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NR 509 Advanced Physical Assessment \Week 4
Midterm Exam — Complete 100 Questions &
Answers \ Graded A+ | 100% Verified | Examplify
Proctored Format
UNIT 1 — HEALTH HISTORY AND INTERVIEWING TECHNIQUES
Q1. A nurse practitioner student is conducting a health history interview. Which of the
following questions is an example of an open-ended question?
A. "Do you have chest pain?" B. "Is your pain sharp or dull?" C. "Tell me about what brought
you in today." ✅ D. "Have you had this before?" E. "Does the pain radiate to your arm?"
Rationale: Open-ended questions allow patients to respond in their own words without being
directed toward a specific answer. They begin with phrases like "Tell me about," "Describe," or
"How has...". Open-ended questions are used at the beginning of the interview to establish the
chief complaint and allow the patient to narrate their experience. Closed-ended questions
(yes/no answers) are used to clarify specific details after the open-ended phase. The advanced
practice provider should use a combination of both techniques throughout the interview.
Q2. During a health history interview, a patient becomes tearful when discussing her
diagnosis of breast cancer. The NP student responds by saying "This must be very difficult for
you." This response is an example of:
A. Sympathy B. Reassurance C. Empathy ✅ D. Confrontation E. Reflection
Rationale: Empathy is the ability to recognize, understand, and acknowledge the patient's
emotional state without judgment. The statement "This must be very difficult for you" reflects
the patient's emotion back to her, communicating understanding. Sympathy involves sharing in
the patient's emotion ("I feel so sorry for you"). Reflection involves repeating back what the
patient said. Confrontation involves pointing out inconsistencies. Empathy is a foundational
pg. 1
, 2
communication skill in advanced practice nursing and is associated with improved patient
outcomes and therapeutic alliance.
Q3. When obtaining the history of present illness (HPI), which mnemonic is MOST commonly
used to characterize symptoms completely?
A. SAMPLE B. PQRST C. OLD CARTS ✅ D. SOAP E. VINDICATE
Rationale: OLD CARTS is the standard mnemonic for HPI characterization:
• O — Onset
• L — Location
• D — Duration
• C — Character
• A — Aggravating/Alleviating factors
• R — Radiation
• T — Timing
• S — Severity
PQRST (Provocation, Quality, Radiation, Severity, Timing) is another common
alternative. SAMPLE is used in emergency settings (Signs/Symptoms, Allergies, Medications,
Past history, Last meal, Events). OLD CARTS is the primary mnemonic in advanced physical
assessment courses.
Q4. A 45-year-old patient reports "chest tightness" that began 3 hours ago. He rates the pain
as 7/10. It radiates to his left jaw. Which component of the HPI does "radiates to his left jaw"
represent?
A. Character B. Location C. Timing D. Radiation ✅ E. Severity
Rationale: Radiation describes where the pain spreads or moves from its primary location. Jaw
pain radiation is a classic feature of myocardial ischemia — the referred pain pathway travels
through sympathetic afferents from the heart to dermatomes C3–T4, which share spinal cord
segments with the jaw, neck, and left arm. This is a high-yield clinical pearl — any patient with
chest pain radiating to the jaw, neck, or left arm must have cardiac etiology ruled out
immediately regardless of other findings.
pg. 2
, 3
Q5. A patient reports taking "a water pill" but cannot recall the name. The NP recognizes this
is likely referring to which class of medications?
A. Beta-blockers B. ACE inhibitors C. Diuretics ✅ D. Calcium channel blockers E. Antiplatelets
Rationale: Diuretics (furosemide, hydrochlorothiazide, spironolactone) are commonly referred
to as "water pills" by patients because they increase urine output. When patients cannot recall
medication names, it is essential to use lay terminology to identify drug classes. The NP should
then clarify the specific medication name using pharmacy records, the patient's pill bottle, or a
medication reconciliation tool. This skill is critical during the medication history component of
the complete health history.
Q6. Which of the following BEST describes the purpose of the functional assessment in a
complete health history?
A. To identify current medications and allergies B. To assess the patient's ability to perform
activities of daily living ✅ C. To document family history of genetic conditions D. To review
systems for unrecognized symptoms E. To establish the chief complaint
Rationale: The functional assessment evaluates the patient's ability to perform Activities of
Daily Living (ADLs) — bathing, dressing, feeding, toileting, transferring — and Instrumental
ADLs (IADLs) — cooking, shopping, managing finances, using transportation. This is particularly
important in elderly patients, those with chronic illness, and post-surgical patients. Functional
status directly impacts treatment planning, discharge planning, and need for home services. It is
a key component of the geriatric assessment.
