NR 509 Advanced Physical Assessment | Chamberlain College of Nursing
The nurse practitioner (NP) is completing a comprehensive occasionally running out of food, being discriminated against in the workplace, has
assessment of Anita, a new client in a primary care facility. a great amount of smog in their community, having difficulty making the rent
Which assessment finding(s) reported by Anita are related payment
to social determinants of health? Select all that apply.
Focused assessment: - 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 present illness, only the system related to the problem in
the ROS
comprehensive assessment: - 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 area of PMhx, family
hx, social hx, at least 10 ROS
subjective data Subjective data includes symptoms that the client describes such as a sore throat,
headache, or pain. It also includes the client's feelings, perceptions, and concerns
objective data Objective data includes the physical examination findings or signs observed.
Information obtained from the client during any part of the health history is
considered subjective data. All physical examinations, laboratory information, and
test data are considered objective data
initial encounter -review the clinical record
-ensure the client is comfortable
-clarify the goals/agenda for the encounter
-establish rapport
-identify client's preferred title, name, and gender pronouns
-use "people first" language (i.e. hearing loss, wheelchair)
-identify the c/o
-open-ended approach for client's story
-gather information about the client's perspective of the illness using the FIFE
(feelings, ideas, function, expectations)
-conduct health history interview
-gather information about PMHx, meds, allergies, family, personal and social, ROS
"How would you describe your sexual identity?"
"How would you describe your gender identity?"
"What is the sex on your original birth certificate?"
Basic Interviewing Skills -active listening-closely attending to what the pt is communicating, connect to pt's
emotional state, use verbal and nonverbal skills
-empathy- the capacity to identify with the pt and feel the pt's pain as your own
-guided questioning- allows for interviewer to facilitate full communications
-validating- affirm legitimacy of pt's emotional experience
-empowerment; encourage pt to ask questions
-partnering; express your commitment to ongoing relationship
-transitioning; inform your pt when you are changing directions
-reassuring; help the pt feel that their problems have been heard
- summarizing; giving a summary of the pt's story to communicate that you have
been carefully listening
-nonverbal communication
-people first language --> ex. patient with diabetes instead of diabetic
history of present illness The history of the present illness is a concise, clear, and chronological description of
the chief complaint which prompted the client's visit. A symptom analysis guided by
the mnemonic OLD CARTS will reveal information regarding the onset, location,
duration, characteristics, aggravating factors, relieving factors, treatments, and
severity of the symptoms. There are other mnemonics and variations of OLD
CARTS that may also be used to guide in gathering information about the chief
complaint.
, NR 509 Advanced Physical Assessment | Chamberlain College of Nursing
personal and social history The Five P's:
-partners
-practices
-protection from STIs
-Past hx of STIs
-Pregnancy plans
-Plus-- assess for trauma, violence, sexual health concerns, provide support for
sexual orientation and gender identity
assessment questions with the related symptom attribute onset, location, duration, characteristics, aggravating factors, relieving factors,
treatments, severity of symptoms
pack-year cig calculations A pack-year calculation is used to measure a person's exposure to tobacco and
assess their risk of developing lung cancer or other diseases related to tobacco use.
The pack year is calculated by multiplying the number of packs of cigarettes (1
pack=20 cigarettes) smoked per day by the number of years the person has
smoked. The U.S. Preventive Services Task Force Links to an external site.(2021)
recommends health care providers ask all adults about tobacco use, advise them to
stop, and provide interventions for smoking cessation
social determinants of health -Social determinants of health are the conditions in the environments where people
are born, live, and work that affects health, well-being, and quality of life
- examples: economic stability, education access and quality, healthcare access and
quality, neighborhood and built environment, social and community context
mental status exam If indicated and not done during the interview, assess the client's orientation, mood,
thought process, thought content, abnormal perceptions, insight and judgment,
memory and attention, information and vocabulary, calculating abilities, abstract
thinking, and constructional ability.
The NP performs a mental status examination. Which of flight of ideas, mismatched/unseasonal clothing, recalls 1/3 items in the exam,
the following are positive findings? Select all that apply erratic speech
skin, hair, nails Do you have any current problems or history of diseases or issues with your skin,
hair, or nails?
Do you have any allergies to drugs, plants, or animals?
Do you have any birthmarks or tattoos?
Tell me about any changes in skin color or moisture.
Tell me about any changes in moles such as color, size, shape, sudden appearance
of tenderness, bleeding, or itching.
Do you have any bruises, sores, rashes, or itching?
Tell me about any changes in hair color, amount, or texture.
Tell me about any changes in nail color, shape, or density.
Tell me about your current lifestyle including typical diet, smoking, sun exposure,
occupation, and hobbies
Dario, a 23-year-old, presents for evaluation of a new rash temperature, pain, change in soap, sexual hx, itching
on the inner thighs with onset three days ago. What
additional assessment data should the FNP collect? Select
all that apply.
