NUR643E Advanced Health Assessment for Nurse Educators
Week 1 Discussion
DQ1 You are
working with a nursing student who is introducing herself to a Native American
patient to establish rapport. The nursing student is trying to make eye contact
and puts her hand on the shoulder of the patient to get his attention. What
situation could arise with this approach?
How would you handle this situation? Defend rationale with references.
DQ2 While
completing a health assessment, you notice that there are indications that the
patient may have been cutting herself. You inquire about the marks and she
indicates that she scratched her wrist when she tried to break her fall. How do
you handle this information? How can you incorporate your Christian worldview
to help in providing quality care? What are the key elements to accurately
obtaining the needed information for effective treatment?
NUR643E Advanced Health Assessment for Nurse Educators
Week 2 Discussion
DQ1 As an
instructor, you are working with a nursing student in the second year of a
4-year nursing program. The student does not perform an ear exam correctly. How
would you explain the appropriate technique to examine the ears?
DQ2 You are
working the triage desk of the ED. A client presents with sudden loss of vision
of the right eye after a head collision during a volleyball game. What would
your assessment include? What could be initial problems and would they warrant
emergent intervention?
NUR643E Advanced Health Assessment for Nurse Educators
Week 3 Discussion
DQ1 Select
one pulmonary, cardiac, peripheral vascular, or lymphatic system disorder.
Discuss the clinical characteristics and identify the appropriate laboratory,
imaging, and other diagnostic and screening tools that apply to this disorder.
Explain why these tests or tools were chosen as appropriate to the conditions.
Select different topics from that of your classmates.
DQ2 You are
called to the bedside of a critical patient as a rapid response team member.
Upon initial inspection the patient is cyanotic, has labored breathing, and is
not responding well. Develop an SBAR (situation, background, assessment,
recommendation) for this patient. Use references to substantiate your approach
to this clinical scenario.
NUR643E Advanced Health Assessment for Nurse Educators
Week 4 Discussion
DQ1 As an
instructor, you are working with a nursing student to develop a problem-focused
exam involving the musculoskeletal system and extremities. Formulate potential questions to support the
student in soliciting specific information about the patient related to past
history, drugs that may adversely affect the musculoskeletal system, family
history, psychosocial profile, and provide rationale.
DQ2 The
goal of a complete musculoskeletal assessment is to detect risk factors,
potential problems, or musculoskeletal dysfunction early and then to plan appropriate
interventions, including teaching health promotion and disease prevention, and
implementing treatment measures. By doing so, you can play a signi?cant role in
preventing pain and dysfunction in your patients. Describe a plan to provide patient teaching
that incorporates health promotion and disease prevention. Provide rationale.
NUR643E Advanced Health Assessment for Nurse Educators
Week 5 Discussion
DQ1 Differentiate
between the appearances of skin lesions in relation to cancerous versus noncancerous.
DQ2 A
patient presents with abdominal discomfort to the point of being in the fetal
position. What questions need to be asked of this patient? What examination
techniques would you perform for this patient?
NUR643E Advanced Health Assessment for Nurse Educators
Week 6 Discussion
DQ1 A
patient is experiencing delirium after the initiation of a new medication. What
are questions you want answered as well as physical findings would you be
looking for?
DQ2 Choose
a special population and detail the approach to history taking and physical
examination with the patient and/or family member.
NUR643E Advanced Health Assessment for Nurse Educators
Week 7 Discussion
DQ1 A
patient presents with heaviness in their chest and diaphoretic. What steps will
you take in providing a proper assessment?
DQ2A patient
calls out on the call system and requests pain medication. We know that a
patient is to rate their pain on a scale. If the pain is unrelated to the
admission diagnosis, what steps will you take in providing a proper assessment?
NUR643E Advanced Health Assessment for Nurse Educators
Week 8 Discussion
DQ1 You
walk into a patient's room and find him unconscious because he does not greet
you when you walk in. What are some of your initial assessment techniques that
need to be employed and why?
DQ2 You
just reviewed the morning laboratory report for a patient in critical care. You
noted that the potassium level is 6.5 mEq/L. What are areas you need to be
assessing the patient to monitor for complications from hyperkalemia? Explain
your approach in a head to toe assessment.
