to preserve health and prevent or delay the onset of chronic disease. Aging adult: Important nutritional features of the older years are a decrease in energy requirements caused by loss of lean body mass (the most metabolically active tissue) and an increase in fat mass. Because protein and vitamin and mineral 183needs remain the same or increase (e.g., vitamin D and calcium), nutrient-dense food choices (e.g., milk, eggs, cheese, and peanut butter) are important to offset lower energy/calorie needs.

State a useful phrase for closing the interview.

Is there anything we missed or anything you would like to add?

Define the term mental disorder.

It is a clinically significant behavioral, emotional, or cognitive syndrome that is associated with significant distress (a painful symptom) or disability (impaired functioning) involving social, occupational, or key activities.

One of the critical-thinking skills is identifying assumptions. Explain how the following statement contains an assumption. How would you get the facts in this situation? "Ellen, you have to break up with your boyfriend. He is too rough with you. He is no good for you."

It is an assumption because the person speaking is placing his or her subjective opinion on "Ellen's" situation. For example, the person's idea of roughness could be incongruent with that of Ellen's, as could be the person's ideals of good and bad. In order to obtain the facts about the situation, one would have to state specific behaviors and occurrences in the relationship and ask Ellen whether or not she feels those behaviors are in alignment with her own ideals of health and safety.

Discuss the extra risk alcohol drinking poses to the aging adult.

Liver metabolism and kidney function are decreased, increasing bioavailability of acohol in the blood for longer, muscle mass decreases which means increased BAC levels, and increased risks of falls, depression, or GI problems. Also, risk of dementia is 5x higher in those who are alcoholics than those who are not.

Differentiate abuse from neglect.

Neglect is a "failure to provide the necessary care, aid or guidance to dependent adults or children by those responsible for their care." Types of abuse include: Physical abuse - such as punching, hitting, slapping, burning etc. Sexual abuse - forcing someone to take part in sexual activity against their will.

Explain the clinical changes associated with each type of malnutrition: obesity, marasmus, kwashikor, marasmus-kwashikor mix

Obesity: Obese appearance Marasmus: Starved appearance Kwashiorkor: Well-nourished appearance Marasmus-kwashiorkor mix: Emaciated appearance

Differentiate organic brain disorder from psychiatric mental disorder.

Organic Disorder: caused by brain disease of known specific organic cause (e.g., delirium, dementia, alcohol and drug intoxication, and withdrawal). Psychiatric Mental Disorder: in which an organic etiology has not yet been established (e.g., anxiety disorder or schizophrenia).

Discuss the impact that racial and cultural diversity of individuals has on the U.S. health care system.

Racial and cultural diversity is continuously expanding in the U.S. - "In 2043 the United States is expected to become a majority-minority nation". Because the U.S. is such a "melting pot" of people, not one single approach is beneficial to every person. With that being said, in order to provide truly holistic health care, one must take into consideration ones racial and cultural backgrounds in order to provide them with the best care. It is also important to know how to treat people of different cultures, so healthcare workers across the country are traveling all over the globe to learn how to effectively meet health needs and treat people by means of their cultural backgrounds.

Differentiate routine universal screening from indicator-based screening.

Routine universal - asking all adult patients each time they are in the healthcare system, no matter what their problem or concern, whether they have experienced IPV Indicator-based - this screening is used after abuse has been indicated to determine how recent and how frequent the abuse takes place; designed to know more specific details about abuse

Identify the most common physical health problems that result from intimate partner violence.

The most obvious health problem caused by abuse from IPV is injury; including lacerations and choking. Abused women also suffer from significantly higher neurologic, gastrointestinal, and gynecologic symptoms and chronic pain. Reproductive health is also significantly affected in abused women.

State the purpose of the complete health history.

The purpose of the health history is to collect subjective data; what the person says about himself or herself. The history is combined with the objective data from the physical examination and laboratory studies to form the database. The database is used to make a judgment or a diagnosis about the health status of the individual.

Discuss the rationale for obtaining a systems review.

The purposes of this section are (1) to evaluate the past and present health state of each body system, (2) to double-check in case any significant data were omitted in the Present Illness section, and (3) to evaluate health promotion practices. The order of the examination of body systems is roughly head to toe.

Define the use of prescription opioid pain relievers for a nonmedical use.

