Test Bank for advanced health assessment & clinical diagnosis in primary care 5th edition by joyce e. dains

Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which type of clinical decision-making is most reliable? A . Intuitive B. Analytical C. Experiential D . Augenblick 2. Which of the following is false? To obtain adequate history, health-care providers must be: A . Methodical and systematic B. Attentive to the patient’s verbal and nonverbal language C. Able to accurately interpret the patient’s responses D . Adept at reading into the patient’s statements 3. Essential parts of a health history include all of the following except: A . Chief complaint B. History of the present illness C. Current vital signs D . All of the above are essential history components 4. Which of the following is false? While performing the physical examination, the examiner must be able to: A . Differentiate between normal and abnormal findings B. Recall knowledge of a range of conditions and their associated signs and symptoms C. Recognize how certain conditions affect the response to other conditions D . Foresee unpredictable findings 5. The following is the least reliable source of information for diagnostic statistics: A . Evidence-based investigations B. Primary reports of research C. Estimation based on a provider’s experience D . Published meta-analyses 6. The following can be used to assist in sound clinical decision-making: A. Algorithm published in a peer-reviewed journal article B. Clinical practice guidelines C. Evidence-based research D. All of the above 7. If a diagnostic study has high sensitivity, this indicates a: A . High percentage of persons with the given condition will have an abnormal result B. Low percentage of persons with the given condition will have an abnormal result C. Low likelihood of normal result in persons without a given condition D . None of the above . B. High percentage of healthy individuals will show a normal result C. High percentage of individuals with a disorder will show a normal result D . Low percentage of individuals with a disorder will show an abnormal result 9. A likelihood ratio above 1 indicates that a diagnostic test showing a: A. Positive result is strongly associated with the disease B. Negative result is strongly associated with absence of the disease C. Positive result is weakly associated with the disease D. Negative result is weakly associated with absence of the disease 10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? A . Clinical practice guideline B. Clinical decision rule C. Clinical algorithm Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana Answer Section MULTIPLE CHOICE 1. ANS: B Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision- making (similar to Augenblink decision-making) is based on the experience and intuition of the clinician and is less reliable and paired with fairly common errors. In contrast, analytical decision-making is based on careful consideration and has greater reliability with rare errors. PTS: 1 2. ANS: D To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and nonverbal language, and able to accurately interpret the patient’s responses to questions. Rather than reading into the patient’s statements, they clarify any areas of uncertainty. PTS: 1 3. ANS: C Vital signs are part of the physical examination portion of patient assessment, not part of the health history. PTS: 1 4. ANS: D While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, recall knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affect the response to other conditions, and distinguish the relevance of varied abnormal findings. PTS: 1 5. ANS: C Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-analyses. Another source of statistics, the one that has been most widely used and available for application to the reasoning process, is the estimation based on a provider’s experience, although these are rarely accurate. Over the past decade, the availability of evidence on which to base clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be based on scientific evidence. Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making. PTS: 1 6. ANS: D To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the clinician. Resources, such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly applied. PTS: 1 7. ANS: A The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an abnormal, or positive, result. A high sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result. PTS: 1 8. ANS: B The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The greater the specificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target condition. PTS: 1 9. ANS: A The likelihood ratio is the probability that a positive test result will be associated with a person who has the target condition and a negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated with the disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease. PTS: 1 10. ANS: B Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-based resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met with regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain situations, settings, and/or patient characteristics. PTS: 1 Chapter 5: Amenorrhea 1. If amenorrhea is reported by the female patient, the clinician should attribute this to until proven otherwise. A . Pregnancy B. Ovarian failure C. Lack of progesterone D . Menopause 2. A 17-year-old female patient complains of amenorrhea for the last 8 months, weight gain, excessive hair growth on the arms and chest, and development of acne. Pelvic examination is normal. The clinician should recognize these are signs of: A . Ovarian cancer B. Endometriosis C. Hormonal imbalance D . Stress-induced anovulation 3.. A 55-year-old woman complains of amenorrhea and hot flashes for the last 3 months. Pregnancy test is negative. The clinician should recognize that menopause is defined as the absence of menses for: A . 