Bates Ch. 3 Test Bank Questions With 100% Correct Answers.

A 23‐year‐old physician assistant (PA) student found that she felt nervous when called upon to examine men in her age group. On one occasion, she encountered a young male patient who appeared embarrassed to see her walk into the room. What should the PA do to minimize their mutual discomfort? a) Adjust lighting so it is tangential to the patient's body. b) Ask the patient where he comes from. c) Explain that she is a PA student. d) Provide ongoing interpretation of findings. e) Explain how the examination will proceed. ‐ e) Explain how the examination will proceed. Patient comfort is a primary concern in setting the stage for the examination, and, if patients know how the exam will proceed, they are likely to feel more relaxed. In addition, explaining a routine may help remind the PA student of the routine she will follow. Adjusting lighting so that it is tangential to the patient's body is important for accurate visualization of body structures but does not necessarily reduce the patient's embarrassment. Asking the patient where he comes from would move the situation away from the professional to the personal, which could enhance discomfort. Explaining that she is a PA student may reduce the PA's own anxiety but will not necessarily calm the patient. Providing ongoing interpretation of findings is not advisable for beginners, who are not primary caregivers and may make errors. A 29‐year‐old electrician complains of persistent cough and wheezing, particularly when he exercises. He says he smokes "occasionally" but rarely so much that he needs to purchase cigarettes: "Mostly, I bum them," he says, chuckling. Upon hearing this information, what is the best next step on the part of the clinician?a) Explain the relationship between smoking and cancer. b) Determine the number of pack‐years the patient smokes. c) Determine the patient's exercise regimen. d) Conduct a mental status examination. e) Determine the patient's immunization history. ‐ b) Determine the number of pack‐years the patient smokes. An accurate determination of a patient's tobacco use is important for assessing the overall health risk due to smoking. Although the patient minimizes his smoking, it is possible that the number of cigarettes smoked per day and the length of time he has smoked would result in a high pack‐year value. Although determining the patient's exercise regimen could be of value later on, it is not necessarily relevant to his presenting problem, which is coughing. Exercise simply precipitates this symptom. There are no signs such as memory loss or anxiety suggesting that a mental status examination would be helpful. At some point, it may become important to explain the relationship between smoking and cancer, but this would not be the best "next step" in fact‐finding. Similarly, determining a patient's immunization history is important for health maintenance, but is not necessary for the initial diagnosis of the causes of his problem. A 32‐year‐old office worker reports excessive stress at work and pain in the right lower quadrant. She states that last night she vomited twice. Her blood pressure is 120/75, heart rate 93 bpm. The patient looks pale and is sweating lightly. Which of the following is an objective finding? a) Accelerated heart rate b) Pain in the right lower quadrantc) History of vomiting d) Pale appearance e) High stress level ‐ a) Accelerated heart rate Objective findings are those detected on physical examination by the clinician. A resting heart rate of 93bpm is higher than normal. Pain in the right lower quadrant, history of vomiting, and the patient's high stress level are all subjective findings because they rely on the patient's report. A pale appearance is not necessarily an objective finding, because what appears pale to one clinician might not appear pale to another. A 39‐year‐old nurse who is a well‐established patient complains of irregular menstrual periods and pelvic pain. She says that she is having trouble sleeping and asks whether she could be given a "sleeping pill." The patient also says she is thinking of leaving her job. What is the best "next step" in caring for this patient? a) Ask about recent travel destinations. b) Obtain a urine sample for testing. c) Obtain a more complete description of problems. d) Perform a pelvic examination. e) Obtain blood for testing. ‐ c) Obtain a more complete description of problems. It is critical to thoroughly understand the patient's problem in order to narrow the focus of the examination. This is particularly true when symptoms are reported in multiple body systems, as in this case. To the extent possible, the seven attributes of each symptom should be explored. Although it may be necessary to perform a pelvic examination, the exam will yield more information if the clinician has determined, for example, the patient's pregnancy history. The clinician may need to obtain a urine sample for testing later but should have a possible diagnosis in mind when doing so. A similar argument applies regarding obtaining blood for testing—testing for what? Recent travel destinations should be elicited if there is a suspicion that an infectious agent was acquired somewhere else, but more information is needed to determine whether this would be a realistic suspicion.A 47‐year‐old fitness trainer visits the physician assistant (PA) because of skin dryness, night sweats, and irregular menstrual periods. It is the PA's first contact with this patient. The patient notes that "My sex life has really gone downhill lately" and says that she is considering divorcing her husband of 20 years, stating that "He's not a bad guy. I just think that I can do better." In which of the following ways should the clinician proceed? a) Obtain a menstrual history for the previous 6 months. b) Help the patient review the pros and cons of divorce. c) Conduct a breast examination. d) Inform the patient that menopause is a normal part of aging. e) Determine the patient's out‐of‐country travel history. ‐ a) Obtain a menstrual history for the previous 6 months. It is important to review the seven attributes of a patient's principal symptom(s), which in this case are skin dryness, night sweats, reduced interest in sex, and irregular menstrual periods. Helping the patient review the pros and cons of divorce would not address her physical symptoms. Informing the patient that menopause is a normal part of aging, although perhaps appropriate in the longer term, is premature since it has not been determined that she is perimenopausal. There are no symptoms that would prompt the clinician to conduct a breast examination. Symptoms that might lead one to determine the patient's out‐of‐country travel historyinclude a rash, fever, or other signs of infection, which are absent here. A 54‐year‐old diplomat working at the United Nations reports occasional chest pain and a sense of tightness in his chest when particularly stressed over work deadlines. The patient is 6 feet 4 inches tall. He has a temperature of 98.6ºF and blood pressure of 140/78. He has a cut over one eye that he says is "from shaving." Which of the following represents subjective information about this patient?a) Blood pressure of 140/78 b) Employment at the United Nations c) Temperature of 98.6ºF d) Cut over eye from shaving e) Height of 6 feet 4 inches ‐ d) Cut over eye from shaving