Exam (elaborations) HS MISC

Multiple Choice 1. You are running late after your quarterly quality improvement meeting at the hospital and have just gotten paged from the nurses’ station because a family member of one of your patients wants to talk with you about that patient’s care. You have clinic this afternoon and are double-booked for the first appointment time; three other patients also have arrived and are sitting in the waiting room. Which of the following demeanors is a behavior consistent with skilled interviewing when you walk into the examination room to speak with your first clinic patient? 2. A) Irritability 3. B) Impatience 4. C) Boredom 5. Ans: D D) Calm 2. Suzanne, a 25 year old, comes to your clinic to establish care. You are the student preparing to go into the examination room to interview her. Which of the following is the most logical sequence for the patient–provider interview? 3. A) Establish the agenda, negotiate a plan, establish rapport, and invite the patient’s story. 4. B) Invite the patient’s story, negotiate a plan, establish the agenda, and establish rapport. 5. C) Greet the patient, establish rapport, invite the patient’s story, establish the agenda, expand and clarify the patient’s story, and negotiate a plan. 6. D) Negotiate a plan, establish an agenda, invite the patient’s story, and establish rapport. Ans: C Chapter: 03 Page and Header: 60, Learning About the Patient: The Sequence of the Interview Feedback: This is the most productive sequence for the interview. Greeting patients and establishing rapport allows them to feel more comfortable before “inviting” them to relate their story. After hearing the patient’s story, together you establish the agenda regarding the most important items to expand upon. At the end, together you negotiate the plan of diagnosis and treatment. 3. Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been omitted? 4. A) Setting in which the symptom occurs 5. B) Associated manifestations 6. C) Quality 7. D) Timing Ans: B Chapter: 03 Page and Header: 65, The Seven Attributes of a Symptom Feedback: The interviewer has not recorded whether or not the pain has been accompanied by nausea, vomiting, fever, chills, weight loss, and so on. Associated manifestations are additional symptoms that may accompany the initial chief complaint and that help the examiner to start refining his or her differential diagnosis. 4. Jason is a 41-year-old electrician who presents to the clinic for evaluation of shortness of breath. The shortness of breath occurs with exertion and improves with rest. It has been going on for several months and initially occurred only a couple of times a day with strenuous exertion; however, it has started to occur with minimal exertion and is happening more than a dozen times per day. The shortness of breath lasts for less than 5 minutes at a time. He has no cough, chest pressure, chest pain, swelling in his feet, palpitations, orthopnea, or paroxysmal nocturnal dyspnea. Which of the following symptom attributes was not addressed in this description? 1. A) Severity 2. B) Setting in which the symptom occurs 3. C) Timing 4. D) Associated manifestations Ans: A Chapter: 03 Page and Header: 65, The Seven Attributes of a Symptom Feedback: The severity of the symptom was not recorded by the interviewer, so we have no understanding as to how bad the symptom is for this patient. The patient could have been asked to rate his pain on a 0 to 10 scale or used one of the other standardized pain scales available. This allows the comparison of pain intensity before and after an intervention. 5. You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is not a component of adaptive questioning? 6. A) Directed questioning: starting with the general and proceeding to the specific in a manner that does not make the patient give a yes/no answer 7. B) Reassuring the patient that the urinary symptoms are benign and that she doesn’t need to worry about it being a sign of cancer 8. C) Offering the patient multiple choices in order to clarify the character of the urinary symptoms that she is experiencing 9. D) Asking her to tell you exactly what she means when she states that she has a urinary tract infection Ans: B Chapter: 03 Page and Header: 68, Building a Therapeutic Relationship: The Techniques of Skilled Interviewing Feedback: Reassurance is not part of clarifying the patient’s story; it is part of establishing rapport and empathizing with the patient. 6. Mr. W. is a 51-year-old auto mechanic who comes to the emergency room wanting to be checked out for the symptom of chest pain. As you listen to him describe his symptom in more detail, you say “Go on,” and later, “Mm-hmmm.” This is an example of which of the following skilled interviewing techniques? 7. A) Echoing 8. B) Nonverbal communication 9. C) Facilitation 10. D) Empathic response ................................CONTINUED..............