NURS 500 - exam one || solved correctly.
What are the two types of visits we conduct as FNPs? When would you conduct each? What are
the components of each? correct answers Comprehensive: all the elements of the health history
and complete PE
Focused: returning for routine care or with specific "urgent" concerns (e.g. sore throat, knee
pain)
What is the difference between subjective and objective data? What are some examples of each?
correct answers Subjective: what the patient tells you (e.g. symptoms, history, from cc to ROS)
Objective: what you detect during the exam, labs, test data, all PE findings or signs
What is the HPI? How would the FNP obtain one? correct answers Complete, clear, and
chronological description of the problems prompting the patient's visit (OLDCART)
What does OLDCART stand for? How is onset in OLDCART different from the onset in the
seven attributes of a symptom? correct answers Onset, location, duration, characteristics,
aggravating/relieving, timing (frequency)
What are the seven attributes of a symptom? How do you define each? What is the difference
between onset and timing? correct answers Location, quality, quantity/severity, timing (onset,
duration, frequency), the setting in which it occurs, factors that have aggravated/relieved the
symptom, associated manifestations
What is a differential diagnosis and how is one formulated? correct answers List of potential
causes for the patient's problems
Identify abnormal findings, localize findings anatomically, cluster clinical findings, search for
the probable cause, cluster clinical data
,What is a leading question? Should these be used when obtaining a history from a patient?
correct answers Already contain an answer or suggested response - DONT USE
How should the FNP quantify tobacco use? correct answers Pack years - a person who has
smoked 1.5 packs a day for 12 years has an 18 pack/year history
How would you approach the silent patient? What should you consider as part of your DDx for
the silent patient? Why are periods of silence important? correct answers If already tried guided
questioning, try asking more direct questions about symptoms (for patients with depression or
dementia)
Important because may be collecting thoughts, trying to remember details, offended by previous
questions asked, etc.
How would you approach the confusing patient? What should you consider as part of your DDx
for the confusing patient? correct answers If patient presents with an array of symptoms ("a
positive ROS") - focus on context of symptom, emphasize patient's perspective, guide the
interview into a psychosocial assessment
Consider mental status change, delirium in acutely ill or intoxicated patients, dementia in elderly
--> shift to MSE and focus on LOC, orientation, memory, capacity to understand
How would you approach the talkative patient? What are some strategies that you can use during
a visit with a talkative patient? correct answers Give them free reign for the first 5-10 minutes
while listening closely, set limits, brief summary can help change subject
Avoid showing impatience, explain possible need for second visit and set time limit
How would you approach the patient with a language barrier? What would you look for in the
ideal interpreter? correct answers Ideal interpreter - "cultural navigator" who is neutral and
trained in both languages/cultures
,Guidelines for working with an interpreter: introductions, note goals, transparency, ethics,
respect beliefs, patient focus, retain control, explain, thanks
How would you approach the patient with a low literacy or low health literacy? What are some
strategies that you can use during a visit with this patient? correct answers Ask about years
completed in school or check how well the patient reads written instructions (hand a patient a
book upside down)
Identify reasons - language barrier, learning disorder, poor vision, level of education
How would you approach the patient with hearing loss? What are some strategies that you can
use during a visit with this patient? correct answers Determine the patient's preferred method of
communication, if they belong to the hearing or deaf culture, when the hearing loss occurred
relative to the development of speech and language, kind of schools the patient attended
Write out instructions for them to take home
How should you approach the history of the patient with an altered mental status or delirium?
correct answers Obtain historical information from other sources (family members or caregivers)
Cannot disclose patient information unless informant is the healthcare proxy, has durable power
of attorney, or permission from the patient
Determine if patient has "decision making capacity" (if no healthcare proxy, may default to
spouse or family member)
What are some questions you should ask the depressed patient? correct answers "Over the past 2
weeks, have you felt down, depressed, or hopeless?", "Over the past 2 weeks, have you felt little
interest or pleasure in doing things?", "Have you ever thought about hurting yourself or ending
your life?"
, What are some strategies you can use and questions that you might ask when taking a sexual
history? correct answers Ask questions during OB/Gyn section of PMH for women, in health
maintenance, or personal and social history (in sexual practices of ROS during comprehensive
exam)
Start with an orienting sentence, use specific language
What are some questions that you might ask when taking a mental health history? correct
answers Ask open-ended questions initially ("Have you ever had any problem with emotional or
mental illnesses?") then move to more specific questions
Have you ever taken medication for a mental health condition? Have you ever been hospitalized
for an emotional or mental health problem? What about members of your family?
When considering alcohol and illicit drug use, what are some screening strategies that the FNP
might use? What questions should the FNP ask? correct answers Conversations follow naturally
after asking about caffeine and cigarettes
Alcohol - "Tell me about your use of alcohol", "Have you ever had a drinking problem?", "When
was your last drink?"
Use CAGE questions - cutting down, annoyance when criticized, guilty feelings, eye openers -->
two affirmatives suggest alcohol misuse --> ask about blackouts, seizures, accidents/injuries, job
problems, conflict in personal relationships
Illicit drugs - "How many times in the past year have you used an illegal drug or used a
prescription med for non-clinical reasons?"
