Question 1

In a genogram,a square that is blackened represents a

Accepted Answer

In a genogram,the symbol of a circle represents a female; a square,a male.If the individual is deceased,the symbol is blackened or marked with an "X." If the individual is alive,the symbol is some color other than black.

Question 2

It is important to assess the educational level of patients primarily to

Accepted Answer

Assessing the educational level of patients is important to determine their ability to read and write in order to tailor information and questions to this level.The health history serves as the foundation for the patient's plan of care and as a means of communicating information to other health care team members.The more complete the HH is,the better; however,this is not the primary reason to assess educational level.Option "b" is also not the primary reason to assess educational level.The patient's education will determine the level at which to provide information,but not the amount of information.

Question 3

After completing the examination of a newly admitted patient,the nurse would document the patient's chief complaint in terms of

Accepted Answer

The chief complaint (CC)is the sign (objective finding)or symptom (subjective finding)that causes the patient to seek health care.The reasons for seeking health care and the chief complaint should be recorded as direct quotes from the patient.They should not be direct quotes from either the health care provider or the nurse.Associated manifestations are one of ten characteristics of the chief complaint and refer to the signs and symptoms that accompany the CC.

Question 4

The PQRSTU mnemonic is a method to remember the characteristics of the chief complaint.If a patient reported tingling in the left arm,the nurse would document this data under which of the following?

Accepted Answer

R is for region (location)and radiation.Tingling in the left arm refers to a location.P is for what provokes the chief complaint (aggravating factors)and for palliative measures or what decreases the severity of the chief complaint (alleviating factors).S is for severity (quantity)and setting in which the chief complaint occurs.T is for timing of the chief complaint (onset,duration,and frequency).U is for the understanding of what the patient's chief complaint means to her (meaning and impact).

Question 5

During the interview,your patient states that his chest pain started before lunch,when he was painting his house,and it lasted about 15 minutes.According to the patient,the pain was relieved when he rested in a chair,but it reoccurred twice today along with tingling in his left arm while he was walking.You would report the duration of the patient's chest pain as

Accepted Answer

The timing used to describe the chief complaint has three elements: onset,duration,and frequency.Duration indicates the amount of time in which the chief complaint is present.Continuous and intermittent are terms used to describe the duration of the complaint.When possible,the duration of the chief complaint should be stated in specific time increments such as minutes,hours,or days.Acute and severe are terms that depict the quantity of the chief complaint.Onset refers to the time at which the chief complaint begins and is usually described as gradual or sudden.

Question 6

A 14-year-old girl has received treatment for a sexually transmitted disease and has been suspended from school for drug use.You follow the suggested guidelines for addressing sensitive topics in your interview with the adolescent.The guidelines include

Accepted Answer

Alcohol,drug use,and sexual practices are some of the most sensitive areas that are addressed in the health history.Guidelines for dealing with these sensitive topics include: posing questions in a matter-of-fact tone; using direct eye contact (this demonstrates to the patient the importance of the topic and your lack of embarrassment); adopting a nonjudgmental demeanor; and asking these questions in the later stages of the interview after rapport has been established.

Question 7

In 2007,carbamazepine became the first mainstream medication to carry a recommendation by the Food and Drug Administration that patients of Asian descent be tested for the HLA-B*1502 gene before starting drug therapy.Asian patients are almost exclusively carriers of this gene,and if placed on carbamazepine,might develop Stevens-Johnson syndrome.What is the most significant outcome of this recommendation?

Accepted Answer

This announcement heralded the start of an era that is sure to continue,that is,the ability to make decisions about which medications patients should or should not take based on their ethnicity and/or race.Stevens-Johnson syndrome is a severe side effect of many medications; therefore,this finding will not provide for early detection.Likewise,it will not provide a cure for the syndrome.Although this recommendation may guide genetically based nursing care,it is not the most significant outcome.

Question 8

A patient answers "yes" to the nurse's question,"In the past year,have you been hit,kicked,punched,or hurt in other ways by someone close to you?" What next nursing intervention is most important?

Accepted Answer

If a patient answers "yes" to questions which assess for domestic and intimate partner violence,the next most important nursing intervention is to inquire if the patient feels safe.Most emergency departments have resources available to assist an abused patient into a climate where she can receive help and feel safe.A physical exam should be performed during this visit,but it is not the next most important intervention.Documenting physical findings concisely and accurately is imperative,but the patient's safety is paramount.

Question 9

Obtaining a complete health history typically requires approximately

Accepted Answer

Taking a complete health history typically requires 30-60 minutes Inform the patient before the interview starts of the amount of time that will be required.The information elicited in such a history is extensive and cannot be completed in 10-15 minutes or 20-30 minutes.If the health history is not completed within the allotted time,it may be best to continue it later to avoid fatiguing the patient.Therefore,90-120 minutes is an incorrect option.

Question 10

The most effective way to assess the quantity of pain is to ask the patient to

Accepted Answer

Quantity depicts the severity,volume,number,or extent of the chief complaint.One mechanism that can be used to assess the quantity of pain is a numerical scale,known as the visual analog scale,which rates pain from 0 (no pain)to 10 (worst pain possible).The terms in options "a" and "b" are subjective and therefore difficult to quantify.If the patient consistently uses the same terms,then a relative scale can be used to assess whether the chief complaint is improving or becoming worse.Option "d" will elicit a subjective term,such as better or worse,which is difficult to quantify.

