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NURS 550 midterm Exam with complete solutions 2024_2025
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NURS 550 midterm Exam with complete solutions 2024_2025
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NURS 550 midterm Exam with completesolutions 2024/2025
Differential Diagnosis - ANSWER-• In deciding which disease to include in the
differential, consider: - What's the most life-threatening disease the patient could
have? - Could this be a common disease presenting with unusual features? -
What diseases present with misleading symptoms? - What rare diseases could be
causing these signs and symptoms?
Develop a Complete, Framed Differential Diagnosis (Hypothesis) - ANSWER-• Not
all diagnoses in a given differential are: - equally likely - equally important
• You must select: - a leading (working) hypothesis - a must not miss hypothesis -
An active alternative hypothesis
SOAP stands for: - ANSWER-• Subjective • Objective • Assessment • Plan
Subjective - ANSWER-The subjective section is what the patient tells you about
their current condition and past conditions.
Chief Complaint - ANSWER-• What brought the patient to the office
• Example: Sore throat for 2 days
History of Present Illness/Injury - ANSWER-- Onset - When did the symptoms
and/or signs begin, what was the mechanism of injury
- Chronology - episodic, variable, constant, etc
- Quality - sharp, dull, ache, sudden, insidious
- Severity - pain rating, 0-10 pain scale, interferes with daily activities
- Modifying factors - aggravating and alleviating factors
- Additional symptoms - unrelated or significant symptoms
- Treatment - medications, herbs, "home remedies", rest, activity, splint, etc
,- Use "OLDCART" to assist you (Onset, Location, Duration, Character ,
Aggravating factors, Relieving factors, Treatments"
History - ANSWER-Allergies - list of allergies to food, medication, and products
with type of reaction
- Medical - past and present medical conditions (i.e. asthma, hypertension,
malaria, etc.)
- Surgical - past surgeries (i.e. appendectomy, CABG, craniotomy, etc.)
- Family - mother, father, siblings, etc. - Social - occupation, alcohol, drug,
tobacco use, risky behavior
- Immunizations - current and past received with dates
- Screenings/Health Promotion - mammography, testicular exams, dental, vision
- Review of Systems - systemic symptoms related to the current problem(s)
including pertinent positives and negatives
Review of Systems - ANSWER-General - fever (subjective) with chills and sweats,
denies fatigue, weakness, weight loss, or malaise
- Skin - denies rashes, lesions, discolorations
- HEENT - positive for generalized headache, sore throat, pain with swallowing
and rhinorrhea. Denies difficulty swallowing saliva, earache, sinus congestion,
sinus pain, visual or auditory aura
- Neck - denies lump, pain, stiffness, or decreased range of motion
- Cardiac - denies chest pain, pressure, tightness, palpitations
- Pulmonary - denies cough, wheeze, hemoptysis
- GI - denies nausea, vomiting, abdominal pain
- GU - denies missed menses, urinary frequency, urgency or hematuria
- MS - denies cramping, pain,
- Neuro - denies unilateral weakness, numbness, tingling
Review of Systems - ANSWER-• Should elaborate on the chief complaint and HPI •
Don't ask questions that the patient may not know
Review of Systems
Do you have a problem with your prostate? Do have anemia, heart failure,
cancer? Do you frequently urinate during the night? Have you noticed a change
in the stream of your urine? Do you avoid drinking fluids during work? Do you
feel tired often? Are you short of breath? Have you had any weight loss recently?
Objective - ANSWER-In this section you document what you observe during the
examination and visit.
,Physical Examination - ANSWER-- Vital signs - Physical examination findings -
the use of "normal", "within normal limits", "unremarkable" and other phrases are
NOT acceptable. - Diagnostic results - Measurements including height, weight,
screening tools, etc. - Mental Status
-Weight 50 Kg previously documented height 5'3" -Vital signs - BP 118/76, HR
104, RR 16, T 38.2C, pulse Ox 99% RA -Diagnostic results •Rapid strep test
positive
-Physical examination findings - ANSWER-• General -Well nourished and
hydrated 28 yo female. Awake, alert and orient; appropriately dressed for season.
Pleasant and cooperative.
*Skin - hot, dry and pink. No rashes or lesions including petechiae noted
• HEENT - normocephalic, symmetric face features. No tenderness in scalp, face,
ethmoid/maxillary/frontal sinuses. Negative transillumination. External ears
without deviations, ear canal clear bilaterally, tympanic membranes pearly grey
with cone of light, bony landmarks visualized bilaterally. Nasal mucosa pink and
moist turbinates with no edema or erythema. Oral mucosa pink and moist,
dentition without obvious caries; no lesions oral cavity. Pharynx with moderate
erythema tonsillar pillars ¼ bilaterally. No exudate. Uvula midline gag reflex
present.
• Neck - supple. Anterior cervical lymphadenopathy with mobile, tender nodes
bilaterally all less than 1 cm diameter. No JVD
- Cardiac - S1 S2 with no murmurs, gallops, or clicks. PMI 5th ICS mid-clavicular
line
- Pulmonary - lungs clear to auscultation bilaterally in all fields. Negative tactile
fremitus, egophony, bronchophony, and whispered pectoriloquy
- GI - no masses or pulsations. Bowel sounds normoactive all 4 quadrants. No
organomegaly no bruits.
-GU- denies missed menses, urinary frequency, urgency or
hematuria
- MS - Strength 4/5 bilateral upper and lower extremities. Gait steady
- Neuro - awake, alert, and oriented to name, place, date, and surroundings. No
nuchal rigidity, Kernigs or Brudzinski signs
Assessment - ANSWER-This section is where the diagnosis and differential
diagnosis are listed for the date the note is written.
Sample
Diagnosis: - Strep Pharyngitis
• Differential Diagnosis:
, - Viral pharyngitis
- Rheumatic fever
- Scarlet fever
Plan - ANSWER-This is where the treatment plan goes.
- Medications
- Diagnostic tests (i.e. laboratory, radiologic, hearing, etc.)
- Education
- Counseling
- Referrals
- Procedures performed and the outcomes/result(s)
- Return to office date(s)/Follow up
Sample
- Amoxicillin 875mg BID for 10 days
- Rapid Strep test done in office
- Verbal instructions given on warm salt water gargles and spit 3-4 times a day;
rest; increased fluids; rest; no work 2 days note given to patient
- Patient instructed to return to the office in 2 days if no improvement. To report
to the emergency department with difficulty swallowing, breathing, rash
develops, or symptoms worse verbalized understanding.
How to Interview a Patient - ANSWER-Stay calm!! • Prepare before you go into the
room - Read the chart, familiarize yourself with the patient • Set an agenda - Time,
needs, issues • Look and be professional - If you look the part you have already
conquered the first hurdle
Set the Stage - ANSWER-• Welcome the patient using their name • Introduce
yourself and your role • Remove communication barriers - Family or professional
translator • Ensure patient privacy and comfort • Set the agenda for the visit -
What are you going to do
Why is the Patient Here?
• - ANSWER-• Begin with open-ended questions - Requires patients to actually
describe their complaints - Obtain accurate, patient-specific information • Avoid
closed-ended questions - Similar to a long health history survey - Actually takes
longer than open-ended questions
• Be attentive while the patient is speaking - Of yourself • Silence, non-verbal
encouragement , body language -The Patient • Look for non-verbal signs and
cues
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