Q7. A 70-year-old man presents for a complete health history. When assessing his social
history, which of the following is MOST important to include?
A. Number of childhood illnesses B. Immunization history C. Living situation, support systems,
and tobacco/alcohol/drug use ✅ D. Family history of cardiovascular disease E. Review of all
prior surgical procedures
Rationale: The social history includes: tobacco use (pack-year history), alcohol use (CAGE
questionnaire or AUDIT tool), illicit drug use (DAST-10), living situation (alone vs. with
family), support systems, occupation and occupational exposures, education level, sexual
history, travel history, and cultural/spiritual beliefs. These factors are social determinants of
pg. 3
, 4
health that significantly impact disease risk, health behaviors, and treatment adherence. In
elderly patients, living situation and support systems are particularly critical for safe discharge
and care planning.
UNIT 2 — GENERAL SURVEY AND VITAL SIGNS
Q8. During the general survey, which of the following observations provides the MOST
immediate information about a patient's overall health status?
A. Review of the patient's medical records B. Patient's appearance, behavior, and level of
distress ✅ C. Patient's chief complaint D. Vital sign trends over time E. Results of laboratory
tests
Rationale: The general survey is the first step of the physical examination and begins the
moment the clinician observes the patient. It includes: apparent state of health, level of
distress, skin color and obvious lesions, dress and hygiene, affect and behavior, body habitus,
posture and gait, and whether the patient appears stated age. This initial gestalt impression
provides critical diagnostic information — a patient who "looks sick" (toxic appearance)
regardless of vital signs may require urgent intervention. The general survey is performed
before touching the patient.
Q9. A patient's blood pressure is 158/96 mmHg on two separate readings taken 5 minutes
apart. Which of the following is the correct interpretation?
A. Normal blood pressure B. Elevated blood pressure (prehypertension) C. Stage 1
hypertension ✅ D. Stage 2 hypertension E. Hypertensive crisis
Rationale: Per ACC/AHA 2017 Blood Pressure Classification:
Category Systolic Diastolic
Normal <120 <80
Elevated 120–129 <80
Stage 1 HTN 130–139 80–89
Stage 2 HTN ≥140 ≥90
pg. 4
NR 509 Advanced Physical Assessment \Week 4
Midterm Exam — Complete 100 Questions &
Answers \ Graded A+ | 100% Verified | Examplify
Proctored Format
UNIT 1 — HEALTH HISTORY AND INTERVIEWING TECHNIQUES
Q1. A nurse practitioner student is conducting a health history interview. Which of the
following questions is an example of an open-ended question?
A. "Do you have chest pain?" B. "Is your pain sharp or dull?" C. "Tell me about what brought
you in today." ✅ D. "Have you had this before?" E. "Does the pain radiate to your arm?"
Rationale: Open-ended questions allow patients to respond in their own words without being
directed toward a specific answer. They begin with phrases like "Tell me about," "Describe," or
"How has...". Open-ended questions are used at the beginning of the interview to establish the
chief complaint and allow the patient to narrate their experience. Closed-ended questions
(yes/no answers) are used to clarify specific details after the open-ended phase. The advanced
practice provider should use a combination of both techniques throughout the interview.
Q2. During a health history interview, a patient becomes tearful when discussing her
diagnosis of breast cancer. The NP student responds by saying "This must be very difficult for
you." This response is an example of:
A. Sympathy B. Reassurance C. Empathy ✅ D. Confrontation E. Reflection
Rationale: Empathy is the ability to recognize, understand, and acknowledge the patient's
emotional state without judgment. The statement "This must be very difficult for you" reflects
the patient's emotion back to her, communicating understanding. Sympathy involves sharing in
the patient's emotion ("I feel so sorry for you"). Reflection involves repeating back what the
patient said. Confrontation involves pointing out inconsistencies. Empathy is a foundational
pg. 1
, 2
communication skill in advanced practice nursing and is associated with improved patient
outcomes and therapeutic alliance.
Q3. When obtaining the history of present illness (HPI), which mnemonic is MOST commonly
used to characterize symptoms completely?
A. SAMPLE B. PQRST C. OLD CARTS ✅ D. SOAP E. VINDICATE
Rationale: OLD CARTS is the standard mnemonic for HPI characterization:
• O — Onset
• L — Location
• D — Duration
• C — Character
• A — Aggravating/Alleviating factors
• R — Radiation
• T — Timing
• S — Severity
PQRST (Provocation, Quality, Radiation, Severity, Timing) is another common
alternative. SAMPLE is used in emergency settings (Signs/Symptoms, Allergies, Medications,
Past history, Last meal, Events). OLD CARTS is the primary mnemonic in advanced physical
assessment courses.
