13 minute read
Chapter 04: Clinical Reasoning
from TEST BANK for SEIDEL'S GUIDE TO PHYSICAL EXAMINATION. An Interprofessional Approach 9th Edition
by StudyGuide
Multiple Choice
1. After the subjective and objective data have been prioritized, the next step is to: a. order laboratory tests. b. formulate a problem list. c. initiate appropriate referrals. d. initiate therapy.
ANS: B
After the data have been prioritized and a presumed diagnosis is made, the next step is to consider the appropriate laboratory tests, imaging studies, or specialty consultations.
DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process evaluating
MSC: Safe and Effective Care: Management of Care
2. New findings of unknown causes are: a. problems to be noted on the problem list. b. deferred for subsequent visits. c. diagnosed before physical examination. d. reserved for specialists.
ANS: A
New findings of unknown causes are added to the problem list, but do not let them become a red herring that distracts your attention from the central issues.
DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care a. Relying on intuition b. Making maximal use of laboratory tests c. Using first assumptions d. Using algorithms
3. Which is an accepted method of making a diagnosis?
ANS: D
Methods to make a diagnosis include recognizing patterns, sampling the universe, and using algorithms. Do not rely on intuition, extensive use of laboratory findings, or always going with your first assumptions.
DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care
4. The adage ha c mm blem cc c mm l ad i e he ac i i e : a. al a diag e he a ie s problem in terms of what their practice usually sees. b. refer any uncommon complaints to specialists as soon as possible. c. not consider more than one diagnosis unless necessary. d. examine uncommon problems critically before assuming that the issue is an unusual presentation of a common problem.
ANS: C
This adage is to guide the practitioner to pay attention to unexpected or unusual findings but not to consider more than one diagnosis unless necessary and to favor the simplest hypothesis when competing hypotheses exist.
DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care
5. The most important guide to sequencing actions should be: a. probability and utility. b. assumption and intuition. c. costs and risks of procedures. d. reimbursement potential and patient acceptance.
ANS: A
Although all choices are relevant, the prioritized guide is to select actions based on an e ima e f he babili f cce f ll achie i g he a ie g al a d he ili f implementation.
DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care
6. Utilitarianism can be described as: a. balancing interests. b. preventing harm. c. choosing wisely. d. doing good.
ANS: C
Utilitarianism occurs when one considers appropriate use of resources with concern for the g ea e g d f he la ge c mm i . I al mea ch e i el .
DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care
7. Positive outcomes depend on the: a. number of laboratory tests ordered. b. quality of decisions made. c. use of pharmacologic modalities. d. time saved by the use of ancillary personnel.
ANS: B
Positive patient outcomes are dependent on your ability to arrive at accurate hypotheses that then direct quality patient care decisions.
DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care
8. Self-analysis assists providers in giving proper context to: a. history and physical findings. b. therapeutic options. c. attitudes, values, and feelings. d. differential diagnoses.
ANS: C
Knowing the intensity of your personal attitudes, values, and emotional feelings about patient care situations helps prevent you from being overtaken by your own impaired or distorted viewpoints.
DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care
9. Medical decision making requires a balance between: a. trust and suspicion. b. ethical and unethical behavior. c. remembering and superstition. d. mechanism and probabilism.
ANS: D
In making medical decisions, you cannot be too scientific or pursue every possible scenario.
DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care
10. A valid history and physical examination can serve to: a. create higher healthcare costs. b. limit the indiscriminate use of diagnostics. c. threaten patient satisfaction. d. increase the risk of liability.
ANS: B
A comprehensive history with a competent clinical examination can lead you to generate a more accurate problem list, and therefore increase the proper usage of diagnostic testing while limiting its indiscriminate use.
DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care
11. A specific test is one that has the ability to: a. correctly identify those who have the disease. b. correctly identify those who do not have the disease. c. be exclusively used to make a diagnosis. d. exclude competing explanations for another test finding.
ANS: B
The specificity of a test is determined by its ability to identify those who do not have the disease for which the test has been designed. Negative results are more likely to be valid.
DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care
12. Mr. Johnson actually has streptococcal pharyngitis; however, the throat culture is initially read as negative. This situation describes a test with a: a. low sensitivity. b. high sensitivity. c. high specificity. d. low specificity.
ANS: A
This situation describes a test designed to test those who are positive for the disease. At this time, the test was not able to detect a true-positive; therefore, the test had a low sensitivity.
DIF: Cognitive Level: Remembering (Knowledge) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care a. Presumptive diagnosis b. Patient education c. Diet modification d. Physical therapy
13. Which of the following is not a component of a management plan?
ANS: A
The management plan details what you are going to do about a patient problem such as education, diet modifications, and physical therapy referrals.
