Harrison's Principles of Internal Medicine
(Vol.1 & Vol.2)
22nd Edition
• Author(s)Joseph Loscalzo; Anthony S.
Fauci; Dennis L. Kasper; Stephen Hauser;
Dan Longo; J. Larry Jameson
Test Bank
Test Bank: Foundations of Clinical Practice
1. A nurse is providing pre-consultation education to a patient.
Which principle best aligns with the concept of the "end of the
paternalistic era" in modern medicine, as described in
foundational texts?
a) The physician alone determines the best treatment plan.
b) The patient's informed preferences are central to shared
decision-making.
c) Nursing staff should implement orders without question to
,ensure efficiency.
d) Treatment plans are based solely on population-level clinical
guidelines.
Answer: b) The patient's informed preferences are central to
shared decision-making.
Rationale: Contemporary medical practice emphasizes a
collaborative model where the clinician's expertise is integrated
with the patient's values, preferences, and expressed needs.
This shared decision-making model has replaced the older
paternalistic approach.
Citation: Harrison’s Principles of Internal Medicine, 22nd ed.
Chapter 1: The Practice of Medicine.
2. When applying the concept of "motivational interviewing" to
promote smoking cessation, which nursing action is most
appropriate?
a) Confronting the patient with graphic images of lung disease
to instill fear.
b) Lecturing on the statistical risks of continued tobacco use.
c) Exploring the patient's own reasons for wanting to quit and
perceived barriers.
d) Setting a firm quit date for the patient during the first
consultation.
Answer: c) Exploring the patient's own reasons for wanting to
quit and perceived barriers.
Rationale: Motivational interviewing is a patient-centered
technique focused on exploring ambivalence, eliciting the
patient's own motivations for change, and resolving resistance,
,rather than using direct confrontation or persuasion.
Citation: Harrison’s Principles of Internal Medicine, 22nd ed.
Chapter 2: Promoting Good Health.
3. A parent expresses hesitation about routine childhood
vaccinations, stating, "I read online that they can cause autism."
What is the nurse's most effective initial response?
a) Dismiss the concern by stating the information is false and
outdated.
b) Provide the parent with the standard vaccine information
statement (VIS) pamphlet.
c) Acknowledge the concern and engage in a respectful
dialogue to understand their specific fears.
d) Immediately escalate the issue to the pediatrician to handle
the discussion.
Answer: c) Acknowledge the concern and engage in a
respectful dialogue to understand their specific fears.
Rationale: Effective communication begins with empathy and
building trust. Dismissing concerns can increase hesitancy.
Engaging in a non-confrontational conversation allows the nurse
to provide tailored, evidence-based information to address
specific misconceptions.
Citation: Harrison’s Principles of Internal Medicine, 22nd ed.
Chapter 3: Vaccine Opposition and Hesitancy.
4. When explaining the concept of "pre-test probability" to a
nursing student during a diagnostic workup, which factor is
most fundamentally used to estimate it?
, a) The result of a highly sensitive laboratory test.
b) The patient's detailed past surgical history.
c) The patient's history and presenting symptoms within an
epidemiologic context.
d) The cost-effectiveness of the planned diagnostic tests.
Answer: c) The patient's history and presenting symptoms
within an epidemiologic context.
Rationale: Pre-test probability is the estimated likelihood of a
disease before a diagnostic test is performed. It is primarily
derived from the clinical history, physical exam findings, and
known prevalence of the condition in the relevant patient
population.
Citation: Harrison’s Principles of Internal Medicine, 22nd ed.
Chapter 4: Decision-Making in Clinical Medicine.
5. A patient with breast cancer is found to have a tumor that is
estrogen-receptor positive. This biomarker is most directly used
to guide which aspect of precision medicine?
a) Selection of a targeted hormonal therapy.
b) Determination of the required surgical margin width.
c) Calculation of the radiation therapy dosage.
d) Diagnosis of the cancer type.
Answer: a) Selection of a targeted hormonal therapy.
Rationale: Precision medicine uses specific molecular or genetic
markers to guide therapy. The presence of estrogen receptors is
a biomarker that predicts responsiveness to anti-estrogen
therapies like tamoxifen or aromatase inhibitors.
