NU 518 Exam 1 Questions and Answers
Question 1.
(Approach to the Clinical Encounter)
Correct Answer:
Question 2.
Sequence of the Clinical Encounter
Correct Answer: Initiating the encounter Setting the stage/preparation Greeting
the patient and establishing initial rapport Gathering information Initiating
information gathering Exploring patient's perspective of illness Exploring
biomedical perspective of disease including relevant background and context
Performing the physical examination Explaining and planning Provide correct
amount and type of information Negotiate plan of action Shared decision
making Closing the encounter
Question 3.
Exploring the patient's perspective
Correct Answer: To understand the patient's perspective, the clinician needs to
explore these four domains: F-I-F-E = Feelings, Ideas, effect on Function,
Expectations The disease/illness distinction model > helps elucidate the
different yet complementary perspectives of the clinician and the patient §
disease is the explanation the clinician uses to organize symptoms that leads to
a clinical diagnosis, AND § illness is a construct that explains how the patient
experiences the disease (e.g., effects on relationships, function, and sense of
well-being). The clinical interview needs to incorporate both these views of
reality.
Question 4.
Shared decision-making
Correct Answer: has been called the pinnacle of patient-centered care. Experts
recommend a three-step process: 1. Introducing choices and describing options
using patient decision support tools when available. 2. Exploring patient
preferences. 3. Moving to a decision, checking that the patient is ready to make
a decision and offering more time, if needed.
Question 5.
Social determinants of health
Correct Answer: Economic stability (employment, food insecurity, housing
instability, poverty) Education (early childhood education and development,
enrollment in higher education, high school graduation, language and literacy)
Social and community context (civic participation, discrimination, incarceration,
social cohesion) Health and health care (access to health care, access to primary
,care, health literacy) Neighborhood and built environment (access to foods that
support healthy eating, patterns, crime and violence, environmental conditions,
quality of housing)
Question 6.
Cultural humility
Correct Answer: Communicating effectively with patients from every
background has always been an important professional skill. To moderate the
disparities, present in healthcare, clinicians are increasingly urged to engage in
self-reflection, critical thinking, and cultural humility as they experience
diversity in their clinical practices. Cultural humility is defined as a "process that
requires humility as individuals continually engage in self-reflection and
self-critique as lifelong learners and reflective practitioners." It is a process that
includes "the difficult work of examining cultural beliefs and cultural systems of
both patients and providers to locate the points of cultural dissonance or
synergy that contribute to patients' health outcomes." Three dimensions of
cultural humility: a. Self-awareness: learn about your own biases; we all have
them. b. Respectful communication: work to eliminate assumptions about what
is "normal." Let your patients be the experts on their own unique cultural
perspectives. c. Collaborative partnerships: build your patient relationships on
respect and mutually acceptable plans.
Question 7.
Core values of medical ethics
Correct Answer: Nonmaleficence ("first, do no harm") directive that health care
professionals should avoid causing harm to patients and minimize the negative
effects of treatments. Beneficence dictum that clinicians are to act for the
patients' good by preventing or treating disease. Respect for autonomy
commitment to accept the choices patients with decisional capacity make about
which treatments to undergo, including to reject treatment. The addition of this
value to medical ethics changed the clinician-patient relationship from a
paternalistic one to a more collaborative one. Decisional capacity ability to
make an autonomous choice that clinicians should respect. Confidentiality duty
to prevent the disclosure of patients' personal information to parties who are
not authorized to learn that information. Informed consent principle that
clinicians must elicit patients' voluntary and informed authorization to test or
treat them for illness or injury. Because patients cannot consent to treatment
without knowing what they are being treated for, this principle also
encompasses the responsibility to inform patients of diagnoses, prognoses, and
treatment alternatives. Truth telling value that clinicians should disclose
information beyond that required by informed consent that may be relevant to
patients (e.g., the number of similar procedures a physician has performed).
Justice value that all patients with similar medical needs should receive similar
medical treatment and should be treated fairly by clinicians.