The use of prescription opioid drugs for a nonmedical use can be defined as using it over the prescribed amount, getting the drug from a friend or relative for recreational use, or buying it off of a friend/relative or drug dealer. This is the 2nd most common form of illicit drug use.

List and define 3 major theories about how people view the causes of illness.

Theories of causation have been formulated on the basis of ethnic identity, religious beliefs, social class, philosophic perspectives, and level of knowledge. Biomedical: assumes that all events in life have a cause and effect, that the human body functions more or less mechanically, that all life can be reduced or divided into smaller parts (e.g., body, mind, and spirit), and that all of reality can be observed and measured (e.g., intelligence tests and psychometric measures of behavior). Naturalistic: Found most frequently among American Indians, Asians, and others who believe that human life is only one aspect of nature and a part of the general order of the cosmos. These people believe that the forces of nature must be kept in natural balance or harmony. Magicoreligious: The basic premise is that the world is an arena in which supernatural forces dominate.

Which mental function is the Four Unrelated Words Test intended to test?

This tests New Learning in cognitive function and the person's ability to lay down new memories.

Describe the provisions of Title VI of the Civil Rights Act of 1964.

Under the provisions of Title VI of the Civil Rights Act of 1964, when people with LEP seek health care in settings such 14as hospitals, nursing homes, clinics, daycare centers, and mental health centers, services cannot be denied to them.

Define the yin yang theory of health and illness, and relate this to different types of foods.

Yin/Yang theory is the view that health exists when all aspects of the person are in perfect balance. It states that all organisms and objects in the universe consist of yin and yang energy forces. Yin energy represents the female and negative forces such as emptiness, darkness, and cold, whereas yang forces are male and positive, emitting warmth and fullness. Foods are classified as hot (yang) and cold (yin) in this theory and are transformed into yin and yang energy when metabolized by the body. Cold foods are eaten with a hot illness, and hot foods are eaten with a cold illness.

List the barriers to evidence-based practice, both on an individual level and on an organizational level.

a. Can take up to 17yrs to implement findings into practice b. As individuals, nurses lack research skills in evaluating quality of research studies, are isolated from other colleagues knowledgeable in research, and lack confidence to implement change. c. Nurses lack time to go to the library to read research; health care institutions have inadequate library research holdings; and organizational support for EBP is lacking when nurses wish to implement changes in patient care.

List three health care interactions you have experienced yourself with another person from a culture or ethnicity different from your own. You may have been the patient or the provider—it makes no difference.

a. It is common for people of Hispanic or Caribbean descent to physically discipline their children. This often conflicted with the services we were supposed to provide. b. It was unethical as a counselor to share a meal in the home of our clients, but it was seen as disrespectful to deny food from clients that either came from the south (I worked in MA), or families from a Hispanic culture. This had to be taken into consideration when building a rapport and establishing a positive therapeutic relationship. c. This next example is not necessarily my own interaction but one I had facilitated. Sometimes, working with parents raised in another country and their children brought up here, as a therapist we had to facilitate their own interactions because although they had the same descent, the children adopted the American culture which made things difficult in the household.

For the following situations, state the type of data collection you would perform (i.e., complete database, focused or problem-centered database, follow-up database, emergency database). OxyContin overdose ______________; ambulatory, apparently well individual who presents at outpatient clinic with a rash ______________; first visit to a health care provider for a checkup ______________; recently placed on antihypertensive medication ______________.

a. OxyContin overdose: Emergency b. Rash: Focused c. Check-up: Complete d. Recently placed on new med: Follow-up

Differentiate subjective data from objective data by placing an S or an O after each of the following: complaint of sore shoulder ________; unconscious ________; blood in the urine ________; family has just moved to a new area ________; dizziness ________; sore throat ________; earache ________; weight gain ________.

a. Sore shoulder: S b. Unconscious: O c. Blood in urine: O d. Family moved to new area: S e. Dizziness: S f. Sore throat: S g. Earache: S h. Weight gain: O

List 8 items of information that should be communicated to the client concerning the terms or expectations of the interview.

a. Time and place of the interview/physical examination b. Introduction of myself and my role as the healthcare provider c. Purpose of the interview d. Duration of the interview e. Expectations of client/people involved f. Presence of anyone else during the interview g. Confidentiality agreement between myself/patient h. Any costs to the client

List and describe factors related to socialization.

