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Study Guide
Chapter 3:
(Seven)
1. Skilled Interviewing
Mr. W. is a 51-year-old auto mechanic who comes to the emergency room wanting to be checked out for the symptom of chest pain. As you listen to him describe his symptom in more detail, you say "Go on," and later, "Mm-hmmm." This is an example of which of the following skilled interviewing techniques? A) Echoing B) Nonverbal communication
C) Facilitation
D) Empathic response Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient? A) Allow the patient to speak uninterrupted for the duration of the appointment.
B) Briefly summarize what you heard from the patient in the first 5
minutes and then tryto have her focus on one aspect of what she told you.
C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview. D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end. When you enter your patient's examination room, his wife is waiting there with him. Which of the following is most appropriate?
A) Ask if it's okay to carry out the visit with both people in the room.
B) Carry on as you would ordinarily. The permission is implied because his wife is in the room with him. C) Ask his wife to leave the room for reasons of confidentiality. D) First ask his wife what she thinks is going on.
2. interviewing sequence
Suzanne, a 25 year old, comes to your clinic to establish care. You are the student preparing to go into the examination room to interview her. Which of the following is the most logical sequence for the patient-provider interview? A) Establish the agenda, negotiate a plan, establish rapport, and invite the patient's story.
B) Invite the patient's story, negotiate a plan, establish the agenda, and establish rapport.
C) Greet the patient, establish rapport, invite the patient's story,
establish the agenda,expand and clarify the patient's story, and
negotiate a plan.
D) Negotiate a plan, establish an agenda, invite the patient's story, and establish rapport.
A patient complains of knee pain on your arrival in the room. What should your first sentence be after greeting the patient?
A) How much pain are you having?
The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category does it belong to?
A) Chief complaint
B) Present illness C) Personal and social history
D) Review of systems
The following information is recorded in the health history: "The patient completed 8th grade. He currently lives with his wife and two children. He works on old cars on the weekend. He works in a glass factory during the week." Which category does it belong to? A) Chief complaint B) Present illness
C) Personal and social history
D) Review of systems
4. Types of challenging patients
Mrs. H. comes to your clinic, wanting antibiotics for a sinus infection. When you enter the room, she appears to be very angry. She has a raised tone of voice and states that she has been waiting for the past hour and has to get back to work. She states that she is unimpressed by the reception staff, the nurse, and the clinic in general and wants to know why the office wouldn't call in an antibiotic for her. Which of the following techniques is not useful in helping to calm this patient?
A) Avoiding admission that you had a part in provoking her anger because
you were late
B) Accepting angry feelings from the patient and trying not to get angry in return C) Staying calm D) Keeping your posture relaxed You have just asked a patient how he feels about his emphysema. He becomes silent, folds his arms across his chest and leans back in his chair, and then replies, "It is what it is." How should you respond?
A) "You seem bothered by this question."
B) "Next, I would like to talk with you about your smoking habit." C) "Okay, let's move on to your other problems." D) "You have adopted a practical attitude toward your problem." Mrs. R. is a 92-year-old retired teacher who comes to your clinic accompanied by her daughter. You ask Mrs. R. why she came to your clinic today. She looks at her daughter and doesn't say anything in response to your question. This is an example of which type of challenging patient? A) Talkative patient B) Angry patient
C) Silent patient
D) Hearing-impaired patient
5. Techniques for interviewing
A patient is describing a very personal part of her history very quickly and in great detail. How should you react to this?
A patient tells you about her experience with prolonged therapy for her breast cancer. You comment, "That must have been a very trying time for you." What is this an example of? A) Reassurance B) Empathy C) Summarization
D) Validation
You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is not a component of adaptive questioning? A) Directed questioning: starting with the general and proceeding to the specific in amanner that does not make the patient give a yes/no answer
B) Reassuring the patient that the urinary symptoms are benign and that
she doesn't
need to worry about it being a sign of cancer C) Offering the patient multiple choices in order to clarify the character of the urinary symptoms that she is experiencing D) Asking her to tell you exactly what she means when she states that she has a urinary tract infection The following information is recorded in the health history: "I feel really tired." Which category does it belong to?
