NR 509 Midterm Exam Test Question and Answers
is the clinical encounter clinician-centered to patient-centered
Answer: both; needs to be a balance of the clinician meeting their needs of the interaction and the
patient feeling heard and create personal dimension
patient-centered approach
Answer: Interviewing technique empowering the patient to provide a candid and complete medical
history
recognizes importance of patient concerns, feelings and emotions and understands the patients
personal contact of the symptoms/disease
FIFE model
Answer: mnemonic for patients perspective on the illness
Feelings (fears and concerns about the problem)
Ideas (about nature and cause of problem)
Functioning (effect of illness on function)
Expectations
general structure of patient encounter (5 steps)
Answer: initiate the encounter
gather information
perform the physical examination
explaining and planning
closing the encounter
2 frameworks that continue throughout whole clinical encounter
Answer: relationship building
structuring the interview
what happens while initiating the encounter
Answer: greet the patient and set the stage/preparation
what does it mean to set the stage
Answer: prepare for the interview
check your appearance
make sure patient is comfortable and environment is conducive to private info being shared
what happens during the gathering information stage
Answer: initiate information gathering
history of present illness
past medical history
social history
explore patients perspective of disease and relevant background information
,what happens during explaining and planning
Answer: provide correct amount and type of information
negotiate plan of action
shared decision making
when asking patient about there pronouns it may be helpful to....
Answer: share your own pronouns
"in an effort to promote an inclusive and respectful environment, we use pronouns that are right for us.
The pronouns I prefer are......how about you what pronouns do you prefer?
the initial moments of your encounter lay the foundation for....
Answer: your ongoing relationship
how to establish rapport
Answer: introduce yourself, explain your role and how you will be a part of their care
3 dimensions of cultural humility
Answer: 1) Self-awareness
2) Respectful communication
3) Collaborative partnerships
active listening
Answer: Closely listening to what the patient is communicating, connecting on an emotional state to the
patient.
use both verbal and nonverbal skills to encourage pt to expand on their feelings/concerns
Empathetic responses
Answer: capacity to identify with a patient and feel patients pain as your own and respond in a
supportive manner
"That must have been difficult for you."
"I understand, you're worried."
Non-verbal: offering a tissue to a crying patient; reaching out and gently touching a patient's hand.
Therapeutic use of self: "I've had surgery before, so I can relate to what you're going through."
guided questioning
Answer: Helps to continue the patients story, shows sustained interest and allows clinician to adapt
questioning based on patient i.e.:
-moving from open ended to focused questions
-using questions that elicit a graded response
-asking a series of questions, ONE at a time
-clarifying what the patient means
-encouraging with continuers
-using echoing
, guided questioning aka
Answer: adaptive questioning
nonverbal communication
Answer: communication using body movements, gestures, and facial expressions rather than speech
validation
Answer: affirm validity of patients emotional experience
"Your accident must have been terrifying. Car accidents are always unsettling because they remind us
how vulnerable we are. Perhaps that explains why you still feel upset,"
reassurance
Answer: first step is to identify and acknowledge the patients feelings
Helps pt feel that the problems have been fully understood and are being addressed
partnering
Answer: express commitment to an ongoing relationship
summarization
Answer: giving a summary of pts story to communicate that you have been listening
transitions
Answer: inform pt when you are changing directions to prepare them for what comes next
"now id like to ask some more questions about your past health"
empowering the patient
Answer: Empower pt to ask questions, express concerns, and probe your recommendations
people first language
Answer: seeing individuals as people first and not as being defined by their disorder/illness
i.e.: person with diabetes not diabetic, person with substance abuse not drug user
informed consent required elements
Answer: discuss nature of procedure or treatment
risks and benefits of the procedure or treatment
reasonable alternatives
risks and benefits of alternatives
assessment of the patients understanding go the first four elements
Protocol for delivering bad news?
