NR 509: Advanced Physical Assessment Examination

NR 509: Advanced Physical Assessment Examination: NR 509 Week 1 Quiz: Questions & Answers 

NR 509: Advanced Physical Assessment Examination:

NR 509 Week 1 Assignments

NR 509 Week 1 Shadow Health History Assignment Completed

Pre-brief

Obtaining an accurate history is the critical first step in determining the etiology of a patient’s problem. A large percentage of the time, you will actually be able to make a diagnosis based on the history alone. The value of the history, of course, will depend on your ability to elicit relevant information. Your sense of what constitutes important data will grow exponentially as you practice your interviewing skills and through increased exposure to patients and illness…………………… Interviewing patients is an art and should remain an essential skill for successful practice.

In this activity, you will interview Tina Jones to collect data to assess Ms. Jones’ condition. You will also have the opportunity to educate and empathize with Tina to engage in effective therapeutic communication; create a problem listusing evidence from the data you collected; prioritize the identified problems to differentiate immediate from non-immediate care; plan how to best address the most important concern with further assessment, interventions, and patient education; and compare your documentation to model documentation.

Ms. Jones is a pleasant, 28-year-old obese African American single woman who presents to establish care and with a recent right foot injury. She is the primary source of the history. Ms. Jones offers information freely and without contradiction. Her speech is clear and coherent and she maintains eye contact throughout the interview.

Reason for visit: Patient presents for an initial primary care visit today complaining of an infected foot wound.

• | Overview
• | Transcript
• | Subjective Data Collection
• | Objective Data Collection
• | Education & Empathy
• | Documentation / Electronic Health Record
• | Information Processing
• | Lab Pass: Certificate of Completion

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NR 509 Week 1 Shadow Health: Conversation Concept Lab

NR 509 Week 1 Assignment Shadow Health Digital Clinical Experience DCE Orientation Spring 2018

NR 509 Week 1 Quiz Questions and Answers

A patient tells the FNP that he is very nervous, that he is nauseated, and that he “feels hot”. This type of data would be:

2.     The patient’s record, laboratory studies, objective data, and subjective data combine to form the:

3.     The FNP is reviewing information about evidence-based practice. Which statement best reflects evidence-based practice?

4.     A 59-year-old patient tells the FNP that he has ulcerative colitis. He has been having black stools for the last 24 hours. How would the FNP best document his reason for seeking care?

5.     A 29-year-old woman tells the FNP that she has excruciating pain in her back. Which would be an appropriate response by the FNP to the woman statement?

6.     In recording the childhood illnesses of a patient who denies having had any, which note by the FNP would be most accurate? 7.      If a female patient tells the FNP that she has had six pregnancies, with four live births at term and two spontaneous abortions. Her four children are still living. How would the FNP record this information?

8.     If a female patient tells the FNP that she has had six pregnancies, with four live births at term and two spontaneous abortions. Her four children are still living. How would the FNP record this information?

9.     Which of these statements represents subjective data the FNP obtained from the patient regarding the patient’s skin?

10.  The FNP is obtaining a history for a 30-year-old male patient and is concerned about health promotion activities. Which of these questions would be appropriate to use to assess health promotion activities for this patient?

11.  Which statement indicates that the FNP understands the pain experienced by an elderly person?

12.  The FNP is performing a vision examination. Which of these charts is most widely used for visual examination?

13.  During a complete health assessment, how would the FNP test the patients hearing?

14.  The FNP has just completed an examination of a patient’s extra-ocular muscles. When documenting the findings, the FNP should document the assessment of which cranial nerves?

15.  A patient’s uvula rises midline when she says “ahh” and she has a positive gag reflex. The FNP has just tested which cranial nerve?

16.  During an examination the FNP notices that a patient is unable to stick out his tongue. Which cranial nerve is involved with successful performance of this action?

17.  A patient is unable to shrug her shoulders against the FNP‘s resistant hands. What cranial nerve is involved with successful shoulder shrugging?

