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

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

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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.       The mother of a three month old infant states that her baby has not been gaining weight. With further questioning the FNP finds that the infant falls asleep after nursing and wakes up after a short amount of time hungry again. What other information with the FNP want to have?

10.   In assessing a patient’s major risk factors for heart disease which would the FNP want to include when taking a history?

11.   The FNP is … the pulses of a patient who has been admitted for untreated hyperthyroidism. The FNP should expect to find a____pulse

12.   A patient complains of leg pain that wakes him at night. He states that he has been having problems with his legs. ….. his legs when they are … and disappears when he dangles them. He recently noticed a sore on the inner aspect of his right ankle. On the basis of this history information the FNP interprets that the patient is most likely experiencing

13.   During an assessment the FNP uses the profile sign to detect

14.   Which of these statements describes the closure of the valves in a normal cardiac cycle?

15.   When performing a peripheral vascular assessment on a patient the FNP is unable to palpate the ulnar pulses. The patient skin is warm and capillary refill is normal. The FNP should next

16.   A 67-year-old patient states that he “recently began have pain in his left calf when climbing the 10 stairs to his apartment”. This pain is relieved by sitting for about two minutes then he’s able to resume activities. The FNP interprets this patient is most likely experiencing

17.   In assessing a 70-year-old man the FNP finds the following blood pressure 140/100 mmHg, heart rate 104 and slightly irregular, split S2. Which of these findings can… by expected hemodynamic changes related to age?

18.   The FNP is examining the lymphatic system of a healthy three year old child. Which finding should the FNP expect?

19.   The FNP is preparing to perform modified Allen test. Which is an appropriate reason for this test?

20.   A 25-year-old woman is in her fifth month of pregnancy has a blood pressure of 100/70 mmHg. In reviewing her previous exam the FNP notes that her blood pressure in her second month was 124/80 mmHg. When evaluating this change what does the FNP know to be true?

21.   Findings from an … of a 70-year-old patient with swelling in his ankles include jugular venous pusations, 5 cm above the sternal angle when the head of his bed is …. 45°. The FNP knows that this finding indicate:

22.   The component of the conduction system referred to as the pacemaker of the heart is the

23.   The FNP is reviewing anatomy and physiology of the heart. Which statement best … by atrial kick?

24.   A 45-year-old man is in the clinic for a routine physical. During history the patient states he has been having difficulty sleeping. I’ll be sleeping great and then I wake up and feel like I can’t catch my breath. The FNP‘s best response to this would be

25.   When assessing a patient the FNP notes that the left femoral pulse as diminished 1+/4+. What should the FNP do next?

NR 509 Week 4 Shadow Health Cardiovascular Physical Assessment Assignment Summer 2018

Overview

| Transcript

| Subjective Data Collection

| Objective Data Collection

| Education & Empathy

| Documentation

| Lifespan

| Review Questions

| Self-Reflection

NR 509 Week 4 Shadow Health Chest Pain Physical Assessment Assignment Summer 2018

Overview

| Transcript

| Subjective Data Collection

| Objective Data Collection

| Education & Empathy

| Documentation

Document: Provider Notes

Document: Vitals

| Self-Reflection

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.       The mother of a three month old infant states that her baby has not been gaining weight. With further questioning the FNP finds that the infant falls asleep after nursing and wakes up after a short amount of time hungry again. What other information with the FNP want to have?

10.   In assessing a patient’s major risk factors for heart disease which would the FNP want to include when taking a history?

