BATES' GUIDE TO PHYSICAL
EXAMINATION AND HISTORY TAKING
13TH EDITION
• AUTHOR(S)LYNN S. BICKLEY; PETER
G. SZILAGYI; RICHARD M. HOFFMAN;
RAINIER P. SORIANO
TEST BANK
1
Reference
Ch. 1 — Approach to the Clinical Encounter — Stage 1: Initiating
the Encounter
APRN-Level Question Stem
A 68-year-old woman arrives for a new-patient visit with her
adult son. You notice the son frequently answers for her and
leans in while you ask open-ended questions. The patient is
quiet and averts eye contact. Integrating communication,
patient autonomy, and the clinical environment, what is the
best next step?
,Options
A. Continue the interview with both the patient and son
together to maintain family support.
B. Privately ask the son to step out and directly invite the
patient to speak about concerns.
C. Direct questions to the son rather than the patient to speed
data gathering.
D. Document that the patient is reserved and proceed with the
physical exam without further discussion.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes initiating the encounter by
establishing rapport and patient-centered communication.
Privately inviting the patient to speak supports autonomy,
clarifies the patient’s own concerns, and reduces surrogate
domination, allowing a more accurate history. This follows the
framework of assessing context and power dynamics during
Stage 1.
Incorrect (A): While family support can help, continuing without
ensuring the patient's voice risks missing the patient’s priorities
and undermines autonomy.
Incorrect (C): Directing questions to the son sacrifices the
primary source of history and violates patient-centered
interviewing principles.
,Incorrect (D): Skipping further discussion ignores a modifiable
communication barrier and may produce an incomplete history.
Teaching Point
Privately invite the patient to speak first to ensure autonomy
and accurate history.
Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
(2021). Bates’ Guide to Physical Examination & History Taking
(13th Ed.). Ch. 1.
2
Reference
Ch. 1 — Structure and Sequence of the Clinical Encounter —
Stage 2: Gathering Information
APRN-Level Question Stem
A 34-year-old with recurrent headaches describes “worst pain”
episodes but appears stoic. Vital signs normal. You suspect pain
underreporting due to cultural norms. How should you
integrate history taking with cultural humility to best assess
severity and impact?
Options
A. Rely solely on your objective exam and document “no acute
distress.”
B. Use culturally framed, open-ended questions about function
and feelings, and ask permission to explore cultural beliefs
, about pain.
C. Increase analgesic dosing immediately because the patient
said “worst pain.”
D. Refer the patient for psychiatric evaluation for stoicism
without further assessment.
Correct Answer
B
Rationales
Correct (B): Bates stresses gathering information sensitively;
cultural humility requires asking about beliefs and function.
Open-ended, permission-seeking questions elicit functional
impairment and culturally influenced expression of symptoms,
improving diagnostic accuracy.
Incorrect (A): Objective findings alone may miss significant
subjective suffering—Bates prioritizes integrating subjective
history with exam.
Incorrect (C): Treating solely on a phrase without fuller history
risks inappropriate management and misses differential
diagnoses.
Incorrect (D): Jumping to psychiatric referral ignores cultural
context and further medical evaluation needed.
Teaching Point
Ask permission and explore cultural beliefs about symptoms to
clarify severity and impact.
Citation
Bickley et al. (2021). Ch. 1.
EXAMINATION AND HISTORY TAKING
13TH EDITION
• AUTHOR(S)LYNN S. BICKLEY; PETER
G. SZILAGYI; RICHARD M. HOFFMAN;
RAINIER P. SORIANO
TEST BANK
1
Reference
Ch. 1 — Approach to the Clinical Encounter — Stage 1: Initiating
the Encounter
APRN-Level Question Stem
A 68-year-old woman arrives for a new-patient visit with her
adult son. You notice the son frequently answers for her and
leans in while you ask open-ended questions. The patient is
quiet and averts eye contact. Integrating communication,
patient autonomy, and the clinical environment, what is the
best next step?
,Options
A. Continue the interview with both the patient and son
together to maintain family support.
B. Privately ask the son to step out and directly invite the
patient to speak about concerns.
C. Direct questions to the son rather than the patient to speed
data gathering.
D. Document that the patient is reserved and proceed with the
physical exam without further discussion.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes initiating the encounter by
establishing rapport and patient-centered communication.
Privately inviting the patient to speak supports autonomy,
clarifies the patient’s own concerns, and reduces surrogate
domination, allowing a more accurate history. This follows the
framework of assessing context and power dynamics during
Stage 1.
Incorrect (A): While family support can help, continuing without
ensuring the patient's voice risks missing the patient’s priorities
and undermines autonomy.
Incorrect (C): Directing questions to the son sacrifices the
primary source of history and violates patient-centered
interviewing principles.
,Incorrect (D): Skipping further discussion ignores a modifiable
communication barrier and may produce an incomplete history.
Teaching Point
Privately invite the patient to speak first to ensure autonomy
and accurate history.
Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
(2021). Bates’ Guide to Physical Examination & History Taking
(13th Ed.). Ch. 1.
2
Reference
Ch. 1 — Structure and Sequence of the Clinical Encounter —
Stage 2: Gathering Information
APRN-Level Question Stem
A 34-year-old with recurrent headaches describes “worst pain”
episodes but appears stoic. Vital signs normal. You suspect pain
underreporting due to cultural norms. How should you
integrate history taking with cultural humility to best assess
severity and impact?
Options
A. Rely solely on your objective exam and document “no acute
distress.”
B. Use culturally framed, open-ended questions about function
and feelings, and ask permission to explore cultural beliefs
, about pain.
C. Increase analgesic dosing immediately because the patient
said “worst pain.”
D. Refer the patient for psychiatric evaluation for stoicism
without further assessment.
Correct Answer
B
Rationales
Correct (B): Bates stresses gathering information sensitively;
cultural humility requires asking about beliefs and function.
Open-ended, permission-seeking questions elicit functional
impairment and culturally influenced expression of symptoms,
improving diagnostic accuracy.
Incorrect (A): Objective findings alone may miss significant
subjective suffering—Bates prioritizes integrating subjective
history with exam.
Incorrect (C): Treating solely on a phrase without fuller history
risks inappropriate management and misses differential
diagnoses.
Incorrect (D): Jumping to psychiatric referral ignores cultural
context and further medical evaluation needed.
Teaching Point
Ask permission and explore cultural beliefs about symptoms to
clarify severity and impact.
Citation
Bickley et al. (2021). Ch. 1.
