Health Assessment Exam 1
_______ questions lead patient to focus on one set of thoughts. Most often used in reviewing systems and evaluating functional status
directive
Which type of verbal communication: - clarifies inconsistent information - focuses client's attention on an observed behavior, action, or feeling
confrontation
What are the last four verbal responses, in which you start to express your own thoughts and feelings? (Examiner leads)
confrontation, interpretation, explanation, summary
In which letter of SBAR do you: - State your assessment findings. This can include what you found and what you think may be wrong.
A (assessment)
A nurse assesses a patient. The nurse will document the following as subjective data . Select all that apply: - 1. I vomited 3 times - 2. Nausea - 3. "Every time I had a bowel movement there was bleeding" - 4. heart sounds abnormal - 5. tachycardia
1, 2, 3
How many traps of interviewing are there?
10
The nurse assesses a patient in the ER (it is a rural area and all of the Urgent Care Clinics are closed). Patient reports falling at home after feeling dizzy. She is complaining of her "knee" hurting. The nurse will do which type of assessment? - 1. focused (problem based) - 2. emergency - 3. comprehensive - 4. follow-up
3
Which letter of SBAR is this example of: - "Ms. Carpenter is rating her pain at 10/10 with no relief from medication. She is reluctant to ambulate, refusing physical therapy. Pedal pulses are 2+, equal bilaterally, surgical site is within normal limits without signs of infection"
A (assessment)
In which letter of SBAR do you: - state the data pertinent to this moments problem: admitting diagnosis, when admitted, and appropriate immediate assessment data (e.g., vital signs, pulse oximetry, change in mental status, allergies, current medications, IV fluids, laboratory results) - do not recite the patient's full history since admission
B (background)
Which letter of SBAR is this example of: - "She has no significant medical history. Yesterday night she has a right knee replacement. Her VS are: HR 126, R 20, BP 140/96. Her labs are within expected parameters. She has an order for Tylenol 650mg every 4 hours for mild/moderate pain and morphine 1-4mg every 2 hours for breakthrough pain. She has no medication allergies and has been consistently taking her pain medication."
B (background)
Which trap of interviewing is this example: Problem- - A young woman who has just met with her physician about infertility issues says, "Dr. Compton just. told me that I have to get surgery and that, if I don't, I won't be able to get pregnant. What would you do?" and then you answer with, "If I were you..." - You cannot make decisions for the client and providing this type of answer would shift the accountability to you rather than the client Solution- - Instead, you could answer with things such as "What are your concerns about the recommendation?" or "What are the pros and cons of this choice for you?" - This takes the time to involve the patient in a problem solving process
Giving unwanted advice
Which type of verbal communication is shown in this example: - "It seems that every time you feel the stomach pain, you have some type of stress in your life." - Client: "I don't want any more treatment, but I can't seem to tell the doctor I'm ready to stop." - Response: "Could it be that you're afraid of her reaction?"
Interpretation
What type of questions are these: - "Tell me how I can help you." - "What brings you to the hospital?" - "You mentioned shortness of breath. Tell me more about that."
Open-ended questions
What letter of PQRSTU is assessed by these questions: - What brings it on? - What were you doing when you first noticed it? - What makes it better? - What makes it worse?
P (provocative or palliative)
What pneumonic do you use to gather the history of the present health concern?
PQRSTU
What does the letter P in PQRSTU stand for?
Provocative or palliative
What letter of PQRSTU is assessed by these questions: - how does it look, feel, sound? - how intense/severe is it?
Q (quality or quantity)
What does the letter Q in PQRSTU stand for?
Quality or quantity
In which letter of SBAR do you: - state what you want/need to continue caring for the patient
R (recommendation/request)
Which letter of SBAR is this example of: - "I believe Ms. Carpenter would benefit from a different pain medication regimen such as scheduled tramadol with oral hydrocodone for more severe pain. What would you like to order for Ms. Carpenter?"
R (recommendation/request)
What letter of PQRSTU is assessed by these questions: - Where is it? - Does it spread anywhere?
R (region or radiation)
What does the letter R in PQRSTU stand for?
Region or radiation
What letter of PQRSTU is assessed by these questions: - How bad is it (on a scale of 0 to 10)? - Is it getting better, worse, or staying the same?
S (Severity)
In which letter of SBAR do you: - state your name, your unit, patient's name, room number, patient's problem, when it happened or when it started, and the severity
S (situation)
Which letter of SBAR is this example of: - "This is Sue in the ortho unit. I am calling about pain control for Ms. Carpenter in room 15."
