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Chapter 01: The History and Interviewing Process
Ball: Seidel’s Guide to Physical Examination, 9th Edition
TOP: Discipline: Behavioral Science MSC: Organ System: General
- Which action would best promote accurate translations as well as confidentiality when the caregiver does not speak the patient's language? a. (^) Ask a person unfamiliar with the patient to translate. b. (^) Have a friend of the patient translate. c. (^) Ask simple leading questions that the patient may understand. d. (^) Use a neighbor as translator. e. (^) Involve the family with the translation. ANS: A When you do not speak the patient's language, family members or friends may pose a communication barrier and may have issues of confidentiality; a stranger as an interpreter is less biased. TOP: Discipline: Behavioral Science MSC: Organ System: General
- Periods of silence during the interview can serve important purposes, such as: a. (^) allowing the clinician to catch up on documentation. b. (^) giving you a clue that you should speed up the interview. c. (^) providing time for reflection. d. (^) increasing the length of the visit. e. (^) promoting a calm environment. ANS: C Silence is a useful tool during interviews for the purposes of reflection, summoning of courage, and displaying compassion. It is usually a clue for you to go slower and not to push too hard. TOP: Discipline: Behavioral Science MSC: Organ System: General
- Which technique is most likely to result in the patient's understanding of questions? a. (^) Use phrases that are commonly used by other patients in the area. b. (^) Use the patient's own terms if possible. MULTIPLE CHOICE
- Which question would be considered a ―leading question?‖ a. (^) ―Please describe any associated symptoms with your headaches?‖ b. (^) ―You don't get headaches often, do you?‖ c. (^) ―What activities affect the severity of your headaches?‖ d. (^) ―What times of the day are your headaches the most severe?‖ e. (^) ―What worries you most about your headache?‖ ANS: B This question would limit the information in the patient's answer. The other choices allow the patient more discretion about the extent of an answer.
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c. (^) Use language that keeps the patient from being expansive in his or her answer. d. (^) Use proper medical and technical terminology. e. (^) Use the simplest language possible. ANS: B To ensure that your questions have been correctly understood, be clear, and explicit while using the patient's idiom and level of understanding. TOP: Discipline: Behavioral Science MSC: Organ System: General
- A patient becomes restless during the history and says, ―I don't have time for all of this conversation. I've got to get back to work.‖ Your most appropriate response would be to: a. (^) stop using open-ended questions and become more direct. b. (^) ask another open-ended question and insist on an answer. c. (^) ask questions about his anger and move closer to him. d. (^) acknowledge his anger and proceed with the history and examination. e. (^) ignore his displeasure and become more assertive about getting answers. ANS: D This is the only answer that resists the tendency for patient manipulation, pursues the information, and confronts the patient's anger. TOP: Discipline: Behavioral Science MSC: Organ System: General
- When questioning a patient regarding alcohol intake, she tells you that she is ―only a social drinker.‖ Which initial response is appropriate? a. (^) ―I'm glad that you are a responsible drinker.‖
b. ―Many people who are reNallyRalcIohoGlic sBay.tCheyMare social drinkers.‖
c. (^) ―What amount and what kind of alcohol do you drink in a week?‖ d. (^) ―If you only drink socially, you won't need to worry about always having a designated driver.‖ e. (^) ―Do the other people in your household consume alcohol?‖ ANS: C This answer clarifies the patient's own term without asking a leading question or being judgmental. TOP: Discipline: Behavioral Science MSC: Organ System: General
- A 50 - year-old man comes to the primary care clinic. He tells you he is worried because he has had severe chest pains for the past 2 weeks. Which initial history interview question is most appropriate? a. (^) ―Can you describe the pain?‖ b. (^) ―The pain doesn't radiate to your arm, does it?‖ c. (^) ―Have you been treated for anxiety before?‖ d. (^) ―Does your father have heart disease?‖ e. (^) ―Are the pains worse after you eat?‖ ANS: A Initially, an open-ended question is a more appropriate response. ―Can you describe the pain?‖ is an open-ended question that offers clues to the chief concern.
