6512 MIDTERM EXAM QUESTIONS AND
ANSWERS
·Communicationvbtechniquesvbusedvbtovbobtainvbavbpatient'svbhealthvbhistoryvb-vbanswer--
Courtesy,vbComfort,vbConnection,vbConfirmation
CourtesyvbCommunicationvbTechniquevb-vbanswer--•vbKnockvbbeforevbenteringvbavbroom.
•vbAddress,vbfirst,vbthevbpatientvbformallyvb(e.g.,vbMiss,vbMs.,vbMrs.,vbMr.)vbItvbisvballvbrightvbtovbshakevbhands.
•vbMeetvbandvbacknowledgevbothersvbinvbthevbroomvbandvbestablishvbtheirvbrolesvbandvbdegreevbofvbparticipation.
•vbLearnvbtheirvbnames.
•vbEnsurevbconfidentiality.
•vbBevbinvbthevbroom,vbsitting,vbwithvbnovbeffortvbtovbreachvbtoovbsoonvbforvbthevbdoorknob.
•vbIfvbtakingvbnotes,vbtakevbnotesvbsparingly;vbnotevbkeyvbwordsvbasvbremindersvbbutvbdovbnotvbletvbnote-
takingvbdistractvbfromvbyourvbobservingvbandvblistening.
•vbIfvbtypingvbinvbthevbelectronicvbmedicalvbrecord,vbtypevbbrieflyvbandvbmaintainvbeyevbcontactvbwithvbpatient,vbifvbpos
sible.
•vbRespectvbthevbneedvbforvbmodesty.
•vbAllowvbthevbpatientvbtimevbtovbbevbdressedvbandvbcomfortablyvbsettledvbaftervbthevbexamination.vbFollow-
upvbdiscussionvbwithvbthevbpatientvbstillvb"onvbthevbtable"vbisvboftenvbdiscomfiting.
ComfortvbCommunicationvbTechniquevb-vbanswer--•vbEnsurevbphysicalvbcomfortvbforvball,vbincludingvbyourself.
•vbTryvbtovbhavevbavbminimumvbofvbfurniturevbseparatingvbyouvbandvbthevbpatient.
•vbMaintainvbprivacy,vbusingvbavailablevbcurtainsvbandvbshades.
•vbEnsurevbavbcomfortablevbroomvbtemperaturevborvbprovidevbavbblanket—
avbcoldvbroomvbwillvbmakevbavbpatientvbwantvbtovbcovervbup.
•vbEnsurevbgoodvblighting.
•vbEnsurevbnecessaryvbquiet.vbTurnvboffvbthevbtelevisionvbset.
•vbTryvbnotvbtovbovertirevbthevbpatient.vbItvbisvbnotvbalwaysvbnecessaryvbtovbdovbitvballvbatvbonevbvisit.
ConfirmationvbCommunicationvbTechniquevb-vbanswer--
•vbAskvbthevbpatientvbtovbsummarizevbthevbdiscussion.vbTherevbshouldvbbevbclearvbunderstandingvbandvbuncertaintyv
bshouldvbbevbeased.
•vbAllowvbthevbpossibilityvbofvbmorevbdiscussionvbwithvbanothervbopen-
endedvbquestion:vb"Anythingvbelsevbyouvbwantvbtovbbringvbup?"
•vbIfvbtherevbisvbavbquestionvbthatvbyouvbcannotvbimmediatelyvbanswer,vbsayvbso.vbBevbsurevbtovbfollowvbupvblatervbifvbat
vballvbpossible.
•vbIfvbyouvbseemvbtovbhavevbmadevbavbmistake,vbmakevbeveryvbeffortvbtovbrepairvbit.vbCandorvbisvbimportantvbforvbdevel
opmentvbofvbavbtrustingvbpartnership.vbMostvbpatientsvbrespectvbit.
ConnectionvbCommunicationvbTechniquevb-vbanswer--
•vbLookvbatvbthevbpatient;vbmaintainvbgoodvbeyevbcontactvbifvbculturalvbpracticesvballow.