11.   The FNP is … the pulses of a patient who has been admitted for untreated hyperthyroidism. The FNP should expect to find a____pulse

12.   A patient complains of leg pain that wakes him at night. He states that he has been having problems with his legs. ….. his legs when they are … and disappears when he dangles them. He recently noticed a sore on the inner aspect of his right ankle. On the basis of this history information the FNP interprets that the patient is most likely experiencing

13.   During an assessment the FNP uses the profile sign to detect

14.   Which of these statements describes the closure of the valves in a normal cardiac cycle?

15.   When performing a peripheral vascular assessment on a patient the FNP is unable to palpate the ulnar pulses. The patient skin is warm and capillary refill is normal. The FNP should next

16.   A 67-year-old patient states that he “recently began have pain in his left calf when climbing the 10 stairs to his apartment”. This pain is relieved by sitting for about two minutes then he’s able to resume activities. The FNP interprets this patient is most likely experiencing

17.   In assessing a 70-year-old man the FNP finds the following blood pressure 140/100 mmHg, heart rate 104 and slightly irregular, split S2. Which of these findings can… by expected hemodynamic changes related to age?

18.   The FNP is examining the lymphatic system of a healthy three year old child. Which finding should the FNP expect?

19.   The FNP is preparing to perform modified Allen test. Which is an appropriate reason for this test?

20.   A 25-year-old woman is in her fifth month of pregnancy has a blood pressure of 100/70 mmHg. In reviewing her previous exam the FNP notes that her blood pressure in her second month was 124/80 mmHg. When evaluating this change what does the FNP know to be true?

21.   Findings from an … of a 70-year-old patient with swelling in his ankles include jugular venous pusations, 5 cm above the sternal angle when the head of his bed is …. 45°. The FNP knows that this finding indicate:

22.   The component of the conduction system referred to as the pacemaker of the heart is the

23.   The FNP is reviewing anatomy and physiology of the heart. Which statement best … by atrial kick?

24.   A 45-year-old man is in the clinic for a routine physical. During history the patient states he has been having difficulty sleeping. I’ll be sleeping great and then I wake up and feel like I can’t catch my breath. The FNP‘s best response to this would be

25.   When assessing a patient the FNP notes that the left femoral pulse as diminished 1+/4+. What should the FNP do next?

NR 509 Week 5 Shadow Health Abdominal Pain Physical Assessment Assignment Summer 2018

·  Overview

·  | Transcript

·  | Subjective Data Collection

·  | Objective Data Collection

·  | Education & Empathy

·  | Documentation

· Document: Provider Notes

· Document: Vitals

·  | Self-Reflection

NR 509 Week 5 Shadow Health Gastrointestinal Physical Assessment Assignment Summer 2018

Transcript

| Subjective Data Collection

| Objective Data Collection

| Education & Empathy

| Documentation 

| Lifespan 

| Review Questions 

| Self-Reflection

NR 509 Week 5 Quiz 2 Practice Versions Advanced Physical Assessment Chamberlain 2018

1.       An older patient has been diagnosed with pernicious anemia. The FNP knows that this condition could be related to

2.       ….. examining a patient who tells the FNP “I sure sweat a lot especially on my face and feet but it doesn’t have an odor”. The FNP knows that this could … related to

3.       During an abdominal assessment the FNP elicits tenderness on light palpation in the right lower quadrant. The FNP interprets that this finding could indicate a disorder which of these structures?

4.       An Inuit visiting Nevada from anchorage has come to the clinic in July during the hottest part of the day. It so happens that the clinics air conditioning is broken and the temperature is very hot. The FNP knows that which of these statements is true about the Inuit sweating tendencies?

5.       The FNP notices that a patient has black, tarry stool and recalls that a possible cause would …

6.       ….. an abdominal …. deep palpation is used to determine

7.       The FNP is assessing the abdomen of an aging adult. Which of these statements regarding an aging adult and abdominal assessment is true?

