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.
“What do you think is causing your headaches?”
b.
“You don’t get headaches often, do you?”
c.
“On a scale of 1 to 10, how would you rate the severity of your headaches?”
d.
“At what time of the day are your headaches the most severe?”
ANS: B
Stating to the patient that he or she does not get headaches would limit the information in
the patient’s answer. Asking the patient what he or she thinks is causing the headaches is an
open-ended question. Asking the patient how he or she would rate the severity of the
headaches and asking what time of the day the headaches are the most severe are direct
questions.
DIF: Cognitive Level: Applying (Application)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
2. When are open-ended questions generally most useful?
a.
During sensitive area part of the interview
b.
After several closed-ended questions have been asked
c.
While designing the genogram
d.
During the review of syst ems
N R I
ANS: A
Asking open-ended questions during the sensitive part of the interview allows you to gather
more information and establishes you as an empathic listener, which is the first step of
effective communication. Asking closed-ended questions may stifle the patient’s desire to
discuss the history of the illness. Interviewing for the purpose of designing a genogram or
conducting a review of systems requires more focused data than can be more easily
gathered with direct questioning.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
3. Periods of silence during the interview can serve important purposes, such as:
a.
allowing the clinician to catch up on documentation.
b.
promoting calm.
c.
providing time for reflection.
d.
increasing the length of the visit.
ANS: C
Silence is a useful tool during interviews for the purposes of reflection, summoning courage,
and displaying compassion. This is not a time to document in the chart, but rather to focus
on the patient. Periods of silence may cause anxiety rather than promote calm. The length of
the visit is less important than getting critical information.
, DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
4. Mr. Franklin is speaking with you, the healthcare provider, about his respiratory problem. Mr.
Franklin says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me
more about your cough.” Mr. Franklin states, “I wish I could tell you more. That’s why
I’m here. You tell me what’s wrong!” Which caregiver response would be most
appropriate for enhancing communication?
a.
“After 3 days, you’re tired of coughing. Have you had a fever?”
b.
“I’d like to hear more about your experiences. Where were you born?”
c.
“I don’t know what’s wrong. You could have almost any disease.”
d.
“I’ll examine you and figure out later what the problem is.”
ANS: A
“After 3 days, you’re tired of coughing. Have you had a fever?” is the only response aimed at
focusing on the chief compliant to gather more data and does not digress from the issue.
DIF: Cognitive Level: Analyzing (Analysis)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
5. After you ask a patient about her family history, she says, “Tell me about your family now.”
Which response is generally most appropriate?
a.
Ignore the patient’s comment and continue with the interview.
b.
Give a brief, undetailed answer.
c.
Ask the patient why she needs to know.
d.
Tell the patient that you do not discuss your family with patients.
ANS: B
Giving a brief, undetailed answer will satisfy the patient’s curiosity about yourself without
invading your private life. Ignoring the patient’s comment, continuing with the interview, and
telling the patient that you do not discuss your family with patients will potentially anger or
frustrate her and keep her from sharing openly. Asking the patient why she needs to know will
distract from the real reason she is seeking care and instead move the interview conversation
away from the topics that should be discussed.
DIF: Cognitive Level: Applying (Application)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
6. A 36-year-old woman complains that she has had crushing chest pain for the past 2 days.
She seems nervous as she speaks to you. An appropriate response is to:
a.
continue to collect information regarding the chief complaint in an
unhurried manner.
b.
finish the interview as rapidly as possible.
c.
ask the patient to take a deep breath and calm down.
d.
ask the patient if she wants to wait until another day to talk to you.
ANS: A
, With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor will
communicate caring to the patient. If you as a healthcare provider are hurried, the patient will
be more anxious. The best way to assist an anxious patient is to not hurry and remain calm,
because this will communicate caring to the patient. Asking the patient if she wants to wait
until another day to talk to you delays the needed health care.
DIF: Cognitive Level: Applying (Application)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
7. 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.
“What in life is causing you such pain?”
c.
“You can’t mean what you’re saying.”
d.
“If you think about it, nothing is worth getting this upset about.”
ANS: B
Specific but open-ended questions are best used when the patient has feelings of loss of
self-worth and depression. “Try to think about the good things in life,” “You can’t mean what
you’re saying,” and “If you think about it, nothing is worth getting this upset about” are
statements that will hurry the patient and offer only superficial assurance.
DIF: Cognitive Level: Analyzing (Analysis)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
8. You are collecting a history from a 16-year-old girl. Her mother is sitting next to her in the
examination room. When collecting history from older children or adolescents, they
should
be:
a.
given the opportunity to be interviewed without the parent at some point during the
interview.
b.
mailed a questionnaire in advance to avoid the need for them to talk.
c.
ignored while you address all questions to the parent.
d.
allowed to direct the flow of the interview.
