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
Stem: A 42-year-old man arrives frustrated and short of breath
during check-in; the nurse reports he’s late and visibly agitated.
As the APRN enters, the patient crosses his arms and answers
questions tersely. Which initial approach best aligns with Bates’
recommendations for initiating the encounter to de-escalate
and gather reliable information?
A. Begin with a brief direct medical history, then perform the
exam quickly to avoid further agitation.
B. Acknowledge his feelings, offer a private space, and ask an
,open-ended question about his concerns.
C. Explain clinic policies about lateness and request he calm
down before proceeding.
D. Start with an immediate focused respiratory exam without
additional rapport building.
Correct Answer: B
Rationale — Correct: Bates emphasizes establishing rapport
and addressing patient emotions at Stage 1. Acknowledging
feelings and asking open-ended questions reduces
defensiveness, improves information quality, and sets a
collaborative tone. This approach is most likely to elicit accurate
history and enable safe assessment.
Rationale — Incorrect:
A. Rushing into history without establishing rapport risks
incomplete data and escalating agitation.
C. Confronting behavior with policy early often increases
defensiveness and impairs information gathering.
D. Skipping rapport may miss important psychosocial context
and increase nonadherence to exam processes.
Teaching Point: Start encounters by acknowledging emotions
and inviting the patient’s story.
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 2: Gathering Information
Stem: A 68-year-old woman with multiple chronic conditions
gives a long, non-linear history interspersed with caregivers’
comments. You need specific timeline details for medication
changes. Which Bates-guided technique most effectively
obtains accurate, chronological information while respecting
the patient’s narrative?
A. Interrupt the patient frequently to keep the timeline linear.
B. Use focused open-ended prompts, then summarize and ask
clarifying timeline questions.
C. Ask only yes/no questions about each medication change.
D. Rely solely on the caregiver’s account to speed collection.
Correct Answer: B
Rationale — Correct: Bates recommends using open-ended
prompts to allow the patient’s story, followed by clinician
summaries and targeted clarifying questions to organize
timeline and details. This preserves patient-centeredness while
producing precise clinical data.
Rationale — Incorrect:
A. Frequent interruptions damage rapport and may omit salient
psychosocial details.
C. Yes/no questions risk losing context and miss nuanced
reasons behind changes.
D. Caregiver accounts are useful but may omit the patient’s
subjective experience and introduce bias.
Teaching Point: Combine open narrative with summarization
, and targeted clarification for accurate timelines.
Citation: Bickley et al. (2021). Ch. 1.
3
Reference: Ch. 1 — Stage 3: Performing the Physical
Examination — Foundational Skills Essential to the Clinical
Encounter
Stem: During a comprehensive exam you notice a patient
flinches when you palpate the abdomen; earlier they denied
abdominal pain. According to Bates’ approach, what is the best
next step to reconcile this discrepancy?
A. Assume the patient lied and proceed with the exam.
B. Pause, inquire sensitively about pain and nonverbal cues,
then re-examine as needed.
C. Continue the exam and document “no pain reported.”
D. Refer immediately for imaging because flinching always
indicates pathology.
Correct Answer: B
Rationale — Correct: Bates emphasizes attending to verbal and
nonverbal cues—pause, ask about discomfort, and adapt the
exam. This respects patient safety, clarifies discrepancies, and
guides further focused assessment.
Rationale — Incorrect:
A. Assuming dishonesty undermines trust and may miss clinical
signs.
C. Ignoring nonverbal pain risks patient harm and inaccurate
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
Stem: A 42-year-old man arrives frustrated and short of breath
during check-in; the nurse reports he’s late and visibly agitated.
As the APRN enters, the patient crosses his arms and answers
questions tersely. Which initial approach best aligns with Bates’
recommendations for initiating the encounter to de-escalate
and gather reliable information?
A. Begin with a brief direct medical history, then perform the
exam quickly to avoid further agitation.
B. Acknowledge his feelings, offer a private space, and ask an
,open-ended question about his concerns.
C. Explain clinic policies about lateness and request he calm
down before proceeding.
D. Start with an immediate focused respiratory exam without
additional rapport building.
Correct Answer: B
Rationale — Correct: Bates emphasizes establishing rapport
and addressing patient emotions at Stage 1. Acknowledging
feelings and asking open-ended questions reduces
defensiveness, improves information quality, and sets a
collaborative tone. This approach is most likely to elicit accurate
history and enable safe assessment.
Rationale — Incorrect:
A. Rushing into history without establishing rapport risks
incomplete data and escalating agitation.
C. Confronting behavior with policy early often increases
defensiveness and impairs information gathering.
D. Skipping rapport may miss important psychosocial context
and increase nonadherence to exam processes.
Teaching Point: Start encounters by acknowledging emotions
and inviting the patient’s story.
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 2: Gathering Information
Stem: A 68-year-old woman with multiple chronic conditions
gives a long, non-linear history interspersed with caregivers’
comments. You need specific timeline details for medication
changes. Which Bates-guided technique most effectively
obtains accurate, chronological information while respecting
the patient’s narrative?
A. Interrupt the patient frequently to keep the timeline linear.
B. Use focused open-ended prompts, then summarize and ask
clarifying timeline questions.
C. Ask only yes/no questions about each medication change.
D. Rely solely on the caregiver’s account to speed collection.
Correct Answer: B
Rationale — Correct: Bates recommends using open-ended
prompts to allow the patient’s story, followed by clinician
summaries and targeted clarifying questions to organize
timeline and details. This preserves patient-centeredness while
producing precise clinical data.
Rationale — Incorrect:
A. Frequent interruptions damage rapport and may omit salient
psychosocial details.
C. Yes/no questions risk losing context and miss nuanced
reasons behind changes.
D. Caregiver accounts are useful but may omit the patient’s
subjective experience and introduce bias.
Teaching Point: Combine open narrative with summarization
, and targeted clarification for accurate timelines.
Citation: Bickley et al. (2021). Ch. 1.
3
Reference: Ch. 1 — Stage 3: Performing the Physical
Examination — Foundational Skills Essential to the Clinical
Encounter
Stem: During a comprehensive exam you notice a patient
flinches when you palpate the abdomen; earlier they denied
abdominal pain. According to Bates’ approach, what is the best
next step to reconcile this discrepancy?
A. Assume the patient lied and proceed with the exam.
B. Pause, inquire sensitively about pain and nonverbal cues,
then re-examine as needed.
C. Continue the exam and document “no pain reported.”
D. Refer immediately for imaging because flinching always
indicates pathology.
Correct Answer: B
Rationale — Correct: Bates emphasizes attending to verbal and
nonverbal cues—pause, ask about discomfort, and adapt the
exam. This respects patient safety, clarifies discrepancies, and
guides further focused assessment.
Rationale — Incorrect:
A. Assuming dishonesty undermines trust and may miss clinical
signs.
C. Ignoring nonverbal pain risks patient harm and inaccurate