A) Chief complaint
B) Present illness C) Personal and social history D) Review of systems You are beginning the examination of a patient. All of the following areas are important to observe as part of the General Survey except: A) Level of consciousness B) Signs of distress C) Dress, grooming, and personal hygiene
D) Blood pressure
Common or concerning symptoms to inquire about in the General Survey and vital signs include all of the following except: A) Changes in weight B) Fatigue and weakness
C) Cough
D) Fever and chills
6. Use of interpreters
When using an interpreter to facilitate an interview, where should the interpreter be positioned? A) Behind you, the examiner, so that the lips of the patient and the patient's nonverbal
cues can be seen
B) Next to the patient, so the examiner can maintain eye contact
and observe thenonverbal cues of the patient
C) Between you and the patient so all parties can make the necessary observations D) In a corner of the room so as to provide minimal distraction to the interview
B)Reassure the mother that this is a normal body weight.
C) Give the patient information about exercise because the patient is obese. D) Give the patient information concerning reduction of fat and cholesterol in her dietbecause she is obese.
A 30-year-old sales clerk comes to your office wanting to lose weight; her BMI is 30. kg/m2. What is the most appropriate amount for a weekly weight reduction goal?
A) .5 to 1 pound per week
B) 1 to 2.5 pounds per week C) 2.5 to 3.5 pounds per week D) 3.5 to 4.5 pounds per week Mr. Curtiss has a history of obesity, diabetes, osteoarthritis of the knees, HTN, and obstructive sleep apnea. His BMI is 43 and he has been discouraged by his difficulty in losing weight. He is also discouraged that his goal weight is 158 pounds away. What would you tell him? A) "When you get down to your goal weight, you will feel so much better." B) "Some people seem to be able to lose weight and others just can't, no matter how hardthey try." C) "We are coming up with new medicines and methods to treat your conditions every day." D) "Even a weight loss of 10% can make a noticeable improvement in the problems you mention."
5. Patient Positioning and comfort
You arrive at the bedside of an elderly woman who has had a stroke, affecting her entire right side. She cannot speak (aphasia). You are supposed to examine her. You notice that the last examiner left her socks at the bottom of the bed, and although sensitive areas are covered by a sheet, the blanket is heaped by her feet at the bottom of the bed. What would you do next? A) Carry out your examination, focusing on the neurologic portion, and then cover her properly. B) Carry out your examination and let the nurse assigned to her "put her back together."
C) Put her socks back on and cover her completely before beginning the
evaluation.
D) Apologize for the last examiner but let the next examiner dress and cover her.
Chapter 7: (Eight)
1. Headaches (types) Mrs. Buckley is a 75-year-old widow who wants you to look at her teeth because over the past 2 weeks she has had right-sided jaw pain when eating. It does not occur otherwise. She also has had a headache. Which of the following should be considered?
A) Palpation of her temples
B) Dental referral C) Ultrasound of the gallbladder
4. Chalazion Inspection of a client's eyelids reveals significant lid swelling, moderate redness, but little pain. Which of the following would the nurse suspect? A) Chalazion
5. Subconjunctival hemorrhage
6. Pterygium A 67 year old lawyer comes to your clinic for an annual examination. He denies any history of eye trauma. He denies visual changes. You inspect his eyes and find a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea. He has normal pupillary reaction to light and accommodation. Based on this description, what is the most likely diagnosis? A) pterygium
7. Retinal detachment
A sudden painless, unilateral vision loss may be caused by which of the following? a)Acute Glucoma b) uveitis
c) retinal detachment
d) corneal ulcer
8. External otitis
9. Lymph node
10. Pupil dilation
11. Visual Acuity
Chapter 8: (Seven)
1. Asthma
Tachypnea, use of accessory muscles, prolonged expiration, intercostal retraction, decreased breath sounds, and expiratory wheezes are all symptomatic of:
(A) Pleural effusion (B) Atelectasis
(C) Asthma
(D) Bronchitis During assessment, the nurse would expect which part of the body to indicate central cyanosis in a client with a severe asthma attack? – Oral Mucosa
**2. COPD
- Chest Landmarks for procedures**
4. Respiratory Distress
Which of the following occurs with respiratory distress? a) Speaking in sentances of 10-20 words b) Skin between the ribs moves inward with inspiration c) neck muscles are relaxed d) patient torso leans posteriorly
1. Murmurs (mitral, systolic, diastolic)
During cardiac examination you notice a new parasternal systolic murmur of 2/ intensity. On palpation, the PMI is slightly higher than usual. What do you suspect?
