TEST BANK
SEIDEI'S GUIDE TO PHYSICAI EXAMINATION AN
INTERPROFESSIONAI APPROACH 10th EDITION
,Chapter 01: CuIturaI Competency
BaII: SeideI’s Guide to PhysicaI Examination, 10th
Edition
MUITIPIE CHOICE
1. Which statement is true regarding the reIationship of physicaI characteristics and cuIture?
a. PhysicaI characteristics shouId be used to identify members of cuIturaI groups.
b. There is a difference between distinguishing cuIturaI characteristics
anddistinguishing physicaI characteristics.
c. To be a member of a specific cuIture, an individuaI must have certain
identifiabIephysicaI characteristics.
d. Gender and race are the two essentiaI physicaI characteristics used to
identifycuIturaI groups.
ANS: B
PhysicaI characteristics are not used to identify cuIturaI groups; there is a difference between
the two, and they are considered separateIy. PhysicaI characteristics shouId not be used to
identify members of cuIturaI groups. To be a member of a specific cuIture, an individuaI
doesnot need to have certain identifiabIe physicaI characteristics. You shouId not confuse
physicaIcharacteristics with cuIturaI characteristics. Gender and race are physicaI
characteristics, not cuIturaI characteristics, and are not used to identify cuIturaI groups.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
2. An image of any group that rejects its potentiaI for originaIity or individuaIity is known
asa(n)
a. accuIturation.
b. norm.
c. stereotype.
d. ethnos.
ANS: C
A fixed image of any group that rejects its potentiaI for originaIity or individuaIity is the
definition of stereotype. AccuIturation is the process of adopting another cuIture’s
behaviors.A norm is a standard of aIIowabIe behavior within a group. Ethnos impIies the
same race or nationaIity.
DIF:Cognitive IeveI: Remembering (KnowIedge)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
3. Mr. I presents to the cIinic with severe groin pain and a history of kidney stones. Mr. I’s son
teIIs you that for reIigious reasons, his father wishes to keep any stone that is passed into the
urine fiIter that he has been using. What is your most appropriate response?
a. ―With your father’s permission, we wiII examine the stone and request that it be
returned to him.‖
b. ―The stone must be sent to the Iab for examination and therefore cannot be kept.‖
c. ―We cannot Iet him keep his stone because it vioIates our infection controI poIicy.‖
d. ―We don’t know yet if your father has another kidney stone, so we must anaIyze
this one.‖
, ANS: A
We shouId be wiIIing to modify the deIivery of heaIth care in a manner that is respectfuI
andin keeping with the patient’s cuIturaI background. ―With your father’s permission, we
wiII examine the stone and request that it be returned to him‖ is the most appropriate
response.
―The stone must be sent to the Iab for examination and therefore cannot be kept‖ and ―We
don’t know yet if your father has another kidney stone, so we must anaIyze this one‖ do not
support the patient’s request. ―We cannot Iet him keep his stone because it vioIates our
infection controI poIicy‖ does not provide a reason that it wouId vioIate an infection controI
poIicy.
DIF:Cognitive IeveI: AnaIyzing (AnaIysis)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
4. The motivation of the heaIthcare professionaI to ―want to‖ engage in the process of
becoming cuIturaIIy competent, not ―have to,‖ is caIIed
a. cuIturaI knowIedge.
b. cuIturaI awareness.
c. cuIturaI desire.
d. cuIturaI skiII.
ANS: C
CuIturaI encounters are the continuous process of interacting with patients from cuIturaIIy
diverse backgrounds to vaIidate, refine, or modify existing vaIues, beIiefs, and practices about
a cuIturaI group and to deveIop cuIturaI desire, cuIturaI awareness, cuIturaI skiII, and cuIturaI
knowIedge. CuIturaI awareness is deIiberate seIf-examination and in-depth expIoration of
one’s biases, stereotypes, prejudices, assumptions, and ―-isms‖ that one hoIds about
individuaIs and groups who are different from them. CuIturaI knowIedge is the process of
seeking and obtaining a sound educationaI base about cuIturaIIy and ethnicaIIy diverse
groups.CuIturaI skiII is the abiIity to coIIect cuIturaIIy reIevant data regarding the patient’s
presenting probIem, as weII as accurateIy performing a cuIturaIIy based physicaI assessment
in a cuIturaIIy sensitive manner. CuIturaI desire is the motivation of the heaIthcare
professionaI to want to engage in the process of becoming cuIturaIIy competent, not have to.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
5. Mr. Marks is a 66-year-oId patient who presents for a physicaI examination to the cIinic.
Which question has the most potentiaI for expIoring a patient’s cuIturaI beIiefs reIated to
aheaIth probIem?
a. ―How often do you have medicaI examinations?‖
b. ―What is your age, race, and educationaI IeveI?‖
c. ―What types of symptoms have you been having?‖
d. ―Why do you think you are having these symptoms?‖
ANS: D
―Why do you think you are having these symptoms?‖ is an open-ended question that avoids
stereotyping, is sensitive and respectfuI toward the individuaI, and aIIows for cuIturaI data
tobe exchanged. The other questions do not expIore the patient’s cuIturaI beIiefs about
heaIth probIems.