ANS: A
The adolescent should be given the opportunity to give information directly. This enhances
the probability that the adolescent will follow your advice. Mailing a questionnaire in
advance to avoid the need for her to talk does not assist the adolescent in learning to respond
to answers regarding her health. The parent can help fill in gaps at the end. If she is ignored
while you address all questions to the parent, the patient will feel as though she is just being
discussed and is not part of the process for the health care. The healthcare provider should
always direct the flow of the interview according to the patient’s responses.
DIF: Cognitive Level: Applying (Application)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
9. Information that is needed during the initial interview of a pregnant woman includes all
the following except:
a.
the gender that the woman hopes the baby will be.
b.
past medical history.
c.
healthcare practices.
, d.
the woman’s remembering (knowledge) about pregnancy.
ANS: A
The initial interview for the pregnant woman should include information about her past
medical history, assessment of health practices, identification of potential risk factors, and
assessment of remembering (knowledge) as it affects the pregnancy. The gender of the fetus
is not as important as the information about her past medical history, healthcare practices, and
the woman’s remembering (knowledge) about her pregnancy.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
10. When interviewing older adults, the examiner should:
a.
speak extremely loudly, because most older adults have significant
hearing impairment.
b.
provide a written questionnaire in place of an interview.
c.
position himself or herself facing the patient.
d.
dim the lights to decrease anxiety.
ANS: C
The healthcare provider should position himself or herself so that the older patient can see his
or her face. Shouting distorts speech, dimming the lights impairs vision, and a written
interview may be necessary if all else fails.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
11. To what extent should the paNtienRt wiIth aGphyBs.icaCl diMsability or emotional
disorder be involved in providing health history information to the health professional?
a.
The patient should be present during information collection but should not
be addressed directly.
b.
All information should be collected from past records and family members
while the patient is in another room.
c.
The patient should be involved only when you sense that he or she may
feel ignored.
d.
The patient should be fully involved to the limit of his or her ability.
ANS: D
Patients who are disabled may not give an effective history, but they must be respected,
and the history must be obtained from them to the greatest extent possible. Patients should
be addressed directly and participate in the interview to the extent of their ability.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
12. When taking a history, the nurse should:
a.
ask the patient to give you any information he or she can recall about his or
her 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.
Ball: Seidel’s Guide to Physical Examination, 9th Edition
MULTIPLE CHOICE
1. Which question would be considered a “leading question?”
a.
“What do you think is causing your headaches?”
b.
“You don’t get headaches often, do you?”
c.
“On a scale of 1 to 10, how would you rate the severity of your headaches?”
d.
“At what time of the day are your headaches the most severe?”
ANS: B
Stating to the patient that he or she does not get headaches would limit the information in
the patient’s answer. Asking the patient what he or she thinks is causing the headaches is an
open-ended question. Asking the patient how he or she would rate the severity of the
headaches and asking what time of the day the headaches are the most severe are direct
questions.
DIF: Cognitive Level: Applying (Application)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
2. When are open-ended questions generally most useful?
a.
During sensitive area part of the interview
b.
After several closed-ended questions have been asked
c.
While designing the genogram
d.
During the review of syst ems
N R I
ANS: A
Asking open-ended questions during the sensitive part of the interview allows you to gather
more information and establishes you as an empathic listener, which is the first step of
effective communication. Asking closed-ended questions may stifle the patient’s desire to
discuss the history of the illness. Interviewing for the purpose of designing a genogram or
conducting a review of systems requires more focused data than can be more easily
gathered with direct questioning.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
3. Periods of silence during the interview can serve important purposes, such as:
a.
allowing the clinician to catch up on documentation.
b.
promoting calm.
c.
providing time for reflection.
d.
increasing the length of the visit.
ANS: C
Silence is a useful tool during interviews for the purposes of reflection, summoning courage,
and displaying compassion. This is not a time to document in the chart, but rather to focus
on the patient. Periods of silence may cause anxiety rather than promote calm. The length of
the visit is less important than getting critical information.
, DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
4. Mr. Franklin is speaking with you, the healthcare provider, about his respiratory problem. Mr.
Franklin says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me
more about your cough.” Mr. Franklin states, “I wish I could tell you more. That’s why
I’m here. You tell me what’s wrong!” Which caregiver response would be most
appropriate for enhancing communication?
a.
“After 3 days, you’re tired of coughing. Have you had a fever?”
b.
“I’d like to hear more about your experiences. Where were you born?”
c.
“I don’t know what’s wrong. You could have almost any disease.”
d.
“I’ll examine you and figure out later what the problem is.”
ANS: A
“After 3 days, you’re tired of coughing. Have you had a fever?” is the only response aimed at
focusing on the chief compliant to gather more data and does not digress from the issue.
