STUDY NOTES & REFERENCE GUIDE
Shadow Health - Tina Jones, ·
Health History Exam ···
ACTUAL QUESTIONS AND CORRECT DETAILED
·
ANSWERS WITH RATIONALES
·
2026 \2027 UPDATED
Fundamentals of Nursing
1
LecClara Stuvia | Page 1 of 52
, STUDY NOTES & REFERENCE GUIDE
1. Acute pain - Correct Answer✅-Priority: High Priority Pro Tip: Managing acute
···
pain is an immediate high priority, because other health concerns cannot be
··
effectively addressed while a patient experiences severe pain. Evidence - Relevant:
·
"...Like a 7. It hurts a lot, but whatever pain med the ER gave me is helping a little
···
bit." "It's throbbing and like, sharp if I try to put weight on it." Evidence Pro Tip: Tina
···
expresses pain, which is the strongest evidence for this problem. She reports intense
···
pain on a numerical scale and describes pain characteristics. The presence of a
···
physical injury supports her susceptibility to acute pain. Planning - Relevant: Assess
··
- Pain: Assess the patient's pain at regular intervals and with each assessment of
vital signs. Assess - Pain: Assess the patient's response to pain medication. Educate
- Medication: Educate the patient on medications used for pain relief. Educate - Pain:
Educate the patient on non-pharmaceutical methods to reduce pain intensity.
Intervene - Pain: Administer non-pharmacologic interventions to reduce pain.
Intervene - Pain: Administer prescribed analgesics to provide optimal pain relief.
Planning Pro Tip: To reduce the patient's pain, assess her current rating. Provide an
appropriate intervention (pharmaceutical or otherwise) and educate the patient. After
an appropriate time interval, assess pain levels again to see how the intervention
affected the pain.
1.Expression of pain Followed Up - Correct Answer✅-Description: Tina expresses
frustration about her level of pain. Student: How effective was the Neosporin? Tina
Jones: Well, I'm here, so I guess it didn't do its job. Student: Can you walk with your
foot being injured? Tina Jones: No, I can't. I can't put any weight on it without like,
shooting pain. Student: What preexisting medical conditions do you have? Tina
Jones: I mean, I have asthma and diabetes, but right I now I just care about my foot!
Student: I understand your foot hurts, but I need to know this information to make
sure I take care of the problem correctly. Tina Jones: Thanks. Model Statement: "I'm
sorry to hear that your pain is returning. We want you to be in as little pain as
possible. I can give you some Advil at this time, and in a few hours, you can have
more tramadol. I can also walk through some pain management exercises with you
that don't involve medication, if you are interested."
2. Impaired skin integrity - Correct Answer✅-Priority: High Priority Pro Tip: This is a
high priority. The infection is the most immediate threat to the patient's health, and
the wound is at risk for delayed healing because of the patient's uncontrolled blood
glucose. Evidence - Relevant: Evidence Pro Tip: As Tina discusses symptoms of her
wound, including symptoms such as discharge, redness, warmth, and swelling, she
reports strong evidence of impaired skin integrity. Planning - Relevant: Planning Pro
Tip: Because wound infections impact the patient's overall health, it's important to
assess perfusion, hydration, and swelling. Assess the status of the wound itself and
ensure proper cleaning and dressing per the physician's order. Prevent worsening
infection by educating the patient about wound care and self-monitoring.
2.Impact of injury on daily life Followed Up - Correct Answer✅-Description: Tina
brings up her pain and frustration at how being unable to bear weight on her foot
impacts her life. Student: What are stressors? Tina Jones: I feel really stressed out
right now! Honestly, I didn't realize that I'd be admitted to the hospital for my foot. I
don't want to miss work or school but now it looks like I'll have to. And I want my foot
2
LecClara Stuvia | Page 2 of 52
, STUDY NOTES & REFERENCE GUIDE
to stop hurting. I know I need sleep, too. Student: We are going to take care of
everything as quickly as possible. Tina Jones: Thanks. Model Statement: "This
sounds like a challenging time for you. I understand your frustration at having your
life interrupted by foot pain. Please let me know if there is anything I can help you
with, such as contacting your employer or asking a family member to bring your
schoolwork. We'll do our best to get you feeling better and, on your way, home as
soon as possible."
