Harrison's Principles of Internal Medicine (Vol.1
& Vol.2)
21st Edition Newer Edition
Author(s)Joseph Loscalzo; Anthony S. Fauci;
Dennis L. Kasper; Stephen Hauser; Dan Longo; J.
Larry Jameson
TEST BANK
Reference: Ch. 1 — The Practice of Medicine
Question Stem: A 72-year-old man with progressive dyspnea is
evaluated. Pretest probability for heart failure is moderate.
Which next diagnostic decision best applies Bayesian reasoning
to avoid unnecessary testing?
A. Order transthoracic echocardiography (TTE) immediately for
,all suspected cases.
B. Obtain BNP level first to refine the post-test probability
before imaging.
C. Proceed directly to cardiac MRI because it has highest
diagnostic accuracy.
D. Send the patient home with diuretics and reassess in 2
weeks.
Correct Answer: B
Rationales:
• B (Correct): BNP measurement alters posttest probability
rapidly and noninvasively; in moderate pretest probability
it helps rule in/out heart failure and guide need for
echocardiography.
• A: TTE is useful but using it universally wastes resources;
Bayesian approach tailors testing to pretest probability.
• C: Cardiac MRI is not first-line for initial heart failure
assessment and is resource-intensive.
• D: Empiric therapy without diagnostic clarification risks
missing alternative diagnoses and is not Bayesian.
Teaching Point: Use noninvasive tests to modify pretest
probability before advanced imaging.
Citation: Loscalzo et al. (2022). Harrison’s Principles of
Internal Medicine (21st Ed.). Ch. 1.
,2)
Reference: Ch. 2 — Promoting Good Health
Question Stem: A primary-care nurse counsels a patient who
smokes and expresses ambivalence about quitting. Which
clinician response most consistently uses motivational
interviewing to promote behavior change?
A. “Quitting now is the only way to reduce your cancer risk.”
B. “On a scale 0–10, how important is quitting to you and why
did you pick that number?”
C. “If you don’t stop, I will refuse to prescribe your inhaler.”
D. “I’ll give you a pamphlet; read it and call me back if you
decide.”
Correct Answer: B
Rationales:
• B (Correct): Eliciting importance and reasons uses
motivational interviewing, enhancing intrinsic motivation
and ambivalence resolution.
• A: Commanding language is prescriptive and may increase
resistance.
• C: Coercion undermines trust and is not motivational
interviewing.
• D: Passive information provision without engagement
rarely changes behavior.
Teaching Point: Motivational interviewing elicits patient's
own reasons for change to resolve ambivalence.
, Citation: Loscalzo et al. (2022). Harrison’s Principles of
Internal Medicine (21st Ed.). Ch. 2.
3)
Reference: Ch. 3 — Vaccine Opposition and Hesitancy
Question Stem: A parent declines routine childhood vaccines
citing safety concerns and online “evidence.” Which nursing
strategy best addresses hesitancy while maintaining therapeutic
alliance?
A. Dismiss the parent’s concerns and document refusal.
B. Provide a confrontational summary of the science to discredit
misinformation.
C. Ask about specific concerns, acknowledge feelings, and offer
clear risk-benefit comparisons.
D. Require vaccination immediately as a condition of continued
care.
Correct Answer: C
Rationales:
• C (Correct): Open inquiry, empathetic acknowledgment,
and clear comparative risk communication reduce
hesitancy and preserve alliance.
• A: Dismissal damages trust and reduces chance of future
acceptance.
• B: Confrontation can entrench beliefs; empathetic
correction is superior.
& Vol.2)
21st Edition Newer Edition
Author(s)Joseph Loscalzo; Anthony S. Fauci;
Dennis L. Kasper; Stephen Hauser; Dan Longo; J.
Larry Jameson
TEST BANK
Reference: Ch. 1 — The Practice of Medicine
Question Stem: A 72-year-old man with progressive dyspnea is
evaluated. Pretest probability for heart failure is moderate.
Which next diagnostic decision best applies Bayesian reasoning
to avoid unnecessary testing?
A. Order transthoracic echocardiography (TTE) immediately for
,all suspected cases.
B. Obtain BNP level first to refine the post-test probability
before imaging.
C. Proceed directly to cardiac MRI because it has highest
diagnostic accuracy.
D. Send the patient home with diuretics and reassess in 2
weeks.
Correct Answer: B
Rationales:
• B (Correct): BNP measurement alters posttest probability
rapidly and noninvasively; in moderate pretest probability
it helps rule in/out heart failure and guide need for
echocardiography.
• A: TTE is useful but using it universally wastes resources;
Bayesian approach tailors testing to pretest probability.
• C: Cardiac MRI is not first-line for initial heart failure
assessment and is resource-intensive.
• D: Empiric therapy without diagnostic clarification risks
missing alternative diagnoses and is not Bayesian.
Teaching Point: Use noninvasive tests to modify pretest
probability before advanced imaging.
Citation: Loscalzo et al. (2022). Harrison’s Principles of
Internal Medicine (21st Ed.). Ch. 1.
,2)
Reference: Ch. 2 — Promoting Good Health
Question Stem: A primary-care nurse counsels a patient who
smokes and expresses ambivalence about quitting. Which
clinician response most consistently uses motivational
interviewing to promote behavior change?
A. “Quitting now is the only way to reduce your cancer risk.”
B. “On a scale 0–10, how important is quitting to you and why
did you pick that number?”
C. “If you don’t stop, I will refuse to prescribe your inhaler.”
D. “I’ll give you a pamphlet; read it and call me back if you
decide.”
Correct Answer: B
Rationales:
• B (Correct): Eliciting importance and reasons uses
motivational interviewing, enhancing intrinsic motivation
and ambivalence resolution.
• A: Commanding language is prescriptive and may increase
resistance.
• C: Coercion undermines trust and is not motivational
interviewing.
• D: Passive information provision without engagement
rarely changes behavior.
Teaching Point: Motivational interviewing elicits patient's
own reasons for change to resolve ambivalence.
, Citation: Loscalzo et al. (2022). Harrison’s Principles of
Internal Medicine (21st Ed.). Ch. 2.
3)
Reference: Ch. 3 — Vaccine Opposition and Hesitancy
Question Stem: A parent declines routine childhood vaccines
citing safety concerns and online “evidence.” Which nursing
strategy best addresses hesitancy while maintaining therapeutic
alliance?
A. Dismiss the parent’s concerns and document refusal.
B. Provide a confrontational summary of the science to discredit
misinformation.
C. Ask about specific concerns, acknowledge feelings, and offer
clear risk-benefit comparisons.
D. Require vaccination immediately as a condition of continued
care.
Correct Answer: C
Rationales:
• C (Correct): Open inquiry, empathetic acknowledgment,
and clear comparative risk communication reduce
hesitancy and preserve alliance.
• A: Dismissal damages trust and reduces chance of future
acceptance.
• B: Confrontation can entrench beliefs; empathetic
correction is superior.