18.  During an examination, the patient has just successfully completed the finger to nose and rapid alternating movements test and is able to run each heel down the opposite shin. The FNP would conclude that the patient’s___ function is intact

19.  A five-year-old child is in the clinic for checkup. The FNP would expect him to:

20.  When the FNP performs the confrontation test the FNP has assessed:

21.  Which of these statements is true regarding the complete physical assessment?

22.  Which of these statements is true regarding recording of data from the history and physical examination?

23.  Which of these is included in assessment of general appearance?

24.  The FNP is performing a review of symptoms. Which of these questions are appropriate as Health promotion questions to ask during this time?

25.  The FNP is incorporating a person’s spiritual values into the health history. Which of these questions illustrates the community portion of the FICA questions?

26.  The FNP is preparing to complete a health assessment on a 16-year-old girl whose parents have brought her to the clinic. Which instruction would be appropriate for the parents before the interview begins?

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 NR 509 Week 2 Shadow Health Respiratory Physical Assessment Spring 2018

Pre Brief
Tina had an asthma episode 2 days ago. At that time she used her albuterol inhaler and her symptoms decreased although they did not completely resolve. Since that incident she notes that she has had ten episodes of wheezing and has shortness of breath approximately every four hours. Tina presents with continued shortness of breath and wheezing. Be sure to ask pertinent questions during the interview about related body systems. This case study will provide the opportunity to carefully assess lung sounds during the physical examination. Be sure to appropriately document your findings using correct medical terminology.

Reason for visit: Patient presents complaining of a recent asthma episode that is not fully resolved.

• | Overview
  | Transcript
  | Subjective Data Collection
  | Objective Data Collection
  | Education & Empathy
  | Documentation / Electronic Health Record
  | Student Pre-Survey
  | Lifespan Activity
  | Review Questions
  | Self-Reflection Activity

 NR 509 Week 2 Alternate Writing Assignment: Respiratory Summer 2018

Purpose

As a family nurse practitioner, you must possess excellent physical assessment skills. This alternative writing assignment mirrors the discussion content of the debriefing session and will allow the student to expand their knowledge of physical health assessment principles specific to the advanced practice role.

Course Outcomes

This assignment is guided by the following Course Outcomes (COs):

1. Apply advanced practice nursing knowledge to collecting health history information and physical examination findings for various patient populations. (PO 1, 2)
2. Differentiate normal and abnormal health history and physical examination findings. (PO 1, 2)
3. Adapt health history and physical examination skills to the developmental, gender-related, age-specific, and special population needs of the individual patient. (PO 1, 2)

The purposes of this assignment are to: (a) identify and articulate advanced assessment health history and physical examination techniques which are relevant to a focused body system (CO 1), (b) differentiate normal and abnormal findings with regard to a disease or condition that impacts the body system (CO 2), and (c) adapt advanced assessment skills if necessary to suit the needs of specific patient populations (CO 4).

NOTE: You are to complete this alternative writing assignment ONLY if you had not participated or do not plan to participate in a debriefing session for the given week.

Due Date: This alternative written assignment is due no later than the Sunday of the week in which you did not attend the weekly debriefing session. The standard MSN Participation Late Assignment policy applies to this assignment.

Preparing the Paper:

1. Select a focused body system from the weekly lesson which corresponds with the week of the written assignment.
2. Carefully read and review the selected body system in your course textbooks.
3. Incorporate at least onescholarly peer-reviewed journal article that relates to the body system. It may be useful to identify an article that relates to a disease that impacts the body system.
4. The paper must clearly articulate the relevance of advanced physical assessment skills, techniques, application of advanced practice knowledge, and assessment modification (when necessary) to accommodate for specific patient populations.
5. Provide concluding statements that should summarize key points of the overall assignment content.
6. In-text citations and reference page(s) must be written using proper APA format (6thedition).

