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NURS550: Advanced Health Assessment and Diagnostic Reasoning Week #1 Guided Reading, Exams of Nursing

Newcastle UniversityNursing

NURS550: Advanced Health Assessment and Diagnostic Reasoning Week #1 Guided Reading Questions with complete solution 2025

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NURS550: Advanced Health Assessment
and Diagnostic Reasoning Week #1
Guided Reading
Chapter 1 (p 4-34) - correct answer FOUNDATIONS FOR CLINICAL PROFICIENCY
1. Describe the differences between
a. A comprehensive health history/exam - correct answer Includes all the elements of the health history
and the complete physical examination.
- 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
b. A focused health history/exam - correct answer Assesses symptoms restricted to a specific body
system (eg. sore throat or knee pain)
Applies examination methods relevant to assessing the concern or problem as thoroughly and carefully
as possible
The patient's symptoms, age, and health history help determine the scope of the focused examination,
as does your knowledge of disease pattern
2. Identify examples of when you would obtain (2 examples for each):
a. A comprehensive health history/exam - correct answer Is appropriate for new patients in the office or
hospital
b. A focused health history/exam - correct answer Is appropriate for established patients, especially
during routine or urgent care visits
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Download NURS550: Advanced Health Assessment and Diagnostic Reasoning Week #1 Guided Reading and more Exams Nursing in PDF only on Docsity!

NURS550: Advanced Health Assessment

and Diagnostic Reasoning Week

Guided Reading

Chapter 1 (p 4-34) - correct answer FOUNDATIONS FOR CLINICAL PROFICIENCY

  1. Describe the differences between a. A comprehensive health history/exam - correct answer Includes all the elements of the health history and the complete physical examination.
  • 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 b. A focused health history/exam - correct answer Assesses symptoms restricted to a specific body system (eg. sore throat or knee pain) Applies examination methods relevant to assessing the concern or problem as thoroughly and carefully as possible The patient's symptoms, age, and health history help determine the scope of the focused examination, as does your knowledge of disease pattern
  1. Identify examples of when you would obtain (2 examples for each): a. A comprehensive health history/exam - correct answer Is appropriate for new patients in the office or hospital b. A focused health history/exam - correct answer Is appropriate for established patients, especially during routine or urgent care visits

Addresses focused concerns or symptoms ( eg. sore throat or knee pain)

  1. Discuss the differences between subjective and objective data - correct answer Subjective data: is what the patient tells you Objective data: what you detect during the examination, laboratory information and test data a. Provide examples of what would constitute Subjective data - correct answer The symptoms and history, from Chief Complaint through Review of Systems Example: Mrs. G. is a 54-year-old hairdresser who reports pressure over her left chest "like an elephant sitting there," which goes into her left neck and arm. b. Provide examples of what would constitute Objective data - correct answer All physical examination findings, or signs Example: Mrs. G. is an older, overweight white female, who is pleasant and cooperative. Height 5 4 ,′ ′′ weight 150 lbs, BMI 26, BP 160/80, HR 96 and regular, respiratory rate 24, temperature 97.5 °F
  2. Identify what goes into each section of the comprehensive health history a. Identifying data and source of history - correct answer Identifying data—such as age, gender, occupation, marital status Source of the history—usually the patient, but can be a family member or friend, letter of referral, or the clinical record If appropriate, establish the source of referral, because a written report may be needed b. Chief complaint - correct answer The one or more symptoms or concerns causing the patient to seek care. Note: make every attempt to quote the pt's own words. Eg. "my stomach hurts and I feel awful" c. History of present illness - correct answer Is a complete, clear, and chronologic description of the problems prompting the patient's visit, including the onset of the problem, the setting in which it developed, its manifestations, and any treatments to date. Pulls in relevant portions of the Review of Systems, called "pertinent positives and negatives" (see p. 11)

a. Identify abnormal findings - correct answer Make a list of the patient's symptoms, the signs you observed during the physical examination, and any laboratory reports avail- able to you. b. Localize findings anatomically - correct answer Clearly localize the symptom to either an organ, location or system. When localizing findings, be as specific as your data allows, however you might have to settle for a body region such as the chest or a body system such as the musculoskeletal system. Eg. scratch throat and the sign of erythematous inflamed posterior pharynx clearly localize the problem to pharynx c. Cluster the clinical findings - correct answer Pt age: eg. younger adults are more likely to have a single disease, whereas old adults tend to have multiple diseases. Timing of symptoms Involvement of different body systems: may help group clinical data ( if S &S occur i a single system, one disease may explain them) Multisystem condition Key questions: ask a series of key questions that may steer your thinking in one direction and allow you to temporarily ignore the others d. Search for the probable cause of the findings - correct answer Pt c/o often stem from a pathologic process involving diseases of a body system or structure. These processes are commonly classified as congenital, inflammatory or infectious, immunologic, neoplastic, metabolic, nutritional, degenerative, vascular, traumatic, and toxic. Eg. Possible pathologic causes of headache, for example, include sinus infection, concussion from trauma, subarachnoid hemorrhage, or even compression from a brain tumor. e. Cluster the clinical data - correct answer f. Generate hypotheses about the cause of the patient's problem Read Steps for Generating Clinical hypotheses table on page #27 - correct answer Draw on the full range of your knowledge and experience, and read widely ( about diseases & abnormalities). By consulting the clinical literature, you embark on the lifelong goal of evidence-based decision making and clinical practice.

