N5220 Exam Pearls

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The absence of a language barrier does not preclude a cultrual barrier, and you will likely need?

cultural translation

Professional dress and grooming go a long way towards establising a first good impression with the patient?

True

Below are part of the Cultural Assessment Guide: The Many Aspects of Understanding except?

Gender-based practices

Term used to describe a person's internal sense of self and how they fit into the world from the perspective of gender.

Gender identity

Term describing a person's sexual, romantic, emotional, or physical attraction towards other people.

Sexual orientation

Identify from the RESPECT model: -Connect on a social level -See the patient's point of view -Consciously suspend judgement -Recognize and avoid making assumptions

Rapport

Identify from the RESPECT model: -Remember the patient has come to you for help -Seek out and understand the patient's rationale for his/her behaviors and illness -Verbally acknowledge and legitimize the patient's feelings

Empathy

Identify from the RESPECT model: -Ask about and understand the barriers to care and compliance -Help the patient overcome barriers; Involve family members if appropriate -Reassure the patient you are and will be available to help

Support

Identify from the RESPECT model: -Be flexible -Negotiate roles when necessary -Stress that you are working together to address health problems

Partnership

Identify from the RESPECT model: -Check often for understanding -Use verbal clarification techniques

Explanations

Identify from the RESPECT model: -Respect the patient's cultural beliefs -Understand that the patient's views of you may be defined by ethnic and cultural sterotypes -Be aware of your own cultural biases and preconceptions -Know your limitations in addressing health issues across cultures -Understand your personal style and recognize when it may not be working with a given patient

Cultural competence

What is a question to avoid asking your patinet in order to enhance patient reponse?

It seems to me that this bothered you a lot didn't it?

During moments of tension there may be periods of silence. How would the provider move the coversation along?

Asking open-ended questions or a mild nudge

This is always what the patients says it is and is subjective data

Review of Systems (ROS)

How is the Chief Complaint (CC) documented?

In quotation marks

What is the difference between a screening and an assessment interview?

Screening is to find out if a problem exists. The assessment continues after a positive screen.

What is unique about the outline of history?

It offers a guide derived from multiple sources to meet the needs of your patient

What is the best question to ask patients to determine how they define themselves?

How do you see yourself?

List the 5 Ps of Sexual History

-Partners -Practices -Protection from STIs -Past history of STIs -Prevention of pregnancy

Evidence suggests that the risk of DMII and CV disease could be reduced in childhood by?

Taking a family history

Starting at what age are children considered good historians?

Age 7

When assessing a child with their parent present what action would decrease patient trust and rapport?

Grabbing the child from the parent and putting them on the exam table

Which of the following is not considered part of the functional assessment?

Patient Safety

Makes you as thoroughly familiar with the patient as possible. Most often, this history is recorded the first time you see the patient.

Complete history

Is taken when the problem is acute, possibly life-threatening, requiring immediate attention so that only the need of the moment is given full attention.

Problem history

Side-lying position with legs extended or flexed. Used to assess heart, spleen, and rectum.

Lateral recumbent

Used for pelvic exams. Supine with knees bent and feet in stirrups with buttocks at edge of table.

Lithotomy

When shaking a patient's hands, how much pressure should be applied?

The same pressure as the patient squeezes with

Of the 5 percussion sounds which one is the loudest?

Tympany

It is OKAY to come across unexpected findings. This may reflect a change in the patient's condition or?

A learning opportunity

List the components of EBP

Best evidence, Patient preference, Clinical expertise, Medical decision making

Choose the example that is a "Red Herring"

A patient with swollen cervical nodes and fever owns a cat, which had claws, but the patient did not have cat scratch fever. This delayed the diagnosis of non-Hodgkin lymphoma.

Do good for the patient

Beneficence

Do no harm to the patient

Nonmaleficence

Consider appropriate use of resources with concern for the greater good of the larger community

Utilitarianism

Recognize the balance between autonomy and competing interests of the family and community

Fairness and justice

Our dutiful responsibilities for offering care are established by tradition and in cultural contexts

Deontologic Imperatives

-The probability of those findings being associated with that diagnosis -The prevalence of both that particular diagnosis and that combination of findings in the community you are serving

Bayes Theorem

What are approved abbreviations?

Unit

What are approved abbreviations?

every other day

What does SOAP stand for?

S = subjective data O = objective data A = assessment P = plan

What are the components of the Problem-Oriented Health Record (POHR)?

1. Comprehesive health history 2. Complete physical examination 3. Problem list 4. Assessment and plan 5. Baseline and problem-directed laboratory and radiologic imaging studies 6. Progress notes

How long do you count for when assessing an apical pulse?