8.       During examination the FNP finds that a patient has excessive dryness of the skin. The best term to describe this condition is

9.       A FNP notices that a patient has ascites, which indicates the presence of

10.   The FNP is performing percussion during an abdominal assessment. Percussion notes during the abdominal assessment may include

11.   The FNP is caring for a black child who has … with marasmus. The FNP would expect to find the

12.   … patient’s medical record that the patient has a lesion that is confluent in nature. On examination the FNP would expect to find

13.   The FNP is assessing the abdomen of a pregnant woman who is complaining of having acid indigestion all the time. The FNP knows that esophageal reflux during pregnancy can cause

14.   The patient has abdominal borborygmi. The FNP knows that this term refers to

15.   A patient has a terrible itch for several months that he … scratching continuously. On examination the FNP might expect to find

16.   During aging process, the hair can look gray or white and begin to feel thin and fine. The FNP knows that this occurs because of a decrease in number of functioning

17.   The FNP notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding the FNP would report this as a

18.   During an abdominal assessment the FNP would consider which of these findings as normal?

19.   A 52 -year-old Woman has a papule on her nose that has a rounded pearly border and a central red ulcer. She said she first noticed it several months ago and that it is slowly growing larger. The FNP suspects which condition?

20.   The FNP is listening to bowel sounds. Which of these statements is true about bowel sounds?

21.   The FNP is watching a new graduate FNP perform auscultation of a patient abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation proceeds percussion and palpitation of the abdomen?

22.   A patient is complaining of a sharp pain along the costovertebral angles. The FNP knows that this symptom is most often indicative of

23.   The patient is … of having inflammation of the gallbladder or cholecystitis. The FNP should conduct which of these techniques to assess for this condition?

24.   A newborn infant is in the clinic for a well baby check. The FNP observes the infant for possibility of fluid loss because of which these factors?

25.   During an assessment of a newborn infant, the FNP recalls that pyloric stenosis would … manifested by

NR 509 Week 5 Quiz: Skin, Hair, Abdomen

1.       Question: The FNP is assessing the abdomen of an aging adult. Which of these statements regarding the agind adult and abdominal assessment is true?

2.       Question: The FNP notices that a patient has had a black tarry stool and recalls that a possible cause would be

3.       Question: The FNP knows that during an abdominal assessment deep palpitation is used to determine

4.       Question: A patient has abdominal borboygmi. The FNP knows that this term refers to

5.       Question: During an abdominal assessment, the FNP would consider which of these findings as normal?

6.       Question: The FNP is caring for a black child who has been diagnosed with marasmus. The FNP would expect to find the

7.       Question: An Inuit visiting Nevada from Anchorage has come to the clinic in July during the hottest part of the day. It so happens that the clinic’s air conditioning is broken and the temperature is very hot. The FNP knows that which of these statements is true about the Inuit sweating tendencies?

8.       Question: The FNP is performing percussion during an abdominal assessment. Percussion notes heard during the abdominal assessment may include:

9.       Question: During an abdominal assessment, the FNP elicits tenderness on light palpation in the right lower quadrant. The FNP interprets that this finding could indicate a disorder of which of these structures?

10.   Question: A patient has a terrible itch for several months that he has been scratching continuously. On examination, the FNP might expect to find

11.   Question: The FNP is listening to bowel sounds. Which of these statements is true of bowel sounds?

12.   Question: A patient is complaining of a sharp pain along the costovertebral angles. The FNP knows that this symptom is most often indicative of

13.   Question: The FNP notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding, the FNP would report this as a

14.   Question: A patient is suspected of having inflammation of the gallbladder, or cholecystitis. The FNP should conduct which of these techniques to assess for this condition?

15.   Question: The FNP just noted from a patient’s medical record that the patient has a lesion that is confluent in nature. On examination, the FNP would expect to find

16.   Question: During an examination, the FNP finds that a patient has excessive dryness of skin. The best term to describe this condition is

17.   Question: An older patient has been diagnosed with pernicious anemia. The FNP knows that this condition could be related to

18.   Question: A 52 year old woman has a papule on her nose that has rounded, pearly borders and a central red ulcer. She said she first noticed it several months ago and that it has slowly grown larger. The FNP suspects which condition?

19.   Question: The FNP is watching a new graduate FNP perform auscultation of a patient’s abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen?

20.   Question: A newborn infant is in the clinic for a well-baby check. The FNP observes the infant for the possibility of fluid loss because of which of these factors?

