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
APRN-Level Question Stem
A 58-year-old man with poorly controlled diabetes presents for
a routine visit. He is quiet, avoids eye contact, and answers
questions with minimal detail. As an APRN, which initial verbal
technique best aligns with Bates’ recommended foundational
skills to elicit a more complete history without making the
patient defensive?
,Options
A. Rapidly summarize the history you have so far and move to
the physical exam.
B. Use an open-ended prompt about his daily health routines
and concerns.
C. Ask a series of closed yes/no questions to expedite
information collection.
D. Interrupt to correct inconsistencies and insist on precise
dates.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes starting with open-ended,
nonjudgmental prompts to encourage patients to describe
concerns in their own words, improving rapport and yielding
richer information. Open prompts reduce defensiveness and
allow assessment of priorities, beliefs, and emotional context,
which are essential in chronic disease management. This
approach fits foundational communication skills for an effective
clinical encounter.
Incorrect (A): Rapid summarization closes further narrative and
may miss psychosocial barriers; Bates recommends summary
after sufficient exploration.
Incorrect (C): Closed questions are useful later for specifics, but
early use limits narrative and may miss salient concerns.
Incorrect (D): Interrupting and insisting on precision damages
,rapport and can obscure contextual factors Bates identifies as
critical.
Teaching Point
Start with open-ended prompts to elicit patient priorities and
context.
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 1: Initiating the Encounter
APRN-Level Question Stem
A 27-year-old woman arrives 15 minutes late and appears
flustered. You have one scheduled appointment remaining.
According to Bates’ recommended approach for initiating the
encounter, what is the best first action to balance patient-
centered care and clinic flow?
Options
A. Tell her you only have five minutes and proceed immediately
to structured questions.
B. Begin with a brief empathic acknowledgment of the lateness
and ask her main concern.
, C. Reschedule the appointment to a different day to preserve
time.
D. Ignore the lateness and continue with your usual opening
script.
Correct Answer
B
Rationales
Correct (B): Bates recommends initiating the encounter with a
warm, respectful opening that includes acknowledging the
patient’s situation and eliciting their chief concern; brevity with
empathy preserves rapport while clarifying priorities. This
balances patient-centeredness with time management and
guides negotiation of agenda.
Incorrect (A): Telling the patient you only have five minutes is
blunt and undermines rapport; Bates advises transparent
negotiation, not abrupt limitation.
Incorrect (C): Rescheduling should be considered only if
necessary and after assessing urgency; automatic rescheduling
risks missing acute issues.
Incorrect (D): Ignoring contextual factors (e.g., lateness,
distress) misses an opportunity to build rapport and understand
barriers, contrary to Bates.
Teaching Point
Acknowledge context, then ask the chief concern to set a
negotiated agenda.
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
APRN-Level Question Stem
A 58-year-old man with poorly controlled diabetes presents for
a routine visit. He is quiet, avoids eye contact, and answers
questions with minimal detail. As an APRN, which initial verbal
technique best aligns with Bates’ recommended foundational
skills to elicit a more complete history without making the
patient defensive?
,Options
A. Rapidly summarize the history you have so far and move to
the physical exam.
B. Use an open-ended prompt about his daily health routines
and concerns.
C. Ask a series of closed yes/no questions to expedite
information collection.
D. Interrupt to correct inconsistencies and insist on precise
dates.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes starting with open-ended,
nonjudgmental prompts to encourage patients to describe
concerns in their own words, improving rapport and yielding
richer information. Open prompts reduce defensiveness and
allow assessment of priorities, beliefs, and emotional context,
which are essential in chronic disease management. This
approach fits foundational communication skills for an effective
clinical encounter.
Incorrect (A): Rapid summarization closes further narrative and
may miss psychosocial barriers; Bates recommends summary
after sufficient exploration.
Incorrect (C): Closed questions are useful later for specifics, but
early use limits narrative and may miss salient concerns.
Incorrect (D): Interrupting and insisting on precision damages
,rapport and can obscure contextual factors Bates identifies as
critical.
Teaching Point
Start with open-ended prompts to elicit patient priorities and
context.
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 1: Initiating the Encounter
APRN-Level Question Stem
A 27-year-old woman arrives 15 minutes late and appears
flustered. You have one scheduled appointment remaining.
According to Bates’ recommended approach for initiating the
encounter, what is the best first action to balance patient-
centered care and clinic flow?
Options
A. Tell her you only have five minutes and proceed immediately
to structured questions.
B. Begin with a brief empathic acknowledgment of the lateness
and ask her main concern.
, C. Reschedule the appointment to a different day to preserve
time.
D. Ignore the lateness and continue with your usual opening
script.
Correct Answer
B
Rationales
Correct (B): Bates recommends initiating the encounter with a
warm, respectful opening that includes acknowledging the
patient’s situation and eliciting their chief concern; brevity with
empathy preserves rapport while clarifying priorities. This
balances patient-centeredness with time management and
guides negotiation of agenda.
Incorrect (A): Telling the patient you only have five minutes is
blunt and undermines rapport; Bates advises transparent
negotiation, not abrupt limitation.
Incorrect (C): Rescheduling should be considered only if
necessary and after assessing urgency; automatic rescheduling
risks missing acute issues.
Incorrect (D): Ignoring contextual factors (e.g., lateness,
distress) misses an opportunity to build rapport and understand
barriers, contrary to Bates.
Teaching Point
Acknowledge context, then ask the chief concern to set a
negotiated agenda.
