Exam 1 (Ch. 1, 2, 25, 26) Flashcards
(96 cards)
1
Q
Which of the following will best facilitate an interview with a deaf person? A. Speaking loudly B. Using gestures Incorrect C. Sitting or standing at eye level D. Sitting to the side of the patient
A
C.
Sitting or standing at eye level
2
Q
Ms. Carol Turner, a 38-year-old female, brings her 1-year-old son in for health care. Which of the following requests made would be most appropriate at the beginning of an interview?
A. “Mom, please place your son in your lap.”
B. “Carol, please place your son in your lap.”
C. “Mrs. Turner, please place your son in your lap.”
D. “Sweetie, please place your son in your lap.”
A
C. “Mrs. Turner, please place your son in your lap.”
3
Q
Which of the following behaviors describes intelligent response?
A. Data from the history are documented using direct patient quotes.
B. Questions are phrased so that they are clear and explicit.
C. The interviewer avoids the trap of giving advice during an interview.
D. The interviewer listens intently and observes nonverbal cues.
A
D. The interviewer listens intently and observes nonverbal cues.
4
Q
A nurse who goes beyond normal expectations to ensure that an infant is receiving the care directed is demonstrating excessive: A. beneficence. B. malfeasance. C. autonomy. D. utilitarianism.
A
A. Beneficence
5
Q
Various behaviors can create tension during the interview. For the following patient behavior, identify the response by the examiner that is least likely to decrease tension.
Anxiety:
A. Avoid information overload.
B. Slow the conversation and use a soft, slower, deeper vocal tone.
C. Use a calm demeanor to pace the conversation.
D. Finish the interview promptly.
A
D. Finish the interview promptly.
6
Q
Which of the following information is particular to a pediatric history? A. Family history B. Developmental history C. Social history D. Past medical history
A
B. Developmental history
7
Q
Mr. Sandstrom has come for his routine appointment for his hypertension. He is not experiencing medication side effects or other health problems. Which of the following questions is most appropriate to ask when you begin the interview?
A. “How have you been doing since your last visit?”
B. “Have you been taking your medications?”
C. “What brings you to the office today?”
D. “How are you doing with your hypertension?”
A
C. “What brings you to the office today?”
8
Q
During an interview, S.J. admits to feeling worthless and having a sleep disturbance for the last 3 weeks. These clues warrant exploring the possibility of: A. functional ability. B. suicidal ideation or plan. C. substance abuse. D. panic attacks.
A
B. suicidal ideation or plan.
9
Q
When questioning a patient regarding a sensitive issue such as drug use, it is best to:
A. begin by describing the effects of drug abuse on health.
B. be direct, firm, and to the point.
C. explain that only health care workers will share the information.
D. apologize to the patient for asking personal questions.
A
B. be direct, firm, and to the point.
10
Q
Interviewers should identify and assess their own feelings, such as hostility and prejudice, in order to: A. avoid inappropriate behavior. B. explain their biases to patients. C. express personal idiosyncrasies. D. promote self-awareness.
A
A. avoid inappropriate behavior.
11
Q
Deontologic imperatives are:
A. the duties of health care providers that have been established by tradition and cultural context.
B. harmless acts of the care provider.
C. resources used for the good of the community.
D. rules related to the interviewing process.
A
A. the duties of health care providers that have been established by tradition and cultural context
12
Q
A patient with diabetes comes into the medical clinic, stating that he has noticed a sore on his foot for the last week. You note that his last visit was 2 months ago. You would conduct a/an: A. complete history. B. focused history. C. problem-oriented history. D. interim history.
A
D. interim history.
13
Q
Various behaviors can create tension during the interview. For the following patient behavior, identify the response by the examiner that is least likely to decrease tension.
Dissembling
A. Allow the topic to be changed.
B. State “I noticed that you changed the topic.”
C. Use gentle questioning to help the patient explore the topic.
D. Return to the topic at later time in the interview.
A
A. Allow the topic to be changed.
14
Q
Ethical dilemmas include issues related to:
A. miscommunication.
B. legal confusion.
C. personality conflict.
D. conflicting opinions when attitudes of patients or their representatives are clearly communicated.
A
D. conflicting opinions when attitudes of patients or their representatives are clearly communicated.
15
Q
What is a complete history?