NUR643E Advanced Health Assessment for Nurse Educators
Week 1 Assignment
Health
Assessment Topic Reflection 1
Complete a
250?word reflection of what you learned during this topic. Include the
following in your reflection:
Think about
an experience you've encountered when viewing or completing the particular
assessment.
Discuss
difficulties that could potentially arise or specific questions related to completing
this type of assessment.
Include
illustrative examples of potential strategies used to overcome the difficulties
encountered when completing (the particular) assessment.
Describe
how the Christian worldview and compassion for all plays a role in this type of
assessment.
APA style
is not required, but solid academic writing is expected.
This
assignment uses a rubric. Please review the rubric prior to beginning the
assignment to become familiar with the expectations for successful completion.
You are not
required to submit this assignment to LopesWrite.
NUR643E Advanced Health Assessment for Nurse Educators
Week 2 Assignment
Health
Assessment Topic Reflection 2
Complete a
250?word reflection of what you have learned during this topic. Include the
following in your reflection:
Think about
an experience you've encountered when viewing or completing the particular
assessment.
Discuss
difficulties that could potentially arise or specific questions related to
completing this type of assessment.
Include
illustrative examples of potential strategies used to overcome the difficulties
encountered when completing (the particular) assessment.
Describe
how the Christian worldview and compassion for all plays a role in this type of
assessment.
APA style
is not required, but solid academic writing is expected.
This
assignment uses a rubric. Please review the rubric prior to beginning the
assignment to become familiar with the expectations for successful completion.
You are not
required to submit this assignment to LopesWrite.
NUR643E Advanced Health Assessment for Nurse Educators
Week 3 Assignment
Health
Assessment Topic Reflection 3
Complete a
250?word reflection of what you have learned during this topic. Include the
following in your reflection:
Think about
an experience you've encountered when viewing or completing the particular
assessment.
Discuss
difficulties that could potentially arise or specific questions related to
completing this type of assessment.
Include
illustrative examples of potential strategies used to overcome the difficulties
encountered when completing (the particular) assessment.
Describe
how the Christian worldview and compassion for all plays a role in this type of
assessment.
APA style
is not required, but solid academic writing is expected.
This
assignment uses a rubric. Please review the rubric prior to beginning the
assignment to become familiar with the expectations for successful completion.
You are not
required to submit this assignment to LopesWrite.
NUR643E Advanced Health Assessment for Nurse Educators
Week 4 Assignment
Health
Assessment Topic Reflection 4
Complete a
250?word reflection of what you have learned during this topic. Include the
following in your reflection:
Think about
an experience you've encountered when viewing or completing the particular
assessment.
Discuss
difficulties that could potentially arise or specific questions related to
completing this type of assessment.
Include
illustrative examples of potential strategies used to overcome the difficulties
encountered when completing (the particular) assessment.
Describe
how the Christian worldview and compassion for all plays a role in this type of
assessment.
APA style
is not required, but solid academic writing is expected.
This
assignment uses a rubric. Please review the rubric prior to beginning the
assignment to become familiar with the expectations for successful completion.
You are not
required to submit this assignment to LopesWrite.
NUR643E Advanced Health Assessment for Nurse Educators
Week 5 Assignment
Health
Assessment Topic Reflection 5
Complete a
250?word reflection of what you have learned during this topic. Include the
following in your reflection:
Think about
an experience you've encountered when viewing or completing the particular
assessment.
Discuss
difficulties that could potentially arise or specific questions related to
completing this type of assessment.
Include
illustrative examples of potential strategies used to overcome the difficulties
encountered when completing (the particular) assessment.
Describe
how the Christian worldview and compassion for all plays a role in this type of
assessment.
APA style
is not required, but solid academic writing is expected.
This
assignment uses a rubric. Please review the rubric prior to beginning the
assignment to become familiar with the expectations for successful completion.
You are not
required to submit this assignment to LopesWrite.
NUR643E Advanced Health Assessment for Nurse Educators
Week 2 Assignment
SBAR
Choose an
experience from your nursing practice. Using the "SBAR" template,
explain the situation in detail, followed with background information. Then
explain your immediate assessment and recommendations you have for the
provider.
Include the
following in the "SBAR" template:
Be sure to
include three or four evidence?based references, not older than 5 years.