g. Test the hypotheses and establish a working diagnosis - correct answer You are likely to need further history, additional maneuvers on physical examination, or laboratory studies or x-rays to confirm or r/o your tentative diagnosis or to clarify which of two or three possible diagnoses are most likely. A hypothesis is a theory without confirmatory evidence - correct answer A diagnosis requires evidence to support the theory Chapter 3 (p 65-86) - correct answer INTERVIEWING AND THE HEALTH HISTORY

  1. Review the techniques for guided questioning to expand and clarify the patient story - correct answer ● Moving from open-ended to focused questions. ● Using questioning that elicits a graded response: rather than a yes-no answer. ● Asking a series of questions, one at a time ● Offering multiple choices for answers ● Clarifying what the patient means ● Encouraging with continuers: Without even speaking, you can use posture, gestures, or words to encourage the patient to say more. ● Using echoing: repeating the pt's last word.
  2. Identify 2-3 examples for each type of questioning: a. Open-ended questions - correct answer " Tell me about your chest discomfort" "What brings you here today?" "Tell me more about that" b. Closed-ended questions - correct answer " Has your pain been improving? "Is your pain like a pressure?" c. A question eliciting a graded response - correct answer "How many steps can you climb before you get short of breath? d. A question asking for clarification - correct answer "Tell me exactly what you mean by 'the flu'"

b. Identify the BMI range for a healthy/normal weight patient - correct answer 18.5-24.9 kg/m c. Identify the BMI range for an overweight patient - correct answer 25.0-29.9 kg/m d. Identify the BMI range for an obese patient (class I) - correct answer 30.0-34.9 kg/m e. Identify the BMI range for an obese patient (class II) - correct answer 35.0-39.9 kg/m f. Identify the BMI range for an extremely obese patient (class III) - correct answer >40 kg/m

  1. Discuss the education/counseling you would provide to a patient based on their BMI a. Identify what education/counseling you would provide to a patient who is determined to be underweight - correct answer b. Identify what education/counseling you would provide to a patient who is determined to be overweight - correct answer Walk 30 to 60 minutes 5 or more days a week, or a total of at least 150 minutes a week. The total calorie deficit goal, usually 500 to 1,000 kilocalories a day, is more important than the type of diet. Portion-controlled meals, meal planning, food diaries, and activity records. c. Identify what education/counseling you would provide to a patient who is determined to be obese (class I, II or III) - correct answer
  2. What components are included in the general survey? - correct answer ● Apparent state of health Acute or chronically ill, frail Posture, gait and motor activity ● Level of consciousness Awake, alert, responsive or lethargic, obtunded, comatose ● Signs of distress Cardiac or respiratory; pain; anxiety/depression

● Skin color and obvious lesions ● Dress, grooming, and personal hygiene Appropriate to weather and temperature Clean, properly buttoned/zipped ● Facial expression Eye contact, appropriate changes in facial expression ● Odors of body and breath ● Posture, gait, and motor activity

  1. Discuss the steps to ensure accurate blood pressure measurement - correct answer Avoid smoking or drinking caffeinated beverages 30 minutes prior to measurement Ensure that the room is quiet and comfortably warm Patient should be seated quietly in a chair with feet on the floor for at least 5 minutes Use patient's bare arm Using the right Cuff Size and Position ● Width: 40% of upper arm circumference ● Length: 80% of upper arm circumference
  2. Identify how to obtain and document the following a. Heart rate and rhythm From powerpoint Radial pulse is commonly used to measure the heart rate Use the pads of the index and middle fingers Count 30 seconds (if rate is 50-90 and rhythm regular) Count 60 seconds (if rate is <50 or >90 and/or rhythm is irregular) - correct answer Count the heart rate for one minute by palpating the radial pulse with your fingers, or by listening for the apical pulse with your stethoscope at the cardiac apex. With the pads of your index and middle fingers, compress the radial artery until a maximal pulsation is detected. If the rhythm is regular and the rate seems normal, count the rate for 30 seconds and multiply
  1. Numeric Rating Scale
  2. Wong- Baker FACES Pain Rating Scale.
  3. Define the types of pain a. Nociceptive or somatic Tissue damage - correct answer Pain linked to tissue damage to the skin, musculoskeletal system, or viscera (visceral pain), but the sensory nervous system is intact, as in arthritis or spinal stenosis. It can be acute or chronic. It is mediated by the afferent A-delta and C-fibers of the sensory system. The involved afferent nociceptors can be sensitized by inflammatory mediators and modulated by both psychological processes and neurotransmitters like endorphins, histamines, acetylcholine, serotonin, norepinephrine, and dopamine. b. Neuropathic - correct answer Direct trauma to the peripheral or central nervous system Mechanisms postulated to evoke neuropathic pain include central nervous system brain or spinal cord injury from stroke or trauma; peripheral nervous system disorders causing entrapment or pressure on spinal nerves, plexuses, or peripheral nerves; and referred pain syndromes with increased or prolonged pain responses to inciting stimuli. c. Idiopathic - correct answer pain without an identifiable etiology. d. Psychogenic - correct answer pain involves the many factors that influence the patient's report of pain —psychiatric conditions like anxiety or depression, personality and coping style, cultural norms, and social support systems.