NR509 Advanced Physical Assessment
MIDTERM DOMINATION GUIDE: Board-
Style Questions, Step-by-Step Clinical
Rationales, and High-Yield Testing
Strategies for the 2026–2027 Academic
Year.
---
### SECTION 1: HEALTH HISTORY AND INTERVIEWING
**Question 1**
A 72-year-old patient presents to the clinic for a routine physical examination. The
patient reports feeling "forgetful lately." Which is the most appropriate initial
question for the advanced practice nurse to ask?
A) "Have you been diagnosed with Alzheimer's disease?"
B) "Can you tell me more about what you've noticed with your memory?"
C) "Would you like me to order a brain MRI?"
D) "Do you want a referral to a neurologist?"
**Answer: B**
,**Rationale:** When a patient reports a symptom, the clinician should first
explore the symptom using open-ended questions. Asking the patient to
elaborate on what they have noticed allows for a thorough assessment of the
nature, onset, duration, and impact of the memory changes before ordering tests
or making referrals.
---
**Question 2**
A 39-year-old nurse who is a well-established patient complains of irregular
menstrual periods and pelvic pain. She says she is having trouble sleeping and
asks whether she could be given a "sleeping pill." The patient also says she is
thinking of leaving her job. What is the best "next step" in caring for this patient?
A) Perform a pelvic examination.
B) Obtain a urine sample for testing.
C) Obtain a more complete description of problems.
D) Obtain blood for testing.
E) Ask about recent travel destinations.
**Answer: C**
**Rationale:** The patient presents with multiple concerns (irregular periods,
pelvic pain, insomnia, job-related stress). Before proceeding with specific tests or
interventions, it is essential to obtain a more complete description of all her
problems to understand the full clinical picture and identify priorities.
,---
**Question 3**
A 29-year-old female professional athlete presents to a new primary care provider
with chronic menstrual complaints. She remarks that, in the past, she has
experienced a dismissal of her complaints because of her high level of physical
fitness. She is seeking a care provider who will explore the issue in more detail.
Which of the following is the description of the patient-centered care this
individual seeks?
A) Structured and clinician-centered with open-ended questions
B) Validating and empathetic with open-ended questions
C) Dismissive and concrete with open-ended questions
D) Affirming and reassuring with close-ended questions
E) Factual and structured with active listening
**Answer: B**
**Rationale:** Patient-centered care involves validating the patient's
experiences, showing empathy, and using open-ended questions to explore
concerns fully. This approach acknowledges past dismissal and builds trust.
---
**Question 4**
A 36-year-old female air traffic controller presents for a routine visit 3 months
after losing her spouse. The patient denies any psychiatric symptoms and states
, she has slept better recently. She becomes wistful and briefly tearful when
speaking of unfulfilled plans with her spouse. What is the most appropriate
response?
A) Refer immediately for grief counseling
B) Prescribe an antidepressant
C) Acknowledge her feelings and continue the history
D) Ask about suicidal ideation
E) Order a sleep study
**Answer: C**
**Rationale:** The patient's tearfulness is a normal grief response.
Acknowledging her feelings validates her experience without pathologizing
normal bereavement. Continued history-taking allows for further assessment
without jumping to unnecessary interventions.
---
**Question 5**
A teenage girl has arrived complaining of pain in her left wrist. She was playing
basketball when she fell and landed on her left hand. What is the most
appropriate initial approach?
A) Order an X-ray immediately
B) Ask open-ended questions about the injury mechanism
MIDTERM DOMINATION GUIDE: Board-
Style Questions, Step-by-Step Clinical
Rationales, and High-Yield Testing
Strategies for the 2026–2027 Academic
Year.
---
### SECTION 1: HEALTH HISTORY AND INTERVIEWING
**Question 1**
A 72-year-old patient presents to the clinic for a routine physical examination. The
patient reports feeling "forgetful lately." Which is the most appropriate initial
question for the advanced practice nurse to ask?
A) "Have you been diagnosed with Alzheimer's disease?"
B) "Can you tell me more about what you've noticed with your memory?"
C) "Would you like me to order a brain MRI?"
D) "Do you want a referral to a neurologist?"
**Answer: B**
,**Rationale:** When a patient reports a symptom, the clinician should first
explore the symptom using open-ended questions. Asking the patient to
elaborate on what they have noticed allows for a thorough assessment of the
nature, onset, duration, and impact of the memory changes before ordering tests
or making referrals.
---
**Question 2**
A 39-year-old nurse who is a well-established patient complains of irregular
menstrual periods and pelvic pain. She says she is having trouble sleeping and
asks whether she could be given a "sleeping pill." The patient also says she is
thinking of leaving her job. What is the best "next step" in caring for this patient?
A) Perform a pelvic examination.
B) Obtain a urine sample for testing.
C) Obtain a more complete description of problems.
D) Obtain blood for testing.
E) Ask about recent travel destinations.
**Answer: C**
**Rationale:** The patient presents with multiple concerns (irregular periods,
pelvic pain, insomnia, job-related stress). Before proceeding with specific tests or
interventions, it is essential to obtain a more complete description of all her
problems to understand the full clinical picture and identify priorities.
,---
**Question 3**
A 29-year-old female professional athlete presents to a new primary care provider
with chronic menstrual complaints. She remarks that, in the past, she has
experienced a dismissal of her complaints because of her high level of physical
fitness. She is seeking a care provider who will explore the issue in more detail.
Which of the following is the description of the patient-centered care this
individual seeks?
A) Structured and clinician-centered with open-ended questions
B) Validating and empathetic with open-ended questions
C) Dismissive and concrete with open-ended questions
D) Affirming and reassuring with close-ended questions
E) Factual and structured with active listening
**Answer: B**
**Rationale:** Patient-centered care involves validating the patient's
experiences, showing empathy, and using open-ended questions to explore
concerns fully. This approach acknowledges past dismissal and builds trust.
---
**Question 4**
A 36-year-old female air traffic controller presents for a routine visit 3 months
after losing her spouse. The patient denies any psychiatric symptoms and states
, she has slept better recently. She becomes wistful and briefly tearful when
speaking of unfulfilled plans with her spouse. What is the most appropriate
response?
A) Refer immediately for grief counseling
B) Prescribe an antidepressant
C) Acknowledge her feelings and continue the history
D) Ask about suicidal ideation
E) Order a sleep study
**Answer: C**
**Rationale:** The patient's tearfulness is a normal grief response.
Acknowledging her feelings validates her experience without pathologizing
normal bereavement. Continued history-taking allows for further assessment
without jumping to unnecessary interventions.
---
**Question 5**
A teenage girl has arrived complaining of pain in her left wrist. She was playing
basketball when she fell and landed on her left hand. What is the most
appropriate initial approach?
A) Order an X-ray immediately
B) Ask open-ended questions about the injury mechanism