When giving
your recommendation discuss how you would educate the client using
evidence?based research and guidelines. How would you deliver your
recommendation in various learning environments?
APA style
is not required, but solid academic writing is expected.
This
assignment uses a rubric. Please review the rubric prior to beginning the
assignment to become familiar with the expectations for successful completion.
You are not
required to submit this assignment to LopesWrite.
NUR643E Advanced Health Assessment for Nurse Educators
Week 2 Quiz
•Which of
the following changes are expected in vision as part of the normal aging
process?
•Cataracts
•Glaucoma
•Macular
Degeneration
•Blurring
of near vision
•A light is
pointed at a patient's pupil, which contracts. It is also noted that the other
pupil contracts as well, though it is not exposed to bright light. Which of the
following terms describes this latter phenomenon?
•Direct
reaction
•Consensual
reaction
•Near
reaction
•Accommodation
•A patient
complains of knee pain on your arrival in the room. What should your first sentence
be after greeting the patient?
•How much
pain are you having?
•Have you
injured this knee in the past?
•When did
this first occur?
•Could you
please describe what happened?
•Mrs. T.
presents for her regular visit to the clinic. She is on your schedule because
her regular provider is on vacation and she wanted to be seen. You have heard
about her many times from your colleague and are aware that she is a very
talkative person. Which of the following is a helpful technique to improve the
quality of the interview for both the provider and the patient?
•Allow the
patient to speak uninterrupted for the duration of the appointment.
•Briefly
summarize what you heard from the patient in the first 5 minutes and then try
to have her focus on one aspect of what she told you.
•Set the
time limit at the beginning of the interview and stick with it, no matter what
occurs in the course of the interview.
•Allow your
impatience to show so that the patient picks up on your nonverbal cue that the
appointment needs to end.
•The
following information is recorded in the health history: “The patient has had
abdominal pain for 1 week. The pain lasts for 30 minutes at a time; it comes
and goes. The severity is 7 to 9 on a scale of 1 to 10. It is accompanied by
nausea and vomiting. It is located in the mid-epigastric area.” To which of
these categories does it belong?
•Chief
complaint
•Present
illness
•Personal
and social history
• Review of
systems
•Is the
following information subjective or objective?
Mr. M. has
a respiratory rate of 32 and a pulse rate of 120.
•Subjective
•Objective
•A patient
is assigned a visual acuity of 20/100 in her left eye. Which of the following
is true?
•She
obtains a 20% correct score at 100 feet.
•She can
accurately name 20% of the letters at 20 feet.
•She can
see at 20 feet what a normal person could see at 100 feet.
•She can
see at 100 feet what a normal person could see at 20 feet.
•Ms.
Whiting is a 68-year-old who presents in for her usual follow-up visit. You
notice a few flat, red, and purple lesions, about 6 centimeters in diameter, on
the ulnar aspect of her forearms but nowhere else. She doesn't mention them.
They are tender when you examine them. What should you do?
•Conclude
that these are lesions she has had for a long time.
•Wait for
her to mention them before asking further questions.
•Ask how
she acquired them.
•Conduct
the visit as usual for the patient.
•Mrs. R. is
a 92-year-old retired teacher who presents to your clinic accompanied by her
daughter. You ask Mrs. R. why she came to your clinic today. She looks at her
daughter and doesn't say anything in response to your question. This is an
example of which type of challenging patient?
•Talkative
patient
•Angry
patient
•Silent
patient
•Hearing-impaired
patient
•You have
just asked a patient how he feels about his emphysema. He becomes silent, folds
his arms across his chest, leans back in his chair, and then replies, “It is
what it is.” How should you respond?
• “You seem
bothered by this question.”
• “Next, I
would like to talk with you about your smoking habit.”
•“Okay,
let's move on to your other problems.”
• “You have
adopted a practical attitude toward your problem.”
NUR643E Advanced Health Assessment for Nurse Educators
Week 5 Midterm Quiz
• Adam is a very successful 15-year-old
student and athlete. His mother brings him in today because he no longer
studies, works out, or sees his friends. This has gone on for a month and a
half. When you speak with him alone in the room, he states it “would be better
if I was not here.” What would you do next?
•Tell him
that he has a very promising career in anything he chooses and soon he will
feel better.
•Tell him
that he needs an antidepressant and it will take about 4 weeks to work.
