Health Assessment Exam 1

*Assessment* is the collection of subjective and objective data about a patient's health.

*Subjective data* consist of information provided by the affected individual.

*Objective data* include information obtained by the health care provider through physical assessment, the patient's record, and laboratory studies.

The *database* is the totality of information available about the patient. The purpose of assessment is to make a judgment or diagnosis.

*Diagnostic reasoning* is the process of analyzing health data and drawing conclusions to identify diagnoses.

*Diagnostic reasoning* has which four major components? (1) *Attending to* initially available *cues*, which are pieces of information, signs, symptoms, or laboratory data; (2) *Formulating diagnostic hypotheses*, which are tentative explanations for a cue or a set of cues and can serve as a basis for further investigation; (3) *Gathering data* relative to the tentative hypotheses; (4) *evaluating each hypothesis* with the new data collected, which leads to a final diagnosis.

The *nursing process* includes which six phases? (1) *assessment*, (2) *diagnosis*, (3) *outcome identification*, (4) *planning*, (5) *implementation*, and (6) *evaluation*. It is a dynamic, interactive process in which practitioners move back and forth within the steps.

The *novice nurse* has no experience with specific patient populations and uses rules to guide performance.

The *experienced nurse* understands a patient situation as a whole rather than as a list of tasks, attends to an assessment data pattern, and acts without consciously labeling it.

*Critical thinking* is the multidimensional thinking process needed for sound diagnostic reasoning and clinical judgment. Seventeen critical thinking skills have been identified, including *setting priorities.*

*First-level priority problems* are emergent, life-threatening, and immediate, such as establishing an airway or supporting breathing.

*Second-level priority problems* are next in urgency. They require prompt intervention to prevent deterioration, and may include a mental status change or acute pain.

*Third-level priority problems* are important to the patient's health, but can be addressed after more urgent problems. Examples include lack of knowledge or family coping.

Evidence-based practice is a systematic approach to practice that uses the *best evidence,* the *clinician's experience,* and the *patient's preferences and values* to make decisions about care and treatment.

Every examiner needs to collect *four kinds of databases* based on the situation. What are the four kinds of databases? (1) A *complete (or total health) database* includes a complete health history and a full physical examination. (2) A *focused (or problem-centered) database* is used for a limited or short-term problem. It is smaller in scope and more targeted than the complete database. (3) A *follow-up database* evaluates the status of any identified problem at regular intervals to follow up on short-term or chronic health problems. (4) An *emergency database* calls for rapid collection of data, which commonly occurs while performing lifesaving measures.

The *biomedical model* of Western medicine views health as the absence of disease. It focuses on collecting data on biophysical signs and symptoms and on curing disease.

The *holistic health model* assesses the whole person because it views the mind, body, and spirit as interdependent and functioning as a whole within the environment. Health depends on all these factors working together.

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Health assessment also should consider what two other factors? (1) The usual and expected *developmental tasks* for each age group (2) the *cultural beliefs and practices* of different people. Obtaining a heritage assessment helps gather data that are accurate and meaningful and can guide culturally sensitive and appropriate care.

According to the biomedical model, a narrow definition of health is: A) an optimal functioning of mind, body, and spirit within the environment. Feedback: INCORRECT Nursing has an expanded concept of health; holistic health includes the mind, body, and spirit as interdependent and functioning as a whole within the environment. *B) the absence of disease.* *Feedback: CORRECT* From a biomedical perspective, health is defined as the absence of disease or elimination of symptoms and signs of disease. C) the response of the whole person to actual or potential problems. Feedback: INCORRECT Nursing diagnoses are clinical judgments about a person's response to an actual or potential health state. D) prevention of disease. Feedback: INCORRECT Health promotion and disease prevention are important aspects of nursing's concept of health.

What type of data base is most appropriate when a rapid collection of data is required and often compiled concurrently with life-saving measures? A) Episodic Feedback: INCORRECT An episodic database is for a limited or short-term problem; this database concerns mainly one problem, one cue complex, or one body system. B) Follow-up Feedback: INCORRECT A follow-up database is used to follow-up short-term or chronic health problems; the statuses of identified problems are evaluated at regular and appropriate intervals. *C) Emergency* *Feedback: CORRECT* An emergency database is rapid collection of the data often obtained concurrently with lifesaving measures. D) Complete Feedback: INCORRECT A complete database includes a complete health history and a full physical examination; it describes the current and past health state and forms a baseline against which all future changes can be measured.

