Deck 1: The History and Interviewing Process

Question 1

During an interview, you have the impression that a patient may be considering suicide. Which action is essential?

A)Immediately begin proceedings for an involuntary commitment.
B)Ask whether the patient has considered self-harm.
C)Ask whether the patient would like to visit a psychiatrist.
D)Record the impression in the patient's chart and refer the patient for hospitalization.
E)Avoid directly confronting the patient regarding your impression.

Answer 1

Ask whether the patient has considered self-harm.

Question 2

A patient becomes restless during the history and says, "I don't have time for all of this conversation. I've got to get back to work." Your most appropriate response would be to

A)stop using open-ended questions and become more direct.
B)ask another open-ended question and insist on an answer.
C)ask questions about his anger and move closer to him.
D)acknowledge his anger and proceed with the history and examination.
E)ignore his displeasure and become more assertive about getting answers.

Answer 2

acknowledge his anger and proceed with the history and examination.

Question 3

When are open-ended questions generally most useful?

A)During the physical examination
B)After several close-ended questions have been asked
C)While designing the genogram
D)During the review of systems
E)During the initial part of the interview

Answer 3

During the initial part of the interview

Question 4

You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should

A)never be interviewed alone because this may alienate the parent.
B)be mailed a questionnaire in advance to avoid the need for her to talk.
C)be given the opportunity to be interviewed without the parent at some point
D)be allowed to direct the flow of the interview.
E)be ignored while you address all questions to the parent.

Question 5

A 50-year-old man comes to the primary care clinic. He tells you he is worried because he has had severe chest pains for the past 2 weeks. Which initial history interview question is most appropriate?

A)"Can you describe the pain?"
B)"The pain doesn't radiate to your arm, does it?"
C)"Have you been treated for anxiety before?"
D)"Does your father have heart disease?"
E)"Are the pains worse after you eat?"

Question 6

Which technique is most likely to result in the patient's understanding of questions?

A)Use phrases that are commonly used by other patients in the area.
B)Use the patient's own terms if possible.
C)Use language that keeps the patient from being expansive in his or her answer.
D)Use proper medical and technical terminology.
E)Use the simplest language possible.

Question 7

Ms. A. states, "My life is just too painful. It isn't worth it." She appears depressed. Which one of the following statements is the most appropriate caregiver response?

A)"Try to think about the good things in life."
B)"You shouldn't feel that way; look at all the good things in your life."
C)"You can't mean what you're saying."
D)"If you think about it, nothing is worth getting this upset about."
E)"What in life is causing you such pain?"

Question 8

Information that is needed during the initial interview of a pregnant woman includes all of the following except

A)the gender that the woman hopes the baby will be.
B)her past medical history.
C)her health care practices.
D)the woman's knowledge about pregnancy.
E)potential pregnancy risk factors.

Question 9

Periods of silence during the interview can serve important purposes, such as

A)allowing the clinician to catch up on documentation.
B)giving you a clue that you should speed up the interview.
C)providing time for reflection.
D)increasing the length of the visit.
E)promoting calm.

Question 10

Which question would be considered a "leading question?"

A)"Please describe any associated symptoms with your headaches?"
B)"You don't get headaches often, do you?"
C)"What activities affect the severity of your headaches?"
D)"What times of the day are your headaches the most severe?"
E)"What worries you most about your headache."

Question 11

When questioning a patient regarding alcohol intake, she tells you that she is "only a social drinker." Which initial response is appropriate?

A)"I'm glad that you are a responsible drinker."
B)"Many people who are really alcoholic say they are social drinkers."
C)"What amount and what kind of alcohol do you drink in a week?"
D)"If you only drink socially, you won't need to worry about always having a designated driver."
E)"Do the other people in your household consume alcohol?"

Question 12

Which action would best promote accurate translations as well as confidentiality when the caregiver does not speak the patient's language?

A)Ask a person unfamiliar with the patient to translate.
B)Have a friend of the patient translate.
C)Ask simple leading questions that the patient may understand.
D)Use a neighbor as translator.
E)Involve the family with the translation.

Question 13

A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She seems nervous as she speaks to you. An appropriate response is to

A)continue to collect information regarding the chief concern in an unhurried manner.
B)finish the interview as rapidly as possible.
C)ask the patient to take a deep breath and calm down.
D)ask the patient if she wants to wait until another day to talk to you.
E)ignore her, because anxiety rarely accompanies physical disorders.