S (situation)
What is the standard communication format that is used when nurses communicate with physicians and sometimes in shift changes (helps us to use a standardized format to ensure continuity in patient treatment)?
SBAR
What does SBAR stand for?
Situation, Background, Assessment, Recommendation
Assessment- - provides us with the patient's _____ - different from what is expected/considered as within "normal limits" - identifies what the patient needs - identifies problems requiring immediate referral - identifies problems requiring assistance from other team members (interdisciplinary care)
baseline
Which type of health assessment is used with a new patient, provides information about past and present history, life-style, and obtains baseline?
complete
Components of the _______ health history- - biographic data- initial visit - reason for seeking care - present health status - family history - personal and psychosocial history - review of all body system
comprehensive
What type of verbal communication is shown in this example: - "You look sad," or "You sound angry." - "Earlier you said you didn't drink, but just now you said that you go out every night after work for 1-2 beers." - "When I press here, you grimace, but you said it doesn't hurt."
confrontation
History of Present Illness: _______ complaint or presenting problem- - brief statement regarding purpose for visit - recorded in direct quotes from the patient - multiple reasons: list and prioritize - patient may not give reasons until comfortable - patient condition determines next step (e.g. urgencies such as chest pain, difficult breathing etc. delay routine data) Include all of the following- - Symptomology: onset, location and duration, relate and alleviating factors, attempts at self-treatment
chief
What type of verbal communication: - is useful when a person's word choice is ambiguous or confusing - summarizes the person's words, simplifies the statement, and ensures that you are on the right track
clarification
What type of verbal response is shown in this example: - Response: "The heaviness in your chest occurs with walking up 1 flight of stairs or more than 1 block, but it stops when you rest. Is that correct?" - Client: "Yes, that's it."
clarification
______ or ______ questions ask for specific information. They elicit a one- or two-word answer, a "yes" or "no," or a forced choice. They help you illicit specific information and are useful to fill in any details that were initially left out after the person's opening narrative.
closed or direct
What type of questions are these: - "Where are your headaches located?" - "Do you exercise?"
closed or direct questions
Interviewing acutely ill people: - emergent situations require ______ the interview and the physical examination. In this case focus the interview on pertinent information only, including history of present illness, medications, allergies, last meal, and basic health state
combining
Interviewing people with a hearing impairment: - people with a hearing impairment may feel isolated and anxious because they cannot understand everything that is happening. Ask the person their preferred way to _________- by signing, lipreading, or writing. If the person has hearing aids, make sure that he or she is using them properly
communication
Which phase of the interview is this: - facilitate, collect, and record health history and data - keep it patient centered- that is, patients share their concerns, beliefs, and values in their own words - nurse facilitates, collects, and records data - nurse promos questions and takes brief notes
discussion (working)
Which trap of interviewing is this example: Problem- - Saying "There is a lump in the left breast," rather than saying "your." - This allows the person to deny association with the disease and protect themselves from it - this can communicate that you're afraid of the procedure or disease Solution- - Use specific language and blunt terms to indicate that your are not fearful of the disease or procedure to help decrease anxiety and help client cope with the reality of the situation
distancing
Which type of health assessment is rapid and used in a life-threatening situation (choking, drowning, cardiac arrest)?
emergency
Displays of _____: - crying is natural and should be expected - postpone further questioning until the patient is ready - a compassionate response enhances relationship - deal with anger directly - identify source of anger - discuss approaches and acknowledge feelings of anger
emotion
What type of verbal communication is shown in this example: - Client (sarcastically): "This is just great! I own a business, direct my employees; now I can't even go to the bathroom without help." - Response: "It must be hard - one day having so much control and now feeling dependent on someone else." - Other responses include: "This must be very hard for you," or just placing hand on person's arm
empathy
What type of verbal communication: - names a feeling and allows its expression - allows person to feel accepted and strengthens rapport - useful in instances when the client hasn't identified the feeling or isn't ready to discuss it
empathy
________ means viewing the world from the other person's inner frame of reference. The ability to understand and be sensitive to the feelings of someone else.
empathy
Which type of verbal communication is shown in this example: - "You order your dinner from the menu provided, and it takes approximately 30 minutes to arrive." - "You may note or drink for 12 hours before your blood test because the food may change the results."
