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Advanced Health Assessment and Diagnostic Reasoning 3rd Edition Rhoads Test Bank
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ADVANCED HEALTH ASSESSMENT AND DIAGNOSTIC REASONING 3RD EDITION RHOADS TESTBANK
Advanced Health Assessment and Diagnostic Reasoning
3rd edition Rhoads
TEST BANK
Chapter 1 Interview and History Taking Strategies
MULTIPLE CHOICE
1. The nurse is conducting an interview with a woman who has recently learned that she is
pregnant and who has come to the clinic today to begin prenatal care. The woman states that she
and her husband are excited about the pregnancy but have a few questions. She looks nervously
at her hands during the interview and sighs loudly. Considering the concept of communication,
which statement does the nurse know to be most accurate? The woman is:
a. Excited about her pregnancy but nervous about the labor.
b. Exhibiting verbal and nonverbal behaviors that do not match.
c. Excited about her pregnancy, but her husband is not and this is upsetting to her.
d.
Not excited about her pregnancy but believes the nurse will negatively
respond to her if she states this.
ANS: B
Communication is all behaviors, conscious and unconscious, verbal and nonverbal. All behaviors
have meaning. Her behavior does not imply that she is nervous about labor, upset by her
husband, or worried about the nurses response.
2. Receiving is a part of the communication process. Which receiver is most likely to
misinterpret a message sent by a health care professional?
a. Well-adjusted adolescent who came in for a sports physical
b. Recovering alcoholic who came in for a basic physical examination
c. Man whose wife has just been diagnosed with lung cancer
d.
Man with a hearing impairment who uses sign language to communicate and who has an
interpreter with him
ANS: C
The receiver attaches meaning determined by his or her experiences, culture, self-concept, and
current physical and emotional states. The man whose wife has just been diagnosed with lung
cancer may be experiencing emotions that affect his receiving.
3. The nurse makes which adjustment in the physical environment to promote the success of an
interview?
a. Reduces noise by turning off televisions and radios
b. Reduces the distance between the interviewer and the patient to 2 feet or less
c. Provides a dim light that makes the room cozy and helps the patient relax
d. Arranges seating across a desk or table to allow the patient some personal space
ANS: A
The nurse should reduce noise by turning off the television, radio, and other unnecessary
equipment, because multiple stimuli are confusing. The interviewer and patient should be
approximately 4 to 5 feet apart; the room should be well-lit, enabling the interviewer and patient
to see each other clearly. Having a table or desk in between the two people creates the idea of a
barrier; equal-status seating, at eye level, is better.
,4. In an interview, the nurse may find it necessary to take notes to aid his or her memory later.
Which statement is trueregarding note-taking?
a. Note-taking may impede the nurses observation of the patients nonverbal behaviors.
b.
Note-taking allows the patient to continue at his or her own pace as the nurse
records what is said.
c.
Note-taking allows the nurse to shift attention away from the patient, resulting
in an increased comfort level.
d.
Note-taking allows the nurse to break eye contact with the patient, which may
increase his or her level of comfort.
ANS: A
The use of history forms and note-taking may be unavoidable. However, the nurse must be aware
that note-taking during the interview has disadvantages. It breaks eye contact too often and shifts
the attention away from the patient, which diminishes his or her sense of importance. Notetaking
may also interrupt the patients narrative flow, and it impedes the observation of the
patients nonverbal behavior.
5. The nurse asks, I would like to ask you some questions about your health and your usual daily
activities so that we can better plan your stay here. This question is found at the __________
phase of the interview process.
a. Summary
b. Closing
c. Body
d. Opening or introduction
ANS: D
When gathering a complete history, the nurse should give the reason for the interview during the
opening or introduction phase of the interview, not during or at the end of the interview.
6. A woman has just entered the emergency department after being battered by her husband. The
nurse needs to get some information from her to begin treatment. What is the best choice for an
opening phase of the interview with this patient?
a. Hello, Nancy, my name is Mrs. C.
b. Hello, Mrs. H., my name is Mrs. C. It sure is cold today!
c. Mrs. H., my name is Mrs. C. How are you?
d. Mrs. H., my name is Mrs. C. Ill need to ask you a few questions about what happened.
ANS: D
Address the person by using his or her surname. The nurse should introduce him or herself and
give the reason for the interview. Friendly small talk is not needed to build rapport.
7. During an interview, the nurse states, You mentioned having shortness of breath. Tell me
more about that. Which verbal skill is used with this statement?
a. Reflection
b. Facilitation
c. Direct question
d. Open-ended question
ANS: D
,The open-ended question asks for narrative information. It states the topic to be discussed but
only in general terms. The nurse should use it to begin the interview, to introduce a new section
of questions, and whenever the person introduces a new topic.