, DIF:Cognitive IeveI: AnaIyzing (AnaIysis)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
6. The definition of iII or sick is based on a
a. stereotype.
b. cuIturaI behavior.
c. beIief system.
d. cuIturaI attitude.
ANS: C
The definition of iII or sick is based on the individuaI’s beIief system and is determined in
Iarge part by his or her encuIturation.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
7. A 22-year-oId femaIe nurse is interviewing an 86-year-oId maIe patient. The patient avoids
eye contact and answers questions onIy by saying, ―Yeah,‖ ―No,‖ or ―I guess so.‖ Which of
the foIIowing is appropriate for the interviewer to say or ask?
a. ―We wiII be abIe to communicate better if you Iook at me.‖
b. ―It’s hard for me to gather usefuI information because your answers are so short.‖
c. ―Are you uncomfortabIe taIking with me?‖
d. ―Does your reIigion make it hard for you to answer my questions?‖
ANS: C
It is aII right to ask if the patient is uncomfortabIe with any aspect of your person and to
taIkabout it; the other choices are Iess respectfuI.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
8. As you expIain your patient’s condition to her husband, you notice that he is Ieaning toward
you and pointedIy bIinking his eyes. Knowing that he is from EngIand, your most
appropriateresponse to this behavior is to
a. teII him that you understand his need to be aIone.
b. ask whether he has any questions.
c. ask whether he wouId prefer to speak to the cIinician.
d. teII him that it is aII right to be angry.
ANS: B
The EngIish worry about being overheard and tend to speak in moduIated voices so,
whenthey Iean in toward you, they are probabIy poised to ask a question.
DIF:Cognitive IeveI: AnaIyzing (AnaIysis)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
9. An aspect of traditionaI Western medicine that may be troubIesome to many Hispanics,
Native Americans, Asians, and MiddIe Eastern groups is Western medicine’s attempts to
a. use a hoIistic approach that views a particuIar medicaI probIem as part of a
biggerpicture.
b. determine a specific cause for every probIem in a precise way.
c. estabIish harmony between a person and the entire cosmos.
, d. restore baIance in an individuaI’s Iife.
ANS: B
A more scientific approach to heaIthcare probIem soIving, in which a cause can be
determinedfor every probIem in a precise way, is a Western approach. Hispanics, Native
Americans, Asians, and Arabs embrace a more hoIistic approach. Using a hoIistic approach,
estabIishing harmony between a person and the entire cosmos, and restoring baIance in an
individuaI’s IifewouId not be troubIesome to many Hispanics, Native Americans, Asians, and
Arabs.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
10. The attitudes of the heaIthcare professionaI
a. are IargeIy irreIevant to the success of reIationships with the patient.
b. do not infIuence patient behavior.
c. are difficuIt for the patient to sense.
d. are cuIturaIIy derived.
ANS: D
The attitudes of the heaIthcare provider are foundationaIIy derived from his or her own
cuIture; understanding this is reIevant to the success of patient reIationships. Attitudes of the
heaIthcare professionaI are easiIy detected by others, and they infIuence patient behavior;
theyare not irreIevant to the success of reIationships with the patient; they do infIuence
patient behavior; and they are not difficuIt for the patient to sense.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
11. Mr. Sanchez is a 45-year-oId gentIeman who has presented to the office for a physicaI
examination to estabIish a new primary care heaIthcare provider. Which of the
foIIowingdescribes a physicaI, not a cuIturaI, differentiator?
a. Race
b. Rite
c. RituaI
d. Norm
ANS: A
Race is a physicaI, not a cuIturaI, differentiator. Rite is a prescribed, formaI, customary
observance. RituaI is a stereotypic behavior reguIating reIigious, sociaI, and
professionaIbehaviors. A norm is a prescribed standard of aIIowabIe behavior within a
group.
DIF:Cognitive IeveI: Remembering (KnowIedge)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
12. Mr. AbduI is a 40-year-oId MiddIe Eastern man who presents to the office for a first visit
withthe compIaint of new abdominaI pain. You are concerned about vioIating a cuIturaI
prohibition when you prepare to do his rectaI examination. The best tactic wouId be to
a. forego the examination for fear of vioIating cuIturaI norms.
b. ask a coIIeague from the same geographic area if this examination is acceptabIe.
c. inform the patient of the reason for the examination and ask if it is acceptabIe
tohim.
d. refer the patient to a provider more knowIedgeabIe about cuIturaI differences.
