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TEST BANK FOR ADVANCED ASSESSMENT INTERPRETING FINDINGS AND FORMULATING DIFFERENTIAL DIAGNOSES 4TH EDITION MARYJO GOOLSBY LAURIE GRUBBS LATEST UPDATED EXAMINATION STUDY GUIDE 2024
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Nursing Academy College9 pag.
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Chapter 1. Assessment and Clinical Decision Making: An Overview
ANS: A 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.
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ANS: D In the PQRST model, “P” refers to exploring precipitating and palliative factors. Identify factors that make the symptom worse and/or better, any previous self-treatment or prescribed treatment, and response.
D. Review of systems
ANS: B Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
Clinical decision trees provide a graphic depiction of the decision-making process, showing the pathway based on findings at various steps in the process.
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.
D. All of the above
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.
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.
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.
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.
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.