(Vol.1 & Vol.2)
22nd Edition
• Author(s)Joseph Loscalzo; Anthony S.
Fauci; Dennis L. Kasper; Stephen Hauser;
Dan Longo; J. Larry Jameson
Test Bank
Test Bank: Foundations of Clinical Practice
1. A nurse is providing pre-consultation education to a patient.
Which principle best aligns with the concept of the "end of the
paternalistic era" in modern medicine, as described in
foundational texts?
a) The physician alone determines the best treatment plan.
b) The patient's informed preferences are central to shared
decision-making.
c) Nursing staff should implement orders without question to
,ensure efficiency.
d) Treatment plans are based solely on population-level clinical
guidelines.
Answer: b) The patient's informed preferences are central to
shared decision-making.
Rationale: Contemporary medical practice emphasizes a
collaborative model where the clinician's expertise is integrated
with the patient's values, preferences, and expressed needs.
This shared decision-making model has replaced the older
paternalistic approach.
Citation: Harrison’s Principles of Internal Medicine, 22nd ed.
Chapter 1: The Practice of Medicine.
2. When applying the concept of "motivational interviewing" to
promote smoking cessation, which nursing action is most
appropriate?
a) Confronting the patient with graphic images of lung disease
to instill fear.
b) Lecturing on the statistical risks of continued tobacco use.
c) Exploring the patient's own reasons for wanting to quit and
perceived barriers.
d) Setting a firm quit date for the patient during the first
consultation.
Answer: c) Exploring the patient's own reasons for wanting to
quit and perceived barriers.
Rationale: Motivational interviewing is a patient-centered
technique focused on exploring ambivalence, eliciting the
patient's own motivations for change, and resolving resistance,
,rather than using direct confrontation or persuasion.
Citation: Harrison’s Principles of Internal Medicine, 22nd ed.
Chapter 2: Promoting Good Health.
3. A parent expresses hesitation about routine childhood
vaccinations, stating, "I read online that they can cause autism."
What is the nurse's most effective initial response?
a) Dismiss the concern by stating the information is false and
outdated.
b) Provide the parent with the standard vaccine information
statement (VIS) pamphlet.
c) Acknowledge the concern and engage in a respectful
dialogue to understand their specific fears.
d) Immediately escalate the issue to the pediatrician to handle
the discussion.
Answer: c) Acknowledge the concern and engage in a
respectful dialogue to understand their specific fears.
Rationale: Effective communication begins with empathy and
building trust. Dismissing concerns can increase hesitancy.
Engaging in a non-confrontational conversation allows the nurse
to provide tailored, evidence-based information to address
specific misconceptions.
Citation: Harrison’s Principles of Internal Medicine, 22nd ed.
Chapter 3: Vaccine Opposition and Hesitancy.
4. When explaining the concept of "pre-test probability" to a
nursing student during a diagnostic workup, which factor is
most fundamentally used to estimate it?
, a) The result of a highly sensitive laboratory test.
b) The patient's detailed past surgical history.
c) The patient's history and presenting symptoms within an
epidemiologic context.
d) The cost-effectiveness of the planned diagnostic tests.
Answer: c) The patient's history and presenting symptoms
within an epidemiologic context.
Rationale: Pre-test probability is the estimated likelihood of a
disease before a diagnostic test is performed. It is primarily
derived from the clinical history, physical exam findings, and
known prevalence of the condition in the relevant patient
population.
Citation: Harrison’s Principles of Internal Medicine, 22nd ed.
Chapter 4: Decision-Making in Clinical Medicine.
5. A patient with breast cancer is found to have a tumor that is
estrogen-receptor positive. This biomarker is most directly used
to guide which aspect of precision medicine?
a) Selection of a targeted hormonal therapy.
b) Determination of the required surgical margin width.
c) Calculation of the radiation therapy dosage.
d) Diagnosis of the cancer type.
Answer: a) Selection of a targeted hormonal therapy.
Rationale: Precision medicine uses specific molecular or genetic
markers to guide therapy. The presence of estrogen receptors is
a biomarker that predicts responsiveness to anti-estrogen
therapies like tamoxifen or aromatase inhibitors.
