Oct 25 NR 509 Midterm Chamberlain University With 100% accurate solutions + rationales 2026

Patient-centered approach

Recognizes the importance of patients' expressions of personal concerns, feelings, and emotions and evokes the personal context of the patient's symptoms and disease.

Disease/illness distinction model

Helps elucidate these different yet complementary perspectives of the clinician and the patient.

Mindfulness

Refers to the state of being purposefully and nonjudgmentally attentive to one's own experience, thoughts, and feelings.

Social determinants of health

The conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.

Implicit bias

A set of unconscious beliefs or associations that lead to a negative evaluation of a person on the basis of their perceived group identity.

Explicit bias

Conscious or deliberate decisions or preferences founded on beliefs, stereotypes or associations on the basis of a perceived group identity.

Cultural humility

A process that requires humility as individuals continually engage in self-reflection and self-critique as lifelong learners and reflective practitioners.

Self-Awareness

How do you describe yourself in terms of ethnicity, class, region or country of origin, religion, and political affiliation?

Respectful Communication

Be open to learning from each patient. Do not assume that your impressions about a given cultural group apply to the individual before you.

Collaborative Partnerships

Communication based on trust, respect, and your own willingness to re-examine assumptions allows patients to be more open to expressing views that diverge from the dominant culture.

Spirituality

Encompasses religion, but is broader, focusing on larger universal themes such as meaning and purpose, transcendence, and connection with others.

Medical ethics

A subdiscipline of applied ethics, which is itself a subdiscipline of philosophy, is the system of norms that guide the practice and support clinician decision making.

Capacity

A clinical designation and can be assessed by clinicians.

Competence

A judicial determination and can only be decided by a court.

Active Listening

Involves closely attending to what the client is communicating, connecting to the client's emotional state, and using verbal and nonverbal skills to encourage the client to expand on their feelings and concerns.

Empathy

Encompasses identifying with the client and feeling their pain as one's own, then responding to them in a supportive manner.

Guided Questioning

Helps to elicit more information while still showing a continued interest in the client's feelings and story.

Nonverbal Communication

Includes eye contact, facial expression, posture, head position, and movement such as shaking or nodding, interpersonal distance, and placement of the arms or legs.

Validating

Affirming the legitimacy of the client's emotional experience.

Reassuring

An appropriate way to help the client feel that problems have been fully understood and are being addressed.

Partnering

Involves expressing commitment to an ongoing relationship with the clients to build rapport.

Summarizing

Giving a summary of the client's story during the interview helps to communicate that they have been carefully listening to.

Transitioning

Can be used to inform the client that the direction of the interview is changing.

Empowerment

Empowering clients to ask questions and express their concerns increases the chances that they will adopt your advice, make lifestyle changes, or take medications as prescribed.

FIFE

A mnemonic used to gather information about the client's perspective of the illness.

5 Ps+

A review of systems that includes gathering information about past medical history, medications and allergies, family history, personal and social history, and sexual history.

Teach-back

A technique used to ensure the client understands the plan.

Initiate Encounter

The first step in the clinical encounter, which includes reviewing the clinical record and ensuring the client is comfortable.

Gather Information

The process of identifying the client's chief complaint or reason for seeking care and inviting the client's story.

Perform the Physical Exam

Conducting the exam based on the information obtained from the health history while maintaining client's comfort and privacy.

Close the Encounter

Leaving time for the client to ask questions and summarizing the plans for future evaluation, treatments, and follow up.

Silent Clients

Clients may be quiet to collect thoughts, remember details, or decide if they trust the provider.

Talkative Clients

Talkative clients should be allowed to talk for several minutes at the beginning of the interview.

Clients with Altered Cognition

Clients with conditions such as dementia or mental health illness may not be able to provide their history.

Clients who are blind, deaf, hard of hearing, or use wheelchairs

Some clients may be able to provide a history, but cannot make their own health decisions.

Angry Clients

Clients may direct anger toward the provider even if their anger is related to being ill, suffering a loss, or feeling overwhelmed and not in control.

Smoking in pack years

The pack year is calculated by multiplying the number of packs of cigarettes (1 pack=20 cigarettes) smoked per day by the number of years the person has smoked.

Comprehensive patient assessment

Is appropriate for new patients in the office or hospital and provides fundamental and personalized knowledge about the patient.

Focused patient assessment

Is appropriate for established patients, especially during routine or urgent care visits and addresses focused concerns or symptoms.

Review of Systems

A systematic approach to assess various body systems for symptoms or complaints.

General survey

The general survey begins the moment you enter the room and continues throughout the encounter.

Appearance & Distress

Overall condition (ill, toxic, obtunded, dyspneic, cachectic, agitated) and note color changes that may indicate hypoxia or shock.

