Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

NR 511 Week 4 Midterm Exam (Version2 Over 100, Q&A)100%Latest 2022/2023 ADVANCED PHYSICAL, Exams of Nursing

NR 511 Week 4 Midterm Exam (Version2 Over 100, Q&A)100%Latest 2022/2023 ADVANCED PHYSICAL ASSESSMENT: CHAMBERLAIN/NR 511 Week 4 Midterm Exam (Version2 Over 100, Q&A)100%Latest 2022/2023 ADVANCED PHYSICAL ASSESSMENT: CHAMBERLAINNR 511 Week 4 Midterm Exam (Version2 Over 100, Q&A)100%Latest 2022/2023 ADVANCED PHYSICAL ASSESSMENT: CHAMBERLAINNR 511 Week 4 Midterm Exam (Version2 Over 100, Q&A)100%Latest 2022/2023 ADVANCED PHYSICAL ASSESSMENT: CHAMBERLAINNR 511 Week 4 Midterm Exam (Version2 Over 100, Q&A)100%Latest 2022/2023 ADVANCED PHYSICAL ASSESSMENT: CHAMBERLAINNR 511 Week 4 Midterm Exam (Version2 Over 100, Q&A)100%Latest 2022/2023 ADVANCED PHYSICAL ASSESSMENT: CHAMBERLAINNR 511 Week 4 Midterm Exam (Version2 Over 100, Q&A)100%Latest 2022/2023 ADVANCED PHYSICAL ASSESSMENT: CHAMBERLAINNR 511 Week 4 Midterm Exam (Version2 Over 100, Q&A)100%Latest 2022/2023 ADVANCED PHYSICAL ASSESSMENT: CHAMBERLAINNR 511 Week 4 Midterm Exam (Version2 Over 100, Q&A)100%Latest 2022/2023 ADVANCED PHYSICAL ASSES

Typology: Exams

2022/2023

Available from 08/11/2023

studymaster1
studymaster1 🇺🇸

2.9

(7)

193 documents

Partial preview of the text

Download NR 511 Week 4 Midterm Exam (Version2 Over 100, Q&A)100%Latest 2022/2023 ADVANCED PHYSICAL and more Exams Nursing in PDF only on Docsity!

NR 511 Week 4 Midterm Exam (Version2 Over 100,

Q&A)100%Latest 202 2 /202 3 ADVANCED PHYSICAL

ASSESSMENT: CHAMBERLAIN

1. Define diagnostic reasoning Reflective thinking because thhe process involves questioning one's thinking to determine if all possible avenues have been explored & if thhe conclusions that are being drawn are based on evidence. Seen as a kind of critical thinking. I. What is subjective data? Anything thhe patient tells you or complains of regarding thheir symptoms Chief complaint HPI ROS II. What is objective data? Anything YOU can see, touch, feel, hear, or smell as part of your exam Includes lab data, diagnostic test results, etc. III. Identify components of HPI Specifically related to thhe chief complaint only Detailed breakdown of CC OLDCARTS IV. Describe thhe differences between medical billing & medical coding. Medical billing: process of submitting & following up on claims made to a payer in order to receive payment for medical services rendered by a healthcare provider Medical coding: thhe use of codes to communicate with payers about which procedures were performed & why.

V. Compare & contrast thhe two coding classification systems that are currently used in thhe US healthcare system. ICD: International classification of disease codes are used to provide payer info on necessity of visit or procedure performed. Shorth& for pt's dx. CPT: common procedural terminology codes offer thhe official procedural coding rules & guidelines required when reporting medical services & procedures performed by physician & non-physician providers. Must have corresponding ICD. VI. How do specificity, sensitivity, & predictive value contribute to thhe usefulness of diagnostic data? Specificity: ability of a test to correctly detect a specific condition. If a pt has a condition but test is negative, it is a false negative. If pt does NOT have condition but test is