NR 509 Week 2 Shadow Health HEENT Physical Assessment Assignment Summer 2018

Pre-Brief
For the last week, Tina has experienced sore, itchy throat, itchy eyes, and runny nose. She states that these symptoms started spontaneously and have been constant in nature. … has treated her throat pain with occasional throat lozenges which has “helped a little”. She states that her nose “runs all day” and has clear discharge. … denies cough and recent illness. … denies fevers, chills, and night sweats. This case study will allow you to use standard office equipment to physically examine the patient’s eyes, ears, nose, and throat. You will need to document what you find in the Electronic Health Record (EHR). Be certain to use medically appropriate terminology, such as “erythematous” to describe redness of the skin, mucous membranes, or conjunctiva.

• | Overview
  | Subjective Data Collection
  | Objective Data Collection
  | Education & Empathy
  | Documentation / Electronic Health Record
  | Lifespan
  | Review Questions
  | Self-Reflection

NR 509 Week 2 Quiz

1. A mother brings her two month old daughter in for an examination says “my daughter rolled over against the wall and now I have noticed that she has the spot soft on the top of her head, is there something terribly wrong?” The FNP‘s best response would be:
2. During percussion the FNP knows that a dull percussion note elicited over a lung lobe. This most likely results from:
3. The patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The FNP suspects Damage to:
4. When examining the face, the FNP is aware that the two pairs of salivary gland‘s that are accessible to examination are the _____ glands
5. A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination by____
6. When examining a patient’s cranial nerve function, the FNP remembers that the muscles in the neck that are innervated by CN XI are the:
7. The patient’s laboratory data reveal an elevated thyroxine level. The FNP would proceed with an examination of the _____ gland
8. A patient says that she has recently noticed a lump in the front of her neck below her “Adams apple” that seems to be getting bigger. During the assessment, the finding that leaves the FNP to suspect that this may not be a cancerous thyroid nodule is that the lump:
9. The FNP notices that the patient’s submental lymph nodes are enlarged. In an effort to identify the cause of the node enlargement, the FNP would assess the patient’s:
10. The FNP is aware that the four areas in the body were lymph nodes accessible are the:
11. A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his eyes. The FNP should know that floaters are usually not significant and are caused by:
12. The FNP is preparing to assess the visual acuity of a 16-year-old patient. How should the FNP proceed?
13. A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. The FNP interprets these results to indicate that:
14. A patient is unable to read even the largest letters on the Snellen chart. The FNP should take which action next:
15. A patient’s vision is reported as 20/80 in each eye. The FNP interprets this finding to mean that
16. When performing the corneal light reflex assessment, the FNP notes that the light is reflected at 2 o’clock in each eye. The FNP should
17. The FNP is performing the diagnostic positions test. Normal findings would be which of these results?
18. During an assessment of the sclera of an African-American patient, the FNP would consider which of these an expected finding?
19. A 60-year-old man is at the clinic for an examination. The FNP suspects that he has ptosis of one eye. How should the FNP check for this?
20. The FNP is doing an assessment on a 21-year-old patient and notices that his nasal mucosa appears pale gray and swollen. What would be the most appropriate question to ask the patient?
21. The FNP is palpating the sinus areas. If the findings are normal, then the patient should report which sensation?
22. During an oral assessment of a 30-year-old African-American patient, the FNP notices bluish lips and a dark line along the gingival margin. What would the FNP do in response to these findings
23. During an assessment of a 20-year-old patient with a three day history of nausea and vomiting the FNP notices dry mucous and deep vertical fissures on the tongue. These findings are reflective of:
24. The FNP is reviewing the technique of palpating for tactile fremitus with a new graduate. Which statement by the graduate FNP reflects a correct understanding of tactile fremitus?
25. The FNP student is reviewing physical assessment findings of the HEENT system associated with pregnancy. Which statement by the graduate FNP reflects a correct understanding of expected HEENT changes associated with pregnancy? During pregnancy:

NR 509 Week 2 Quiz Review – (Jarvis 8,9,13,14,15,16,18), (Swartz 4,6,7,8,9,10)