8. A patient has finished giving the nurse information about the reason he is seeking care. When
reviewing the data, the nurse finds that some information about past hospitalizations is missing.
At this point, which statement by the nurse would be most appropriate to gather these data?
a. Mr. Y., at your age, surely you have been hospitalized before!
b. Mr. Y., I just need permission to get your medical records from County Medical.
c.
Mr. Y., you mentioned that you have been hospitalized on several occasions.
Would you tell me more about that?
d.
Mr. Y., I just need to get some additional information about your past hospitalizations.
When was the last time you were admitted for chest pain?
ANS: D
The nurse should use direct questions after the persons opening narrative to fill in any details he
or she left out. The nurse also should use direct questions when specific facts are needed, such as
when asking about past health problems or during the review of systems.
9. In using verbal responses to assist the patients narrative, some responses focus on the patients
frame of reference and some focus on the health care providers perspective. An example of a
verbal response that focuses on the health care providers perspective would be:
a. Empathy.
b. Reflection.
c. Facilitation.
d. Confrontation.
ANS: D
When the health care provider uses the response of confrontation, the frame of reference shifts
from the patients perspective to the perspective of the health care provider, and the health care
provider starts to express his or her own thoughts and feelings. Empathy, reflection, and
facilitation responses focus on the patients frame of reference.
10. When taking a history from a newly admitted patient, the nurse notices that he often pauses
and expectantly looks at the nurse. What would be the nurses best response to this behavior?
a. Be silent, and allow him to continue when he is ready.
b.
Smile at him and say, Dont worry about all of this. Im sure we can find out why
youre having these pains.
c. Lean back in the chair and ask, You are looking at me kind of funny; there isnt anything wrong,
ishere
d.
Stand up and say, I can see that this interview is uncomfortable for you.
We can continue it another time.
ANS: A
Silent attentiveness communicates that the person has time to think and to organize what he or
she wishes to say without an interruption from the nurse. Health professionals most often
interrupt this thinking silence. The other responses are not conducive to ideal communication.
, 11. A woman is discussing the problems she is having with her 2-year-old son. She says, He
wont go to sleep at night, and during the day he has several fits. I get so upset when that happens.
The nurses best verbal response would be:
a. Go on, Im listening.
b. Fits? Tell me what you mean by this.
c. Yes, it can be upsetting when a child has a fit.
d. Dont be upset when he has a fit; every 2 year old has fits.
ANS: B
The nurse should use clarification when the persons word choice is ambiguous or confusing
(e.g., Tell me what you mean by fits.). Clarification is also used to summarize the persons words
or to simplify the words to make them clearer; the nurse should then ask if he or she is on the
right track.
12. A 17-year-old single mother is describing how difficult it is to raise a 3-year-old child by
herself. During the course of the interview she states, I cant believe my boyfriend left me to do
this by myself! What a terrible thing to do to me! Which of these responses by the nurse uses
empathy?
a. You feel alone.
b. You cant believe he left you alone?
c. It must be so hard to face this all alone.
d. I would be angry, too; raising a child alone is no picnic.
ANS: C
An empathetic response recognizes the feeling and puts it into words. It names the feeling,
allows its expression, and strengthens rapport. Other empathetic responses are, This must be very
hard for you, I understand, or simply placing your hand on the persons arm. Simply reflecting the
persons words or agreeing with the person is not an empathetic response.
13. A man has been admitted to the observation unit for observation after being treated for a
large cut on his forehead. As the nurse works through the interview, one of the standard
questions has to do with alcohol, tobacco, and drug use. When the nurse asks him about tobacco
use, he states, I quit smoking after my wife died 7 years ago. However, the nurse notices an open
pack of cigarettes in his shirt pocket. Using confrontation, the nurse could say:
a. Mr. K., I know that you are lying.
b. Mr. K., come on, tell me how much you smoke.
c. Mr. K., I didnt realize your wife had died. It must be difficult for you at this time.
Please tell me more about that.
d.
Mr. K., you have said that you dont smoke, but I see that you have an open pack of
cigarettes in your pocket.
ANS: D
In the case of confrontation, a certain action, feeling, or statement has been observed, and the
nurse now focuses the patients attention on it. The nurse should give honest feedback about what
is seen or felt. Confrontation may focus on a discrepancy, or the nurse may confront the patient
when parts of the story are inconsistent. The other statements are not appropriate.
14. The nurse has used interpretation regarding a patients statement or actions. After using this
technique, it would be best for the nurse to:
a. Apologize, because using interpretation can be demeaning for the patient.
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