Test Bank for Primary Care: The Art and Science of Advanced
Practice Nursing and Interprofessional Approach 6th Edition M
Dunphy / 9781719644655 / Chapter 1-88 ,All Chapters with
Answers and Rationals .
In the context of screening for referral, primary purpose of a diagnosis is:
a. To obtain reimbursement
b. To guide the plan of care and intervention strategies
c. To practice within the scope of physical therapy
d. To meet the established standards for accreditation - ANSWER: B. To guide the plan of care and
intervention strategies
T/F: Direct access is the only reason physical therapists must screen for systemic disease. - ANSWER:
False
A patient/client gives you a written prescription from a physician, chiropractor, or dentist. The first
screening question to ask is:
a. What did the physician say is the problem?
b. Did the physician examine you?
c. When do you go back to see the doctor?
d. How many times per week did the doctor suggest you come to therapy? - ANSWER: b. Did the
physician examine you?
Screening for medical disease takes place:
a. only during the first interview
b. just before the client returns to the physician for his/her next appointment
c. throughout the episode of care
d. none of the above - ANSWER: c. throughout the episode of care
Physical Therapists are qualified to make a human movement system diagnosis regarding primary
neuromusculoskeletal conditions, but we must do so in accordance with:
a. The Guide to PT Practice
b. The State Practice Act
c. The screening process
d. The SOAP method - ANSWER: b. The State Practice Act
Medical referral for a problem outside the scope of the physical therapy practice occurs when:
a. No apparent movement dysfunction exists
b. No causative factors can be identified
c. Findings are not consistent with neuromuscular or musculoskeletal dysfunction
d. Client presents with suspicious red-flag symptoms
e. Any of the above
f. None of the above - ANSWER: e. Any of the above
T/F: Physical therapy evaluation and intervention may be part of the physician's differential diagnosis.
- ANSWER: True
What is the difference between a yellow- and a red-flag symptom? - ANSWER: A yellow flag is a
cautionary or warning symptom that signals, "Slow down, and think about the need for screening." A
red flag symptom requires immediate attention, either to pursue further screening questions or tests,
or to make an appropriate referral. The presence of a single yellow or red flag is not usually cause for
immediate medical attention. Each cautionary or warning flag must be viewed in the context of the
whole person, given his or her age, gender, past medical history, and current clinical presentation.
,What are the major decision-making tools used in the screening process? - ANSWER: 1. Past medical
history
2. Risk factor assessment
3. Clinical presentation (including pain types and pain patterns)
4. Associated signs and symptoms
5. Review of systems.
What are constitutional symptoms? - ANSWER: -Fever
-Diaphoresis (unexplained perspiration)
-Sweats (anytime)
-Nausea
-Vomiting
-Diarrhea
-Pallor
-Dizziness/Syncope (fainting)
-Fatigue
-Weight loss
What is the effect of NSAIDs on blood pressure?
a. No effect
b. Increases blood pressure
c. Decreases blood pressure - ANSWER: b. Increases blood pressure
Most of the information needed to determine the cause of symptoms is contained in the:
a. Subjective examination
b. Family/Personal History Form
c. Objective information
d. All of the above
e. a and c - ANSWER: a. Subjective examination
With what final question should you always end your interview? - ANSWER: Any of the following
questions (or similar questions) is appropriate:
-Are any other symptoms of any kind anywhere else in your body that we haven't discussed yet?
-Is there anything else you think is important about your condition that we have not discussed yet?
-Is there anything else you think I should know?
A risk factor for NSAID-related gastropathy is the use of:
a. Antibiotics
b. Antidepressants
c. Antihypertensives
d. Antihistamines - ANSWER: b. Antidepressants
After interviewing a new client, you summarize what she has told you by saying, "You told me you are
here because of right neck and shoulder pain that began 5 years ago as a result of a car accident. You
also have a 'pins and needles' sensation in your third and fourth fingers but no other symptoms at this
time. You have noticed a considerable decrease in your grip strength and you would like to be able to
pick up a pot of coffee without fear of spilling it."
