Anchoring bias
A clinician "locks onto" a patient's description of an aura that precedes her headaches as
indicative of a migraine and fails to recognize red flags of increased intracranial pressure
that should prompt neuroimaging for this patient
Availability heuristic
A clinician who has recently seen several patients with acute appendicitis does not consider
ovarian torsion in an adolescent girl presenting with acute right lower quadrant abdominal
pain
Confirmation bias
A clinician makes a presumptive diagnosis of an upper respiratory infection in a
well-appearing patient presenting with cough, rhinorrhea, and fever, and does not consider
pneumonia even after finding asymmetric chest wall excursion and dullness to chest
percussion on examination
Diagnostic momentum
A clinician does not consider acute myocardial infarction in a patient who was recently
diagnosed with acid reflux in the setting of similar symptoms
Representation error
Clinician who often sees older patients places diverticular bleed high on her differential
diagnosis when evaluating rectal bleeding in an adolescent patient
Framing effect
A patient is presented as having "frequent emergency room visits for asthma exacerbation in
the setting of medication noncompliance." The clinician fails to explore structural forces that
drive medication adherence and fails to explore alternative causes of the current
exacerbation
Visceral bias
Clinician assumes that a patient who is homeless will not be able to manage a complicated
treatment plan and prescribes a simpler, less optimal plan, without discussing the options
with the patient
, Clinical Reasoning Step 1
Gathering initial patient information (health history and physical examination). · Information
gathered: historical information, findings from your physical examination, and any preliminary
diagnostic and laboratory testing. information you have obtained from other clinicians and
from your review of the patient's prior health records.
Clinical Reasoning Step 2
Organizing and interpreting information to synthesize the problem (problem representation).
· Organize and interpret these sets of information with the goal of creating a concise and
appropriate problem representation (documented in the clinical record as the summary
statement). Make it a point to ask your supervising clinicians to articulate ("think out loud")
this critical step in the clinical reasoning process. Often, experienced clinicians may not be
consciously aware of this cognitive step.
Clinical Reasoning Step 3
Generating hypotheses (differential diagnosis) for patient's problem. · From this problem
representation, generate, prioritize, and test a list of possible diagnosis until you have
selected a working diagnosis
Clinical Reasoning Step 4
Testing hypotheses until a working diagnosis is selected, one that fits your patient's problem
best.
Clinical Reasoning Step 5
Planning the diagnostic and treatment strategy. · Your working diagnosis will then be your
basis for selecting your patient's treatment plan.
Which of the following steps will the NP take before beginning the comprehensive physical
examination?
All the above
3 multiple choice options
The student NP realizes that he has missed a component of the physical examination. The
best response is for the student NP to:
Examine that area out of sequence
3 multiple choice options
The beginning NP should focus on interpreting the findings of the physical examination.
False
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