Exam Study Guide BUNDLE | contains both Midterm Exam & Final Exam NR509 \/ NR 509 Advanced Physical Assessment – Chamberlain.<\/p>\n\n\n\n
NR-509 Advanced Physical Assessment
NR509 Midterm Exam Study Guide
\uf0b7 Articular structures include joint capsule and articular cartilage, the
synovium and synovial fluid, intra-articular ligaments and juxta-articular
bone
o Articular disease involves:
\uf0a7 Swelling
\uf0a7 Tenderness of the joint
\uf0a7 Crepitus
\uf0a7 Instability \u201clocking\u201d
\uf0a7 Deformity
\uf0a7 Limits active and passive range of motion due to stiffness or
pain
\uf0b7 Extra-articular structures include periarticular ligaments, tendons, bursae,
muscle, fascia, bone, nerve and overlying skin
o Extra-articular disease involves:
\uf0a7 \u201cpoint of focal tenderness in regions adjacent to articular
structures
\uf0a7 Limits active range of motion
\uf0a7 RARELY causes swelling, instability, joint deformity
Know the sources of joint pain (pg. 627 algorithm)
\uf0b7 Nonarticular conditions: trauma\/fracture, fibromyalgia, polymyalgia
rheumatica, bursitis, tendinitis
\uf0b7 Intra-articular (acute, < 6 weeks): acute arthritis o infectious arthritis o gout o pseudogout o Reiter syndrome \uf0b7 Intra-articular (chronic, > 6 weeks): chronic inflammatory arthritis vs chronic
noninflammatory arthritis
o Chronic inflammatory arthritis with 1-3 joints involved:
\uf0a7 Indolent infection
\uf0a7 Psoriatic arthritis
\uf0a7 Reiter syndrome
\uf0a7 Periarticular JA
o Chronic inflammatory arthritis with >3 joints involved:<\/p>\n\n\n\n
\uf0a7 Psoriatic arthritis or Reiter syndrome (no symmetry)
\uf0a7 rheumatoid arthritis if not RA then \uf0e0 systemic lupus,
scleroderma, polymyositis
*Know what causes saddle numbness and urinary retention (pg. 678?)
\uf0b7 CES (cauda equina syndrome) most commonly results from a massive
herniated disc in the lumbar region.
\uf0b7 A single excessive strain or injury may cause a herniated disc.
\uf0b7 However, disc material degenerates naturally as a person ages, and the
ligaments that hold it in place begin to weaken. As this degeneration
progresses, a relatively minor strain or twisting movement can cause a disc to
rupture.
The following are other potential causes of CES:
\uf0b7 Spinal lesions and tumors
\uf0b7 Spinal infections or inflammation
\uf0b7 Lumbar spinal stenosis
\uf0b7 Violent injuries to the lower back (gunshots, falls, auto accidents)
\uf0b7 Birth abnormalities
\uf0b7 Spinal arteriovenous malformations (AVMs)
\uf0b7 Spinal hemorrhages (subarachnoid, subdural, epidural)
\uf0b7 Postoperative lumbar spine surgery complications
\uf0b7 Spinal anesthesia
Know how retinal detachment presents (p.217)
\uf0b7 Sudden, painless vision loss that is unilateral
Know what the word obtunded means (p. 769)
\uf0b7 The obtunded patient opens eyes and looks at you but responds slowly and is
somewhat confused. Alertness and interest in the environment are decreased.
Know what cranial nerve you\u2019re assessing when checking lateral gaze (p. 237)
\uf0b7 Cranial nerve VI: abducens
Know what should be listed under adult illnesses in health history (pg. 10)
\uf0b7 Medical illnesses: such as diabetes, hypertension, hepatitis, asthma, and
HIV. Also hospitalizations, number and gender of sexual partners, and risktaking sexual practices
\uf0b7 Surgical: dates, indications, and types of operations<\/p>\n\n\n\n
\uf0b7 Obstetric\/Gynecologic: obstetric history, menstrual history, methods of
contraception, and sexual function
\uf0b7 Psychiatric: illness and timeframe, diagnoses, hospitalizations, and
treatments
Know what conditions do not have red reflexes (p. 239)
\uf0b7 Absence of red reflex suggests an opacity of the lens (cataract), or possibly the
vitreous (or even an artificial eye).
\uf0b7 Less commonly, a detached retina, or in children a retinoblastoma may
obscure this reflex.
Know the signs of seasonal allergies (p. 27)
\uf0b7 itching, watery eyes, sneezing, ear congestion, postnasal drainage
Know how optic neuritis presents (p. 217)
\uf0b7 Sudden visual loss that is unilateral and can be painful, associated with
multiple sclerosis
Know how pityriasis rosacea presents (p. 912)
\uf0b7 Oval lesions on trunk, in older children often in a Christmas tree pattern,
sometimes a Harold patch (a large patch that appears first)
Know what is listed under present illness (p. 9)
\uf0b7 Complete, clear, and chronologic description of the problems prompting the
patient\u2019s visit, including the onset of the problem, the setting in which it
developed, it\u2019s manifestation and any treatments to date.
\uf0b7 (OLDCART) Onset, Location, Duration, Characteristics, Aggravating factors,
Relieving factors, Treatments (past)
Know where the acromion process is (be able to identify it on a picture)
\uf0b7 Located between the clavicle and the shoulder<\/p>\n\n\n\n
*Know what to do if you have a + finding on physical exam but otherwise negative
work-up (p. 30)
Know what can cause falsely high BP\u2019s (p. 127)
\uf0b7 If the brachial artery is below the heart level, the blood pressure reading will
be higher. If the cuff is too small (narrow) the blood pressure will read high.