1.       What does dullness when percussing lung fields: Jarvis pg 427

2.       Facial sensation controlled by which CN: Jarvis 283,

3.       Know what two salivary glands are accessible during exam

4.       What CN is being … when pt shrugs shoulders Jarvis 646

5.       What muscles are being …. when …. CN 11 (spinal accessory nerve)

6.       Concern for malignant nodules versus benign lymph nodule

7.       Know what you’d do next if you palpated a submental lymph node: Jarvis pg 253

8.       Define visual acuity

9.       Know what to do if your patient can’t read the largest number on the Snellen chart: Jarvis 289

10.   Example of good visual acuity : Jarvis 289

11.   Example of poor visual acuity: Jarvis 289

12.   What is …. with corneal light reflex-

13.   Know normal variances of sclera : Jarvis 283

14.   Know how to check for Ptosis: Jarvis 292

15.   What does ptosis indicate: Jarvis 292

16.   Nasal fissure of pt with chronic allergies : Jarvis 271

·         Acute allergies : Jarvis p 363 .

17.   What is an abnormal palpation of sinuses: Jarvis 362

·         Normal palpation of sinuses

18.   Know normal variations in gingival margin

19.   Know what a dehydrated oral cavity will look like: Jarvis 387

20.   What is tactile fremitus, how do you test for it and what does it indicate. Jarvis 425

NR 509 Week 3 Alternate Writing Assignment Neurological System Summer 2018

Purpose

As a family nurse practitioner, you must possess excellent physical assessment skills. This alternative writing assignment mirrors the discussion content of the debriefing session and will allow the student to expand their knowledge of physical health assessment principles specific to the advanced practice role.

The purposes of this assignment are to: (a) identify and articulate advanced assessment health history and physical examination techniques which are relevant to a focused body system (CO 1), (b) differentiate normal and abnormal findings with regard to a disease or condition that impacts the body system (CO 2), and (c) adapt advanced assessment skills if necessary to suit the needs of specific patient populations (CO 4).

NOTE: Complete this alternative writing assignment ONLY if you had not participated or do not plan to participate in a debriefing session for the given week.

Due Date: Alternative written assignment is due no later than the Sunday of the week in which you did not attend the weekly debriefing session.

Preparing the Paper:

1. Select a focused body system from the weekly lesson which corresponds with the week of the written assignment.
2. Carefully read and review the selected body system in your course textbooks.
3. Incorporate at least onescholarly peer-reviewed journal article that relates to the body system. It may be useful to identify an article that relates to a disease that impacts the body system.
4. The paper must clearly articulate the relevance of advanced physical assessment skills, techniques, application of advanced practice knowledge, and assessment modification (when necessary) to accommodate for specific patient populations.
5. Provide concluding statements that should summarize key points of the overall assignment content.
6. In-text citations and reference page(s) must be written using proper APA format (6thedition).

 NR 509 Week 3 Shadow Health Assessment Musculoskeletal Spring 2018

Subjective:

HPI: Ms. Jones presents to the clinic complaining of back pain that began 3 days ago after she “tweaked it” while lifting a heavy box while helping a friend move. She states that lifted several boxes before this event without incident and does……………………………… She presents today as the pain has continued and is interfering with her activities of daily living.

Social History: Ms. Jones’ job is mostly supervisory, although she does report that she may have to sit or stand for extended periods of time……………. use of tobacco, alcohol, and illicit drugs. She does not exercise.

ROS: General: Denies changes in weight, fatigue, weakness, fever, chills, and night sweats. •

Musculoskeletal: Denies muscle weakness, pain, joint instability, or swelling. She does state that she has difficulties with range of motion…… lower back has impacted her comfort while sleeping and sitting in class…….. numbness, tingling, radiation, or bowel/bladder dysfunction. She denies previous musculoskeletal injuries or fractures. •

Neurologic: Denies loss of sensation, numbness, tingling, tremors, weakness, paralysis, fainting, blackouts, or seizures.

Objective:

ROS: General: Ms. Jones is a pleasant, obese 28-year-old African American woman in no acute distress. She is alert and oriented. She maintains eye contact throughout interview and examination.

Musculoskeletal: Bilateral upper extremities without muscle atrophy or joint deformity. Bilateral upper extremities with full range of motion of shoulder, elbow, and wrist……………….. upper extremity strength equal and 5/5 in neck, shoulders, elbows, wrists, hands. Bilateral lower extremity strength equal and 5/5 in hip flexors, knees, and ankles.

