Patient Assessment Test 1 Set 1

Front 1

(Medication and Patient) History purpose (3)

Back 1

1)learn about pt
2)disc pt issues and problems
3)assign priority

Front 2

First steps in getting medication and pt History (4)

Back 2

1)greet pt
2)address pt formally
3)introduce yourself and your title
4)acknowledge other in the room

Front 3

(Medication and Patient) History--pt comfort (6)

Back 3

1)pt on table/chair
2)sit on stool/chair next to pt
3)don't watch clock
4)minimize distractions
5)have good eye contact
6)do NOT overtire pt--comeback later if needed

Front 4

Types of questions for (Medication and Patient) History (6)

Back 4

1)opening q's
2)open-ended q's
3)closed-ended q's
4)combination
5)leading q's
6)graded-response q's

Front 5

Opening questions
a)ex
b)fxn
c)other

Back 5

a)"what brings you here today"
b)obtain the cc
c)do NOT accept a previous diagnosis as cc (ie pneumonia is not a cc, cough would be)

Front 6

Open-ended questions leave...

Back 6

discretion to the pt about the extent of the answer

Front 7

Close-ended questions are useful for...

Back 7

eliciting specific info/details and to speed up the interaxn

Front 8

Combination question? (2)

Back 8

1)combo of open and close-ended questions
2)most efficient/productive way of obtaining needed pt info

Front 9

Leading questions are bad b/c...

Back 9

limit the info provided to what the pt thinks you want to know

Front 10

Graded-response questions
a)puts a...
b)allows you to compare...
c)ex

Back 10

a)# variable to symptoms
b)degree of symptom from one time point to another
c)"how many stairs can you climb before you get short of breath?"

Front 11

Facilitation?
a)fxn
b)2ex

Back 11

a)Encourage pt to say more w/ words or w/ a silence that the pt may break when give the opportunity for reflection
b)"go on", "i'm listening"

Front 12

Fxn of silence in communication (3)

Back 12

1)become comfortable w/ silence
2)is a necessary part of the communication process
3)don't interrupt short pauses--pt is thinking and you can destroy their thought process

Front 13

Reflection (2)

Back 13

1)repeat what you have heard to encourage more detail
2)repeat the pts own words

Front 14

Clarification (2)

Back 14

1)ask "what do you mean"
2)use this if you have trouble understanding what the pt means

Front 15

Empathetic Response (4)

Back 15

1)show your understanding and acceptance
2)say "i understand" or "i'm sorry" if the moment calls for it
3)offer tissue
4)physical contact to convey understanding

Front 16

Sensitive Subjects (5)

Back 16

1)be direct and firm
2)do NOT apologize for asking sensitive questions, it is your job
3)do NOT preach
4)do NOT push too hard if pt has trouble or gets defensive
5)it is OK and appropriate to ask about the pts feelings

Front 17

Language/jargon (3)

Back 17

1)medical terminology is often inappropriate, but do not be too simplistic either
2)talk on an appropriate level for children
3)use an interpreter if pt does NOT speak your language

Front 18

Take history and perform physical exam before...

Back 18

you look @ info such as x-rays and lab studies

Front 19

Note Taking during history? (2)

Back 19

1)do so sparingly
2)jot down enough key words making sure it does not distract you from the interview

Front 20

Closing the history (2) and 1ex

Back 20

1)give pt opportunity for review and necessary elaboration
2)summarize what has been discussed and indicate what is to happen next
3)"oh by the way"

Front 21

History and Physical components diagnosis can...