positive, it is false positive. Sensitivity: test that has few false negatives. Ability of a test to correctly identify a specific condition when it is present. Thhe higher thhe sensitivity, thhe lesser thhe likelihood of a false negative. Predictive value: Thhe likelihood that thhe pt actually has thhe condition & is, in part, dependent upon thhe prevalence of thhe condition in thhe population. If a condition is highly likely, thhe positive result would be more accurate. Diagnostic tests can be used to confirm or rule out hypothheses. Diagnostic tests may be used to screen for conditions. Diagnostic tests may be used to monitor thhe progress in managing a chronic condition. VII. Discuss thhe elements that need to be considered when developing a plan. Pt's preferences & actions Research evidence Clinical state/circumstances Clinical expertise VIII. Describe thhe components of medical decision making in E&M coding. Risk, data, diagnosis Thhe more time & consideration involved in dealing with a pt, thhe higher thhe reimbursement from thhe payer. Documentation must reflect MDM IX. Correctly order thhe E&M office visit codes based on complexity from least to most complex. New pt:

  1. Minimal/RN visit: 99201
  2. Problem focused: 99202
  3. Exp&ed problem focused: 99203

Established pt:

    1. Detailed:
    1. Comprehensive:
    1. Minimal/RN visit:
    1. Problem focused:
    1. Exp&ed problem focused:
    1. Detailed:
    1. Comprehensive:

11. Thhe 5 key components of a comprehensive treatment plan are:

  1. Diagnostics
  2. Medication
  3. Education
  4. Referral/consultation
  5. Follow-up planning 12. Define thhe components of a SOAP note. S: subjective (what thhe pt tells you) CC HPI PMH Fam Hx Social Hx ROS O: objective (what you can see, hear, feel on exam) Physical findings Vital signs General survey HEENT Etc... A: assessment Global assessment of pt including differentials in order from most to least likely Combination of subjective & objective info List of dx addressed & billed for at thhe visit P: plan What you will Rx When to come back Diagnostic tests Pt education

13. Discuss minimum of three purposes of thhe written history & physical in relation to thhe importance of documentation. Important reference document that gives concise info about thhe pt's hx & exam findings Outlines a plan for addressing issues that prompted thhe visit. Info should be presented in a logical fashion that prominently features all data relevant to thhe pt's condition. Is a means of communicating info to all providers involved in pt's care Is a medical-legal document

Is essential in order to accurately code & bill for services

14. Why does every procedure code need a corresponding diagnosis code? Diagnosis code explains thhe necessity of thhe procedure code. Insurance won't pay if thhey don't correspond. 15. What are thhe three components required in determining an outpatient, office visit E&M code? Plan of service Type of service Patient status 16. Correctly ID a pt as a new or established given historical info. Pt status: whethher or not pt is new or established. New: has not received professional service from provider in same group within past 3 years. Established: has received professional service from provider in same group in last 3 years. 17. What does a well-rounded clinical experience mean? Includes seeing kids from birth through young adult visits for well child & acute visits, as well as adults for wellness or acute/routine visits. Seeing a variety of pt's, including 15% of peds & 15% of women's health of total time in thhe program. 18. What are thhe maximum number of hours that time can be spent "rounding" in a facility? No more than 25% of total practicum hours in thhe program 19. What are 9 things that must be documented when inputting data into clinical encounter logs? Date of service

Age Gender & ethnicity Visit E&M code CC Procedures Tests performed/ordered Dx Level of involvement

20. What does thhe acronym SNAPPS st& for?

S: summarize (present pt's H&P findings) N: narrow (based on H&P, narrow down top 2 - 3 differentials) A: analyze (compare/contrast H&P findings for each differential & narrow it down to most likely one) P: probe (ask preceptor questions of anything you are unsure of) P: plan (come up with specific management plan) S: Self-directed learning (opportunity to investigate more about topics you are uncertain of)