A
A history completed the first time a patient is seen
16
Q
What is a family history?
A
Pedigree diagram or genogram
17
Q
What is an inventory history?
A
Touches on major points of concern without detail
18
Q
What is a systems review?
A
Organized physiologic data
19
Q
What is a present problem?
A
Step-by-step evaluation of circumstances
20
Q
What is a social history?
A
Education, home environment, hobbies
21
Q
What is a focused history?
A
Taken during an acute situation requiring immediate attention
22
Q
What is an interim history?
A
A chronicle of events since last meeting with the patient
23
Q
What is a medical history?
A
Previous childhood and adult illness
24
Q
What is a chief complaint?
A
Brief description of the perceived problem
25
Developing cultural awareness and sensitivity is vital for the examiner to succeed at:
A. applying statistical trends of various ethnic and cultural groups.
B. performing a physical examination.
C. identifying patients at high risk for various diseases.
D. recognizing and accepting beliefs about health that differ from personal beliefs
D. recognizing and accepting beliefs about health that differ from personal beliefs
26
```
Ms. Baron is a 27-year-old woman who marries Mr. Zazar who is of Iranian culture. After her marriage, she has assumed the traits and behaviors of the Iranian culture, and has rejected her traits and behaviors from Christian culture. This change in her behavior is called:
A. enculturation.
B. acculturation.
C. ethnocentrism.
D. custom.
```
A. enculturation.
27
Which of the following correctly describes lineal cultural value orientation?
A. Interpersonal relationships are subject to the environment.
B. A son’s goals are not as important as his father's.
C. Outside social relationships are more important than family. Incorrect
D. Expression of self is the individual's main goal.
B. A son’s goals are not as important as his father's.
28
A young Native American/American Indian child with severe abdominal pain and fever is brought to the clinic by his mother and grandmother. On examination, you find a foul-smelling cloth wrapped around the child’s abdomen. If not removed, the cloth will interfere with the completion of the examination. Of the following, which action best demonstrates cultural sensitivity?
A. Ask about its purpose and then remove the cloth.
B. Ignore the cloth.
C. Ask permission to remove the cloth. Incorrect
D. Inform the family that the cloth will be replaced immediately after the abdominal exam.
A. Ask about its purpose and then remove the cloth.
29
```
Formal, religious, or other ceremonial acts are:
A. rites.
B. acculturation.
C. values.
D. beliefs.
```
A. rites.
30
```
Regulating behavior used in different situations is:
A. ritual.
B. custom. Incorrect
C. the norm.
D. ethnocentrism.
```
A. ritual.
31
An individual from which of the following groups is most likely to believe that humans have little control over their destiny?
A. Dominant Americans
B. Native Americans/American Indians Incorrect
C. Eastern Asians
D. Hispanics
D. Hispanics
32
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Behavior approved by group standards is:
A. ritual
B. values.
C. beliefs. Incorrect
D. the norm.
```
D. the norm.
33
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Mr. Javed is an Arabic gentleman who is experiencing a sore throat. He is most likely to treat this with:
A. meditations and prayer.
B. ginger root, a “hot” medicine.
C. barley water, a “cold” food.
D. no treatment at all.
```
C. barley water, a “cold” food.
34
In the naturalistic or holistic approach, which of the following statements accurately reflect the naturalist belief?
A. External factors must be kept in perfect balance.
B. A person eats and uses only naturally grown foods.
C. Restoring a disturbed balance requires well-heated foods.
D. All prescribed medications are considered “cold.”
A. External factors must be kept in perfect balance.
35
What is the norm?
Behavior approved by group standards
36
What is a rite?
Formal, religious, or other ceremonial acts
37
What is a custom?
A habitual activity passed along by family members
38
What is a ritual?
Regulating behavior used in different situations
39
What is a sterotype?
Inflexible generalizations about a group
40
What are values?
Ideas, customs, and behaviors within a group/subgroup
41
What is acculturation?