Answer: S-set up meeting
P-perception (patients)
I-invitation (of conversation/questions)
K-knowledge
is the clinical encounter clinician-centered to patient-centered
Answer: both; needs to be a balance of the clinician meeting their needs of the interaction and the
patient feeling heard and create personal dimension
patient-centered approach
Answer: Interviewing technique empowering the patient to provide a candid and complete medical
history
recognizes importance of patient concerns, feelings and emotions and understands the patients
personal contact of the symptoms/disease
FIFE model
Answer: mnemonic for patients perspective on the illness
Feelings (fears and concerns about the problem)
Ideas (about nature and cause of problem)
Functioning (effect of illness on function)
Expectations
general structure of patient encounter (5 steps)
Answer: initiate the encounter
gather information
perform the physical examination
explaining and planning
closing the encounter
2 frameworks that continue throughout whole clinical encounter
Answer: relationship building
structuring the interview
what happens while initiating the encounter
Answer: greet the patient and set the stage/preparation
what does it mean to set the stage
Answer: prepare for the interview
check your appearance
make sure patient is comfortable and environment is conducive to private info being shared
what happens during the gathering information stage
Answer: initiate information gathering
history of present illness
past medical history
social history
explore patients perspective of disease and relevant background information
,what happens during explaining and planning
Answer: provide correct amount and type of information
negotiate plan of action
shared decision making
when asking patient about there pronouns it may be helpful to....
Answer: share your own pronouns
"in an effort to promote an inclusive and respectful environment, we use pronouns that are right for us.
The pronouns I prefer are......how about you what pronouns do you prefer?
the initial moments of your encounter lay the foundation for....
Answer: your ongoing relationship
how to establish rapport
Answer: introduce yourself, explain your role and how you will be a part of their care
3 dimensions of cultural humility
Answer: 1) Self-awareness
2) Respectful communication
3) Collaborative partnerships
active listening
Answer: Closely listening to what the patient is communicating, connecting on an emotional state to the
patient.
use both verbal and nonverbal skills to encourage pt to expand on their feelings/concerns
Empathetic responses
Answer: capacity to identify with a patient and feel patients pain as your own and respond in a
supportive manner
"That must have been difficult for you."
"I understand, you're worried."
Non-verbal: offering a tissue to a crying patient; reaching out and gently touching a patient's hand.
Therapeutic use of self: "I've had surgery before, so I can relate to what you're going through."
guided questioning
Answer: Helps to continue the patients story, shows sustained interest and allows clinician to adapt
questioning based on patient i.e.:
-moving from open ended to focused questions
-using questions that elicit a graded response
-asking a series of questions, ONE at a time
-clarifying what the patient means
-encouraging with continuers
-using echoing
, guided questioning aka
Answer: adaptive questioning
nonverbal communication
Answer: communication using body movements, gestures, and facial expressions rather than speech
validation
Answer: affirm validity of patients emotional experience
"Your accident must have been terrifying. Car accidents are always unsettling because they remind us
how vulnerable we are. Perhaps that explains why you still feel upset,"
reassurance
Answer: first step is to identify and acknowledge the patients feelings
Helps pt feel that the problems have been fully understood and are being addressed
partnering
Answer: express commitment to an ongoing relationship
summarization
Answer: giving a summary of pts story to communicate that you have been listening
transitions
Answer: inform pt when you are changing directions to prepare them for what comes next
"now id like to ask some more questions about your past health"
empowering the patient
Answer: Empower pt to ask questions, express concerns, and probe your recommendations
people first language
Answer: seeing individuals as people first and not as being defined by their disorder/illness
i.e.: person with diabetes not diabetic, person with substance abuse not drug user
informed consent required elements
Answer: discuss nature of procedure or treatment
risks and benefits of the procedure or treatment
reasonable alternatives
risks and benefits of alternatives
assessment of the patients understanding go the first four elements
Protocol for delivering bad news?
Answer: S-set up meeting
P-perception (patients)
I-invitation (of conversation/questions)
K-knowledge
