Open-ended questions are more pertinent to:
- Review of systems.
- Past illness.
- Present illness.
- Family history.
3. Present illness.
Open-ended questions are especially pertinent to eliciting the patient’s chief concerns and the History of the Present Illness.
Mary is a 62-year-old female established patient who presents to the clinic with complaints of intermittent diarrhea and nausea for the past week. The type of history taking most appropriate will be:
- A comprehensive health history.
- A detailed review of systems.
- Focused or problem-centered.
4. Focused or problem-centered.
For patients who seek care for specific complaints—for example, coughs or painful urination—a more limited interview tailored to that specific problem may be indicated. This is sometimes known as a focused or problem-oriented history.
Jennifer is a 16-year-old female who comes to the clinic with complaints of a headache and stomachache for 4 days. To elicit the most information, it is best to ask as many questions as possible.
Open-ended questions are best for getting information about chief complaints, but they are especially important when working with adolescent patients. Adolescents tend to be very brief with their answers and asking as many open-ended questions as possible will yield more details about their symptoms.
The patient is a 68-year-old Asian American female seeing the FNP for the first time. The female provider starts the interview by asking some basic questions like "What brings you here today?" Her responses are very brief and she nods frequently during the conversation. Understanding about Asian culture, the FNP knows that:
- The patient may expect you to already know what is wrong with them.
- Nodding reflects her full understanding of what is being said.
- The patient would prefer to see a male provider.
- Nodding reflects her agreement with the provider.
1. The patient may expect you to already know what is wrong with them.
Some Asian Americans may expect providers to already know what is wrong with them. Nodding is not a reflection of agreement or understanding but their cultural value for interpersonal harmony.
When interviewing a patient, it is best to be:
- Standing above the patient.
- Sitting below the patient.
- At eye-level with the patient.
- 2 to 3 feet from the patient.
3. At eye-level with the patient.
Ideally, the FNP should be at eye level, with the patient four to five feet from the patient. Avoid facing a patient across a desk.
Note-taking during an interview:
- Can be threatening to patients when discussing sensitive issues.
- Should never be done and is always avoidable.
- Makes the patient feel you are paying attention to them and you are carefully noting their comments.
- Shifts the attention to the patient and gives them a sense of importance.
1. Can be threatening to patients when discussing sensitive issues.
Note-taking should be avoided whenever possible, but is sometimes necessary. It can, however, be threatening to a patient, especially when discussing sensitive issues. It can shift the attention away from the patient and make them feel unimportant.
When using an interpreter, it is important to note that:
- The same or similar age is often preferred.
- The same gender is often preferred.
- A summary of the conversation is often relayed.
- Using children of the patient is best.
2. The same gender is often preferred.
An interpreter of the same gender is often preferred. Older interpreters are often preferred by patients. Avoid using children of the patient when at all possible. An interpreter should provide a line-by-line verbatim account of the conversation.
Johnny is a 2-year-old male who was diagnosed with sickle cell anemia shortly after birth. Prior to conducting a physical assessment, it is important to note which of the following can be a chronic manifestation of sickle cell anemia?
Jaundice can be a chronic manifestation of sickle cell anemia, whereas the other conditions may be an acute manifestation that can lead to chronic issues.
Mrs. Adam’s note says that she has a lesion that is confluent in nature. On examination, the FNP would expect to find:
- Lesions that run together.
- Annual lesions that have grown together.
- Lesions arranged in a line along a nerve route.
- Lesions that are grouped or clustered together.
1. Lesions that run together.
Confluent is defined as flowing together, blending as one, or merging together.
Assessing a patient’s ability to think abstractly can be done in one of two ways:
- Asking them who the president of the United States is or five previous presidents.
- Ask the patient to count backward or give them a proverb and ask them to explain it.
- Give them a proverb and ask them to explain it, or ask them to explain how two words are alike.
- Give them two words and ask them to explain how they are different, or ask them to calculate several numbers.
