TEST BANK
Bates' Guide To Physical Examination and History Taking
Lynn S. Bickley, Peter G. Szilagyi, Richard M. Hoffman, and Rainier P. Soriano
13th Edition
,Table of Contents
Chapter 1. Foundations for Clinical Proficiency 1
Chapter 2. Evaluating Clinical Evidence 9
Chapter 3. Interviewing and the Health History 19
Chapter 4. Beginning the Physical Examination General Survey, Vital Signs, and Pain 26
Chapter 5. Behavior and Mental Status 34
Chapter 6. The Skin, Hair, and Nails 44
Chapter 7. The Head and Neck 52
Chapter 8. The Thorax and Lungs 61
Chapter 9. The Cardiovascular System 69
Chapter 10. The Breasts and Axillae 78
Chapter 11. The Abdomen 87
Chapter 12. The Peripheral Vascular System 95
Chapter 13. Male Genitalia and Hernias 103
Chapter 14. Female Genitalia 111
Chapter 15. The Anus, Rectum, and Prostate 120
Chapter 16. The Musculoskeletal System 128
Chapter 17. The Nervous System 136
Chapter 18. Assessing Children Infancy Through Adolescence 145
Chapter 19. The Pregnant Woman 147
Chapter 20. The Older Adult 156
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Test Bank - Bates Guide To Physical Examination and History Taking, 13th Edition (Bickley, 2021)
Chapter 1. Foundations for Clinical Proficiency
MULTIPLE CHOICE
1. After completing an initial assessment of a patient, the nurse has charted that his respirations
are eupneic and his pulse is 58 beats per minute. These types of data would be:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS: A
Objective data are what the health professional observes by inspecting, percussing,
palpating, and auscultating during the physical examination. Subjective data is what the
person says about him or herself during history taking. The terms reflective and
introspective are not used to describe data.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These types of
data would be:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective. WWW.TBSM.WS
ANS: C
Subjective data are what the person says about him or herself during history taking.
Objective data are what the health professional observes by inspecting, percussing,
palpating, and auscultating during the physical examination. The terms reflective and
introspective are not used to describe data.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. The patients record, laboratory studies, objective data, and subjective data combine to form
the:
a. Data base.
b. Admitting data.
c. Financial statement.
d. Discharge summary.
ANS: A
Together with the patients record and laboratory studies, the objective and subjective data
form the data base. The other items are not part of the patients record, laboratory studies, or
data.
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 2
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Test Bank - Bates Guide To Physical Examination and History Taking, 13th Edition (Bickley, 2021)
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. When listening to a patients breath sounds, the nurse is unsure of a sound that is heard. The
nurses next action should be to:
a. Immediately notify the patients physician.
b. Document the sound exactly as it was heard.
c. Validate the data by asking a coworker to listen to the breath sounds.
d. Assess again in 20 minutes to note whether the sound is still present.
ANS: C
When unsure of a sound heard while listening to a patients breath sounds, the nurse
validates the data to ensure accuracy. If the nurse has less experience in an area, then he or
she asks an expert to listen.
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 2
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
5. The nurse is conducting a class for new graduate nurses. During the teaching session, the
nurse should keep in mind that novice nurses, without a background of skills and experience
from which to draw, are more likely to make their decisions using:
a. Intuition.
b. A set of rules.
c. Articles in journals.
d. Advice from supervisors.
ANS: B
Novice nurses operate from a set of defined, structured rules. The expert practitioner uses
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intuitive links.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 3
MSC: Client Needs: General
6. Expert nurses learn to attend to a pattern of assessment data and act without consciously
labeling it. These responses are referred to as:
a. Intuition.
b. The nursing process.
c. Clinical knowledge.
d. Diagnostic reasoning.
ANS: A
Intuition is characterized by pattern recognition expert nurses learn to attend to a pattern of
assessment data and act without consciously labeling it. The other options are not correct.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4
MSC: Client Needs: General
7. The nurse is reviewing information about evidence-based practice (EBP). Which statement
best reflects EBP?
a. EBP relies on tradition for support of best practices.
b. EBP is simply the use of best practice techniques for the treatment of patients.
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Test Bank - Bates Guide To Physical Examination and History Taking, 13th Edition (Bickley, 2021)
c. EBP emphasizes the use of best evidence with the clinicians experience.
d. The patient’s own preferences are not important with EBP.
ANS: C
EBP is a systematic approach to practice that emphasizes the use of best evidence in
combination with the clinicians experience, as well as patient preferences and values, when
making decisions about care and treatment. EBP is more than simply using the best practice
techniques to treat patients, and questioning tradition is important when no compelling and
supportive research evidence exists.
