J NR509 PHYSICAL ASSESSMENT
jj 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. - occasionally 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: - - 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: - - 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 - Subjective 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 - Objective 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 - -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?" -
Basic Interviewing Skills - -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 - The 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 - The 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 - onset, location, duration, characteristics,
aggravating factors, relieving factors, treatments, severity of symptoms
pack-year cig calculations - A 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 - -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 - If 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 NP performs a mental status examination. Which of the following are positive findings? Select all
that apply - flight of ideas, mismatched/unseasonal clothing, recalls 1/3 items in the exam, erratic
speech
skin, hair, nails - Do you have any current problems or history of diseases or issues with your skin, hair, or
nails?
Do you have any allergies to drugs, plants, or animals?
Do you have any birthmarks or tattoos?
Tell me about any changes in skin color or moisture.
Tell me about any changes in moles such as color, size, shape, sudden appearance of tenderness,
bleeding, or itching.
Do you have any bruises, sores, rashes, or itching?
Tell me about any changes in hair color, amount, or texture.
Tell me about any changes in nail color, shape, or density.
Tell me about your current lifestyle including typical diet, smoking, sun exposure, occupation, and
hobbies
Dario, a 23-year-old, presents for evaluation of a new rash on the inner thighs with onset three days ago.
What additional assessment data should the FNP collect? Select all that apply. - temperature, pain,
change in soap, sexual hx, itching
jj 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. - occasionally 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: - - 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: - - 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 - Subjective 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 - Objective 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 - -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?" -
Basic Interviewing Skills - -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 - The 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 - The 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 - onset, location, duration, characteristics,
aggravating factors, relieving factors, treatments, severity of symptoms
pack-year cig calculations - A 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 - -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 - If 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 NP performs a mental status examination. Which of the following are positive findings? Select all
that apply - flight of ideas, mismatched/unseasonal clothing, recalls 1/3 items in the exam, erratic
speech
skin, hair, nails - Do you have any current problems or history of diseases or issues with your skin, hair, or
nails?
Do you have any allergies to drugs, plants, or animals?
Do you have any birthmarks or tattoos?
Tell me about any changes in skin color or moisture.
Tell me about any changes in moles such as color, size, shape, sudden appearance of tenderness,
bleeding, or itching.
Do you have any bruises, sores, rashes, or itching?
Tell me about any changes in hair color, amount, or texture.
Tell me about any changes in nail color, shape, or density.
Tell me about your current lifestyle including typical diet, smoking, sun exposure, occupation, and
hobbies
Dario, a 23-year-old, presents for evaluation of a new rash on the inner thighs with onset three days ago.
What additional assessment data should the FNP collect? Select all that apply. - temperature, pain,
change in soap, sexual hx, itching
