Shadow Health - Tina Jones, Health History| Exam Questions with Correct Answers 100%
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1. Acute pain 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.
2. Impaired skin integrity 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.
3. Impaired walking 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.
4. Ineffective diabetes management 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.
5. Risk for falls 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. Risk for unstable blood glucose level 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. Obesity Priority - Low Priority Pro Tip: A BMI greater than 30 indicates obesity, but this
diagnosis is a low priority at present. Obesity is a long-term health concern that cannot be
addressed in a single visit. Evidence - Relevant: "BMI: 31" Evidence Pro Tip: Tina's BMI is 31,
which is in the obese range. This numerical evidence is required to establish obesity. Other
contributing factors are her family history of diabetes mellitus and a lack of physical exercise.
Planning - Relevant: Educate - Diet: Educate the patient on balanced nutritional intake. Educate
- Disease Process: Educate the patient on health risks related to obesity. Educate - Exercise:
Educate the patient about the benefits of exercise. Planning Pro Tip: To help your patient
address her obesity, which is often a sensitive topic, use therapeutic communication
techniques. First, gain a deep understanding of your patient's situation. Determine her level of
health literacy, her feelings and beliefs related to the disease, and the motivation behind their
choices. Then educate the patient on risks of obesity, recommended dietary changes, and
healthy exercise.
8. Risk for ineffective respiratory function Priority - Low Priority Pro Tip: When caring for a
patient diagnosed with asthma, it's important to be aware of the possibility of emerging
respiratory symptoms. However, for a patient with no active respiratory complaints, this
, problem does not need to be addressed immediately. Evidence - Relevant: Evidence Pro Tip:
Tina's asthma puts her at general risk for breathing problems. She also reports sometimes
needing more puffs to resolve symptoms. Contributing factors are a past history of
hospitalization and asthma attacks, as well as sedentary lifestyle and obesity. Planning -
Relevant: Planning Pro Tip: Take a general survey of the patient for changes in skin color, and
assess respiratory rate, rhythm, depth, and quality to confirm there are no acute breathing
issues. Gather data on the patient's breathing status by checking pulse and blood pressure.
Auscultate the lungs to listen for abnormal sounds. While the patient is in your care, educate
her on the cause and symptoms of shortness of breath so that she can let you know about
emerging problems. Empower the patient to take part in her own care by educating her on
controlled breathing techniques.
9. Sedentary lifestyle Priority - Low Priority Pro Tip: A patient's sedentary lifestyle
compromises her overall health and problems such as diabetes. However, this issue is low
priority for a patient with acute pain and a wound that prevents her from walking. Evidence -
Relevant: Evidence Pro Tip: Tina directly reports that she doesn't exercise, which is the primary
evidence for a sedentary lifestyle. She describes being too busy to exercise and reports that her
primary activity is being on her feet at work, a belief which demonstrates her misunderstanding
of exercise. Planning - Relevant: Planning Pro Tip: Interview the patient to determine her level
of health literacy, and her attitudes and beliefs toward exercise. Educate the patient about the
benefits to overall health and blood sugar control and finding an appropriate form of exercise.
Ask the patient questions about what changes she may be willing to make.
Health History Tips & Tricks: TJ Health Interview
Student: Hello! Diana Shadow: Hi. I'm Preceptor Diana. I will explain the details of this
assignment and your objectives, just as a preceptor would in real life. Pay close attention to this
information as it will help guide your exam. At the end of this prebrief, you will answer a short
question about the upcoming assignment. During the simulation, you may return to these
instructions at any time by scrolling to the top of your transcript.
Student: What is the situation? Diana Shadow: Your patient is Tina Jones:, a 28-year-old
African American woman who has just been admitted to Shadow General Hospital for a painful
foot wound. Your role in this simulation is that of a healthcare provider who will take Ms. Jones'
health history, a key component of her admission process.
Verified By Experts| Latest Update Guaranteed Success
Information Processing:
1. Acute pain 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.
2. Impaired skin integrity 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.
3. Impaired walking 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.
4. Ineffective diabetes management 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.
5. Risk for falls 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. Risk for unstable blood glucose level 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. Obesity Priority - Low Priority Pro Tip: A BMI greater than 30 indicates obesity, but this
diagnosis is a low priority at present. Obesity is a long-term health concern that cannot be
addressed in a single visit. Evidence - Relevant: "BMI: 31" Evidence Pro Tip: Tina's BMI is 31,
which is in the obese range. This numerical evidence is required to establish obesity. Other
contributing factors are her family history of diabetes mellitus and a lack of physical exercise.
Planning - Relevant: Educate - Diet: Educate the patient on balanced nutritional intake. Educate
- Disease Process: Educate the patient on health risks related to obesity. Educate - Exercise:
Educate the patient about the benefits of exercise. Planning Pro Tip: To help your patient
address her obesity, which is often a sensitive topic, use therapeutic communication
techniques. First, gain a deep understanding of your patient's situation. Determine her level of
health literacy, her feelings and beliefs related to the disease, and the motivation behind their
choices. Then educate the patient on risks of obesity, recommended dietary changes, and
healthy exercise.
8. Risk for ineffective respiratory function Priority - Low Priority Pro Tip: When caring for a
patient diagnosed with asthma, it's important to be aware of the possibility of emerging
respiratory symptoms. However, for a patient with no active respiratory complaints, this
, problem does not need to be addressed immediately. Evidence - Relevant: Evidence Pro Tip:
Tina's asthma puts her at general risk for breathing problems. She also reports sometimes
needing more puffs to resolve symptoms. Contributing factors are a past history of
hospitalization and asthma attacks, as well as sedentary lifestyle and obesity. Planning -
Relevant: Planning Pro Tip: Take a general survey of the patient for changes in skin color, and
assess respiratory rate, rhythm, depth, and quality to confirm there are no acute breathing
issues. Gather data on the patient's breathing status by checking pulse and blood pressure.
Auscultate the lungs to listen for abnormal sounds. While the patient is in your care, educate
her on the cause and symptoms of shortness of breath so that she can let you know about
emerging problems. Empower the patient to take part in her own care by educating her on
controlled breathing techniques.
9. Sedentary lifestyle Priority - Low Priority Pro Tip: A patient's sedentary lifestyle
compromises her overall health and problems such as diabetes. However, this issue is low
priority for a patient with acute pain and a wound that prevents her from walking. Evidence -
Relevant: Evidence Pro Tip: Tina directly reports that she doesn't exercise, which is the primary
evidence for a sedentary lifestyle. She describes being too busy to exercise and reports that her
primary activity is being on her feet at work, a belief which demonstrates her misunderstanding
of exercise. Planning - Relevant: Planning Pro Tip: Interview the patient to determine her level
of health literacy, and her attitudes and beliefs toward exercise. Educate the patient about the
benefits to overall health and blood sugar control and finding an appropriate form of exercise.
Ask the patient questions about what changes she may be willing to make.
Health History Tips & Tricks: TJ Health Interview
Student: Hello! Diana Shadow: Hi. I'm Preceptor Diana. I will explain the details of this
assignment and your objectives, just as a preceptor would in real life. Pay close attention to this
information as it will help guide your exam. At the end of this prebrief, you will answer a short
question about the upcoming assignment. During the simulation, you may return to these
instructions at any time by scrolling to the top of your transcript.
Student: What is the situation? Diana Shadow: Your patient is Tina Jones:, a 28-year-old
African American woman who has just been admitted to Shadow General Hospital for a painful
foot wound. Your role in this simulation is that of a healthcare provider who will take Ms. Jones'
health history, a key component of her admission process.