DIF: Cognitive Level: Remembering (Knowledge)
OBJ: Nursing process implementing MSC: Safe and Effective Care: Management of Care
14. When determining actions for the management plan, the practitioner should first address: a. problems in the order of their chronologic development. b. he a ie s concern about a particular problem. c. he a ie cial a d ec mic ci c m a ce . d. the most urgent problem.
ANS: D
In developing patient care plans, priority should be given to the most life-threatening and urgent physical needs of the patie . The f c add e i g he a ie cial a d economic circumstances.
DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process diagnosis
MSC: Safe and Effective Care: Management of Care
Multiple Response
1. When utilizing a joint approach with the patient, which factors are likely to be considered? (Select all that apply.)
a. Consultations b. Laboratory studies c. Assistive technology d. Patient education e. Practitioner background
ANS: A, B, C
A joint approach between the patient and practitioner should include laboratory and imaging studies, subspecialty consultation, medications, equipment, special care, diet and activity modification, follow-up visit, and patient education.
DIF: Cognitive Level: Remembering (Knowledge)
OBJ: Nursing process evaluating MSC: Safe and Effective Care: Management of Care
Multiple Choice
1. Which pa of he info ma ion con ained in he pa ien eco d ma be ed in co ?
a. Subjective information only b. Objective information only c. Diagnostic information only d. All information
ANS: D
An hing ha i en e ed in o a pa ien eco d, in pape o elec onic fo m, i s a legal document and can be used in court.
DIF: Cognitive Level: Remembering (Knowledge)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
2. Ms. S reports that she is concerned about her loss of appetite. During the history, you learn that her last child recently moved out of her house to go to college. Rather than infer the cause of M . S lo of appe i e, i o ld be be e o: a. defer or omit her comments. b. have her husband call you. c. quote her concerns verbatim. d. refer her for psychiatric treatment.
ANS: C
It is best to document what you observe and what is said by the patient rather than documenting your interpretation. Listening and quoting exactly what the patient says is the better rule to follow.
DIF: Cognitive Level: Applying (Application)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort a. Relationship to anatomic landmarks b. Computer graphics c. Comparison with other patients of same gender and size d. Comparison to previous examinations using light pen markings
3. Which is an effective adjunct to document the location of findings during the recording of the physical examination?
ANS: A
Abnormal or normal findings are best described in relationship to universal topographic and anatomic landmarks.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
4. The position on a clock, topographic notations, and anatomic landmarks: a. are methods for recording locations of findings. b. are used for noting disease progression. c. are ways for recording laboratory study results. d. should not be used in the legal record.
ANS: A
Descriptions of the locations of findings are universally referenced by using positions on a clock, topographic notations, or anatomic landmarks.
DIF: Cognitive Level: Remembering (Knowledge)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
5. Regardless of the origin, discharge is described by noting: a. a grading scale of 0 to 4. b. color and consistency. c. demographic data and risk factors. d. associated symptoms in alphabetic order.
ANS: B
Regardless of where the discharge originates, color and consistency determine whether it is an expected finding.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
6. Drawing of stick figures is most useful to: a. compare findings in extremities. b. demonstrate radiation of pain. c. indicate consistency of lymph nodes. d. indicate mobility of masses.
ANS: A
Simple drawings, such as stick figures, are more practical illustrations for findings in extremities. Radiation of pain, consistency of lymph nodes, and mobility of masses would not be adequately described by such simple drawings.
DIF: Cognitive Level: Applying (Application)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort a. Common age variations b. Expected findings c. Problems needing further evaluation d. Minor variations
7. Which i an e ample of a p oblem ha e i e eco ding on he pa ien p oblem li ?
ANS: C
Any problem is worth noting on the patient problem list, even if the cause or significance is unknown. Common age variations, expected findings, and minor variations within normal limits should not be classified as a problem.
DIF: Cognitive Level: Applying (Application)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
8. A problem may be defined as anything that will require: a. evaluation. b. medication. c. surgery. d. treatment.
ANS: A
The need for further evaluation or attention indicates a problem. If a problem is found, it does not necessarily warrant medication, surgery, or treatment.
DIF: Cognitive Level: Remembering (Knowledge)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
9. Differential diagnoses belong in the: a. history. b. physical examination. c. assessment. d. plan.
ANS: C
Differential diagnoses for problems that have not been diagnosed are placed in the assessment category for each problem. The differentials are prioritized, and contributing factors are identified.