A medical diagnosis is used to evaluate: A) a person's state of health. Feedback: INCORRECT Nursing diagnoses are clinical judgments about a person's response to an actual or potential health state. B) the response of the whole person to actual or potential health problems. Feedback: INCORRECT Nursing diagnoses are used to evaluate the response of the whole person to actual or potential health problems. C) a person's culture. Feedback: INCORRECT Holistic model of health care is used in nursing, and culture is an important factor to consider in a nursing assessment. *D) the cause of disease.* *Feedback: CORRECT* Medical diagnoses are used to evaluate the etiology (cause) of disease.

An example of subjective data is: A) decreased range of motion. Feedback: INCORRECT Objective data is gathered by what the health professional observes by inspecting, percussing, palpating, and auscultating during the physical examination. Range of motion is assessed by inspection. B) crepitation in the left knee joint. Feedback: INCORRECT Objective data is gathered by what the health professional observes by inspecting, percussing, palpating, and auscultating during the physical examination. Crepitation is assessed by palpating. *C) left knee has been swollen and hot for the past 3 days.* *Feedback: CORRECT* Subjective data is what the person says about himself or herself during history taking. D) arthritis. Feedback: INCORRECT Arthritis is a medical diagnosis.

What type of database is most appropriate for an individual who is admitted to a long-term care facility? A) Episodic Feedback: INCORRECT An episodic database is for a limited or short-term problem; this database concerns mainly one problem, one cue complex, or one body system. B) Follow-up Feedback: INCORRECT A follow-up database is used to follow up short-term or chronic health problems; the statuses of identified problems are evaluated at regular and appropriate intervals. C) Emergency Feedback: INCORRECT An emergency database is rapid collection of the data often obtained concurrently with lifesaving measures. *D) Complete* *Feedback: CORRECT* A complete database includes a complete health history and a full physical examination; it describes the current and past health state and forms a baseline against which all future changes can be measured.

Which of the following is considered an example of objective data? *A) Alert and oriented* *Feedback: CORRECT* Objective data is what the health professional observes; level of consciousness and orientation are observations. B) Dizziness Feedback: INCORRECT Subjective data is what the person says about himself or herself during history taking. C) An earache Feedback: INCORRECT Subjective data is what the person says about himself or herself during history taking. D) A sore throat Feedback: INCORRECT Subjective data is what the person says about himself or herself during history taking.

An example of objective data is: A) complaints of left knee pain. Feedback: INCORRECT Subjective data is what the person says about himself or herself during history taking. *B) crepitation in the left knee joint.* *Feedback: CORRECT* Objective data is what the health professional observes by inspecting, percussing, palpating, and auscultating during the physical examination. Crepitation is assessed by palpation. C) left knee has been swollen and hot for the past 3 days. Feedback: INCORRECT Subjective data is what the person says about himself or herself during history taking. D) report of impaired mobility from left knee pain as evidenced by an inability to walk, swelling, and pain on passive range of motion. Feedback: INCORRECT Subjective data is what the person says about himself or herself during history taking.

A nursing diagnosis is best described as: A) a determination of the etiology of disease. Feedback: INCORRECT Medical diagnoses determine the etiology (or cause) of disease. B) a pattern of coping. Feedback: INCORRECT Coping patterns would include methods to relieve stress. C) an individual's perception of health. Feedback: INCORRECT Health perception is how the person describes and defines personal health. *D) a concise statement of actual or potential health concerns or level of wellness.* *Feedback: CORRECT* Nursing diagnoses are clinical judgments about a person's response to an actual or potential health state.

A complete data base is: A) used to rapidly collect data and is often compiled concurrently with life-saving measures. Feedback: INCORRECT An emergency database is rapid collection of the data often obtained concurrently with lifesaving measures. B) used for a limited or short-term problem usually consisting of one problem, one cue complex, or one body system. Feedback: INCORRECT An episodic database is for a limited or short-term problem; this database concerns mainly one problem, one cue complex, or one body system. C) used to evaluate cause and etiology of disease. Feedback: INCORRECT Medical diagnoses are used to evaluate the cause or etiology of disease. *D) used to perform a thorough or comprehensive health history and physical examination.* *Feedback: CORRECT* A complete database includes a complete health history and a full physical examination; it describes the current and past health state and forms a baseline against which all future changes can be measured.

A patient admitted to the hospital with asthma has the following problems identified based on an admission health history and physical assessment. Which problem is a first-level priority? A) Ineffective self-health management Feedback: INCORRECT Third-level priority problems are those that are import to the patient's health but can be addressed after more urgent health problems are addressed. Ineffective self-health management is an example of a third-level priority. B) Risk for infection Feedback: INCORRECT Second-level priority problems are those that are next in urgency; those requiring prompt intervention to forestall further deterioration. Risk for infection is an example of a second-level priority. *C) Impaired gas exchange* *Feedback: CORRECT* First-level priority problems are those that are emergent, life threatening, and immediate. Impaired gas exchange is an emergent and immediate problem. D) Readiness for enhanced spiritual well-being Feedback: INCORRECT Third-level priority problems are those that are import to the patient's health but can be addressed after more urgent health problems are addressed. Wellness diagnoses are third-level priority problems.

