NR 302 Exam 1

Student Name

Chamberlain University

NR-302: Health Assessment I

Prof. Name

Date

NR 302 Exam 1

Test One Concept Review: Physical vs. Emotional

The distinction between physical and emotional aspects in nursing communication is essential for determining whether a question seeks an objective, fact-based answer or a communication-oriented, subjective response.

• Clues for objective answers often include phrasing like: How do you…?, What type of data…?, What is the name…?, What steps…?, Which technique…?, or specific mentions of “physical” or “emotional.”
• Clues for communicative or emotional answers include: What factors…?, What approach…?, The nurse expects…?, How to improve…?, and How to eliminate…?

1. Communication

Open-ended vs. Closed-ended Questions

• When to use open-ended questions: These are best when more narrative, descriptive information is needed. For example, during the patient’s history-taking or when encouraging them to elaborate on symptoms.
• When to use closed-ended questions: These are useful when specific, concise answers are needed—such as confirming details, guiding the interview back on track if the patient digresses, or concluding the interview.

Type of Question	Purpose	Example
Open-ended	Encourages detailed responses and personal narratives	“Can you describe what your pain feels like?”
Closed-ended	Seeks specific, factual responses	“What time did you take your medication?”

Examples:

• Open-ended: “How has your condition affected your daily routine?”
• Closed-ended: “Did you take your medication this morning?”

Cultural Awareness in Nursing

Cultural sensitivity is a cornerstone of quality nursing care. When approaching patients from different cultural backgrounds:

• The patient is the most reliable source for cultural information.
• Respecting cultural beliefs is critical.
• Care plans should be adapted to fit those beliefs.

If the patient refuses care due to cultural beliefs: The nurse should acknowledge and respect their decision while providing education on available alternatives.

Verbal Responses During the Interview

• Confrontation: Address discrepancies between statements and observations.
  Example: “You mentioned you don’t smoke, but I noticed cigarettes in your pocket. Can we clarify that?”
• Interpretation: Provide your understanding of the patient’s situation based on collected data.
• Explanation: Offer factual information about the patient’s condition or results.
• Summary: Condense and restate key points discussed during the interview.

Technique	Purpose	Example
Confrontation	Clarifies inconsistencies	“You said you have no pain, but I notice you grimacing.”
Interpretation	Links events or patterns	“Your symptoms seem to worsen after physical activity.”
Explanation	Informs with factual data	“Your lab results show elevated glucose levels.”
Summary	Condenses and reviews facts	“So today we discussed your cough and breathing issues.”

Techniques for a Successful Interview

• Create a comfortable environment: Ensure appropriate room temperature and privacy.
• Maintain appropriate non-verbal communication: Facial expressions, eye contact, and avoiding distracting gestures.
• Show empathy: Express genuine concern for the patient’s situation.

Traps to Avoid

• Talking excessively
• Using medical jargon
• Offering false reassurance
• Displaying authoritative behavior
• Interrupting the patient

Interpreters in the Hospital Setting

Only certified and trained interpreters should provide translation services in healthcare settings. Bilingual staff may serve as interpreters if they have completed proper certification.

2. Subjective vs. Objective Data

In nursing, subjective data refers to information reported by the patient that cannot be directly measured or verified, such as feelings or perceptions. Objective data, on the other hand, includes observable signs, measurable findings, and diagnostic results obtained through examination or testing.

Subjective Example	Objective Example
“I feel nauseous.”	Patient observed vomiting.
“I feel dizzy.”	Gait is unsteady when standing.
“I think I have an infection.”	Elevated WBC, fever, increased HR and RR.
“My pain is 8/10.”	FLACC score 5, patient grimaces, HR elevated.
“I have a headache; my BP must be high.”	BP recorded at 160/90 mmHg.
“I feel hot.”	Temperature recorded at 101°F.
“My baby has had a fever for 24 hours.”	Temperature recorded at 98.9°F.

Key point: Both subjective and objective data are important for forming a complete clinical picture.

3. Priority Setting in Patient Care

In clinical decision-making, patient needs are ranked according to urgency:

Priority Level	Description	Examples
First-level	Life-threatening and emergent	Airway obstruction, respiratory distress, shock
Second-level	Urgent, prevents deterioration	Acute pain, sudden mental status change, severe hyperglycemia
Third-level	Can be addressed later	Discharge teaching, family support, home care arrangements

Note: Immediate attention to first-level priorities is critical before addressing lower-priority needs (Potter et al., 2021).

