Week 1: Intro to Health Assessment

Question 1

What are the two types of visits we conduct as FNPs? When would you conduct each?

Answer 1

Comprehensive patient assessment: new patients in the office or hospital, annual well-visit

Focused patient assessment: appropriate for established patients, especially during routine or UC visits

Question 2

Regardless of visit type, collect the following information: _____ (3)

Answer 2

Identifying data
Reliability
Chief complaint

Question 3

What are the components of the comprehensive exam and what is generally collected during each? (6)

Answer 3

Initial information: identifying patient info and source/reliability
Chief complaint(s): primary symptom or concern causing the patient to seek care
HPI: amplifies the CC describing the chronology of events as to how each symptom developed; includes patient’s thoughts/feelings; pulls relevant portions of ROS
Past medical history: lists adult illnesses with dates for events (medical, surgical, OB/gyn, psych)
Family history: outlines or diagrams age and health or age and cause of death of siblings, parents, grandparents
Personal and social history: history of tobacco, alcohol, recreational drug use, sexual history, educational level, family of origin, current household etc.

Question 4

What is the difference between subjective and objective data?

Answer 4

Subjective: what the patient is telling you
Objective: measurable data

Question 5

What is a differential diagnosis and how is it formulated?

Answer 5

List of potential causes for patient’s problems - formulated using the data from assessment

Question 6

What is the HPI?

Answer 6

concise, clear and chronologic description of the problems prompting the patient’s visit

Question 7

What are the 7 attributes of a symptom?

Answer 7

Location: where in/on the body the problem, symptom or pain occur or move to other areas
Quality: an adjective describing the type of problem, symptom or pain
Quantity or severity: patient’s nonverbal actions or verbal description as to the degree or extent of the problem, symptom or pain: pain scale, comparison of the current problem, symptom or pain to previous experiences, how bad is it?
Timing: describes when the symptom or pain started
○ Onset: setting in which it occurs, what actions or circumstances cause the problem, symptom or pain to occur worsen or improve
○ Duration: how long the problem, symptom or pain have been present or how long the problem/symptom or pain lasts
○ Frequency: how often it occurs
Remitting or exacerbating factors: actions or activities taken to improve the issue and the outcome
Associated manifestations: other s/sx that occur when the issue occurs

Question 8

What does OLDCART stand for?

Answer 8

Onset
Location
Duration
Characteristics
Aggravating/alleviating factors
Radiation
Timing

Question 9

What is a leading question?

Answer 9

Question that elicits a specific response

Question 10

How should the FNP quantify tobacco use?

Answer 10

Cigarettes are reported in pack-years; calculated by multiplying number of packs of cigarettes smoked per day by the number of years the person has smoked
One pack is 20 cigarettes

Question 11

What are the validated screening questions for depression?

Answer 11

“Over the past 2 weeks, have you felt down, depressed, or hopeless?”

“Over the past 2 weeks, have you felt little interest or pleasure in doing things?”

Question 12

What is the acronym for alcohol/drug screening?

Answer 12

CAGE
C: cutting down
A: Annoyance when criticized
G: Guilty feelings
E: Eye-openers

Question 13

What question is important to ask regarding drug use?

Answer 13

How many times in the past year have you used an illegal drug or prescription medication for non-clinical reasons?

Question 14

What is the USPSTF screening recommendation for IPV?

Answer 14

routine screening of all women of childbearing age for intimate partner violence and providing or referring those who screen positive for intervention services

Question 15

What is the difference between weakness and fatigue?

Answer 15

Weakness denotes a demonstrable loss of muscle power, if localized can be related to neuropathy or myopathy
Fatigue is a nonspecific symptom with many causes - refers to a sense of weariness or loss of energy

Question 16

When is fatigue an expected finding?

Answer 16

Normal response to hard work, sustained stress or grief, elicit the life circumstances in which it occurs
Will be associated with many chronic/acute diseases/illnesses

Question 17

How do we define weight loss?

Answer 17

loss of 5% or greater of usual body weight over a 6-month period

Question 18

How do we define obesity?

Answer 18

BMI > 30

Question 19

Define validity. What is the gold standard?

Answer 19

Measure whether the test accurately identify whether a patient has a disease
The gold standard: the best measure of whether a patient has disease

Question 20

What is the difference between sensitivity and specificity?

Answer 20

Sensitivity: probability that a person with the disease has a positive test (true positive rate)
Specificity: probability that a nondiseased person has a negative test (true negative rate)

Question 21

What type of routine screening do older adults need?

Answer 21

Fall prevention
Immunizations
Consider life expectancy, functional status

Question 22

What geriatric syndromes should the FNP assess for in older adults?

Answer 22

Falls, urinary incontinence, frailty, cognitive impairment

Question 23

What are some ways to approach a pediatric patient? (6)

Answer 23

Direct questions to child first if possible
When appropriate, review with child the purpose of the visit
Examine child on parents lap
Distract, play, patience
Engage child with questions about their interests
Move from least invasive to most invasive - save ears, mouth, abdomen for last

Question 24

When observing the parent-child interaction during an exam, what would the FNP be looking for?

Answer 24

goodness of fit between parents and child, any issues with attention, maternal depression