Stumped! 2 questions from 1st exam (BSN, soph)

[acerbia]

I took my first exam today (and I passed, yay!), but there were two questions that have been driving me nuts! I was wondering if anyone had some thoughts on them. I don't remember them verbatim of course, but I will try to word them as best I can.

1. You are taking the health history an older man. He periodically glances out the window, and away from you during the interview. How do you respond?

A. Re-word the questions into "yes/no".

B. Leave the sensitive questions until the end of the interview.

C. Keep asking him until he focuses.

D. (Don't remember, lol)

2. Your female patient has been diagnosed with benign (fibrocystic) breast disease. You are educating her on the diet she will need to follow. You instruct her to avoid:

A. Diet cola

B. Grapefruit juice

C. Coffee

D. Tea

For the first one, I chose C. I did not choose A because yes/no questions can limit the interview, and are only appropriate at certain times (e.g. 'have you ever had lung cancer?'). I did not choose B either, because I don't know if "I'm" asking sensitive questions or not. The question itself only says "health history" and "interview". If the questions to the man are "sensitive", wouldn't the test question say so? I chose C because I thought that the man may have trouble concentrating due to ADD/ADHD or maybe some mental or neurological disorder. Asking him the same question may get his attention and then I can re-focus the interview.

The second one was a bit trickier. Women with benign breast disease should avoid caffeinated beverages such as coffee and cola. Everything in the test question is caffeinated except for the grapefruit juice. Wouldn't that be something I would recommend? (When faced with the other 3 options.)

I know these kinds of posts come up a lot, and there's always great responses and discussions! Any thoughts on these?

[NCRNMDM, ASN, RN]

I'm not sure about the second, but I think the answer to the first is A. The man is having difficulty focusing, and you can use yes/no questions as a therapeutic tool in this situation. Yes/no questions, or closed-ended questions, can be therapeutic when you want to control the topics in order to gain useful information from a patient. In this situation, the man was unable to concentrate, and therefore unable to give you the information you needed. It may be that he is confused by your questions, he may be overwhelmed, he may be afraid due to his admission to the hospital (or illness), etc. By asking yes/no questions and focusing the interview, you are making things easier for him, and removing the thought process from his end.

This may mean asking something like, "have you ever been diagnosed with high blood pressure" rather than, "tell me about any heart or circulatory problems you have." By asking a direct question, the patient can indicate that they have the disease or condition, and they don't have to think as much. By asking an open-ended question you require that the patient try and remember every health problem they have (which can be a difficult task for those with a long medical history), and you then ask them to decide whether the issues they have fall into the category you are asking about. Some patients may not know what diseases or illnesses to include in each section, and you may quickly lose their interest because they are confused and anxious.

[Jennifer0512]

I'm thinking the second one sounds like a mistake, but I could be wrong. I agree with your reasoning that they should avoid anything with caffeine, so avoiding colas, coffees, and teas, seems logical to me. Wonder if it was a typo on your exam?!

[BacktotheBeach, ADN, BSN, RN]

for # 2 We just covered fibrocystic breast disease and our notes say no coffee! Could it be something in coffee, not just the caffeine to avoid?

[Jennifer0512]

I looked it up because I was curious and I read it was no coffee, tea, or colas, among a bunch of other no-no items, so I think it's more than just coffee, but who knows.

[NightNurseRN13]

The only things I can add is that with the elderly, you need to give them time to form a response, C sounds like a good answer, but how often and fast are you re-asking is the key point to the answer. And for the 2nd one I know that grapefruit juice interacts with a lot of medications, but the question doesn't list any medications.. did you guys cover medications that women going through that often take?

[acerbia]

@mattrnstudent23

You've got a great point with the yes/no questions! I think you're probably right, and your reasoning makes sense. I'll have to keep that in mind for the future.

"By asking an open-ended question you require that the patient try and remember every health problem they have" -- this is true, and since the exam question specially stated I was doing a health history, your answer is spot on. Thanks!

@superV and Jennifer0512

I have no idea, lol. My pp notes say to avoid "caffeinated beverages such as coffee and cola". And that's why I'm so confused on this question! They all have caffeine, except for the grapefruit juice. I probably just misread the question or can't remember it accurately. I am going to find out and report back though! lol

@Osteward

We didn't cover any medication interactions yet, but I know from a previous class that grapefruit juice and some medications are a no-no. Great point about question #1 too :)

Thanks everyone!

[NightNurseRN13]

another thing to keep in mind is that cola, tea and coffee can come in decaf form as well and that wasn't specified on the test question... looks like a trick question that could be over thought... I think I would have chosen grapefruit juice though.

[quiksilverkn12]

Grapefruit increases the amount of caffeine in your body. So if the patient is taking meds that interact with grapefruit, or if she has coffee and then takes in grapefruit it could be bad. I don't know but if you find out the answer let us know!

[AZMOMO2]

Are you sure you read the second question right? Sometimes I think I see something and I actually don't. Turns out I actually missed the part where it says, " All of these except or something along those lines?

Otherwise, I would be bringing that one directly to the attention of the tester during the exam. Never question your own knowledge :-)

[nurseprnRN, BSN, RN]

when someone looks out the window when you're talking to him, it could mean any number of things. i think it's presumptuous to say it means he's not concentrating, or he's got difficulty focusing, or whatever else. he could be hard of hearing and embarrassed to tell you. he could be grieving and you remind him of his dead child and he can't bear to look at you. he may be bored. he may have a cultural prohibition against talking about some health topics with someone like you (whatever that is). he may be embarrassed about something he hasn't told anyone and fears it might come out. he might be afraid that his expression might betray fear or anger or embarrassment. he might not want to talk to you, now or at any other time.

all that said, i'd want to know what "d" was. i'm not thrilled c any of the others. "b" might be the best if you assume he's got some reason not to want to trust you and you think you can use the time to establish a better therapeutic relationship c him, but that also assumes facts not in evidence.

interesting question. i'd be interested in hearing the alleged correct answer.