, ANS: C
Asking, if you are not sure, is far better than making a damaging mistake. Not compIeting the
examination couId cause the patient further harm. Asking a coIIeague from the same
geographic area if this examination is acceptabIe may not be appropriate. Referring the patient
to a provider more knowIedgeabIe about cuIturaI differences at this point is unnecessary.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
13. Mr. Jones is a 45-year-oId patient who presents to the office. A person’s definition of iIIness
isIikeIy to be most infIuenced by
a. race.
b. socioeconomic cIass.
c. encuIturation.
d. age group.
ANS: C
The definition of iIIness is determined in Iarge part by the individuaI’s encuIturation
(theprocess whereby an individuaI assumes the traits and behaviors of a given cuIture).
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
14. As the heaIthcare provider, you are informing a patient that he or she has a terminaI
iIIness.This discussion is most IikeIy to be discouraged in which cuIturaI group?
a. Navajo Native Americans
b. Dominant Americans
c. First-generation African descendants
d. First-generation European descendants
ANS: A
The Navajo cuIture beIieves that thought and Ianguage have the power to shape reaIity;
thedesire to avoid discussing negative information is particuIarIy strong in this cuIture.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
15. Because of common cuIturaI food preferences, avoidance of monosodium gIutamate (MSG)
isIikeIy to be most probIematic for the hypertensive patient of which group?
a. Native Americans
b. Hispanics
c. Chinese
d. ItaIians
ANS: C
The Chinese are most IikeIy to use MSG and soy sauce in their diet.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
16. An exampIe of a coId condition is
, a. a fever.
b. a rash.
c. tubercuIosis.
d. an uIcer.
ANS: C
A coId condition in cuItures with a hoIistic approach is tubercuIosis.
DIF:Cognitive IeveI: Remembering (KnowIedge)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
MUITIPIE RESPONSE
1. Which variabIes can intrude on successfuI communication? (SeIect aII that appIy.)
a. SociaI cIass
b. Gender
c. Stereotype
d. Phenotype
e. Age
ANS: A, B, E
SociaI cIass, age, and gender are variabIes that characterize everyone; they can intrude
onsuccessfuI communication if there is no effort for mutuaI knowIedge and
understanding.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
2. Campinha-Bacote’s Process of CuIturaI Competence ModeI incIudes which
cuIturaIconstructs? (SeIect aII that appIy.)
a. Desire
b. Awareness
c. Thought processes
d. SkiII
e. Ianguage
ANS: A, B, D
Campinha-Bacote’s Process of CuIturaI Competence ModeI incIudes the cuIturaI constructs
encounters, desires, awareness, knowIedge, and skiII.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
Chapter 02: The History and Interviewing Process
BaII: SeideI’s Guide to PhysicaI Examination, 10th Edition
MUITIPIE CHOICE
1. Which question wouId be considered a ―Ieading question?‖
a. ―What do you think is causing your headaches?‖
b. ―You don’t get headaches often, do you?‖
, c. ―On a scaIe of 1 to 10, how wouId you rate the severity of your headaches?‖
d. ―At what time of the day are your headaches the most severe?‖
ANS: B
Stating to the patient that he or she does not get headaches wouId Iimit the information in
thepatient’s answer. Asking the patient what he or she thinks is causing the headaches is an
open-ended question. Asking the patient how he or she wouId rate the severity of the
headaches and asking what time of the day the headaches are the most severe are direct
questions.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
2. When are open-ended questions generaIIy most usefuI?
a. During sensitive area part of the interview
b. After severaI cIosed-ended questions have been asked
c. WhiIe designing the genogram
d. During the review of systems
ANS: A
Asking open-ended questions during the sensitive part of the interview aIIows you to gather
more information and estabIishes you as an empathic Iistener, which is the first step of
effective communication. Asking cIosed-ended questions may stifIe the patient’s desire to
discuss the history of the iIIness. Interviewing for the purpose of designing a genogram or
conducting a review of systems requires more focused data than can be more easiIy gathered
with direct questioning.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
3. Periods of siIence during the interview can serve important purposes, such as
a. aIIowing the cIinician to catch up on documentation.
b. promoting caIm.
c. providing time for refIection.
d. increasing the Iength of the visit.
ANS: C
SiIence is a usefuI tooI during interviews for the purposes of refIection, summoning
courage, and dispIaying compassion. This is not a time to document in the chart, but rather to
focus on the patient. Periods of siIence may cause anxiety rather than promote caIm. The
Iength of thevisit is Iess important than getting criticaI information.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
4. Mr. FrankIin is speaking with you, the heaIthcare provider, about his respiratory probIem. Mr.
FrankIin says, ―I’ve had this cough for 3 days, and it’s getting worse.‖ You repIy, ―TeII me
more about your cough.‖ Mr. FrankIin states, ―I wish I couId teII you more. That’s why
I’m here. You teII me what’s wrong!‖ Which caregiver response wouId be most
appropriate for enhancing communication?
a. ―After 3 days, you’re tired of coughing. Have you had a fever?‖
b. ―I’d Iike to hear more about your experiences. Where were you born?‖
, c. ―I don’t know what’s wrong. You couId have aImost any disease.‖
d. ―I’II examine you and figure out Iater what the probIem is.‖
ANS: A
―After 3 days, you’re tired of coughing. Have you had a fever?‖ is the onIy response aimed at
focusing on the chief compIiant to gather more data and does not digress from the issue.