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e. (^) desire for adult companionship. ANS: D Adolescents are usually reluctant to talk; therefore, the provider should clearly communicate a respect for their confidentiality. TOP: Discipline: Behavioral Science MSC: Organ System: General
- When you suspect that your 81-year-old patient has short-term memory loss because he cannot remember what he had for breakfast, you should: a. (^) order a neurology consult. b. (^) stop all of his medications. c. (^) continue to press the patient for appropriate answers. d. (^) validate the concern with his family or caregivers. e. (^) dismiss the finding as a normal age-related change. ANS: D When older adults experience memory loss for recent events, consult other family members to clarify discrepancies or to fill in the gaps. TOP: Discipline: Behavioral Science MSC: Organ System: General
- To what extent should the patient with a physical disability or emotional disorder be involved in providing health history information to the health professional? a. (^) All information should be obtained from family members. b. All information should be collected from past records while the patient is in another room.
c. The patient should be invNolveRd oInlyGwheBn.yCou sMense that he or she may feel
ignored. d. (^) The patient should be fully involved to the limit of his or her ability. e. (^) The patient should be present during information collection but should not be addressed directly. ANS: D Patients with disabilities may not give an effective history, but they must be respected, and the history must be obtained from them to the greatest extent possible. Family members may help provide a more complete history but not at the exclusion of the patient. TOP: Discipline: Behavioral Science MSC: Organ System: General
- When taking a history, you should: a. (^) ask patients to give you any information they can recall about their health. b. (^) start the interview with the patient's family history. c. (^) use a chronologic and sequential framework. d. (^) use a holistic and eclectic structure. e. (^) start the interview with the social history. ANS: C To give structure to the present problem or chief concern, the provider should proceed in a chronologic and sequential framework. Asking patients to give you any information they can recall about their health and using a holistic and eclectic structure do not provide for structure. Starting the interview with the patient's family history and with the social history are incorrect because gathering data about the chief concern is the initial step. TOP: Discipline: Behavioral Science MSC: Organ System: General
- When questioning the patient regarding his or her sexual history, which question should be asked initially? a. (^) ―Do you have any particular sexual likes or dislikes?‖ b. (^) ―Do you have any worries or concerns regarding your sex life?‖ c. (^) ―How often do you have intercourse and with whom?‖ d. ―Do you have any reason to think you may have been exposed to a sexually transmitted infection?‖ e. (^) ―What sexually transmitted diseases have you had in the past?‖ ANS: B When approaching questioning about a sensitive area, it is recommended that the provider first ask open-ended questions that explore the patient's feelings about the issue. TOP: Discipline: Behavioral Science MSC: Organ System: General
- Direct questioning about intimate partner violence in the home should be: a. (^) a routine component of history taking with female patients. b. avoided for fear of offending the woman's partner. c. (^) conducted only in cases in which there is a history of abuse.
d. used only when the patienNtUisRoSbvIioNuGslTy Bbe.inCgOvMictimized.
e. (^) used only when bruises are found on physical examination. ANS: A The presence of intimate partner violence should be routinely queried, and the questioning should be direct for all female patients. TOP: Discipline: Behavioral Science MSC: Organ System: General
- Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the: a. (^) Miller Analogies Test. b. (^) PACE Assessment Instrument. c. (^) CAGE questionnaire. d. (^) Glasgow Coma Scale. e. (^) HITS questionnaire. ANS: C The CAGE questionnaire is a model for approaching a discussion of the use of alcohol. TOP: Discipline: Behavioral Science MSC: Organ System: General
- When you enter the examination room of a 3 - year-old girl, you find her sitting on her father's lap. She turns away from you when you greet her. Initially, your best response is to: a. (^) screen the child for sexual abuse. b. (^) ask the child to be seated on the examination table so you can talk to her father. c. (^) explain to the child that you will not hurt her and that she will have to trust you. d. (^) ask the father to persuade the child to cooperate with you. e. (^) leave the child sitting in the father's lap while you talk to the father. ANS: E Interaction with children must be modified according to age and in a manner that promotes trust. TOP: Discipline: Behavioral Science MSC: Organ System: General
