NURS550 Advanced Health Assessment and Diagnostic Reasoning Week 1
Guided Reading Exam Questions And Answers
Chapter 1 (p 4-34) - ANSWER FOUNDATIONS FOR CLINICAL PROFICIENCY
1. Define the types of pain
a. Nociceptive or somatic
Tissue damage- ANSWER Pain related to tissue damage of the skin, musculoskeletal
system, or viscera-visceral pain-but with an intact sensory nervous system, as in
arthritis or spinal stenosis. It can be of an acute or chronic nature. It is mediated
through the afferent A-delta and C-fibers of the sensory system. The afferent
nociceptors involved may be sensitised through inflammatory mediators and modulated
by psychological process and neurotransmitters such as endorphins, histamines,
acetylcholine, serotonin, norepinephrine, and dopamine.
b. Neuropathic - ANSWER Result of trauma directly to the peripheral or central nervous
system
The mechanisms that are postulated to evoke neuropathic pain include central nervous
system injury due to stroke or trauma of the brain or spinal cord; peripheral nervous
system disorders that cause entrapment or pressure on spinal nerves, plexuses, or
peripheral nerves; and referred pain syndromes with increased or prolonged pain
responses to inciting stimuli.
c. Idiopathic - ANSWER pain without an identifiable etiology.
d. Psychogenic - ANSWER pain involves the many factors that influence the patient's
report of pain—psychiatric conditions like anxiety or depression, personality and coping
style, cultural norms, and social support systems.
2. Identify examples of when you would obtain (2 examples for each):
a. A comprehensive health history/exam - ANSWER Appropriate for new patients in the
office or hospital
, b. A focused health history/exam - ANSWER Appropriate for established patients
especially during routine or urgent care visits
Addresses focused concerns or symptoms
( eg. sore throat or knee pain)
3. Compare and contrast subjective and objective data - ANSWER Subjective data:
information from the patient
Objective data: data observed during the physical exam, lab and test results
a. Give an example of what would be considered Subjective data - ANSWER The
symptoms and history, from Chief Complaint through Review of Systems
Sample: Mrs. G. is a 54-year-old hairstylist who refers to pressure over her left chest
"like an elephant sitting there," which extends into her left neck and arm.
b. Provide examples of what would be Objective data - ANSWER All physical
examination findings, or signs
Sample: Mrs. G. is a respectful and easygoing overweight elderly white female. Height
5′4′′, weight 150 lbs, BMI 26, BP 160/80, HR 96 and regular, respiratory rate 24,
temperature 97.5 °F
4. For each element of the complete health history describe what is included
a. Identifying data and source of history - ANSWER Identifying data—such as age,
gender, occupation, marital status
Source of the history—usually the patient, but can be a family member or friend, letter of
referral, or the clinical record
If appropriate, establish the source of referral, because a written report may be needed
b. Chief complaint - ANSWER The one or more symptoms or concerns causing the
patient to seek care.
Note: make every attempt to quote the pt's own words. Eg. "my stomach hurts and I feel
awful"
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