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
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 arrives for a
routine visit. He appears anxious, answers questions tersely,
and avoids eye contact while his spouse quietly interjects. Using
Bates’ approach to initiating the encounter, which initial
clinician action best balances rapport-building, clinical
efficiency, and accurate history gathering?
Options
A. Proceed directly to focused biomedical questions to save
,time and avoid discomfort.
B. Address the spouse briefly, ask an open-ended question to
the patient, and acknowledge observed anxiety.
C. Ask the spouse to leave the room immediately to obtain a
private history.
D. Continue the visit and defer psychosocial concerns to a later
appointment.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes initiating the encounter with
patient-centered communication: brief acknowledgment of
emotions, open-ended questions, and inclusion of relevant
companions as appropriate. This approach balances rapport
and data-gathering, reduces anxiety, and elicits clinically useful
information. It also aligns with beginning the encounter in a
way that respects patient autonomy and promotes accuracy.
Incorrect (A): Prioritizing biomedical questions ignores the
patient's emotion and may reduce disclosure—contrary to
Bates’ recommendation to begin broadly.
Incorrect (C): Removing the spouse without explanation can
damage trust; Bates supports negotiating companion presence
rather than abrupt exclusion.
Incorrect (D): Deferring psychosocial issues risks missing
contextual factors that affect diabetes management; Bates
advocates addressing salient concerns during the encounter.
,Teaching Point
Begin encounters with empathy and open-ended questions to
improve disclosure and diagnostic accuracy.
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
You are supervising an APRN student who rushes through
introductions, immediately asks about a single symptom, and
documents minimal context. Which feedback, grounded in
Bates’ Stage 1 principles, most directly addresses the student’s
deficit?
Options
A. Tell the student to rely on checklists to speed data capture.
B. Advise the student to open with patient-centered
introductions and a nonjudgmental statement inviting the
patient’s story.
C. Recommend the student to defer introductions when the
clinic is busy.
, D. Suggest the student use closed yes/no questions to limit
tangential information.
Correct Answer
B
Rationales
Correct (B): Bates stresses that initiating the encounter requires
clear introductions, setting agenda, and inviting the patient’s
narrative—improving accuracy and patient rapport. Coaching to
start with these skills addresses the observed shortcomings
directly.
Incorrect (A): Checklists aid completeness but cannot replace
rapport-building and may worsen patient perception when used
prematurely.
Incorrect (C): Deferring introductions undermines
professionalism; Bates recommends consistent introductions
regardless of clinic flow.
Incorrect (D): Closed questions early in the encounter limit the
patient’s narrative and may miss important contextual clues.
Teaching Point
Start with clear introductions and invite the patient's story to
set a diagnostic agenda.
Citation
Bickley et al. (2021). Ch. 1.
3
EXAMINATION AND HISTORY TAKING
13TH EDITION
• AUTHOR(S)LYNN S. BICKLEY; PETER
G. SZILAGYI; RICHARD M. HOFFMAN;
RAINIER P. SORIANO
TEST BANK
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 arrives for a
routine visit. He appears anxious, answers questions tersely,
and avoids eye contact while his spouse quietly interjects. Using
Bates’ approach to initiating the encounter, which initial
clinician action best balances rapport-building, clinical
efficiency, and accurate history gathering?
Options
A. Proceed directly to focused biomedical questions to save
,time and avoid discomfort.
B. Address the spouse briefly, ask an open-ended question to
the patient, and acknowledge observed anxiety.
C. Ask the spouse to leave the room immediately to obtain a
private history.
D. Continue the visit and defer psychosocial concerns to a later
appointment.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes initiating the encounter with
patient-centered communication: brief acknowledgment of
emotions, open-ended questions, and inclusion of relevant
companions as appropriate. This approach balances rapport
and data-gathering, reduces anxiety, and elicits clinically useful
information. It also aligns with beginning the encounter in a
way that respects patient autonomy and promotes accuracy.
Incorrect (A): Prioritizing biomedical questions ignores the
patient's emotion and may reduce disclosure—contrary to
Bates’ recommendation to begin broadly.
Incorrect (C): Removing the spouse without explanation can
damage trust; Bates supports negotiating companion presence
rather than abrupt exclusion.
Incorrect (D): Deferring psychosocial issues risks missing
contextual factors that affect diabetes management; Bates
advocates addressing salient concerns during the encounter.
,Teaching Point
Begin encounters with empathy and open-ended questions to
improve disclosure and diagnostic accuracy.
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
You are supervising an APRN student who rushes through
introductions, immediately asks about a single symptom, and
documents minimal context. Which feedback, grounded in
Bates’ Stage 1 principles, most directly addresses the student’s
deficit?
Options
A. Tell the student to rely on checklists to speed data capture.
B. Advise the student to open with patient-centered
introductions and a nonjudgmental statement inviting the
patient’s story.
C. Recommend the student to defer introductions when the
clinic is busy.
, D. Suggest the student use closed yes/no questions to limit
tangential information.
Correct Answer
B
Rationales
Correct (B): Bates stresses that initiating the encounter requires
clear introductions, setting agenda, and inviting the patient’s
narrative—improving accuracy and patient rapport. Coaching to
start with these skills addresses the observed shortcomings
directly.
Incorrect (A): Checklists aid completeness but cannot replace
rapport-building and may worsen patient perception when used
prematurely.
Incorrect (C): Deferring introductions undermines
professionalism; Bates recommends consistent introductions
regardless of clinic flow.
Incorrect (D): Closed questions early in the encounter limit the
patient’s narrative and may miss important contextual clues.
Teaching Point
Start with clear introductions and invite the patient's story to
set a diagnostic agenda.
Citation
Bickley et al. (2021). Ch. 1.
3