NR 509 Week 5 Quiz Review

1.       Tenderness in RLQ is concerning for

2.       Inuit people tend to sweat more on face than trunk and extremities when exposed to heat

3.       spot on face with round pearly boarder with central red lesion concerning for

4.       Murphy sign= positive with deep palpation causes pain on inspiration

5.       Why do you auscultate first in abd assessment

6.       Tympany in the umbilical area

7.       Pt with decreased gastric secretions is at increase

8.       Another name for hyperactive bowels

9.       Black tarry stool concerning

10.   Lichenification caused by

11.   A papule is

12.   Older adults have

13.   CVA tenderness

14.   Confluent lesions

15.   Dryness of the skin

16.   Newborns are at greater risk of fluid loss

17.   High pitched irregular bowel sounds

18.   Changes in hair texture and color of an AA child with Marasmus

19.   Know how to assess for enlarged organs in the abd region

20.   Know three sounds heard in percussion

NR 509 Week 6 Shadow Health Mental Health Physical Assessment Assignment Summer 2018

NR 509 Mental Health Results | Transcript

NR 509 Mental Health Results | Subjective Data Collection

NR 509 Mental Health Results | Education and Empathy

NR 509 Mental Health Results | Documentation

NR 509 Mental Health Results | Life Span

NR 509 Mental Health Results | Review Questions

NR 509 Mental Health Results | Self Reflection

NR 509 Week 7 Shadow Health Comprehensive Health History and Physical Assessment Assignment

NR 509 Comprehensive Assessment Results: Experience Overview

1. Digital Clinical Experience Score: Score 98.4%
2. Student Performance Index: 121 out of 123

NR 509: Comprehensive Assessment Results: Transcript (FNP Student Conducting Interview)

NR-509 Comprehensive Assessment Results: Subjective Data Collection: 50 of 50 (100%)

NR 509: Comprehensive Assessment Results: Objective Data Collection: 71.0 of 73 (97.3%)

NR-509 Comprehensive Assessment Results: Documentation / Electronic Health Record

NR 509 Comprehensive Assessment Results: Plan My Exam

Your Final Plan

1. Head and neck,
2. Anterior chest,
3. Posterior chest,
4. Abdomen,
5. Upper extremities,
6. Lower extremities,
7. Full body

NR 509: Comprehensive Assessment 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
4. learned” within the assignment to your professional practice.

NR 509 Week 7 Assignment Immersion Completion Spring 2018

__________, my name is ____________, I will be doing your exam today. I’ll begin with inspecting your face. I’ll note that I don’t see any discolorations or lesions & the head is midline & symmetrical.

1. LYMPH NODES: Next, I’ll palpate the lymph nodes. I’ll begin with the preauricular lymph nodes & postauricular lymph nodes. Next the occipital lymph nodes. I’ll move forward to palpate the tonsillar lymph nodes, submandibular & submental. I’m palpating the anterior cervical lymph nodes & posterior cervical lymph nodes & lastly the supraclavicular lymph nodes. I don’t feel any enlargement & they’re equal bilaterally.
2. FACE : I’m testing trigeminal nerve, which is cranial nerve # 5. Palpating over the masseter muscle as the pt clenches the jaw. I don’t feel any distortions & my pt has great strength. Now, I’m testing the sensory portion of the trigeminal nerve. I’ll ask my pt to close your eyes & let me know where you feel my touch. (>> Forehead, right cheek, left cheek, chin, nose)………. which is cranial nerve # 7. I’m going to ask you to do some facial expressions. I’m going to have you smile, next, frown for me. Now raise your eyebrows & puff up your cheeks, pucker your lips. I notice all expressions have bilateral symmetry.
3. EARS
4. EYES
5. NOSE
6. MOUTH
7. NECK & THROAT
8. HEART/CHEST((pt sitting))
9. UPPER EXTREMITIES
10. ABDOMEN((have pt lie down))
11. LOWER EXTREMITIES

NR 509 Week 6 Quiz Practice 2 Versions Advanced Physical Assessment Chamberlain 2018

1.       A woman has come to the clinic to seek help with a substance-abuse problem. She admits to using cocaine just before arrival. Which of these assessment findings would the FNP expect to find when examining the woman?