4. Nursing Basics

Hand Hygiene

The single most important practice to prevent disease transmission in healthcare is proper hand hygiene.

Stethoscope Use

• Diaphragm: Best for high-pitched sounds (e.g., normal heart, lung, and bowel sounds).
• Bell: Best for low-pitched sounds (e.g., heart murmurs, bruits).

Vital Sign	Normal Range (Adult)
Blood Pressure	~120/80 mmHg
Heart Rate	60–100 bpm
Respiratory Rate	10–20 breaths/min
Temperature	96.5–99°F (35.8–37.2°C)
Oxygen Saturation	≥90%

5. The Nursing Process

The nursing process is a systematic framework with six steps (ADOPIE):

Step	Action	Example
Assessment	Collect data from multiple sources	Physical exam, patient history
Diagnosis	Interpret data to identify problems	Acute pain related to injury
Outcome Identification	Set measurable goals	“Patient will walk independently in 3 days”
Planning	Develop plan of care	PT referrals, wound care
Implementation	Carry out interventions	Administer meds, provide education
Evaluation	Assess outcomes	Check if goals met

6. Developmental Considerations

Older Adults

• Keep the environment comfortable.
• Move the patient as little as possible.
• Give instructions slowly.
• Do not assume reduced cognitive function based on age alone.

Adolescents

• Establish trust and confidentiality.
• Encourage honest answers.
• Respect their growing autonomy.

Toddlers & Infants

• Approach toddlers through caregivers first; allow warming-up time.
• Use a calm, soothing voice with infants.

Why adolescents require more calories: Hormonal changes, muscle growth, and bone development increase energy needs.

7. Level of Consciousness & Mental Status

To assess orientation, ask four questions:

1. What is your name?
2. Where are you?
3. What is the date or time?
4. What is happening right now?

A&Ox2: Patient is oriented to two factors.
A&Ox3: Oriented to three.

NR 302 Exam 1

State	Description
Alert	Fully awake and responsive
Lethargic	Sleepy but can stay awake without help
Obtunded	Requires repeated stimulation to stay awake
Coma	Unresponsive to stimuli
Delirium	Acute confusion, often reversible
Chronic Confusion	Long-standing disorientation

Quick mental status tools: Mini-Mental State Examination (MMSE).

8. Nursing Assessment

Order of Physical Assessment:

1. Inspection – Observe appearance and function.
2. Palpation – Feel for temperature, texture, and masses.
3. Percussion – Tap to detect abnormalities.
4. Auscultation – Listen to heart, lungs, and bowel sounds.

General survey includes: Age, sex, consciousness, ethnicity, and skin color.

System	Main Method
Skin	Inspection
Abdomen	Auscultation
Lungs	Auscultation
Heart	Auscultation
Organs	Palpation

9. Pain

Most reliable source: The patient’s self-report.

Before giving pain meds: Check vital signs, level of consciousness, and investigate cause.
Do not give meds if there is a contraindication (e.g., allergy, risk of respiratory depression).

Pain Types:

• Acute (nociceptive): Short-term, protective, resolves when cause is treated.
• Chronic (neuropathic): Persistent, often due to nerve damage.

Source	Origin
Visceral	Internal organs
Somatic	Muscles, bones, joints
Cutaneous	Skin
Referred	Pain felt away from origin

10. Nutrition

Factors affecting nutrition include:

• Physical problems: Swallowing disorders, GI conditions.
• Age-related changes: Reduced appetite, altered metabolism.

To assess diet: Use food diaries, patient interviews, or direct observation.

BMI formula:

BMI=Weight (kg)Height (m)2BMI = \frac{\text{Weight (kg)}}{\text{Height (m)}^2}

BMI is a standard medical tool for classifying weight status.

References

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2021). Fundamentals of nursing (10th ed.). Elsevier Health Sciences.

Jarvis, C. (2020). Physical examination & health assessment (8th ed.). Elsevier.

NR 302 Exam 1

American Nurses Association. (2022). Code of ethics for nurses with interpretive statements. ANA Publishing.