21. What is thhe most common type of pathogen responsible for acute gastroenteritis? Viral (can be viral, bacterial, or parasitic), usually norovirus 22. T/F Assessing for prior antibiotic use is a critical part of thhe history in pt's presenting with diarrhea. True 23. What is thhe difference between irritable bowel disease (IBD) & irritable bowel syndrome (IBS)? IBS: disorder of bowel function (as opposed to being due to an anatomic abnormality). Changes in bowel habits (diarrhea, constipation, abd pain, bloating, rectal urgency w/diarrhea). Symptoms fall into two categories: abd pain/altered bowel habits, & painless diarrhea. Usually pain is LLQ. PE: normal except for tenderness in colon. Labs: CBC, ESR. Most othher labs & radiology/scopes are normal. Dx made on careful H&P. May be associated with nonintestinal (extra-intestinal) symptoms (sexual function difficulty, muscle aches/pains, fatigue, fibromyalgia, HAs, back pain, urinary symptoms). Not associate with serious medical consequences. Not a risk factor for othher serious GI dz's. Does not put extra stress on othher organs. Overall prognosis is excellent.

Major problem: changes quality of life. Treatment: based on symptom pattern. May include diet, education, pharm (for mod- severe pt's)/othher supportive interventions. Usually focuses on lifestyle, diet, & stress reduction. NO PROVEN TREATMENT! Antidiarrheals: use temporarily, reserve for severe. Loperamide (Imodium) or diphenoxylate (Lomotil) 2.5-5mg q6h usually works. Constipation: high fiber diet, hydration, exercise, bulking agents. If thhese don't work, intermittent use of stimulant laxatives (lactulose or mag hydroxide); don't use long-term! Linzess (linaclotide), Trulance (plecanatide), & Amitiza (lubiprostone): newer for constipation, work locally on apical membrane of GI tract to increase intestinal fluid secretion & improve fecal transit. Abd pain: dicloclymine (Bentyl), hyoscyamine (avoid anticholinergics in glaucoma & BPH, especially in elderly). TCAs & SSRIs can relieve symptoms in some pt's.

Can be managed by PCP, but if not responsive to tx, refer to GI. IBD: chronic immunological dz that manifests in intestinal inflammation. UC & Crohn's are most common. UC: mucosal surface of colon is inflamed, resulting in friability, erosions, bleeding. Usually occurs in rectosigmoid area, but can involve entire colon. Ulcers form in eroded tissue, abscesses form in crypts, become necrotic & ulcerate, mucosa thickens/swells, narrowing lumen. Pt's are at risk for perforation. Symptoms: bleeding, cramping, urge to defecate. Stools are watery diarrhea with blood/mucus. Fecal leuks almost always present in active UC. Tenderness usually in LLQ or across entire abd. Crohn's: inflammation extends deeper into intestinal wall. Can involve all or any layer of bowel wall & any portion of GI tract from mouth to anus. Characteristic segmental presentation of dz'd bowel separated by areas of normal mucosa ("skipped lesions"). With progression, fibrosis thickens bowel wall, narrowing lumen, leading to obstructions, fistulas, ulcerations. Pt's are at greater risk for colorectal cancer. Most common symptoms: cramping, fever, anorexia, wt loss, spasms, flatulance, RLQ pain/mass, bloody/mucus/pus stools. Symptoms increase with stress, after meals. 50% of pt's have perianal involvement (anal/perianal fissures). Inflammation can lead to bleeding, fever, increased WBC, diarrhea, cramping. Abnormalities can be seen on cross-sectional imaging or colonscopy. No single explanation for IBD. Thheory: viral, bacterial, or allergic process initially inflames small or large intestine, results in antibody development which chronically attack intestine, leading to inflammation. Possible genetic predisposition. Dx made by H&P correlated with symptoms, must exclude infectious cause for colitis. Primary dx tools: sigmoidoscopy, colonoscopy, barium enema w/small bowel follow- through, CT. Tx is very complex, managed by GI. Drugs: 5 - aminosalicylic acid agents have been used for >50yrs, but have shown to be of little value in CD; still used as first attempt for UC. Antidiarrheals w/caution (constipation). Don't use in acute UC or if toxic megacolon. Corticosteroids used when 5 - ASA not working. If corticosteroids don't work, use immunomodulators (azathioprine, methotrexate, 6-mercaptopurine), but can cause bone marrow suppression & infection. Newer class: anti-TNF (biologic response modifiers) for mod-severe dz. Remicade (infliximab), Humira (adalimumab), Entyvio (vedolizumab); can increase risk of infection.

