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 —
FOUNDATIONAL SKILLS ESSENTIAL TO THE CLINICAL
ENCOUNTER
Question (APRN-Level): A 52-year-old patient with poorly
controlled diabetes arrives for a new visit and appears anxious.
You must rapidly establish rapport, obtain a focused history, and
decide whether to proceed with a full physical exam today.
Which initial approach best balances patient-centered care with
safety and efficiency while reflecting Bates’ foundational skills?
Options:
,A. Begin with a broad-open question about the patient’s health
concerns, then perform the complete head-to-toe physical
exam.
B. Use a focused opening agenda (ask about chief concern,
expectations), perform targeted exam of problem systems, and
negotiate follow-up.
C. Immediately collect vitals and complete the physical exam
first, postponing history to after the exam to avoid missing
objective findings.
D. Limit interaction to checking vitals and scheduling a later visit
because the patient appears anxious.
Correct Answer: B
Rationale — Correct: Bates emphasizes establishing an agenda
and using foundational communication skills to prioritize
problem-focused assessment. A focused opening gathers
patient expectations and lets you perform a targeted exam
addressing urgent issues while planning follow-up, balancing
thoroughness and patient comfort. This approach reduces
unnecessary testing and aligns with patient-centered care.
Rationale — Incorrect A: A broad-open question can be
valuable, but immediately doing a full head-to-toe exam
without negotiation may waste time and increase patient
anxiety; Bates recommends agenda setting.
Rationale — Incorrect C: Deferring history until after the exam
in most outpatient encounters loses context; Bates prioritizes
history to guide targeted exams.
Rationale — Incorrect D: Avoiding engagement or postponing
,care due to anxiety neglects patient-centered techniques; Bates
promotes addressing emotional cues to proceed safely.
Teaching Point: Start with an agenda, prioritize focused history,
and perform targeted exams.
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 — Approach to the Clinical Encounter —
STRUCTURE AND SEQUENCE OF THE CLINICAL ENCOUNTER —
Stage 1: Initiating the Encounter
Question (APRN-Level): During intake, a 28-year-old pregnant
patient mentions brief lightheadedness and says she’s “not sure
why she came.” You suspect orthostatic symptoms but also note
the clinic is busy. According to Bates’ Stage 1 priorities, what
should the clinician do first?
Options:
A. Immediately perform orthostatic vital signs while the patient
waits in the hallway.
B. Quickly acknowledge concern, ensure privacy and safety, and
ask the patient to describe current symptoms briefly.
C. Have the patient fill out a long intake form while you prepare
the exam room.
D. Tell the patient to rest and schedule an urgent phone follow-
up the next day.
, Correct Answer: B
Rationale — Correct: Stage 1 emphasizes establishing rapport,
ensuring safety, and eliciting the chief concern. Acknowledge
and gather brief, immediate information to triage risk. This
approach identifies red flags efficiently and directs urgent
assessment if needed.
Rationale — Incorrect A: Orthostatic vitals may be appropriate,
but performing them without brief history, safety check, or
privacy is premature. Bates recommends initial verbal
engagement.
Rationale — Incorrect C: Lengthy paperwork first delays
identification of potential red flags and fails to establish rapport
as outlined in Stage 1.
Rationale — Incorrect D: Delaying evaluation risks harm when
orthostatic symptoms in pregnancy could indicate urgency;
immediate brief assessment is preferred.
Teaching Point: Prioritize safety and a brief focused history to
triage risk at encounter start.
Citation: Bickley et al. (2021). Ch. 1.
3)
Reference: Ch. 1 — Approach to the Clinical Encounter —
STRUCTURE AND SEQUENCE — Stage 2: Gathering Information
Question (APRN-Level): A 65-year-old with COPD reports
increased dyspnea over two days and uses oxygen at home. You
must distinguish COPD exacerbation from cardiac causes. Which
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 —
FOUNDATIONAL SKILLS ESSENTIAL TO THE CLINICAL
ENCOUNTER
Question (APRN-Level): A 52-year-old patient with poorly
controlled diabetes arrives for a new visit and appears anxious.
You must rapidly establish rapport, obtain a focused history, and
decide whether to proceed with a full physical exam today.
Which initial approach best balances patient-centered care with
safety and efficiency while reflecting Bates’ foundational skills?
Options:
,A. Begin with a broad-open question about the patient’s health
concerns, then perform the complete head-to-toe physical
exam.
B. Use a focused opening agenda (ask about chief concern,
expectations), perform targeted exam of problem systems, and
negotiate follow-up.
C. Immediately collect vitals and complete the physical exam
first, postponing history to after the exam to avoid missing
objective findings.
D. Limit interaction to checking vitals and scheduling a later visit
because the patient appears anxious.
Correct Answer: B
Rationale — Correct: Bates emphasizes establishing an agenda
and using foundational communication skills to prioritize
problem-focused assessment. A focused opening gathers
patient expectations and lets you perform a targeted exam
addressing urgent issues while planning follow-up, balancing
thoroughness and patient comfort. This approach reduces
unnecessary testing and aligns with patient-centered care.
Rationale — Incorrect A: A broad-open question can be
valuable, but immediately doing a full head-to-toe exam
without negotiation may waste time and increase patient
anxiety; Bates recommends agenda setting.
Rationale — Incorrect C: Deferring history until after the exam
in most outpatient encounters loses context; Bates prioritizes
history to guide targeted exams.
Rationale — Incorrect D: Avoiding engagement or postponing
,care due to anxiety neglects patient-centered techniques; Bates
promotes addressing emotional cues to proceed safely.
Teaching Point: Start with an agenda, prioritize focused history,
and perform targeted exams.
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 — Approach to the Clinical Encounter —
STRUCTURE AND SEQUENCE OF THE CLINICAL ENCOUNTER —
Stage 1: Initiating the Encounter
Question (APRN-Level): During intake, a 28-year-old pregnant
patient mentions brief lightheadedness and says she’s “not sure
why she came.” You suspect orthostatic symptoms but also note
the clinic is busy. According to Bates’ Stage 1 priorities, what
should the clinician do first?
Options:
A. Immediately perform orthostatic vital signs while the patient
waits in the hallway.
B. Quickly acknowledge concern, ensure privacy and safety, and
ask the patient to describe current symptoms briefly.
C. Have the patient fill out a long intake form while you prepare
the exam room.
D. Tell the patient to rest and schedule an urgent phone follow-
up the next day.
, Correct Answer: B
Rationale — Correct: Stage 1 emphasizes establishing rapport,
ensuring safety, and eliciting the chief concern. Acknowledge
and gather brief, immediate information to triage risk. This
approach identifies red flags efficiently and directs urgent
assessment if needed.
Rationale — Incorrect A: Orthostatic vitals may be appropriate,
but performing them without brief history, safety check, or
privacy is premature. Bates recommends initial verbal
engagement.
Rationale — Incorrect C: Lengthy paperwork first delays
identification of potential red flags and fails to establish rapport
as outlined in Stage 1.
Rationale — Incorrect D: Delaying evaluation risks harm when
orthostatic symptoms in pregnancy could indicate urgency;
immediate brief assessment is preferred.
Teaching Point: Prioritize safety and a brief focused history to
triage risk at encounter start.
Citation: Bickley et al. (2021). Ch. 1.
3)
Reference: Ch. 1 — Approach to the Clinical Encounter —
STRUCTURE AND SEQUENCE — Stage 2: Gathering Information
Question (APRN-Level): A 65-year-old with COPD reports
increased dyspnea over two days and uses oxygen at home. You
must distinguish COPD exacerbation from cardiac causes. Which
