Comprehensive Nursing Exam Blueprint Key Concepts

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326 EXAM 1 BLUEPRINT - SUMMER 2024Topic/Nursing ConceptNumber ofItemsBloom's TaxonomyClassificationRemember, Understand,Application, Analysis,Evaluate, Create *Module 1: Chapters 1-3□Steps of nursing process□Interview & health history□Physical exam techniques488□Understand (12)UApplication(8)Module 2: Chapters 4-5, 9nValidating & documenting data□SBARSteps of clinical judgmentHPain assessment1115□Understand (4)□Application (4)Module 3: Chapters 6, 10, 11, 12HMental health□Substance abuse□Violence□Culture□Spirituality/Religion52233UUnderstand (9)□Application (6)Module 4: Chapters: 8, 9□Vital signs assessment7□Understand (3)□Application (4)Total Number of Items50MC= 45FITB = 1SATA= 2NGN =2* This can vary slightly.Module 1: Chapters 1-3

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326 EXAM 1 BLUEPRINT - SUMMER 2024□Steps of nursing process□A= Assessment: Collecting data is that subjective and objectivenD= Diagnosis: Analyzing subjective and objective data to make andprioritize professional clinical judgements, (client concerns, collaborativeproblems, or referral)□P= Planning: Generating solutions, developing a plan, and determiningwhich outcomes need to be met firstn1= Implementation: Taking action. Prioritizing and implementing theplanned interventions□E= Evaluation: Assessing whether outcomes have been met and revisingthe plan if the interventions did not make a difference□Interview & health history□Phases of the interview:□Preintroductory Phase= The nurse reviews the medical recordbefore meeting with the client. Prior knowledge of the patient'sbiographical information can assist the nurse with conducting theinterview.□Introductory Phase= The nurse introduces themselves to theclient, explains the purpose of the interview, discusses the type ofquestions that will be asked, explains the reason for taking notes,and ensures confidentiality (HIPAA). The nurse makes sure thatthe patient is comfortable (physically and emotionally) and hasprivacy. Interview is conducted at eye level demonstrating respectand that the nurse and client are at eye levels. The key is todevelop a rapport to ensure that the client trusts you to fullydisclose information. Developing rapport is influenced heavily onverbal and nonverbal communication.□Working Phase= The nurse addresses the patients commentsregarding important biographical data, reason for seeking care,history of present health concern, past health history, familyhistory, review of body systems (ROS) for current health problems,lifestyle and health practices, and developmental level. The nursethen listens, observes cues, and applies critical thinking skills tointerpret and validate information received from the patient. Thenthe nurse and patient collaborate to identify the clients problemsand goals. This can be free flowing or more structured based ontime and specific data needed to be collected.□Summary and closing phase= The nurse summarizes theinformation collected during the working phase. Validatesproblems and goals with the patient. Identifies and discussespossible plans to resolve the problem. Finally, the nurse asks ifthere are any other concerns and if there are any furtherquestions.□Health History:

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326 EXAM 1 BLUEPRINT - SUMMER 2024□COLDSPA= Used as a comprehensive analysis of any symptom topromote an accurate clinical judgement. Also used for history ofpresent health concernoC=Character: Describe the signs and symptoms□Feeling, appearance, sound, smell, taste, ectoO=Onset: when did it begin?oL= Location: where does it occur?oD=Duration: how long does it last?oS= Severity: on a scale 0-10 (0 being no pain and 10 beingthe worse pain you've experienced) what is the pain scale?oP= Pattern: what makes it better or worse?oA= Associated factors: what other symptoms occur with it?How does it affect you?□Are there any other problems that seem related toyour problem?□Complete health history= excellent way to begin the healthassessment because it provides the foundation for clinicaljudgments in identifying nursing problems, where to focus, andareas where a more detailed physical examination may berequired. Health history data are used to identify clients' strengthsand limitations in lifestyle and health status. Also provides specificcues to health problems that are most apparent to the client.HHead to toe physical assessment= collection of subjective datausually requires that the nurse take a complete health history. Thiscan be modified or shortened when necessary. Taking a healthhistory should begin with an explanation on why the informationis being requested.oBiographical data:HName□Address□Phone□Gender□Provider of historynDate of birth□Place of birth□Race or Ethnicity□Primary or secondary language□Marital status□Religion□EducationnOccupation□Significant other or next of kinoReasons for seeking health care