24. What are two common IBD's? Ulcerative colitis Crohn's disease 25. Describe thhe characteristics of acute diverticulitis. Subjective: S/S of infection (fever, chills, tachycardia) Localized pain LLQ Anorexia, n/v If fistula present, additional s/s will be present associated w/affected organ (dysuria, pneumaturia, hematachzia, frank rectal bleeding, etc)

Objective: Tenderness in LLQ Maybe firm, fixed mass at area of diverticuli Maybe rebound tenderness w/involuntary guarding/rigidity Hypoactive bowel sounds initially, thhen hyperactive if obstructive process present Rectal tenderness +occult blood Diagnostics: Mild-moderate leukocytosis Possibly decreased hgb/hct r/t rectal bleeding Bladder fistula: urine will have increased WBC/RBC, culture may be + If peritonitis, blood culture should be done (for bacteremia) Abd XR: perforation, peritonitis, ileus, obstruction CT may be needed to confirm

26. What is thhe difference between sensorineural & conductive hearing loss? Sensorineural: results from deterioration of cochlea due to loss of hair cells from organ of Corti. Very common in adults. Gradual, progressive, predominantly high-frequency loss w/advanced aging (presbyacusis). Othher causes: ototoxic drugs, loud noises, head trauma, autoimmune dz, metabolic dz, acoustic neuroma. Genetic makeup can influence. Not correctable w/medical or surgical thherapies, but can stabilize if loss is gradual. Sudden loss may respond to corticosteroids if given in first few weeks of onset. Dx usually made by audiometry (audiogram) where bone conduction thresholds are measured. Done by audiologist. No proven or recommended treatment/cure. Hearing strategies/aids, or for profound/total deafness, cochlear implants. In Weber test: normal ear hears sounds better. Commonly seen in primary care: tinnitus & Meniere's.

Conductive: result of obstruction between middle & outer ear. From cerumen accumulation/impaction, FB in canal, otitis externa/media, middle ear effusion, otosclerosis, vascular anomaly, or cholesteatoma. Tx depends on accurately identified etiology. Most types are reversible. In Weber test: defective ear hears tuning fork louder. In Rinne test: bone conduction is greater than air conduction, so pt will report BC sound longer than AC sound.

27. What is thhe triad of symptoms associated with Meniere's disease?

Vertigo Hearing loss Tinnitus

28. What symptoms are associated with peritonsilar abscess? Almost always unilateral, located between tonsil & superior pharyngeal constrictor muscle Gradual onset of severe unilateral sore throat Odynophagia Fever Otalgia Asymmetric cervical adenopathy Pronounced trismus (hot potato voice) Toxic appearance (poor/absent eye contact, failure to recognize parents, irritability, inability to be consoled/distracted, drooling, severe halitosis, tonsillar erythhema, exudates) Swelling above affected tonsil with a discrete bulge, deviation of soft palate/uvula 29. What is thhe most common cause of viral pharyngitis? Adenovirus Mononucleosis (Epstein-Barr) HSV- 1 RSV Flu A&B Coxsackie Enteroviruses 30. What is thhe most common cause of acute n/v? Acute gastroenteritis 31. What is thhe importance of obtaining an abdominal XR to rule out perforation or obstruction even though thhe diagnosis of diverticulitis can be made clinically? To look for free air (indicating perforation), ileus, or obstruction & treat empirically. Early

treatment leads to better outcomes, so don't delay treatment.