This is an example of:
a. An open-ended question
b. A funnel technique
c. A paraphrasing technique
d. None of the above - ANSWER: c. A paraphrasing technique
T/F: Screening for alcohol use would be appropriate when the client reports a history of accidents. -
ANSWER: True
,What is the significance of sweats?
a. A sign of systemic disease
b. Side effect of chemotherapy or other medications
c. Poor ventilation while sleeping
d. All of the above
e. None of the above - ANSWER: d. All of the above
T/F: Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires
medical referral. - ANSWER: True
Which of the following are red flags to consider when screening for systemic or viscerogenic causes of
neuromuscular and musculoskeletal signs and symptoms:
a. Fever, (night) sweats, dizziness
b. Symptoms are out of proportion to injury
c. Insidious onset
d. No position is comfortable
e. All of the above - ANSWER: e. All of the above
A 52-year-old man with low back pain and sciatica on the left side has been referred to you by his
family physician. He had a discectomy and laminectomy on two separate occasions about 5 to 7 years
ago. No imaging studies have been performed since that time. What follow-up questions should you
ask to screen for medical disease? - ANSWER: The first question should always be, "Did you actually
see your physician?" Then ask questions directed at assessing for the presence of constitutional
symptoms. For example, after paraphrasing what the client has told you, ask, "Are you having any
other symptoms of any kind in your body that you haven't mentioned?" If no, ask more specifically
about the presence of associated signs and symptoms, including naming constitutional symptoms one
by one. Follow up with Special Questions for Men (see Appendix B-21).
You should assess clients who are receiving NSAIDs for which physiologic effect associated with
increased risk of hypertension?
a. Decreased heart rate
b. Increased diuresis
c. Slowed peristalsis
d. Water retention - ANSWER: d. Water retention.
Look for sacral and pedal edema.
Instruct clients with a history of hypertension and arthritis to:
a. Limit physical activity and exercise
b. Avoid OTC medications
c. Inform their primary care provider of both conditions
d. Drink plenty of fluids to avoid edema - ANSWER: c. Inform their primary care provider of both
conditions
Alcohol screening tools should be:
a. Used with every client sometime during the episode of care
b. Brief, easy to administer, and nonthreatening
c. Deferred when the client has been drinking or has the smell of alcohol on their breath
d. Conducted with one other family member present as a witness. - ANSWER: b. Brief, easy to
administer, and nonthreatening
What is the best follow-up question for someone who tells you that the pain is constant?
a. Can you use one finger to point to the pain location?
b. Do you have that pain right now?
c. Does the pain wake you up at night after you have fallen asleep? - ANSWER: b. Do you have that
pain right now?
, A 52-year-old woman with shoulder pain tells you that she has pain at night that awakens her. After
asking a series of follow-up questions, you are able to determine that she had trouble falling asleep
because her pain increases when she goes to bed. Once she falls asleep, she wakes up as soon as she
rolls onto that side. What is the most likely explanation for this pain behavior?
a. Minimal distractions heighten a person's awareness of musculoskeletal discomfort.
b. This is a systematic pattern that is associated with a neoplasm.
c. It is impossible to tell.
d. This represents a chronic clinical presentation of a musculoskeletal problem. - ANSWER: a. Minimal
distractions heighten a person's awareness of musculoskeletal discomfort.
Pain that wakes a client up as soon as he or she rolls onto that side is indicative of an acute
inflammatory process. Night pain associated with neoplasm is more likely to wake the client up after
he or she falls asleep, when the tumor keeps normal tissue from obtaining essential blood and
nutrients, thus creating tissue ischemia and subsequent pain. With chronic musculoskeletal
conditions, the client can often get to sleep with just the right positioning and may even be able to
sleep on that side for up to an hour or two before pressure and ischemia develop, causing pain.
Referred pain patterns associated with impairment of the spleen can produce musculoskeletal
symptoms in:
a. The left shoulder
b. The right shoulder
c. The mid-back or upper back, scapular, and right shoulder areas
d. The thorax, scapulae, right shoulder, or left shoulder - ANSWER: a. The left shoulder
Left shoulder pain associated with damage or injury to the spleen is called *Kehr's sign*.
T/F: Associated signs and symptoms are a major red flag for pain of a systemic or visceral origin
compared to musculoskeletal pain. - ANSWER: True
Words used to describe neurogenic pain often include:
a. Throbbing, pounding, beating
b. Crushing, shooting, pricking
c. Aching, heavy, sore
d. Agonizing, piercing, unbearable - ANSWER: b. Crushing, shooting, pricking
Pain (especially intense bone pain) that is disproportionately relieved by aspirin can be a symptom of:
a. Neoplasm
b. Assault or trauma
c. Drug dependence
d. Fracture - ANSWER: a. Neoplasm
In particular, primary bone cancer
Joint pain can be a reactive, delayed, or allergic response to:
a. Medications
b. Chemicals
c. Infections
d. Artificial sweeteners
e. All of the above - ANSWER: e. All of the above
Bone pain associated with neoplasm is characterized by:
a. Increases with weight bearing
b. Negative heel strike
c. Relieved by Tums or other antacid in women
d. Goes away after eating - ANSWER: a. Increases with weight bearing
T/F: Pain of a viscerogenic nature is not relieved by a change in position. - ANSWER: False
Practice Nursing and Interprofessional Approach 6th Edition M
Dunphy / 9781719644655 / Chapter 1-88 ,All Chapters with
Answers and Rationals .