3. Impaired walking - Correct Answer✅-Priority - High Priority Pro Tip: This is a high
priority. The patient is unable to bear weight on her affected leg, which prevents
walking. This impacts her daily life and increases her risk for falls and deep-vein
thrombosis. Evidence - Relevant: "I mean, it's all red and swollen, and there's pus, it
feels hot, it hurts like hell... It's got all that going on." "I got this scrape on my foot a
while ago, and it got really infected. It's killing me." "No, I can't. I can't put any weight
on it without like, shooting pain." Evidence Pro Tip: The strongest evidence of
impaired walking is that Tina directly reports she can't bear weight or walk on her
affected foot. Other supporting data points are the presence of her foot wound and
her general reports of pain. Planning - Relevant: Assess - Musculoskeletal: Assess
the patient's ability to bear weight and gait. Assess - Musculoskeletal: Assess the
patient's mobility. Consult / Refer: Consult with physical therapist to develop a plan to
improve the patient's mobility. Intervene - Mobility: Assist the patient as needed with
mobility. Intervene - Mobility: Provide assistive devices to facilitate mobility (crutches,
therapeutic boot to minimize pressure on plantar surface, wheelchair). Planning Pro
Tip: Assess how well the patient can bear weight and walk. While the patient is in
your care, work with other healthcare professionals to keep the pain managed and
improve the patient's mobility. Provide assistance with activities such as toileting and
ensure that the patient can access and use assistive devices.
3.Gaps in health literacy around diabetic diet Not Encountered - Correct Answer✅-
Description: Tina describes controlling her diabetes by avoiding "sweets." Model
Statement: "Staying away from sugar is a great start. I can give you some more
information on what a balanced diet looks like for someone with diabetes. For
example, many starchy foods break down into glucose in the body, like pasta, and so
you can eat those in moderation, too. Most people with diabetes feel better when
they limit all starches, eat protein, and take regular medication."
4. Ineffective diabetes management - Correct Answer✅-Priority - High Priority Pro
Tip: Poorly managed diabetes and uncontrolled blood glucose complicate wound
healing. As the underlying cause for delayed healing and infection, they must be
addressed. Evidence - Relevant: "No, I don't take anything for my diabetes
anymore." "I guess I just got sick of feeling sick and gassy all the time, and it was
overwhelming, remembering to take pills and check my sugar. I feel a lot better now
that I'm just eating healthier than I did when I was taking the pills." "I have a monitor
at home, but to be honest I don't really use it that often." Evidence Pro Tip: Tina
directly reports ineffective diabetes management when discussing her lack of
treatment. She expresses gaps in health literacy about the risk of ceasing prescribed
medication and blood glucose monitoring. Supporting evidence comes from her
inability to incorporate meaningful dietary changes or increase her exercise.
Planning - Relevant: Assess - Health Literacy and Patterns: Assess the patient's
knowledge related to diabetic disease process, assess personal/social supports.
3
LecClara Stuvia | Page 3 of 52
, STUDY NOTES & REFERENCE GUIDE
Assess - Health Literacy and Patterns: Assess the patient's perceived barriers to
adherence to the prescribed regimen (cost, adverse effects, lack of knowledge).
Assess - Health Literacy and Patterns: Assess the patient's readiness for
change/education. Educate - Disease Process: Educate the patient on diabetes
pathophysiology, risks of morbidity and mortality, importance of self-care. Planning
Pro Tip: To gain a deep understanding of your patient's situation, determine her level
of health literacy, her feelings and beliefs about the disease, and the motivation
behind her choices. Educate the patient about what risks are, and what good
diabetes care looks like. Most importantly, ask about her goals and changes she
may be willing to make.
4.Lack of treatment with diabetes medication Not Followed Up - Correct Answer✅-
Description: Tina reveals that she does not treat her diabetes with medication.