_____ confirm the diagnosis

Back 21

1)70% of diagnosis can be made by history alone
2)90% can by make by physical exam alone

Labs/radiology

Front 22

When recording history and physical data it should have... (7)

Back 22

1)ALWAYS the date
2)time
3)place
4)author
5)referring physician
6)occasion
7)interview source (pt, spouse, kids)

Front 23

Reliability of history grades (4)

Back 23

1)pt fully alert and oriented
2)pt has delusions/hallucinations
3)pt gives conflicting info to chart and/or family
4)pt is vague and unable to specify details

Front 24

Pt profile should includes...(7)

Back 24

1)name
2)age
3)race
4)sex
5)marital status
6)city residence
7)occupation

Front 25

Components of pt history (7)

Back 25

1)CC
2)HPI
3)PMH
4)ROS
5)family history
6)personal and social history
7)identifiers (name, age, job, race, etc)

Front 26

CC? (2)

Back 26

1)what brought the pt in
2)use pts own words

Front 27

Big 8 of HPI

Back 27

1)body location
2)quality
3)quantity
4)chronology
5)setting
6)aggrevating factors
7)alleviating factors
8)associated manifestations

Front 28

Body location? (2) HPI

Back 28

1)actual location of problem
2)radiation to other areas

Front 29

Quality ex (4) HPI

Back 29

1)burning
2)stabbing
3)crushing
4)itchy

Front 30

Quantity (1 and 3ex) HPI

Back 30

1)amount of time since onset of problem
2)constant, intermittent, occasional

Front 31

Chronology (1) HPI

Back 31

1)order of how symptoms progressed

Front 32

Setting (1) HPI

Back 32

1)how and when symptoms started

Front 33

Associated Manifestations (1) HPI

Back 33

1)other symptoms related to the CC

Front 34

PMH consists of... (11)

Back 34

1)general health and strength
2)childhood illnesses
3)major illnesses
4)surgeries
5)accidents and injuries and resulting disability
6)obstetrical history
7)screening tests/lab work
8)immunizations
9)medical allergies
10)current medication
11)current treatment modalities

Front 35

Family History consists of.. (2)

Back 35

1)Ages and Health of close relatives
2)Family Disease Screening (include disease and age died at)

Front 36

Personal/Social History includes... (4 and 3ex of 3 and 4ex of 1)

Back 36

1)home environment (past/present/atmosphere)
2)social activities (educaion, work, military, religion, etc)
3)Marital-sexual (#, satisfacion, contraception)
4)Personal Habits (diet, sleep, smoking, etc)

Front 37

4 basic things of Physical exam

Back 37

1)inspection (see)
2)palpation (feel)
3)auscultation (hear)
4)percussion (hear when tapping on structures)

Front 38

Vital signs (6)

Back 38

1)ht
2)wt
3)temperature
4)pulse
5)respiration
6)BP

Front 39

Proper rectal temperature technique (3)

Back 39

1)cover tip w/ KY
2)insert into rectum 1in
3)leave in 2minutes

Front 40

Normal Temp Range for...
a)Axillary
b)Oral
c)Rectal
d)Tympanic

Back 40

a)97.9 to 100.4
b)95.9 to 99.5
c)94.5 to 99.1
d)96.4 to 100.4

Front 41

Age birth to 5yrs first and second choice of thermometer

Back 41

1st)rectal
2nd)axillary

Front 42

5yrs+ choice of thermometer

Back 42

1st)oral
2nd)axillary

Front 43

Normal pulse
Fast pulse
Slow pulse

Back 43

a)60-100
b)>100
c)<60

Front 44

How to check pulse

Back 44

compress radial artery w/ index and middle fingers just below thumb

Front 45

How to measure respirations and normal rate

Back 45

watch the respirations as "fake" checking pulse; do NOT announce you are checking respirations

14-20 respirations

Front 46

Single Head Stethoscope modes (2)

Back 46

1)Bell Mode for low frequency (use light contact on skin)
2)Diaphragm Mode for high frequency (use heavy contact on skin)

Front 47

Double Head Stethoscope modes (2)

Back 47

1)Bell Mode for low frequency use light contact on Bell Side
2)Diaphrage Mode for high frequency, turn chest piece over and apply heavy pressure

Front 48

Measuring BP (4)