In the context of screening for referral, primary purpose of a diagnosis is:
a. To obtain reimbursement
b. To guide the plan of care and intervention strategies
c. To practice within the scope of physical therapy
d. To meet the established standards for accreditation - ANSWER: B. To guide the plan of care and
intervention strategies
T/F: Direct access is the only reason physical therapists must screen for systemic disease. - ANSWER:
False
A patient/client gives you a written prescription from a physician, chiropractor, or dentist. The first
screening question to ask is:
a. What did the physician say is the problem?
b. Did the physician examine you?
c. When do you go back to see the doctor?
d. How many times per week did the doctor suggest you come to therapy? - ANSWER: b. Did the
physician examine you?
Screening for medical disease takes place:
a. only during the first interview
b. just before the client returns to the physician for his/her next appointment
c. throughout the episode of care
d. none of the above - ANSWER: c. throughout the episode of care
Physical Therapists are qualified to make a human movement system diagnosis regarding primary
neuromusculoskeletal conditions, but we must do so in accordance with:
a. The Guide to PT Practice
b. The State Practice Act
c. The screening process
d. The SOAP method - ANSWER: b. The State Practice Act
Medical referral for a problem outside the scope of the physical therapy practice occurs when:
a. No apparent movement dysfunction exists
b. No causative factors can be identified
c. Findings are not consistent with neuromuscular or musculoskeletal dysfunction
d. Client presents with suspicious red-flag symptoms
e. Any of the above
f. None of the above - ANSWER: e. Any of the above
T/F: Physical therapy evaluation and intervention may be part of the physician's differential diagnosis.
- ANSWER: True
What is the difference between a yellow- and a red-flag symptom? - ANSWER: A yellow flag is a
cautionary or warning symptom that signals, "Slow down, and think about the need for screening." A
red flag symptom requires immediate attention, either to pursue further screening questions or tests,
or to make an appropriate referral. The presence of a single yellow or red flag is not usually cause for
immediate medical attention. Each cautionary or warning flag must be viewed in the context of the
whole person, given his or her age, gender, past medical history, and current clinical presentation.
,What are the major decision-making tools used in the screening process? - ANSWER: 1. Past medical
history
2. Risk factor assessment
3. Clinical presentation (including pain types and pain patterns)
4. Associated signs and symptoms
5. Review of systems.
What are constitutional symptoms? - ANSWER: -Fever
-Diaphoresis (unexplained perspiration)
-Sweats (anytime)
-Nausea
-Vomiting
-Diarrhea
-Pallor
-Dizziness/Syncope (fainting)
-Fatigue
-Weight loss
What is the effect of NSAIDs on blood pressure?
a. No effect
b. Increases blood pressure
c. Decreases blood pressure - ANSWER: b. Increases blood pressure
Most of the information needed to determine the cause of symptoms is contained in the:
a. Subjective examination
b. Family/Personal History Form
c. Objective information
d. All of the above
e. a and c - ANSWER: a. Subjective examination
With what final question should you always end your interview? - ANSWER: Any of the following
questions (or similar questions) is appropriate:
-Are any other symptoms of any kind anywhere else in your body that we haven't discussed yet?
-Is there anything else you think is important about your condition that we have not discussed yet?
-Is there anything else you think I should know?
A risk factor for NSAID-related gastropathy is the use of:
a. Antibiotics
b. Antidepressants
c. Antihypertensives
d. Antihistamines - ANSWER: b. Antidepressants
After interviewing a new client, you summarize what she has told you by saying, "You told me you are
here because of right neck and shoulder pain that began 5 years ago as a result of a car accident. You
also have a 'pins and needles' sensation in your third and fourth fingers but no other symptoms at this
time. You have noticed a considerable decrease in your grip strength and you would like to be able to
pick up a pot of coffee without fear of spilling it."
This is an example of:
a. An open-ended question
b. A funnel technique
c. A paraphrasing technique
d. None of the above - ANSWER: c. A paraphrasing technique
T/F: Screening for alcohol use would be appropriate when the client reports a history of accidents. -
ANSWER: True
,What is the significance of sweats?
a. A sign of systemic disease
b. Side effect of chemotherapy or other medications
c. Poor ventilation while sleeping
d. All of the above
e. None of the above - ANSWER: d. All of the above
T/F: Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires
medical referral. - ANSWER: True
Which of the following are red flags to consider when screening for systemic or viscerogenic causes of
neuromuscular and musculoskeletal signs and symptoms:
a. Fever, (night) sweats, dizziness
b. Symptoms are out of proportion to injury
c. Insidious onset
d. No position is comfortable
e. All of the above - ANSWER: e. All of the above
A 52-year-old man with low back pain and sciatica on the left side has been referred to you by his
family physician. He had a discectomy and laminectomy on two separate occasions about 5 to 7 years
ago. No imaging studies have been performed since that time. What follow-up questions should you
ask to screen for medical disease? - ANSWER: The first question should always be, "Did you actually
see your physician?" Then ask questions directed at assessing for the presence of constitutional
symptoms. For example, after paraphrasing what the client has told you, ask, "Are you having any
other symptoms of any kind in your body that you haven't mentioned?" If no, ask more specifically
about the presence of associated signs and symptoms, including naming constitutional symptoms one
by one. Follow up with Special Questions for Men (see Appendix B-21).
You should assess clients who are receiving NSAIDs for which physiologic effect associated with
increased risk of hypertension?
a. Decreased heart rate
b. Increased diuresis
c. Slowed peristalsis
d. Water retention - ANSWER: d. Water retention.
Look for sacral and pedal edema.
Instruct clients with a history of hypertension and arthritis to:
a. Limit physical activity and exercise
b. Avoid OTC medications
c. Inform their primary care provider of both conditions
d. Drink plenty of fluids to avoid edema - ANSWER: c. Inform their primary care provider of both
conditions
Alcohol screening tools should be:
a. Used with every client sometime during the episode of care
b. Brief, easy to administer, and nonthreatening
c. Deferred when the client has been drinking or has the smell of alcohol on their breath
d. Conducted with one other family member present as a witness. - ANSWER: b. Brief, easy to
administer, and nonthreatening
What is the best follow-up question for someone who tells you that the pain is constant?
a. Can you use one finger to point to the pain location?
b. Do you have that pain right now?
c. Does the pain wake you up at night after you have fallen asleep? - ANSWER: b. Do you have that
pain right now?
, A 52-year-old woman with shoulder pain tells you that she has pain at night that awakens her. After
asking a series of follow-up questions, you are able to determine that she had trouble falling asleep
because her pain increases when she goes to bed. Once she falls asleep, she wakes up as soon as she
rolls onto that side. What is the most likely explanation for this pain behavior?
a. Minimal distractions heighten a person's awareness of musculoskeletal discomfort.
b. This is a systematic pattern that is associated with a neoplasm.
c. It is impossible to tell.
d. This represents a chronic clinical presentation of a musculoskeletal problem. - ANSWER: a. Minimal
distractions heighten a person's awareness of musculoskeletal discomfort.
Pain that wakes a client up as soon as he or she rolls onto that side is indicative of an acute
inflammatory process. Night pain associated with neoplasm is more likely to wake the client up after
he or she falls asleep, when the tumor keeps normal tissue from obtaining essential blood and
nutrients, thus creating tissue ischemia and subsequent pain. With chronic musculoskeletal
conditions, the client can often get to sleep with just the right positioning and may even be able to
sleep on that side for up to an hour or two before pressure and ischemia develop, causing pain.
Referred pain patterns associated with impairment of the spleen can produce musculoskeletal
symptoms in:
a. The left shoulder
b. The right shoulder
c. The mid-back or upper back, scapular, and right shoulder areas
d. The thorax, scapulae, right shoulder, or left shoulder - ANSWER: a. The left shoulder
Left shoulder pain associated with damage or injury to the spleen is called *Kehr's sign*.
T/F: Associated signs and symptoms are a major red flag for pain of a systemic or visceral origin
compared to musculoskeletal pain. - ANSWER: True
Words used to describe neurogenic pain often include:
a. Throbbing, pounding, beating
b. Crushing, shooting, pricking
c. Aching, heavy, sore
d. Agonizing, piercing, unbearable - ANSWER: b. Crushing, shooting, pricking
Pain (especially intense bone pain) that is disproportionately relieved by aspirin can be a symptom of:
a. Neoplasm
b. Assault or trauma
c. Drug dependence
d. Fracture - ANSWER: a. Neoplasm
In particular, primary bone cancer
Joint pain can be a reactive, delayed, or allergic response to:
a. Medications
b. Chemicals
c. Infections
d. Artificial sweeteners
e. All of the above - ANSWER: e. All of the above
Bone pain associated with neoplasm is characterized by:
a. Increases with weight bearing
b. Negative heel strike
c. Relieved by Tums or other antacid in women
d. Goes away after eating - ANSWER: a. Increases with weight bearing
T/F: Pain of a viscerogenic nature is not relieved by a change in position. - ANSWER: False