The act of shedding one culture and assuming another
42
```
Mr. Shaken is a 46-year-old patient who presents for a routine physical examination. After you have identified and confirmed a problem, the next step is to:
A. assess the data collected.
B. formulate a clinical opinion.
C. conduct further assessment.
D. determine the management plan
```
D. determine the management plan
43
The use of a computer could potentially be detrimental to the examiner because:
A. it may become a substitute for critical thinking.
B. computer dysfunction makes it unreliable.
C. the computer is limited in the amount of data it can interpret.
D. the level of skill needed to run a diagnostic computer program is beyond the computer skills of most examiners.
A. it may become a substitute for critical thinking.
44
In order to identify problems based on clinical examination, it is helpful to organize the data:
A. by dividing data into normal and abnormal findings.
B. by body systems.
C. by chief complaints.
D. in the order the data were collected.
B. by body systems.
45
A problem is best identified as:
A. something that bothers the patient.
B. something that is out of the ordinary.
C. something that is unexplainable.
D. something that will need further evaluation and/or attention.
D. something that will need further evaluation and/or attention.
46
Once a close match between the data and diagnosis is made, the next step in the process is to:
A. return to the physical examination and repeat certain parts to validate the presence of specific signs.
B. consider laboratory tests/consultations necessary for further evaluation.
C. confirm the presumptive diagnosis with patient.
D. reanalyze history data to determine where more information is needed.
B. consider laboratory tests/consultations necessary for further evaluation.
47
Probabilism recognizes that truth is difficult to achieve because:
A. individuals are incapable of always telling the truth.
B. cause and effect are not always directly related to each other.
C. science is incapable of completely uncovering the truth.
D. truth is in the eye of the beholder.
B. cause and effect are not always directly related to each other.
48
```
Mrs. Bowers is a 38-year-old patient who presents to your office for a routine examination. The ability of an observation to identify correctly those who have a disease is the definition of:
A. specificity.
B. sensitivity.
C. certainty.
D. positive predictive value.
```
B. sensitivity.
49
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If an individual is suspected of having a specific condition, the condition is in fact present, and a laboratory test confirms its presence, then the outcome of the laboratory test is identified as a(n):
A. true positive.
B. absolute positive.
C. false positive.
D. sensitive positive.
```
A. true positive.
50
Which of the following best describes Bayes formula?
A. The validity of your diagnosis depends on the reliability of the individual as a historian. Incorrect
B. The greater your years of experience, the greater your probability of a valid diagnosis.
C. The likelihood of your diagnosis being related to your findings depends on the probability of the findings being associated with that diagnosis and the prevalence of both that diagnosis and combination of findings in the community.
D. The probability that you will come up with the correct diagnosis is indirectly proportional to the specificity of your observations and directly proportional to the sensitivity of your observations.
C. The likelihood of your diagnosis being related to your findings depends on the probability of the findings being associated with that diagnosis and the prevalence of both that diagnosis and combination of findings in the community.
51
```
Which of the following is appropriate to use in the decision-making process but must also be subject to critical thinking?
A. Intuition
B. Inferences
C. Divination
D. Premonitions
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A. Intuition
52
The indiscriminate use of technology can be minimized by recognizing that:
A. the great majority of diagnoses can be achieved with information gleaned from a competent clinical examination.
B. limiting the amount of time required to perform the physical examination will increase the patient’s satisfaction and reduce litigation.
C. reducing consultation and frequency of return visits will maximize patients' involvement with their own treatment and improve compliance.
D. involving the family in treatment and follow-up will maximize use of resources and increase satisfaction and compliance.
A. the great majority of diagnoses can be achieved with information gleaned from a competent clinical examination.
53
Mrs. Tucker is a 57-year-old patient who presents to your office for a routine physical examination. Most of her physical findings are normal. How are “normal findings” best documented?
A. Write "normal" or "within normal limits" on the documentation form.
B. Write "NA" (not applicable) on the documentation sheet.
C. Because documentation focuses on abnormal findings, do not write anything down for normal findings.
D. Document what was actually assessed in specific terms.
D. Document what was actually assessed in specific terms.
54
Which of the following issues have most recently challenged the health care system regarding privacy of patient records?
