Shadow Health quiz test with correct
answers
1. Acute pain - CORRECT ANSWERS-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 ANSWERS-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 ANSWERS-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 ANSWERS-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 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 ANSWERS-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
ANSWERS-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 ANSWERS-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. 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 ANSWERS-
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 ANSWERS-
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 ANSWERS-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
ANSWERS-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 from my
inhaler, but sometimes I need three. [Nurse confirmed with Pharmacy: albuterol
90mcg/spray MDI] Student: What are some things that trigger your asthma? Tina Jones:
Being around cats is the worst, but dust and running up stairs can make my breathing
bad, too. Student: What allergies do you have? Tina Jones: I'm allergic to cats. Model
Statement: "It sounds like your asthma is giving you some problems, and you're not
getting full relief from your inhaler. I would like to talk with you about changing your
medication and your regimen, to reduce your frequent breathing problems, so that you
feel better day-to-day. Most patients find that using a daily inhaler is an easy way to
reduce your asthma symptoms even more."
6. Risk for unstable blood glucose level - CORRECT ANSWERS-Priority - High Priority
Pro Tip: Uncontrolled blood glucose levels delay or prevent wound healing, and must be
addressed to resolve the infection. Unstable blood glucose levels could increase the
patient's risk for falls. Evidence - Relevant: "Random blood glucose: 238" Evidence Pro
Tip: Tina reports infrequent blood glucose monitoring and a general lack of diabetes
management, which increases her risk for fluctuating blood glucose levels. Infection can
contribute to poorer glycemic control, and so Tina is likely to experience blood glucose
levels that are significantly higher than her baseline. Planning - Relevant: Assess -
Vitals: Assess the patient's blood glucose levels according to orders. Educate - Disease
Process: Educate the patient on the signs and symptoms of hyper- and hypoglycemia.
Intervene - Diet: Provide the patient a diet without concentrated sweets. Intervene -
Hypoglycemia: Administer insulin and/or oral hypoglycemics, per physician orders.
Planning Pro Tip: First, gauge your patient's current status by checking hydration, vital
signs, and perfusion. Measure the patient's blood glucose and provide medication as
per the physician's orders. While the patient is in your care, ensure that their meals align
with a low glycemic diet, and educate the patient on monitoring her own health status.
7. Loss of a family member Not Followed Up - CORRECT ANSWERS-Description: Tina
shares information about her father dying. Student: Why don't you have your dad's
answers
1. Acute pain - CORRECT ANSWERS-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 ANSWERS-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 ANSWERS-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 ANSWERS-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 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 ANSWERS-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
ANSWERS-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 ANSWERS-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. 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 ANSWERS-
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 ANSWERS-
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 ANSWERS-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
ANSWERS-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 from my
inhaler, but sometimes I need three. [Nurse confirmed with Pharmacy: albuterol
90mcg/spray MDI] Student: What are some things that trigger your asthma? Tina Jones:
Being around cats is the worst, but dust and running up stairs can make my breathing
bad, too. Student: What allergies do you have? Tina Jones: I'm allergic to cats. Model
Statement: "It sounds like your asthma is giving you some problems, and you're not
getting full relief from your inhaler. I would like to talk with you about changing your
medication and your regimen, to reduce your frequent breathing problems, so that you
feel better day-to-day. Most patients find that using a daily inhaler is an easy way to
reduce your asthma symptoms even more."
6. Risk for unstable blood glucose level - CORRECT ANSWERS-Priority - High Priority
Pro Tip: Uncontrolled blood glucose levels delay or prevent wound healing, and must be
addressed to resolve the infection. Unstable blood glucose levels could increase the
patient's risk for falls. Evidence - Relevant: "Random blood glucose: 238" Evidence Pro
Tip: Tina reports infrequent blood glucose monitoring and a general lack of diabetes
management, which increases her risk for fluctuating blood glucose levels. Infection can
contribute to poorer glycemic control, and so Tina is likely to experience blood glucose
levels that are significantly higher than her baseline. Planning - Relevant: Assess -
Vitals: Assess the patient's blood glucose levels according to orders. Educate - Disease
Process: Educate the patient on the signs and symptoms of hyper- and hypoglycemia.
Intervene - Diet: Provide the patient a diet without concentrated sweets. Intervene -
Hypoglycemia: Administer insulin and/or oral hypoglycemics, per physician orders.
Planning Pro Tip: First, gauge your patient's current status by checking hydration, vital
signs, and perfusion. Measure the patient's blood glucose and provide medication as
per the physician's orders. While the patient is in your care, ensure that their meals align
with a low glycemic diet, and educate the patient on monitoring her own health status.
7. Loss of a family member Not Followed Up - CORRECT ANSWERS-Description: Tina
shares information about her father dying. Student: Why don't you have your dad's