Student: Do you currently take medicine for your diabetes? Tina Jones: No, I don't
take anything for my diabetes anymore. Student: What made you stop taking
medication for your diabetes? Tina Jones: I guess I just got sick of feeling sick and
gassy all the time, and it was overwhelming, remembering to take pills and check my
sugar. I feel a lot better now that I'm just eating healthier than I did when I was taking
the pills. Model Statement: "I understand that it can be challenging to keep up with
daily medication. But it's important to keep your blood sugar under control to prevent
long-term damage to your health, and medication can really help. I'd like to talk with
you more about getting back onto a prescription. We could start you at a low dose,
which reduces the side effects."
5. Lack of blood glucose monitoring Not Followed Up - Correct Answer✅-
Description: Tina reveals that she does not check her blood sugar. Student: Do you
monitor your blood glucose? Tina Jones: I have a monitor at home, but to be honest
I don't really use it that often. Model Statement: "I understand how it can feel like a
frustrating chore to check your sugar every day. But it is important to keeping your
diabetes under control. When you monitor your sugar, it helps you understand what
foods, activities, and times of day contribute to you feeling your best. And keeping
your sugar down will help your foot wound heal quickly, too. If you would like, I can
help you find a monitor that is as painless as possible. I can also teach you more
about what the numbers mean."
5. Risk for falls - Correct Answer✅-Priority - High Priority Pro Tip: The patient's foot
wound impairs her walking, which in turn increases her risk for falls while she is an
admitted patient. Her past history of injury also adds to this risk. Evidence - Relevant:
Evidence Pro Tip: The strongest evidence of Tina's fall risk is reports of being unable
to bear weight or walk on her foot. Other supporting evidence is her recent injury
caused by falling. Planning - Relevant: Planning Pro Tip: Protect your patient by
taking all fall precautions, and educate your patient about how to be safe as she
goes through her daily activities at the hospital. Make sure that the patient feels
comfortable asking for your assistance.
6. Gaps in health literacy around asthma control Not Followed Up - Correct
Answer✅-Description: Tina describes increased inhaler use and decreased
effectiveness, indicating that her asthma is uncontrolled. Student: How many puffs
do you take when using your asthma inhaler? Tina Jones: I usually use two puffs
4
LecClara Stuvia | Page 4 of 52
Shadow Health - Tina Jones, ·
Health History Exam ···
ACTUAL QUESTIONS AND CORRECT DETAILED
·
ANSWERS WITH RATIONALES
·
2026 \2027 UPDATED
Fundamentals of Nursing
1
LecClara Stuvia | Page 1 of 52
, STUDY NOTES & REFERENCE GUIDE
1. Acute pain - Correct Answer✅-Priority: High Priority Pro Tip: Managing acute
···
pain is an immediate high priority, because other health concerns cannot be
··
effectively addressed while a patient experiences severe pain. Evidence - Relevant:
·
"...Like a 7. It hurts a lot, but whatever pain med the ER gave me is helping a little
···
bit." "It's throbbing and like, sharp if I try to put weight on it." Evidence Pro Tip: Tina
···
expresses pain, which is the strongest evidence for this problem. She reports intense
···
pain on a numerical scale and describes pain characteristics. The presence of a
···
physical injury supports her susceptibility to acute pain. Planning - Relevant: Assess
··
- Pain: Assess the patient's pain at regular intervals and with each assessment of
vital signs. Assess - Pain: Assess the patient's response to pain medication. Educate
- Medication: Educate the patient on medications used for pain relief. Educate - Pain:
Educate the patient on non-pharmaceutical methods to reduce pain intensity.
Intervene - Pain: Administer non-pharmacologic interventions to reduce pain.
Intervene - Pain: Administer prescribed analgesics to provide optimal pain relief.
Planning Pro Tip: To reduce the patient's pain, assess her current rating. Provide an
appropriate intervention (pharmaceutical or otherwise) and educate the patient. After
an appropriate time interval, assess pain levels again to see how the intervention
affected the pain.
1.Expression of pain Followed Up - Correct Answer✅-Description: Tina expresses
frustration about her level of pain. Student: How effective was the Neosporin? Tina
Jones: Well, I'm here, so I guess it didn't do its job. Student: Can you walk with your
foot being injured? Tina Jones: No, I can't. I can't put any weight on it without like,
shooting pain. Student: What preexisting medical conditions do you have? Tina
Jones: I mean, I have asthma and diabetes, but right I now I just care about my foot!