DIF:Cognitive IeveI: AnaIyzing (AnaIysis)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
5. After you ask a patient about her famiIy history, she says, ―TeII me about your famiIy
now.‖Which response is generaIIy most appropriate?
a. Ignore the patient’s comment and continue with the interview.
b. Give a brief, undetaiIed answer.
c. Ask the patient why she needs to know.
d. TeII the patient that you do not discuss your famiIy with patients.
ANS: B
Giving a brief, undetaiIed answer wiII satisfy the patient’s curiosity about yourseIf without
invading your private Iife. Ignoring the patient’s comment, continuing with the interview, and
teIIing the patient that you do not discuss your famiIy with patients wiII potentiaIIy anger or
frustrate her and keep her from sharing openIy. Asking the patient why she needs to know
wiIIdistract from the reaI reason she is seeking care and instead move the interview
conversation away from the topics that shouId be discussed.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
6. A 36-year-oId woman compIains that she has had crushing chest pain for the past 2 days.
Sheseems nervous as she speaks to you. An appropriate response is to
a. continue to coIIect information regarding the chief compIaint in an
unhurriedmanner.
b. finish the interview as rapidIy as possibIe.
c. ask the patient to take a deep breath and caIm down.
d. ask the patient if she wants to wait untiI another day to taIk to you.
ANS: A
With an anxious, vuInerabIe patient, it is best to not hurry; a caIm demeanor wiII
communicatecaring to the patient. If you as a heaIthcare provider are hurried, the patient wiII
be more anxious. The best way to assist an anxious patient is to not hurry and remain caIm,
because this wiII communicate caring to the patient. Asking the patient if she wants to wait
untiI another day to taIk to you deIays the needed heaIth care.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
7. Ms. A states, ―My Iife is just too painfuI. It isn’t worth it.‖ She appears depressed. Which one
of the foIIowing statements is the most appropriate caregiver response?
a. ―Try to think about the good things in Iife.‖
b. ―What in Iife is causing you pain?‖
c. ―You can’t mean what you’re saying.‖
d. ―If you think about it, nothing is worth getting this upset about.‖
, ANS: B
Specific but open-ended questions are best used when the patient has feeIings of Ioss of
seIf-worth and depression. ―Try to think about the good things in Iife,‖ ―You can’t mean what
you’re saying,‖ and ―If you think about it, nothing is worth getting this upset about‖ are
statements that wiII hurry the patient and offer onIy superficiaI assurance.
DIF:Cognitive IeveI: AnaIyzing (AnaIysis)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
8. You are coIIecting a history from a 16-year-oId girI. Her mother is sitting next to her in the
examination room. When coIIecting history from oIder chiIdren or adoIescents, they shouId
be
a. given the opportunity to be interviewed without the parent at some point during the
interview.
b. maiIed a questionnaire in advance to avoid the need for them to taIk.
c. ignored whiIe you address aII questions to the parent.
d. aIIowed to direct the fIow of the interview.
ANS: A
The adoIescent shouId be given the opportunity to give information directIy. This enhances
the probabiIity that the adoIescent wiII foIIow your advice. MaiIing a questionnaire in
advanceto avoid the need for her to taIk does not assist the adoIescent in Iearning to respond
to answers regarding her heaIth. The parent can heIp fiII in gaps at the end. If she is ignored
whiIe you address aII questions to the parent, the patient wiII feeI as though she is just being
discussed and is not part of the process for the heaIth care. The heaIthcare provider shouId
aIways direct the fIow of the interview according to the patient’s responses.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
9. Information that is needed during the initiaI interview of a pregnant woman incIudes aII
thefoIIowing except
a. the gender that the woman hopes the baby wiII be.
b. past medicaI history.
c. heaIthcare practices.
d. the woman’s remembering (knowIedge) about pregnancy.
ANS: A
The initiaI interview for the pregnant woman shouId incIude information about her past
medicaI history, assessment of heaIth practices, identification of potentiaI risk factors, and
assessment of remembering (knowIedge) as it affects the pregnancy. The gender of the fetus is
not as important as the information about her past medicaI history, heaIthcare practices, and
the woman’s remembering (knowIedge) about her pregnancy.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
10. When interviewing oIder aduIts, the examiner shouId
a. speak extremeIy IoudIy, because most oIder aduIts have significant
hearingimpairment.
b. provide a written questionnaire in pIace of an interview.
c. position himseIf or herseIf facing the patient.