DIF: Cognitive Level: Applying (Application) REF: p. 5
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
8. The nurse is conducting a class on priority setting for a group of new graduate nurses.
Which is an example of a first-level priority problem?
a. Patient with postoperative pain
b. Newly diagnosed patient with diabetes who needs diabetic teaching
c. Individual with a small laceration on the sole of the foot
d. Individual with shortness of breath and respiratory distress
ANS: D
First-level priority problems are those that are emergent, life threatening, and immediate
(e.g., establishing an airway, supporting breathing, maintaining circulation, monitoring
abnormal vital signs) (see Table 1-1).
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4
MSC: Client Needs: Safe and WWW.TBSM.WS
Effective Care Environment: Management of Care
9. When considering priority setting of problems, the nurse keeps in mind that second-level
priority problems include which of these aspects?
a. Low self-esteem
b. Lack of knowledge
c. Abnormal laboratory values
d. Severely abnormal vital signs
ANS: C
Second-level priority problems are those that require prompt intervention to forestall further
deterioration (e.g., mental status change, acute pain, abnormal laboratory values, risks to
safety or security) (see Table 1-1).
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
10. Which critical thinking skill helps the nurse see relationships among the data?
a. Validation
b. Clustering related cues
c. Identifying gaps in data
d. Distinguishing relevant from irrelevant
ANS: B
Clustering related cues helps the nurse see relationships among the data.
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Test Bank - Bates Guide To Physical Examination and History Taking, 13th Edition (Bickley, 2021)
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
11. The nurse knows that developing appropriate nursing interventions for a patient relies on the
appropriateness of the diagnosis.
a. Nursing
b. Medical
c. Admission
d. Collaborative
ANS: A
An accurate nursing diagnosis provides the basis for the selection of nursing interventions to
achieve outcomes for which the nurse is accountable. The other items do not contribute to
the development of appropriate nursing interventions.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 6
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
12. The nursing process is a sequential method of problem solving that nurses use and includes
which steps?
a. Assessment, treatment, planning, evaluation, discharge, and follow-up
b. Admission, assessment, diagnosis, treatment, and discharge planning
c. Admission, diagnosis, treatment, evaluation, and discharge planning
d. Assessment, diagnosis, outcome identification, planning, implementation, and
evaluation
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ANS: D
The nursing process is a method of problem solving that includes assessment, diagnosis,
outcome identification, planning, implementation, and evaluation.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 3
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
13. A newly admitted patient is in acute pain, has not been sleeping well lately, and is having
difficulty breathing. How should the nurse prioritize these problems?
a. Breathing, pain, and sleep
b. Breathing, sleep, and pain
c. Sleep, breathing, and pain
d. Sleep, pain, and breathing
ANS: A
First-level priority problems are immediate priorities, remembering the ABCs (airway,
breathing, and circulation), followed by second-level problems, and then third-level
problems.
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 4
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
14. Which of these would be formulated by a nurse using diagnostic reasoning?
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Test Bank - Bates Guide To Physical Examination and History Taking, 13th Edition (Bickley, 2021)
a. Nursing diagnosis
b. Medical diagnosis
c. Diagnostic hypothesis
d. Diagnostic assessment
ANS: C
Diagnostic reasoning calls for the nurse to formulate a diagnostic hypothesis; the nursing
process calls for a nursing diagnosis.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
MSC: Client Needs: General
15. Barriers to incorporating EBP include:
a. Nurses lack of research skills in evaluating the quality of research studies.
b. Lack of significant research studies.
c. Insufficient clinical skills of nurses.
d. Inadequate physical assessment skills.
ANS: A
As individuals, nurses lack research skills in evaluating the quality of research studies, are
isolated from other colleagues who are knowledgeable in research, and often lack the time to
visit the library to read research. The other responses are not considered barriers.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 6
MSC: Client Needs: General
16. What step of the nursing process includes data collection by health history, physical
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examination, and interview?
a. Planning
b. Diagnosis
c. Evaluation
d. Assessment
ANS: D
Data collection, including performing the health history, physical examination, and
interview, is the assessment step of the nursing process (see Figure 1-2).
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 2
MSC: Client Needs: General
17. During a staff meeting, nurses discuss the problems with accessing research studies to
incorporate evidence-based clinical decision making into their practice. Which suggestion
by the nurse manager would best help these problems?
a. Form a committee to conduct research studies.
b. Post published research studies on the units bulletin boards.
c. Encourage the nurses to visit the library to review studies.
d. Teach the nurses how to conduct electronic searches for research studies.
ANS: D
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Test Bank - Bates Guide To Physical Examination and History Taking, 13th Edition (Bickley, 2021)
Facilitating support for EBP would include teaching the nurses how to conduct electronic
searches; time to visit the library may not be available for many nurses. Actually conducting
research studies may be helpful in the long-run but not an immediate solution to reviewing
existing research.
DIF: Cognitive Level: Applying (Application) REF: p. 6
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
18. When reviewing the concepts of health, the nurse recalls that the components of holistic
health include which of these?
a. Disease originates from the external environment.
b. The individual human is a closed system.
c. Nurses are responsible for a patient’s health state.
d. Holistic health views the mind, body, and spirit as interdependent.