explanation
Which type of verbal communication: - informs person - shares factual and objective information
explanation
What type of verbal response consists of: - saying "Mm-hmmm, go on, uh-huh" - maintaining eye contact -shifting forward, and nodding yes
facilitation
What type of verbal response: - encourages the client to say more - shows the person that you are interested
facilitation
What are the first 5 types of verbal responses, in which you involve your reactions to the facts or feelings that the person has communicated? (Client leads)
facilitation, silence, reflection, empathy, clarification
What are the 9 types of verbal responses?
facilitation, silence, reflection, empathy, clarification, confrontation, interpretation, explanation, summary
Which type of health assessment do you use when there is an existing database and a specific health concern (does not cover non-related areas)?
focused or problem based
which type of health assessment is used for an annual exam or to see if a previous problem has improved (may include "mini-assessment" of previous findings, e.g. "mini-mental exam)?
follow up
________ ________: - refers to the "history" and "physical assessment" - usually the first thing she do when the patient comes into the hospital
health assessment
Which type of verbal communication: - links events, makes associations, and implies cause - is not based on direct observations, but instead on inference or conclusion - may be incorrect but helps prompt further discussion
interpretation
While a pt is in the hospital, we do "ongoing assessments"- referred to as the "______ assessment"
patient
Which trap of interviewing is this example: Problem- - cutting a client off if you think you know what they are going to say next - this is not good, because you are signaling boredom or impatience - you are unable to fully understand what the person is saying Solution- - leave at least a second of space between the end of the client speaking and your next statement to ensure that the client is finished
interrupting
It is important to refuse _______ during a patient interview. You need to concentrate and establish rapport.
interruptions
What methods are used to obtain subjective data?
interview
Which phase of the interview is this: - prepare the patient for what to expect
introduction
what are the 3 phases of an interview?
introduction, discussion (working), summary
Challenges to the interview- ______ barriers: - interpreter should be objective observer, same gender, and not a family member - takes more time to obtain the most important data
language
Answering _____ questions: - brief direct answer - share experiences that support the patient - enhance relationship and increase credibility
personal
Challenges to the interview- Managing overly _____ patients: - overly detailed problems may become a distraction - refocus interview on events relative to the patient - redirect conversation with closed ended questions that may help reduce distractions
talkative
What type of communication is your body language (posture, gestures, facial expression, eye contact, foot tapping, touch, even where you place your chair)?
nonverbal communication
Excessive ______-______ during a patient interview can have many disadvantages: - breaks eye contact way too often - it shifts your attention away from the person, diminishing their sense of importance - it may cause the person to slow his or her tempo and they lose their natural mode of expression - it is threatening to the client during the discussion of sensitive issues (e.g., alcohol and illicit drug use, number of sexual partners, or incidence of abuse)
note taking
Sources for _______ data: - observation and physical assessment findings of the nurse or others, documentation of assessments made in health record, and observation made by the patient's family or SO
objective
These skills are needed to obtain ______ data: - inspection - palpation - percussion - auscultation
objective
what type of data are these examples of: - RR 16 - BP 180/110 - AP 80 - X-Ray: fractured pelvis
objective
What you obtain through physical examination is considered to be what type of data?
objective data
What methods are used to obtain objective data?
observation and physical assessment
When interviewing the ______ adult: - always address the person by his or her proper surname, and avoid using the first name (it can demonstrate a lack of respect - plan accordingly with your time, do to the fact that these adults usually have a longer story to tell
older
_____-______ questions ask for narrative information, It states the topic to be discussed but only in general terms. Use it to begin the interview, to introduce a new section of questions, and whenever the person introduces a new topic. This type of question is unbiased and leaves the person free to answer in any way. It lets the person express themselves fully.
open-ended
What type of question do you use to open an interview?
open-ended questions
It is important to ensure _____ when conducting a patient interview. You can do this by using a private room, or pulling a curtain.
privacy
Which trap of interviewing is this example: Problem- - A pregnant woman says, "I've been spotting on and off all day, and I haven't felt the baby kick. I just know I'm going to miscarry." and your response is "Don't worry. I'm sure you and the baby will be fine." Solution- - This type of answer trivializes the woman's anxiety and closes off communication. You have promised something that may not be true, which can diminish rapport. Instead you can say things such as, "You're really worried about your baby, aren't you?" or "It must be hard to wait for the doctor. Is there anything I can get you or anything that you'd like to talk about?" These responses acknowledge the feeling and open the door for more communication.