\uf0b7 If the cuff is too large (wide) the BP will read high on a large arm
Know how to check for nystagmus (p. 737)
\uf0b7 Nystagmus is seen in cerebellar disease especially with
o gait ataxia
o dysarthria (increases with retinal fixation
o vestibular disorders (decreases with retinal fixation)
o internuclear ophthalmoplegia
\uf0b7 Identify any nystagmus, an involuntary jerking movement of the eyes with
quick and slow components.
\uf0b7 Note the direction of the gaze in which it appears, the plane of the nystagmus
(horizontal, vertical, rotary, or mixed), and the direction of the quick and slow
components.
\uf0b7 Nystagmus is named for the direction of the quick component.
\uf0b7 Ask the patient to fix his or her vision on a distant object and observe if the
nystagmus increases or decreases.
Know what yellow sclera indicates (p. 234)
\uf0b7 A yellow sclera indicates jaundice
<\/p>\n\n\n\n
NR-509 Advanced Physical Assessment
NR509 Final Exam Study Guide
Chapter 1 – Foundations for Clinical Proficiency
-Know what should be listed under adult illnesses in health history (p.10)
Medical, Surgical, OBGYN, Psychiatric
-Know what is listed under present illness (p.9)
Problems prompting the patients visit, including the onset of the problem, the setting in which it
developed, its manifestations, and any treatments to date
-Know what makes up the health history (subjective) (p.7)
Identifying data and source of the history; reliability
Chief complaint(s)
Present Illness
Past history
Family history
Personal and social history
Review of Systems
-Know how to prioritize patient complaints (p.37)
List most active & serious problems first and their date of onset
Problems can be symptoms, signs, past health events such as a hospital admission or surgery or
diagnoses
-Be able to figure out what is missing in an HPI (p.9)
O.L.D.C.A.R.T
-Know what subjective information is (p.6)
What patient tells you
-Know what objective information is (p.6)
Examination findings, vital signs, laboratory data
-Know the C-sections should be listed in surgeries (p.10)
Surgical history- make sure you include date, indication, type of surgery.
-Subjective info (ROS) (p.12)
Goes under the review of systems<\/p>\n\n\n\n
Chapter 2 – Evaluating Clinical Evidence
Evaluating Clinical Evidence
Critical Thinking and Clinical Reasoning
Differential Diagnoses
Pathological and Physiological Processes
Problem List
Problem Prioritization
Chapter 3 – Interviewing and the Health History
-Know how to get a patient to open up when they seem upset (p.72)
Effective reassurance-identifying and acknowledging patients feelings
Meaningful reassurance-deal openly with concerns
Validate the legitimacy of his or her emotional experience
Moving closer or making physical contact
-Know that you need permission of the patient to carry out the visit if someone is in the room
(p.75)
Whenever visitors are present, you are obligated to maintain the patient\u2019s confidentiality
-Know how to make a pelvic exam less intimidating (p.76)
Avoid interviewing patient when she is already positioned for a pelvic exam
-Know that if a patient return from a country with malaria you still need to be selective of which
patients you screen for malaria (p.66) Review page
-Where to sit when interpreter in the room (p.90)
Arrange seating so that you have eye contact with the patient, have the interpreter sit close or
behind you (keeps you from turning your head back and forth)
-Know the order of meeting a patient and conducting an interview (p.73)<\/p>\n\n\n\n
Chapter 4 – Beginning the Physical Examination: General Survey, Vital Signs, and Pain
-Know what can cause falsely high BP (p.127)
Cuff too small BP will read high; cuff too large BP will read low on small arm and high on large
arm
Brachial artery below heart, BP will be higher, if brachial artery is above heart, reading will be
lower
-Know what is included in constitutional symptoms (p.112)
Fatigue, weakness, fever\/chills, night sweats, weight changes or pain
-BMI interpretation (p.122)
The BMI incorporates estimated but more accurate measures of body fat than weight alone
Chapter 6 – The Skin, Hair, and Nails
-Know that cherry angiomas are benign (p.196 & 205)
Benign tumors that result from overgrowth of capillaries
-Know risk factors of melanoma (p.177)
-Know what acanthosis nigricans can clue into (p.207)
Diabetes
-Know labs to check with vitiligo (p.191)
Thyroid panel\/CBC
-Know how psoriasis presents (p.192)
Scattered erythematous; raised on skin, over 1 cm; plaque- Raised papule- rough, dry, silver,
grey. Found most often over joints.
<\/p>\n","protected":false},"excerpt":{"rendered":"
Exam Study Guide BUNDLE | contains both Midterm Exam & Final Exam NR509 \/ NR 509 Advanced Physical Assessment – Chamberlain. NR-509 Advanced Physical AssessmentNR509 Midterm Exam Study Guide\uf0b7 Articular structures include joint capsule and articular cartilage, thesynovium and synovial fluid, intra-articular ligaments and juxta-articularboneo Articular disease involves:\uf0a7 Swelling\uf0a7 Tenderness of the joint\uf0a7 Crepitus\uf0a7 Instability […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-114713","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/114713","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=114713"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/114713\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=114713"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=114713"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=114713"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}