Test Bank for Advanced Assessment: Interpreting Findings and Formulating Differential Diagnoses, 4th Edition, Mary Jo Goolsby, Laurie Grubbs

Test Bank for Advanced Assessment: Interpreting Findings and Formulating Differential Diagnoses, 4th Edition, Mary Jo Goolsby, Laurie Grubbs

Test Bank for Advanced Assessment: Interpreting Findings and Formulating Differential Diagnoses, 4th Edition, Mary Jo Goolsby, Laurie Grubbs/

Chapter 1. Assessment and Clinical Decision-Making: Overview

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____

1. Which type of clinical decision-making is most reliable?

A. Intuitive

B. Analytical

C. Experiential

D. Augenblick

____

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

A. Methodical and systematic

B. Attentive to the patient’s verbal and nonverbal language

C. Able to accurately interpret the patient’s responses

D. Adept at reading into the patient’s statements

____

3. Essential parts of a health history include all of the following except:

A. Chief complaint

B. History of the present illness

C. Current vital signs

D. All of the above are essential history components

____

4. Which of the following is false? While performing the physical examination, the examiner must be

able to:

A. Differentiate between normal and abnormal findings

B. Recall knowledge of a range of conditions and their associated signs and symptoms

C. Recognize how certain conditions affect the response to other conditions

D. Foresee unpredictable findings

____

5. The following is the least reliable source of information for diagnostic statistics:

A. Evidence-based investigations

B. Primary reports of research

C. Estimation based on a provider’s experience

D. Published meta-analyses

____

6. The following can be used to assist in sound clinical decision-making:

A. Algorithm published in a peer-reviewed journal article

B. Clinical practice guidelines

C. Evidence-based research

D. All of the above

____

7. If a diagnostic study has high sensitivity, this indicates a:

A. High percentage of persons with the given condition will have an abnormal result

B. Low percentage of persons with the given condition will have an abnormal result

C. Low likelihood of normal result in persons without a given condition

D. None of the above

____

8. If a diagnostic study has high specificity, this indicates a:

A. Low percentage of healthy individuals will show a normal result

B. High percentage of healthy individuals will show a normal result

C. High percentage of individuals with a disorder will show a normal result

D. Low percentage of individuals with a disorder will show an abnormal result

____

9. A likelihood ratio above 1 indicates that a diagnostic test showing a:

A. Positive result is strongly associated with the disease

B. Negative result is strongly associated with absence of the disease

C. Positive result is weakly associated with the disease

D. Negative result is weakly associated with absence of the disease

____ 10. Which of the following clinical reasoning tools is defined as evidence-based resource based on

mathematical modeling to express the likelihood of a condition in select situations, settings, and/or

patients?

A. Clinical practice guideline

B. Clinical decision rule

C. Clinical algorithm

D. Clinical recommendation

Chapter 1. Assessment and Clinical Decision-Making: Overview

Answer Section

MULTIPLE CHOICE

1. ANS: B

Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and

analytical. Intuitive decision-making (similar to Augenblink decision-making) is based on the

experience and intuition of the clinician and is less reliable and paired with fairly common errors.

In contrast, analytical decision-making is based on careful consideration and has greater reliability

with rare errors.

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 accurately interpret the patient’s responses to questions. Rather

than reading into the patient’s statements, they clarify any areas of uncertainty.

PTS: 1

3. ANS: C

Vital signs are part of the physical examination portion of patient assessment, not part of the health

history.

PTS: 1

4. ANS: D

While performing the physical examination, the examiner must be able to differentiate between

normal and abnormal findings, recall knowledge of a range of conditions, including their

associated signs and symptoms, recognize how certain conditions affect the response to other

conditions, and distinguish the relevance of varied abnormal findings.

PTS: 1

5. ANS: C

Sources for diagnostic statistics include textbooks, primary reports of research, and published

meta-analyses. Another source of statistics, the one that has been most widely used and available

for application to the reasoning process, is the estimation based on a provider’s experience,

although these are rarely accurate. Over the past decade, the availability of evidence on which to

base clinical reasoning is improving, and there is an increasing expectation that clinical reasoning

be based on scientific evidence. Evidence-based statistics are also increasingly being used to

develop resources to facilitate clinical decision-making.

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, such as algorithms and clinical practice guidelines, assist in

clinical reasoning when properly applied.