3 months B. 6 months C. 1 year D . 18 months 4. To confirm the diagnosis of amenorrhea due to menopause, blood should be drawn for hormones. Which are the changes that occur with menopause? A . FSH rises B. LH decreases C. LH rises D . A & C 1. ANS: A Last menstrual period is one of the most important questions to ask, particularly when prescribing medications, because many are contraindicated in pregnancy. If menstrual cycles are not regular, pregnancy should be ruled out first, and then other diagnoses can be considered. The menstrual history includes any episodes of amenorrhea, menorrhagia (excessive bleeding at the time of the menstrual cycle), metrorrhagia (bleeding at irregular noncyclic intervals), dysmenorrhea, and postmenopausal bleeding. Amenorrhea has many causes, including pregnancy; anorexia nervosa; excessive exercise; low body fat; and disorders or tumors of the hypothalamus, pituitary gland, ovary, uterus, and thyroid gland. 2.. ANS: C Anovulation may present with amenorrhea but also may present with dysfunctional uterine bleeding, polymenorrhea, or menorrhagia. The symptoms vary with the cause. Overweight may be seen with several of the causes, including hypothyroidism, polycystic ovarian syndrome, and pituitary and adrenal dysfunction. Underweight is seen in anorexia nervosa, excessive exercise, hyperthyroidism, or stress-induced anovulation. Hirsutism, acne, and other skin changes can be seen with imbalances in LH, FSH, and androgens, as seen in polycystic ovary disease. Delayed puberty or regression of sexual characteristics is seen in hypopituitarism; galactorrhea can be the presenting symptom in pituitary tumors. PTS: 1 3.. ANS: B Menopause is the absence of menses for at least 6 months. Age of menopause varies greatly, although age 50 to 55 is the typical range of onset. Although the absence of menses in a woman around the age of 50 years is diagnostic for menopause, measurement of FSH, LH, and estradiol levels are helpful in confirming the diagnosis. PTS: 1 4.. ANS: D In menopause, FSH rises first and then LH rises, both greater than 100 mU/mL. A fall in estradiol is the last hormonal change that occurs with the decline of ovarian function. An estradiol level of less than 30 pg/mL indicates loss of ovarian function. Chapter 9. Confusion in older adults Multiple Choice Identify the choice that best completes the statement or answers the question. 1. An 85-year-old female patient arrives by ambulance to the emergency department accompanied by her husband. He reports that his wife had been ill with pneumonia and, 2 days ago, went to the family physician who prescribed azithromycin twice a day. The husband reports that he is making sure she gets the medicine. His wife has been staying in bed and resting. She awoke from sleep last night and was extremely agitated, left the house, and was walking outside. She did not recognize her husband and wanted to call the police. Which of the following is an appropriate question for the history? A. Does your wife have dementia or frequent episodes of confusion? B. Has your wife been running a fever? C. Is your wife allergic to any medication? D. Has your wife ever had a mental status exam? PTS: 1 ANS: A Delirium can be observed in both elderly and younger patients and is generally defined as an acute confusional state, affecting all aspects of cognition and mentation. The signs and symptoms of delirium generally have a more acute or rapidly progressive onset as opposed to the slow, gradual decline noted in the organic dementias. The acute mental status change is often associated with other signs or symptoms—such as hallucinations, illusions, incoherent speech, and constant aimless activity—that help to narrow the differential diagnosis. Electrolyte disturbances, infection, and polypharmacy are frequent causes of delirium in the elderly. 2. An older patient has been admitted to the intensive care unit (ICU) after falling at home. Within 8 hours, his condition has stabilized and he is transferred to a medical unit. The family is wondering whether he will be able to go back home. Which assessment instrument is most appropriate for the nurse to choose at this time? a. Lawton IADL instrument b. Hospital Admission Risk Profile (HARP) c. Mini-Cog d. NEECHAM Confusion Scale ANS: B Hospital-acquired functional decline may occur within 2 days of a hospital admission. The HARP helps identify older adults who are at greatest risk of losing their ability to perform ADLs or mobility at this critical time. The Lawton IADL measures instrumental activities of daily living, which may be difficult to observe in the hospital setting. The Mini-Cog is an assessment of mental status. The NEECHAM Confusion Scale is used to assess for delirium. 