Question 11

Your patient has smoked 1.5 packs of cigarettes a day for the past 15 years.Prior to that he smoked 3.5 packs of cigarettes a day for 30 years.You record his pack/year history as

Accepted Answer

The quantity of cigarette smoking is usually described in pack/year history.To calculate the patient's pack/year history,multiply the number of packs of cigarettes smoked on a daily basis by the number of years that the patient has smoked.
pack/year history = 1.5 × 15 = 22.5
= 3.5 × 30 = 105
Total pack/year history = 22.5 + 105 = 127.5

Question 12

A patient tells you that he periodically takes a prescribed medication to relieve arthritis pain.It was prescribed by his health care provider 5 years ago.What is the nurse's most appropriate response?

Accepted Answer

Many patients keep unused medications past their expiration date.This presents a potential health hazard because some medications lost their potency after a period of time,and others become toxic.The nurse should inform the patient to discard any unused portion of medication by the stated expiration date.It is potentially unsafe to continue taking an expired medication; therefore,option "b" is not appropriate.It is inappropriate for the nurse to ask the patient's health care provider for a new prescription.Because herbal products are considered dietary supplements in the United States,they are not held to the same level of scrutiny and accountability as medications.Different brands of the same herbal product can have varying levels of potency and purity.It is not appropriate for a nurse to recommend an herbal product in this instance.

Question 13

Your patient complains of sneezing accompanied by clear nasal discharge and watering eyes,but he denies having a sore throat,body aches,cough,or fever.The pertinent negative finding(s)in your assessment of the patient include

Accepted Answer

Negative findings,also called pertinent negatives,are those manifestations expected in the patient with a suspected pathology,but which are denied by the patient.If the patient does not mention specific signs or symptoms that might be present with a given illness,ask whether they are present.Lack of pertinent negatives may lead to a different diagnosis.Document both positive findings and pertinent negatives because both give clues to the patient's condition.

Question 14

Which question is most appropriate to elicit the patient's history of her present illness?

Accepted Answer

The history of the present illness (HPI)is a chronological account of the patient's CC and the events surrounding it.The chronology can be taken in one of two ways: from the current state of the problem back to its origin (reverse chronology)or from the origin of the symptom leading to the current status (forward chronology).Option "d" allows the patient to give the HPI in forward chronology.The question in option "a" elicits the reason the patient is seeking health care today.The question in option "b" is appropriate in obtaining the timing of the CC.It asks for the onset of the CC or the time at which it began.The question in option "c" elicits the meaning or significance of the CC to the patient and the impact of the CC on the patient's lifestyle.

Question 15

When interviewing a patient whose health problems are most likely related to exposure to a potentially dangerous substance,which areas should you explore?

Accepted Answer

The work environment can be hazardous.Exposure to toxic substances such as asbestos and lead is a factor that can create health problems.Military personnel who have been in combat areas may have been exposed to many chemicals and toxic agents.Potentially dangerous substances exist in the home environment also.Older houses may have been painted with lead-based paint,which poses a health threat to a young child who might eat the paint chips.The presence of radon gas in the home is also a health concern.Hobbies such as constructing model cars or planes can lead to respiratory problems.Sexual practices do not usually involve exposure to dangerous substances.Economic status is not associated with exposure to dangerous substances.Religion and stress are not associated with exposure to dangerous substances.

Question 16

To assess the quality of pain,you would ask the patient

Accepted Answer

The quality of the chief complaint describes the way it feels to the patient.Use the patient's own terms to describe the quality of the chief complaint.Option "a "asks about the location or primary area where the pain occurs.The question in option "c" assesses the meaning or significance of the pain to the patient.Option "d" asks about the impact of the pain on the patient's lifestyle.

Question 17

While conducting the review of systems (ROS),the nurse asks the patient if he has experienced headaches,loss of memory,incoordination,or weakness.In which section of the ROS would this information be recorded?

Accepted Answer

These are signs and symptoms that may be indicative of a problem in the neurological system.They would not be documented in the psychological,endocrine,or cardiovascular systems.

Question 18

Your patient is complaining of wheezing and tightness in his chest that started 1 hour ago.Which type of health history is most appropriate in this situation?

Accepted Answer

The emergency health history is elicited from the patient or other sources in an emergency situation.Only information required immediately to treat the emergent need of the patient is gathered.After the life-threatening condition is no longer present,the nurse can elicit a more comprehensive history.The complete health history is a comprehensive history of the patient's past and present health status.It is usually gathered during a patient's initial visit to a health care facility on a nonemergency basis and on admission to the hospital.The episodic health history is shorter and is specific to the patient's current reason for seeking health care.The interval or follow-up health history builds on a preceding visit to a health care facility.

Question 19

A patient with appendicitis reports gastric or periumbilical pain that over the past 4 hours has localized to the right upper quadrant.The patient denies nausea,vomiting,anorexia,or a low-grade fever.What term characterizes lack of nausea,vomiting,anorexia,and low-grade fever?

Accepted Answer

Negative findings,also called pertinent negatives,are those manifestations expected in the patient with a suspected pathology,but which are denied by the patient.Nausea,vomiting,anorexia,and a low-grade fever are signs and symptoms that might be present with appendicitis.The chief complaint is the sign or symptom that caused the patient to seek health care.Associated manifestations are the signs and symptoms that accompany the chief complaint.Those factors that worsen the severity of the chief complaint are the aggravating factors.

Question 20

The patient's past health history includes which of the following?

Accepted Answer

The past health history (PHH)or past medical history (PMH)provides information on the patient's health status from birth to the present.The PHH includes a medical history,surgical history,allergies,medications,communicable diseases,injuries and accidents,special needs,blood transfusions,childhood illnesses,and immunizations.Alcohol,tobacco,and drug use; sexual practice; travel history; work environment; home environment; hobbies; stress; education; economic status; military service; religion; ethnic background; roles and relationships; and characteristic patterns of daily living are included in the social history.

Quiz 3: The Complete Health History Including Documentation