Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses 4th Edition Goolsby - Test Bank

Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses 4th Edition Goolsby – Test Bank

 

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Sample Questions Are Posted Below

 

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?

1. Intuitive
2. Analytical
3. Experiential
4. Augenblick

____ 2. Which of the following is false? To obtain adequate history, health-care

providers must be:

1. Methodical and systematic
2. Attentive to the patient’s verbal and

nonverbal language

1. Able to accurately interpret the patient’s

responses

1. Adept at reading into the patient’s

statements

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

1. Chief complaint
2. History of the present illness
3. Current vital signs
4. 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:

1. Differentiate between normal and

abnormal findings

1. Recall knowledge of a range of conditions

and their associated signs and symptoms

1. Recognize how certain conditions affect

the response to other conditions

1. Foresee unpredictable findings

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

statistics:

1. Evidence-based investigations
2. Primary reports of research
3. Estimation based on a provider’s

experience

1. Published meta-analyses

 

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

1. Algorithm published in a peer-reviewed

journal article

1. Clinical practice guidelines
2. Evidence-based research
3. All of the above

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

1. High percentage of persons with the given

condition will have an abnormal result

1. Low percentage of persons with the given

condition will have an abnormal result

1. Low likelihood of normal result in

persons without a given condition

1. None of the above

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

1. Low percentage of healthy individuals

will show a normal result

1. High percentage of healthy individuals

will show a normal result

1. High percentage of individuals with a

disorder will show a normal result

1. 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:

1. Positive result is strongly associated with

the disease

1. Negative result is strongly associated with

absence of the disease

1. Positive result is weakly associated with

the disease

1. Negative result is weakly associated with

absence of the disease

____ 10. Which of the following clinical reasoning tools is defined as evidencebased

resource based on mathematical modeling to express the likelihood of a condition

in select situations, settings, and/or patients?

1. Clinical practice guideline
2. Clinical decision rule
3. Clinical algorithm
4. 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 decisionmaking)

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. Evidencebased

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.

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, result. A high sensitivity indicates that a

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

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 specificity, the greater the percentage of individuals

who will have negative, or normal, results if they do not have the target condition.

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 negative result will be associated with a healthy

person. A likelihood ratio above 1 indicates that a positive result is associated with the

disease; a likelihood ratio less than 1 indicates that a negative result is associated with an

absence of the disease.

PTS: 1

10. ANS: B

Clinical decision (or prediction) rules provide another support for clinical reasoning.

Clinical decision rules are evidence-based resources that provide probabilistic statements

regarding the likelihood that a condition exists if certain variables are met with regard to

the prognosis of patients with specific findings. Decision rules use mathematical models

and are specific to certain situations, settings, and/or patient characteristics.

PTS: 1