Question 8.
, (Interviewing, Communication, and Interpersonal Skills)
Correct Answer:
Question 9.
Skilled interviewing techniques
Correct Answer: -Active or attentive listening -Guided questioning -Empathic
responses -Summarization -Transitions -Partnering -Validation -Empowering the
patient -Reassurance -Appropriate verbal communication -Appropriate
nonverbal communication
Question 10.
Active Listening
Correct Answer: Closely attending to what the patient is communicating,
connecting to the patient's emotional state, and using verbal and nonverbal
skills to encourage the patient to expand on his or her feelings and concerns.
Question 11.
Empathic Responses
Correct Answer: Empathy has been described as the capacity to identify with the
patient and feel the patient's pain as your own, then respond in a supportive
manner. Empathy requires a willingness to suffer some of the patient's pain in
the sharing of suffering that is vital to healing. To express empathy, you must
first recognize the patient's feelings, then actively move toward and elicit
emotional content. For a response to be empathic, it must convey that you feel
what the patient is feeling.
Question 12.
Guided Questioning
Correct Answer: goal is to facilitate full communication, in the patient's own
words, without interruption. Guided questions show your sustained interest in
the patient's feelings and deepest disclosures. Techniques of guided
questioning include: Moving from open-ended to focused questions: questions
should flow from general to specific, and leading questions should be avoided.
Using questioning that elicits a graded response: ask questions that require a
graded response rather than a yes or no; e.g., "How many steps can you climb
before you get short of breath?" instead of "Do you get short of breath climbing
stairs?" Asking a series of questions, one at a time: pause and establish eye
contact as you ask one question at a time. Offering multiple choices for
answers: to minimize bias, offer multiple choice answers when patients need
help describing their symptoms. Clarifying what the patient means:
acknowledge any confusion by requesting clarification; this reassures the
patient that you want to understand his or her story and builds your therapeutic
relationship. Encouraging with continuers: without even speaking, you can use
posture, gestures, or words to encourage the patient to say more (e.g., pausing
Question 1.
(Approach to the Clinical Encounter)
Correct Answer:
Question 2.
Sequence of the Clinical Encounter
Correct Answer: Initiating the encounter Setting the stage/preparation Greeting
the patient and establishing initial rapport Gathering information Initiating
information gathering Exploring patient's perspective of illness Exploring
biomedical perspective of disease including relevant background and context
Performing the physical examination Explaining and planning Provide correct
amount and type of information Negotiate plan of action Shared decision
making Closing the encounter
Question 3.
Exploring the patient's perspective
Correct Answer: To understand the patient's perspective, the clinician needs to
explore these four domains: F-I-F-E = Feelings, Ideas, effect on Function,
Expectations The disease/illness distinction model > helps elucidate the
different yet complementary perspectives of the clinician and the patient §
disease is the explanation the clinician uses to organize symptoms that leads to
a clinical diagnosis, AND § illness is a construct that explains how the patient
experiences the disease (e.g., effects on relationships, function, and sense of
well-being). The clinical interview needs to incorporate both these views of
reality.
Question 4.
Shared decision-making
Correct Answer: has been called the pinnacle of patient-centered care. Experts
recommend a three-step process: 1. Introducing choices and describing options
using patient decision support tools when available. 2. Exploring patient
preferences. 3. Moving to a decision, checking that the patient is ready to make
a decision and offering more time, if needed.
Question 5.
Social determinants of health
Correct Answer: Economic stability (employment, food insecurity, housing
instability, poverty) Education (early childhood education and development,
enrollment in higher education, high school graduation, language and literacy)
Social and community context (civic participation, discrimination, incarceration,
social cohesion) Health and health care (access to health care, access to primary
,care, health literacy) Neighborhood and built environment (access to foods that
support healthy eating, patterns, crime and violence, environmental conditions,
quality of housing)
Question 6.