Modify CAGE questions by adding "or drugs" to each question
What are the two types of visits we conduct as FNPs? When would you conduct each? What are
the components of each? correct answers Comprehensive: all the elements of the health history
and complete PE
Focused: returning for routine care or with specific "urgent" concerns (e.g. sore throat, knee
pain)
What is the difference between subjective and objective data? What are some examples of each?
correct answers Subjective: what the patient tells you (e.g. symptoms, history, from cc to ROS)
Objective: what you detect during the exam, labs, test data, all PE findings or signs
What is the HPI? How would the FNP obtain one? correct answers Complete, clear, and
chronological description of the problems prompting the patient's visit (OLDCART)
What does OLDCART stand for? How is onset in OLDCART different from the onset in the
seven attributes of a symptom? correct answers Onset, location, duration, characteristics,
aggravating/relieving, timing (frequency)
What are the seven attributes of a symptom? How do you define each? What is the difference
between onset and timing? correct answers Location, quality, quantity/severity, timing (onset,
duration, frequency), the setting in which it occurs, factors that have aggravated/relieved the
symptom, associated manifestations
What is a differential diagnosis and how is one formulated? correct answers List of potential
causes for the patient's problems
Identify abnormal findings, localize findings anatomically, cluster clinical findings, search for
the probable cause, cluster clinical data
,What is a leading question? Should these be used when obtaining a history from a patient?
correct answers Already contain an answer or suggested response - DONT USE
How should the FNP quantify tobacco use? correct answers Pack years - a person who has
smoked 1.5 packs a day for 12 years has an 18 pack/year history
How would you approach the silent patient? What should you consider as part of your DDx for
the silent patient? Why are periods of silence important? correct answers If already tried guided
questioning, try asking more direct questions about symptoms (for patients with depression or
dementia)
Important because may be collecting thoughts, trying to remember details, offended by previous
questions asked, etc.
How would you approach the confusing patient? What should you consider as part of your DDx
for the confusing patient? correct answers If patient presents with an array of symptoms ("a
positive ROS") - focus on context of symptom, emphasize patient's perspective, guide the
interview into a psychosocial assessment
Consider mental status change, delirium in acutely ill or intoxicated patients, dementia in elderly
--> shift to MSE and focus on LOC, orientation, memory, capacity to understand
How would you approach the talkative patient? What are some strategies that you can use during
a visit with a talkative patient? correct answers Give them free reign for the first 5-10 minutes
while listening closely, set limits, brief summary can help change subject
Avoid showing impatience, explain possible need for second visit and set time limit
How would you approach the patient with a language barrier? What would you look for in the
ideal interpreter? correct answers Ideal interpreter - "cultural navigator" who is neutral and
trained in both languages/cultures
,Guidelines for working with an interpreter: introductions, note goals, transparency, ethics,
respect beliefs, patient focus, retain control, explain, thanks
How would you approach the patient with a low literacy or low health literacy? What are some
strategies that you can use during a visit with this patient? correct answers Ask about years
completed in school or check how well the patient reads written instructions (hand a patient a
book upside down)
Identify reasons - language barrier, learning disorder, poor vision, level of education
How would you approach the patient with hearing loss? What are some strategies that you can
use during a visit with this patient? correct answers Determine the patient's preferred method of
communication, if they belong to the hearing or deaf culture, when the hearing loss occurred
relative to the development of speech and language, kind of schools the patient attended
Write out instructions for them to take home
How should you approach the history of the patient with an altered mental status or delirium?
correct answers Obtain historical information from other sources (family members or caregivers)
Cannot disclose patient information unless informant is the healthcare proxy, has durable power
of attorney, or permission from the patient
Determine if patient has "decision making capacity" (if no healthcare proxy, may default to
spouse or family member)
What are some questions you should ask the depressed patient? correct answers "Over the past 2
weeks, have you felt down, depressed, or hopeless?", "Over the past 2 weeks, have you felt little
interest or pleasure in doing things?", "Have you ever thought about hurting yourself or ending
your life?"
, What are some strategies you can use and questions that you might ask when taking a sexual
history? correct answers Ask questions during OB/Gyn section of PMH for women, in health
maintenance, or personal and social history (in sexual practices of ROS during comprehensive
exam)
Start with an orienting sentence, use specific language
What are some questions that you might ask when taking a mental health history? correct
answers Ask open-ended questions initially ("Have you ever had any problem with emotional or
mental illnesses?") then move to more specific questions
Have you ever taken medication for a mental health condition? Have you ever been hospitalized
for an emotional or mental health problem? What about members of your family?
When considering alcohol and illicit drug use, what are some screening strategies that the FNP
might use? What questions should the FNP ask? correct answers Conversations follow naturally
after asking about caffeine and cigarettes
Alcohol - "Tell me about your use of alcohol", "Have you ever had a drinking problem?", "When
was your last drink?"
Use CAGE questions - cutting down, annoyance when criticized, guilty feelings, eye openers -->
two affirmatives suggest alcohol misuse --> ask about blackouts, seizures, accidents/injuries, job
problems, conflict in personal relationships
Illicit drugs - "How many times in the past year have you used an illegal drug or used a
prescription med for non-clinical reasons?"
Modify CAGE questions by adding "or drugs" to each question