•Speak with
his mother about getting him together more with his friends.
•Assess his
suicide risk.
•Mr. Chin
is an 82-year-old man who presents to your office for a routine check. On
examination, you notice a somewhat high-pitched murmur in the second right
intercostal space during systole. It does not radiate and the rest of his
examination is normal for his age. Which is true of the most likely cause of
this murmur?
•It often
increases carotid upstroke.
•It carries
with it increased risk for cardiovascular disease.
•It is
usually accompanied by an S3 gallop.
•It is
found in 10% of otherwise normal elderly patients.
•Mrs.
Fletcher complains of numbness of her right hand. On examination, sensation of
the volar aspect of the web of the thumb and index finger and the pulp of the
middle finger are normal. The pulp of the index finger has decreased sensation.
Which of the following is affected?
•Median
nerve
•Ulnar
nerve
•Radial
nerve
•You are
assessing a patient for peripheral vascular disease in the arms, secondary to a
complaint of increased weakness and a history of coronary artery disease and
diabetes. You assess the brachial and radial pulses and note that they are
bounding. What does that translate to on a scale of 0 to 3?
•0
•3+
•2+
•1+
•A
70-year-old retired auto mechanic presents to your office because his neighbor
is concerned about his memory. The patient himself admits to misplacing his
keys more often and forgets what he is supposed to buy from the grocery store
and where he has parked the car. He denies getting lost in familiar places.
Upon further questioning, he states that his wife of 40 years died 8 months
ago; his three children live in three different states; and he has limited his
activities because the people he interacted with were “his wife's friends, not
his.” He drinks a six-pack of beer daily; he does not smoke or use illicit
drugs. You perform a mini-mental state examination and obtain a total score of
24 out of 28. Based on this information, what is the most likely condition?
•Benign
forgetfulness
•Dementia
•Meningitis
•Depression
•You are screening
people at the mall as part of a health fair. The first person who presents for
screening has a blood pressure of 132/85. How would you categorize this?
•Normal
•Prehypertension
•Stage 1
hypertension
•Stage 2
hypertension
•A
17-year-old high school senior presents to your clinic in acute respiratory
distress. Between shallow breaths, he states he was at home finishing his
homework when he suddenly began having right-sided chest pain and severe
shortness of breath. He denies any recent traumas or illnesses. His past
medical history is unremarkable. He doesn't smoke but drinks several beers on
the weekend. He has tried marijuana several times but denies any other illegal
drugs. He is an honors student and is on the basketball team. His parents are both
in good health. He denies any recent weight gain, weight loss, fever, or night
sweats. On examination you see a tall, thin young man in obvious distress. He
is diaphoretic and is breathing at a rate of 35 breaths per minute. On
auscultation, you hear no breath sounds on the right side of his superior chest
wall. On percussion, he is hyperresonant over the right upper lobe. With
palpation, he has absent fremitus over the right upper lobe.
What
disorder of the thorax or lung best describes his symptoms?
•Spontaneous
pneumothorax
•Chronic
obstructive pulmonary disease (COPD)
•Asthma
•Pneumonia
•When
assessing the lung fields, what does the technique of percussion look for?
•Consolidation
•Rales
•Wheezing
•Rhonchi
•Which of
the following events occurs at the start of diastole?
•Closure of
the tricuspid valve
•Opening of
the pulmonic valve
•Closure of
the aortic valve
•Production
of the first heart sound (S1)
•A pregnant
woman finally presents in for her prenatal checkup. She complains today of
headache and abdominal pain of several months' duration. She appears somewhat
hurried or nervous. What question would you ask next?
•Do you
have a family history of thyroid disease?
•Have you
been eating properly and taking a prenatal vitamin?
•Do you
feel safe at home?
•How much
activity have you been able to fit into your schedule?
NUR643E Advanced Health Assessment for Nurse Educators
Week 8 Final Quiz
• A 62-year-old woman, who has been
coming to you for 3 years, has a recent onset of hypertension. She is still not
at goal despite three antihypertensive medicines, and you strongly doubt
nonadherence. Her father died of a heart attack at age 58. Today her pressure
is 168/94 and pressure on the other arm is similar. What would you do next?