2.       A 63-year-old Chinese American man enters the office with complaints of chest pain, shortness of breath, and palpitations. Which statement most accurately reflect the FNPs best course of action?

3.       The FNP is planning to assess new memory with the patient. The best way for the FNP to do this would be

4.       During the health history the FNP asks a female patient “how many alcoholic drinks do you have a week?” Which answer by the patient would indicate at risk drinking?

5.       Symptoms such as pain are often influenced by a person’s cultural heritage. Which of the following is a true statement regarding pain?

6.       The FNP suspect abuse when a 10-year-old child is taken to the urgent care center for leg injury. The best way to document the history and physical findings is to

7.       During a mental status assessment, which question by the FNP would best assess a persons judgment?

8.       The FNP is performing a mental status assessment on a five-year-old girl. Her parents are undergoing a bitter divorce and are worried about the effect it is having on their daughter. Which action or statement might leave FNP to be concerned about the girls mental status?

9.       During mental status examination, the FNP wants to assess a patient’s affect. The FNP should ask the patient which question?

10.   During an examination FNP notices a patterned injury on a patients back. Which of these would cause such an injury?

11.   The FNP is aware that intimate partner violence screening should occur with which situation?

12.   Which statement is best for the FNP to use when preparing to administer the abuse assessment screen?

13.   The FNP is conducting a class on alcohol and the effects of alcohol on the body. How many standard drinks (each containing 12 g alcohol) Per day are associated with increased deaths from cirrhosis, cancers of the mouth, esophagus and injuries in men?

14.   A woman who has just discovered that she is pregnant is in the clinic for her first obstetric visit. She asked the FNP how many drinks a day safe for my baby? The FNP‘s best response is

15.   The FNP is performing the Denver II screen test on a 12 month old infant during a routine well child visit. The FNP should tell the infants parents that the Denver II

16.   Which term refers to a one produced by tearing or splitting of body tissue usually from blunt impact of a bony surface

17.   When reviewing the use of alcohol by older adults the FNP notes that the older adults have several characteristics that can increase the risk of alcohol use which would increase the bioavailability of alcohol in the blood for longer periods of time in the older adult?

18.   The FNP is reviewing concepts of cultural aspects of pain. Which statement is
true regarding pain?

19.   The FNP is planning to assess a child using behavioral checklist. This tool is most appropriate for a(an)

20.   The FNP is assessing orientation in a 79-year-old patient. Which of these responses … leave the FNP to … that the patient is … ?

21.   As a mandatory reporter of elder abuse, which of these must be present before an FNP notifies the authorities?

22.   A 30-year-old female patient is describing feelings of hopelessness and depression. She has attempted self-mutilation and has a history of prior suicide attempts. She describes difficulty sleeping at night and has lost 10 pounds in the past month. Which of these statements or questions is the FNP‘s best response in this situation?

23.   For persons age 12 years and older which of these illicit substances was one of the most commonly used?

24.   Which of these individuals would the FNP consider at highest risk for suicide attempt?

25.   The FNP is …. a patient who has … for cirrhosis of the liver secondary to chronic alcohol use. During the physical … the FNP looks for cardiac problems that are … with chronic heavy use of alcohol such as

NR 509 Week 7 Quiz Practice 2 Versions Advanced Physical Assessment Chamberlain 2018

1.       During an examination of an aging male the FNP recognizes that normal changes to expect would be:

2.       During a health history, a 22-year-old woman asks “can I get that vaccine for HPV? I have gentle warts and I’d like them to go away!” What is the FNP‘s best response?