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b. (^) inventory c. (^) problem or focused d. interim e. (^) family ANS: C If the patient is well known or if you have been seeing the patient for the same problem over time, a focused history is appropriate. TOP: Discipline: Behavioral Science MSC: Organ System: General
24. A^ pedigree^ diagram is^ draftedNfoRr^ theIpuGrposBe.oCf^ obMtaining:
a. (^) sexual orientation and history. b. (^) growth and developmental status. c. (^) genetic and familial health problems. d. (^) ethnic and cultural backgrounds. e. the past medical history. ANS: C Drafting a pedigree diagram, or genogram, is a method to determine consanguinity of health problems. TOP: Discipline: Behavioral Science MSC: Organ System: General
Chapter 02: Cultural Competency
Ball: Seidel’s Guide to Physical Examination, 9th Edition
MULTIPLE CHOICE
- Which statement is true regarding the relationship of physical characteristics and culture? a. (^) Physical characteristics should be used to identify members of cultural groups. b. (^) There is a difference between distinguishing cultural characteristics and distinguishing physical characteristics. c. (^) To be a member of a specific culture, an individual must have certain identifiable physical characteristics. d. (^) Gender and race are the two essential physical characteristics used to identify cultural groups. e. (^) Whereas all cultural traits can be viewed as static, physical traits are dynamic. ANS: B Physical characteristics do not symbolize cultural groups; there is a difference between the two, and they are considered separately. Cultures are dynamic in their evolution. TOP: Discipline: Behavioral Science MSC: Organ System: General
- A fixed image of any group that rejects its potential for originality or individuality is known as a(n): a. (^) acculturation. b. (^) norm. c. (^) stereotype. d. (^) ethnos. e. (^) custom. ANS: C
NURSINGTB.COM
This definition describes a stereotype. A norm, on the other hand, is a standard of allowable behavior within a group, ethnos implies the same race or nationality, and acculturation is a process of adopting another culture's behaviors. A custom refers to a habitual activity of a group in a given situation. TOP: Discipline: Behavioral Science MSC: Organ System: General
- Your new patient is a 40 - year-old Middle Eastern man with a complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to: a. (^) do the examination because it is a necessary part of the physical examination. b. (^) ask a colleague from the same geographic area if this examination is acceptable. c. (^) inform the patient of the reason for the examination and ask if it is acceptable to him. d. (^) refer the patient to a provider more knowledgeable about cultural differences. e. (^) forego the examination for fear of violating cultural norms. ANS: C Asking, if you are not sure, is far better than making a damaging mistake. You would not be doing your job as a professional if you deferred the examination without a reason. It is not necessary to refer a skill you are capable of performing. TOP: Discipline: Behavioral Science MSC: Organ System: General
- Which statement is true regarding impoverished people? a. (^) In the United States, socioeconomic status does not influence the delivery of health care. b. (^) The morbidity and mortality rates of impoverished people are greater than those of the middle class. c. (^) The morbidity and mortality rates of impoverished people are less than those of the middle class. d. (^) No reliable statistics exist regarding the relationship of poverty to morbidity and mortality. e. (^) The morbidity and mortality rates of impoverished people are similar to those of the middle class. ANS: B Poorly educated people and people in poverty die at higher rates than those who are advantaged; the same is true for morbidity. TOP: Discipline: Behavioral Science MSC: Organ System: General
- In terms of cultural communication differences, Americans are more likely to than other groups of patients. a. (^) emphasize attitudes and feelings
b. maintain eye contact NURSINGTB.COM
d. (^) that there are hot and cold conditions but not hot and cold remedies. e. (^) that hot and cold conditions are the same among different cultures. ANS: C A naturalistic or holistic approach often assumes that there are external factors—some good, some bad—that must be kept in balance if we are to remain well. TOP: Discipline: Behavioral Science MSC: Organ System: General
- Which maternal factor is most predictive of whether an infant will receive inoculations? a. (^) The mother has family support. b. (^) The mother is divorced. c. (^) The mother breast-feeds. d. (^) The mother uses drugs. e. (^) The mother received prenatal care. ANS: E Mothers who take advantage of appropriate prenatal care generally take advantage of other infant care practices as well.