32. What are colon cancer screening recommendations relative to certain populations? Age 50 or older: initial scope at 50yo, thhen every 10yrs. If at increased/high risk of colorectal cancer, start screening earlier (i.e. age 40) & be screened more often based on findings. African Americans: Starts screening at age 40 - 45. 33. Identify at least two disorders that are considered to be disorders related to conductive hearing loss. Cerumen accumulation/impaction FB in ear canal

Otitis externa Chronic otitis media Middle ear effusion Tosclerosis Vascular anomaly Cholesteatoma

34. What is thhe most common cause of bacterial pharyngitis? Group A Beta Hemolytic Streptococcus (GABHS) 35. What are thhe clinical findings associated with mononucleosis? Gradual onset of fever Marked malaise Severe sore throat Maybe exudative tonsillitis (50% of cases) Palatal petechiae/rash Anterior/posterior cervical lymphadenopathy Splenic enlargement 36. How is thhe diagnosis of streptococcal pharyngitis made clinically based on thhe Centor criteria? Fever >38C (100.5F) Tender anterior cervical lymphadenopathy No cough Pharyngotonsillar exudate Presence of all 4 strongly suggest GABHS infection. 3 or more present: empirically dx & treat w/out furthher testing 37. What is one intervention for a pt with gastroenteritis? Fluid repletion (PO if possible, pedialyte; IVF for more severe dehydration) Nutrition 38. When are stool studies warranted?

In pts with severe or prolonged diarrhea, fever >38.5C, bloody stools, stools +leukocytes/occult blood

39. What is an appropriate treatment for prophylaxis or treatment of traveler's diarrhea? Trimethoprim-sulfamethoxazole (Bactrim DS) 1 tab BID x3days Cipro 500mg Norfloxacin (Noroxin) 400mg Ofloxacin (Floxin) 300mg 40. Describe thhe component of thhe H&P that should be done for a pt with abd pain.

OLDCARTS

Upper abd pain: ask about chronic/recurring & related symptoms (bloating, fullness, heartburn, n/v) Lower abd pain: if acute, is pain sharp, intermittent continuous? If chronic, is thhere a change in bowel habits (alternating diarrhea/constipation)? Radiation?

41. What is at least one effective treatment for IBS? Diet (avoid lactose, caffeine, legumes, artificial sweeteners; eat low-fat diet with increased protein, high fiber, bulk-producing agents, 64oz water daily) Lifestyle modification Exercise Stress reduction Pharm (for moderate-severe symptoms only): antidiarrheals (imodium, lomotil), laxatives (lactulose, mag hydroxide), antispasmodics (dicyclomine, hyoscyamine), tricyclic antidepressants; avoid anticholinergics with glaucoma & BPH pts. 42. What is at least one prescription med used to treat chronic constipation? Linzess (linaclotide) Trulance (plecanatide) Amitiza (lubiprostone) Lactulose Mag hydroxide 43. What is at least one treatment for Meniere's disease? Bedrest with eyes closed, protection from falling Maintenance thherapy: chlorothiazide (Diurel) 500mg/day Meclizine Promethazine Dimenhydrinate Diphenhydramine Metoclopramide 44. T/F

Thhe majority of dyspnea complaints are due to cardiac or pulmonary decompensation. True

45. What are thhe differences between intrathorax & extrathorax flow disorders? Intra: obstruction of distal/smaller airway (asthma, bronchiolitis, vascular ring, solid FB aspiration, lymph node enlargement pressure). Take place in thhe supraglottic, glottis, & infraglottic regions. Supraglottic = space above larynx & epiglottis. Glottis = area of opening in vocal cords. Infraglottic = starts at bottom of vocal cords & ends at top of trachea.

Extra: Obstruction of proximal/larger airway (rhinitis with nasal obstruction, nasal polyp, cranio-facial malformation, OSA, tonsil/adenoid hypertrophy, laryngotracheomalacia, larynx papilloma, diphthheria, croup, epiglottitis, thymus hypertrophy) Difference is location of obstruction.

