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Chapter 01: The History and Interviewing Process Ball: Seidel¶V GXide WR Ph\Vical E[aPiQaWiRQ, 9Wh EdiWiRQ MULTIPLE CHOICE 1. Which TXeVWiRQ ZRXld be cRQVideUed a ³leadiQg TXeVWiRQ?´ a. ³PleaVe deVcUibe aQ\ aVVRciaWed V\mSWRmV ZiWh \RXU headacheV?´ b. ³YRX dRQ¶W geW headacheV RfWeQ, dR \RX?´ c. ³WhaW acWiYiWieV affecW Whe VeYeUiW\ Rf \RXU headacheV?´ d. ³WhaW WimeV Rf Whe da\ aUe \RXU headacheV Whe mRVW VeYeUe?´ e. ³WhaW ZRUUieV \RX mRVW abRXW \RXU headache?´ ANS: B ThiV TXeVWiRQ ZRXld limiW Whe iQfRUmaWiRQ iQ Whe SaWieQW¶V aQVZeU. The RWheU chRiceV allRZ Whe 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 caUegiYeU dReV QRW VSeak Whe SaWieQW¶V laQgXage? 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 WheQ \RX dR QRW VSeak Whe SaWieQW¶V laQgXage, famil\ membeUV RU fUieQdV ma\ SRVe 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 WechQiTXe iV mRVW likel\ WR UeVXlW iQ Whe SaWieQW¶V XQdeUVWaQdiQg Rf TXeVWiRQV? a. Use phrases that are commonly used by other patients in the area. b. UVe Whe SaWieQW¶V RZQ WeUmV if SRVVible. NURSINGTB.COM Seidel's Guide to Physical Examination 9th Edition Ball Test Bank NURSINGTB.COM 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 XViQg Whe SaWieQW¶V idiRm aQd leYel Rf XQdeUVWaQdiQg. TOP: Discipline: Behavioral Science MSC: Organ System: General 5. A SaWieQW becRmeV UeVWleVV dXUiQg Whe hiVWRU\ aQd Va\V, ³I dRQ¶W haYe Wime fRU all of this cRQYeUVaWiRQ. I¶Ye gRW WR geW back WR ZRUk.´ YRXU mRVW aSSURSUiaWe UeVSRQVe ZRXld be WR: 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 iQfRUmaWiRQ, aQd cRQfURQWV Whe SaWieQW¶V aQgeU. TOP: Discipline: Behavioral Science MSC: Organ System: General 6. WheQ TXeVWiRQiQg a SaWieQW UegaUdiQg alcRhRl iQWake, Vhe WellV \RX WhaW Vhe iV ³RQl\ a VRcial dUiQkeU.´ Which iQiWial UeVSRQVe iV aSSURSUiaWe? a. ³I¶m glad WhaW \RX aUe a UeVSRQVible dUiQkeU.´ b. ³MaQ\ SeRSle ZhR aUe Ueall\ alcRhRlic Va\ Whe\ aUe VRcial dUiQkeUV.´ c. ³WhaW amRXQW aQd ZhaW kiQd Rf alcRhRl dR \RX dUiQk iQ a Zeek?´ d. ³If \RX RQl\ dUiQk VRciall\, \RX ZRQ¶W Qeed WR ZRUU\ abRXW alZa\V haYiQg a deVigQaWed dUiYeU.´ e. ³DR Whe RWheU SeRSle iQ \RXU hRXVehRld cRQVXme alcRhRl?´ ANS: C ThiV aQVZeU claUifieV Whe SaWieQW¶V RZQ WeUm ZiWhRXW aVkiQg a leadiQg TXeVWiRQ RU beiQg 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. ³CaQ \RX deVcUibe Whe SaiQ?´ b. ³The SaiQ dReVQ¶W UadiaWe WR \RXU aUm, dReV iW?´ c. ³HaYe \RX beeQ WUeaWed fRU aQ[ieW\ befRUe?´ d. ³DReV \RXU faWheU haYe heaUW diVeaVe?´ e. ³AUe Whe SaiQV ZRUVe afWeU \RX eaW?´ ANS: A Initially, an open-eQded TXeVWiRQ iV a mRUe aSSURSUiaWe UeVSRQVe. ³CaQ \RX deVcUibe Whe SaiQ?´ is an open-ended question that offers clues to the chief concern. NURSINGTB.COM Seidel's Guide to Physical Examination 9th Edition Ball Test Bank NURSINGTB.COM TOP: Discipline: Behavioral Science MSC: Organ System: General 8. MV. A. VWaWeV, ³M\ life iV jXVW WRR SaiQfXl. IW iVQ¶W ZRUWh iW.´ She aSSeaUV deSUeVVed. Which RQe of the following statements is the most appropriate caregiver response? a. ³TU\ WR WhiQk abRXW Whe gRRd WhiQgV iQ life.´ b. ³YRX VhRXldQ¶W feel WhaW Za\; lRRk aW all Whe gRRd WhiQgV iQ \RXU life.´ c. ³YRX caQ¶W meaQ ZhaW \RX¶Ue Va\iQg.´ d. ³If \RX WhiQk abRXW iW, QRWhiQg iV ZRUWh geWWiQg WhiV XSVeW abRXW.´ e. ³WhaW iQ life iV caXViQg \RX VXch SaiQ?´ 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. RecRUd Whe imSUeVViRQ iQ Whe SaWieQW¶V chaUW aQd UefeU Whe SaWieQW fRU hospitalization. e. Avoid directly confronting the patient regarding your impression. ANS: B If you think the patient may be considering suicide, he 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. SaUeQW¶V QeedV. b. natural urge to communicate. c. need for verbal instructions. d. typical reluctance to talk. NURSINGTB.COM Seidel's Guide to Physical Examination 9th Edition Ball Test Bank NURSINGTB.COM 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 M