3.       During a speculum inspection of the vagina the FNP would expect to see what at the end of the vaginal canal?

4.       A 62-year-old man is experiencing fever, chills, malaise, urinary frequency and urgency. He also reports urethral discharge and a dull aching pain in the perineal and rectal area. The symptoms are most consistent with which of the following?

5.       When performing a genital examination on a 25-year-old man the FNP notices deeply pigmented, wrinkled scrotal skin with large sebaceous follicles. On the basis of this information the FNP would:

6.       The mother of a 10-year-old boy asks the FNP to discuss the recognition of puberty. The FNP should reply by saying:

7.       The uterus is usually … tilting forward and superior to the bladder. This position is known as

8.       A male patient with possible fertility problems asks the FNP where sperm is produced. The FNP knows that sperm production occurs in

9.       A 15-year-old boy is seen in the clinic for complaints of dull pain and pulling in the scrotal area. On examination the FNP palpates a soft, irregular mass posterior to and above the testes on the left. This mass collapses when the patient is supine in refills when he is up right. This description is consistent with:

10.   In performing an assessment of a woman’s axillary lymph system the FNP should assess which of these nodes?

11.   A patient contacts the office and tells the FNP that she is worried about her 10-year-old daughter having breast cancer. She describes a unilateral enlargement of the right breast with associated tenderness. She is worried because the left breast is not enlarged. What would be the FNP‘s best response?

12.   An 11-year-old girl is in the clinic for a sports physical. The FNP notices that she has begun to develop breasts, and during the conversation the girl reveals that she is worried about her development. …. which of these techniques to best assist the young girl in understanding the expected sequence for development? The FNP should:

13.   A 54-year-old woman who has just completed menopause is in the clinic today for yearly physical examination. Which of these statements should the FNP include in patient education? A post menopausal woman:

14.   A 62-year-old man states that his doctor told him that he has an inguinal hernia. He asks the FNP to explain what a hernia is……:

15.   When performing a genital assessment on a middle-age man, the FNP notices multiple soft, moist, painless papules in the shape of cauliflower like patches scattered across the shaft of the penis. These lesions are characteristics of:

16.   If a patient reports a recent breast infection, then the FNP should expect to find_____node enlargement

17.   A 9-year-old girl is in the clinic for a sports physical. After some initial shyness she finally asked “am I normal? I don’t seem to need a bra yet, but I have some friends who do. What if I never get breasts?” The FNP‘s best response would be:

18.   Which of these statements about the testes this true?

19.   During an examination FNP observes a female patients vestibule and expect to see the

20.   A 14-year-old girl is anxious about not having reached menarche. When taking history, the FNP should ascertain which of the following? The age:

21.   A woman who is 22 weeks pregnant has a vaginal infection. She tells the FNP that she is afraid that the infection will hurt the fetus. The FNP knows that which of these statements is true?

22.   In performing a breast examination the FNP knows that it is especially important to examine the upper outer quadrant of the breast. The reason for this is that the upper outer quadrant

23.   An accessory glandular structure for the male genital organs is the

24.   Which of these statements is true regarding the penis?

25.   A woman who is 8 weeks pregnant is in the clinic for a check up. The FNP reads on her chart that her cervix is … cyanotic. The FNP knows that the woman is exhibiting____sign and _____sign

NR 509 Week 8 Reflection MSN program outcome 1 and the MSN Essential

Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #1 and the MSN Essential I.

NR 509 Week 1 Discussion (Patient Information: JDS, 30, M, African American, Cigna)

NR.509 Week 2 Discussion (Patient Information: KMW, 27, F, African American, Aetna)

NR 509 Week 3 Discussion (Patient Information: SJS 33, F, African American, Cigna)

Using a friend, family member, or colleague, perform a neurovascular (include all cranial nerves), musculoskeletal, and cardiopulmonary (includes the heart, lungs, and peripheral vasculature) exam. Document the physical examination findings in the SOAP note format.

Even though your patient may have abnormal findings, you must document the expected normal exam findings for the system. If you would like to include the abnormal findings they should be noted in parenthesis next to the normal expected findings. The complete subjective and objective sections must be included………… plan portion of the SOAP note, but these sections will not be graded.