3. Give them a proverb and ask them to explain it, or ask them to explain how two words are alike.
Interpreting proverbs measures one’s ability to think abstractly, as does interpreting similarities and differences between words.
It is important for clinicians to understand the terminology when assessing for alcohol and drug usage and possible addiction. A state of adaption in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time is the definition of:
- Physical dependence.
This is the definition for tolerance.
When assessing for domestic violence, a statement such as, "I routinely ask all my patients about domestic violence" should come:
- Prior to asking probing questions.
- Prior to asking in-depth questions.
- After asking in-depth questions.
- At the end of the overall interview.
1. Prior to asking probing questions.
A normalizing statement should be at the beginning of the interview. First ask probing questions, then follow with more in-depth questions.
Which statement is true about dying patients?
- Dying patients often want to talk about their illness at each encounter.
- Dying patients may experience Kübler-Ross’s stages for death and dying in any sequence, and stages may overlap.
- Dying patients often want to discuss their condition with multiple people.
- Media often gives the dying patients a realistic view of the effectiveness of resuscitation.
2. Dying patients may experience Kübler-Ross’s stages for death and dying in any sequence, and stages may overlap.
The patient may experience the stages of death and dying in any stage or sequence or combination thereof.
When interviewing a patient, he says he doesn’t have any energy. What are some general statements about the fatigue that will assist in asking further appropriate questions?
- Fatigue is a specific symptom with few causes.
- Fatigue is an abnormal response to stress.
- Fatigue can be a normal response to grief.
- Fatigue related to stress or hard work requires further investigation.
3. Fatigue can be a normal response to grief.
Fatigue can be a normal response to hard work, stress, or grief. If it is not related to such situations, it requires further investigation.
The PQRSTU or PQRST mnemonic is a way to:
- Assess a patient’s pain level or presenting symptom.
- Assess a patient’s skin.
- Determine a patient’s level of understanding of instructions.
- Assess a patient’s family history.
1. Assess a patient’s pain level or presenting symptom.
The PQRST method of assessing pain is a valuable tool to accurately describe, assess, and document a patient’s pain (or other presenting symptoms).
A family tree can also be described as a:
- Family map.
- Genogram and Pedigree.
4. Genogram and Pedigree.
A family tree may be referred to as a genogram or pedigree.
The FNP is doing an interview of a 21-year-old male. In the assessment, the FNP asks the patient, "You don’t smoke, do you?" This type of question is:
- An appropriate open-ended question.
- An appropriate close-ended question.
- An inappropriate leading question.
- An inappropriate open-ended question.
3. An inappropriate leading question.
This type of question is leading, and leading questions imply that there is a right or wrong response, and if the person wants to please you, they will respond how they think you want them to respond.
A 39-year-old female presents to the clinic for her annual GYN visit. During her interview, she uses unusual frequent and long pauses with speech that is slow and monotone. The patient is most likely:
Depressed: Unusually frequent and long pauses in speech that are slow and monotone are usually a sign of depression and need further investigation.
When assessing the patient for strabismus, an eye muscle problem such as esotropia or exotropia, the practitioner should select which of the following eye tests?
- An ophthalmoscope exam
- The cover-uncover test
- The confrontation visual field test
- The eye test for distance vision
2. The cover-uncover test
A cover test or cover-uncover test is an objective determination of the presence and amount of ocular deviation.
A 37-year-old male arrives at the clinic for a work physical. The FNP places both hands on the patient’s shoulders and asks him to shrug his shoulders. This tests which cranial nerve?
You are testing cranial nerve 11 (cranial nerve XI).
A 43-year-old female presents to the clinic with complaints of frequent headaches. While attempting to test her cranial nerve function, she is requested to: puff out her checks, close her eyes tightly, and clench her teeth. Which of the following cranial nerves was tested?
- V and VII
- III, IV, and VI
- III and V
- IV, V, and VI
1. V and VII
To test cranial nerve V, ask the patient to clinch their teeth. To test cranial nerve VII, have the patient puff out their cheeks and close their eyes tightly.
