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Seidel's Guide to Physical Examination 9th Edition Ball Test BankNURS6501

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Chapter 01: The History and Interviewing Process Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. Which question would be considered a “leading question?” a. “Pleas... e 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. TOP: Discipline: Behavioral Science MSC: Organ System: General 2. 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 3. 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 4. 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. 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 5. 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 6. 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 7. 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. TOP: Discipline: Behavioral Science MSC: Organ System: General 8. Ms. A. states, “My life is just too painful. It isn’t worth it.” She appears depressed. Which one of the following statements is the most appropriate caregiver response? a. “Try to think about the good things in life.” b. “You shouldn’t feel that way; look at all the good things in your life.” c. “You can’t mean what you’re saying.” d. “If you think about it, nothing is worth getting this upset about.” e. “What in life is causing you such pain?” ANS: E Specific yet open-ended questions are best used when the patient has feelings of loss of self-worth and depression. The other responses hurry the patient and offer superficial assurance. TOP: Discipline: Behavioral Science MSC: Organ System: General 9. During an interview, you have the impression that a patient may be considering suicide. Which action is essential? a. Immediately begin proceedings for an involuntary commitment. b. Ask whether the patient has considered self-harm. c. Ask whether the patient would like to visit a psychiatrist. d. Record the impression in the patient’s chart and refer the patient for hospitalization. e. Avoid directly confronting the patient regarding your impression. ANS: B If you think the patient may bNeUcRonSsiIdeNrGinTg BCidOe,Mhe or she probably is. Mentioning it gives permission to talk about it. TOP: Discipline: Behavioral Science MSC: Organ System: General 10. You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should: a. never be interviewed alone because this may alienate the parent. b. be mailed a questionnaire in advance to avoid the need for her to talk. c. be given the opportunity to be interviewed without the parent at some point. d. be allowed to direct the flow of the interview. e. be ignored while you address all questions to the parent. ANS: C An older child should be given the opportunity to give information directly. This enhances the probability that the child will follow your advice. TOP: Discipline: Behavioral Science MSC: Organ System: General 11. When communicating with older children and teenagers, you should be sensitive to their: a. parent’s needs. b. natural urge to communicate. c. need for verbal instructions. d. typical reluctance to talk. 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 12. 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 13. 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 14. 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 15. 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 16. 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 BCgOvMictimized. 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 17. 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 18. 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 19. Tom is a 16-year-old young man with diabetes who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom’s health? a. Attachment to parents b. Tendency to give too much information c. Low peer support needs d. Propensity for risk taking e. High self-esteem ANS: D Adolescents tend to experiment with risky behaviors that lead to a high incidence of morbidity and mortality. Adolescents may be reluctant to provide information. TOP: Discipline: Behavioral Science MSC: Organ System: General 20. Pain is difficult to assess in older adults because: a. their histories are usuallyNunrReliaIble.G B.C M b. sharp pain may be felt as a dull ache. c. they tend to exaggerate symptoms. d. their language skills decline. e. drugs act more rapidly with age. ANS: B Pain is often an unreliable symptom in older adults because they lose pain perception and experience pain in a different manner from those in other age groups. TOP: Discipline: Behavioral Science MSC: Organ System: General 21. A survey of mobility and activities of daily living (ADL) is part of a(n): a. ethnic assessment. b. functional assessment. c. genetic examination. d. social history. e. sexual history. ANS: B A functional assessment is an assessment of a patient’s mobility, upper extremity movement, household management, activities of daily living, and instrumental activities of daily living. TOP: Discipline: Behavioral Science MSC: Organ System: General 22. Constitutional symptoms in the ROS refer to: a. height, visual acuity, and body mass index. b. fever, chills, fatigue, and malaise. c. hearing loss, tinnitus, and diplopia. d. rashes, skin turgor, and temperature. e. joint stiffness, redness, and swelling. ANS: B General constitutional symptoms refer to fever, chills, malaise, fatigability, night sweats, sleep patterns, and weight (average, preferred, present, change). TOP: Discipline: Behavioral Science MSC: Organ System: General 23. J.M. has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) history. a. complete 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 1. 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 2. 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 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 3. 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 4. 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 5. 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 c. come quickly to the point d. use silence comfortably e. speak more softly than other cultures ANS: C In the United States, individuals are very direct in conversation and come to the point quickly. They also tend to talk more loudly and to worry less about being overheard. TOP: Discipline: Behavioral Science MSC: Organ System: General 6. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem? a. “How often do you have a medical examination?” b. “What are your age, race, and educational level?” c. “What types of symptoms have you been having?” d. “Why do you think you are having these symptoms?” e. “Do you take herbal remedies?” ANS: D This open-ended question avoids stereotyping, is sensitive and respectful toward the individual, and allows for cultural data to be exchanged. TOP: Discipline: Behavioral Science MSC: Organ System: General 7. A person’s definition of illness is likely to be most influenced by: a. race. b. ritual. c. enculturation. d. age group. e. socioeconomic class. ANS: C The definition of “ill” is determined in large part by the individualand the process whereby an individual assumes the traits and behaviors of a given culture. TOP: Discipline: Behavioral Science MSC: Organ System: General 8. An aspect of traditional Western medicine that may be troublesome to many Hispanics, Native Americans, Asians, and Arabs is Western medicine’s attempt to: a. use a holistic approach that views a particular medical problem as part of a bigger picture. b. determine a specific cause for every problem in a precise way. c. establish harmony between a person and the entire cosmos. d. use herbal remedies and rituals. e. promote balance in an individual’s life. ANS: B A more scientific approach to healthcare problem solving, in which a cause can be determined for every problem in a precise way, is a Western approach. Hispanics, Native Americans, Asians, and Arabs embrace a more “holistic” approach. TOP: Discipline: Behavioral SNciUenRceSINGMTSBC.: COrOgaMn System: General 9. A naturalistic or holistic approach to health care often assumes: a. that hot conditions require treatment with a hot remedy. b. a reductionist view that looks to a very narrow cause and effect. c. there are external factors that must be kept in balance. 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 10. 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 11. 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 12. 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 [Show More]

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