Test Bank for Advanced Health Assessment & Clinical Diagnosis in Primary Care ||6th Edition Dains.pdf

TESTBANK v




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 v v




Chapter1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis
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Multiple Choice v




Identifythe choice that best completes the statement oranswers thequestion.
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1. Which type of clinical decision-making is most reliable?
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A. Intuitive
B. Analytical
C. Experiential
D. Augenblick

2. Which of the following is false? To obtain adequate history, health-care providers must be:
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A. Methodical and systematic v v




B. Attentive to the patient’s verbal and nonverbal language
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C. Able to accurately interpret the patient’s responses
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D. Adept at reading into the patient’s statements
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3. Essential parts of a health history include all of the following except: v v v v v v v v v v v




A. Chief complaint v




B. History of the present illness v v v v




C. Current vital signs v v




D. All of the above are essential history components
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4. Which of the following is false? While performing the physical examination, the examiner must be able to:
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A. Differentiate between normal and abnormal findings v v v v v




B. Recall knowledge of a range of conditions and their associated signs and symptoms
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C. Recognize how certain conditions affect the response to other conditions
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D. Foresee unpredictable findings v v




5. The following is the least reliable source of information for diagnostic statistics:
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A. Evidence-based investigations v




B. Primary reports of research v v v




C. Estimation based on a provider’s experience v v v v v




D. Published meta-analyses v




6. The following can be used to assist in sound clinical decision-making:
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A. Algorithmpublished in a peer-reviewed journal article v v v v v v




B. Clinical practice guidelines v v




C. Evidence-based research v




D. All of the above
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7. If a diagnostic studyhas high sensitivity, this indicates a:
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A. High percentage of persons with the given condition will have an abnormal result
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B. Low percentage of persons with the given condition will have an abnormal result
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C. Low likelihood of normal result in persons without a given condition
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D. None of the above v v v




8. If a diagnostic studyhas high specificity, this indicates a:
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A. Low percentage of healthy individuals will show a normal result
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B. High percentage of healthy individuals will show a normal result
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C. High percentage of individuals with a disorder will show a normal result
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D. Low percentage of individuals with a disorder will show an abnormal result
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9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
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A. Positive result is strongly associated with the disease
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B. Negative result is strongly associated with absence of the disease
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C. Positive result is weakly associated with the disease
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D. Negative result is weakly associated with absence of the disease
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10. Which of the following clinical reasoning tools is defined as evidence-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. Clinical practice guideline v v




B. Clinical decision rule v v




C. Clinical algorithm v




Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
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Answer Section
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MULTIPLE CHOICEv




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
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paired with fairly common errors. In contrast, analytical decision-making is based on careful consideration and has greater
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reliability with rare errors.
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PTS: 1
2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal 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
Vital signs are part of the physical examination portion of patient assessment, not part of the health 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, the one that has been most widelyused and available for application to the reasoning process, is the estimation 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
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clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be based on scientific evidence.
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Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making.
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PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the clinician. Resources,
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such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly applied.
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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,
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result. Ahigh sensitivity indicates 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
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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
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negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated with
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the disease; a likelihood ratio less 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
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regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain
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situations, settings, and/or patient characteristics.
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PTS: 1