NR 509 Week 4 Midterm Exam | Advanced Physical Assessment
Original Questions • Correct Answers • Expert Rationales
Question 1
1. A 23-year-old physician assistant (PA) student found that she felt nervous when called
upon to examine men in her age group. On one occasion, she encountered a young male
patient who appeared embarrassed to see her walk into the room. What should the PA do to
minimize their mutual discomfort?
a. Adjust lighting so it is tangential to the patient's body.
b. Explain how the examination will proceed.
c. Ask the patient where he comes from.
d. Explain that she is a PA student.
e. Provide ongoing interpretation of findings.
Correct Answer: b. Explain how the examination will proceed.
Expert Rationale: Explaining the sequence of the examination reduces uncertainty, preserves the
patient's sense of control, and normalizes the encounter. It is more effective than focusing on lighting,
the student's status, or unrelated small talk because it directly addresses embarrassment while
maintaining professional boundaries.
Question 2
A 34-year-old male with a history of complex social and medical needs (including current
substance abuse) presents to a primary care teaching clinic. The patient has experienced a
number of adversarial relationships with prior clinicians, including voluntarily leaving two
practices within the previous year and being asked to leave care at a third clinic due to
misbehavior. The attending physician desires to utilize the approaches to this patient that
are most likely lead to comprehensive care and patient compliance. Which of the following is
the most appropriate interview style for the attending physician to use?
a. Focusing on the need for immediate diagnostic certainty over personal connection
b. Taking charge of the interaction to meet the clinician's desire to acquire diagnostic information
c. Following the patient's lead to understand their thoughts, ideas, concerns, and requests
d. Deferring respect, empathy, humility, and sensitivity in favor of the acquisition of concrete details
about the patient's condition
e. Taking a symptom-focused approach to reduce the involvement of the patient's emotional
difficulties
Correct Answer: c. Following the patient's lead to understand their thoughts, ideas, concerns, and
requests
Expert Rationale: A patient-centered style follows the patient's narrative and explores ideas, concerns,
expectations, and priorities. This approach is especially useful when prior clinician relationships have
been adversarial because it promotes trust, shared decision-making, and adherence rather than control
or premature diagnostic closure.
Question 3
A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his
brother, who convinced the patient to attend the clinic after he disclosed that he prefers
homosexual partners but is afraid that his last partner may have given him an infection. The
patient expresses to the intake nurse that he is unashamed of his sexual orientation and will
Page 1
,not stay through the visit if he feels that he is dismissed or discriminated against because of
it. The nurse practitioner receives this communication prior to entering the examination
room and decides to employ active listening to best connect with the patient at this critical
juncture in his care with the clinic. Which of the following is an example of an active listening
technique?
a. Ignoring visual cues to focus on the patient's exact words
b. Setting aside the patient's emotional state to focus on his medical needs
c. Paring down the patient's concerns to concrete medical needs
d. Using nonverbal communication to encourage the patient to expand their narrative
e. Considering a differential diagnosis while the patient is speaking to maximize the patient's time
with the provider
Correct Answer: d. Using nonverbal communication to encourage the patient to expand their narrative
Expert Rationale: Active listening includes attentive posture, eye contact, appropriate facial expression,
silence, nodding, and other nonverbal cues that invite the patient to continue. Ignoring emotional or
visual cues weakens rapport and can cause important psychosocial information to be missed.
Question 4
A 42-year-old female mathematician presents for follow-up care regarding a new diagnosis of
systemic lupus erythematosus 6 months ago after a lengthy diagnostic process during
which she was debilitated with fatigue and joint pain. Since her diagnosis, she has been
minimally compliant with medications and has switched her rheumatology provider twice.
She continues to feel ill, and, in explanation for her lack of adherence to the prescribed
treatment, she simply says, "I don't like it." At this initial visit with her third rheumatology
provider, the clinician elects to explore the issues behind her noncompliance before
engaging in diagnostics and treatment using the FIFE model. Which of the following best
defines the elements of the FIFE model?
a. Focus, intensity, function, and evaluation
b. Facts, intensity, focus, and evidence
c. Feelings, ideas, function, and expectations
d. Feelings, impression, fantasy, and emotion
e. Facts, intelligence, fortuity, and eventuality
Correct Answer: c. Feelings, ideas, function, and expectations
Expert Rationale: FIFE stands for Feelings, Ideas, Function, and Expectations. It is used to understand
the patient's personal experience of illness, including emotional response, beliefs about the problem,
effect on daily life, and expectations for care.