Back 48

1)Pump cuff 30 above estimated systolic pressure
2)let pressure off gently (5 per second)
3)level at which you consistently hear beats is the systole
4)diastole is pressure where sounds disappear

Front 49

HTN BP levels but when does treatment begin

Back 49

140/90, but treatment begins at high-normal (130-139)/(85-89)

Front 50

Average pulse and BP in children pattern

Back 50

pulse decr over time and BP incr over time

Front 51

Things that cause hypovolemia that can cause orthostasis (4)

Back 51

1)diuretics
2)vasodilators
3)dehydration
4)prolonged bed rest

Front 52

BP cuff that is too big...
BP cuff that is too small...

Back 52

gives false lower BP
gives false high BP

Front 53

How to make sure BP cuff is right size
a)adults
b)kids

Back 53

a)1/3 to 1/2 the circumference of the limb
2)cover 2/3 of the upper arm or thigh

Front 54

Preload?

Back 54

passive filling of ventricles causing stretching of muscle wall

Front 55

Afterload?

Back 55

resistance heart pumps against

Front 56

Location of heart sounds
a)Aortic
b)Pulmonic
c)Tricuspid
d)Mitral

Back 56

1)2nd right ICS LSB (only one on right side of body)
2)2nd left ICS LSB
3)4th left ICS LSB
4)5th left ICS just medial to the MCL

Front 57

Heart sounds at...
a)Base
b)Apex

Back 57

a)Aortic and Pulmonic (upper chest)
b)Tricuspid and Mitral (lower chest)

Front 58

Heart sound 1 (S1) is... (3)

Back 58

1)closure of mitral and tricuspid valves
2)systole
3)ventricles contracting

Front 59

Where and how to best hear S1 (2)

Back 59

1)best w/ diaphragm
2)best in apex

Front 60

Heart sound 2 (S2) is... (3)

Back 60

1)closure of aortic and pulmonic valve
2)diastole
3)aortic contraction

Front 61

Where and how to best hear S2 (2)

Back 61

1)best w/ diaphragm
2)best @ base

Front 62

Listening to the APEX which is louder S1 or S2?

Back 62

S1

Front 63

Listening to the BASE which is louder S1 or S2?

Back 63

S2

Front 64

When S2 splits, how can it?

Back 64

b/c the sound is made up of 2 sounds; closure of aortic and pulmonic valve

Front 65

Physiologic S2 split (4)

Back 65

1)deep inspiration loads the right side of the heart
2)A-P split during inspiration
3)lub and split dub during inspiration
4)lub and dub during expiration

Front 66

Fixed S2 split (2)

Back 66

1)right bundle branch block or right ventricular failure delays emptying of RV
2)end up w/ A-P split in dub during inspiration and expiration

Front 67

Where will a Fixed S2 split be loudest?

Back 67

On right side of chest since the pulmonary is delayed not the aortic (aortic is only sound on right side of chest)

Front 68

Reversed S2 Split (2)

Back 68

1)left bundle branch block or left ventricular failure delays emptying of LV
2)end up w/ P-A split during dub in inspiration and expiration

Front 69

Where will a Reversed S2 split be loudest?

Back 69

left side of chest since the aortic is delayed

Front 70

Paradoxical S2 split (2)

Back 70

1)left bundle branch block or left ventricular failure delays emptying of the LV COMBINED w/ a physiologic split
2)end up w/ P-A split during dub in expiration

Front 71

Where will a Paradoxical S2 split be loudest?