In the United States, about *one* in *eight* people are *immigrants.*

*One* in every *three* residents belongs to a *group other than single-race, non-Hispanic White.*

Of the emerging majority in the US, *Hispanics* are the largest population.

The second largest population is *Asians* followed by *Blacks*, American Indians, Alaska natives, Native Hawaiians, and other Pacific islanders.

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*Cultural care* is professional health care that is culturally sensitive, appropriate, and competent. To develop cultural care, you must have knowledge of *your personal heritage* and the *heritage of the nursing profession, the health care system, and the patient.*

*Heritage consistency* is the degree to which *a person's lifestyle reflects his or her traditional heritage.* A person can possess values that are consistent with the norms of the traditional culture or that are modern (or acculturated to the norms of the dominant society). Heritage consistency includes determination of a person's *cultural, ethnic, and religious background and socialization experiences.*

*Culture* has the following four characteristics: (1) it is *learned* from birth through language acquisition and socialization. (2) it is *shared* by all members of the same cultural group. (3) it is *adapted* to specific conditions related to environmental and technical factors. (4) it is *dynamic* and ever changing.

*Ethnicity* pertains to membership in a social *group that claims to possess a common* geographic origin, migratory status, religion, race, language, shared values, traditions or symbols, and food preferences. One's cultural background is a fundamental component of one's ethnic background.

*Religion* is the belief in a divine or superhuman power or powers to be obeyed and worshipped as the creator or ruler of the universe.

*Spirituality* is borne out of each person's unique life experience and his or her personal effort to find purpose and meaning in life. Spirituality may be used to *find meaning and purpose for illnesses.*

*Socialization* is the process of being raised within a culture and acquiring the characteristics of the group. Education is a form of socialization.

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*Cultural conflicts* between nurses and patients from diverse backgrounds are related to *different time and relationship perceptions*. For example, in some cultures, the past may influence health practices. When making decisions about health, patients may rely on relationships with others, and their behavior may depend on the opinion of others.

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Religious beliefs may influence the person's: (1) Explanation of the *cause of illness* (2) Perception of its *severity* (3) And choice of *healers.*

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ach culture has its own healers who usually: A) speak at least two languages. Feedback: INCORRECT Most healers speak the person's native tongue. B) own and operate specialty community clinics. Feedback: INCORRECT Most healers make house calls. *C) cost less than traditional or biomedical providers.* *Feedback: CORRECT* Most healers cost significantly less than healers practicing in the biomedical or scientific health care system. D) recommend folk practices that are dangerous. Feedback: INCORRECT Most of health practices used by folk healers are not dangerous and are usually harmless.

While evaluating the health history, the nurse determines that the patient subscribes to the hot/cold theory of health. Which of the following will most likely describe this patient's view of wellness? A) Good is hot. Feedback: INCORRECT Beverages, foods, herbs, medicines, and diseases are classified as hot or cold according to their perceived effects on the body, not on their physical characteristics. B) Evil is hot. Feedback: INCORRECT Beverages, foods, herbs, medicines, and diseases are classified as hot or cold according to their perceived effects on the body, not on their physical characteristics. *C) The humors must be balanced.* *Feedback: CORRECT* The hot/cold theory of health is based on humoral theory; the treatment of disease is based on the balance of the humors. D) The phlegm will be replaced with dryness. Feedback: INCORRECT The four humors of the body include the blood, phlegm, black bile, and yellow bile; the humors regulate basic bodily functions and are described in terms of temperature, dryness, and moisture. The treatment of disease consists of adding or subtracting cold, heat, dryness, or wetness to restore the balance of the humors.

Before determining whether cultural practices are helpful, harmful, or neutral, nurses must first understand: *A) the logic of the traditional belief systems.* B) the beliefs of the patients family. C) their personal belief models. D) the risk of disease in the patients ethnic group.

On the basis of median age: A) the non-Hispanic white population tends to be younger. Feedback: INCORRECT The non-Hispanic, single-race white population was older than the population as a whole; the respective median ages were 40.8 and 36.6 years. B) the Hispanic population tends to be older. Feedback: INCORRECT The Hispanic population was much younger, with a median age of 27.6 years, and about one-third of the Hispanic population was younger than 18 years old. *C) the Asian population tends to be younger.* *Feedback: CORRECT* The Asian population was younger with a median age of 35.4 years, and about 26% of the Asian population was younger than 18 years old. D) minorities tend to be older than non-Hispanic white populations. Feedback: INCORRECT Minorities tend to be younger than non-Hispanic white populations.

