Quiz 1

Question 1

Common communication techniques

Answer 1

• open/close ended questions
• facilitation/affirmation
• echoing/reflection
• silence
• empathy
• confirmation/clarification
• redirecting
• humor

Question 2

Common communication pitfalls

Answer 2

• giving false reassurance
• giving unwanted advice
• using authority
• using professional jargon
• using unclear/undefined words
• using leading/why questions (ie. You don’t smoke, do you?
• letting family members answer for the patient
• asking more than one question at a time
• asking “why”?

Question 3

Types of health histories

Answer 3

• complete- a baseline; identifies potential or actual problem
• episodic- focused or limited scope to specific complaint; used in our patient facilities or in hospital for specific complaint
• follow-up- conducted at regular or set intervals; limited in its focus
• emergency- rapid collection of data simultaneously with life-saving measures

Question 4

Preparing for a health history

Answer 4

*set goals for yourself
*review any given information
*review own appearance
prepare for note-taking
*prepare the environment

Question 5

Techniques of a physical assessment

Answer 5

• inspection- use of vision and smell
• palpation- use of touch; light palpations are used to assess surface areas for temperature, texture, moisture, swelling, vibration. tenderness, crepitus, rigidity; deep palpation is used to assess internal organs and masses; always leave the painful areas for last
• percussion- involves tapping of fingers on a body part and listening to sounds; identifies density, organ shape and position; there’s direct (hand to body) and indirect percussion (hand to hand to body); characteristics of percussion: hyperresonance, tympany.. dull, flat
• auscultation- use of listening; diaphragm is used for high-pitched sound; bell is used for low pitched sound

Question 6

Primary skin lesions

Answer 6

• macule- less than 1 cm; spot; perceptibly different in color from the surrounding tissue; a spot more than 1 cm is considered a patch
• papule- less than 1 cm; circumscribed; solid elevation on the skin; more than 1 cm is considered a plaque
• nodule- greater than 3 cm is considered a tumor
• wheal- a circumscribed papule or irregular plaque of edema of the skin
• vesicle- less than 1 cm; circumscribed elevation of the skin containing fluid; more than 1 cm is considered a bulla
• cyst- encapsulated fluid-filled lesion that extends down into the dermis
• pustule- small; circumscribed elevation of the skin; contains purulent material

Question 7

Health promotion for the skin

Answer 7

Know a pt.’s:

• allergies
• hx chronic skin condition
• hx of skin cancer
• hx of skin infection
• hx of hepatitis

Question 8

Warning signs o skin cancer

Answer 8

Any lesions that is larger than 6 mm, asymmetrical, has uneven edges, is made up of two or more shades

Question 9

Components of a nail assessment

Answer 9

• color
• shape and contour- should be 160 degrees nail bed to skin
• consistency
• circulation (capillary refill)

Question 10

Assessment of the neck

Answer 10

• perform ROM of neck (should smoothly and without effort move from side to side and up and down)
• inspect that neck is mid-line and holding head erect
• check symmetry of sternomastoid and trapezius muscles
• inspect then auscultate carotid arteries for pulsations and presence of bruits of the neck (pulsation may be palpated but not heard; bruits should not be present)
• palpate the lymph nodes (nodes should be palpable; if palpable then note the size, shape, borders, mobility, consistency, tenderness, and drainage)

Question 11

The nursing process

Answer 11

ADPIE

• assessment- gathering subjective and objective data; instrumental in devising a care plan; key points and relevant pieces of information are grouped together; prioritized problem list if formalized; assessment phase continues throughout entire patient encounter
• diagnosis- based on real or potential health problems; based on assessment data; sets stage for remainder of care plan; formulated based on problem
• planning- chart the best course to address pt.’s diagnosis; nurse and pt. select goals for each diagnosis; set short-term and long-term goals; be realistic; work with pt.’s economic means, competing responsibilities, and family structure and dynamics
• implementation- can be completed by pt., family, or health care team; clearly relate to nursing diagnosis; individualized for each pt.; modified as changes occur; support positive outcomes
• evaluation- continuing process to determine if goals are met; based on pt.’s condition; ongoing process; confirms that nursing care is relevant

Question 12

Subjective Data

Answer 12

“symptoms”

• what the pt. tells you
• history
• chief complaint
• review of symptoms
• OLD CART: onset, location, duration/frequency, characteristic symptoms, associated manifestations, relieving factors, treatments tried (if any) and success

Question 13

Objective data

Answer 13

“signs”

• what you see
• physical examination
• laboratory reports
• radiologic findings, etc.
• primarily factual and descriptive

Question 14

Cervical lymph nodes

Answer 14

Lymph nodes are assessed primarily by using two fingers and palpating the area in a circular motion (twice)

• preauricular
• posterior auricular
• occipital
• submandibular
• submental
• jugulodigastic
• superficial cervical chain
• deep cervical chain
• posterior cervical
• supracavicular

Question 15

Mouth assessment

Answer 15

• inspect lips, teeth and gums, U-shaped area under the tongue, Wharton and Stensen’s duct, buccal mucosa, palate
• lips should be pink, intact and moist (darkly-pigmented individuals ay have blue tinges)
• teeth should be present (actual or dentures), white, straight, and free of decay
• tongue is pink with a roughened dorsal surface; bottom tongue is moist with bluish veins
• abnormalities of oral cavity: sore throat, hoarseness, lesions, sore tongue, bleeding gums, toothache, dysphagia

Question 16

Nose and sinuses assessment

Answer 16

• nose should be mid-line, symmetrical and free of lesions or deformities; patent in both nares; inspect nasal mucosa (should be smooth, moist, and red and should have no swelling, discharge, or bleeding), septum (should show no bleeding, perforation or significant deviation) and turbinates (should match color and consistency of normal nasal mucosa
• maxillary and frontal sinuses should be tender upon applied pressure

Question 17

Qualities of a history of present illness (HPI)

Answer 17

"PQRSTU"
*provocative or palliative
*quality or quantity
*region and radiation
*severity and scale
*timing and type of onset
*understanding 
"OLD CART"
*onset
*location
*duration/frequency
*characteristic symptoms
*associated manifestations
*relieving factors
*treatments tried (if any) and success

Question 18

Inspection of lesions

Answer 18

• location/distribution on body
• color
• elevation
• shape and pattern
• size
• exudate

Question 19

Inspection of abnormal or concerning lesions

Answer 19

“ABCDE”

• ASYMMETRY of one side of mole compared to the other
• irregular BORDERS, especially ragged, notched, blurred
• variation or change in COLOR. especially black or blue
• DIAMETER and DRAINAGE (should be smaller than 6 mm)
• ELEVATION and EVOLVING, a mole or skin lesion that looks different from the rest or is changing in size, shape, or color

Question 20

Discoid

Answer 20

resembling a disc; disc-shaped