A. Inclusion of sensitive details regarding family and social data
B. Access to the record by multiple health care professionals
C. Inappropriate handling of patient confidentiality by students in the health care delivery area
D. Computer-based health data systems
D. Computer-based health data systems
55
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A 74-year-old patient has fallen against a coffee table and knocked out all of her incisors. How is this best documented by the examiner?
A. Teeth missing: 11, 21, 31, 41
B. Teeth missing: 51, 61, 71, 81
C. No teeth: 11, 12, 13, 14
D. “Knocked out all the incisors”
```
A. Teeth missing: 11, 21, 31, 41
56
Which of the following statements is true regarding the use of abbreviations?
A. The use of abbreviations is fine as long as you can interpret them.
B. Abbreviations should be used as much as possible to reduce the time and space needed for documentation.
C. Abbreviations should be avoided; they are not considered acceptable.
D. The use of abbreviations for documentation is acceptable only if universally accepted abbreviations are used.
D. The use of abbreviations for documentation is acceptable only if universally accepted abbreviations are used.
57
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Mrs. Harris is a 46-year-old patient who presents to your office for a routine physical examination. During the history and physical you note expected Rinne and Weber tests. This would be documented:
A. objective data.
B. subjective data.
C. systematic data.
D. functional data.
```
A. objective data.
58
When recording data into the patient's record, the health care provider must remember that the record is a:
A. patient's personal and private record
B. legal document that may be used in court and other legal proceedings.
C. health care organization's record that can only be used for medical treatment within that organization.
D. public document that is available to those who are affiliated with the health care organization.
B. legal document that may be used in court and other legal proceedings.
59
Mr. Black is a 57-year-old patient who presents for a complaint of chest pain. Which of the following is the best way to document an individual's chief complaint?
A. “I’m having some pain in my chest.”
B. Patient states having some substernal chest pain.
C. Patient experiencing angina.
D. CC: Impending MI.
A. “I’m having some pain in my chest.”
60
Incremental grading is often used for recording which of the following?
A. Size of lymph nodes
B. Tenderness related to pain perception
C. Deep tendon reflexes
D. Amount of discharge visible from an orifice
C. Deep tendon reflexes
61
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For structures that have a round shape, such as the tympanic membrane, the best way to document locations of alterations is to relate its location to the:
A. numbers on the face of a clock.
B. degrees in a circle. Incorrect
C. divisions on a chronometer.
D. spokes on a wheel.
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A. numbers on the face of a clock.
62
Which of the following is an example of a resolution to a problem?
A. The problem has been inactive for the past five office visits.
B. The patient denies that the problem exists.
C. The problem has been corrected surgically.
D. The manifestations of the problem have disappeared.
C. The problem has been corrected surgically.
63
The plan is divided into which of the following three sections?
A. Diagnostics, therapeutics, and medicritics
B. Therapeutics, diacritics, and education
C. Diagnostics, diacritics, and education
D. Therapeutics, diagnostics, and education
D. Therapeutics, diagnostics, and education
64
```
Body system data are described and recorded as:
A. objective data.
B. impartial data.
C. systematic data.
D. synthetic data.
```
A. objective data.
65
Mrs. Wolf brings her newborn in for a routine infant checkup. In the newborn examination, the focus is on:
A. developmental disabilities.
B. the transition to extrauterine life and congenital anomalies.
C. the prenatal care of the mother and birth trauma.
D. the past medical history of the mother.
B. the transition to extrauterine life and congenital anomalies.
66
Additional information related to data for children and adolescents is Tanner Stage data, which measure:
A. neurologic development.
B. sexual maturity and development.
C. the presence of soft neurologic signs.
D. language and emotional development.
B. sexual maturity and development.
67
```
Use of the phrase “patient denies” in recording the nonexistence of symptoms has a negative connotation and may imply that the individual is:
A. noncompliant.
B. confrontational.
C. deceptive.
D. reactionary.
```
B. confrontational.
68
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The review of systems data is described and recorded as:
A. objective data.
B. systematic data.
C. subjective data.
D. impartial data.
```
C. subjective data.
69
```
Mrs. Yates brings in her 3-year-old for a follow-up examination. You notice a cavity in a tooth. Which of the following documents the cavity in a 3-year-old?
