CELBAN Patient Health History Taking 3 — Questions and Answers
Question 1: A patient reports a family history of 'heart trouble.' Which follow-up question provides the most clinically useful information?
- Who in your family had heart trouble?
- How did it affect their daily life?
- At what age were they diagnosed? (Correct answer)
- Did they recover from it?
Correct answer: At what age were they diagnosed?
Age of onset is the most clinically significant detail in family history because early-onset cardiac disease (before 55 in males, 65 in females) indicates a hereditary risk factor.
Question 2: While documenting social history, which question best screens for intimate partner violence?
- Is your home environment safe and comfortable?
- Do you ever feel afraid of someone at home? (Correct answer)
- Are you in a relationship?
- Who lives with you at home?
Correct answer: Do you ever feel afraid of someone at home?
Asking if the patient ever feels afraid of someone at home is a validated, direct screening question for intimate partner violence that is sensitive yet clinically effective.
Question 3: A patient's past medical history includes 'CABG x3.' When clarifying for the patient's record, the nurse should explain this means:
- Coronary artery bypass graft on three vessels (Correct answer)
- Three cardiac catheterizations
- Three cardiac ablation procedures
- Three coronary angioplasty procedures
Correct answer: Coronary artery bypass graft on three vessels
CABG x3 means a triple coronary artery bypass graft, where three blocked coronary arteries were bypassed using a graft vessel.
Question 4: When taking an obstetric history, a patient states she is G4P2. What does this indicate?
- Four pregnancies, two of which ended in delivery (Correct answer)
- Four deliveries, two of which were vaginal
- Two pregnancies, four living children
- Four prenatal visits, two at term
Correct answer: Four pregnancies, two of which ended in delivery
G4P2 means gravida 4 (four total pregnancies) and para 2 (two deliveries beyond 20 weeks gestation), which implies two pregnancies ended in abortion or miscarriage.
Question 5: A patient declines to answer questions about alcohol use. The nurse's best response is:
- Document 'patient denies alcohol use'
- Insist the patient answer, as it is medically necessary
- Acknowledge the patient's right to decline and document that the information was not provided (Correct answer)
- Skip the social history entirely
Correct answer: Acknowledge the patient's right to decline and document that the information was not provided
Patients have the right to decline to answer health history questions, and the nurse must respect this while accurately documenting that information was not obtained.
Question 6: Which statement best demonstrates the nurse using OLDCART to assess a patient's symptom?
- 'Is the pain in your chest or somewhere else?'
- 'Tell me where it hurts, when it started, and what makes it better or worse.' (Correct answer)
- 'Does this happen every day?'
- 'On a scale of 1 to 10, how bad is it?'
Correct answer: 'Tell me where it hurts, when it started, and what makes it better or worse.'
OLDCART (Onset, Location, Duration, Characteristics, Aggravating/relieving factors, Radiation, Treatment) is a systematic symptom assessment framework, and asking about location, timing, and modifying factors covers multiple OLDCART components.
Question 7: A nurse is taking a history from an elderly patient with cognitive decline. Which strategy is most appropriate?
- Rely entirely on collateral information from the family
- Conduct the interview with the patient first, then supplement with family input (Correct answer)
- Skip the history and proceed to physical examination
- Use only yes/no questions to reduce confusion
Correct answer: Conduct the interview with the patient first, then supplement with family input
The patient should always be interviewed first to preserve dignity and obtain first-person perspective; family members can then supplement or clarify as needed.
CELBAN Patient Health History Taking 3
A patient reports a family history of 'heart trouble.' Which follow-up question provides the most clinically useful information?