providing false assurance or reassurance
What is the term for establishing a "professional relationship" between you ant the patient?
rapport
What type of verbal communication is shown in this example: - Client: "It's so hard having to stay in bed during my pregnancy. I have kids at home that I'm worried about." - Response: "You feel anxious and worried about your children?"
reflection
What type of verbal communication: - echoes the client's words by repeating part of what the person has just said -can help express feelings behind words - mirrors client's words and can help them elaborate on the problem
reflection
Challenges to the interview- When there are others in the room: - do not assume _______; it is best to clarify - parent or guardian may answer for the child - interview adolescents directly - for adults unable to answer, another person may assist
relationships
When introducing the interview it is importance to keep the introduction short and formal. You address the person using their surname, and avoid using the first name unless directed otherwise. If you are unsure how to correctly pronounce the name, ask the patient. Interest in pronunciation shows ______.
respect
What does the letter S in PQRSTU stand for?
severity
What type of verbal response consists of: - waiting for response without interruption - sitting quietly (don't fidget) - counting silently from 1 to 10
silence
What type of verbal response: - communications that the client has time to think - helps the client to not lose their train of thought - provides you with a chance to observe the client and note nonverbal cues
silence
While a pt is in the hospital, we do "_____ assessments" on patients, such as: skin assessment, fall risk assessment, pressure injury risk assessment
special
Gathering subjective data in an interview is an opportunity to start building a _______ relationship with the patient
subjective
Sources for _______ data: - patient, family and SO, health record, and other health care professionals
subjective
These skills are needed to obtain ______ data: - interview and therapeutic communication skills - caring ability and empathy - listening skills
subjective
What type of data are these examples of: - "I have a headache" - "It frightens me" - "I am not hungry"
subjective
what the person says about himself or herself during the interview is considered to be what type of data?
subjective data
Which phase of the interview is this: - data collection the foundation for personalized and effective health care - allows for clarification of data and provides validation of accurate understanding - provides closure
summary
Which type of verbal communication: - condenses facts and validates what was discussed during the interview - signals that termination of the interview is imminent - Both the client and the examiners should be active participants - reviews pertinent facts - allows client time to make corrections
summary
Which trap of interviewing is this example: Problem- - associating helpfulness with verbal productivity/ thinking that they have met the client's needs because they have talked through everything - this is not good because the client may just let you talk and not get the chance to express themselves Solution- - Listen more than you talk
talking too much
What does the letter T in PQRSTU stand for?
timing
What does the letter U in PQRSTU stand for?
understanding
Which trap of interviewing is this example: Problem- - Asking questions such as "Why did you wait so long before coming to the hospital if you were having chest pain?" - this is not good because it usually implies blame and puts the person on the defensive - this type of question makes you sound accusatory and judgmental and makes the client come up with an excuses to rationalize their behavior Solution- - Say something like, "I see you started to have chest pain early in the day. What was happening between the time the pain started and the time you came to the emergency department?"
using "why" questions
Which trap of interviewing is this example: Problem- - Saying "Your doctor/nurse knows best." - This response promotes dependency and inferiority and diminishes the client's concerns. Solution- - Using authority should be avoided. Even though you have more professional knowledge, you both have equally important roles and the client must make the final decision about their health
using authority
Which trap of interviewing is this example: Problem- - Using euphemisms such as "passed on" or "has gone to a better place" to avoid discussing an unpleasant topic. - This promotes the avoidance of reality and allows people to hide their feelings. Solution- - Use direct language to deal with frightening or uncomfortable topics
using avoidance language
Which trap of interviewing is this example: Problem- - Asking a client, "You don't smoke, do you?" or "You don't ever have unprotected sex, correct?" - This implies that one answer is "better" than the other and may cause the client to feel guilty and answer falsely in order to please you Solution- - Ask unbiased question so that you do not lead clients to answer in the "correct" way - For example, ask questions like "Do you smoke?" or "When you have sexual intercourse, do you use protection?"
using leading or biased questions
Which trap of interviewing is this example: Problem- - assuming that a client using medical jargon means that they understand the correct meaning - this can be a problem because the client might think something like "hypertensive" means tense, which could cause them to only take their meds when they are feeling tense rather than taking it all the time Solution- - adjust vocabulary to ensure understanding - correct misinformation immediately to ensure compliance
using professional jargon