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NR 509 Midterm Exam Study Guide / NR509 Midterm Exam Study Guide (V2)(NEW-2022): Chamberlain college of Nursing(Download to score A) $8.49
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NR 509 Midterm Exam Study Guide / NR509 Midterm Exam Study Guide (V2)(NEW-2022): Chamberlain college of Nursing(Download to score A)
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  • NR 509 Exam / NR509 Exam
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  • Chamberlain College Of Nursing

NR 509 Midterm Exam Study Guide / NR509 Midterm Exam Study Guide (V2)(NEW-2022): Chamberlain college of Nursing(Download to score A)

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  • February 5, 2022
  • 16
  • 2021/2022
  • Other
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  • nr 509 midterm exam study guide nr509 midterm exam study guide v2new 2022 chamberlain college of nursingdownload to score a

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NR 509 Midterm Exam Study Guide
Ch. 1

 Basic and Advanced Interviewing Techniques
 Basic
o Gather a sensitive and nuanced hx.
o Perform thorough and accurate exam
o Improve pt. rapport
o Focus your assessment
o Sent guideposts that direct clinical decision making
o Avoid interpreting your findings- may be premature.
o Warn pt. that your assessment may take longer but that doesn’t mean
negative findings
 Advanced
o With time and practice- able to integrate:
o Empathetic listening
o Ability to interview pts of all ages, genders, races, ethnicities, etc.
o Improved techniques to examine different body systems
o Differentiate level of sick vs. not sick
o Improved process of clinical reasoning leading to diagnosis and plan
o Will grow and begin clinical reasoning from first impression of meeting pt.
o ID Sx. And abnormal findings, linking underlying pa xtho
o Establish and test explanatory hypotheses
 Components of the Health History
 Identifying data – age, gender, marital status, occupation
o Source of hx. - usually pt. but could be family or friend, letter of referral or
clinical record
o Establish the source of referral is necessary
 Reliability- pt. memory, trust, mood
 Chief Complaint- one or more symptoms or concerns causing pt. to seek care
o Try and keep this in patients own words “my stomach feels awful”
 Present illness- amplifies CC
o **Complete, clear and chronologic description of the problems prompting
the pts. Visit including onset, setting it developed how it manifests and tx.
To date
o Includes pt. thoughts and feelings about illness
o *pertinent positives and pertinent negatives*
o May include meds, allergies, tobacco, ETOH…
o Seven attributes of a symptom 1. Location 2. Quality 3. Quantity or
severity 4. Timing (onset, duration, frequency) 5. Setting it occurs 6.
Factors that aggravate or relieve 7. Associated manifestations
o Consider placing PMHx in this area to support potential problem (hx. Of
CAD with pt. presenting with CP)
o How these sx are affecting ADLs

, o Medications taking to help or than may exacerbate

 Past medical hx. – list illnesses (childhood and adult) with dates
o Surgeries
o OBGYN
o Health maintenance
o psych
o Immunizations, screenings, lifestyle issues and home safety
 Family hx. – include parents, siblings and grandparents
o Outline current age or age at death, medical hx. / illnesses, reason of
death
 Personal and social hx. – education, family origin, current household, interests
and lifestyle, relationship? Stress, job, important life experiences, financial status,
religion, retirement plan, leisure activities, friends/ support
 Review of symptoms
o Documents presence or absence of common symptoms related to each of
the major body symptoms
o Start- General, skin, HEENT, neck, breasts, respiratory, cardiovasc., GI,
peripheral vasc., urinary, genitals, musculoskeletal, psych, neuro,
hematologic, endocrine.
 All this health hx. is done with the following
o Physical exam
o Clinical reasoning
o Assessment
o Plan
o The quality clinical record
o Comprehensive vs. focused?
 Comprehensive
o New pt.
o Identifies or rules out causes related to concerns
o Lengthy or difficult pt. complaint
o Platform for health promotion
o Has potential for increased health care savings and decreased testing
o Can be seen as a diagnostic test
 Focused
o Problem focused
o Good for routine or urgent visits
o Symptoms related to specific body system.
 **** MAKE SURE THE DATE IS ALWAYS ON THE HEALTH HX****
 Subjective Data
 What the patient tells you
 “the symptoms and hx. From chief complaint through review of systems
 Pain, reports “headache”
 Objective Data
 What you observe or detect through exam, lab results and test data
 Psychical exam findings or signs

,  Height 5’3, weight 73kg, purulent discharge, etc.
 SOAP Note Documentation
 Subjective, objective, assessment, plan
 Make sure pertinent negatives or positives are specifically described
 Avoid excessive detail
 Described what you saw now what you did
 Take measurements
 Make sure tone is professional

Chap 2.

 Evaluating Clinical Evidence
 Initial step in evaluating diagnostic testing is ensuring validity of results
 “does the test accurately identify whether a pt. has a disease?”
 Compare to the “gold standard”
 Test sensitivity and specificity of testing
o Sensitivity- probability that a pt. with the disease has a + test
o “true positive rate
o Specificity- the probability that a non-diseased pt. has a negative test.
o Known as the true negative rate
 A negative result from a test with a test with high sensitivity (very low false neg.
rate) usually excludes the disease.
o SnNout- sensitive test with negative result rules OUT
o SpPIN- specific test with a positive result rules IN disease.
 Positive predictive value (PPV)- probability that a person with a + test has the
disease
o Prostate Ca screening where a man with a PSA value greater than
4.0ng/mL has only a 30% probability of having prostate Ca found on
biopsy
 Negative predictive value (NPV)- probability that a person with a – test does not
have the disease
o Among men with a PSA level of 4.0ng/mL or below, 85% are found to be
Ca free on biopsy.
 Prevalence of disease- important to understand the prevalence of the disease
you are looking into- patient population- age, gender, location etc.
 Likelihood ratios- probability of obtaining a given test result in a diseased patient
divided by the probability of obtaining a given test result in a non-diseased pt.
o A higher value (much >1) indicates that a positive test is much more likely
to be coming from a diseased person than from a non-diseased person,
increasing confidence that a person with a + result has the disease
 Bayes Theorem- relates the direct probability of a hypothesis conditional on a
given body of data conditional on the hypothesis
 Fagan Nomogram- terms of probability of having a disease.
o Read the pretest probabilities from the line on left then take a straight
edge and draw a line through the likelihood ration in the middle and read
the posttest line on the right

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