•vbWatchvbyourvblanguage.vbAvoidvbprofessionalvbjargon.vbDovbnotvbpatronizevbwithvbwhatvbyouvbsay.
•vbDovbnotvbdominatevbthevbdiscussion.vbListenvbalertly.vbLetvbthevbpatientvbordervbprioritiesvbifvbseveralvbissuesvbarevb
raised.
, •vbDovbnotvbacceptvbavbpreviousvbdiagnosisvbasvbavbchiefvbconcern.vbDovbnotvbtoovbreadilyvbfollowvbavbpredeterminedv
bpath.
•vbFindvboutvbwhethervbthevbpatientvbhasvbturnedvbfromvbothervbhealthcarevbprovidersvbtovbcomevbtovbyou.
•vbTakevbthevbhistoryvbandvbconductvbthevbphysicalvbexaminationvbbeforevbyouvblookvbatvbpreviousvbstudiesvborvbtest
s.vbConsidervbfirstvbwhatvbthevbpatientvbhasvbtovbsay.
•vbAvoidvbleadingvborvbdirectvbquestionsvbatvbfirst.vbOpen-
endedvbquestionsvbarevbbettervbforvbstarters.vbLetvbspecificsvbevolvevbfromvbthese.
•vbAvoidvbbeingvbjudgmental.
•vbRespectvbsilence.vbPausesvbcanvbbevbproductive.
•vbBevbflexible.vbRigidityvblimitsvbthevbpotentialvbofvbanvbinterview.
•vbAssessvbthevbpatient'svbpotentialvbasvbavbpartner.
•vbSeekvbcluesvbtovbproblemsvbfromvbthevbpatient'svbverbalvbbehaviorsvbandvbbodyvblanguagevb(e.g.,vbtalkingvbtoovbfa
stvborvbtoovblittle).
•vbLookvbforvbthevbhiddenvbconcernsvbunderlyingvbchiefvbconcerns.
•vbNevervbtrivializevbanyvbfindingvborvbclue.
•vbProblemsvbcanvbhavevbmultiplevbcauses.vbDovbnotvbleapvbtovbonevbcausevbtoovbquickly.
•vbDefinevbanyvbconcernvbcompletely:vbWhere?vbHowvbsevere?vbHowvblong?vbInvbwhatvbcontext?
vbWhatvbsoothesvborvbaggravatesvbthevbproblem?
SOAPvbNotesvb-vbanswer--SvbSubjectivevbdata—
thevbinformation,vbincludingvbthevbabsencevborvbpresencevbofvbpertinentvbsymptoms,vbthatvbthevbpatientvbtellsvbyou
OvbObjectivevbdata—
yourvbdirectvbobservationsvbfromvbwhatvbyouvbsee,vbhear,vbsmell,vbandvbtouchvbandvbfromvbdiagnosticvbtestvbresults
AvbAssessment—
yourvbinterpretationsvbandvbconclusions,vbyourvbrationale,vbthevbdiagnosticvbpossibilities,vbandvbpresentvbandvbantic
ipatedvbproblems
PvbPlan—
diagnosticvbtesting,vbtherapeuticvbmodalities,vbneedvbforvbconsultants,vbandvbrationalevbforvbthesevbdecisions
EthicalvbConsiderationsvb-vbanswer--•vbAutonomy:vbThevbpatient'svbneedvbforvbself-
determination.vbAutonomyvbsuggestsvbthatvbchoicesvbexist,vbandvbavbpatientvbmayvbchoosevbbetweenvbalternatives
.vbUncertaintyvbexistsvbwhenvbthevbpatientvbisvbavbchildvborvbisvbcognitivelyvbimpaired.vbParents,vbguardians,vbfamily,v
borvbothervbsignificantvbpersonsvbshouldvbthenvbbevbincluded,vbandvbthevbboundariesvbofvbthatvbparticipationvbmustvb
bevbclearlyvbset.vbInvbsomevbcases,vbthevbboundariesvbarevbestablishedvbbyvbanvbadvancevbdirectivevbfromvbthevbpati
ent.vbCompetencyvbisvbnotvbalwaysvbeasilyvbdetermined,vbandvbtherevbmayvbbevbdisagreement.vbBothvbthevbmentalvb
statusvbexaminationvb(seevbChaptervb7)vbandvbconsultationvbwithvbindividualsvbwhovbknowvbthevbpersonvbwellvbcanvb
assist.
