NR 509 Midterm Exam Question and Answers
Focused Assessment
Answer: -Addresses focused concerns or symptoms
-Used for established clients during routine or urgent care visits
-Health history and physical exams are focused on the problem
-Includes:
• brief history of the present illness
• only the system related to the problem in the review of systems
Comprehensive Assessment
Answer: -Used for new clients
-Provides personalized information about the client
-Strengthens the clinician-client relationship
-Provides a baseline for future assessments
-Provides an opportunity for health promotion education and counseling
-Includes:
• extended history of the present illness
• at least two areas of past medical history, family history, and social history
• at least 10 systems in the review of systems
Subjective data
Answer: includes symptoms that the client describes such as a sore throat, headache, or pain. It also
includes the client's feelings, perceptions, and concerns
Information obtained from the client during any part of the health history
Examples of Subjective Data:
-Lower back pain
-Fatigue
-Stomach cramps
-Immunization history
Objective data
Answer: includes the physical examination findings or signs observed
All physical examinations, laboratory information, and test data
Examples of Objective Data:
-Heart rate
-Blood pressure
-Lung sounds
-Wound appearance
-Ambulation description
-Weight
Clinical Encounter Sequence (detailed)
Answer: Initiate Encounter
-Review the clinical record
-Ensure the client is comfortable
-Clarify the goals/agenda for the encounter; balance provider and client goals
,-Establish rapport
-Identify the client's preferred title, name, and gender pronouns
-Use "people first" language (i.e., a person with hearing loss, a person who uses a wheelchair)
Gather Information
-ID the client's chief complaint or reason for seeking care
-Invite the client's story using an open-ended approach
-Gather information about the client's perspective of the illness using the mnemonic FIFE
-Conduct the health history interview
-Gather information about past medical history, medications and allergies, family history, personal and
social history, and ROS
Perform the Physical Exam
-Conduct the exam based on the information obtained from the health history
-Maintain client's comfort and privacy throughout the exam
Explain and Plan
-Assess and respond to the client's needs for information
-Negotiate and make decisions together
-Utilize teach-back to ensure the client understands the plan
Close the Encounter
-Leave time for the client to ask questions
-Summarize the plans for future evaluation, treatments, and follow up
The general sequence of a clinical encounter is to:
Answer: -initiate the encounter
-gather information
-perform a physical exam
-develop a shared plan
-close the encounter
FIFE mnemonic
Answer: Feelings
Ideas
Function
Expectations
-A mnemonic for the patient's perspective on the illness
• The patient's Feelings, including fears or concerns, about the problem
• The patient's Ideas about the nature and the cause of the problem
• The effect of the problem on the patient's life and Function
• The patient's Expectations of the disease, of the clinician, or of health care, often based on prior
personal or family experiences
Basic interviewing techniques
Answer: -active listening
-empathy
,-guided questioning
-validating
-empowerment
-partnering
-transitioning
-reassuring
-summarizing
-nonverbal communication
active listening
Answer: closely attending to what the client is communicating, connecting to the client's emotional
state, and using verbal and nonverbal skills to encourage the client to expand on their feelings and
concerns.
empathy
Answer: identifying with the client and feeling their pain as one's own, then responding to them in a
supportive manner.
guided questioning
Answer: -Guided questions help to elicit more information, while still showing a continued interest in
the client's feelings and story.
-Some techniques of guided questioning include moving from open-ended to more focused questions;
clarifying what the client means; encouraging with continuers such as "go on"; using a series of
questions one at a time; and using questions that require a graded response (i.e., how many stairs can
you climb before feeling short of breath?).
validating
Answer: affirming the legitimacy of the client's emotional experience.
-Examples: "That must have been a difficult experience. It's very common to feel the way you are
feeling."
empowerment
Answer: Empowering clients to ask questions and express their concerns increases the chances that they
will adopt your advice, make lifestyle changes, or take medications as prescribed.
partnering
Answer: involves expressing commitment to an ongoing relationship with the clients to build rapport
transitioning
Answer: Transitions can be used to inform the client that the direction of the interview is changing.
reassuring
Answer: Reassurance is an appropriate way to help the client feel that problems have been fully
understood and are being addressed.
summarizing
Answer: Giving a summary of the client's story during the interview helps to communicate that they
have been carefully listening.