Question 14

Ms. T. is crying and states that her mother couldn't possibly have a tumor. "No one else in the family has ever had cancer!" exclaims the daughter. The most appropriate response to Ms. T. would be

A)"Has anyone explained hospice care to your mother?"
B)"I'm so sorry that your mother was diagnosed with cancer."
C)"Didn't you know that all tumors are not cancerous?"
D)"Why do you think that your mother's tumor is cancerous?"
E)"That is odd because cancer usually runs in families."

Question 15

Mr. F. is speaking with you, the health care provider, about his respiratory problem. Mr. F. says, "I've had this cough for 3 days, and it's getting worse." You reply, "Tell me more about your cough." Mr. F. states, "I wish I could tell you more. That's why I'm here. You tell me what's wrong!" Which caregiver response would be most appropriate for enhancing communication?

A)"After 3 days, you're tired of coughing. Have you had a fever?"
B)"I'd like to hear more about your experiences. Where were you born?"
C)"You may have a serious problem, and being confrontational will not help."
D)"I'll examine you and figure out the problem later."
E)"I don't know what's wrong. You could have almost any disease."

Question 16

During a history-taking session, Mr. B. appears to be avoiding certain questions. He keeps looking out the window. What should the caregiver do?

A)Ask direct questions and insist on a "yes" or "no" answer to each question.
B)Continue to ask questions until Mr. B. responds appropriately.
C)Let the patient know all relevant information should be revealed in one interview.
D)Stop the interview until the patient is ready to cooperate.
E)Make a note to pursue sensitive issues later in the interview.

Question 17

During an interview, tears appear in the patient's eyes, and his voice becomes shaky. Initially, you should

A)ask the patient what he is upset about.
B)offer a tissue and let him know it is all right to cry.
C)explain to the patient that you will be able to help him more if he can control his emotions.
D)keep the interview moving to distract the patient.
E)ask him if he would like some time alone.

Question 18

To prevent personal appearance from becoming an obstacle in patient care, the health care professional should

A)wear a uniform.
B)always wear a white coat.
C)avoid extremes in dress.
D)avoid wearing any jewelry.
E)avoid wearing white.

Question 19

Behaviors that diffuse anxiety during the interview include

A)trying to limit the patient to simple "yes" or "no" answers.
B)providing forthright answers to questions.
C)providing all necessary information before the patient has to ask for it.
D)completing the interview as quickly as possible.
E)avoiding the wearing of uniforms and laboratory coats.

Question 20

After you ask a patient about her family history, she says, "Tell me about your family now." Which response is generally most appropriate?

A)Ignore the patient's comment and continue with the interview.
B)Give a brief, undetailed answer.
C)Ask a direct question that refocuses the patient on the chief concern.
D)Tell the patient that you do not discuss your family with patients.
E)Ask the patient why she needs to know.

Question 21

A tool used to screen adolescents for alcoholism is the

A)CAGE questionnaire.
B)CRAFFT.
C)PACE Assessment Instrument.
D)HITS questionnaire.
E)Glasgow Coma Scale.

Question 22

When interviewing older adults, the examiner should

A)speak extremely loudly because most older adults have significant hearing impairment.
B)provide a written questionnaire in place of an interview.
C)position himself- or herself face to face with the patient.
D)ask questions containing double negatives.
E)dim the lights to decrease anxiety.

Question 23

When questioning the patient regarding his or her sexual history, which question should be asked initially?

A)"Do you have any particular sexual likes or dislikes?"
B)"Do you have any worries or concerns regarding your sex life?"
C)"How often do you have intercourse and with whom?"
D)"Do you have any reason to think you may have been exposed to a sexually transmitted infection?"
E)"What sexually transmitted diseases have you had in the past?"

Question 24

A brief statement of the reason the patient is seeking health care is called the

A)medical history.
B)chief concern
C)assessment.
D)diagnosis.
E)review of systems.

Question 25

Mr. D. complains of a headache. During the history, he mentions his use of alcohol and illicit drugs. This information would most likely belong in the

A)chief concern.
B)family history.
C)personal and social history.
D)review of systems.
E)past medical history.

