Midterml Exam:l NRl 569l NR569l Latestl

Midterml Exam:l NRl 569/l NR569l (Latestl

2026/l 2027l Update)l Differentiall Diagnosisl inl Acutel Carel Practicuml Guide|l Q/Al |l Gradel A|l 100%l Correctl (Verifiedl Answers)l -Chamberlain

Q:l Principlesl ofl Goodl Documentation

**Checklistl tol Ensurel al Qualityl Clinicall Record.**

Answer:

1.l Isl thel organizationl clear?-l Makel thel headingsl clear.-l Accentl yourl organizationl withl indentationsl andl spacing.-l Arrangel thel HPIl inl chronologicl order,l startingl withl thel currentl episode,l thel fillingl inl relevantl backgroundl information.l

2.l Doesl thel includedl informationl contributel directlyl tol thel Assessment?-l Spelll outl thel supportingl evidence,l bothl positivel andl negative,l orl eachl probleml orl diagnosis.l Makel surel therel isl sufficientl detaill tol supportl yourl differentiall diagnosisl andl plan.

3.l Arel pertinentl negativesl specificallyl described?-l Oftenl portionsl ofl thel historyl orl examinationl suggestl thatl anl abnormalityl mightl existl orl developl inl thatl area.l Forl example,l forl thel ptl withl notablel bruises,l recordl thel "pertinentl negatives",l suchl asl thel absencel ofl injuryl orl violence,l familiall bleedingl disorders,l orl medications/nutritionall deficitsl thatl mightl leadl tol bruising.

4.l Arel therel overgeneralizationsl orl omissionsl ofl importantl data?-l REMEMBERl THATl ANYl INFORMATIONl NOTl RECORDEDl ISl INFORMATIONl LOST.l

6.l Isl therel tool muchl detail?-l Isl therel excessl informationl orl redundancy?l Makel yourl descriptionsl concise.l Youl canl omitl unimportantl structuresl evenl thoughl youl examinedl them,l suchl asl normall eyebrowsl 1 / 3

andl eyel lashes.l CONCENTRATEl ONl MAJORl NEGATIVEl FINDINGSl suchl asl "nol heartl murmurs"l ratherl thanl negativel findingsl unrelatedl tol thel patient'sl complaints.l

7.l Isl thel writtenl stylel succinct?l Arel phrases,l shortl words,l andl abbreviationsl usedl appropriately?l Isl datal unnecessarilyl repeated?-l Usingl wordsl orl briefl phrasesl insteadl ofl wholel sentencesl isl common,l butl abbreviationsl andl symbolsl shouldl bel usedl onlyl ifl theyl arel readilyl understood.l Omitl unnecessaryl words.l Describel whatl youl observed,l notl whatl youl did.l

8.l Arel clearl descriptionsl orl imagesl includedl wheneverl possible?-l Tol ensurel accuratel evaluationsl andl futurel comparisons,l describel findings

Q:l Evaluationl andl Managementl (E/M)l codes

Answer:

Evaluationl andl managementl (E/M)l codingl involvesl thel usel ofl CPTl codesl rangingl froml 99202-99499.l Thesel representl servicesl byl al providerl inl whichl thel providerl isl eitherl evaluatingl orl managingl al patient'sl health.

Q:l Evidence-Basedl Medicine

Answer:

-l Thel conscientious,l explicit,l judiciousl andl reasonablel usel ofl modern,l bestl evidencel inl makingl decisionsl aboutl thel carel ofl individuall patients.

Q:l PICOTl question

Answer:

-l Al mnemonicl derivedl froml thel elementsl ofl al clinicall researchl questionl -l Patient,l Intervention,l Comparison,l Outcomel andl Time.l Thel PICOTl processl beginsl withl al casel scenario,l andl thel questionl isl phrasedl tol elicitl anl answer.

Q:l Sensitivity

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Answer:

Sensitivityl refersl tol al test'sl abilityl tol designatel anl individuall withl al diseasel asl positive.l -l Al sensitivel testl correctlyl identifiesl patientsl dol whol havel thel diseasel inl question.l Testsl withl highl sensitivityl arel ideall screeningl testsl tol discoverl asl manyl patientsl asl possiblel withl thel disease,l frequentlyl al tradeoffl ofl increasedl falsel positivel results.l **Confirmatoryl testingl mayl requirel al morel specificl test.**

Q:l Sensitivityl Formula

Answer:

-l Tol calculatel sensitivityl thel numberl ofl patientsl whol dol havel thel diseasel andl testl positivel (truel positivel =l TP)l isl dividedl byl alll whol havel thel disease,l includingl thosel whol falselyl testl negativel (falsel negativel =l FN)

-l TP/(TPl +l FN)

Q:l Specificity

Answer:

-l Specificityl refersl tol thel abilityl ofl testingl tol recognizel patientsl whol dol notl havel thel disease.l -l Forl example,l D-Dimerl hasl highl sensitivityl andl willl bel positivel inl mostl casesl ofl PE;l however,l thisl comesl atl thel costl ofl al highl falsel positivel ratel duel tol lowl specificity.l Al confirmatory,l morel specific,l imagingl testl mayl bel requiredl tol makel thel diagnosis.

Q:l Specificityl Formula

Answer:

-l Tol calculatel specificity,l thel numberl ofl patientsl whol testl negativel andl dol notl havel thel diseasel (truel negativel =l TN)l isl dividedl byl thel totall numberl withoutl thel disease,l includingl thosel whol falselyl testl positivel (falsel positivel =l FP).l

-l TN/(TNl +l FP)

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