Spirituality is defined as: A) participating in religious services on a regular basis. Feedback: INCORRECT Religion refers to an organized system of beliefs concerning the cause, nature, and purpose of the universe. *B) a personal effort to find meaning and *purpose in life. *Feedback: CORRECT* Spirituality is a personal effort to find purpose and meaning in life. C) the process of being raised within a culture. Feedback: INCORRECT Socialization is the process of being raised within a culture and acquiring the characteristics of that group. D) a social group that claims to possess variable traits. Feedback: INCORRECT Ethnicity pertains to a social group within the social system that claims to possess variable traits.

Which of the following is true regarding language barriers and health care? *A) There are laws addressing language barriers and health care.* *Feedback: CORRECT* Title VI of the Civil Rights Act of 1964 provides people with limited English proficiency access to health care; these individuals cannot be denied health care services. B) Limited English proficiency is associated with a higher quality of care. Feedback: INCORRECT Limited English proficiency is associated with a lower quality of care. C) English proficiency is associated with a lower quality of care. Feedback: INCORRECT English proficiency is associated with a higher quality of care. D) Patients with language barriers have a decreased risk of nonadherence to medication regimens. Feedback: INCORRECT Patients with language barriers have an increased risk of nonadherence to medication regimens.

What is the yin/yang theory of health? *A) Health exists when all aspects of the person are in perfect balance.* *Feedback: CORRECT* In the yin/yang theory, health is believed to exist when all aspects of the person are in perfect balance. B) Health exists when physical, psychologic, spiritual, and social needs are met. Feedback: INCORRECT In the hot/cold theory, health consists of a positive state of total well-being, including physical, psychologic, spiritual, and social aspects of the person. C) Health exists in the absence of illness. Feedback: INCORRECT The biomedical model of Western tradition views health as the absence of disease. D) Health exists when there is optimal functioning. Feedback: INCORRECT In the biomedical or scientific theory, high-level wellness (or health) exists with optimal functioning of the human body.

Which theory has been expanded in an attempt to study the degree to which a person's lifestyle reflects his or her traditional heritage? A) Behavior theory Feedback: INCORRECT Behavior theory or behaviorism is a learning theory. *B) Heritage consistency* *Feedback: CORRECT* Heritage consistency theory has been expanded in an attempt to study the degree to which a person's lifestyle reflects his or her traditional heritage. C) Congruence mechanism Feedback: INCORRECT Carl Rogers described the concepts of congruence and incongruence as important ideas in his theory of personality and human development. D) Socialization experience Feedback: INCORRECT Socialization is the process of being raised within a culture and acquiring the characteristics of that group.

What symptom is greatly influenced by a person's cultural heritage? A) hearing loss Feedback: INCORRECT Hearing loss is more common in whites than in blacks. *B) pain* *Feedback: CORRECT* Pain is a very private, subjective experience that is greatly influenced by cultural heritage. Expectations, manifestations, and management of pain are all embedded in a cultural context. C) breast lump Feedback: INCORRECT The incidence of breast cancer varies with different cultural groups. D) food intolerance Feedback: INCORRECT Food intolerance varies with different cultural groups. For example, lactose intolerance is common in African Americans, American Indians, and Asian Americans.

When considering cultural competence, there are discrete areas that the nurse must develop knowledge of to understand the health care needs of others. These discrete areas include understanding of: (Select all that apply.) *A) his or her own heritage.* B) cultural and ethnic values. *C) the heritage of the nursing profession.* *D) the heritage of the patient.* *E) the heritage of the health care system.* Feedback: A discrete area of knowledge for cultural competence is understanding of ones own heritage, the heritage of the nursing profession, the heritage of the patient, and the heritage of the health care system.

*Empathy* means viewing the world from the other person's inner frame of reference while remaining yourself.

A health *interview* is a structured interaction between you and the patient. The *rules* governing this interaction should be *clearly outlined and agreed on* by you and the patient at the start of the interview. Your mutual *goal* is the *patient's optimal health*.

*Communication* carries you and the patient through the interview. Communication is the *exchange of information* so that each person clearly understands the other.

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*Internal factors* are what *you* bring to the interview.

Three internal factors promote good communication: (1) *liking others*, (2) *expressing empathy*, and (3) *having the ability to listen.*

*External factors* relate mainly to the *physical setting.*

You can foster good communication with certain external factors, such as by *ensuring privacy*, *preventing interruptions*, *creating a conducive environment*, and *documenting responses* without interfering with the conversation.