, nonverbal communication
Answer: includes eye contact, facial expression, posture, head position, and movement such as shaking
or nodding, interpersonal distance, and placement of the arms or legs (i.e., crossed, neutral, or open).
Managing Challenging Situations: Silent Clients
Answer: -Clients may be quiet to collect thoughts, remember details, or decide if they trust the provider
-Become comfortable with periods of silence
-Acknowledge that the client is quiet and ask what they are thinking about or if something has upset
them
Managing Challenging Situations: Talkative Clients
Answer: -Talkative clients should be allowed to talk for several minutes at the beginning of the interview
-Focus on what seems to be most important to the client
-Offer a summary of the main concerns and suggest a focus on one problem or ask the client to identify
their priority concern for the day
Managing Challenging Situations: Clients with Altered Cognition
Answer: -Clients with conditions such as dementia or mental health illness may not be able to provide
their history
-Obtain information from family members or caregivers
-Some clients may be able to provide a history, but cannot make their own health decisions
Managing Challenging Situations: Angry Clients
Answer: -Clients may direct anger toward the provider even if their anger is related to being ill, suffering
a loss, or feeling overwhelmed and not in control
-Acknowledge clients' anger and frustration, but avoid reinforcing criticism of other providers or the
clinical setting
-Alert security staff for clients who are overly disruptive or out of control
-Remain calm and avoid being confrontational
Comprehensive health history
Answer: Chief Complaint
History of Present Illness
Past Medical History
Medications and Allergies
Family History
Personal and Social History
Review of Systems
History of present illness
Answer: use OLDCARTS
Past medical history
Answer: -Childhood Illnesses: Inquire about childhood illnesses such as measles, chickenpox, or scarlet
fever and chronic childhood illnesses such as diabetes or asthma.
-Adult Illnesses: Inquire about illnesses such as diabetes, hypertension, or asthma and hospitalizations.
-Surgical: Document dates, indications, and types of surgical procedures.
Focused Assessment
Answer: -Addresses focused concerns or symptoms
-Used for established clients during routine or urgent care visits
-Health history and physical exams are focused on the problem
-Includes:
• brief history of the present illness
• only the system related to the problem in the review of systems
Comprehensive Assessment
Answer: -Used for new clients
-Provides personalized information about the client
-Strengthens the clinician-client relationship
-Provides a baseline for future assessments
-Provides an opportunity for health promotion education and counseling
-Includes:
• extended history of the present illness
• at least two areas of past medical history, family history, and social history
• at least 10 systems in the review of systems
Subjective data
Answer: includes symptoms that the client describes such as a sore throat, headache, or pain. It also
includes the client's feelings, perceptions, and concerns
Information obtained from the client during any part of the health history
Examples of Subjective Data:
-Lower back pain
-Fatigue
-Stomach cramps
-Immunization history
Objective data
Answer: includes the physical examination findings or signs observed
All physical examinations, laboratory information, and test data
Examples of Objective Data:
-Heart rate
-Blood pressure
-Lung sounds
-Wound appearance
-Ambulation description
-Weight
Clinical Encounter Sequence (detailed)
Answer: Initiate Encounter
-Review the clinical record
-Ensure the client is comfortable
-Clarify the goals/agenda for the encounter; balance provider and client goals
,-Establish rapport
-Identify the client's preferred title, name, and gender pronouns
-Use "people first" language (i.e., a person with hearing loss, a person who uses a wheelchair)
Gather Information
-ID the client's chief complaint or reason for seeking care
-Invite the client's story using an open-ended approach
-Gather information about the client's perspective of the illness using the mnemonic FIFE
-Conduct the health history interview
-Gather information about past medical history, medications and allergies, family history, personal and
social history, and ROS
Perform the Physical Exam
-Conduct the exam based on the information obtained from the health history
-Maintain client's comfort and privacy throughout the exam
Explain and Plan
-Assess and respond to the client's needs for information
-Negotiate and make decisions together
-Utilize teach-back to ensure the client understands the plan
Close the Encounter
-Leave time for the client to ask questions
-Summarize the plans for future evaluation, treatments, and follow up
The general sequence of a clinical encounter is to:
Answer: -initiate the encounter
-gather information
-perform a physical exam
-develop a shared plan
-close the encounter
FIFE mnemonic
Answer: Feelings
Ideas
Function
Expectations
-A mnemonic for the patient's perspective on the illness
• The patient's Feelings, including fears or concerns, about the problem
• The patient's Ideas about the nature and the cause of the problem
• The effect of the problem on the patient's life and Function
• The patient's Expectations of the disease, of the clinician, or of health care, often based on prior
personal or family experiences
Basic interviewing techniques
Answer: -active listening
-empathy
,-guided questioning
-validating
-empowerment
-partnering
-transitioning
-reassuring
-summarizing
-nonverbal communication
active listening
Answer: closely attending to what the client is communicating, connecting to the client's emotional
state, and using verbal and nonverbal skills to encourage the client to expand on their feelings and
concerns.