DIF: Cognitive Level: Remembering (Knowledge)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort a. Diagnostics ordered b. Therapeutics c. Patient education d. Differential diagnosis
10. Which of the following is not a component of the plan portion of the problem-oriented medical record?
ANS: D
The differential diagnosis is part of the assessment phase.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
11. Your patient returns for a blood pressure check 2 weeks after a visit during which you performed a complete history and physical examination. This visit would be documented by creating a(n): a. progress note. b. accident report. c. problem-oriented medical record. d. triage note.
ANS: A
A second visit with the clinician is always recorded on a progress note, noting any updates to the condition.
DIF: Cognitive Level: Applying (Application)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
12. A detailed description of the symptoms related to the chief complaint is presented in the: a. history of present illness. b. differential diagnosis. c. assessment. d. general patient information section.
ANS: A
The ign and mp om and hi o ical da a of he pa ien e pe ience ha led p o he chief complaint are placed in the history of present illness.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort a. Chief complaint b. History of present illness c. Past medical history d. Social history
13. The effec of he chief complain on he pa ien life le i eco ded in hich ec ion of he medical record?
ANS: B
The effec of he pa ien complain on c en e e da life le o o k pe fo mance i recorded in the history of present illness.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
14. The pa ien pe cei ed di abili ie and f nc ional limi a ion a e eco ded in he: a. problem list. b. general patient information. c. social history. d. history of present illness.
ANS: D
The hi o of p e en illne con ain info ma ion abo he pa ien life l e, as well as disabilities or functional limitations that alter activities of daily living.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
15. The review of systems is a component of the: a. physical examination. b. health history. c. assessment. d. past medical-surgical history.
ANS: B
The review of systems relates health history according to physical systems and is presented just before the actual physical examination.
DIF: Cognitive Level: Remembering (Knowledge)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort a. History of present illness b. Past medical history c. Social history d. Problem list
16. Allergies to drugs and foods are generally listed in which section of the medical record?
ANS: B
The past medical history section contains information such as allergies to drugs and foods and environmental allergies.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
17. Information recorded about an infant differs from that recorded about an adult, mainly beca e of he infan : a. attention span. b. developmental status. c. nutritional differences. d. source of information.
ANS: B
The o gani a ional c e of an infan eco d i diffe en beca e he infan c en and future health is referenced in terms of developmental status.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort a. Fontanel size b. Liver span c. Prostate size d. Thyroid position
18. Which finding is unique to the documentation of a physical examination of an infant?
ANS: A
The size and characteristic of the fontanel are unique and important in the assessment of an infant.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
19. Data relevant to the social history of older adults includes information on: a. family support systems. b. previous healthcare visits. c. over-the-counter medication intake. d. date of last cancer screening.
ANS: A
The social history of older adults includes community and family support systems.
DIF: Cognitive Level: Remembering (Knowledge)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort a. Preventive care b. Problem oriented c. Systems review d. Traditional treatment
20. A SOAP note is used in which type of recording system?
ANS: B
A SOAP note subjective problem data, objective problem data, assessment, and plan is a type of recording system that has a problem-oriented style.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
21. The e amine e al a ion of a pa ien men al a belong in he: a. history of present illness. b. review of systems. c. physical examination. d. patient education.
ANS: C
Mental status assessment, including cognitive and emotional stability and speech and language, is part of the physical examination.
DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort a. Brief SOAP note b. Comprehensive health history c. Progress note d. Referral note
22. Which format would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?
ANS: A
Follow-up visits for problems identified in the POMR are recorded in the progres s notes. Those visits not identified as problems are recorded using the SOAP format. Careful review of all SOAP notes on a regular basis will detect the emergence of a condition that explains the pa ien complain ; a ha poin , SOAP doc men a ion i topped.
DIF: Cognitive Level: Applying (Application)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort a. GM is a 22-year-old male he e fo alle gie . b. GM came into the clinic complaining of green discharge for the past 72 hours. c. GM, a 22-year-old male, states that he has allergies and wants them checked. d. GM is a 22-year-old male he e fo ha ing g een na al di cha ge fo r the past 72 hours.
23. George Michaels, a 22-year-old pa ien , ell he n e ha he i he e oda o check hi alle gie . He ha been ha ing g een na al di cha ge fo he la 72 ho . Ho o ld he nurse document his reason for seeking care?
ANS: D
Doc men a ion of he chief complain ho ld al a be done b ing he pa ien o n words in quotation marks.
DIF: Cognitive Level: Analyzing (Analysis)
OBJ: Integrated process communication and documentation
MSC: Physiologic Integrity: Basic Care and Comfort