Student: I understand your foot hurts, but I need to know this information to make
sure I take care of the problem correctly. Tina Jones: Thanks. Model Statement: "I'm
sorry to hear that your pain is returning. We want you to be in as little pain as
possible. I can give you some Advil at this time, and in a few hours, you can have
more tramadol. I can also walk through some pain management exercises with you
that don't involve medication, if you are interested."
2. Impaired skin integrity - Correct Answer✅-Priority: High Priority Pro Tip: This is a
high priority. The infection is the most immediate threat to the patient's health, and
the wound is at risk for delayed healing because of the patient's uncontrolled blood
glucose. Evidence - Relevant: Evidence Pro Tip: As Tina discusses symptoms of her
wound, including symptoms such as discharge, redness, warmth, and swelling, she
reports strong evidence of impaired skin integrity. Planning - Relevant: Planning Pro
Tip: Because wound infections impact the patient's overall health, it's important to
assess perfusion, hydration, and swelling. Assess the status of the wound itself and
ensure proper cleaning and dressing per the physician's order. Prevent worsening
infection by educating the patient about wound care and self-monitoring.
2.Impact of injury on daily life Followed Up - Correct Answer✅-Description: Tina
brings up her pain and frustration at how being unable to bear weight on her foot
impacts her life. Student: What are stressors? Tina Jones: I feel really stressed out
right now! Honestly, I didn't realize that I'd be admitted to the hospital for my foot. I
don't want to miss work or school but now it looks like I'll have to. And I want my foot
2
LecClara Stuvia | Page 2 of 52
, STUDY NOTES & REFERENCE GUIDE
to stop hurting. I know I need sleep, too. Student: We are going to take care of
everything as quickly as possible. Tina Jones: Thanks. Model Statement: "This
sounds like a challenging time for you. I understand your frustration at having your
life interrupted by foot pain. Please let me know if there is anything I can help you
with, such as contacting your employer or asking a family member to bring your
schoolwork. We'll do our best to get you feeling better and, on your way, home as
soon as possible."
3. Impaired walking - Correct Answer✅-Priority - High Priority Pro Tip: This is a high
priority. The patient is unable to bear weight on her affected leg, which prevents
walking. This impacts her daily life and increases her risk for falls and deep-vein
thrombosis. Evidence - Relevant: "I mean, it's all red and swollen, and there's pus, it
feels hot, it hurts like hell... It's got all that going on." "I got this scrape on my foot a
while ago, and it got really infected. It's killing me." "No, I can't. I can't put any weight
on it without like, shooting pain." Evidence Pro Tip: The strongest evidence of
impaired walking is that Tina directly reports she can't bear weight or walk on her
affected foot. Other supporting data points are the presence of her foot wound and
her general reports of pain. Planning - Relevant: Assess - Musculoskeletal: Assess
the patient's ability to bear weight and gait. Assess - Musculoskeletal: Assess the
patient's mobility. Consult / Refer: Consult with physical therapist to develop a plan to
improve the patient's mobility. Intervene - Mobility: Assist the patient as needed with
mobility. Intervene - Mobility: Provide assistive devices to facilitate mobility (crutches,
therapeutic boot to minimize pressure on plantar surface, wheelchair). Planning Pro
Tip: Assess how well the patient can bear weight and walk. While the patient is in
your care, work with other healthcare professionals to keep the pain managed and
improve the patient's mobility. Provide assistance with activities such as toileting and
ensure that the patient can access and use assistive devices.
3.Gaps in health literacy around diabetic diet Not Encountered - Correct Answer✅-
Description: Tina describes controlling her diabetes by avoiding "sweets." Model
Statement: "Staying away from sugar is a great start. I can give you some more
information on what a balanced diet looks like for someone with diabetes. For
example, many starchy foods break down into glucose in the body, like pasta, and so
you can eat those in moderation, too. Most people with diabetes feel better when
they limit all starches, eat protein, and take regular medication."
