Bates' Guide to Physical Examination and History
Taking, 13e
LYNN S. BICKLEY, PETER G. SZILAGYI, R ICHARD M. HOFFMAN, R AINIER P. SORIANO
,Chapter 1: Approach to the Clinical Encounter
1.
A 47 year old man presents to the clinic for a routine physical exam. He is seated with
arms folded, giving short answers. What is the nurse’s best next step to establish
rapport?
A. Begin the physical exam immediately
B. Ask, “Why are you so defensive today?”
C. Use open ended questions to explore his concerns
D. Explain clinic rules and policies
ANS: C
Rationale: Open ended questions promote dialogue and demonstrate interest in the
patient's experience, helping build trust and rapport. This is central to the therapeutic
nurse patient relationship. Confrontation (B) and proceeding without rapport (A, D) may
escalate resistance.
2.
During an initial encounter, a nurse notices that a 60 year old woman avoids eye
contact and appears withdrawn. What should the nurse consider first?
A. She is uninterested in the visit
B. She is likely dishonest
C. This may reflect cultural norms or anxiety
D. She should be asked to reschedule
ANS: C
Rationale: Nonverbal behaviors may reflect anxiety, cultural differences, or emotional
states. The nurse should respond with sensitivity rather than judgment. Stereotyping or
making assumptions undermines patient centered care.
3.
A patient shares personal information about recent family struggles. Which nursing
response best demonstrates active listening?
A. “That’s unfortunate. Let’s focus on your health today.”
B. Nodding and saying, “I’m listening. Please go on.”
,C. “I went through the same thing last year.”
D. Changing the topic to physical symptoms
ANS: B
Rationale: Active listening includes verbal and nonverbal cues that show engagement
without shifting focus to the nurse or redirecting prematurely. It fosters trust and deeper
disclosure.
4.
In a hospital setting, a nurse asks an elderly patient, “Do you have any concerns?” The
patient pauses for a long time. What should the nurse do next?
A. Repeat the question louder
B. Wait silently and attentively
C. Ask a yes or no follow up
D. Assume the answer is no and move on
ANS: B
Rationale: Silence gives patients time to process and respond, particularly in older
adults. Interrupting or rushing can prevent full disclosure. This reflects respect and
patient centered care.
5.
A nurse begins an interview with a patient using, “What brings you in today?” This is an
example of:
A. A closed ended question
B. A leading question
C. A summarizing technique
D. An open ended question
ANS: D
Rationale: Open ended questions invite narrative responses and uncover key
concerns. This aligns with best practices in clinical interviewing.
6.
A nurse is summarizing a patient’s story to ensure understanding. This technique is
known as:
, A. Reflection
B. Validation
C. Clarification
D. Summarization
ANS: D
Rationale: Summarizing helps confirm understanding and organizes information. It's
particularly useful before transitioning to the physical exam or another topic.
7.
A patient mentions increased stress at work. The nurse replies, “You seem
overwhelmed.” This is an example of:
A. Empathic response
B. Judgmental phrasing
C. Closed ended questioning
D. Diagnostic labeling
ANS: A
Rationale: Empathy involves recognizing and verbalizing emotions to convey
understanding. It strengthens therapeutic rapport and supports patient disclosure.
8.
When conducting a patient centered interview, the nurse should prioritize:
A. Systematic checklist completion
B. Disease oriented questioning
C. Patient’s concerns and perspective
D. Rapid identification of symptoms
ANS: C
Rationale: A patient centered approach addresses the person’s narrative, emotions,
and context, not just symptoms. This is foundational to holistic, evidence based
practice.
9.
A nurse interrupts a patient several times while documenting. The patient becomes
quiet. What is the most appropriate corrective action?
Taking, 13e
LYNN S. BICKLEY, PETER G. SZILAGYI, R ICHARD M. HOFFMAN, R AINIER P. SORIANO
,Chapter 1: Approach to the Clinical Encounter
1.
A 47 year old man presents to the clinic for a routine physical exam. He is seated with
arms folded, giving short answers. What is the nurse’s best next step to establish
rapport?
A. Begin the physical exam immediately
B. Ask, “Why are you so defensive today?”
C. Use open ended questions to explore his concerns
D. Explain clinic rules and policies
ANS: C
Rationale: Open ended questions promote dialogue and demonstrate interest in the
patient's experience, helping build trust and rapport. This is central to the therapeutic
nurse patient relationship. Confrontation (B) and proceeding without rapport (A, D) may
escalate resistance.
2.
During an initial encounter, a nurse notices that a 60 year old woman avoids eye
contact and appears withdrawn. What should the nurse consider first?
A. She is uninterested in the visit
B. She is likely dishonest
C. This may reflect cultural norms or anxiety
D. She should be asked to reschedule
ANS: C
Rationale: Nonverbal behaviors may reflect anxiety, cultural differences, or emotional
states. The nurse should respond with sensitivity rather than judgment. Stereotyping or
making assumptions undermines patient centered care.
3.
A patient shares personal information about recent family struggles. Which nursing
response best demonstrates active listening?
A. “That’s unfortunate. Let’s focus on your health today.”
B. Nodding and saying, “I’m listening. Please go on.”
,C. “I went through the same thing last year.”
D. Changing the topic to physical symptoms
ANS: B
Rationale: Active listening includes verbal and nonverbal cues that show engagement
without shifting focus to the nurse or redirecting prematurely. It fosters trust and deeper
disclosure.
4.
In a hospital setting, a nurse asks an elderly patient, “Do you have any concerns?” The
patient pauses for a long time. What should the nurse do next?
A. Repeat the question louder
B. Wait silently and attentively
C. Ask a yes or no follow up
D. Assume the answer is no and move on
ANS: B
Rationale: Silence gives patients time to process and respond, particularly in older
adults. Interrupting or rushing can prevent full disclosure. This reflects respect and
patient centered care.
5.
A nurse begins an interview with a patient using, “What brings you in today?” This is an
example of:
A. A closed ended question
B. A leading question
C. A summarizing technique
D. An open ended question
ANS: D
Rationale: Open ended questions invite narrative responses and uncover key
concerns. This aligns with best practices in clinical interviewing.
6.
A nurse is summarizing a patient’s story to ensure understanding. This technique is
known as:
, A. Reflection
B. Validation
C. Clarification
D. Summarization
ANS: D
Rationale: Summarizing helps confirm understanding and organizes information. It's
particularly useful before transitioning to the physical exam or another topic.
7.
A patient mentions increased stress at work. The nurse replies, “You seem
overwhelmed.” This is an example of:
A. Empathic response
B. Judgmental phrasing
C. Closed ended questioning
D. Diagnostic labeling
ANS: A
Rationale: Empathy involves recognizing and verbalizing emotions to convey
understanding. It strengthens therapeutic rapport and supports patient disclosure.
8.
When conducting a patient centered interview, the nurse should prioritize:
A. Systematic checklist completion
B. Disease oriented questioning
C. Patient’s concerns and perspective
D. Rapid identification of symptoms
ANS: C
Rationale: A patient centered approach addresses the person’s narrative, emotions,
and context, not just symptoms. This is foundational to holistic, evidence based
practice.
9.
A nurse interrupts a patient several times while documenting. The patient becomes
quiet. What is the most appropriate corrective action?