TOP: Discipline: Behavioral Science MSC: Organ System: General
- Knowledge of the culture(s) of the patient should be used to: a. (^) form a standard practice procedure for that culture. b. (^) draw conclusions regarding individual patient needs. c. (^) form stereotypical categories. d. (^) help make the interview questions more pertinent. e. (^) form a sense of the patient based on prior knowledge. ANS: D The purpose of understanding the patient's culture(s) is to help the provider construct pertinent questioning and avoid stereotyping. TOP: Discipline: Behavioral Science MSC: Organ System: General
- The attitudes of the healthcare professional are largely: a. (^) acculturated and cannot be changed. b. (^) uninfluenced by patient behavior. c. (^) difficult for the patient to sense. d. (^) culturally derived. e. (^) irrelevant to the success of relationships with the patient. ANS: D The attitude of a healthcare provider is foundationally derived from his or her own culture but cannot cause stereotypical judgments to be made; understanding this is relevant to the success of patient relationships. Attitudes of the healthcare professional are easily detected by others,
and they influence patient beNhaUvRioSr. INGTB.COM
TOP: Discipline: Behavioral Science MSC: Organ System: General
- All of the following are important aspects of reducing disparities in health care except: a. (^) identify and monitor conscious and unconscious biases. b. (^) help the patient to learn about his or her disease or condition. c. (^) consider the health literacy of one's patients. d. (^) try to discuss aspects of care without the influence of friends, partner, or family members. e. (^) encourage patients to complete patient satisfaction and demographics forms. ANS: D All of the above are ways a healthcare provider can reduce disparities in health care except the exclusion of a patient's friends, partner, or family members. It is important in reducing disparities in health care for the provider to partner with patients and families to provide high-quality care. TOP: Discipline: Behavioral Science MSC: Organ System: General
- Which of the following is not an aspect of cultural humility? a. (^) Ability to recognize one's limitations in knowledge and cultural perspective b. (^) Self-reflection and self-critique c. (^) Assuming all patients of a particular culture fit a certain stereotype d. (^) Meeting patients ―where they are‖ without judgment
Chapter 03: Examination Techniques and Equipment
Ball: Seidel’s Guide to Physical Examination, 9th Edition
MULTIPLE CHOICE
- Guidelines for Standard Precautions indicate that mask and eye protection or a face mask should be worn while performing: a. (^) suture removal. b. (^) trachea care and suctioning. c. (^) wet-to-dry dressing changes. d. (^) patient bathing. e. (^) tube feedings. ANS: B Masks and eye protection or a face mask are indicated during procedures that are likely to generate splashes or sprays of body fluids, which include endotracheal secretions. TOP: Discipline: Pathophysiology MSC: Organ System: General
- Standard Precautions apply to all patients: a. (^) with bloodborne infections. b. (^) with infected, draining wounds. c. (^) in intensive care units. d. (^) receiving care in hospitals or office settings. e. (^) believed to have an infectious disease.
ANS: D NURSINGTB.COM
Although all of these statements are true, the best answer is patients receiving care in hospitals. Standard Precautions were developed with the intent of application to the care of all hospitalized or outpatients; however, the standard has merit and should be applied to all cases of patient care regardless of the environment where care is delivered. TOP: Discipline: Pathophysiology MSC: Organ System: General
- Which patient is at the highest risk for the development of latex allergy? a. (^) A new patient who has no chronic illness and has never been hospitalized b. (^) A patient who has had multiple procedures or surgeries c. (^) A patient who is allergic to eggs d. (^) A patient who is allergic to contrast dye e. (^) A patient who is a vegetarian ANS: B A patient who has had multiple procedures or surgeries has a higher exposure rate to rubber gloves and to equipment and supplies that contain latex and therefore is at a higher risk for developing an allergic response. TOP: Discipline: Pathophysiology MSC: Organ System: General
- Which patient position is useful for auscultating heart tones? a. (^) Lithotomy
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b. (^) Dorsal recumbent c. (^) Left lateral recumbent d. (^) Right Sims e. (^) Prone ANS: C The left lateral recumbent position places the left ventricle closer to the chest wall and is recommended for hearing low-pitched sounds such as the third and fourth heart sounds. TOP: Discipline: Pathophysiology MSC: Organ System: General
- The use of secondary, tangential lighting is most helpful in the detection of: a. (^) variations in skin color. b. (^) enlarged tonsils. c. (^) foreign objects in the nose or ear. d. (^) variations in contour of the body surface. e. (^) variations in texture and mobility. ANS: D Tangential lighting is used to cast shadows so as to best observe contours and variations in body surfaces. All the other choices are best observed with direct lighting that does not cast shadows. TOP: Discipline: Pathophysiology MSC: Organ System: General
- You are conducting a head to toe examination as part of a patient's preventive health assessment. The room has adequate lighting, and you have access to both sides of the
examining table. What positiNon sRhouIld yGou Bas.suCmeMwhile conducting this examination?