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326 EXAM 1 BLUEPRINT - SUMMER 2024□Major health problem or concern□Feelings about seeking health care (fears and pastexperiences)oHistory of present health concern□COLDSPA:□£= Character: how does it look, smell,sound, ect□0= Onset: when did it begin? Is it better,worse, or the same since it began?□L= Location: where is it? Does it radiate?□D= Duration: how long does it last? Does itrecur?□S= Severity: how bad is it on a scale of 0-10.0= no pain & 10= worse pain ever□P= Pattern: what make it better and whatmakes it worse?□A= Associated factors: what othersymptoms do you have with it? Will you beable to continue doing your work or otheractivates (leisure or exercise)?oPersonal health history□Problems at birth□Childhood illnessesUImmunizations to date□Adult illnesses (physical, emotional, mental)□Surgeries□Accidents□Prolonged pain or pain patternsnAllergies□Physical, emotional, social, or spiritual weaknessesUPhysical, emotional, social, or spiritual strengthsoFamily history□Age of parents (living/ date of death)□Parents' illnesses and longevityHChildren's ages and illnesses or handicaps andlongevityoROS for current health practices profile□Skin, heair and nails:color, temperature, condition,rashes, lesions, excessive sweating, hair loss,dandruff□Head and neck: headache, stiffness, difficultyswallowing, enlarged lymph nodes, sore throat

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326 EXAM 1 BLUEPRINT - SUMMER 2024□Eyes:pain, infections, impaired vision, redness,tearing, halos, blurring, black spots, flashes, doublevision□Mouth, throat, nose, and sinuses:mouth pain, sorethroat, lesions, hoarseness, nasal obstruction,sneezing, coughing, snoring, nosebleeds□Thorax, and lungs: pain, difficulty breathing,shortness of breath with activities, orthopnea,cough, sputum, hemoptysis, respiratory infections□Breasts and regional lymphatics: pain, lumps,discharge from nipples, dimpling or changes inbreast size, swollen and tender lymph nodes inaxilla□Heart and neck vessels: chest pain or pressure,palpitations, edema, last blood pressure, lastelectrocardiogram (ECG)□Peripheral vascular: leg or feet pain, swelling of feetor legs, sores on feet or legs, color of feet and legs□Abdomen: pain, indigestion, difficulty swallowing,nausea and vomiting, gas, jaundice, hernias□Male genitalia: painful urination, frequency ordifficulty starting or maintaining urinary system,blood in urine, sexual problems, penile lesions,penile pain, scrotal swelling, difficulty with erectionor ejaculation, exposure to STI's□Female genitalia: pelvic pain, voiding pain, sexualpain, voiding problems (dribbling, incontinence),age of menarche or menopause (date of lastmenstrual period), pregnancies and types ofproblems, abortions, STI's, hormone replacementtherapy (HRT), birth control methods□Anus, rectum, and prostate: pain, with defecation,hemorrhoids, bowel habits, constipation, diarrhea,blood in stoolnMusculoskeletal: pain, swelling, redness, stiff joints,strength of extremities, abilities to care for self andwork□Neurologic: mood, behavior, depression, anger,headaches, concussions, loss of strength orsensation, coordination, difficulty with speech,memory problems, strange thoughts or actions,difficulty reading or learningoLifestyle and health practices□Description of a typical day (AM to PM)

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326 EXAM 1 BLUEPRINT - SUMMER 2024□Nutrition and weight management□24 hour dietary intake (foods and fluids)□Who purchases and prepares meals□Activities on a typical day□Exercise habits and patterns□Sleep and rest habits and patterns□Use of medications and other substances (caffeine,nicotine, alcohol, recreational dings)□Self- concept□Self-care responsibilities□Social activities for fun and relaxation□Social activities contributing to society□Relationships with family, significant others, andpets□Values, religious affiliation, spiritualty□Past, current, and future plans for education□Type of work, level of job satisfaction, workstressors□Finances□Stressors in life, coping strategies used□Residency, type of environment, neighborhood,environmental risksoDevelopmental levelUYoung adult: intimacy versus isolation□Middle scent: generativity versus stagnation□Older adult: ego integrity versus despair□Head to toe physical assessment= collection of subjective data usuallyrequires that the nurse take a complete health history. This can bemodified or shortened when necessary.□Physical exam techniquesH4 physical examination techniques must be mastered before you canperform a thorough and complete assessment of the client□Technique□Definition□Guideline□Inspection□Involves the use of the senses(smell, vision, hearing) to observe anddetect any normal or abnormal findings.This begins the moment you meet theclient and continues throughout theexamination.□Ensure roomtemperature iscomfortable. Too hot ortoo cold can alter thenormal behavior of thepatient and theappearance of the skinUGood lighting□Look and observebefore touching

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