The interview has *three phases*: (1) *introduction*, (2) *working phase*, (3) *closing.*

During the first phase, *introduce the interview.*

During the working phase, *gather data.* Start with *open-ended questions,* which ask for narrative information. Then use *closed questions,* which ask for specific information in short, one- or two-word answers.

During the closing, *signal that the interview is ending*, which gives the patient one last chance to share concerns or express himself or herself. Also briefly *summarize what you learned* during the interview.

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*10 traps of interviewing*. These nonproductive verbal messages include: (1) Providing false assurance or reassurance, (2) Giving unwanted advice, (3) Using authority, (4) Using avoidance language, (5) Engaging in distancing, (6) Using professional jargon, (7) Using leading or biased questions, (8) Talking too much, (9) Interrupting, (10) And using "why" questions.

*Nonverbal modes of communication* include: - Physical appearance, - Posture, - Gestures, - Facial expression, - Eye contact, - Voice, and - Touch.

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*Facilitation* These responses encourage the patient to say more, to continue with the story ("mm-hmm, go on, continue, uh-huh"). Also called general leads, these responses show the person you are interested and will listen further. Simply maintaining eye contact, shifting forward in your seat with increased attention, nodding "Yes," or using your hand to gesture, "Yes, go on, I'm with you," encourage the person to continue talking.

Silence is golden after open-ended questions. Your silent attentiveness communicates that the patient has time to think, to organize what he or she wishes to say without interruption from you.

*Reflection.* This response echoes the patient's words. Reflection is repeating part of what the person has just said.

*Clarification.* Use this when the person's word choice is ambiguous or confusing (e.g., "Tell me what you mean by 'tired blood.' "). Clarification also is used to summarize the person's words, simplify the words to make them clearer, and then ask if you are on the right track. You are asking for agreement, and the person can then confirm or deny your understanding.

*Confrontation.* These responses now include your own thoughts and feelings. Use this only when merited by the situation. If you use it too often, you take over at the patient's expense. In the case of confrontation, you have observed a certain action, feeling, or statement and you now focus the person's attention on it. You give your honest feedback about what you see or feel.

*Interpretation.* This statement is not based on direct observation as with confrontation, but it is based on your inference or conclusion. It links events, makes associations, or implies cause: "It seems that every time you feel the stomach pain, you have had some kind of stress in your life." Interpretation also ascribes feelings and helps the person understand his or her own feelings in relation to the verbal message.

*Explanation.* With these statements, you inform the person. You share factual and objective information. This may be for orientation to the agency setting: "Your dinner comes at 5:30 PM." Or, it may be to explain cause: "The reason you cannot eat or drink before your blood test is that the food will change the test results."

When preparing the physical setting for an interview, the interviewer should: A) set the room temperature between 64 and 66° F. Feedback: INCORRECT The room temperature should be set at a comfortable level; a temperature between 64 and 66° F is too cool. B) reduce noise by turning the volume on the television or radio down. Feedback: INCORRECT Turn off the television or radio and any unnecessary equipment to reduce noise. *C) conduct the interview at eye level and at a distance of 4 to 5 feet.* *Feedback: CORRECT* Both the interviewer and the patient should be at eye level at a distance of 4 to 5 feet. D) stand next to the patient to convey a professional demeanor. Feedback: INCORRECT The interviewer and patient should be comfortably seated; standing communicates haste and assumes superiority.

Parents or caretakers accompany children to the health care setting. Starting at ___ years of age, the interviewer asks the child directly about his or her presenting symptoms. A) 5 Feedback: INCORRECT Refer to feedback in option B. *B) 7* *Feedback: CORRECT* School-age children (starting at age 7) have the verbal ability to add important data to the history. The nurse should interview the parent and child together, but when a presenting symptom or sign exists, the nurse should ask the child about it first, then gather data from the parent. C) 9 Feedback: INCORRECT Refer to feedback in option B. D) 11 Feedback: INCORRECT Refer to feedback in option B.

Which of the following statements, if made by the interviewer, would be an appropriate response? A) "I know just how you feel." Feedback: INCORRECT This response is an inappropriate communication technique referred to as false reassurance. B) "If I were you, I would have the surgery." Feedback: INCORRECT This response is an inappropriate communication technique referred to as giving unwanted advice. C) "Why did you wait so long to make an appointment?" Feedback: INCORRECT This response is an inappropriate communication technique referred to as using "Why" questions. *D) "Tell me what you mean by 'bad blood'."* *Feedback: CORRECT* This response is an appropriate communication technique referred to as seeking further clarification.