empathy
Answer: identifying with the client and feeling their pain as one's own, then responding to them in a
supportive manner.
guided questioning
Answer: -Guided questions help to elicit more information, while still showing a continued interest in
the client's feelings and story.
-Some techniques of guided questioning include moving from open-ended to more focused questions;
clarifying what the client means; encouraging with continuers such as "go on"; using a series of
questions one at a time; and using questions that require a graded response (i.e., how many stairs can
you climb before feeling short of breath?).
validating
Answer: affirming the legitimacy of the client's emotional experience.
-Examples: "That must have been a difficult experience. It's very common to feel the way you are
feeling."
empowerment
Answer: Empowering clients to ask questions and express their concerns increases the chances that they
will adopt your advice, make lifestyle changes, or take medications as prescribed.
partnering
Answer: involves expressing commitment to an ongoing relationship with the clients to build rapport
transitioning
Answer: Transitions can be used to inform the client that the direction of the interview is changing.
reassuring
Answer: Reassurance is an appropriate way to help the client feel that problems have been fully
understood and are being addressed.
summarizing
Answer: Giving a summary of the client's story during the interview helps to communicate that they
have been carefully listening.
, nonverbal communication
Answer: includes eye contact, facial expression, posture, head position, and movement such as shaking
or nodding, interpersonal distance, and placement of the arms or legs (i.e., crossed, neutral, or open).
Managing Challenging Situations: Silent Clients
Answer: -Clients may be quiet to collect thoughts, remember details, or decide if they trust the provider
-Become comfortable with periods of silence
-Acknowledge that the client is quiet and ask what they are thinking about or if something has upset
them
Managing Challenging Situations: Talkative Clients
Answer: -Talkative clients should be allowed to talk for several minutes at the beginning of the interview
-Focus on what seems to be most important to the client
-Offer a summary of the main concerns and suggest a focus on one problem or ask the client to identify
their priority concern for the day
Managing Challenging Situations: Clients with Altered Cognition
Answer: -Clients with conditions such as dementia or mental health illness may not be able to provide
their history
-Obtain information from family members or caregivers
-Some clients may be able to provide a history, but cannot make their own health decisions
Managing Challenging Situations: Angry Clients
Answer: -Clients may direct anger toward the provider even if their anger is related to being ill, suffering
a loss, or feeling overwhelmed and not in control
-Acknowledge clients' anger and frustration, but avoid reinforcing criticism of other providers or the
clinical setting
-Alert security staff for clients who are overly disruptive or out of control
-Remain calm and avoid being confrontational
Comprehensive health history
Answer: Chief Complaint
History of Present Illness
Past Medical History
Medications and Allergies
Family History
Personal and Social History
Review of Systems
History of present illness
Answer: use OLDCARTS
Past medical history
Answer: -Childhood Illnesses: Inquire about childhood illnesses such as measles, chickenpox, or scarlet
fever and chronic childhood illnesses such as diabetes or asthma.
-Adult Illnesses: Inquire about illnesses such as diabetes, hypertension, or asthma and hospitalizations.
-Surgical: Document dates, indications, and types of surgical procedures.
