SEIDEL'S GUIDE TO PHYSICAL EXAMINATION 9TH EDITION BALL TEST BANK JANE W.BALL COMPLETE SOLUTION
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Chapter 01: The History and Interviewing
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Ball: Seidel’s Guide to Physical Examination, 9th Edition
MULTIPLE CHOICE
1. 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.
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 isless 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 pushtoo 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 socialdrinker.” Which initial response is appropriate?
a. “I'm glad that you are a responsible drinker.”
b. “Many people who are reNallyRalcoI hoGlic 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 adesignated 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 hashad 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 ofself-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 bNeUcRonSsiIdeNrGingTBsui.cCidOe,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 theexamination 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 theprobability 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 arespect 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 hecannot 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 toclarify 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 involvedin 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 inanother 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 beaddressed 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 incorrectbecause 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 beasked 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 sexuallytransmitted 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 providerfirst 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 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 questioningshould 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 forproblem 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 promotestrust.
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 istypical 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 morbidityand 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 andexperience 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, sleeppatterns, 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 ofacute 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 overtime, 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 healthproblems.
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 anddistinguishing physical characteristics.
c. To be a member of a specific culture, an individual must have certain identifiablephysical characteristics.
d. Gender and race are the two essential physical characteristics used to identifycultural 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 thetwo, 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 knownas a(n):
a. acculturation.
b. norm.
c. stereotyp e.
d. ethnos.
e. custom.
ANS: C
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This definition describes a stereotype. A norm, on the other hand, is a standard of allowablebehavior 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 abdominalpain. 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 tohim.
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 bedoing 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 healthcare.
b. The morbidity and mortality rates of impoverished people are greater than those ofthe middle class.
c. The morbidity and mortality rates of impoverished people are less than those of themiddle class.
d. No reliable statistics exist regarding the relationship of poverty to morbidity andmortality.
e. The morbidity and mortality rates of impoverished people are similar to those ofthe middle class.
ANS: B
Poorly educated people and people in poverty die at higher rates than those who areadvantaged; 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 thanother groups of patients.
a. emphasize attitudes and feelings
b. maintain eye contact
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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 theindividual, and allows for cultural data to be exchanged.
TOP: Discipline: Behavioral Science MSC: Organ System: General [Show Less]