Exam Study GuideGeneral: Review terminology from the terms presented under each class moduleClass 1: Chapters 1 and 2 (Evidenced Based Assessment and Cultural Care):Teah Lane1. Be able to prioritize problems: see Table 1-1, page 5. 2. In emergency situations it is important to address first the problems that relate to cardiac and respiratory systems (i.e. prioritize the assessments of presenting signs that may indicate cardiac/respiratory distress).3. Know the types of data bases for assessment: see page 7 & 8.4. Know the importance of having another qualified health care provider validate assessment findings with which one is unfamiliar.5. Know the differences between first, second and third-level priorities.6. Review the nursing process and the order in which the phases occur. It is important for the nurse to begin with assessment.7. Know general growth changes associated with infancy, early childhood, middle childhood, adolescence, early adulthood, middle adulthood and late adulthood.8. Review the Denver II developmental screening test and the Ages and Stages Questionnaire as to what these are designed to detect and what age group they are supposed to assess.9. Know what a cultural assessment is and the importance of providing culturally-sensitive care. Review Table 2-5 on pages 27.10.Know the importance of examining one’s own cultural values in order to provide culturally competent care.11.Review examples of cultural differences in values, such as time orientation (i.e. some cultures place greater emphasis on the past versus the future versus the present). These differences can result in corresponding conflicts, such as with discharge planning in the case of the patient who “lives in the present”.12. Distinguish between subjective versus objective data.13.The most effect approach to overcome language barriers with interviews: use of a culturally-sensitive interpreter.14.Know the importance of conducting a spiritual assessment (how it can affect the patient’s health, illness and health care).15.The importance of knowing the patient’s ethnic background in assessment of the patient’s pain.Class 2: Chapter 3, 9 and 10: (The General Survey, Vital Signs and Pain Assessment):Melissa Huber 1. Review open-ended questions vs. closed or direct questions.2. Be able to distinguish between facilitation, reflection, empathy, clarification, confrontation and interpretation.3. Review recommended therapeutic communication techniques.4. Review developmental considerations when interviewing, pages 60 – 62.5. Review interviewing people with special needs: hearing-impaired and cutely ill people 6. How should the nurse address sensitive topics? (answer: remain non-judgmentaland reserve these questions towards the end of the interview and until a degree ofrapport has been established)7. Know normal parameters of the General Survey: physical appearance, body structure, mobility, behavior. 8. Know the various measurement techniques of assessing vital signs: temperature,blood pressure, respirations and pulse.9. Review erroneous readings that may be obtained with blood pressure cuffs that are too large or too small.10.How to take the blood pressure on an individual with documented hypertension.11.Know what orthostatic blood pressure is and how to measure for possible orthostatic hypotension.12.Know examples of blood pressure readings and the timing of these readings (taken three days apart) that confirm hypertension.13.Review Tables 9-4 (page 141), Korotkoff Sounds, and Table 9-3 (page 139), errors in blood pressure measurement. 14.What are the recommended techniques of assessing the vital signs of an infant?15.Know that to assess peripheral pulses that cannot be palpated, it is recommendedto use the Doppler device.Julie Busfield 16.Know how to perform a competent pain assessment.17.Be able to formulate assessment questions related to pain quality versus pain severity (using a pain scale).18.Know what is the most reliable indicator of pain: what the patient says it is.19.Know that it is important to address pain issues before proceeding with a physical examination.20.Know behavioral manifestations of acute vs. chronic pain.21.Be aware of misconceptions concerning pain and the elder: it is not a normal part of aging and older adults with mental status changes do not feel pain any less. Often nurses are not educated as to adequate pain management and hospital understaffing contributes to unrelieved pain in the acute care patient.Class 3: Chapters 8 and 18: (Assessment Techniques and Thorax and Lungs)1. Know examination techniques of inspection, palpation (including light versus deep), percussion and auscultation and proper sequence for the various body regions.2. Know special techniques of assessing certain age groups: infants (head and chest circumferences, vital signs including technique for assessing respirations) and the aging adult (specifically, age changes commonly seen in this population).3. Review general guidelines for assessing the pediatric population: allowing young children to sit on parents’ lap, establishing rapport with the parent that the child can observe and not allowing “choices” when there aren’t any.4. Review how to estimate the costal angle along the costal margins for possible hyperinflation seen in COPD (emphysema) or in bronchiectasis.5. Know how to assess for symmetric expansion and diaphragmatic excursion.6. What is the normal “excursion” (i.e. movement) of the diaphragm? 3-5 cm in an adult7. Know how to assess for tactile fremitus. When would tactile fremitus be decreased? (answer: in asthma) When would tactile fremitus be increased? (answer: in situations where there is fluid or solid tissue to amply the sounds, i.e. pneumonia, atelectasis and lung cancer)8. Know the correct technique for auscultating breath sounds and the importance of auscultating from side to side for comparison. 9. Review expected assessment findings in the normal adult lung.Tara Reme 10.What respiratory assessment findings would indicate respiratory distress?11.Review “Characteristics of Normal Breath Sounds”.12.Review age considerations for pulmonary assessment. 13.Review terminology of adventitious breath sounds: crackles, wheezes, rhonchi, stridor. (Know that it is not uncommon for crackles to be auscultated in a newborninfant due to excessive fluid in the lungs because of a Caesarean birth or prematurity.)14.Review COPD: bronchitis