a. (^) Behind the patient b. (^) To the left side of the patient c. (^) Seated in a chair in front of the patient d. (^) To the right side of the patient e. (^) Standing in front of the patient ANS: D Although conventionally taught to approach an examination from the patient's right side, it is not always practical. Therefore, it is important that the examiner develop the skills necessary to approach either side of the patient. TOP: Discipline: Pathophysiology MSC: Organ System: General
- Which part of the examiner's hand is best for palpating vibration? a. (^) Dorsal surface b. (^) The thumb c. (^) Fingertips d. (^) Ulnar surface and base of the fingers e. (^) Finger pads ANS: D The ulnar surface of the hand and the base of the fingers can best feel vibratory sensations such as thrills and fremitus.
The dominant hand's middle finger strikes the stationary finger with a wrist motion and is lifted quickly off the striking surface. TOP: Discipline: Pathophysiology MSC: Organ System: General
- During auscultation, you can limit your perceptual field best by: a. (^) asking patients to describe their symptoms. b. (^) listening through the patient's clothing. c. (^) closing your eyes. d. (^) performing palpation before percussion. e. (^) turning out the lights in the examination room. ANS: C By closing your eyes, your sense of hearing becomes more acute, increasing your ability to isolate sounds. TOP: Discipline: Pathophysiology MSC: Organ System: General
- When examining the abdomen, which technique should be used first? a. (^) Inspection b. (^) Light palpation c. (^) Percussion d. (^) Auscultation e. (^) Direct palpation ANS: A Inspection is always used as the first technique in all physical examinations, including the
abdomen. N
URSINGTB.COM
TOP: Discipline: Pathophysiology MSC: Organ System: General
- Auscultation should be carried out last except when examining: a. (^) the neck area. b. (^) the abdomen. c. (^) the lungs. d. (^) the heart. e. (^) none of the above; auscultation is always carried out last in a proper physical examination. ANS: B Auscultation is the last examination technique used for all areas except the abdomen. In this case, it is performed after inspection. TOP: Discipline: Pathophysiology MSC: Organ System: General
- Which of the following statements is true regarding tympanic membrane temperature? a. (^) It is taken by placing an infrared probe anterior to the ear. b. The probe is placed in the external auditory canal to occlude it. c. (^) Temperatures taken with a tympanic thermometer never vary from those taken by the oral or rectal route. d. (^) It is an accurate measurement of body temperature because the tympanic membrane shares its blood supply with the hypothalamus.
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e. (^) It is taken by placing an infrared probe posterior to the ear. ANS: D The tympanic membrane shares its blood supply with the hypothalamus and is therefore an accurate measurement of body temperature. Tympanic thermometer probes are gently placed at the external opening of the ear canal, but not in the canal, and they should not occlude the canal. TOP: Discipline: Pathophysiology MSC: Organ System: General
- A scale used to assess a patient's weight should be calibrated: a. (^) when the patient tells you the weight is not correct. b. (^) by a qualified technician at regularly scheduled intervals. c. (^) each time it is used. d. (^) when necessary, with the patient standing on the scale. e. (^) only by the manufacturer. ANS: C Obtaining weight begins with a manual calibration of the scale before the patient stands on the scale. Electronic scales are automatically calibrated before each reading. TOP: Discipline: Pathophysiology MSC: Organ System: General
- An infant should be placed in which position to have his or her height or length measured? a. (^) Vertical, with the examiner's hands under the infant's axilla b. Supine on a measuring board c. (^) While being held by a parent
d. In the lateral position witNh thRe toIes aGgainBst.aCmeMasuring board
e. (^) Prone on a measuring board ANS: B An infant should be placed supine on a measuring board to measure height or length. TOP: Discipline: Pathophysiology MSC: Organ System: General
- The stethoscope's diaphragm is most useful in the assessment of sounds. a. (^) high-pitched b. (^) dull c. (^) low-pitched d. (^) rhythmic e. (^) tympanic ANS: A The diaphragm is best for hearing high-pitched sounds, such as breath sounds, bowel sounds, and normal heart tones. TOP: Discipline: Pathophysiology MSC: Organ System: General
- Which of the following occurs when firm pressure is used to apply the stethoscope's bell endpiece to the skin? a. (^) It transmits low-pitched sounds. b. (^) It functionally converts to a diaphragm endpiece.