Basal Cell Carcinoma Epidermal skin cancer
Slow progression without pain
Occurs in sun-exposed areas
Often on face
May ooze, crust, or bleed
Refer to dermatology
The nurse practitioner (NP) is completing a comprehensive occasionally running out of food, being discriminated against in the workplace, has
assessment of Anita, a new client in a primary care facility. a great amount of smog in their community, having difficulty making the rent
Which assessment finding(s) reported by Anita are related payment
to social determinants of health? Select all that apply.
Focused assessment: - 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 present illness, only the system related to the problem in
the ROS
comprehensive assessment: - 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 area of PMhx, family
hx, social hx, at least 10 ROS
subjective data Subjective data includes symptoms that the client describes such as a sore throat,
headache, or pain. It also includes the client's feelings, perceptions, and concerns
objective data Objective data includes the physical examination findings or signs observed.
Information obtained from the client during any part of the health history is
considered subjective data. All physical examinations, laboratory information, and
test data are considered objective data
initial encounter -review the clinical record
-ensure the client is comfortable
-clarify the goals/agenda for the encounter
-establish rapport
-identify client's preferred title, name, and gender pronouns
-use "people first" language (i.e. hearing loss, wheelchair)
-identify the c/o
-open-ended approach for client's story
-gather information about the client's perspective of the illness using the FIFE
(feelings, ideas, function, expectations)
-conduct health history interview
-gather information about PMHx, meds, allergies, family, personal and social, ROS
"How would you describe your sexual identity?"
"How would you describe your gender identity?"
"What is the sex on your original birth certificate?"
Basic Interviewing Skills -active listening-closely attending to what the pt is communicating, connect to pt's
emotional state, use verbal and nonverbal skills
-empathy- the capacity to identify with the pt and feel the pt's pain as your own
-guided questioning- allows for interviewer to facilitate full communications
-validating- affirm legitimacy of pt's emotional experience
-empowerment; encourage pt to ask questions
-partnering; express your commitment to ongoing relationship
-transitioning; inform your pt when you are changing directions
-reassuring; help the pt feel that their problems have been heard
- summarizing; giving a summary of the pt's story to communicate that you have
been carefully listening
-nonverbal communication
-people first language --> ex. patient with diabetes instead of diabetic
history of present illness The history of the present illness is a concise, clear, and chronological description of
the chief complaint which prompted the client's visit. A symptom analysis guided by
the mnemonic OLD CARTS will reveal information regarding the onset, location,
duration, characteristics, aggravating factors, relieving factors, treatments, and
severity of the symptoms. There are other mnemonics and variations of OLD
CARTS that may also be used to guide in gathering information about the chief
complaint.
, NR 509 Advanced Physical Assessment | Chamberlain College of Nursing
personal and social history The Five P's:
-partners
-practices
-protection from STIs
-Past hx of STIs
-Pregnancy plans
-Plus-- assess for trauma, violence, sexual health concerns, provide support for
sexual orientation and gender identity
assessment questions with the related symptom attribute onset, location, duration, characteristics, aggravating factors, relieving factors,
treatments, severity of symptoms
pack-year cig calculations A pack-year calculation is used to measure a person's exposure to tobacco and
assess their risk of developing lung cancer or other diseases related to tobacco use.
The pack year is calculated by multiplying the number of packs of cigarettes (1
pack=20 cigarettes) smoked per day by the number of years the person has
smoked. The U.S. Preventive Services Task Force Links to an external site.(2021)
recommends health care providers ask all adults about tobacco use, advise them to
stop, and provide interventions for smoking cessation
social determinants of health -Social determinants of health are the conditions in the environments where people
are born, live, and work that affects health, well-being, and quality of life
- examples: economic stability, education access and quality, healthcare access and
quality, neighborhood and built environment, social and community context
mental status exam If indicated and not done during the interview, assess the client's orientation, mood,
thought process, thought content, abnormal perceptions, insight and judgment,
memory and attention, information and vocabulary, calculating abilities, abstract
thinking, and constructional ability.
The NP performs a mental status examination. Which of flight of ideas, mismatched/unseasonal clothing, recalls 1/3 items in the exam,
the following are positive findings? Select all that apply erratic speech
skin, hair, nails Do you have any current problems or history of diseases or issues with your skin,
hair, or nails?
Do you have any allergies to drugs, plants, or animals?
Do you have any birthmarks or tattoos?
Tell me about any changes in skin color or moisture.
Tell me about any changes in moles such as color, size, shape, sudden appearance
of tenderness, bleeding, or itching.
Do you have any bruises, sores, rashes, or itching?
Tell me about any changes in hair color, amount, or texture.
Tell me about any changes in nail color, shape, or density.
Tell me about your current lifestyle including typical diet, smoking, sun exposure,
occupation, and hobbies
Dario, a 23-year-old, presents for evaluation of a new rash temperature, pain, change in soap, sexual hx, itching
on the inner thighs with onset three days ago. What
additional assessment data should the FNP collect? Select
all that apply.
Basal Cell Carcinoma Epidermal skin cancer
Slow progression without pain
Occurs in sun-exposed areas
Often on face
May ooze, crust, or bleed
Refer to dermatology