While discussing the treatment plan, the nurse infers that the patient is uncomfortable asking the physician for a different treatment because of fear of the physician's reaction. In this situation, the nurse's verbal interpretation: A) affects the nurse-physician relationship. Feedback: INCORRECT The nurse-physician relationship is not the barrier to communication in this situation B) impedes further discussion. Feedback: INCORRECT The interpretation by the nurse will improve communication. *C) helps the patient understand personal feelings in relation to his or her verbal message.* *Feedback: CORRECT* Patients may experience barriers to communication with a health care provider seen as an authority figure. The patient may not share personal feelings if fear is experienced. In this situation, the nurse identified the patient's personal feelings in relation to the patient's verbal message. D) helps the nurse understand his or her own feelings in relation to the patient's verbal message. Feedback: INCORRECT The nurse's feelings are not the barrier to communication in this situation.

The use of euphemisms to avoid reality or to hide feelings is known as: A) distancing language. Feedback: INCORRECT Distancing is the use of impersonal speech to put space between a threat and the self. B) sympathetic language. Feedback: INCORRECT Empathy means viewing the world from the other person's inner frame of reference. Empathy is therapeutic; sympathy is nontherapeutic. *C) avoidance language.* *Feedback: CORRECT* Euphemisms are used to avoid reality or to hide feelings. Using direct language is the best way to deal with frightening topics instead of using avoidance language. D) ethnocentric language. Feedback: INCORRECT Ethnocentrism is the belief that one's ethnic or cultural group is more important or superior.

When addressing a toddler during the interview, the health care provider should: A) ask the child, before the caretaker, about symptoms. Feedback: INCORRECT For a younger child such as a toddler, the parent will provide all or most of the history. B) use nonverbal communication. Feedback: INCORRECT Nonverbal communication is the primary communication method for infants. *C) use short, simple, concrete sentences.* *Feedback: CORRECT* A toddler's communication is direct, concrete, literal, and set in the present. The health care provider should use short, simple sentences with concrete explanations. D) use detailed explanations. Feedback: INCORRECT Detailed explanations would be more appropriate for a school-age child, adolescent, or adult.

Nonverbal communication is the primary form of communication for which group of individuals? *A) Infants* *Feedback: CORRECT* Nonverbal communication is the primary form of communication method for infants. B) Preschoolers Feedback: INCORRECT Preschooler's communication is direct, concrete, literal, and set in the present. C) Adolescents Feedback: INCORRECT Adolescents should be treated with respect; the nurse should use open, honest, professional communication. D) Older adults Feedback: INCORRECT Older adults may need special considerations related to physical limitations (e.g., adjusted pace to avoid fatigue, impaired hearing).

Viewing the world from another person's inner frame of reference is called: A) reflection. Feedback: INCORRECT Reflection is repeating part of what the person has just said. *B) empathy.* *Feedback: CORRECT* Empathy means viewing the world from the other person's inner frame of reference. C) clarification. Feedback: INCORRECT Clarification is used to summarize the person's words or to simplify the words to make them clearer. D) sympathy. Feedback: INCORRECT Sympathy is a social affinity in which one person stands with another person, closely understanding his or her feelings.

An example of an open-ended question or statement is: *A) "Tell me about your pain."* *Feedback: CORRECT* Open-ended questions and statements ask for narrative information; they state the topic to be discussed, but only in general terms. This type of question encourages the person to respond in paragraphs and to give a spontaneous account in any order chosen. B) "On a scale of 1 to 10, how would you rate your pain?" Feedback: INCORRECT This is a closed or direct question. Closed or direct questions and statements ask for specific information. This type of question or statement will elicit a short, one- or two-word answer, a yes or no response, or a forced choice. C) "I can see that you are quite uncomfortable." Feedback: INCORRECT This is a closed or direct statement. Refer to feedback in Option B. D) "You are upset about the level of pain, right?" Feedback: INCORRECT This is a closed or direct statement. Refer to feedback in Option B.

The most appropriate introduction to use to start an interview with an older adult patient is: *A) "Mr. Jones, I want to ask you some questions about your health so that we can plan your care."* *Feedback: CORRECT* An older adult should be addressed by the last name; older adults may be offended by a younger person using their first names. B) "David, I am here to ask you questions about your illness; we want to determine what is wrong." Feedback: INCORRECT The initial introduction should include the person's surname (unless a child) and the reason for the interview. C) "Mr. Jones, is it okay if I ask you several questions this morning about your health?" Feedback: INCORRECT This introduction is a closed-ended question. D) "Because so many people have already asked you questions, I will just get the information from the chart." Feedback: INCORRECT This introduction does not allow for free expression of ideas.

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*complete health history data category 1.* First, collect *biographic data*, such as the patient's name, address, and date of birth as well as language and communication needs.

*complete health history data category 2.* Second, note the *source of the history*, which is usually the patient, but may be someone else, such as a relative or interpreter.