You should devise a chief complaint so that you may document the OLDCART (HPI) data. You must use the chief complaint of headache, back pain, and cough. ______ ROS based on the patient’s chief complaint and the body systems being examined. Refer to the SOAP Note Format document in Course Resources as necessary. This will be the same format that faculty will follow during the immersion weekend.

* There are videos of the exams to be performed at immersion in Modules → Introduction and Resources→ Immersion section. Also the immersion evaluation forms are located in the Course Resources section. They should be reviewed and practiced often.

NR.509 Week 4 Discussion (Patient Information: NJL, 22, M, African American, Cigna)

Using a friend, family member, or colleague, perform a detailed men’s health history. Document the history and the expected normal physical examination findings in the SOAP note format.

Even though your patient may have abnormal findings, you must document the expected normal exam findings for the system. If you would like to include the abnormal findings they should be noted in parenthesis next to the normal expected findings. The complete subjective and objective sections must be included…………..assessment and plan portion of the SOAP note, but these sections will not be graded.

You should devise a chief complaint so that you may document the OLDCART (HPI) data. You must use the chief complaint of penile discharge, rectal bleeding, or frequent urination. You should also focus the ROS based on the patient’s chief complaint and the body systems being examined. Refer to the SOAP Note Format document in Course Resources as necessary. This will be the same format that faculty will follow during the immersion weekend.

* There are videos of the exams to be performed at immersion in Modules → Introduction and Resources→ Immersion section. Also the immersion evaluation forms are located in the Course Resources section. They should be reviewed and practiced often.

NR 509 Week 5 Discussion (Patient Information: JDS, 21, M, African American, Blue Cross Blue Shield)

Using a friend, family member, or colleague, perform a detailed women’s health history. Document the history and the expected normal physical examination findings in the SOAP note format.

Even though your patient may have abnormal findings, you must document the expected normal exam findings for the system. If you would like to include the abnormal findings they should be noted in parenthesis next to the normal expected findings. The complete subjective and objective sections must be included.  You may include the assessment and plan portion of the SOAP note, but these sections will not be graded.

You should devise a chief complaint so that you may document the OLDCART (HPI) data. You must use the chief complaint of burning while urinating, irregular menstrual cycle, or pelvic pain………. focus the ROS based on the patient’s chief complaint and the body systems being examined. Refer to the SOAP Note Format document in Course Resources as necessary. This will be the same format that faculty will follow during the immersion weekend.

* There are videos of the exams to be performed at immersion in Modules → Introduction and Resources→ Immersion section. Also the immersion evaluation forms are located in the Course Resources section. They should be reviewed and practiced often.

NR 509 Focused Exam Cough Assignment Completed Shadow Health

Introduction

Daniel “Danny” Rivera is an 8-year-old boy who comes to the clinic with a cough. Students determine if Danny is in distress, explore the underlying cause of his cough, and look for related symptoms in other body systems.

Case Highlights

• Ask about a variety of psychosocial factors related to home life, such as second-hand smoke exposure
• Observe non-verbal cues as Danny presents with intermittent coughing and visible breathing difficulty
• Rule out asthma, a common childhood affliction, by examining Danny

NR 509 Focused Exam Cough | Transcript

• Interview Questions (76)
• Statements (8)
• Exam Actions (96)

NR 509 Focused Exam Cough | Subjective Data Collection: 20 of 20 (100.0%)

NR-509 Focused Exam Cough | Objective Data Collection: 12.6 of 13 (96.92%)

NR 509 Focused Exam Cough | Education & Empathy:  4 of 5 (80.0%)

• Symptoms
• Medications
• Vitamins
• Secondhand Smoke
• Family History

NR 509 Focused Exam-Cough | Documentation / Electronic Health Record

• Document: Vitals
• Document: Provider Notes

NR 509 Focused Exam Cough | Self-Reflection

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