3. During a functional assessment of an older persons home environment, which statement or question by the nurse is most appropriate regarding common environmental hazards? a. These low toilet seats are safe because they are nearer to the ground in case of falls. b. Do you have a relative or friend who can help to install grab bars in your shower? c. These small rugs are ideal for preventing you from slipping on the hard floor. d. It would be safer to keep the lighting low in this room to avoid glare in your eyes. ANS: B Environmental hazards within the home can be a potential constraint on the older persons day-to- day functioning. Common environmental hazards, including inadequate lighting, loose throw rugs, curled carpet edges, obstructed hallways, cords in walkways, lack of grab bars in tub and shower, and low and loose toilet seats, are hazards that could lead to an increased risk of falls and fractures. Environmental modifications can promote mobility and reduce the likelihood of the older adult falling. 4. When assessing aging adults, the nurse knows that one of the first things that should be assessed before making judgments about their mental status is: a. Presence of phobias b. General intelligence c. Presence of irrational thinking patterns d. Sensory-perceptive abilities ANS: D Age-related changes in sensory perception can affect mental status. For example, vision loss (as detailed in Chapter 14) may result in apathy, social isolation, and depression. Hearing changes are common in older adults, which produces frustration, suspicion, and social isolation and makes the person appear confused. 5. During the taking of the health history of a 78-year-old man, his wife states that he occasionally has problems with short-term memory loss and confusion: He cant even remember how to button his shirt. When assessing his sensory system, which action by the nurse is most appropriate? a. The nurse would not test the sensory system as part of the examination because the results would not be valid. b. The nurse would perform the tests, knowing that mental status does not affect sensory ability. c. The nurse would proceed with an explanation of each test, making certain that the wife understands. d. Before testing, the nurse would assess the patients mental status and ability to follow directions. ANS: D The nurse should ensure the validity of the sensory system testing by making certain that the patient is alert, cooperative, comfortable, and has an adequate attention span. Otherwise, the nurse may obtain misleading and invalid results. 6. The nurse is assessing orientation in a 79-year-old patient. Which of these responses would lead the nurse to conclude that this patient is oriented? a. I know my name is John. I couldnt tell you where I am. I think it is 2010, though. b. I know my name is John, but to tell you the truth, I get kind of confused about the date. c. I know my name is John; I guess Im at the hospital in Spokane. No, I dont know the date. I know my name is John. I am at the hospital in Spokane. I couldnt tell you what date it is, but I know t d. ANS: D it is February of a new year2010. Many aging persons experience social isolation, loss of structure without a job, a change in residence, or some short-term memory loss. These factors affect orientation, and the person may not provide the precise date or complete name of the agency. You may consider aging persons oriented if they generally know where they are and the present period. They should be considered oriented to time if the year and month are correctly stated. Orientation to place is accepted with the correct identification of the type of setting (e.g., hospital) and the name of the town. 7. A 69-year-old patient has been admitted to an adult psychiatric unit because his wife thinks he is getting more and more confused. He laughs when he is found to be forgetful, saying Im just getting old! After the nurse completes a thorough neurologic assessment, which findings would be indicative of Alzheimer disease? Select all that apply. a. Occasionally forgetting names or appointments b.Difficulty performing familiar tasks, such as placing a telephone call c.Misplacing items, such as putting dish soap in the refrigerator d.Sometimes having trouble finding the right word e.Rapid mood swings, from calm to tears, for no apparent reason f.Getting lost in ones own neighborhood ANS: B, C, E, F Difficulty performing familiar tasks, misplacing items, rapid mood swings, and getting lost in ones own neighborhood can be warning signs of Alzheimer disease. Occasionally forgetting names or appointments, and sometimes having trouble finding the right word are part of normal aging. (For other examples of Alzheimer disease) 8. The nurse is assessing orientation in a 79-year-old patient. Which of these responses would lead the nurse to conclude that this patient is oriented? a.I know my name is John. I couldnt tell you where I am. I think it is 2010, though. b.I know my name is John, but to tell you the truth, I get kind of confused about the date. c.I know my name is John; I guess Im at the hospital in Spokane. No, I dont know the date. d.I know my name is John. I am at the hospital in Spokane. I couldnt tell you what date it is, but I know that it is February of a new year2010. ANS: D Many aging persons experience social isolation, loss of structure without a job, a change in residence, or some short-term memory loss. These factors affect orientation, and the person may not provide the precise date or complete name of the agency. You may consider aging persons oriented if they generally know where they are and the present period. They should be considered oriented to time if the year and month are correctly stated. Orientation to place is accepted with the correct identification of the type of setting (e.g., hospital) and the name of the town.