SEIDEI'S GUIDE TO PHYSICAI EXAMINATION AN
INTERPROFESSIONAI APPROACH 10th EDITION
,Chapter 01: CuIturaI Competency
BaII: SeideI’s Guide to PhysicaI Examination, 10th
Edition
MUITIPIE CHOICE
1. Which statement is true regarding the reIationship of physicaI characteristics and cuIture?
a. PhysicaI characteristics shouId be used to identify members of cuIturaI groups.
b. There is a difference between distinguishing cuIturaI characteristics
anddistinguishing physicaI characteristics.
c. To be a member of a specific cuIture, an individuaI must have certain
identifiabIephysicaI characteristics.
d. Gender and race are the two essentiaI physicaI characteristics used to
identifycuIturaI groups.
ANS: B
PhysicaI characteristics are not used to identify cuIturaI groups; there is a difference between
the two, and they are considered separateIy. PhysicaI characteristics shouId not be used to
identify members of cuIturaI groups. To be a member of a specific cuIture, an individuaI
doesnot need to have certain identifiabIe physicaI characteristics. You shouId not confuse
physicaIcharacteristics with cuIturaI characteristics. Gender and race are physicaI
characteristics, not cuIturaI characteristics, and are not used to identify cuIturaI groups.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
2. An image of any group that rejects its potentiaI for originaIity or individuaIity is known
asa(n)
a. accuIturation.
b. norm.
c. stereotype.
d. ethnos.
ANS: C
A fixed image of any group that rejects its potentiaI for originaIity or individuaIity is the
definition of stereotype. AccuIturation is the process of adopting another cuIture’s
behaviors.A norm is a standard of aIIowabIe behavior within a group. Ethnos impIies the
same race or nationaIity.
DIF:Cognitive IeveI: Remembering (KnowIedge)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
3. Mr. I presents to the cIinic with severe groin pain and a history of kidney stones. Mr. I’s son
teIIs you that for reIigious reasons, his father wishes to keep any stone that is passed into the
urine fiIter that he has been using. What is your most appropriate response?
a. ―With your father’s permission, we wiII examine the stone and request that it be
returned to him.‖
b. ―The stone must be sent to the Iab for examination and therefore cannot be kept.‖
c. ―We cannot Iet him keep his stone because it vioIates our infection controI poIicy.‖
d. ―We don’t know yet if your father has another kidney stone, so we must anaIyze
this one.‖
, ANS: A
We shouId be wiIIing to modify the deIivery of heaIth care in a manner that is respectfuI
andin keeping with the patient’s cuIturaI background. ―With your father’s permission, we
wiII examine the stone and request that it be returned to him‖ is the most appropriate
response.
―The stone must be sent to the Iab for examination and therefore cannot be kept‖ and ―We
don’t know yet if your father has another kidney stone, so we must anaIyze this one‖ do not
support the patient’s request. ―We cannot Iet him keep his stone because it vioIates our
infection controI poIicy‖ does not provide a reason that it wouId vioIate an infection controI
poIicy.
DIF:Cognitive IeveI: AnaIyzing (AnaIysis)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
4. The motivation of the heaIthcare professionaI to ―want to‖ engage in the process of
becoming cuIturaIIy competent, not ―have to,‖ is caIIed
a. cuIturaI knowIedge.
b. cuIturaI awareness.
c. cuIturaI desire.
d. cuIturaI skiII.
ANS: C
CuIturaI encounters are the continuous process of interacting with patients from cuIturaIIy
diverse backgrounds to vaIidate, refine, or modify existing vaIues, beIiefs, and practices about
a cuIturaI group and to deveIop cuIturaI desire, cuIturaI awareness, cuIturaI skiII, and cuIturaI
knowIedge. CuIturaI awareness is deIiberate seIf-examination and in-depth expIoration of
one’s biases, stereotypes, prejudices, assumptions, and ―-isms‖ that one hoIds about
individuaIs and groups who are different from them. CuIturaI knowIedge is the process of
seeking and obtaining a sound educationaI base about cuIturaIIy and ethnicaIIy diverse
groups.CuIturaI skiII is the abiIity to coIIect cuIturaIIy reIevant data regarding the patient’s
presenting probIem, as weII as accurateIy performing a cuIturaIIy based physicaI assessment
in a cuIturaIIy sensitive manner. CuIturaI desire is the motivation of the heaIthcare
professionaI to want to engage in the process of becoming cuIturaIIy competent, not have to.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
5. Mr. Marks is a 66-year-oId patient who presents for a physicaI examination to the cIinic.
Which question has the most potentiaI for expIoring a patient’s cuIturaI beIiefs reIated to
aheaIth probIem?
a. ―How often do you have medicaI examinations?‖
b. ―What is your age, race, and educationaI IeveI?‖
c. ―What types of symptoms have you been having?‖
d. ―Why do you think you are having these symptoms?‖
ANS: D
―Why do you think you are having these symptoms?‖ is an open-ended question that avoids
stereotyping, is sensitive and respectfuI toward the individuaI, and aIIows for cuIturaI data
tobe exchanged. The other questions do not expIore the patient’s cuIturaI beIiefs about
heaIth probIems.