4. Ineffective diabetes management - Correct Answer✅-Priority - High Priority Pro
Tip: Poorly managed diabetes and uncontrolled blood glucose complicate wound
healing. As the underlying cause for delayed healing and infection, they must be
addressed. Evidence - Relevant: "No, I don't take anything for my diabetes
anymore." "I guess I just got sick of feeling sick and gassy all the time, and it was
overwhelming, remembering to take pills and check my sugar. I feel a lot better now
that I'm just eating healthier than I did when I was taking the pills." "I have a monitor
at home, but to be honest I don't really use it that often." Evidence Pro Tip: Tina
directly reports ineffective diabetes management when discussing her lack of
treatment. She expresses gaps in health literacy about the risk of ceasing prescribed
medication and blood glucose monitoring. Supporting evidence comes from her
inability to incorporate meaningful dietary changes or increase her exercise.
Planning - Relevant: Assess - Health Literacy and Patterns: Assess the patient's
knowledge related to diabetic disease process, assess personal/social supports.
3
LecClara Stuvia | Page 3 of 52
, STUDY NOTES & REFERENCE GUIDE
Assess - Health Literacy and Patterns: Assess the patient's perceived barriers to
adherence to the prescribed regimen (cost, adverse effects, lack of knowledge).
Assess - Health Literacy and Patterns: Assess the patient's readiness for
change/education. Educate - Disease Process: Educate the patient on diabetes
pathophysiology, risks of morbidity and mortality, importance of self-care. Planning
Pro Tip: To gain a deep understanding of your patient's situation, determine her level
of health literacy, her feelings and beliefs about the disease, and the motivation
behind her choices. Educate the patient about what risks are, and what good
diabetes care looks like. Most importantly, ask about her goals and changes she
may be willing to make.
4.Lack of treatment with diabetes medication Not Followed Up - Correct Answer✅-
Description: Tina reveals that she does not treat her diabetes with medication.
Student: Do you currently take medicine for your diabetes? Tina Jones: No, I don't
take anything for my diabetes anymore. Student: What made you stop taking
medication for your diabetes? Tina Jones: I guess I just got sick of feeling sick and
gassy all the time, and it was overwhelming, remembering to take pills and check my
sugar. I feel a lot better now that I'm just eating healthier than I did when I was taking
the pills. Model Statement: "I understand that it can be challenging to keep up with
daily medication. But it's important to keep your blood sugar under control to prevent
long-term damage to your health, and medication can really help. I'd like to talk with
you more about getting back onto a prescription. We could start you at a low dose,
which reduces the side effects."
5. Lack of blood glucose monitoring Not Followed Up - Correct Answer✅-
Description: Tina reveals that she does not check her blood sugar. Student: Do you
monitor your blood glucose? Tina Jones: I have a monitor at home, but to be honest
I don't really use it that often. Model Statement: "I understand how it can feel like a
frustrating chore to check your sugar every day. But it is important to keeping your
diabetes under control. When you monitor your sugar, it helps you understand what
foods, activities, and times of day contribute to you feeling your best. And keeping
your sugar down will help your foot wound heal quickly, too. If you would like, I can
help you find a monitor that is as painless as possible. I can also teach you more
about what the numbers mean."
5. Risk for falls - Correct Answer✅-Priority - High Priority Pro Tip: The patient's foot
wound impairs her walking, which in turn increases her risk for falls while she is an
admitted patient. Her past history of injury also adds to this risk. Evidence - Relevant:
Evidence Pro Tip: The strongest evidence of Tina's fall risk is reports of being unable
to bear weight or walk on her foot. Other supporting evidence is her recent injury
caused by falling. Planning - Relevant: Planning Pro Tip: Protect your patient by
taking all fall precautions, and educate your patient about how to be safe as she
goes through her daily activities at the hospital. Make sure that the patient feels
comfortable asking for your assistance.
6. Gaps in health literacy around asthma control Not Followed Up - Correct
Answer✅-Description: Tina describes increased inhaler use and decreased
effectiveness, indicating that her asthma is uncontrolled. Student: How many puffs
do you take when using your asthma inhaler? Tina Jones: I usually use two puffs
4
LecClara Stuvia | Page 4 of 52