Level of Consciousness

Assess orientation, eye opening, speech, and response to stimuli; document GCS or RASS if appropriate.

Body Habitus & Hygiene

Obesity, cachexia, muscle wasting, or neglect can signal chronic disease or social determinants impacting care.

Posture & Mobility

Tripod position, use of accessory muscles, contractures, or involuntary movements guide respiratory and neurologic assessment.

Affect & Behavior

Anxiety, confusion, or agitation may reflect hypoxia, hypercarbia, or delirium.

Constitutional Review

No fatigue or sleep disturbance; No weight gain or loss.

Ears, nose, mouth, and throat Review

No complaints.

Cardiovascular Review

No chest pain, palpitations, or sweating.

Respiratory Review

No cough or hemoptysis.

Gastrointestinal Review

See HPI.

Genitourinary Review

Regular menses; LMP three weeks ago; Husband had vasectomy eight years ago; Denies abnormal vaginal bleeding, discharge, pelvic pain, or dyspareunia.

Musculoskeletal Review

Intermittent bilateral knee pain and stiffness.

Integumentary Review

No jaundice or pruritus.

Neurological Review

No complaints.

Psychiatric Review

No history of mental illness.

Endocrine Review

No history of diabetes or thyroid dysfunction.

Hematological/Lymphatic Review

No history of anemia or blood disorders.

Allergic/immunologic Review

HIV screen negative two years ago.

Slurred or pressured speech

Can indicate stroke, intoxication, or metabolic disturbance.

Baseline trajectory

Helps establish whether a patient's condition is stable, improving, or deteriorating.

Target MAP

≥65 mmHg (sepsis/shock) unless neuro or cardiac exceptions.

Narrow pulse pressure

Indicates low stroke volume (shock, tamponade).

Widened pulse pressure

Can indicate sepsis, aortic regurgitation, or chronic hypertension.

Shock Index

Calculated as HR/SBP; >0.9 indicates concern for hemodynamic instability.

Tachycardia

Often an early sign of hypovolemia, pain, or sepsis.

Bradycardia

May indicate hypoxia, high vagal tone, β-blocker toxicity, or raised ICP.

Tachypnea

An early marker of decompensation, often seen in sepsis, acidosis, or pain.

Bradypnea

Can indicate CNS depression or opioid effects.

Core temperature

Preferred measurement in ICU; can be taken via esophageal, bladder, or rectal probes.

Fever

≥38.3 °C indicates possible infection.

Hypothermia

<35 °C indicates poor perfusion or sepsis in elderly patients.

Oxygen Saturation

Maintain SpO₂ ≥92-94% (88-92% in chronic CO₂ retainers).

Daily weights and I&O balance

Critical for fluid management; rapid weight gain indicates fluid overload.

Differential Diagnosis

A structured list of all reasonable causes for a patient's problem, organized by likelihood and urgency.

Core Process of Differential Diagnosis

Gather and cluster findings from history, exam, and initial diagnostics.

Anatomic reasoning

Organizes possibilities by identifying the location of the problem.

Pathophysiologic reasoning

Explains findings through underlying mechanisms.

Temporal reasoning

Considers how onset and duration fit known disease patterns.

High-risk diagnoses

Prioritize conditions that are life-threatening or immediately reversible.

Documentation Format

Begin with the chief problem and list most likely, alternative, and emergent causes.

Pulmonary embolism

Sudden, pleuritic pain, hypoxemia

Pneumonia

Fever, focal crackles, infiltrate on CXR

Heart failure exacerbation

Orthopnea, elevated JVP, rales

Asthma/COPD exacerbation

Wheezing, prior history

Pneumothorax

Unilateral decreased breath sounds

Illness scripts

Mental models of typical disease patterns that guide pattern recognition

Semantic qualifiers

Opposing descriptors (acute vs chronic, sharp vs dull) to refine differentials

Worst-case rule

Always include and rule out diagnoses with high morbidity or mortality

Re-evaluation

Continuously reassess the list as new data emerge

Problem list

A concise summary of all active or significant issues identified during the encounter

Current diagnoses

Acute symptoms that require immediate attention

Chronic conditions

Health issues requiring ongoing monitoring

Abnormal findings

Results that need further evaluation

Psychosocial factors

Health risks such as housing insecurity or tobacco use

Allergies and adverse reactions

Patient sensitivities that must be documented

Behavior and Mental Health Assessment

Assess for organic and psychiatric mental disorders

Cultural competence

Understanding cultural beliefs/values to ensure accurate diagnosis and treatment

Mental status exam (MSE)

A structured evaluation of a patient's current psychological, cognitive, and behavioral functioning

Core Components of MSE

Includes appearance and behavior, speech and language, mood and affect, thought process, insight and judgment, cognition