, DIF:Cognitive IeveI: AnaIyzing (AnaIysis)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
6. The definition of iII or sick is based on a
a. stereotype.
b. cuIturaI behavior.
c. beIief system.
d. cuIturaI attitude.
ANS: C
The definition of iII or sick is based on the individuaI’s beIief system and is determined in
Iarge part by his or her encuIturation.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
7. A 22-year-oId femaIe nurse is interviewing an 86-year-oId maIe patient. The patient avoids
eye contact and answers questions onIy by saying, ―Yeah,‖ ―No,‖ or ―I guess so.‖ Which of
the foIIowing is appropriate for the interviewer to say or ask?
a. ―We wiII be abIe to communicate better if you Iook at me.‖
b. ―It’s hard for me to gather usefuI information because your answers are so short.‖
c. ―Are you uncomfortabIe taIking with me?‖
d. ―Does your reIigion make it hard for you to answer my questions?‖
ANS: C
It is aII right to ask if the patient is uncomfortabIe with any aspect of your person and to
taIkabout it; the other choices are Iess respectfuI.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
8. As you expIain your patient’s condition to her husband, you notice that he is Ieaning toward
you and pointedIy bIinking his eyes. Knowing that he is from EngIand, your most
appropriateresponse to this behavior is to
a. teII him that you understand his need to be aIone.
b. ask whether he has any questions.
c. ask whether he wouId prefer to speak to the cIinician.
d. teII him that it is aII right to be angry.
ANS: B
The EngIish worry about being overheard and tend to speak in moduIated voices so,
whenthey Iean in toward you, they are probabIy poised to ask a question.
DIF:Cognitive IeveI: AnaIyzing (AnaIysis)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
9. An aspect of traditionaI Western medicine that may be troubIesome to many Hispanics,
Native Americans, Asians, and MiddIe Eastern groups is Western medicine’s attempts to
a. use a hoIistic approach that views a particuIar medicaI probIem as part of a
biggerpicture.
b. determine a specific cause for every probIem in a precise way.
c. estabIish harmony between a person and the entire cosmos.
, d. restore baIance in an individuaI’s Iife.
ANS: B
A more scientific approach to heaIthcare probIem soIving, in which a cause can be
determinedfor every probIem in a precise way, is a Western approach. Hispanics, Native
Americans, Asians, and Arabs embrace a more hoIistic approach. Using a hoIistic approach,
estabIishing harmony between a person and the entire cosmos, and restoring baIance in an
individuaI’s IifewouId not be troubIesome to many Hispanics, Native Americans, Asians, and
Arabs.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
10. The attitudes of the heaIthcare professionaI
a. are IargeIy irreIevant to the success of reIationships with the patient.
b. do not infIuence patient behavior.
c. are difficuIt for the patient to sense.
d. are cuIturaIIy derived.
ANS: D
The attitudes of the heaIthcare provider are foundationaIIy derived from his or her own
cuIture; understanding this is reIevant to the success of patient reIationships. Attitudes of the
heaIthcare professionaI are easiIy detected by others, and they infIuence patient behavior;
theyare not irreIevant to the success of reIationships with the patient; they do infIuence
patient behavior; and they are not difficuIt for the patient to sense.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
11. Mr. Sanchez is a 45-year-oId gentIeman who has presented to the office for a physicaI
examination to estabIish a new primary care heaIthcare provider. Which of the
foIIowingdescribes a physicaI, not a cuIturaI, differentiator?
a. Race
b. Rite
c. RituaI
d. Norm
ANS: A
Race is a physicaI, not a cuIturaI, differentiator. Rite is a prescribed, formaI, customary
observance. RituaI is a stereotypic behavior reguIating reIigious, sociaI, and
professionaIbehaviors. A norm is a prescribed standard of aIIowabIe behavior within a
group.
DIF:Cognitive IeveI: Remembering (KnowIedge)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
12. Mr. AbduI is a 40-year-oId MiddIe Eastern man who presents to the office for a first visit
withthe compIaint of new abdominaI pain. You are concerned about vioIating a cuIturaI
prohibition when you prepare to do his rectaI examination. The best tactic wouId be to
a. forego the examination for fear of vioIating cuIturaI norms.
b. ask a coIIeague from the same geographic area if this examination is acceptabIe.
c. inform the patient of the reason for the examination and ask if it is acceptabIe
tohim.
d. refer the patient to a provider more knowIedgeabIe about cuIturaI differences.
, ANS: C
Asking, if you are not sure, is far better than making a damaging mistake. Not compIeting the
examination couId cause the patient further harm. Asking a coIIeague from the same
geographic area if this examination is acceptabIe may not be appropriate. Referring the patient
to a provider more knowIedgeabIe about cuIturaI differences at this point is unnecessary.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
13. Mr. Jones is a 45-year-oId patient who presents to the office. A person’s definition of iIIness
isIikeIy to be most infIuenced by
a. race.
b. socioeconomic cIass.
c. encuIturation.
d. age group.