Back 71

right side of chest during expiration

Front 72

a)What is S3
b)How to hear S3 (3)
c)Cause of S3 (2)

Back 72

a)rapid ventricular filling
b)LOW pitched, at APEX, use BELL
c)left ventricular failure or very healthy person

Front 73

Dilated Cardiomyopathy (3)

Back 73

1)muscle fibers have stretched
2)heart chamber enlarges
3)very low ejection fraction

Front 74

Hypertrophic Cardiomyopathy (2)

Back 74

1)growth and arrangement of muscle fibers are abnormal
2)heart walls thicken, esecially LV

Front 75

Restrictive Cardiomyopathy (2)

Back 75

1)ventricle walls stiffen and lose flexibility
2)INHERITED

Front 76

CHF consists of.... (3)

Back 76

1)dilated cardiomyopathy
2)hypertrophic cardiomyopathy
3)restrictive cardiomyopathy

Front 77

CHF symptoms (8)

Back 77

1)SOB
2)DOE
3)PND
4)orthopnea
5)peripheral edema
6)cough
7)weakness
8)fatigue

Front 78

SIGNS of CHF (10)

Back 78

1)JVD
2)LVH
3)incr BUN
4)tachycardia
5)gallop
6)rales/crackles
7)EF < 40%
8)wt gain
9)hepatomegaly
10)hepatojugular reflex

Front 79

a)What is S4?
b)What does S4 sound like? (3)
c)Cause of S4? (2)

Back 79

a)forceful atrial ejection into a dilated LV
b)LOW pitched, at APEX, use BELL
c)cardiomyopathy or young healthy person

Front 80

When do you hear S3 and S4

Back 80

S3 is immediately after S2
S4 is right before S1

Front 81

Gallop?

Back 81

When a person has S3 and S4

Front 82

a)Ejection Sound?
b)What it sound like?
c)where and how to hear it

Back 82

1)opening of a diseased AORTIC Valve
2)HIGH pitched snap on top of S1
3)use diaphragm on 2nd right ICS @ BASE

Front 83

a)Opening Snap?
b)What it sounds like?
c)where and how to hear it

Back 83

a)opening of a diseased MITRAL valve
b)HIGH pitched snap on top of S2
c)use diaphragm on 4th ICS @ apex

Front 84

a)Click?
b)what does click sound like?
c)how to hear click

Back 84

a)prolapse of the MITRAL valve
b)HIGH pitched click b/w S1 and S2
c)use diaphrage on 4th ICS

Front 85

Murmurs (2)

Back 85

1)stenosis
2)regurgitation

Front 86

Stenosis? (2)

Back 86

2)occurs when blood normally flows across a valve in normal direction
3)MED-LOW pitch

Front 87

Regurgitation (2)

Back 87

2)when blood flows backward against a valve
3)HIGH pitch

Front 88

Assessing Murmurs*** (4)

Back 88

1)systolic/diastolic
2)determine pitch to tell if it is stenosis or regurgitation
3)location (aortic, pulmonic, tricuspid, mitral)
4)special characteristics

Front 89

Diastole

Back 89

Blood fills chamers, no moving across valves

Front 90

Systole

Back 90

Heart beats and moves blood across chambers

Front 91

Describing murmurs (6)

Back 91

1)timing (early, mid, late systole or diastole)
2)location of maximal intensity
3)radiation or transmission from point of max intensity
4)intensity
5)pitch (high, medium, low)
6)quality (blowing, rumbling, harsh, or musical)

Front 92

Grade of Murmurs 1-6

Back 92

1)very faint; only know its there after listener has tuned in
2)quiet but heard upon placing stethoscope on chest
3)moderately loud
4)loud, use side of stethoscope
5)very loud, stethoscope near chest
6)do NOT need stethoscope

Front 93

Mitral valve fxn

Back 93

separates LA from LV

Front 94

Aortic valve fxn

Back 94

separates LV from aorta/body

Front 95

Pulmonary valve fxn

Back 95

RV to body

Front 96

Tricuspid valve fxn

Back 96

RA to RV

Front 97

Systole blood flow

Back 97

LV to body thru aortic valve
RV to body thru pulmonary valve

Front 98

Diastole blood flow

Back 98

RA to RV thru tricuspid valve
LA to LV thru mitral valve