*complete health history data category 3.* Third, obtain the *reason for seeking care*, formerly known as the chief complaint. In the patient's own words, briefly describe the reason for the visit.

*complete health history data category 4.* Fourth, record the *present health or history of present illness*. For a well person, briefly note the general state of health. For a sick person, chronologically record the reason for seeking care. When a patient reports a symptom, perform a *symptom analysis*. If you find it helpful, use the mnemonic PQRSTU to do this.

*PQRSTU* stands for *P*rovocative or palliative, *Q*uality or quantity, *R*egion or radiation, *S*everity scale, *T*iming, and *U*nderstanding the patient's perception of the problem.

*complete health history data category 5.* Fifth, investigate *past health events*, such as illnesses, injuries, hospitalizations, and allergies as well as current medications.

*complete health history data category 6.* Sixth, gather a *family history* to help detect health risks for the patient. To aid in this process, draw a pedigree or genogram.

*complete health history data category 7.* Seventh, perform a *review of systems* to evaluate the past and present health of each body system, double-check for significant data, and assess health promotion practices. For each body system, assess for symptoms and health-promoting behaviors.

*complete health history data category 8.* Finally, perform a *functional assessment*, including activities of daily living, such as bathing dressing, toileting, eating, walking, housekeeping, shopping, cooking, and other factors.

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When obtaining a *child's health history*, use the same structure you would use for an adult, but make pertinent modifications or additions. Additions include: - A prenatal and perinatal history, - The parents' description of the present problem, - Any childhood illnesses or accidents, Immunization data, - A developmental overview, - And a nutritional history.

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The *Comprehensive Older Person's Evaluation* is particularly useful because it addresses: Basic and instrumental *activities of daily living*, *Functional assessments*, And physical, social, psychologic, demographic, financial, and legal *issues*.

*CAGE* test is a screening questionnaire to identify excessive or uncontrolled drinking, such as: - *C* Cut down - Have you ever thought you should cut down your drinking? - *A* Annoyed - Have you ever been annoyed by criticism of your drinking? - *G* Guilty - Have you ever felt guilty about your drinking? - *E* Eye-opener - Do you drink in the morning (i.e. an eye-opener?) If the person answers "yes" to 2 or more CAGE questions, you should suspect alcohol abuse and continue with a more complete substnce abuse assessment.

Which of the following is included in documenting a history source? A) Appearance, dress, and hygiene Feedback: INCORRECT Appearance, dress, and hygiene are observations included in the general survey. B) Cognition and literacy level Feedback: INCORRECT Cognition and literacy level is part of the mental status assessment. C) Documented relationship of support systems Feedback: INCORRECT Interpersonal relationships and resources such as support systems are assessed during the functional assessment of the complete health history. *D) Reliability of informant Feedback: CORRECT* The source of history is a record of who furnishes the information, how reliable the informant seems, and how willing he or she is to communicate. In addition, there should be a note of any special circumstances, such as the use of an interpreter.

A patient seeks care for "debilitating headaches that cause excessive absences at work." On further exploration, the nurse asks, "What makes the headaches worse?" With this question, the nurse is seeking information about: A) the patient's perception of pain. Feedback: INCORRECT To determine the patient's perception of pain, the nurse would determine the meaning of the symptom by asking how it affects daily activities and what the patient thinks the pain means. B) the nature or character of the headache. Feedback: INCORRECT The nature or character calls for specific descriptive terms to describe the pain. *C) aggravating factors.* *Feedback: CORRECT* Aggravating factors are determined by asking the patient what makes the pain worse. D) relieving factors. Feedback: INCORRECT Relieving factors are determined by asking the patient what relieves the pain, what is the effect of any treatment, what the patient has tried, and what seems to help.

The CAGE test is a screening questionnaire that helps to identify: A) unhealthy lifestyle behaviors. Feedback: INCORRECT The health history will assess lifestyle, including such factors as exercise, diet, risk reduction, and health promotion behaviors. B) personal response to stress. Feedback: INCORRECT Coping and stress management are assessed during the functional assessment of the complete health history. *C) excessive or uncontrollable drinking. Feedback: CORRECT* CAGE is a screening questionnaire to identify excessive or uncontrolled drinking (e.g., C = Cut down; A = Annoyed; G = Guilty; E = Eye opener). D) depression. Feedback: INCORRECT Depression is assessed during the review of systems and during the mental status assessment (mood and affect). The Geriatric Depression Scale, Short Form (Yesavage and Brink, 1983) is an assessment instrument for use with the older adult.