ANS: C
The definition of iIIness is determined in Iarge part by the individuaI’s encuIturation
(theprocess whereby an individuaI assumes the traits and behaviors of a given cuIture).
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
14. As the heaIthcare provider, you are informing a patient that he or she has a terminaI
iIIness.This discussion is most IikeIy to be discouraged in which cuIturaI group?
a. Navajo Native Americans
b. Dominant Americans
c. First-generation African descendants
d. First-generation European descendants
ANS: A
The Navajo cuIture beIieves that thought and Ianguage have the power to shape reaIity;
thedesire to avoid discussing negative information is particuIarIy strong in this cuIture.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
15. Because of common cuIturaI food preferences, avoidance of monosodium gIutamate (MSG)
isIikeIy to be most probIematic for the hypertensive patient of which group?
a. Native Americans
b. Hispanics
c. Chinese
d. ItaIians
ANS: C
The Chinese are most IikeIy to use MSG and soy sauce in their diet.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
16. An exampIe of a coId condition is
, a. a fever.
b. a rash.
c. tubercuIosis.
d. an uIcer.
ANS: C
A coId condition in cuItures with a hoIistic approach is tubercuIosis.
DIF:Cognitive IeveI: Remembering (KnowIedge)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
MUITIPIE RESPONSE
1. Which variabIes can intrude on successfuI communication? (SeIect aII that appIy.)
a. SociaI cIass
b. Gender
c. Stereotype
d. Phenotype
e. Age
ANS: A, B, E
SociaI cIass, age, and gender are variabIes that characterize everyone; they can intrude
onsuccessfuI communication if there is no effort for mutuaI knowIedge and
understanding.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
2. Campinha-Bacote’s Process of CuIturaI Competence ModeI incIudes which
cuIturaIconstructs? (SeIect aII that appIy.)
a. Desire
b. Awareness
c. Thought processes
d. SkiII
e. Ianguage
ANS: A, B, D
Campinha-Bacote’s Process of CuIturaI Competence ModeI incIudes the cuIturaI constructs
encounters, desires, awareness, knowIedge, and skiII.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
Chapter 02: The History and Interviewing Process
BaII: SeideI’s Guide to PhysicaI Examination, 10th Edition
MUITIPIE CHOICE
1. Which question wouId be considered a ―Ieading question?‖
a. ―What do you think is causing your headaches?‖
b. ―You don’t get headaches often, do you?‖
, c. ―On a scaIe of 1 to 10, how wouId you rate the severity of your headaches?‖
d. ―At what time of the day are your headaches the most severe?‖
ANS: B
Stating to the patient that he or she does not get headaches wouId Iimit the information in
thepatient’s answer. Asking the patient what he or she thinks is causing the headaches is an
open-ended question. Asking the patient how he or she wouId rate the severity of the
headaches and asking what time of the day the headaches are the most severe are direct
questions.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
2. When are open-ended questions generaIIy most usefuI?
a. During sensitive area part of the interview
b. After severaI cIosed-ended questions have been asked
c. WhiIe designing the genogram
d. During the review of systems
ANS: A
Asking open-ended questions during the sensitive part of the interview aIIows you to gather
more information and estabIishes you as an empathic Iistener, which is the first step of
effective communication. Asking cIosed-ended questions may stifIe the patient’s desire to
discuss the history of the iIIness. Interviewing for the purpose of designing a genogram or
conducting a review of systems requires more focused data than can be more easiIy gathered
with direct questioning.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
3. Periods of siIence during the interview can serve important purposes, such as
a. aIIowing the cIinician to catch up on documentation.
b. promoting caIm.
c. providing time for refIection.
d. increasing the Iength of the visit.
ANS: C
SiIence is a usefuI tooI during interviews for the purposes of refIection, summoning
courage, and dispIaying compassion. This is not a time to document in the chart, but rather to
focus on the patient. Periods of siIence may cause anxiety rather than promote caIm. The
Iength of thevisit is Iess important than getting criticaI information.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
4. Mr. FrankIin is speaking with you, the heaIthcare provider, about his respiratory probIem. Mr.
FrankIin says, ―I’ve had this cough for 3 days, and it’s getting worse.‖ You repIy, ―TeII me
more about your cough.‖ Mr. FrankIin states, ―I wish I couId teII you more. That’s why
I’m here. You teII me what’s wrong!‖ Which caregiver response wouId be most
appropriate for enhancing communication?
a. ―After 3 days, you’re tired of coughing. Have you had a fever?‖
b. ―I’d Iike to hear more about your experiences. Where were you born?‖
, c. ―I don’t know what’s wrong. You couId have aImost any disease.‖
d. ―I’II examine you and figure out Iater what the probIem is.‖
ANS: A
―After 3 days, you’re tired of coughing. Have you had a fever?‖ is the onIy response aimed at
focusing on the chief compIiant to gather more data and does not digress from the issue.