TOP: Discipline: Pathophysiology MSC: Organ System: General
- The pneumatic attachment for the otoscope is used to evaluate: a. (^) ear canal patency. b. (^) eardrum landmarks. c. (^) hearing acuity. d. (^) tympanic membrane movement. e. (^) tympanic membrane temperature. ANS: D The pneumatic attachment on the otoscope produces a puff or air to the tympanic membrane, resulting in its movement. TOP: Discipline: Pathophysiology MSC: Organ System: General
- Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure: a. (^) vibratory sensations. b. (^) hearing from bone conduction. c. (^) hearing range of normal speech. d. (^) noise above the threshold level. e. (^) peripheral motor nerve damage. ANS: C Normal speech has a range of 300 to 3000 Hz; therefore, a 500 - to 1000 - Hz fork is used most often because it can estimate hearing loss in the range of normal speech.
TOP: Discipline: PathophysiolNogyR I GMSBC:.COrgaMn System: General
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- A variant of the percussion hammer is a neurologic hammer, which is equipped with which of the following? a. (^) Brush and needle b. (^) Tuning fork and cotton swab c. (^) Penlight and goniometer d. (^) Ruler and bell e. (^) Transilluminator ANS: A A neurologic hammer unscrews at the handle to reveal a soft brush, and the knob on the head unscrews, to which a sharp needle is attached. TOP: Discipline: Pathophysiology MSC: Organ System: General
- Transillumination functions on the principle that: a. (^) infrared radiation is easily detected. b. (^) black light causes certain substances to fluoresce. c. (^) converging and diverging light brings structures into focus. d. (^) tangential light casts shadows that illuminate contours. e. (^) air, fluid, and tissue transmit light differentially. ANS: E
Transillumination functions to differentiate between various media in a cavity. It can distinguish among air, fluid, and tissue. It consists of a strong light in the visible spectrum with a narrow beam. TOP: Discipline: Pathophysiology MSC: Organ System: General
- For a woman with a small vaginal opening, the examiner should use a _ speculum. a. (^) plastic Graves b. (^) Pederson c. (^) pediatric d. (^) nasal e. (^) metal Graves ANS: B The Pederson speculum has blades that are as long as those of the Graves speculum, but are narrower and flatter and are therefore more comfortable for women with small vaginal openings. Pediatric or nasal speculums would be too small for adult use. Plastic speculums are similar in use to their metal counterparts. TOP: Discipline: Pathophysiology MSC: Organ System: General
- You are performing a vaginal examination on a patient with a history of spina bifida. As you insert the metal speculum, the patient suddenly feels nauseated and is sweating, and her skin turns blotchy. What is your most immediate reaction to this situation? a. (^) Replace the metal speculum with a plastic one. b. (^) Put a blanket over the patient's legs. c. (^) Remove the speculum.
d. Take her blood pressure. NURS INGT B.COM
e. (^) Raise her legs above her heart. ANS: C This patient is experiencing symptoms of autonomic hyperreflexia. The first reaction should be for the examiner to remove the source of the stimulation. Cold tables, stirrups, insertion of a speculum, and pressure during pelvic examinations are examples of stimulations. TOP: Discipline: Pathophysiology MSC: Organ System: General