The "review of systems" in the health history is: A) an evaluation of past and present health state of each body system. Feedback: INCORRECT The purposes of the review of systems are to evaluate the past and present health state of each body system, to double-check in case any significant data were omitted in the present illness section, and to evaluate health promotion practices. *B) a documentation of the problem as perceived by the patient.* *Feedback: CORRECT* The reason for seeking care is a statement in the person's own words that describes the reason for the visit. C) a record of objective findings. Feedback: INCORRECT Objective data is the observations obtained by the health care professional during the physical examination. D) a short statement of general health status. Feedback: INCORRECT For the well person, the present health or history of present illness is a short statement about the general state of health.

When recording information for the review of systems, the interviewer must document: A) physical findings, such as skin appearance, to support historic data. Feedback: INCORRECT Recording physical findings in the review of systems is incorrect; review of systems is limited to the patient statements or subjective data. B) "negative" under the system heading. Feedback: INCORRECT Writing negative after the system heading is also incorrect because it would be unknown which factors were asked. *C) the presence or absence of all symptoms under the system heading.* *Feedback: CORRECT* When recording information for the review of systems, the interviewer should record the presence or absence of all symptoms, otherwise it is unknown which factors were asked. D) objective data that supports the history of present illness. Feedback: INCORRECT Recording objective data in the review of systems is incorrect; review of systems is limited to the patient statements or subjective data.

Assessment of self-esteem and self-concept is part of the functional assessment. Areas covered under self-esteem and self-concept include: *A) education, financial status, and value-belief system.* *Feedback: CORRECT* Functional assessment measures a person's self-care ability. The areas assessed under the self-esteem and self-concept section of the functional assessment include education, financial status, and value-belief system. B) exercise and activity, leisure activities, and level of independence. Feedback: INCORRECT These areas are related to the activity and exercise section of the of the functional assessment. C) family role, interpersonal relations, social support, and time spent alone. Feedback: INCORRECT These areas are related to the interpersonal relationships and resources section of the functional assessment. D) stressors, coping mechanisms, and change in past year. Feedback: INCORRECT These areas are related to the coping and stress management section of the functional assessment.

PQRSTU is a mnemonic that helps the clinician to remember to address characteristics specific to: A) severity of dementia. Feedback: INCORRECT Tests used to assess for dementia include the Mini-Mental State Examination, the Set Test, the Short Portable Mental Status Questionnaire, the Mini-Cog, and the Blessed Orientation-Memory-Concentration Test. B) substance use and abuse. Feedback: INCORRECT Functional assessment includes questions on substance use and abuse. *C) symptoms.* *Feedback: CORRECT* The eight critical characteristics of any symptom reported in the history of the present illness are: P = provocative or palliative; Q = quality or quantity; R = region or radiation; S = severity scale; T = timing; and U = understand patient's perception. D) the ability to perform activities of daily living (ADLs). Feedback: INCORRECT Functional assessment measures a person's self-care ability including the ability to perform activities of daily living.

The nurse questions the reliability of the history provided by the patient. One method to verify information within the context of the interview is to: A) review previous medical records. Feedback: INCORRECT This option is not within the context of the interview. *B) rephrase the same questions later in the interview.* *Feedback: CORRECT* A reliable person always gives the same answers, even when questions are rephrased or are repeated later in the interview. C) ask the patient if there is someone who could verify information. Feedback: INCORRECT This option is not within the context of the interview. D) call a family member to confirm information. Feedback: INCORRECT This option is not within the context of the interview.

When taking a health history from an adolescent, the interviewer should: A) ask about violence and abuse before asking about alcohol and drug use. Feedback: INCORRECT Questions should move from expected and less-threatening questions to those that are more personal. Ask about alcohol and drug use before asking about safety (related to injury and violence). B) have at least one parent present during the interview. Feedback: INCORRECT The adolescent interview during the health history should be with the youth alone. *C) interview the youth alone with a parent in the waiting area.* *Feedback: CORRECT* The adolescent interview during the health history should be with the youth alone; the parent(s) may wait in the waiting area and complete other past health questionnaire forms. D) ask every youth about the use of condoms. Feedback: INCORRECT Questions about condom use would only be appropriate if the youth is sexually active. The HEEADSSS method of interviewing adolescents has essential questions, important questions, and situational questions.

What information is included in greater detail when taking a health history on an infant? *A) nutritional data* *Feedback: CORRECT* The amount of nutritional information needed depends on the child's age; the younger the child is the more detailed and specific the data should be. B) history of present illness Feedback: INCORRECT The health history is adapted to include information specific for the age and developmental stage of the child (e.g., mother's health during pregnancy, labor and delivery, and the perinatal period). The developmental history and nutritional data are important for current health of infants and children. C) family history Feedback: INCORRECT Refer to feedback in Option B. D) environmental hazards Feedback: INCORRECT Refer to feedback in Option B.