NR509 physical assessment
The nurse practitioner (NP) is completing a comprehensive assessment of Anita, a new client in a
primary care facility. Which assessment finding(s) reported by Anita are related to social determinants
of health? Select all that apply. - answeroccasionally running out of food, being discriminated against in
the workplace, has a great amount of smog in their community, having difficulty making the rent
payment
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 present illness, only the system related to the problem in the ROS
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 area of PMhx, family hx, social hx, at least
10 ROS
subjective data - answerSubjective 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 - answerObjective 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 - answer-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?" - answer
Basic Interviewing Skills - answer-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 - answerThe 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.
personal and social history - answerThe 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 - answeronset, location, duration,
characteristics, aggravating factors, relieving factors, treatments, severity of symptoms
pack-year cig calculations - answerA 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 - answer-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 - answerIf 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 nurse practitioner (NP) is completing a comprehensive assessment of Anita, a new client in a
primary care facility. Which assessment finding(s) reported by Anita are related to social determinants
of health? Select all that apply. - answeroccasionally running out of food, being discriminated against in
the workplace, has a great amount of smog in their community, having difficulty making the rent
payment
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 present illness, only the system related to the problem in the ROS
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 area of PMhx, family hx, social hx, at least
10 ROS
subjective data - answerSubjective 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 - answerObjective 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 - answer-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?" - answer
Basic Interviewing Skills - answer-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 - answerThe 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.
personal and social history - answerThe 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 - answeronset, location, duration,
characteristics, aggravating factors, relieving factors, treatments, severity of symptoms
pack-year cig calculations - answerA 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 - answer-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 - answerIf 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.