•Add a
fourth medicine
•Refer to
nephrology
•Get a CT
scan
•Listen
closely to her abdomen
• Mrs. Jaeger is a 67–year-old who
went through menopause at age 55. She has now had some vaginal bleeding. Which
of the following should be considered?
•Endometrial
cancer
•Hormone
replacement therapy
•Uterine or
cervical polyps
•All of
these
• A 73-year-old retired accountant
presents to your office for her annual examination. She has incontinence of
urine when she coughs or sneezes. She takes several medications for control of
hypertension and diabetes. You use the DIAPERS mnemonic to assess the cause of
her incontinence. All of the following are items represented by the mnemonic
except for:
•Atrophic
vaginitis
•Depression
•Pharmaceuticals
•Restricted
mobility
• A 58-year-old gardener presents to
your office for evaluation of a new lesion on her upper chest. The lesion
appears to be “stuck on” and is oval, brown, and slightly elevated with a flat
surface. It has a rough, wartlike texture on palpation. Based on this
description, what is your most likely diagnosis?
•Actinic
keratosis
•Seborrheic
keratosis
•Basal cell
carcinoma
•Squamous
cell carcinoma
• A patient presents to you because
she is experiencing a tremor only when she reaches for things. This becomes
worse as she nears the “target.” When you ask her to hold out her hands, no
tremor is apparent. What type of tremor does this most likely represent?
•Intention
tremor
•Postural
tremor
•Resting
tremor
•Intention
tremor
• A 77-year-old retired bus driver
presents to your clinic for a physical examination at his wife's request. He
has recently been losing weight and has felt very fatigued. He has had no chest
pain, shortness of breath, nausea, vomiting, or fever. His past medical history
includes arthritis and colon cancer, for which he had surgery. He has been
married for more than 40 years. He denies any tobacco or drug use and has not
had alcohol in more than 40 years. His parents both died of cancer in their
60s. On examination, his vital signs are normal. His head, cardiac, and
pulmonary examinations are unremarkable. On abdominal examination, you hear
normal bowel sounds, but when you palpate his liver it is abnormal. His rectal
examination is positive for occult blood.
What
further abnormality of the liver was likely found on examination?
•Smooth,
large, non-tender liver
•Soft,
sharp, liver edge
•Elongated
right lobe
•Irregular,
large liver
• A 32-year-old attorney presents to
your office for her second prenatal visit. She has had two previous pregnancies
with uneventful prenatal care and vaginal deliveries. Her only problem was that
with each pregnancy she gained 50 lbs (23 kg) and had difficulty losing the
weight afterward. She has no complaints today. Looking at her chart, you see
she is currently 10 weeks pregnant and that her prenatal weight was 130 lbs (59
kg). Her weight today is 134 lbs (60.9 kg). Her height is 5'4”, giving her a
BMI of 22. Her blood pressure, pulse, and urine tests are unremarkable. The
fetal heart tone is difficult to find but is located and is 150. While you give
her first trimester education, you tell her how much weight you expect her to
gain.
How much
weight should this patient gain during pregnancy?
•Less than
15 pounds (less than 7 kg)
•15 to 25
pounds (7 to 11.5 kg)
•25 to 35
pounds (11.5 to 16 kg)
•30 to 40
pounds (12.5 to 18 kg)
• Abby is a newly married woman who
is unable to have intercourse because of vaginismus. Which of the following is
true?
•This is
most likely due to lack of lubrication.
•This is
most likely due to atrophic vaginitis.
•This is
most likely due to pressure on an ovary.
•Psychosocial
reasons may cause this condition.
• You are speaking to an eighth-grade
class about health prevention and are preparing to discuss the ABCDEs of
melanoma. Which of the following descriptions correctly defines the ABCDEs?
•A =
actinic; B = basal cell; C = color changes, especially blue; D = diameter >6
mm; E = evolution
•A =
asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter
>6 mm; E = evolution
•A =
actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E =
evolution
•A =
asymmetry; B = regular borders; C = color changes, especially orange; D =
diameter >6 mm; E = evolution
• You are examining an elderly man
and notice the following: decreased vibration sense in the feet and ankles,
diminished gag reflex, right patellar reflex less than the left, and diminished
abdominal reflexes. Which of these is abnormal?
