261 Study Guide Midterm
If it’s not on this list it’s not on the midterm!!
Multiple choice test-60 questions; 90 mins
Taking the midterm in class, bring pencil and V-#
Hey guys! I thought it would be helpful for us to combine study guides/ work on this stuff
together. I’ve already started, so please feel free to add stuff/ make notes anywhere and
everywhere! -Rachel
1. What are the different types of health assessments, and when would each be
performed?
o Comprehensive health assessment: mainly done in the community by nurses; doctors/residents
in a hospital setting (head to toe; typically at admission)
o Problem-based or focused health assessment: example is cardiac; focuses on an any urgent
change in status or a particular risk related to the hospitalized pts situation
o Episodic assessment: follow-up exam
o Shift assessment: first encounter – hospital when you come on shift; an abbreviated exam with
emphasis on critical body systems and areas of risk
● Ten minute assessment is a good example of a shift assessment
○ ABC: Airway, Breathing, Circulation
o Screening assessment: person is basically well, but looking for an opportunity to promote
health and wellness; short exam focused on disease detection (ex:BP, physical etc…)
2. What are the purposes of a nursing health assessment?
● To conduct a health history and perform a physical exam while taking in the pts age,
gender, physical and psychological status
● Correct problem identification: first assessment gives you a baseline.
● Detecting changes in patient’s condition: reassessment is needed after a change such as
giving a new medication or giving blood.
● Ongoing process for evaluating effectiveness (or not) of care plan
● Developing a therapeutic relationship: Touch is therapeutic. Have effective
communication (Be courteous, provide comfort, establish a connection, confirm what the
patient says and feels). As a nurse, your appearance, demeanor, and comfort level serve as
nonverbal communication that the patient can pick up on. You will have to tailor how you
communicate to each patient. Never use “honey” or “sweetie.”
● Understanding patient’s experience of illness: Patients may have tremendous fear that
their symptoms are the result of cancer or another debilitating disease. They may be
embarrassed or they may not understand their condition or medical terminology that you
use. Always communicate vitals and information – this reassures the patient and provides
them the opportunity to tell you if what you observe and the objective data you gather is
, normal for them; i.e. blood pressure. Always find out their health literacy. This can serve
as a good teaching area.
● Basis for planning nursing care – to restore, maintain, or improve the patient’s health
● Maintaining a safe patient care situation
3. What are the steps in clinical decision making?
● Problem formation, data input, data interpretation also known as noticing, interpreting,
responding, reflecting
● Clinical decision making requires careful reasoning (i.e., choosing the options for the best
patient outcomes on the basis of a patient’s condition and the priority of the problem.)
● Assessment, nursing diagnosis, planning, implementation
● You must know your patient so that you can recognize changes that are abnormal for
them.
● Steps of Evidence Based Clinical Decision making according to Fundamentals of
Nursing Textbook:
○ Ask a Clinical question - what makes sense to you and what needs to be clarified?
○ Search for the most relevant and best evidence - using all of the most reliable
resources around you
○ Critically appraise the evidence you gather - evaluate everything you find and
determine its value, feasibility, and usefulness regarding your clinical question.
○ Integrate all evidence with your clinical expertise and patient preferences/values. -
once you decide the evidence you found is strong enough to use how can you
integrate it into a way to use with your patients?
○ Evaluate the outcomes of practice decisions or changes using evidence.
○ Share the outcomes of Evidence based practice with others
4. What are the factors in symptom analysis?
● (OLDCARTS) -used to assess pain;
○ Onset- When did this first happen?
○ Location- Where exactly in the body is this problem?
○ Duration- How has the symptom changed over time? Has it gotten better? Worse?
Is it in intervals or constant? How has the symptom behaved since the onset?
○ Character- characteristics. Example - what type of pain? What type of cough?
○ Alleviated/Aggravating factors- What makes it better? What makes it worse?
○ Related Symptoms- What happens at the same time this symptom occurs?
○ Treatment- what are some prescribed treatments that the patient is currently on or
has previously tried? Example could be taking nitroglycerin for sudden onset of
chest pain
○ Severity- usually a 0-10 pain scale; 0 being no pain and 10 being the worst pain
you have ever felt
5. How does the nurse assess pain?
, ● Nature of pain – “Describe your pain,” “Place your hand over the area that hurts or is
uncomfortable.”
● During physical assessment, observe the patient’s nonverbal cues. And, observe where
patient points to pain; note if it radiates or is localized.
● Precipitating factors – “Do you notice if pain worsens during any activities or specific
time of day,” “Is pain associated with movement?”
● During assessment, observe if the patient demonstrates nonverbal signs of pain during
movement, positioning, swallowing.
● Severity – “Rate your pain on a scale of 0 to 10.”
● During assessment, inspect the area of discomfort; palpate for tenderness.
6. Know the difference between biological sex, gender identity, gender expression,
and sexual orientation.
● Biological sex- are you male or female → Male = XY → Female = XX
○ Ovaries & testes: some people have both, some have one of each, some have other
variations.
○ Some people can be born with genitalia that is very difficult to distinguish.
○ Criteria: chromosomal configuration, gonads, internal reproductive structures,
external genitalia, hormonal secretions, sex assigned at birth, gender identity
● Gender identity- who you consider yourself to be
● Gender expression- how you choose to portray yourself to the world (He, She, They).
How they express gender (clothing, appearance, behavior)
● Sexual orientation- to whom you are attracted to in an erotic way
7. Differentiate between culturally-sensitive and culturally-insensitive methods for
asking about gender identity and sexual orientation.
● Your assessment needs to match how the patient would assess themselves when it comes
to sexuality, gender identity, biological sex, and sexual orientation.
● Ask your patient what they would like to be called. Don’t automatically assume they are
a woman or a man.
8. Compare health promotion and health protection.
● Health promotion- behavior motivated by desire to increase well-being and actualize
health potential. A person is relatively healthy already, trying to increase wellbeing.
Already healthy – ex: suggest 30 minutes of exercise each day if they don’t already get it.
● Health protection- behavior motivated by desire to avoid illness, detect illnesses early,
and maintain functioning when ill. Trying to avoid, delay, or prevent a health problem.
You would help them to avoid a health problem, such as early blood pressure screening if
they have a family history of hypertension.
○ Four levels of health literacy: Below Basic, Basic, Intermediate, & Proficient.
One in seven adults is below basic, ex: can’t read directions on medication bottle.