ASSESSMENT: Low back muscle strain related to lifting

• | Overview 
  | Transcript
  | Subjective Data Collection 
  | Objective Data Collection 
  | Education & Empathy 
  | Documentation
  | Lifespan
  | Review Questions
  | Self-Reflection

NR 509 Week 3 Shadow Health Neurological Physical Assignment Completed

Pre Brief

Two days after a minor, low-speed car accident in which Tina was a passenger, she noticed daily bilateral headaches along with neck stiffness. She reports that it hurts to move her neck, and she believes her neck might … swollen. She did not lose consciousness in the accident and denies changes in level of consciousness since that time. … that she gets a headache every day that lasts approximately 1-2 hours. … occasionally takes 650 mg of over the counter Tylenol with relief of the pain. This case study will allow you the opportunity to examine the patient’s optic nerve via use of the ophthalmoscope as well as assess her visual acuity. You will need to document your findings using appropriate medical terminology. Be sure to assess for foot neuropathy using the monofilament test. Reason for visit: Patient presents complaining of headache.NR 509 Neurological Results | Transcript

• Interview Questions (113)

NR 509 Neurological Results | Subjective Data Collection: 18 of 20 (90.0%)

NR-509 Neurological Results | Objective Data Collection: 36.75 of 37 (99.32%)

NR 509 Neurological Results | Education & Empathy: 4 of 4 (100.0%)

1. Symptoms
2. Cause of Injury
3. Medications
4. Vision

NR 509 Neurological Results | Documentation / Electronic Health Record

NR 509 Neurological Results | Pre-Survey Lifespan

1. Tina’s three-year-old neighbor presents to the clinic with fever, neck pain, headache, and confusion. He has no symptoms of an upper respiratory infection. The parents mention that they do not believe in immunizations. Based on the information given, what diagnosis is of the greatest concern? What is your next action?
2. Tina’s 83-year-old great uncle forgets where he is during his yearly check-up. He doesn’t remember if he’s had memory problems before and no family members came to your office with him. List your differential diagnosis. What assessments would you perform?

NR 509 Neurological Results | Review Questions

1. To assess spinal levels L2, L3 and L4 in Tina, which deep tendon reflexes would have to be tested?
2. Imagine that you were preparing to irrigate a Foley catheter of a patient with a spinal cord injury at T4 in a urology clinic. Upon moving the leg bag, the patient became suddenly flushed and diaphoretic above the nipple line. What would you suspect was happening?
3. Which of the following is not a common symptom of Parkinson’s disease?
4. Name at least three ways to assess cerebellar function during a physical exam.
5. If Tina had a fever and photophobia, you would have had to test for meningitis. Describe how you would have tested for the Kernig’s sign
6. Suppose you assessed pain sensation over Tina’s left foot, and noticed that she had decreased sensation. How would you have proceeded with your exam?

NR 509 Neurological Results | Self-Reflection

1. Explicitly describe the tasks you undertook to complete this exam.
2. Explain the clinical reasoning behind your decisions and tasks.
3. Identify how your performance could be improved and how you can apply “lessons learned” within the assignment to your professional practice.

NR 509 Week 4 Quiz Advanced Physical Assessment Chamberlain 2018

1.       A 35-year-old man is seen in the clinic for an infection in his left foot. Which of these findings should the FNP expect to see during an assessment of this patient?

2.       The direction of blood flow through the heart is best described by which of these

3.       In assessing the carotid artery’s of an older patient with cardiovascular disease, the FNP would

4.       When listening to heart sounds the FNP knows that the valve closures that can be heard best at the base of the heart are

5.       The sack that surrounds and protects the heart is called the

6.       When assessing a newborn infant who is five minutes old the FNP knows that which of these statements would be true?

7.       The FNP is performing an assessment on an adult. The adults vital signs are normal and capillary refill is five seconds. What should the FNP do next?

8.       During an assessment of an older adult the FNP should expect to notice which finding as normal physiologic change associated with aging process?

9.    &n