Putting it all Together

Question 1

Investigate cognitive abilities

Answer 1

State of consciousness, response to analogies, abstract reasoning, arithmetic calculation, memory, attention span

Question 2

Pre-screening exam

If positive, then administer

Answer 2

PHQ-9

Question 3

First two questions of the PHQ-9

Answer 3

During the past two weeks, have you often been bothered by feeling down, depressed, or hopeless?
During the past two weeks, have you often been bothered by having little interest or pleasure in doing things?

Question 4

Generalized anxiety disorder (GAD) - Charcterized by and other features

Answer 4

Characterized by excessive and persistent worrying that is hard to control, causes significant distress or impairment, and occurs on more days than not for at least six months.

Other features include psychological symptoms of anxiety, such as apprehensiveness and irritability, and physical (or somatic) symptoms of anxiety, such as increased fatigue and muscular tension

Question 5

Screening tool for anxeity

Answer 5

GAD-7

Question 6

Most common psychiatric disorder in the general population

Answer 6

Depression

Question 7

In the absence of screening, it is estimated that only 50 percent of patients with

Answer 7

major depression are identified

Question 8

Depression May present with

Answer 8

mood, cognitive, neurovegetative, or somatic symptoms.

Question 9

Depression mood manifiestations include

Answer 9

sadness, emotional distress, emotional numbness, or sometimes anxiety or irritability.

Question 10

Depression Neurovegetative symptoms

Answer 10

include loss of energy, changes in sleep, appetite, or weight

Question 11

At the Start

Answer 11

Identify self as student nurse practitioner.
Integrate the history and PE to meet the needs of the patient.
Put the patient at ease by explaining your actions.
Respect patient privacy.
Revisit problem areas.
Trust your instincts.

Question 12

Patient factors affecting accuracy

Answer 12

Sensory deprivation
Emotional constraints, apparent and unapparent
Language barriers
Cultural barriers

Question 13

Every observation has a certain sensitivity

Answer 13

Assurance that if something is to be found, it will be found

Question 14

Every observation has a certain specificity

Answer 14

Assurance that if it is found, it is a true finding and not a misinterpretation or false-positive finding

Question 15

Uncertainty

Answer 15

The potential for error increases uncertainty and our discomfort.
We cannot always express our findings in numbers.
We cannot avoid probabilities.
There is false comfort in the apparent certainty of many numbers.

Question 16

Concluding the Examination

Answer 16

Allow patient time to dress.
Discuss findings and plan of care with patient.
Answer questions.
Include family, if patient requests.
If examination takes place in a hospital bed, return everything to normal position and ensure patient’s comfort.

Question 17

Newborn

Answer 17

Apgar score; gestational age; congenital anomalies; degree of awareness or apathy; posture; skin color; facies
Inspect for congenital anomalies.
Palpate fontanels; extremities; abdomen; rest of baby

Question 18

Infant

Answer 18

Vary sequence as appropriate for age and wakefulness; observe before touching; evaluate feeding and crying
Examination sequence: general inspection; chest, lungs, heart; abdomen; head and neck; upper and lower extremities; genitals and rectum; neurologic; back; behavior

Question 19

Examination of Children

Answer 19

Observe parent-child connection; slowly initiate contact during history; remain flexible.
General inspection; observe child playing.
Child on parent’s lap
Upper and lower extremities; head and neck; chest, heart, lungs
Child supine, still on lap, diaper loosened
Abdomen; inguinal lymph nodes; external genitalia
Child standing
Spinal alignment; posture; gait
Child returns to parent’s lap
Eyes/vision; ears/hearing; nose; mouth; pharynx

Question 20

Examination of Pregnant Patients and Older Adults

Answer 20

Pregnant patients
Abdomen; pelvis 
Older adults
May require alternative positions
May take longer to examine
Functional assessment
Medications
General and focused assessment
Psychosocial assessment

Question 21

Closing Discussion

Answer 21

Be aware of your biases.
Determine difference between urgent and nonurgent data and patient needs.
Share summary information with the patient.