•vbBeneficence:vbDovbgoodvbforvbthevbpatient.vbThisvbmayvbbevbtoovbeagerlyvbpursuedvbandvbmayvbresultvbinvbavbpater
nalismvbthatvbmightvbprecludevbautonomyvbofvbthevbpatient.vbHowever,vbpaternalismvbmayvbhavevbsomevbbenefitvbw
henvbusedvbwithvbconstraintvbandvbrespectvbforvbautonomy.
•vbNonmaleficence:vbDovbnovbharmvbtovbthevbpatient.
•vbUtilitarianism:vbConsidervbappropriatevbusevbofvbresourcesvbwithvbconcernvbforvbthevbgreatervbgoodvbofvbthevblarge
rvbcommunity.vbChoosevbwisely.
•vbFairnessvbandvbjustice:vbRecognizevbthevbbalancevbbetweenvbautonomyvbandvbcompetingvbinterestsvbofvbthevbfa
milyvbandvbcommunity.
•vbDeontologicvbimperatives:vbOurvbdutifulvbresponsibilitiesvbforvbofferingvbcarevbarevbestablishedvbbyvbtraditionvban
dvbinvbculturalvbcontexts.vbBecausevbculturesvbvary,vbthesevbmayvbnotvbbevbuniversallyvbbindingvbforvballvbpatients.vbE
thicalvbprinciplesvbcanvbcomevbintovbconflictvbinvbanyvbgivenvbcircumstance.
ANSWERS
·Communicationvbtechniquesvbusedvbtovbobtainvbavbpatient'svbhealthvbhistoryvb-vbanswer--
Courtesy,vbComfort,vbConnection,vbConfirmation
CourtesyvbCommunicationvbTechniquevb-vbanswer--•vbKnockvbbeforevbenteringvbavbroom.
•vbAddress,vbfirst,vbthevbpatientvbformallyvb(e.g.,vbMiss,vbMs.,vbMrs.,vbMr.)vbItvbisvballvbrightvbtovbshakevbhands.
•vbMeetvbandvbacknowledgevbothersvbinvbthevbroomvbandvbestablishvbtheirvbrolesvbandvbdegreevbofvbparticipation.
•vbLearnvbtheirvbnames.
•vbEnsurevbconfidentiality.
•vbBevbinvbthevbroom,vbsitting,vbwithvbnovbeffortvbtovbreachvbtoovbsoonvbforvbthevbdoorknob.
•vbIfvbtakingvbnotes,vbtakevbnotesvbsparingly;vbnotevbkeyvbwordsvbasvbremindersvbbutvbdovbnotvbletvbnote-
takingvbdistractvbfromvbyourvbobservingvbandvblistening.
•vbIfvbtypingvbinvbthevbelectronicvbmedicalvbrecord,vbtypevbbrieflyvbandvbmaintainvbeyevbcontactvbwithvbpatient,vbifvbpos
sible.
•vbRespectvbthevbneedvbforvbmodesty.
•vbAllowvbthevbpatientvbtimevbtovbbevbdressedvbandvbcomfortablyvbsettledvbaftervbthevbexamination.vbFollow-
upvbdiscussionvbwithvbthevbpatientvbstillvb"onvbthevbtable"vbisvboftenvbdiscomfiting.
ComfortvbCommunicationvbTechniquevb-vbanswer--•vbEnsurevbphysicalvbcomfortvbforvball,vbincludingvbyourself.
