NSG 500 Quiz 1 Module 1,2 and 3 Wilkes University Study Guide
1. Interviewing skills: how to approach patients, start the process, obtain information.
Greet patient. Establish what the patient goals are for the interaction. In general start with open
ended and lead to more direct questions. Chart brief notes but maintain eye contact.
Open-ended questions allows patient to control the extent of the answer. Are helpful during
sensitive parts of the interview and allow you to gather more information and establish you as an
empathetic listener.
For example, when asking about sexual history and appropriate question would be” Do you have any
worries or concerns about your sex life?”
Close-ended questions can be stifling
Direct questions seek specific information
Leading questions are to be avoided. Limits information to what the patient thinks you want to
know.
Ex” “You don’t get headaches often, do you?”
Silence in the interview. Useful for reflection and summoning courage and displaying compassion,
do not use times of silence to document and chart. Periods of silence can cause anxiety for patients.
Anxious or worried patients
Do not rush, a calm demeanor communicates caring
2. Cultural sensitivity: purpose, reason it is important, how culture may impact aspects of an exam of
emotional health
Healthcare providers who do not practice cultural awareness can compromise the quality of healthcare
provided to populations from diverse cultures. As leaders in healthcare delivery, advanced practice nurses
need to be sensitive and well informed of the issues pertinent to maintaining cultural competence.
stereotype a fixed image of any group that rejects its potential for originality or individuality is the.
acculturation is the process of adopting another culture’s behaviors.
norm is a standard of allowable behavior within a group. ethnos implies the same race or nationality.
Cultural awareness is deliberate self-examination and in-depth exploration of one’s biases, stereotypes,
prejudices, assumptions, and “-isms” that one holds about individuals and groups who are different from
them.
Cultural knowledge is the process of seeking and obtaining a sound educational base about culturally
and ethnically diverse groups.
,Cultural skill is the ability to collect culturally relevant data regarding the patient’s presenting problem,
as well as accurately performing a culturally based physical assessment in a culturally sensitive manner.
Cultural desire is the motivation of the healthcare professional to want to engage in the process of
becoming culturally competent, not have to.
The definition of illness is determined in large part by the individual’s enculturation (the process
whereby an individual assumes the traits and behaviors of a given culture).
EMOTIONAL EXAM
Link to NAMI brief differences in how cultures view mental health.
https://www.nami.org/Blogs/NAMI-Blog/July-2017/Challenging-Multicultural-Disparities-in-
Mental-He
Variations in how different cultural groups view cause mental health disorders: biomedical
vs spiritual/ character, stigma, reporting of symptoms ( some cultures express psychological
symptoms as physical symptoms
2. The steps of assessment, inspection, palpation, percussion, auscultation;
What they are, how to perform; sequence used; how to palpate (what parts of the hands
work best for different purposes; fine discrimination, vibration)
What are normal percussion notes, know where they are found
How to use equipment; how to apply a stethoscope, otoscope
Inspections-Inspection is the process of observation. Your eyes and nose are sensitive tools for gathering
data throughout the examination. —unlike palpation, percussion, and auscultation— can continue
throughout the history-taking process and during the physical examination
Palpation- involves the use of the hands and fingers to gather information through the sense of touch.
The palmer surface of the fingers and finger pads is more sensitive than the fingertips. Use this surface
whenever discriminatory touch is needed for determining position, texture, size, consistency, masses,
fluid, and crepitus. The ulnar surface of the hand and fingers is the most sensitive area for
distinguishing vibration. The dorsal surface of the hands is best for estimating temperature. Palpation
may be either light or deep and is controlled by the amount of pressure applied with the fingers or hand.
Short fingernails are essential to avoid discomfort or injury to the patient. Touch is in many ways
therapeutic, and palpation is the actuality of the “laying on of hands.” Our advice that your approach be
gentle and your hands warm is not only practical but also symbolic of your respect for the patient and for
the privilege the patient gives you. It is the convention, at least in the United States, to examine
patients from the right side and to palpate and percuss with the right hand..
, Percussion- involves striking one object against another to produce vibration and subsequent sound
waves, physical examination, your finger functions as a hammer, and the impact of the finger against
underlying tissue produces the vibration. Sound waves are heard as percussion tones (called resonance)
that arise from vibrations 4 to 6 cm deep in the body tissue. The density of the medium through which the
sound waves travel determines the degree of percussion tone. The more dense the medium, the quieter the
percussion tone. The percussion tone over air is loud, over fluid less loud, and over solid areas soft. The
degree of percussion tone is classif
ied and ordered as listed in Table 3.3. Tympany is the loudest, and flatness is the quietest.
For points of reference, as noted in Table 3.3, the gastric bubble is considered to be tympanic; air-filled
lungs (as in emphysema) to be hyperresonant; healthy lungs to be resonant; the liver to be dull; and
muscle to be flat. Degree of resonance is more easily distinguished by listening to the sound change as
you move from one area to another. Because it is easier to hear the change from resonance to dullness
(rather than from dullness to resonance), proceed with percussion from areas of resonance to areas of
dullness. A partially full milk carton is a good tool for practicing percussion skills. Begin with percussion
over the air-filled space of the carton, appreciating its resonant quality. Work your way downward and
listen for the change in sound as you encounter the milk. This principle applies in percussion of body
tissues and cavities. The techniques of percussion are the same regardless of the structure you are
percussing. Immediate (direct) percussion involves striking the finger or hand directly against the body.
