terviewing Process Ball: Seidel’s Guide to Physical Examination, 9th Edition MULTIPLE CHOICE 1. Which question would be considered a “leading question?” a. “What do you think is causing your headaches?” b. “You don’t get headaches often, do you?” c. “On a scale of 1 to 10, how would you rate the severity of your headaches?” d. “At what time of the day are your headaches the most severe?” ANS: B Stating to the patient that he or she does not get headaches would limit the information in the patient’s answer. Asking the patient what he or she thinks is causing the headaches is an open-ended question. Asking the patient how he or she would rate the severity of the headaches and asking what time of the day the headaches are the most severe are direct questions. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. When are open-ended questions generally most useful? a. During sensitive area part of the interview b. After several closed-ended questions have been asked c. While designing the genogram d. During the review of systems ANS: A Asking open-ended questions during the sensitive part of the interview allows you to gather more information and establishes you as an empathic listener, which is the first step of effective communication. Asking closed-ended questions may stifle the patient’s desire to discuss the history of the illness. Interviewing for the purpose of designing a genogram or conducting a review of systems requires more focused data than can be more easily gathered with direct questioning. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. Periods of silence during the interview can serve important purposes, such as: a. allowing the clinician to catch up on documentation. b. promoting calm. c. providing time for reflection. d. increasing the length of the visit. ANS: C Silence is a useful tool during interviews for the purposes of reflection, summoning courage, and displaying compassion. This is not a time to document in the chart, but rather to focus on the patient. Periods of silence may cause anxiety rather than promote calm. The length of the visit is less important than getting critical information. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. Mr. Franklin is speaking with you, the healthcare provider, about his respiratory problem. Mr. Franklin says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. Franklin 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. “I don’t know what’s wrong. You could have almost any disease.” d. “I’ll examine you and figure out later what the problem is.” ANS: A “After 3 days, you’re tired of coughing. Have you had a fever?” is the only response aimed at focusing on the chief compliant to gather more data and does not digress from the issue. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. 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 the patient why she needs to know. d. Tell the patient that you do not discuss your family with patients. ANS: B Giving a brief, undetailed answer will satisfy the patient’s curiosity about yourself without invading your private life. Ignoring the patient’s comment, continuing with the interview, and telling the patient that you do not discuss your family with patients will potentially anger or frustrate her and keep her from sharing openly. Asking the patient why she needs to know will distract from the real reason she is seeking care and instead move the interview conversation away from the topics that should be discussed. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. 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 complaint 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. ANS: A With an anxious, vulnerable patient, it is best to not hurry; a calm demeanor will communicate caring to the patient. If you as a healthcare provider are hurried, the patient will be more anxious. The best way to assist an anxious patient is to not hurry and remain calm, because this will communicate caring to the patient. Asking the patient if she wants to wait until another day to talk to you delays the needed health care. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 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. “What in life is causing you such pain?” c. “You can’t mean what you’re saying.” d. “If you think about it, nothing is worth getting this upset about.” ANS: B Specific but open-ended questions are best used when the patient has feelings of loss of self-worth and depression. “Try to think about the good things in life,” “You can’t mean what you’re saying,” and “If you think about it, nothing is worth getting this upset about” are statements that will hurry the patient and offer only superficial assurance. DIF: Cognitive Level: Analyzing (Analysis) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. You are collecting a history from a 16-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be: a. given the opportunity to be interviewed without the parent at some point during the interview. b. mailed a questionnaire in advance to avoid the need for them to talk. c. ignored while you address all questions to the parent. d. allowed to direct the flow of the interview. ANS: A The adolescent should be given the opportunity to give information directly. This enhances the probability that the adolescent will follow your advice. Mailing a questionnaire in advance to avoid the need for her to talk does not assist the adolescent in learning to respond to answers regarding her health. The parent can help fill in gaps at the end. If she is ignored while you address all questions to the parent, the patient will feel as though she is just being discussed and is not part of the process for the health care. The healthcare provider should always direct the flow of the interview according to the patient’s responses. DIF: Cognitive Level: Applying (Application) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Information that is needed during the initial interview of a pregnant woman includes all the following except: a. the gender that the woman hopes the baby will be. b. past medical history. c. healthcare practices. d. the woman’s remembering (knowledge) about pregnancy. ANS: A The initial interview for the pregnant woman should include information about her past medical history, assessment of health practices, identification of potential risk factors, and assessment of remembering (knowledge) as it affects the pregnancy. The gender of the fetus is not as important as the information about her past medical history, healthcare practices, and the woman’s remembering (knowledge) about her pregnancy. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. 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 facing the patient. d. dim the lights to decrease anxiety. ANS: C The healthcare provider should position himself or herself so that the older patient can see his or her face. Shouting distorts speech, dimming the lights impairs vision, and a written interview may be necessary if all else fails. DIF: Cognitive Level: Understanding (Comprehension) OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation