,TESTBANK FOR Advanced Health Assessment and
Differential Diagnosis Essentials for Clinical
Practice, 1e Myrick
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,4 Advanced Health Assessment and Differential Diagnosis
,Copyright © 2021 Springer Publishing Company, LLC
All rights reserved.
This work is protected by U.S. copyright laws and is provided solely for the use of instructors in teaching their courses and as an
aid for student learning. No part of this publication may be sold, reproduced, stored in a retrieval system, or transmitted in any
form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer
Publishing Company, LLC.
Springer Publishing Company, LLC
11 West 42nd Street
New York, NY 10036
www.springerpub.com
ISBN: 978-0-8261-6266-3
The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information
that is accurate and compatible with the standards generally accepted at the time of publication. The author and publisher shall
not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or
reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs
for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such
websites is, or will remain, accurate or appropriate.
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
, CHAPTER 1: HEALTH HISTORY, THE PATIENT INTERVIEW,
AND MOTIVATIONAL INTERVIEWING
1. Which statement, if said by the nursing student, indicates a correct understanding of the health
history?
a. “The health history is a minor part of evaluating a patient’s health status.”
b. “The health history provides a snapshot of the patient and their daily life.”
c. “The health history does not reveal the patient’s understanding about health.”
*d. “The health history is a holistic picture of the patient, their support systems, and habits.”
Rationale: The health history is a crucial part of evaluating a patient’s health status. It establishes a
baseline for the patient and can reveal the patient’s understanding about health and the factors that
influence their health. Finally, it also provides a comprehensive, holistic picture of the patient, their
support systems, habits, and daily life.
2. The clinician is getting ready to perform a health history but wants to ensure the patient can
communicate before beginning. Which of the following areas should the clinician assess? Select all
that apply.
*a. Mental status
*b. Memory
c. Stressors
*d. Reasoning
e. Hygiene
Rationale: A quick assessment of whether the patient is capable of providing accurate information is
crucial to the entire process. The patient must be able to communicate, although not necessarily orally, in
order to convey information. Mental status plays a role in history taking. Anyone whose mental status is
altered may not provide accurate information. Memory and reasoning must be intact to be able to relay
past events and how they may have led to the patient’s condition. Stressors and hygiene are assessed as
part of the patient assessment, not their health history.
3. The clinician is performing a health history on a patient who does not speak English. In light of the
language barrier, which of the following considerations are important for this patient? Select all that
apply.
*a. Address the patient, even if the interpreter is in the room.
b. Focus on the interpreter.
*c. Focus on the patient.
d. Ask the patient to bring a family member to the visit to interpret.
*e. Use an in-person interpreter when available.
Rationale: Interpreters may be used in person or via an app which gives you the translation for a phrase
or via phone. The provider still addresses the patient although the interpreter translates the language
spoken. The provider should not be focused on the interpreter, but rather, the patient remains the focus of
the conversation. Family members can be used as interpreters, although this may not be the best option
because the patient may not want a family to accompany them in the room. Also, a family member may
answer with their perspective versus the patient’s perspective, or may not fully translate what the patient
says.
Copyright © Springer Publishing Company, LLC. All Rights Reserved. 1
,2 Advanced Health Assessment and Differential Diagnosis
4. Clinicians try to ask open-ended questions to get patients to answer more fully. Which of the
following questions is an example of an open-ended question?
a. “Do you smoke?”
*b. “How much alcohol do you drink?”
c. “Are you in pain?”
d. “Do you want to eat lunch?”
Rationale: Exploring a patient’s health history involves asking different types of questions. Avoid asking
closed-ended questions, which will only provide a yes or no answer. Rather, ask open-ended questions to
capture more detail and help the provider focus on areas to clarify.
5. What information gathered by the clinician would be classified as the history of the present illness
(HPI)?
a. Age, gender, and occupation
b. Support system, profession, and dietary habits
*c. Onset, location, duration, frequency, intensity, and alleviating and exacerbating factors
surrounding the patient’s symptom(s)
d. The reason for the visit. It may be a direct quote or brief summary of patent’s comments.
Rationale: Age, gender, and occupation relate to identification of the patient. The social history includes
the patient’s support system, profession, living situation, exercise, dietary and other habits, and safety at
home and at work. The onset, location, duration, frequency, intensity, and alleviating and exacerbating
factors surrounding the patient’s symptom(s) comprise the HPI. The reason for the visit as a direct quote
or brief summary of patient’s comments is the chief complaint (CC).
6. What information should the clinician include in the allergy section of the health history? Select all
that apply.
*a. When the allergy occurred
b. The use of over-the-counter medications
*c. The type of reaction experienced
*d. The name of the offending substance
*e. Any reaction related to eating shellfish
Rationale: Allergies must be written in the patient’s chart including, if the patient recalls, when the
allergy occurred and what the reaction was. The patient should name the offending substance. Reactions
to shellfish could indicate an allergy to dye. The use of over-the-counter medications is not important here
unless an allergy to one of them exists.
7. Why is the social history important for the clinician to document?
*a. The social history addresses patient’s habits, such as smoking.
b. The social history addresses only patient information.
c. The social history should take place with family members in the room.
d. The social history should include the habits of parents and children.
Rationale: Understanding the social history of a patient has the potential to be clinically significant. It is
important to interview the patient individually, without others present, so that they can respond truthfully.
In the social interview, the provider learns about the patient’s family, significant others, friends, and
anyone else in their support system. Some personal habits included in a patient’s social history include
diet, exercise, and smoking.
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
, Chapter 1: Health History, the Patient Interview, and Motivational Interviewing 3
8. Identify the components of the Review of Systems (ROS) as done by the clinician. Select all that
apply.
*a. Skin
*b. Neurological
c. Allergies
*d. Musculoskeletal
e. Smoking
Rationale: The ROS allows the provider to gather information about each body system. Skin,
neurological, and musculoskeletal are systems included in the ROS. Smoking is addressed under the
social history. Allergies are addressed under the allergy section of the health history.
9. A clinician engages with a patient who presents with a chief complaint of a sore throat. Which areas
should be included in the assessment of this patient?
a. Dietary concerns
*b. Ears, nose, and throat
c. Respiratory and cardiac
d. Family history
Rationale: Not all assessments need to be comprehensive. A patient with an identified problem will need
an assessment that explores the symptom(s). Only areas that are related to the symptom are investigated.
For a patient whose chief complaint is a sore throat, the provider must do a thorough history in the area of
head, eyes, ears, nose, throat, and respiratory and review habits such as smoking. Work and home
environments are explored to ensure no contributing factors are present at home or work. The cardiac
system, dietary concerns, and family history have no bearing on the chief complaint of a sore throat.
10. The clinician is attempting to identify a patient’s differential diagnosis. Which of the following is a
component of differential diagnosis?
a. It is not necessary to use the health history in determining the differential diagnosis.
b. The differential diagnosis can be made during the physical examination.
c. The provider must maintain a wide focus during the physical examination.
*d. A differential diagnosis cannot be made until after both the health history and physical
examination.
Rationale: A differential diagnosis is the process of differentiating between two or more conditions that
share similar signs or symptoms. The health history is a necessary and important component in diagnostic
reasoning and determining the differential diagnosis. A differential diagnosis cannot be determined until
after both the history and the physical examination. The provider should not narrowly focus the
examination in order to entertain all possibilities in the differential diagnosis.
11. Which information gathered by the clinician would be classified as the chief complaint (CC)?
a. Age, gender, and occupation
b. Support system, profession, and dietary habits
c. The onset, location, duration, frequency, intensity, and alleviating and exacerbating factors
surrounding the patient’s symptom(s)
*d. The reason for the visit. It may be a direct quote or brief summary of the patient’s comments.
Rationale: Age, gender, and occupation relate to identification of the patient. The social history includes
the patient’s support system, profession, living situation, exercise, dietary and other habits, and safety at
home and at work. The onset, location, duration, frequency, intensity, and alleviating and exacerbating
factors surrounding the patient’s symptom(s) comprise the history of the present illness (HPI). The reason
for the visit as a direct quote or brief summary of patient’s comments is the CC.
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
,4 Advanced Health Assessment and Differential Diagnosis
12. A patient with a diagnosis of congestive heart failure (CHF) is seen in the medical office by the
clinician. Which question should be included in the review of systems (ROS) for this patient?
a. “Do you have any difficulty swallowing?”
*b. “Are you experiencing any trouble speaking words?”
c. “Are you short of breath when walking short distances?”
d. “Do you have any double vision?”
Rationale: Questions to include in the ROS for cardiac concerns include chest pain, swelling of the legs,
and shortness of breath when walking short distances or up a flight of stairs. Difficulty swallowing would
be a concern for the throat. Double vision would be a concern for those with vision or concerns with their
eyes. Difficulty speaking would be included under the neurological ROS.
13. Name the seven attributes of a symptom, which may be recalled with the mnemonic OLD CART.
Answer:
OL: Onset Location
D: Duration
C: Characteristics
A: Aggravating factors
R: Relieving factors
T: Treatment
Rationale: If there is a specific complaint, it must be fully explored. The onset, location, and duration of
the symptoms as well as any accompanying symptoms, aggravating or relieving activities, and what the
patient has tried for treatment must be discussed. These areas are known as the seven attributes of a
symptom, which may be recalled with the mnemonic OLD CART.
14. Describe how to document a patient’s family history.
Answer: Family history may be documented in a narrative format or a genogram may be constructed.
Rationale: The family history should include relatives in a direct line to the patient such as parents,
grandparents, and children of the patient. Patterns may indicate genetic predisposition to certain illnesses,
but environmental influences should not be overlooked.
15. Describe the purpose of doing a motivational interview.
Answer: Motivational interviewing is a skill that can help a provider move more to a patient-centered
approach during the health history interview.
Rationale: Motivational interviewing helps the patient explore the pros and cons of change and the
implications of change. The health history interview becomes less provider-driven and more patient-
centered. The patient considers the reasons for or against changes in health behaviors. The provider
guides the patient in the process of thinking about a behavior. The behavioral change will come from a
desire within the patient rather than the provider telling the patient what to do.
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
, Chapter 1: Health History, the Patient Interview, and Motivational Interviewing 5
16. Discuss the role of the focused health history.
Answer: A focused health history is the detailed assessment of specific body system(s) relating to the
presenting problem or current concern(s) of the patient.
Rationale: The components of the focused health history must be recorded for documentation of the
complaint as well as billing and reimbursement. For a focused history, anything pertinent to the patient
problem must be explored and documented in the history.
17. Identify some considerations a clinician should consider caring for special populations of patients.
Answer: Physical disabilities, mental disabilities, and communication difficulties due to culture and
language.
Rationale: The provider must be sensitive to patients and their abilities. Some patients may have physical
or mental disabilities. In a health history, the provider must remain nonjudgmental and supportive of the
patient. The provider must ensure that the patient understands the information presented and that they
answer the patient’s questions clearly. This is especially important if culture and language differences
exist. An open patient–provider relationship serves to maintain communication and create an environment
of wellness and healing for the patient.
18. Why is it important to differentiate between subjective and objective information obtained during the
taking of health history of a patient?
Answer: What the patient tells the provider may be confirmed or opposed to the findings of the provider.
Rationale: The entire health history is subjective information as it is what the patient tells the provider.
The physical examination is the objective information gathered by the provider. It is important to
distinguish between these two types of information in a history and physical examination. Incongruent
findings may lead to more questions to determine the reason for the discrepancies. Often providers can
uncover a misunderstanding about wellness or illness and educate the patient about physiology and
disease process.
19. What information should be included under the allergies section of the health history?
Answer: When the allergy occurred and what the reaction was.
Rationale: Allergies must be written in the patient’s chart including, if the patient recalls, when the
allergy occurred and what the reaction was. At times, patients may list an allergy to a substance when the
actual offending agent may be different.
20. State why the social history is such an important part of the health history.
Answer: The social history fills in the gaps regarding the living situation and support system for the patient.
Rationale: The social history is extremely important and is often overlooked or not explored in detail.
The provider learns about the patient’s family, significant others, friends, coworkers, and anyone else who
the patient considers part of the support system. In addition, the provider must ask about habits including
dietary, exercise, smoking, use of other substances, sleeping habits, safety in and outside the home, and
anything else the patient may reveal. Healthcare providers are uniquely positioned to uncover difficult
situations that patients may find themselves in.
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
, CHAPTER 2: ADVANCED HEALTH ASSESSMENT OF THE
HEAD, NECK, AND LYMPHATIC SYSTEM
1. The clinician is assessing the skull of an adolescent. The clinician notes the skull bones are separated
by the following sutures: (Select all that apply.)
*a. Squamosal
*b. Sagittal
c. Sphenoid
*d. Coronal
*e. Lambdoid
Rationale: The skull bones are separated by lambdoid, sagittal, coronal, sagittal, and squamosal sutures.
The sutures connect the occipital, parietal, frontal, and temporal bones. The sagittal suture attaches the
two parietal bones to each other. The frontal bone is attached to the parietal bones by the coronal suture.
The sphenoid is a bone in the skull that makes up part of the base of the skull.
2. A 63-year-old male presents to the office complaining of increasing dry mouth that began
approximately 1 month ago. Which of the following should the clinician assess to identify a possible
cause for the dry mouth?
*a. Submandibular gland
b. Sternocleidomastoid muscle
c. Cervico-trigeminal reflexes
d. Mylohyoid
Rationale: The submandibular gland is essential for the production of salivary fluid. Saliva is necessary
for the breakdown and digestion of food. Additionally, the gland helps to facilitate lymphatic drainage.
The sternocleidomastoid muscle (SCM) plays a fundamental role in the posture of the body. The cervico-
trigeminal reflexes assist with the electrical activity of the SCM. However, the cervico-trigeminal reflexes
do not assist with the development of salivary fluid. Although located behind the submandibular gland,
the mylohyoid does not produce salivary fluid or contribute to the production of salivary fluid.
3. Which areas should the clinician expect to assess for lymph nodes in a patient’s leg? Select all that
apply.
a. Axillary
*b. Inguinal
c. Submental
d. Occipital
*e. Popliteal
Rationale: Lymph nodes of the leg include the inguinal and popliteal nodes. Axillary nodes are located in
the arms. The submental and occipital nodes are located in the neck region.
4. A patient complains of a migraine headache that is precipitated by her menstrual cycle. The
symptoms include generalized location lasting hours to days with noted throbbing. Which test would
be prudent for the clinician to order?
a. x-Ray
*b. MRI
c. Ultrasound
d. Thyroid function tests
6 Copyright © Springer Publishing Company, LLC. All Rights Reserved.
Differential Diagnosis Essentials for Clinical
Practice, 1e Myrick
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,4 Advanced Health Assessment and Differential Diagnosis
,Copyright © 2021 Springer Publishing Company, LLC
All rights reserved.
This work is protected by U.S. copyright laws and is provided solely for the use of instructors in teaching their courses and as an
aid for student learning. No part of this publication may be sold, reproduced, stored in a retrieval system, or transmitted in any
form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer
Publishing Company, LLC.
Springer Publishing Company, LLC
11 West 42nd Street
New York, NY 10036
www.springerpub.com
ISBN: 978-0-8261-6266-3
The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information
that is accurate and compatible with the standards generally accepted at the time of publication. The author and publisher shall
not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or
reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs
for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such
websites is, or will remain, accurate or appropriate.
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
, CHAPTER 1: HEALTH HISTORY, THE PATIENT INTERVIEW,
AND MOTIVATIONAL INTERVIEWING
1. Which statement, if said by the nursing student, indicates a correct understanding of the health
history?
a. “The health history is a minor part of evaluating a patient’s health status.”
b. “The health history provides a snapshot of the patient and their daily life.”
c. “The health history does not reveal the patient’s understanding about health.”
*d. “The health history is a holistic picture of the patient, their support systems, and habits.”
Rationale: The health history is a crucial part of evaluating a patient’s health status. It establishes a
baseline for the patient and can reveal the patient’s understanding about health and the factors that
influence their health. Finally, it also provides a comprehensive, holistic picture of the patient, their
support systems, habits, and daily life.
2. The clinician is getting ready to perform a health history but wants to ensure the patient can
communicate before beginning. Which of the following areas should the clinician assess? Select all
that apply.
*a. Mental status
*b. Memory
c. Stressors
*d. Reasoning
e. Hygiene
Rationale: A quick assessment of whether the patient is capable of providing accurate information is
crucial to the entire process. The patient must be able to communicate, although not necessarily orally, in
order to convey information. Mental status plays a role in history taking. Anyone whose mental status is
altered may not provide accurate information. Memory and reasoning must be intact to be able to relay
past events and how they may have led to the patient’s condition. Stressors and hygiene are assessed as
part of the patient assessment, not their health history.
3. The clinician is performing a health history on a patient who does not speak English. In light of the
language barrier, which of the following considerations are important for this patient? Select all that
apply.
*a. Address the patient, even if the interpreter is in the room.
b. Focus on the interpreter.
*c. Focus on the patient.
d. Ask the patient to bring a family member to the visit to interpret.
*e. Use an in-person interpreter when available.
Rationale: Interpreters may be used in person or via an app which gives you the translation for a phrase
or via phone. The provider still addresses the patient although the interpreter translates the language
spoken. The provider should not be focused on the interpreter, but rather, the patient remains the focus of
the conversation. Family members can be used as interpreters, although this may not be the best option
because the patient may not want a family to accompany them in the room. Also, a family member may
answer with their perspective versus the patient’s perspective, or may not fully translate what the patient
says.
Copyright © Springer Publishing Company, LLC. All Rights Reserved. 1
,2 Advanced Health Assessment and Differential Diagnosis
4. Clinicians try to ask open-ended questions to get patients to answer more fully. Which of the
following questions is an example of an open-ended question?
a. “Do you smoke?”
*b. “How much alcohol do you drink?”
c. “Are you in pain?”
d. “Do you want to eat lunch?”
Rationale: Exploring a patient’s health history involves asking different types of questions. Avoid asking
closed-ended questions, which will only provide a yes or no answer. Rather, ask open-ended questions to
capture more detail and help the provider focus on areas to clarify.
5. What information gathered by the clinician would be classified as the history of the present illness
(HPI)?
a. Age, gender, and occupation
b. Support system, profession, and dietary habits
*c. Onset, location, duration, frequency, intensity, and alleviating and exacerbating factors
surrounding the patient’s symptom(s)
d. The reason for the visit. It may be a direct quote or brief summary of patent’s comments.
Rationale: Age, gender, and occupation relate to identification of the patient. The social history includes
the patient’s support system, profession, living situation, exercise, dietary and other habits, and safety at
home and at work. The onset, location, duration, frequency, intensity, and alleviating and exacerbating
factors surrounding the patient’s symptom(s) comprise the HPI. The reason for the visit as a direct quote
or brief summary of patient’s comments is the chief complaint (CC).
6. What information should the clinician include in the allergy section of the health history? Select all
that apply.
*a. When the allergy occurred
b. The use of over-the-counter medications
*c. The type of reaction experienced
*d. The name of the offending substance
*e. Any reaction related to eating shellfish
Rationale: Allergies must be written in the patient’s chart including, if the patient recalls, when the
allergy occurred and what the reaction was. The patient should name the offending substance. Reactions
to shellfish could indicate an allergy to dye. The use of over-the-counter medications is not important here
unless an allergy to one of them exists.
7. Why is the social history important for the clinician to document?
*a. The social history addresses patient’s habits, such as smoking.
b. The social history addresses only patient information.
c. The social history should take place with family members in the room.
d. The social history should include the habits of parents and children.
Rationale: Understanding the social history of a patient has the potential to be clinically significant. It is
important to interview the patient individually, without others present, so that they can respond truthfully.
In the social interview, the provider learns about the patient’s family, significant others, friends, and
anyone else in their support system. Some personal habits included in a patient’s social history include
diet, exercise, and smoking.
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
, Chapter 1: Health History, the Patient Interview, and Motivational Interviewing 3
8. Identify the components of the Review of Systems (ROS) as done by the clinician. Select all that
apply.
*a. Skin
*b. Neurological
c. Allergies
*d. Musculoskeletal
e. Smoking
Rationale: The ROS allows the provider to gather information about each body system. Skin,
neurological, and musculoskeletal are systems included in the ROS. Smoking is addressed under the
social history. Allergies are addressed under the allergy section of the health history.
9. A clinician engages with a patient who presents with a chief complaint of a sore throat. Which areas
should be included in the assessment of this patient?
a. Dietary concerns
*b. Ears, nose, and throat
c. Respiratory and cardiac
d. Family history
Rationale: Not all assessments need to be comprehensive. A patient with an identified problem will need
an assessment that explores the symptom(s). Only areas that are related to the symptom are investigated.
For a patient whose chief complaint is a sore throat, the provider must do a thorough history in the area of
head, eyes, ears, nose, throat, and respiratory and review habits such as smoking. Work and home
environments are explored to ensure no contributing factors are present at home or work. The cardiac
system, dietary concerns, and family history have no bearing on the chief complaint of a sore throat.
10. The clinician is attempting to identify a patient’s differential diagnosis. Which of the following is a
component of differential diagnosis?
a. It is not necessary to use the health history in determining the differential diagnosis.
b. The differential diagnosis can be made during the physical examination.
c. The provider must maintain a wide focus during the physical examination.
*d. A differential diagnosis cannot be made until after both the health history and physical
examination.
Rationale: A differential diagnosis is the process of differentiating between two or more conditions that
share similar signs or symptoms. The health history is a necessary and important component in diagnostic
reasoning and determining the differential diagnosis. A differential diagnosis cannot be determined until
after both the history and the physical examination. The provider should not narrowly focus the
examination in order to entertain all possibilities in the differential diagnosis.
11. Which information gathered by the clinician would be classified as the chief complaint (CC)?
a. Age, gender, and occupation
b. Support system, profession, and dietary habits
c. The onset, location, duration, frequency, intensity, and alleviating and exacerbating factors
surrounding the patient’s symptom(s)
*d. The reason for the visit. It may be a direct quote or brief summary of the patient’s comments.
Rationale: Age, gender, and occupation relate to identification of the patient. The social history includes
the patient’s support system, profession, living situation, exercise, dietary and other habits, and safety at
home and at work. The onset, location, duration, frequency, intensity, and alleviating and exacerbating
factors surrounding the patient’s symptom(s) comprise the history of the present illness (HPI). The reason
for the visit as a direct quote or brief summary of patient’s comments is the CC.
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
,4 Advanced Health Assessment and Differential Diagnosis
12. A patient with a diagnosis of congestive heart failure (CHF) is seen in the medical office by the
clinician. Which question should be included in the review of systems (ROS) for this patient?
a. “Do you have any difficulty swallowing?”
*b. “Are you experiencing any trouble speaking words?”
c. “Are you short of breath when walking short distances?”
d. “Do you have any double vision?”
Rationale: Questions to include in the ROS for cardiac concerns include chest pain, swelling of the legs,
and shortness of breath when walking short distances or up a flight of stairs. Difficulty swallowing would
be a concern for the throat. Double vision would be a concern for those with vision or concerns with their
eyes. Difficulty speaking would be included under the neurological ROS.
13. Name the seven attributes of a symptom, which may be recalled with the mnemonic OLD CART.
Answer:
OL: Onset Location
D: Duration
C: Characteristics
A: Aggravating factors
R: Relieving factors
T: Treatment
Rationale: If there is a specific complaint, it must be fully explored. The onset, location, and duration of
the symptoms as well as any accompanying symptoms, aggravating or relieving activities, and what the
patient has tried for treatment must be discussed. These areas are known as the seven attributes of a
symptom, which may be recalled with the mnemonic OLD CART.
14. Describe how to document a patient’s family history.
Answer: Family history may be documented in a narrative format or a genogram may be constructed.
Rationale: The family history should include relatives in a direct line to the patient such as parents,
grandparents, and children of the patient. Patterns may indicate genetic predisposition to certain illnesses,
but environmental influences should not be overlooked.
15. Describe the purpose of doing a motivational interview.
Answer: Motivational interviewing is a skill that can help a provider move more to a patient-centered
approach during the health history interview.
Rationale: Motivational interviewing helps the patient explore the pros and cons of change and the
implications of change. The health history interview becomes less provider-driven and more patient-
centered. The patient considers the reasons for or against changes in health behaviors. The provider
guides the patient in the process of thinking about a behavior. The behavioral change will come from a
desire within the patient rather than the provider telling the patient what to do.
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
, Chapter 1: Health History, the Patient Interview, and Motivational Interviewing 5
16. Discuss the role of the focused health history.
Answer: A focused health history is the detailed assessment of specific body system(s) relating to the
presenting problem or current concern(s) of the patient.
Rationale: The components of the focused health history must be recorded for documentation of the
complaint as well as billing and reimbursement. For a focused history, anything pertinent to the patient
problem must be explored and documented in the history.
17. Identify some considerations a clinician should consider caring for special populations of patients.
Answer: Physical disabilities, mental disabilities, and communication difficulties due to culture and
language.
Rationale: The provider must be sensitive to patients and their abilities. Some patients may have physical
or mental disabilities. In a health history, the provider must remain nonjudgmental and supportive of the
patient. The provider must ensure that the patient understands the information presented and that they
answer the patient’s questions clearly. This is especially important if culture and language differences
exist. An open patient–provider relationship serves to maintain communication and create an environment
of wellness and healing for the patient.
18. Why is it important to differentiate between subjective and objective information obtained during the
taking of health history of a patient?
Answer: What the patient tells the provider may be confirmed or opposed to the findings of the provider.
Rationale: The entire health history is subjective information as it is what the patient tells the provider.
The physical examination is the objective information gathered by the provider. It is important to
distinguish between these two types of information in a history and physical examination. Incongruent
findings may lead to more questions to determine the reason for the discrepancies. Often providers can
uncover a misunderstanding about wellness or illness and educate the patient about physiology and
disease process.
19. What information should be included under the allergies section of the health history?
Answer: When the allergy occurred and what the reaction was.
Rationale: Allergies must be written in the patient’s chart including, if the patient recalls, when the
allergy occurred and what the reaction was. At times, patients may list an allergy to a substance when the
actual offending agent may be different.
20. State why the social history is such an important part of the health history.
Answer: The social history fills in the gaps regarding the living situation and support system for the patient.
Rationale: The social history is extremely important and is often overlooked or not explored in detail.
The provider learns about the patient’s family, significant others, friends, coworkers, and anyone else who
the patient considers part of the support system. In addition, the provider must ask about habits including
dietary, exercise, smoking, use of other substances, sleeping habits, safety in and outside the home, and
anything else the patient may reveal. Healthcare providers are uniquely positioned to uncover difficult
situations that patients may find themselves in.
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, CHAPTER 2: ADVANCED HEALTH ASSESSMENT OF THE
HEAD, NECK, AND LYMPHATIC SYSTEM
1. The clinician is assessing the skull of an adolescent. The clinician notes the skull bones are separated
by the following sutures: (Select all that apply.)
*a. Squamosal
*b. Sagittal
c. Sphenoid
*d. Coronal
*e. Lambdoid
Rationale: The skull bones are separated by lambdoid, sagittal, coronal, sagittal, and squamosal sutures.
The sutures connect the occipital, parietal, frontal, and temporal bones. The sagittal suture attaches the
two parietal bones to each other. The frontal bone is attached to the parietal bones by the coronal suture.
The sphenoid is a bone in the skull that makes up part of the base of the skull.
2. A 63-year-old male presents to the office complaining of increasing dry mouth that began
approximately 1 month ago. Which of the following should the clinician assess to identify a possible
cause for the dry mouth?
*a. Submandibular gland
b. Sternocleidomastoid muscle
c. Cervico-trigeminal reflexes
d. Mylohyoid
Rationale: The submandibular gland is essential for the production of salivary fluid. Saliva is necessary
for the breakdown and digestion of food. Additionally, the gland helps to facilitate lymphatic drainage.
The sternocleidomastoid muscle (SCM) plays a fundamental role in the posture of the body. The cervico-
trigeminal reflexes assist with the electrical activity of the SCM. However, the cervico-trigeminal reflexes
do not assist with the development of salivary fluid. Although located behind the submandibular gland,
the mylohyoid does not produce salivary fluid or contribute to the production of salivary fluid.
3. Which areas should the clinician expect to assess for lymph nodes in a patient’s leg? Select all that
apply.
a. Axillary
*b. Inguinal
c. Submental
d. Occipital
*e. Popliteal
Rationale: Lymph nodes of the leg include the inguinal and popliteal nodes. Axillary nodes are located in
the arms. The submental and occipital nodes are located in the neck region.
4. A patient complains of a migraine headache that is precipitated by her menstrual cycle. The
symptoms include generalized location lasting hours to days with noted throbbing. Which test would
be prudent for the clinician to order?
a. x-Ray
*b. MRI
c. Ultrasound
d. Thyroid function tests
6 Copyright © Springer Publishing Company, LLC. All Rights Reserved.
