Test Bank - Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition (Dains,

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ADVANCEDHEALTHASSESSMENT&CLINICALDIAGNOSISIN
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PRIMARY CARE, 6TH EDITION
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Joyce E.Dains, Linda Ciofu Baumann & Pamela Scheibel
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Test Bank for Advanced Health Assessment & Clinical Diagnosis in Primary Care 6th
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Edition Dains l l




Chapter1:Clinical Reasoning, DifferentialDiagnosis, Evidence-BasedPractice, and SymptomAnalysis
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Multiple Choice l




Identifythechoice thatbest completesthe statement oranswers thequestion.
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1. Which type ofclinical decision-makingis mostreliable? l l l l l l l




A. Intuitive
B. Analytical
C. Experiential
D. Augenblick

2. Which ofthefollowing is false?Toobtainadequatehistory, health-care providers must be:
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A. Methodical andsystematic l l




B. Attentiveto thepatient’s verbal andnonverballanguage l l l l l l l




C. Abletoaccuratelyinterpret thepatient’s responses
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D. Adept at readingintothepatient’s statements
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3. Essential partsof ahealth historyinclude all ofthefollowing except: l l l l l l l l l l l




A. Chiefcomplaint l




B. Historyof the present illness l l l l




C. Current vital signs l l




D. All ofthe above areessential historycomponents
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4. Which ofthe following is false? Whileperformingthephysical examination,theexaminer must beableto:
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A. Differentiatebetweennormalandabnormal findings l l l l l




B. Recallknowledge of arangeof conditionsandtheir associated signs andsymptoms
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C. Recognizehowcertain conditionsaffect theresponsetoother conditions l l l l l l l l l




D. Foresee unpredictable findings l l




5. Thefollowingistheleast reliablesource ofinformation for diagnosticstatistics:
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A. Evidence-based investigations l




B. Primaryreports ofresearch l l l




C. Estimationbased on aprovider’sexperience l l l l l




D. Published meta-analyses l




6. Thefollowing can beusedtoassist in sound clinical decision-making:
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A. Algorithmpublishedinapeer-reviewed journal article l l l l l l




B. Clinicalpractice guidelines l l




C. Evidence-based research l




D. All of theabove
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7. Ifa diagnosticstudyhas high sensitivity, thisindicates a:
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A. High percentage ofpersons with the given condition will haveanabnormal result
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B. Lowpercentage ofpersonswith the given condition will have anabnormal result
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C. Lowlikelihood ofnormal result in persons without a given condition
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D. None of theabove l l l




8. Ifa diagnosticstudyhas high specificity, this indicates a:
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A. Lowpercentage ofhealthyindividuals will show a normalresult
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B. High percentage ofhealthyindividuals will showa normal result
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C. High percentage ofindividuals with adisorderwill showa normal result
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D. Lowpercentage ofindividuals with adisorder will show anabnormal result
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9. Alikelihood ratio above 1 indicates that adiagnostictest showing a:
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A. Positive resultis stronglyassociated withthe disease l l l l l l l




B. Negativeresultisstronglyassociated with absence ofthe disease l l l l l l l l l




C. Positive result isweaklyassociated with thedisease l l l l l l l




D. Negativeresultis weaklyassociated withabsence ofthe disease l l l l l l l l l




10. Whichofthefollowingclinicalreasoningtoolsisdefinedasevidence-based resource based on mathematical modeling to
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express the likelihood of a condition in select situations, settings, and/or patients?
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A. Clinicalpractice guideline l l




B. Clinicaldecision rule l l




C. Clinical algorithm l




Chapter1:Clinicalreasoning,differentialdiagnosis,evidence-basedpractice,andsymptomana
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AnswerSection
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MULTIPLE CHOICE l




1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision-
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making (similar to Augenblink decision-making) is based on the experience and intuition of the clinician and is less reliable and paired
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with fairly common errors. In contrast, analytical decision-making is based on careful consideration and has greater reliability with
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rare errors.
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PTS: 1
2. ANS: D
To obtain adequate history, providers must be well organized, attentive tothe patient’sverbal and nonverbal language, and able to
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accurately interpret the patient’s responses to questions. Rather than reading into the patient’s statements, they clarify any areas of
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uncertainty.
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PTS: 1
3. ANS: C
Vitalsignsarepart ofthephysical examination portion ofpatient assessment, not part ofthehealth history.
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PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, recall
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knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affect the
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response to other conditions, and distinguish the relevance of varied abnormal findings.
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PTS: 1
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-analyses. Another source of
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statistics,theonethathasbeen most widelyusedandavailable for application tothereasoningprocess, istheestimation based on a
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provider’s experience, although these are rarely accurate. Over the past decade, the availability of evidence on which to base clinical
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reasoningis improving, and there is an increasing expectation that clinical reasoning be based on scientific evidence.
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Evidence-based statistics are also increasinglybeing used to develop resources to facilitate clinical decision-making. l l l l l l l l l l l l l




PTS: 1
6. ANS: D
To assist in clinical decision-making, anumber of evidence-based resources have been developed toassist the clinician. Resources,
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such as algorithms and clinical practice guidelines, assist in clinical reasoning when properlyapplied.
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PTS: 1
7. ANS: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an abnormal, or positive, result.
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Ahigh sensitivityindicates that a greater percentage of persons with the given condition will have an abnormal result.
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PTS: 1
8. ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The greater the
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specificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target condition.
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PTS: 1
9. ANS: A
The likelihood ratio is the probability that a positive test result will be associated with a person who has the target condition and a negative
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result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated withthe disease; a
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likelihood ratioless than 1 indicates that a negative result is associated with an absence of the disease.
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PTS: 1
10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-based
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resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met with regard
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to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain situations,
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settings, and/or patient characteristics.
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PTS: 1