60 sec

How do you measure the respiratory rate?

count 30 sec x2

What blood pressure is considered Stage I HTN?

130-139/80-89

What blood pressure is considered Stage II HTN?

>/= 140/90

List the physical examination components

1. physical appearance 2. cognitive abilites 3. speech and language 4. emotional stability

When it is difficult or impossible to elicit a social smile in an infant who appears ill, be concerned about?

A neurologic condition or infection

Expressive language milestones: uses 2 to 3 word sentences

24-36 mos

Expressive language milestone: says sounds correctly except l, s, r, v, z, ch, sh, th, and uses detailed sentences and tells stories

48-60 mos

When performing a functional assessment related to mental health and ADL, all of the following should be assessed except?

ability to socialize with friends and family

How to you assess skeletal muscle mass?

Measuring the mid-arm circumference

How do you calcuate BMI?

(weight lbs/(height inches^2)) x 703

What BMI is considered underweight?

under 18.5

What BMI is considered overweight?

25 - 29.9

What Tanner Stage is associated with pre-adolescence in women?

Tanner Stage 1

What Tanner Stage is considered the adult stage in males?

Tanner Stage 5

Most pregnant patients have some degree of increased pigmentation called?

Colasma

Terminal hair can turn into vellus hair, but men can have terminal hair in ____ and ___?

ears and nares

What Asian practice is often confused physical abuse?

Cupping

This skin condition is r/t hormones in dark skin pregnant patients

Melasma

Tend to be large usually > 5 mm with fla component, brown in color, and shape can be round, oval, or irregular

Atypical nevi

Boarder is irregular, tend to be larger than 6mm, with wide color variation

Melanoma

How do you assess skin turgor?

with palmar surface of hand and pinch sternum and forearms

What type of skin lesion is herpes zoster?

Vesicle

What equipment do you use to look at cafe a lait spots?

Woods Lamp

Be suspicious what disease if you find six or more cafe au lait spots that are greater than 5mm in diameter?

Neurofibromatosis

How do you distinguish a nail injury from pseudomonas of the nail?

While both are black, pseudomonas is painless whereas nail injury is painful

How many degress is a normal nail base?

160

Assoicated with a variety of respiratory, CV diseases, cirrhosis, colitis, and thyroid disease

Clubbing

Flat, evenly pigmented spots varying in color from light brown to dark brown or black in darker skin; larger than 5 mm, associated with neurofiromatosis

Cafe au lait macules

These hyperpigmentaiton "Mongolian Spots" are often mistaken for physical abuse in children that usually affect?

Dark skinned

How do you assess skin turgor in infants?

Pinch abdomen

Known as the "mask of pregnancy"

Melasma

Why is skin turgor not a good indicator of hydrartion status in older adults?

Becasue it is a common finding

When assessing the ABCDEs for a melanoma, what does it stand for?

Asymmetry, Borders, Color, Diameter, Evolution

What size do you worry for a melanoma?

> 6 mm

Known as "Dew on a Rose Petal"

Chicken Pox

Injuries to soft tissue non-uniform worry about?

Abuse

Enlarged lymph nodes

Lymphadenopathy

Inflamed and enlarged lymph nodes

Lymphadenitis

Inflammation of the lymphatics that drain an area of infection; tender erythematous streaks extend proximally from the infected area; regional nodes may also be tender

Lymphangitis

Edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage

Lymphedema

Congenital malformation of dilated lymphatics

Lymphangioma

Small non-tender nodes that feel like BBs under skin

Shotty

Wavelike motion that is felt when the node is palpated

Fluctuant

Group of nodes that feel connected and seem to move as a unit

Matted

A hard, fixed, painless node suggests?

Malignancy

The more tender a node is the more likely it is?

Inflammation

This type of palpable node on the left is associated with thoracic and abdominal malignancy

Supraclavicular

Slow progression on nodal enlargment suggests?

Benign process

A submandibular lymph node < 1cm and inguinal lymph node < 2 cm are considered?

Normal

The thyroid gland moves with _____; subcutanteous fat that mimics a _____ does not.

swallowing; goiter

At about age 45, a progressive weakinging of accomodation causes?

presbyopia

Term for unequal pupils

Anisocoria

Enlarged lacrimal apparatus could suggest?

Tumor or Sjorgrens

What cranial nerves control extraocular movements?

CN III, IV, and VI

The fundus (retina) appears as a ______ or _____ background and can vary in pigment with the patients skin color.

yellow or reddish

Associated with AV nicking and copper wiring

HTN

100

Initial sign is leukocoria, a white reflex (cat's eye) rather than red reflex. White pupils on photographs.

Retinoblastoma

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