NR 509 Midterm Study Guide

14 July 2024

Focus and Repetition: Topics and content on guides are intended to focus student attention when reading/studying. Some topics may be repeated in multiple chapters to reinforce learning.
Depth of Understanding: Multiple test items are derived from the same topic areas to encourage deeper comprehension. Students must have a broad understanding of the content and not simply memorize passages in textbooks or articles.
Key Information: Information in red letters in the chapters, as well as tables and appendices at the end of the chapters, may include test items.
Cognitive Levels: Exam questions represent various levels of cognitive learning. Students are expected to analyze, synthesize, and evaluate patient scenarios to answer questions effectively.
Reading Strategy: Read all of the answers BEFORE reading the stem of the question. This helps focus on the key content and avoids distractions by extraneous information.
Techniques of Examination and Recording Findings: Be familiar with these sections for all body system chapters in the textbook.

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The Interviewing Process
- Stages of the Interview
  - Initiating the Encounter: Set the stage, adjust the environment, review the clinical record, set your agenda, greet the patient, establish rapport, identify patient title/pronouns.
  - Gathering Information: Chief complaint, establish agenda, invite patient’s story, gather information about the patient’s perspective (FIFE: Feelings, Ideas, Effect on function, Experience), identify and respond to emotional cues, explore biomedical perspective, gather background information.
  - Performing the Physical Examination
  - Explaining and Planning: Assess and respond to the patient’s need for information, establish shared understanding, verify patient understanding, negotiate the plan of action with shared decision-making.
  - Closing the Encounter: Allow time for final questions, follow-up plans, self-reflection.
Interviewing Techniques
- Gather information about the patient’s understanding of illness (FIFE).
- Respond to emotional cues (Name, Understand, Respect, Support, Explore).
- Gather information by exploring the biomedical perspective.
- Gather important background information and context (Medical, family, and personal/social history).
Setting the Stage for the Examination
- Set the stage, adjust the environment, review the clinical record, set your agenda, greet the patient, establish rapport, identify patient name and gender pronoun.

Focused and Comprehensive Health Histories
Determining the Scope of the Patient Assessment
The Seven Attributes of a Patient’s Principal Symptoms
- Location, quality, quantity and severity, timing, onset, duration, frequency, setting, aggravating and relieving factors, associated manifestations.
Subjective vs. Objective Data
- Subjective: What the patient tells you (medical history).
- Objective: What is observed (labs).
Modifying the Clinical Interview for Various Clinical Settings

Determining the Scope of the Physical Examination
Techniques of Examination (Note: Be familiar with specific techniques in body system chapters)
Head-to-Toe Physical Assessment
Examining the Patient from the Right Side: Advantages include more reliable estimates of jugular venous pressure, more comfortable palpation of the apical impulse, more frequently palpable right kidney, and examining tables accommodating right-handed approach.
Elevating the Head of the Examining Table: Adjust to see jugular venous pulsations. For cardiovascular examination, ask the patient to roll partly onto the left side to listen at the apex for S3 or mitral stenosis. For aortic regurgitation, the patient should sit, lean forward, and exhale.

The Clinical Reasoning Process
The Problem List: List the most active and serious problems first, record their date of onset. Separate lists for active and inactive problems or one list in order of priority.
The Differential Diagnosis (DDx) List
The Summary Statement
Assessment (Medical Diagnoses)
Planning (Treatment and Interventions)

Normal vs. Abnormal Findings and Interpretation
Common Skin Conditions
- Melanoma, Primary and Secondary Skin Lesion Nomenclature, Psoriasis, Tinea, Pityriasis Rosea, Lyme Disease, Acne, Systemic Lupus Erythematosus, Herpes Zoster, Cellulitis.

Using Elements of the Physical Examination as Diagnostic Tests
Evaluating Diagnostic Tests
Critically Appraising Clinical Evidence
Communicating Clinical Evidence to Patients
- Five As (ask, advise, assess, assist, and arrange).
- FRAMES (feedback about personal risk, responsibility of patient, advice to change, empathetic style, promote self-efficacy).