• Acculturation: the process of social and psychological exchanges that take place when there are ongoing encounters between individuals of different cultures, with subsequent 15changes in either or both groups. • Assimilation: to take on the characteristics of the dominant culture. • Biculturalism: biculturalism and integration are bidirectional and bi-dimensional, inducing reciprocal changes in both cultures and maintaining aspects of the original culture in one's ethnic identity.

Explain 4 factors that could affect a patient's response to the mental status examination but have nothing to do with mental disorders.

• Any known illnesses or health problems such as alcohol use disorders or chronic renal disease • Current medications with side effects that may cause confusion or depression • The usual educational and behavioral level—note that factor as the normal baseline and do not expect performance on the mental status examination to exceed it • Responses to personal history questions indicating current stress, social interaction patterns, sleep habits, drug and alcohol use

Identify important elements of assessment for an abused person.

• Completing a head-to-toe physical exam • Taking down history of the abused person • Documentation of the abuse in pictures and writing • Assessing risk of homicide

Identify risk factors that may contribute to child maltreatment.

• Disabilities or chronic illnesses in children that may increase caregiver burden • Social isolation of families • Parents' lack of understanding of children's needs and of child development • Poverty and other socioeconomic disadvantages such as unemployment and low educational achievement • Family disorganization, dissolution, and violence, including IPV • Substance abuse in family • Young, single, non-biological parents • Poor parent-child relationships and negative interactions • Parental thoughts and emotions supporting maltreatment behaviors • Parental stress and distress, including depression or other mental health conditions • Community violence

Identify commonly used screening questions for older adult abuse.

• Has anyone prevented you from getting food, clothes, medication, glasses, hearing aids, or medical care, or from being with people you wanted to be with? • Have you been upset because someone talked to you in a way that made you feel shamed or threatened? • Has anyone made you afraid, touched you in ways you do not want, or hurt you physically?

List at least 4 questions you could ask a patient that would screen for suicide ideation.

• Have you ever felt that life is not worth living? • Have you ever felt so blue that you thought of hurting yourself? • Do you feel like hurting yourself now? • Do you have a plan to hurt yourself?

Describe the patient response level of consciousness that would be graded as: lethargic/somnolent, obtunded, stupor/semicoma, come, delirium

• Lethargic or somnolent: Not fully alert; drifts off to sleep when not stimulated; can be aroused to name when called in normal voice but looks drowsy; responds appropriately to questions or commands but thinking seems slow and fuzzy; inattentive; loses train of thought; spontaneous movements are decreased. • Obtunded: Sleeps most of time; difficult to arouse—needs loud shout or vigorous shake; acts confused when is aroused; converses in monosyllables; speech may be mumbled and incoherent; requires constant stimulation for even marginal cooperation. • Stupor or semicoma: Spontaneously unconscious; responds only to persistent and vigorous shake or pain; has appropriate motor response (i.e., withdraws hand to avoid pain); otherwise can only groan, mumble, or move restlessly; reflex activity persists. • Coma: Completely unconscious; no response to pain or any external or internal stimuli (e.g., when suctioned, does not try to push the catheter away); light coma has some reflex activity but no purposeful movement; deep coma; has no motor response. • Delirium: Clouding of consciousness (dulled cognition, impaired alertness); inattentive; incoherent conversation; impaired recent memory and confabulatory for recent events; often agitated and having visual hallucinations; disoriented, with confusion worse at night when environmental stimuli are decreased.

List 4 situations in which it would be necessary to perform a complete mental status examination.

• Patients whose initial brief screening suggests an anxiety disorder or depression. • Family members concerned about a person's behavioral changes such as memory loss or inappropriate social interaction. • Brain lesions (trauma, tumor, stroke). • Symptoms of psychiatric mental illness, especially with acute onset.

Identify some of the important elements of the child's medical history when assessing for suspected child maltreatment.

• Previous hospitalizations • Injuries • Chronic medical conditions • Frequent hospital visits • Delays in seeking care • Financial/social stress on family

List 2 potential sources of lethality in intimate partner violence situations.

• Suicide • Homicide

Identify commonly used screening questions for intimate partner violence.

• When you and your partner argue, are you ever afraid of him or her? • Does your partner try to control you? Where you go? Who you see? How much money you can have? • Has your partner ever forced you into sex when you did not want to participate?