Indirect or mediate percussion is a technique in which the finger of one hand acts as the hammer (plexor)
and a finger of the other hand acts as the striking surface. To perform indirect percussion, place your
1. Interviewing skills: how to approach patients, start the process, obtain information.
Greet patient. Establish what the patient goals are for the interaction. In general start with open
ended and lead to more direct questions. Chart brief notes but maintain eye contact.
Open-ended questions allows patient to control the extent of the answer. Are helpful during
sensitive parts of the interview and allow you to gather more information and establish you as an
empathetic listener.
For example, when asking about sexual history and appropriate question would be” Do you have any
worries or concerns about your sex life?”
Close-ended questions can be stifling
Direct questions seek specific information
Leading questions are to be avoided. Limits information to what the patient thinks you want to
know.
Ex” “You don’t get headaches often, do you?”
Silence in the interview. Useful for reflection and summoning courage and displaying compassion,
do not use times of silence to document and chart. Periods of silence can cause anxiety for patients.
Anxious or worried patients
Do not rush, a calm demeanor communicates caring
2. Cultural sensitivity: purpose, reason it is important, how culture may impact aspects of an exam of
emotional health
Healthcare providers who do not practice cultural awareness can compromise the quality of healthcare
provided to populations from diverse cultures. As leaders in healthcare delivery, advanced practice nurses
need to be sensitive and well informed of the issues pertinent to maintaining cultural competence.
stereotype a fixed image of any group that rejects its potential for originality or individuality is the.
acculturation is the process of adopting another culture’s behaviors.
norm is a standard of allowable behavior within a group. ethnos implies the same race or nationality.
Cultural awareness is deliberate self-examination and in-depth exploration of one’s biases, stereotypes,
prejudices, assumptions, and “-isms” that one holds about individuals and groups who are different from
them.
Cultural knowledge is the process of seeking and obtaining a sound educational base about culturally
and ethnically diverse groups.
,Cultural skill is the ability to collect culturally relevant data regarding the patient’s presenting problem,
as well as accurately performing a culturally based physical assessment in a culturally sensitive manner.
Cultural desire is the motivation of the healthcare professional to want to engage in the process of
becoming culturally competent, not have to.
The definition of illness is determined in large part by the individual’s enculturation (the process
whereby an individual assumes the traits and behaviors of a given culture).
EMOTIONAL EXAM
Link to NAMI brief differences in how cultures view mental health.
https://www.nami.org/Blogs/NAMI-Blog/July-2017/Challenging-Multicultural-Disparities-in-
Mental-He
Variations in how different cultural groups view cause mental health disorders: biomedical
vs spiritual/ character, stigma, reporting of symptoms ( some cultures express psychological
symptoms as physical symptoms
2. The steps of assessment, inspection, palpation, percussion, auscultation;
What they are, how to perform; sequence used; how to palpate (what parts of the hands
work best for different purposes; fine discrimination, vibration)
What are normal percussion notes, know where they are found
How to use equipment; how to apply a stethoscope, otoscope
Inspections-Inspection is the process of observation. Your eyes and nose are sensitive tools for gathering
data throughout the examination. —unlike palpation, percussion, and auscultation— can continue
throughout the history-taking process and during the physical examination
Palpation- involves the use of the hands and fingers to gather information through the sense of touch.
The palmer surface of the fingers and finger pads is more sensitive than the fingertips. Use this surface
whenever discriminatory touch is needed for determining position, texture, size, consistency, masses,
fluid, and crepitus. The ulnar surface of the hand and fingers is the most sensitive area for
distinguishing vibration. The dorsal surface of the hands is best for estimating temperature. Palpation
may be either light or deep and is controlled by the amount of pressure applied with the fingers or hand.
Short fingernails are essential to avoid discomfort or injury to the patient. Touch is in many ways
therapeutic, and palpation is the actuality of the “laying on of hands.” Our advice that your approach be
gentle and your hands warm is not only practical but also symbolic of your respect for the patient and for
the privilege the patient gives you. It is the convention, at least in the United States, to examine
patients from the right side and to palpate and percuss with the right hand..
, Percussion- involves striking one object against another to produce vibration and subsequent sound
waves, physical examination, your finger functions as a hammer, and the impact of the finger against
underlying tissue produces the vibration. Sound waves are heard as percussion tones (called resonance)
that arise from vibrations 4 to 6 cm deep in the body tissue. The density of the medium through which the
sound waves travel determines the degree of percussion tone. The more dense the medium, the quieter the
percussion tone. The percussion tone over air is loud, over fluid less loud, and over solid areas soft. The
degree of percussion tone is classif
ied and ordered as listed in Table 3.3. Tympany is the loudest, and flatness is the quietest.
For points of reference, as noted in Table 3.3, the gastric bubble is considered to be tympanic; air-filled
lungs (as in emphysema) to be hyperresonant; healthy lungs to be resonant; the liver to be dull; and
muscle to be flat. Degree of resonance is more easily distinguished by listening to the sound change as
you move from one area to another. Because it is easier to hear the change from resonance to dullness
(rather than from dullness to resonance), proceed with percussion from areas of resonance to areas of
dullness. A partially full milk carton is a good tool for practicing percussion skills. Begin with percussion
over the air-filled space of the carton, appreciating its resonant quality. Work your way downward and
listen for the change in sound as you encounter the milk. This principle applies in percussion of body
tissues and cavities. The techniques of percussion are the same regardless of the structure you are
percussing. Immediate (direct) percussion involves striking the finger or hand directly against the body.
Indirect or mediate percussion is a technique in which the finger of one hand acts as the hammer (plexor)
and a finger of the other hand acts as the striking surface. To perform indirect percussion, place your