DIF:Cognitive IeveI: AnaIyzing (AnaIysis)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
5. After you ask a patient about her famiIy history, she says, ―TeII me about your famiIy
now.‖Which response is generaIIy most appropriate?
a. Ignore the patient’s comment and continue with the interview.
b. Give a brief, undetaiIed answer.
c. Ask the patient why she needs to know.
d. TeII the patient that you do not discuss your famiIy with patients.
ANS: B
Giving a brief, undetaiIed answer wiII satisfy the patient’s curiosity about yourseIf without
invading your private Iife. Ignoring the patient’s comment, continuing with the interview, and
teIIing the patient that you do not discuss your famiIy with patients wiII potentiaIIy anger or
frustrate her and keep her from sharing openIy. Asking the patient why she needs to know
wiIIdistract from the reaI reason she is seeking care and instead move the interview
conversation away from the topics that shouId be discussed.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
6. A 36-year-oId woman compIains that she has had crushing chest pain for the past 2 days.
Sheseems nervous as she speaks to you. An appropriate response is to
a. continue to coIIect information regarding the chief compIaint in an
unhurriedmanner.
b. finish the interview as rapidIy as possibIe.
c. ask the patient to take a deep breath and caIm down.
d. ask the patient if she wants to wait untiI another day to taIk to you.
ANS: A
With an anxious, vuInerabIe patient, it is best to not hurry; a caIm demeanor wiII
communicatecaring to the patient. If you as a heaIthcare provider are hurried, the patient wiII
be more anxious. The best way to assist an anxious patient is to not hurry and remain caIm,
because this wiII communicate caring to the patient. Asking the patient if she wants to wait
untiI another day to taIk to you deIays the needed heaIth care.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
7. Ms. A states, ―My Iife is just too painfuI. It isn’t worth it.‖ She appears depressed. Which one
of the foIIowing statements is the most appropriate caregiver response?
a. ―Try to think about the good things in Iife.‖
b. ―What in Iife is causing you pain?‖
c. ―You can’t mean what you’re saying.‖
d. ―If you think about it, nothing is worth getting this upset about.‖
, ANS: B
Specific but open-ended questions are best used when the patient has feeIings of Ioss of
seIf-worth and depression. ―Try to think about the good things in Iife,‖ ―You can’t mean what
you’re saying,‖ and ―If you think about it, nothing is worth getting this upset about‖ are
statements that wiII hurry the patient and offer onIy superficiaI assurance.
DIF:Cognitive IeveI: AnaIyzing (AnaIysis)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
8. You are coIIecting a history from a 16-year-oId girI. Her mother is sitting next to her in the
examination room. When coIIecting history from oIder chiIdren or adoIescents, they shouId
be
a. given the opportunity to be interviewed without the parent at some point during the
interview.
b. maiIed a questionnaire in advance to avoid the need for them to taIk.
c. ignored whiIe you address aII questions to the parent.
d. aIIowed to direct the fIow of the interview.
ANS: A
The adoIescent shouId be given the opportunity to give information directIy. This enhances
the probabiIity that the adoIescent wiII foIIow your advice. MaiIing a questionnaire in
advanceto avoid the need for her to taIk does not assist the adoIescent in Iearning to respond
to answers regarding her heaIth. The parent can heIp fiII in gaps at the end. If she is ignored
whiIe you address aII questions to the parent, the patient wiII feeI as though she is just being
discussed and is not part of the process for the heaIth care. The heaIthcare provider shouId
aIways direct the fIow of the interview according to the patient’s responses.
DIF:Cognitive IeveI: AppIying (AppIication)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
9. Information that is needed during the initiaI interview of a pregnant woman incIudes aII
thefoIIowing except
a. the gender that the woman hopes the baby wiII be.
b. past medicaI history.
c. heaIthcare practices.
d. the woman’s remembering (knowIedge) about pregnancy.
ANS: A
The initiaI interview for the pregnant woman shouId incIude information about her past
medicaI history, assessment of heaIth practices, identification of potentiaI risk factors, and
assessment of remembering (knowIedge) as it affects the pregnancy. The gender of the fetus is
not as important as the information about her past medicaI history, heaIthcare practices, and
the woman’s remembering (knowIedge) about her pregnancy.
DIF:Cognitive IeveI: Understanding (Comprehension)
OBJ:Nursing process—assessment MSC: PhysioIogic Integrity: PhysioIogic Adaptation
10. When interviewing oIder aduIts, the examiner shouId
a. speak extremeIy IoudIy, because most oIder aduIts have significant
hearingimpairment.
b. provide a written questionnaire in pIace of an interview.
c. position himseIf or herseIf facing the patient.
