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 — Stage 1: Initiating
the Encounter
APRN-Level Question Stem
A 62-year-old man with poorly controlled diabetes arrives for a
first-time visit. He appears withdrawn, pauses before
answering, and declines eye contact. You note his daughter is
answering most questions. Using Bates’ recommended opening
approach, what initial communication strategy best establishes
,rapport while assessing decision-making capacity and social
context?
Options
A. Continue the interview with daughter answering, deferring
direct questions to patient later.
B. Privately ask the daughter to step out for a few minutes and
directly address the patient with open-ended questions.
C. Tell the daughter you will focus on physical exam now and
ask history later.
D. Immediately ask the daughter for a full medical history to
save time.
Correct Answer
B
Rationales
Correct Option — B: Bates emphasizes initiating the encounter
by directly greeting and engaging the patient, using open-ended
questions to assess communication and cognition while
ensuring privacy when appropriate; this approach respects
autonomy and allows assessment of capacity.
Incorrect A: Relying on the daughter obscures patient's voice
and can miss cognitive impairment; Bates recommends direct
patient engagement.
Incorrect C: Deferring history avoids establishing rapport and
misses early cognitive or affective cues that guide exam.
Incorrect D: Asking family for full history without first engaging
,the patient risks violating autonomy and missing behavioral
cues Bates highlights.
Teaching Point
Always begin by addressing the patient directly; secure privacy
when sensitive or capacity concerns arise.
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 — Stage 1: Initiating
the Encounter
APRN-Level Question Stem
A 28-year-old pregnant woman presents anxious about a
prenatal ultrasound. She sits forward, voice quavering, and asks
many rapid questions. According to Bates’ framework for
initiating the encounter and nonverbal communication, which
immediate clinician behavior is most likely to reduce anxiety
and elicit an accurate history?
Options
A. Maintain a brisk pace and provide succinct factual answers to
reduce visit length.
B. Mirror her posture and increase vocal volume to match her
, energy.
C. Slow your speech, offer a calm open posture, and ask one
open-ended question about her concerns.
D. Immediately provide extensive educational materials to read
while you perform the exam.
Correct Answer
C
Rationales
Correct Option — C: Bates highlights nonverbal cues and
pacing; calming tone and open-ended questions reduce anxiety
and invite the patient to prioritize concerns.
Incorrect A: Brisk pace can increase anxiety and may truncate
important psychosocial details Bates recommends eliciting.
Incorrect B: Mirroring high arousal can escalate anxiety; Bates
endorses calming, not amplifying, nonverbal cues.
Incorrect D: Handing materials substitutes for empathic
engagement and may prevent verbalizing immediate fears.
Teaching Point
Use calming speech and one focused open-ended question to
lower anxiety and prioritize concerns.
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
1
Reference
Ch. 1 — Approach to the Clinical Encounter — Stage 1: Initiating
the Encounter
APRN-Level Question Stem
A 62-year-old man with poorly controlled diabetes arrives for a
first-time visit. He appears withdrawn, pauses before
answering, and declines eye contact. You note his daughter is
answering most questions. Using Bates’ recommended opening
approach, what initial communication strategy best establishes
,rapport while assessing decision-making capacity and social
context?
Options
A. Continue the interview with daughter answering, deferring
direct questions to patient later.
B. Privately ask the daughter to step out for a few minutes and
directly address the patient with open-ended questions.
C. Tell the daughter you will focus on physical exam now and
ask history later.
D. Immediately ask the daughter for a full medical history to
save time.
Correct Answer
B
Rationales
Correct Option — B: Bates emphasizes initiating the encounter
by directly greeting and engaging the patient, using open-ended
questions to assess communication and cognition while
ensuring privacy when appropriate; this approach respects
autonomy and allows assessment of capacity.
Incorrect A: Relying on the daughter obscures patient's voice
and can miss cognitive impairment; Bates recommends direct
patient engagement.
Incorrect C: Deferring history avoids establishing rapport and
misses early cognitive or affective cues that guide exam.
Incorrect D: Asking family for full history without first engaging
,the patient risks violating autonomy and missing behavioral
cues Bates highlights.
Teaching Point
Always begin by addressing the patient directly; secure privacy
when sensitive or capacity concerns arise.
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 — Stage 1: Initiating
the Encounter
APRN-Level Question Stem
A 28-year-old pregnant woman presents anxious about a
prenatal ultrasound. She sits forward, voice quavering, and asks
many rapid questions. According to Bates’ framework for
initiating the encounter and nonverbal communication, which
immediate clinician behavior is most likely to reduce anxiety
and elicit an accurate history?
Options
A. Maintain a brisk pace and provide succinct factual answers to
reduce visit length.
B. Mirror her posture and increase vocal volume to match her
, energy.
C. Slow your speech, offer a calm open posture, and ask one
open-ended question about her concerns.
D. Immediately provide extensive educational materials to read
while you perform the exam.
Correct Answer
C
Rationales
Correct Option — C: Bates highlights nonverbal cues and
pacing; calming tone and open-ended questions reduce anxiety
and invite the patient to prioritize concerns.
Incorrect A: Brisk pace can increase anxiety and may truncate
important psychosocial details Bates recommends eliciting.
Incorrect B: Mirroring high arousal can escalate anxiety; Bates
endorses calming, not amplifying, nonverbal cues.
Incorrect D: Handing materials substitutes for empathic
engagement and may prevent verbalizing immediate fears.
Teaching Point
Use calming speech and one focused open-ended question to
lower anxiety and prioritize concerns.
Citation
Bickley et al. (2021). Ch. 1.
3