•vbTryvbtovbhavevbavbminimumvbofvbfurniturevbseparatingvbyouvbandvbthevbpatient.
•vbMaintainvbprivacy,vbusingvbavailablevbcurtainsvbandvbshades.
•vbEnsurevbavbcomfortablevbroomvbtemperaturevborvbprovidevbavbblanket—
avbcoldvbroomvbwillvbmakevbavbpatientvbwantvbtovbcovervbup.
•vbEnsurevbgoodvblighting.
•vbEnsurevbnecessaryvbquiet.vbTurnvboffvbthevbtelevisionvbset.
•vbTryvbnotvbtovbovertirevbthevbpatient.vbItvbisvbnotvbalwaysvbnecessaryvbtovbdovbitvballvbatvbonevbvisit.
ConfirmationvbCommunicationvbTechniquevb-vbanswer--
•vbAskvbthevbpatientvbtovbsummarizevbthevbdiscussion.vbTherevbshouldvbbevbclearvbunderstandingvbandvbuncertaintyv
bshouldvbbevbeased.
•vbAllowvbthevbpossibilityvbofvbmorevbdiscussionvbwithvbanothervbopen-
endedvbquestion:vb"Anythingvbelsevbyouvbwantvbtovbbringvbup?"
•vbIfvbtherevbisvbavbquestionvbthatvbyouvbcannotvbimmediatelyvbanswer,vbsayvbso.vbBevbsurevbtovbfollowvbupvblatervbifvbat
vballvbpossible.
•vbIfvbyouvbseemvbtovbhavevbmadevbavbmistake,vbmakevbeveryvbeffortvbtovbrepairvbit.vbCandorvbisvbimportantvbforvbdevel
opmentvbofvbavbtrustingvbpartnership.vbMostvbpatientsvbrespectvbit.
ConnectionvbCommunicationvbTechniquevb-vbanswer--
•vbLookvbatvbthevbpatient;vbmaintainvbgoodvbeyevbcontactvbifvbculturalvbpracticesvballow.
•vbWatchvbyourvblanguage.vbAvoidvbprofessionalvbjargon.vbDovbnotvbpatronizevbwithvbwhatvbyouvbsay.
•vbDovbnotvbdominatevbthevbdiscussion.vbListenvbalertly.vbLetvbthevbpatientvbordervbprioritiesvbifvbseveralvbissuesvbarevb
raised.
, •vbDovbnotvbacceptvbavbpreviousvbdiagnosisvbasvbavbchiefvbconcern.vbDovbnotvbtoovbreadilyvbfollowvbavbpredeterminedv
bpath.
•vbFindvboutvbwhethervbthevbpatientvbhasvbturnedvbfromvbothervbhealthcarevbprovidersvbtovbcomevbtovbyou.
•vbTakevbthevbhistoryvbandvbconductvbthevbphysicalvbexaminationvbbeforevbyouvblookvbatvbpreviousvbstudiesvborvbtest
s.vbConsidervbfirstvbwhatvbthevbpatientvbhasvbtovbsay.
•vbAvoidvbleadingvborvbdirectvbquestionsvbatvbfirst.vbOpen-
endedvbquestionsvbarevbbettervbforvbstarters.vbLetvbspecificsvbevolvevbfromvbthese.
•vbAvoidvbbeingvbjudgmental.
•vbRespectvbsilence.vbPausesvbcanvbbevbproductive.
•vbBevbflexible.vbRigidityvblimitsvbthevbpotentialvbofvbanvbinterview.
•vbAssessvbthevbpatient'svbpotentialvbasvbavbpartner.
•vbSeekvbcluesvbtovbproblemsvbfromvbthevbpatient'svbverbalvbbehaviorsvbandvbbodyvblanguagevb(e.g.,vbtalkingvbtoovbfa
stvborvbtoovblittle).
•vbLookvbforvbthevbhiddenvbconcernsvbunderlyingvbchiefvbconcerns.