Mr. Davis is a 42-year-old construction worker. He has come to the clinic complaining of decreased hearing over the last few months. Upon examination, the FNP notes that both his ear canals are occluded with dark brown cerumen. Hearing loss due to impacted cerumen is an example of:
- Otitis media.
- A conductive hearing loss.
- A sensorineural hearing loss.
- Otitis externa.
2. A conductive hearing loss.
Conductive hearing loss occurs when there is a problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles). This can be caused by obstruction.
Boggy turbinates is usually associated with which condition?
- Allergic rhinitis
- Nasal polyps
- A deviated septum
- A foreign body in the nose
1. Allergic rhinitis
Nasal turbinates that are swollen, pale, boggy, or bluish are a sign of allergic rhinitis.
A 27-year-old patient is 27 weeks pregnant and has come to the clinic for her prenatal exam. The fundal height measures 21 centimeters. This may be a sign of:
- Too much amniotic fluid.
- Twin gestation.
- Slow fetal growth.
- An expected finding for gestational age.
3. Slow fetal growth.
After 16 weeks of gestation fundal height measurement often matches the number of weeks gestation. A smaller than expected measurement can be a sign of slow fetal growth.
While performing a 24-year-old female’s GYN exam, it is observed that the cervix is friable. This condition is most commonly associated with what?
- Cervical cancer
- Pelvic Inflammatory Disease (PID)
- Cervical cancer and Pelvic Inflammatory Disease (PID)
2. Pelvic Inflammatory Disease (PID)
In rare cases, a friable cervix is an early sign of cervical cancer. The most likely cause is HPV or chlamydia. Commonly, it is a sign associated with PID. It may also be due to trichomoniasis, but is more likely a result of chlamydia or PID.
A patient is being assessed for range of motion. He is asked to move his arms in toward the center of his body. This movement is called what?
Adduction is movement toward the mid-line of the body.
A 57-year-old bank teller comes to the office complaining of fever, shortness of breath, and a productive cough with slightly brown sputum. She says she had a cold the last two weeks and her symptoms continue to get worse. She has been taking over-the-counter cold and flu medications without any improvement. She mentions a slight chest pain upon breathing deeply, and has a history of HTN and a grade II murmur. She denies alcohol or drug use. She smokes half a pack of cigarettes a day. Both her parents are living. Both have HTN and elevated cholesterol. She looks ill and her temperature is elevated (100.7). Her blood pressure is 140/87 and pulse 85. On auscultation, she has decreased air movement, and fine crackles are heard over the right lower lobe. There is dullness on percussion, and increased fremitus during palpation. What disorder of the thorax or lung best describes her symptoms?
- Upper respiratory infection
Pneumonia is usually associated with dyspnea, cough, and fever. On auscultation, there can be coarse or fine crackles heard over the affected lobe. Percussion over the affected area is dull and there is often an increase in fremitus.
A 36-year-old man comes to the ER for examination after a motorcycle accident. It was reported that he landed on his left side on the handlebars. It is suspected that he may have some internal injuries. Which of the following is the best response regarding assessment of the spleen in this situation?
- It is normal for the spleen to be palpable.
- The spleen can be enlarged as a result of trauma.
- If an enlarged spleen is noted, palpate thoroughly to determine size.
- An enlarged spleen should not be palpated because it can rupture easily.
4. An enlarged spleen should not be palpated because it can rupture easily.
If an enlarged spleen is palpated, do not continue to palpate and order an immediate ultrasound. An enlarged spleen is friable and can rupture easily with overpalpation.
While assessing the carotid pulse of a 57-year-old male, the FNP notices that the pulse is bounding. This would be documented as what?
- A normal carotid pulse
A forceful pulse might be described as 3+ or even 4+ and is also described as bounding.
The finding in the previous question may be due to:
- A normal physiological reaction.
- Fluid overload.
2. Fluid overload.
Increased carotid-pulse amplitude may be associated with fluid-volume overload or hypertension.