NR 509 BATES TEST BANK SPRING MIDTERM EXAM TEST QUESTIONS WITH ACCURATE
SOLUTIONS
A patient presents for evaluation of a sharp, aching chest pain which increases with
breathing. Which anatomic area would you localize the symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine
A) Musculoskeletal
Chest pain may be due to a musculoskeletal condition, such as costochondritis or
intercostal muscle cramp. This would be worsened by motion of the chest wall. Pleuritic
chest pain is also a sharp chest pain which increases with a deep breath. This type of pain
can
occur with inflammation of the pleura from pneumonia or other conditions and pulmonary
embolus.
A 23-year-old graduate student comes to your clinic for evaluation of a urethral discharge.
As the provider, you need to get a sexual history. Which one of the following questions is
inappropriate for eliciting the information?
A) Are you sexually active?
B) When was the last time you had intimate physical contact with someone, and did that
contact include sexual intercourse?
C) Do you have sex with men, women, or both?
D) How many sexual partners have you had in the last 6 months?
,A) Are you sexually active?
This is inappropriate because it is too vague. Given the complaint, you should probably
assume that he is sexually active. A specific sexual history will help you to assess this
patient's risk for other sexually transmitted infections.
Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has
come to the office many times in the past with a variety of injuries, and you suspect that he
has a problem with alcohol. Which one of the following questions will be most helpful in
diagnosing this problem?
A) You are an alcoholic, aren't you?
B) When was your last drink?
C) Do you drink 2 to 3 beers every weekend?
D) Do you drink alcohol when you are supposed to be working?
B) When was your last drink?
This is a good opening question that is general and neutral in tone; depending on the
timing, you will be able to ask for more specific information related to the patient's last
drink.
The others will tend to stifle the conversation because they are closed-ended questions.
On a very busy day in the office, Mrs. Donelan, who is 81 years old, comes for her usual visit
for her blood pressure. She is on a low-dose diuretic chronically and denies any side
effects. Her blood pressure is 118/78 today, which is well-controlled. As you are writing her
script, she mentions that it is hard not having her husband Bill around anymore. What
would you
,do next?
A) Hand her the script and make sure she has a 3-month follow-up appointment.
B) Make sure she understands the script.
C) Ask why Bill is not there.
D) Explain that you will have more time at the next visit to discuss this.
C) Ask why Bill is not there.
Sometimes, the patient's greatest need is for support and empathy. It would be
inappropriate to ignore this comment today. She may have relied heavily upon Bill for care
and
may be in danger. She may be depressed and even suicidal, but you will not know unless
you
discuss this with her. Most importantly, you should empathize with her by saying something
like "It must be very difficult not to have him at home" and allow a pause for her to answer.
You may also ask "What did you rely on him to do for you?"
A patient is describing a very personal part of her history very quickly and in great detail.
How should you react to this?
A) Write down as much as you can, as quickly as possible.
B) Ask her to repeat key phrases or to pause at regular intervals, so you can get almost
every
word.
C) Tell her that she can go over the notes later to make sure they are accurate.
D) Push away from the keyboard or put down your pen and listen.
, D) Push away from the keyboard or put down your pen and listen.
This is a common event in clinical practice. It is much more important to listen actively with
good eye contact at this time than to document the story verbatim. You want to
minimize interruption (e.g., answer B). It is usually not appropriate to ask a patient to go
over
the written notes, but it would be a good idea to repeat the main ideas back to her. You
should be
certain she has completed her story before doing this.
You arrive at the bedside of an elderly woman who has had a stroke, affecting her entire
right side. She cannot speak (aphasia). You are supposed to examine her. You notice that
the last examiner left her socks at the bottom of the bed, and although sensitive areas are
covered by a sheet, the blanket is heaped by her feet at the bottom of the bed. What would
you do next?
A) Carry out your examination, focusing on the neurologic portion, and then cover her
properly.
B) Carry out your examination and let the nurse assigned to her "put her back together."
C) Put her socks back on and cover her completely before beginning the evaluation.
D) Apologize for the last examiner but let the next examiner dress and cover her.
C) Put her socks back on and cover her completely before beginning the evaluation.
It is crucial to make an effort to make a patient comfortable. In this scenario, the
patient can neither speak nor move well. Take a moment to imagine yourself in her
situation.
As a matter of respect as well as comfort, you should cover the patient appropriately and
consider returning a little later to do your examination if you feel she is cold.