Q4. A 45-year-old patient reports "chest tightness" that began 3 hours ago. He rates the pain
as 7/10. It radiates to his left jaw. Which component of the HPI does "radiates to his left jaw"
represent?
A. Character B. Location C. Timing D. Radiation ✅ E. Severity
Rationale: Radiation describes where the pain spreads or moves from its primary location. Jaw
pain radiation is a classic feature of myocardial ischemia — the referred pain pathway travels
through sympathetic afferents from the heart to dermatomes C3–T4, which share spinal cord
segments with the jaw, neck, and left arm. This is a high-yield clinical pearl — any patient with
chest pain radiating to the jaw, neck, or left arm must have cardiac etiology ruled out
immediately regardless of other findings.
pg. 2
, 3
Q5. A patient reports taking "a water pill" but cannot recall the name. The NP recognizes this
is likely referring to which class of medications?
A. Beta-blockers B. ACE inhibitors C. Diuretics ✅ D. Calcium channel blockers E. Antiplatelets
Rationale: Diuretics (furosemide, hydrochlorothiazide, spironolactone) are commonly referred
to as "water pills" by patients because they increase urine output. When patients cannot recall
medication names, it is essential to use lay terminology to identify drug classes. The NP should
then clarify the specific medication name using pharmacy records, the patient's pill bottle, or a
medication reconciliation tool. This skill is critical during the medication history component of
the complete health history.
Q6. Which of the following BEST describes the purpose of the functional assessment in a
complete health history?
A. To identify current medications and allergies B. To assess the patient's ability to perform
activities of daily living ✅ C. To document family history of genetic conditions D. To review
systems for unrecognized symptoms E. To establish the chief complaint
Rationale: The functional assessment evaluates the patient's ability to perform Activities of
Daily Living (ADLs) — bathing, dressing, feeding, toileting, transferring — and Instrumental
ADLs (IADLs) — cooking, shopping, managing finances, using transportation. This is particularly
important in elderly patients, those with chronic illness, and post-surgical patients. Functional
status directly impacts treatment planning, discharge planning, and need for home services. It is
a key component of the geriatric assessment.
Q7. A 70-year-old man presents for a complete health history. When assessing his social
history, which of the following is MOST important to include?
A. Number of childhood illnesses B. Immunization history C. Living situation, support systems,
and tobacco/alcohol/drug use ✅ D. Family history of cardiovascular disease E. Review of all
prior surgical procedures
Rationale: The social history includes: tobacco use (pack-year history), alcohol use (CAGE
questionnaire or AUDIT tool), illicit drug use (DAST-10), living situation (alone vs. with
family), support systems, occupation and occupational exposures, education level, sexual
history, travel history, and cultural/spiritual beliefs. These factors are social determinants of
pg. 3
, 4
health that significantly impact disease risk, health behaviors, and treatment adherence. In
elderly patients, living situation and support systems are particularly critical for safe discharge
and care planning.
UNIT 2 — GENERAL SURVEY AND VITAL SIGNS
Q8. During the general survey, which of the following observations provides the MOST
immediate information about a patient's overall health status?
A. Review of the patient's medical records B. Patient's appearance, behavior, and level of
distress ✅ C. Patient's chief complaint D. Vital sign trends over time E. Results of laboratory
tests
Rationale: The general survey is the first step of the physical examination and begins the
moment the clinician observes the patient. It includes: apparent state of health, level of
distress, skin color and obvious lesions, dress and hygiene, affect and behavior, body habitus,
posture and gait, and whether the patient appears stated age. This initial gestalt impression
provides critical diagnostic information — a patient who "looks sick" (toxic appearance)
regardless of vital signs may require urgent intervention. The general survey is performed
before touching the patient.
Q9. A patient's blood pressure is 158/96 mmHg on two separate readings taken 5 minutes
apart. Which of the following is the correct interpretation?
A. Normal blood pressure B. Elevated blood pressure (prehypertension) C. Stage 1
hypertension ✅ D. Stage 2 hypertension E. Hypertensive crisis
Rationale: Per ACC/AHA 2017 Blood Pressure Classification:
Category Systolic Diastolic
Normal <120 <80
Elevated 120–129 <80
Stage 1 HTN 130–139 80–89
Stage 2 HTN ≥140 ≥90
pg. 4