A. Caries noted in tooth 6
B. Caries noted in the incisor
C. Caries noted in tooth D
D. Caries noted on examination
```
C. Caries noted in tooth D
70
Which of the following will best facilitate the interview when obtaining a history from a deaf person?
A. Speaking loudly
B. Using gestures
C. Speaking slowly
C. Speaking slowly
71
Approximately what % of patients interviewed have a sexual orientation other than heterosexual?
A. 2%
B. 20%
C. 10%
C. 10%
72
Which type of questionnaire concerning drug and alcohol use is advocated, although not clinically validated for adolescent patients?
A. TACE
B. CAGE
C. CRAFFT
C. CRAFFT
73
Interviewers should identify and assess their own feelings, such as hostility and prejudice, in order to
A. Avoid inappropriate behavior
B. Reduce communication barriers
C. Express their idiosyncrasies
B. Reduce their communication barriers
74
What is Occam"s razor?
A principle stating that all findings should be unified into 1 diagnoses.....this is not always true
75
What is Sensitivity?
The ability of an observation to identify correctly those who have a disease
76
What is Specificity?
The ability of an observation to identify correctly those who do not have the disease
77
Concept; If it looks like a cat, it must be a cat
Recognizing patterns
78
Concept; Sore throats are common problems
Guidelines to decision making
79
Concept; Including everything precludes missing anything
Sampling the universe
80
Concept; Rigidly defined thought process precludes error
Using algorithms
81
What is a True positive?
An expected observation that is found when the disease characterized by the observation is present
EX: A patient with cholecystitis has a positive murphy sign
82
What is a True negative?
An expected observation that is not found when the disease characterized by that observation is not present
EX: The patient does not demonstrate tenderness at the McBurney point and does not have appendicitis
83
What is a False positive?
An observation madfe that suggests a disease when that disease is not present
EX: The examiner notes a positive Homans sign in the absence of thrombophlebitits
84
What is a False negative?
A disease is present, the observation is there to be made, and it is not appreciated
EX: The examiner notes normal findings in a patient with cancer of the prostate
85
What is Positive predictive value?
The proportion of persons with an observation characteristic of a disease who have it ( e.g. when an observation is made 100 x and 95 of those times the observation is consistent with diagnoses, the positive predictive value is 95%)
EX: With acute MI, 90% of patients demonstrate diaphoresis
86
What is a Negative predictive value?
The proportion of persons with an expected observation who ultimatley prove not to have the expected conditon
EX: A numeric value is assigned, predicting the probability that a patient with negative findings does not have a given illness
87
A diagnoses of Hep B infection is made based on the patient symptoms and the population of IV drug users, of which he is part of.
Bayes formula
88
When determining a need for additional examination, testing, or procedures, the examiner knows that these should be done:
A: to obtain as much data as possible
B. If they relate to the examiners hypothesis
C. Only when absolutely necessary
B. If they relate to the examiners hypothesis
89
Which statement best characterizes a belief that supports a sound descion making process?
A. The underlying problem is always related to the chief complaint
B. Rare problems tend to have unusual presentations
C. Common problems occur commonly, and rare problems occur rarely
C. Common problems occur commonly, and rare problems occur rarely
90
What is Acculturation?
The act of shedding one culture and assuming another
91
What is Enculturation?
The act of assuming the traits or behaviors of a given culture
92
An integral part of the overall effort to respond adequately to a person in need is
A. Cultural awareness
B. Political correctness
C. Racial alertness
A. Cultural awareness
93
A young mother brings her infant to the emergency dept with a high temp and dehydration. Which of the following questions asked by the examiner demonstrate cultural awareness?
A. When did the symptoms begin
B. What do you think is causing this illness
C. What have you done at home to manage your childs illness
B. What do you think is causing this illness
94
Which group is most likely to be subjected to invasive cardiac procedures in the US?
A. Middle class black individuals
B. White males
B. White males
95
Which of the following beliefs is characteristic of a present oriented individual?
The individual accepts each day as it comes and see the future as unpredicatable
96
The definition of "sick" is based on the individuals belief system and is determined in large part by his.................
Enculturation