SOLUTIONS
A patient presents for evaluation of a sharp, aching chest pain which increases with
breathing. Which anatomic area would you localize the symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine
A) Musculoskeletal
Chest pain may be due to a musculoskeletal condition, such as costochondritis or
intercostal muscle cramp. This would be worsened by motion of the chest wall. Pleuritic
chest pain is also a sharp chest pain which increases with a deep breath. This type of pain
can
occur with inflammation of the pleura from pneumonia or other conditions and pulmonary
embolus.
A 23-year-old graduate student comes to your clinic for evaluation of a urethral discharge.
As the provider, you need to get a sexual history. Which one of the following questions is
inappropriate for eliciting the information?
A) Are you sexually active?
B) When was the last time you had intimate physical contact with someone, and did that
contact include sexual intercourse?
C) Do you have sex with men, women, or both?
D) How many sexual partners have you had in the last 6 months?
,A) Are you sexually active?
This is inappropriate because it is too vague. Given the complaint, you should probably
assume that he is sexually active. A specific sexual history will help you to assess this
patient's risk for other sexually transmitted infections.
Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has
come to the office many times in the past with a variety of injuries, and you suspect that he
has a problem with alcohol. Which one of the following questions will be most helpful in
diagnosing this problem?
A) You are an alcoholic, aren't you?
B) When was your last drink?
C) Do you drink 2 to 3 beers every weekend?
D) Do you drink alcohol when you are supposed to be working?
B) When was your last drink?
This is a good opening question that is general and neutral in tone; depending on the
timing, you will be able to ask for more specific information related to the patient's last
drink.
The others will tend to stifle the conversation because they are closed-ended questions.
On a very busy day in the office, Mrs. Donelan, who is 81 years old, comes for her usual visit
for her blood pressure. She is on a low-dose diuretic chronically and denies any side
effects. Her blood pressure is 118/78 today, which is well-controlled. As you are writing her
script, she mentions that it is hard not having her husband Bill around anymore. What
would you
,do next?
A) Hand her the script and make sure she has a 3-month follow-up appointment.
B) Make sure she understands the script.
C) Ask why Bill is not there.
D) Explain that you will have more time at the next visit to discuss this.
C) Ask why Bill is not there.
Sometimes, the patient's greatest need is for support and empathy. It would be
inappropriate to ignore this comment today. She may have relied heavily upon Bill for care
and
may be in danger. She may be depressed and even suicidal, but you will not know unless
you
discuss this with her. Most importantly, you should empathize with her by saying something
like "It must be very difficult not to have him at home" and allow a pause for her to answer.
You may also ask "What did you rely on him to do for you?"
A patient is describing a very personal part of her history very quickly and in great detail.
How should you react to this?
A) Write down as much as you can, as quickly as possible.
B) Ask her to repeat key phrases or to pause at regular intervals, so you can get almost
every
word.
C) Tell her that she can go over the notes later to make sure they are accurate.
D) Push away from the keyboard or put down your pen and listen.
, D) Push away from the keyboard or put down your pen and listen.
This is a common event in clinical practice. It is much more important to listen actively with
good eye contact at this time than to document the story verbatim. You want to
minimize interruption (e.g., answer B). It is usually not appropriate to ask a patient to go
over
the written notes, but it would be a good idea to repeat the main ideas back to her. You
should be
certain she has completed her story before doing this.
You arrive at the bedside of an elderly woman who has had a stroke, affecting her entire
right side. She cannot speak (aphasia). You are supposed to examine her. You notice that
the last examiner left her socks at the bottom of the bed, and although sensitive areas are
covered by a sheet, the blanket is heaped by her feet at the bottom of the bed. What would
you do next?
A) Carry out your examination, focusing on the neurologic portion, and then cover her
properly.
B) Carry out your examination and let the nurse assigned to her "put her back together."
C) Put her socks back on and cover her completely before beginning the evaluation.
D) Apologize for the last examiner but let the next examiner dress and cover her.
C) Put her socks back on and cover her completely before beginning the evaluation.
It is crucial to make an effort to make a patient comfortable. In this scenario, the
patient can neither speak nor move well. Take a moment to imagine yourself in her
situation.
As a matter of respect as well as comfort, you should cover the patient appropriately and
consider returning a little later to do your examination if you feel she is cold.