Cultural humility
Correct Answer: Communicating effectively with patients from every
background has always been an important professional skill. To moderate the
disparities, present in healthcare, clinicians are increasingly urged to engage in
self-reflection, critical thinking, and cultural humility as they experience
diversity in their clinical practices. Cultural humility is defined as a "process that
requires humility as individuals continually engage in self-reflection and
self-critique as lifelong learners and reflective practitioners." It is a process that
includes "the difficult work of examining cultural beliefs and cultural systems of
both patients and providers to locate the points of cultural dissonance or
synergy that contribute to patients' health outcomes." Three dimensions of
cultural humility: a. Self-awareness: learn about your own biases; we all have
them. b. Respectful communication: work to eliminate assumptions about what
is "normal." Let your patients be the experts on their own unique cultural
perspectives. c. Collaborative partnerships: build your patient relationships on
respect and mutually acceptable plans.
Question 7.
Core values of medical ethics
Correct Answer: Nonmaleficence ("first, do no harm") directive that health care
professionals should avoid causing harm to patients and minimize the negative
effects of treatments. Beneficence dictum that clinicians are to act for the
patients' good by preventing or treating disease. Respect for autonomy
commitment to accept the choices patients with decisional capacity make about
which treatments to undergo, including to reject treatment. The addition of this
value to medical ethics changed the clinician-patient relationship from a
paternalistic one to a more collaborative one. Decisional capacity ability to
make an autonomous choice that clinicians should respect. Confidentiality duty
to prevent the disclosure of patients' personal information to parties who are
not authorized to learn that information. Informed consent principle that
clinicians must elicit patients' voluntary and informed authorization to test or
treat them for illness or injury. Because patients cannot consent to treatment
without knowing what they are being treated for, this principle also
encompasses the responsibility to inform patients of diagnoses, prognoses, and
treatment alternatives. Truth telling value that clinicians should disclose
information beyond that required by informed consent that may be relevant to
patients (e.g., the number of similar procedures a physician has performed).
Justice value that all patients with similar medical needs should receive similar
medical treatment and should be treated fairly by clinicians.
Question 8.
, (Interviewing, Communication, and Interpersonal Skills)
Correct Answer:
Question 9.
Skilled interviewing techniques
Correct Answer: -Active or attentive listening -Guided questioning -Empathic
responses -Summarization -Transitions -Partnering -Validation -Empowering the
patient -Reassurance -Appropriate verbal communication -Appropriate
nonverbal communication
Question 10.
Active Listening
Correct Answer: Closely attending to what the patient is communicating,
connecting to the patient's emotional state, and using verbal and nonverbal
skills to encourage the patient to expand on his or her feelings and concerns.
Question 11.
Empathic Responses
Correct Answer: Empathy has been described as the capacity to identify with the
patient and feel the patient's pain as your own, then respond in a supportive
manner. Empathy requires a willingness to suffer some of the patient's pain in
the sharing of suffering that is vital to healing. To express empathy, you must
first recognize the patient's feelings, then actively move toward and elicit
emotional content. For a response to be empathic, it must convey that you feel
what the patient is feeling.
Question 12.
Guided Questioning
Correct Answer: goal is to facilitate full communication, in the patient's own
words, without interruption. Guided questions show your sustained interest in
the patient's feelings and deepest disclosures. Techniques of guided
questioning include: Moving from open-ended to focused questions: questions
should flow from general to specific, and leading questions should be avoided.
Using questioning that elicits a graded response: ask questions that require a
graded response rather than a yes or no; e.g., "How many steps can you climb
before you get short of breath?" instead of "Do you get short of breath climbing
stairs?" Asking a series of questions, one at a time: pause and establish eye
contact as you ask one question at a time. Offering multiple choices for
answers: to minimize bias, offer multiple choice answers when patients need
help describing their symptoms. Clarifying what the patient means:
acknowledge any confusion by requesting clarification; this reassures the
patient that you want to understand his or her story and builds your therapeutic
relationship. Encouraging with continuers: without even speaking, you can use
posture, gestures, or words to encourage the patient to say more (e.g., pausing