•Decreased
vibration sense
•Diminished
gag reflex
•Diminished
right patellar reflex compared to the left
•Diminished
abdominal reflexes
• You are assessing an infant and
notice that his nares flare, he has a soft grunt with each breath, and the skin
between his ribs is pulled inward with inhalation. What is the significance of
these findings?
•These are
indicative of a CNS process.
•These are
indicative of respiratory distress.
•These are
indicative of muscular dystrophy.
•These are
frequently accompanied by stridor.
• Jacob, a 33-year-old presents with
fluid filled lesions on neck. On examination multiple small pustules and
vesicles grouped together are seen on erythematous base.
What is
most likely?
•Herpes
Simplex Virus
•Contact
dermatitis
•Actinic
keratosis
•Sebaceous
hyperplasia
• A 76-year-old retired farmer
presents to your office complaining of abdominal pain, constipation, and a
low-grade fever for about 3 days. He denies any nausea, vomiting, or diarrhea.
The only unusual thing he remembers eating is two bags of popcorn at the movies
with his grandson 3 days before his symptoms began. He denies any other recent
illnesses. His past medical history is significant for coronary artery disease
and high blood pressure. He has been married for more than 50 years. He denies
any tobacco, alcohol, or drug use. His mother died of colon cancer, and his
father had a stroke. On examination, he appears his stated age and is in no
acute distress. His temperature is 100.9 degrees, and his other vital signs are
unremarkable. His head, cardiac, and pulmonary examinations are normal. He has
normal bowel sounds and is tender over the left lower quadrant. He has no
rebound or guarding. His rectal examination is unremarkable, and his fecal
occult blood test is negative. His prostate is slightly enlarged, but his
testicular, penile, and inguinal examinations are all normal. Blood work is
pending.
What
condition that typically causes abdominal pain best describes his symptoms and
signs
•Acute
diverticulitis
•Acute
cholecystitis
•Acute
appendicitis
•Mesenteric
ischemia
• Which of the following booster
immunizations is recommended in the older adult population?
•Tdap
•Diphtheria
•Measles
•Mumps
• A 72-year-old teacher presents to a
skilled nursing facility for rehabilitation after being in the hospital for 6
weeks. She was treated for sepsis and respiratory failure and had to be on the
ventilator for 3 weeks. You are completing your initial assessment and are
evaluating her skin condition. On her sacrum, there is full-thickness skin loss
that is 5 cm in diameter, with damage to the subcutaneous tissue. The
underlying muscle is not affected. You diagnose this as a pressure ulcer. What
is the stage of this ulcer?
•Stage 1
•Stage 2
•Stage 3
•Stage 4
• A 21-year-old receptionist presents
to your clinic complaining of frequent diarrhea. She states that the stools are
very loose and there is some cramping beforehand. She states this has occurred
on and off since she was in high school. She denies any nausea, vomiting, or
blood in her stool. Occasionally, she has periods of constipation, but that is
rare. She thinks the diarrhea is much worse when she is nervous. Her past
medical history is not significant. She is single and a junior in college
majoring in accounting. She smokes when she drinks alcohol but denies using any
illegal drugs. Both of her parents are healthy. Her entire physical examination
is unremarkable.
What is
most likely the etiology of her diarrhea?
•An
infection
•Trauma
•Irritable
bowel syndrome
•An
endocrine disorder
• A young patient presents with a
left-sided mass in her abdomen. You confirm that it is present in the left
upper quadrant. Which of the following would support that this represents an
enlarged kidney rather than her spleen?
•A palpable
“notch” along its edge
•The
inability to push your fingers between the mass and the costal margin
•The
presence of normal tympany over this area
•The
ability to push your fingers medial and deep to the mass
• Mrs. Hill is a 28-year-old
African-American with a history of SLE (systemic lupus erythematosus). She has
noticed a raised, dark red rash on her legs. When you press on the rash, it
doesn't blanch. What would you tell her regarding her rash?
•It is likely
to be related to her lupus.
•It is
likely to be related to an exposure to a chemical.
•It is
likely to be related to an allergic reaction.
•It should
not cause any problems.
• An elderly woman with a history of
coronary bypass presents in with severe, diffuse, abdominal pain. Strangely,
during your examination, the pain is not made worse by pressing on the abdomen.
What do you suspect?
•Malingering
•Neuropathy
•Ischemia
•Physical
abuse