DIF: Cognitive Level: Analyzing (Analysis)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
5. After you ask a patient about her family history, she says, “Tell me about your family now.”
Which response is generally most appropriate?
a.
Ignore the patient’s comment and continue with the interview.
b.
Give a brief, undetailed answer.
c.
Ask the patient why she needs to know.
d.
Tell the patient that you do not discuss your family with patients.
ANS: B
Giving a brief, undetailed answer will satisfy the patient’s curiosity about yourself without
invading your private life. Ignoring the patient’s comment, continuing with the interview, and
telling the patient that you do not discuss your family with patients will potentially anger or
frustrate her and keep her from sharing openly. Asking the patient why she needs to know will
distract from the real reason she is seeking care and instead move the interview conversation
away from the topics that should be discussed.
DIF: Cognitive Level: Applying (Application)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
6. A 36-year-old woman complains that she has had crushing chest pain for the past 2 days.
She seems nervous as she speaks to you. An appropriate response is to:
a.
continue to collect information regarding the chief complaint in an
unhurried manner.
b.
finish the interview as rapidly as possible.
c.
ask the patient to take a deep breath and calm down.
d.
ask the patient if she wants to wait until another day to talk to you.
ANS: A
, With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor will
communicate caring to the patient. If you as a healthcare provider are hurried, the patient will
be more anxious. The best way to assist an anxious patient is to not hurry and remain calm,
because this will communicate caring to the patient. Asking the patient if she wants to wait
until another day to talk to you delays the needed health care.
DIF: Cognitive Level: Applying (Application)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
7. 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.
“What in life is causing you such pain?”
c.
“You can’t mean what you’re saying.”
d.
“If you think about it, nothing is worth getting this upset about.”
ANS: B
Specific but open-ended questions are best used when the patient has feelings of loss of
self-worth and depression. “Try to think about the good things in life,” “You can’t mean what
you’re saying,” and “If you think about it, nothing is worth getting this upset about” are
statements that will hurry the patient and offer only superficial assurance.
DIF: Cognitive Level: Analyzing (Analysis)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
8. You are collecting a history from a 16-year-old girl. Her mother is sitting next to her in the
examination room. When collecting history from older children or adolescents, they
should
be:
a.
given the opportunity to be interviewed without the parent at some point during the
interview.
b.
mailed a questionnaire in advance to avoid the need for them to talk.
c.
ignored while you address all questions to the parent.
d.
allowed to direct the flow of the interview.
ANS: A
The adolescent should be given the opportunity to give information directly. This enhances
the probability that the adolescent will follow your advice. Mailing a questionnaire in
advance to avoid the need for her to talk does not assist the adolescent in learning to respond
to answers regarding her health. The parent can help fill in gaps at the end. If she is ignored
while you address all questions to the parent, the patient will feel as though she is just being
discussed and is not part of the process for the health care. The healthcare provider should
always direct the flow of the interview according to the patient’s responses.
DIF: Cognitive Level: Applying (Application)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
9. Information that is needed during the initial interview of a pregnant woman includes all
the following except:
a.
the gender that the woman hopes the baby will be.
b.
past medical history.
c.
healthcare practices.
, d.
the woman’s remembering (knowledge) about pregnancy.
ANS: A
The initial interview for the pregnant woman should include information about her past
medical history, assessment of health practices, identification of potential risk factors, and
assessment of remembering (knowledge) as it affects the pregnancy. The gender of the fetus
is not as important as the information about her past medical history, healthcare practices, and
the woman’s remembering (knowledge) about her pregnancy.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
10. When interviewing older adults, the examiner should:
a.
speak extremely loudly, because most older adults have significant
hearing impairment.
b.
provide a written questionnaire in place of an interview.
c.
position himself or herself facing the patient.
d.
dim the lights to decrease anxiety.
ANS: C
The healthcare provider should position himself or herself so that the older patient can see his
or her face. Shouting distorts speech, dimming the lights impairs vision, and a written
interview may be necessary if all else fails.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
11. To what extent should the paNtienRt wiIth aGphyBs.icaCl diMsability or emotional
disorder be involved in providing health history information to the health professional?
a.
The patient should be present during information collection but should not
be addressed directly.
b.
All information should be collected from past records and family members
while the patient is in another room.
c.
The patient should be involved only when you sense that he or she may
feel ignored.
d.
The patient should be fully involved to the limit of his or her ability.
ANS: D
Patients who are disabled may not give an effective history, but they must be respected,
and the history must be obtained from them to the greatest extent possible. Patients should
be addressed directly and participate in the interview to the extent of their ability.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation
12. When taking a history, the nurse should:
a.
ask the patient to give you any information he or she can recall about his or
her 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.