ANS: D
Consideration of the whole person is the essence of holistic health, which views the mind,
body, and spirit as interdependent. The basis of disease originates from both the external
environment and from within the person. Both the individual human and the external
environment are open systems, continually changing and adapting, and each person is
responsible for his or her own personal health state.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 7
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
19. The nurse recognizes that the concept of prevention in describing health is essential
because: WWW.TBSM.WS
a. Disease can be prevented by treating the external environment.
b. The majority of deaths among Americans under age 65 years are not preventable.
c. Prevention places the emphasis on the link between health and personal behavior.
d. The means to prevention is through treatment provided by primary health care
practitioners.
ANS: C
A natural progression to prevention rounds out the present concept of health. Guidelines to
prevention place the emphasis on the link between health and personal behavior.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 7
MSC: Client Needs: General
20. The nurse is performing a physical assessment on a newly admitted patient. An example of
objective information obtained during the physical assessment includes the:
a. Patients history of allergies.
b. Patients use of medications at home.
c. Last menstrual period 1 month ago.
d. 2 5 cm scar on the right lower forearm.
ANS: D
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Test Bank - Bates Guide To Physical Examination and History Taking, 13th Edition (Bickley, 2021)
Objective data are the patients record, laboratory studies, and condition that the health
professional observes by inspecting, percussing, palpating, and auscultating during the
physical examination. The other responses reflect subjective data.
DIF: Cognitive Level: Applying (Application) REF: p. 2
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
21. A visiting nurse is making an initial home visit for a patient who has many chronic medical
problems. Which type of data base is most appropriate to collect in this setting?
a. A follow-up data base to evaluate changes at appropriate intervals
b. An episodic data base because of the continuing, complex medical problems of this
patient
c. A complete health data base because of the nurses primary responsibility for
monitoring the patient’s health
d. An emergency data base because of the need to collect information and make
accurate diagnoses rapidly
ANS: C
The complete data base is collected in a primary care setting, such as a pediatric or family
practice clinic, independent or group private practice, college health service, women’s
health care agency, visiting nurse agency, or community health agency. In these settings, the
nurse is the first health professional to see the patient and has the primary responsibility for
monitoring the persons health care.
DIF: Cognitive Level: Applying (Application) REF: p. 6
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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22. Which situation is most appropriate during which the nurse performs a focused or problem-
centered history?
a. Patient is admitted to a long-term care facility.
b. Patient has a sudden and severe shortness of breath.
c. Patient is admitted to the hospital for surgery the following day.
d. Patient in an outpatient clinic has cold and influenza-like symptoms.
ANS: D
In a focused or problem-centered data base, the nurse collects a mini data base, which is
smaller in scope than the completed data base. This mini data base primarily concerns one
problem, one cue complex, or one body system.
DIF: Cognitive Level: Applying (Application) REF: p. 7
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
23. A patient is at the clinic to have her blood pressure checked. She has been coming to the
clinic weekly since she changed medications 2 months ago. The nurse should:
a. Collect a follow-up data base and then check her blood pressure.
b. Ask her to read her health record and indicate any changes since her last visit.
c. Check only her blood pressure because her complete health history was
documented 2 months ago.
d. Obtain a complete health history before checking her blood pressure because much
of her history information may have changed.
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Test Bank - Bates Guide To Physical Examination and History Taking, 13th Edition (Bickley, 2021)
ANS: A
A follow-up data base is used in all settings to follow up short-term or chronic health
problems. The other responses are not appropriate for the situation.
DIF: Cognitive Level: Applying (Application) REF: p. 7
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
24. A patient is brought by ambulance to the emergency department with multiple traumas
received in an automobile accident. He is alert and cooperative, but his injuries are quite
severe. How would the nurse proceed with data collection?
a. Collect history information first, then perform the physical examination and
institute life-saving measures.
b. Simultaneously ask history questions while performing the examination and
initiating life-saving measures.
c. Collect all information on the history form, including social support patterns,
strengths, and coping patterns.
d. Perform life-saving measures and delay asking any history questions until the
patient is transferred to the intensive care unit.
ANS: B
The emergency data base calls for a rapid collection of the data base, often concurrently
compiled with life-saving measures. The other responses are not appropriate for the
situation.
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 7
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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25. A 42-year-old patient of Asian descent is being seen at the clinic for an initial examination.
The nurse knows that including cultural information in his health assessment is important to:
a. Identify the cause of his illness.
b. Make accurate disease diagnoses.
c. Provide cultural health rights for the individual.
d. Provide culturally sensitive and appropriate care.
ANS: D
The inclusion of cultural considerations in the health assessment is of paramount importance
to gathering data that are accurate and meaningful and to intervening with culturally
sensitive and appropriate care.
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