A) Mammary souffle
B) Mitral stenosis C) Mitral regurgitation
D) Aortic insufficiency Mr. Chin is an 82-year-old man who comes to your office for a routine check. On examination, you notice a somewhat high-pitched murmur in the second right intercostal space during systole. It does not radiate and the rest of his examination is normal for his age. Which is true of the most likely cause of this murmur? A) It often decreases carotid upstroke.
B) It carries with it increased risk for cardiovascular disease.
C) It is usually accompanied by an S3 gallop. D) It is found in 10% of otherwise normal elderly patients.
2. PMI
3. Heart Sounds Ms. Wright comes to your office, complaining of palpitations. While checking her pulse you notice an irregular rhythm. When you listen to her heart, every fourth beat sounds different. It sounds like a triplet rather than the usual "lub dup." How would you document your examination? A) Regular rate and rhythm B) Irregularly irregular rhythm
C) Regularly irregular rhythm
D) Bradycardia A 49-year-old truck driver comes to the emergency room for shortness of breath and swelling in his ankles. He is diagnosed with congestive heart failure and admitted to the hospital. You are the student assigned to do the patient's complete history and physical examination. When you palpate the pulse, what do you expect to feel? A) Large amplitude, forceful
B) Small amplitude, weak
C) Normal D) Bigeminal
4. Grading
Chapter 12
Arterial and Venous Insufficiency – assessment tests and complications of
- If someone has Peripheral Artery Disease (PAD) what should you always do? Check all of the arteries for pulses in case there is an occlusion.
- What are some arterial issues with our older population? -Arteries calcify and lose elasticity and vasomotor tone. -Peripheral arteries lengthen, become tortuous (crooked) and are less resilient (can kink and decrease flow)
Episodic muscular ischemia induced by exercise due to atherosclerosis of large or medium-size arteries.
- How is claudication brought on and how is it relieved?
Brought on by walking and exercising; relieved with rest. *Patients can have claudication with rest also, but it intensifies with activity
- If someone has claudication, where do they usually have pain?
In their calves
- What are the three types of pain patients who have claudication normally experience?
Aching, Throbbing and Burning in calf muscle.
- What happens when you have varicose veins and what are you at risk for?
The valves in the veins are engorged and don't work right anymore. Blood doesn't get back up to the great veins and remains pooled. Patients are at risk for clotting or DVT.
- What does the Allen Test evaluate? Arterial insufficiency of the hand
- What is the process for doing an Allen Test?
-Compress both radial and ulnar arteries -Close and open fist 5 times -Release ulnar artery ONLY and check for reperfusion
- What are four things to look for during an assessment for venous insufficiency?Thrombosis, Homan Sign, Edema, and Varicose Veins
- A patient you are seeing complains of a sore on his lower leg that does not seem to get better. Based on examination findings, you suspect venous insufficiency. Which of the clinical findings below would suggest venous insufficiency as the cause of his problem? A. Leg discomfort is exacerbated by dependency B. Hyperpigmentation is present around the lower calf area C. Ulceration is present on the medial side of the ankle D. Affected leg feels warm to the touch
E. All the above
- A patient you are seeing complains of severe pain in her right foot. Based on examinationfindings, you suspect arterial insufficiency. Which of the clinical findings below would suggest arterial insufficiency as the cause of her problem? A. Brisk posterior tibial and dorsalis pedis pulses
B. Pallor of the foot upon elevation
C. Pitting edema of the lower leg D. Warmth of the right foot
- The client has a 1+ dorsal pedal pulse and a nonpalpable posterior tibial pulse on the right. The extremity is pale and painful, a skin ulceration is forming. This description ismost consistent with:
a. Arterial insufficiency to the right leg b. Femoral arteritis c. Coarctation of the aorta
d.Venous insufficiency to the right leg.