46. What are at least 3 examples of flow & volume disorders (intra &/or extra thorax)? Intra Flow: Asthma Bronchiolitis Vascular ring Solid FB aspiration Lymph node enlargement pressure Extra flow: Rhinitis w/nasal obstruction/nasal polyp Cranio-facial malformation Obstructive sleep apnea Tonsil-adenoid hypertrophy Laryngo-tracheo-malacia Larynx papilloma Diphthheria Croup Epiglottitis Thymus hypertrophy Intra Volume: PNA Atelectasis Pulmonary edema Near drowning Extra Volume:

Pneumothorax Pneumomediastinum Cardiomegaly Heart failure Pleural effusion Hernia diaphragmatica Diaphragmatica eventration Intra-thorax mass Chest trauma Thorax deformity Neuromuscular disorders Gastritis

PUD

Extreme obesity Peritonitis Appendicitis Acute abdomen Aerophagia Meteorismus Ascites Hepato-splenomegaly Abdominal solid tumor Anemia Metabolic acidosis CNS infections Encephalopathy Psychologic Poisoning Trauma capitis CNS disease sequelae

47. Differentiate between rubeola, rubella, varicella, roseola, 5ths disease, pityriasis rosea, h&/foot/mouth, & molluscum contagiosum. Rubeola: "thhe Measles" From morbillivirus Highly contagious spread through respiratory drops No cure Vaccine since 1963 Pt appears very sick: high fever, red mucosal membranes, conjunctivitis, nasal congestion, reddish/purple generalized macular & papular rash. Lesions start on head, esp. face or behind ears, spread down body within 1 - 2 days. Blood work: reverese-transcriptase polymrease chain reaction (RT-PCR) & IgG & IgM. All positive cases must be reported to CDC. Possible complications: PNA, bronchitis, myocarditis, encephalitis. Pregnant: possible miscarriage. Tx: symptomatic (pain relievers, monitor for few weeks, watch for complications).

Infectious 4 days before onset of rash up to 4 days after onset. Able to return to work/school after rash gone. Rubella: German measles or 3 - day measles. Caused by rubella virus. Rash may start 2wks after exposure, spread from respiratory droplets. Low-grade fever, HA, sore throat, rhinorrhea, malaise, eye pain, myalgia 2 - 5 days before rash (may last weeks after outbreak). Skin rash: rose-pink macules & papules, first on head, travel down body. Fades in 1 - 2 days in same order thhey appeared. Clinical diagnosis. Tx: symptomatic (apap, NSAIDs, rest).

Rubella vaccination. Infectious 4 - 7 days before rash, can return to work/school after rash gone. Varicella: chicken pox. Highly contagious. Caused by varicella zoster virus (VZV). Malaise, fever, chills, HA, arthralgia, thhen 1-2 days later urticarial erythhematous macules & papules appear, quickly turning into vesicles & pustules. Rash starts on face/chest, spreads quickly over entire body. Blisters can be in ear canal or mouth. Dry up in 1wk. Clinical diagnosis. Tx: symptomatic (oral antihistamines, NSAIDs, cool compresses, oatmeal baths). Varicella vaccination. Contagious 2 - 3 days before rash, can return to work/school after lesions scabbed over. Roseola: 6th disease Caused by human herpes virus types 6 & 7. Virus usually mild, common in children under age 2. Spread through saliva. Short-lived, 3 - 5 days. High fever, irritability, diarrhea, cough, cervical lymphadenopathy. Rash: light pink, erythhematous macules & papules on face, neck, extremities. Usually resolves in 1 - 3 days. Dx based on clinical presentation & history. Tx: symptomatic. Contagious 1 - 2 days before fever, can return to work/school when fever, fatigue, cough, diarrhea gone. Fifth's dz: erythhema infectiosum, human parvovirus. Spread through respiratory drops, blood products. 3 stages: HA, fever/chills, possible cough, classic slapped cheek rash, bright red bilat cheeks (not forehead, nasal bridge, perioral area); pink lacy (reticulated) erythhematous macules on all extremities & trunk (not palms, sole surfaces), may be itchy; 2-3wks of body rash