•vbNevervbtrivializevbanyvbfindingvborvbclue.
•vbProblemsvbcanvbhavevbmultiplevbcauses.vbDovbnotvbleapvbtovbonevbcausevbtoovbquickly.
•vbDefinevbanyvbconcernvbcompletely:vbWhere?vbHowvbsevere?vbHowvblong?vbInvbwhatvbcontext?
vbWhatvbsoothesvborvbaggravatesvbthevbproblem?
SOAPvbNotesvb-vbanswer--SvbSubjectivevbdata—
thevbinformation,vbincludingvbthevbabsencevborvbpresencevbofvbpertinentvbsymptoms,vbthatvbthevbpatientvbtellsvbyou
OvbObjectivevbdata—
yourvbdirectvbobservationsvbfromvbwhatvbyouvbsee,vbhear,vbsmell,vbandvbtouchvbandvbfromvbdiagnosticvbtestvbresults
AvbAssessment—
yourvbinterpretationsvbandvbconclusions,vbyourvbrationale,vbthevbdiagnosticvbpossibilities,vbandvbpresentvbandvbantic
ipatedvbproblems
PvbPlan—
diagnosticvbtesting,vbtherapeuticvbmodalities,vbneedvbforvbconsultants,vbandvbrationalevbforvbthesevbdecisions
EthicalvbConsiderationsvb-vbanswer--•vbAutonomy:vbThevbpatient'svbneedvbforvbself-
determination.vbAutonomyvbsuggestsvbthatvbchoicesvbexist,vbandvbavbpatientvbmayvbchoosevbbetweenvbalternatives
.vbUncertaintyvbexistsvbwhenvbthevbpatientvbisvbavbchildvborvbisvbcognitivelyvbimpaired.vbParents,vbguardians,vbfamily,v
borvbothervbsignificantvbpersonsvbshouldvbthenvbbevbincluded,vbandvbthevbboundariesvbofvbthatvbparticipationvbmustvb
bevbclearlyvbset.vbInvbsomevbcases,vbthevbboundariesvbarevbestablishedvbbyvbanvbadvancevbdirectivevbfromvbthevbpati
ent.vbCompetencyvbisvbnotvbalwaysvbeasilyvbdetermined,vbandvbtherevbmayvbbevbdisagreement.vbBothvbthevbmentalvb
statusvbexaminationvb(seevbChaptervb7)vbandvbconsultationvbwithvbindividualsvbwhovbknowvbthevbpersonvbwellvbcanvb
assist.
•vbBeneficence:vbDovbgoodvbforvbthevbpatient.vbThisvbmayvbbevbtoovbeagerlyvbpursuedvbandvbmayvbresultvbinvbavbpater
nalismvbthatvbmightvbprecludevbautonomyvbofvbthevbpatient.vbHowever,vbpaternalismvbmayvbhavevbsomevbbenefitvbw
henvbusedvbwithvbconstraintvbandvbrespectvbforvbautonomy.
•vbNonmaleficence:vbDovbnovbharmvbtovbthevbpatient.
•vbUtilitarianism:vbConsidervbappropriatevbusevbofvbresourcesvbwithvbconcernvbforvbthevbgreatervbgoodvbofvbthevblarge
rvbcommunity.vbChoosevbwisely.
•vbFairnessvbandvbjustice:vbRecognizevbthevbbalancevbbetweenvbautonomyvbandvbcompetingvbinterestsvbofvbthevbfa
milyvbandvbcommunity.
•vbDeontologicvbimperatives:vbOurvbdutifulvbresponsibilitiesvbforvbofferingvbcarevbarevbestablishedvbbyvbtraditionvban
dvbinvbculturalvbcontexts.vbBecausevbculturesvbvary,vbthesevbmayvbnotvbbevbuniversallyvbbindingvbforvballvbpatients.vbE
thicalvbprinciplesvbcanvbcomevbintovbconflictvbinvbanyvbgivenvbcircumstance.