Question 26

When you enter the examination room of a 3-year-old girl, you find her sitting on her father's lap. She turns away from you when you greet her. Initially, your best response is to

A)screen the child for sexual abuse.
B)ask the child to be seated on the examination table so you can talk to her father.
C)explain to the child that you will not hurt her and that she will have to trust you.
D)ask the father to persuade the child to cooperate with you.
E)leave the child sitting in the father's lap while you talk to the father.

Question 27

When you suspect that your 81-year-old patient has short-term memory loss because he cannot remember what he had for breakfast, you should

A)order a neurology consult.
B)stop all of his medications.
C)continue to press the patient for appropriate answers.
D)validate the concern with his family or caregivers.
E)dismiss the finding as a normal age-related change.

Question 28

Pain is difficult to assess in older adults because

A)their histories are usually unreliable.
B)sharp pain may be felt as a dull ache.
C)they tend to exaggerate symptoms.
D)their language skills decline.
E)drugs act more rapidly with age.

Question 29

Constitutional symptoms in the ROS refer to:

A)height, visual acuity, and body mass index.
B)fever, chills, fatigue, and malaise.
C)hearing loss, tinnitus, and diplopia.
D)rashes, skin turgor, and temperature.
E)joint stiffness, redness, and swelling.

Question 30

Tom is a 16-year-old young man with diabetes who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom's health?

A)Attachment to parents
B)Tendency to give too much information
C)Low peer support needs
D)Propensity for risk taking
E)High self-esteem

Question 31

Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the

A)Miller Analogies Test.
B)PACE Assessment Instrument.
C)CAGE questionnaire.
D)Glasgow Coma Scale.
E)HITS questionnaire.

Question 32

J.M. has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) _____ history.

A)complete
B)inventory
C)problem or focused
D)interim
E)family

Question 33

To what extent should the patient with a physical disability or emotional disorder be involved in providing health history information to the health professional?

A)All information should be obtained from family members.
B)All information should be collected from past records while the patient is in another room.
C)The patient should be involved only when you sense that he or she may feel ignored.
D)The patient should be fully involved to the limit of his or her ability.
E)The patient should be present during information collection but should not be addressed directly.

Question 34

A survey of mobility and activities of daily living (ADLs) is part of a(n)

A)ethnic assessment.
B)functional assessment.
C)genetic examination.
D)social history.
E)sexual history.

Question 35

Which of the following is considered an IADL but not an ADL?

A)Paying bills
B)Toileting
C)Walking around the house
D)Dressing oneself
E)Eating

Question 36

Direct questioning about intimate partner violence in the home should be

A)a routine component of history taking with female patients.
B)avoided for fear of offending the woman's partner.
C)conducted only in cases in which there is a history of abuse.
D)used only when the patient is obviously being victimized.
E)used only when bruises are found on physical examination.

Question 37

A guideline for history taking is for caregivers to

A)ask direct questions before open-ended questions so that the data move from simple to complex.
B)use a previous diagnosis as a chief concern whenever possible.
C)make notes sparingly so that patients can be observed during the history taking.
D)write detailed information as stated by patients so their priorities are reflected.
E)ask for a complete history at once so that data are not forgotten between meetings.

Question 38

When taking a history, you should

A)ask patients to give you any information they can recall about their health.
B)start the interview with the patient's family history.
C)use a chronologic and sequential framework.
D)use a holistic and eclectic structure.
E)start the interview with the social history.

Question 39

Mary Jane has brought in her 16-year-old son, Kyle. She states that he has been sleeping more and doesn't hang around his friends, and recently his girlfriend broke up with him. Your most immediate question is to ask Kyle

A)"Do you want to see a counselor today?"
B)"Is your father out of jail yet?"
C)"Are you taking any illegal drugs?"
D)"Have you made plans to harm yourself?"
E)"What sexual practices did you have with your girlfriend?"

Question 40

When communicating with older children and teenagers, you should be sensitive to their

A)parent's needs.
B)natural urge to communicate.
C)need for verbal instructions.
D)typical reluctance to talk.
E)desire for adult companionship.

Question 41

A pedigree diagram is drafted for the purpose of obtaining

A)sexual orientation and history.
B)growth and developmental status.
C)genetic and familial health problems.
D)ethnic and cultural backgrounds.
E)the past medical history.