Question 5
A 39-year-old nurse who is a well-established patient complains of irregular menstrual
periods and pelvic pain. She says that she is having trouble sleeping and asks whether she
Page 2
,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.
Correct Answer: c. Obtain a more complete description of problems.
Expert Rationale: Before ordering tests or performing a focused examination, the clinician should clarify
the patient's concerns and obtain a fuller history. Multiple symptoms and major life changes may be
related, and a complete description helps determine what physical examination and testing are actually
indicated.
Question 6
A 29-year-old female professional athlete presents to a new primary care provider with
chronic menstrual complaints. She remarks to the nursing staff that, in the past, she has
experienced a dismissal of her complaints because of her high level of physical fitness and
conditioning. She is seeking a care provider who will explore the issue in more detail and
work with her particular concerns. 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
Correct Answer: b. Validating and empathetic with open-ended questions
Expert Rationale: Patient-centered care is validating, empathetic, and driven by open-ended questions
that allow the patient to explain concerns in her own words. A rigid clinician-centered or predominantly
closed-question approach risks repeating the dismissive experience she is specifically trying to avoid.
Question 7
A 36-year-old female air traffic controller presents to her primary care provider for a routine
visit 3 months after losing her spouse to a lengthy battle with a neurodegenerative disease.
The patient denies any psychiatric symptoms on review of systems and, in fact, states that
she has slept better in the last month than she had in the previous years. She endorses a
healthy support system, including the extended family of her deceased spouse, with whom
she is still close. She becomes wistful and briefly tearful when speaking of the plans that
they had when they first married that were never fulfilled; she then changes the subject
Page 3
, rapidly to whether her Pap smear is due. Which of the following is an example of an
empathetic response to this patient?
a. Assuming that the event caused her to become depressed and expressing the same feeling on
behalf of the patient
b. Recognizing the patient's emotions by asking or confirming how she feels about the event
c. By allowing the crying patient to look around the room for tissues to permit her an excuse to hide
her face and defer her emotions
d. Presuming that the patient's emotions meet social expectations, such as being depressed and
even traumatized by her spouse's death
e. Narrowing the understanding of the patient's emotional response to only thoughts and feelings that
have been verbalized
Correct Answer: b. Recognizing the patient's emotions by asking or confirming how she feels about the
event
Expert Rationale: Empathy begins by recognizing and validating the patient's emotion rather than
assuming what she feels. Asking or confirming the meaning of her tearfulness acknowledges grief while
allowing her to define her own emotional experience.
Question 8
A 63-year-old male presents to establish care at a new primary care clinic to discuss issues
with pain and fatigue. The clinician conducting the visit begins with general historical
questions but quickly becomes suspicious that the patient is suffering from decompensated
heart failure. When the patient mentions that he has had vague chest pain since last night,
the clinician feels that the focus must be redirected to this potentially emergent condition.
Which of the following interview techniques is the most appropriate to effectively manage
this visit?
a. Providing serial reassurances such as, "Don't worry, you're going to be fine."
b. Asking a series of negative questions such as, "You don't have any swelling in your feet, do you?"
c. Nonverbally cuing the patient to focus on his narrative regarding a motor vehicle accident
d. (MVA) that led to back pain
e. Asking leading questions that focus on the presumed diagnosis of chest pain
f. Moving from open-ended to focused questions
Correct Answer: f. Moving from open-ended to focused questions
Expert Rationale: When a potentially urgent symptom emerges, the interview should narrow from open-
ended exploration to focused questions that quickly clarify severity, timing, associated symptoms, and
immediate risk. Leading or negatively phrased questions can bias the history and should be avoided.
Question 9
A 59-year-old patient presents to his primary care provider with a history of several episodes
of sharp epigastric pain. His father died of pancreatic cancer at age 52 years, and the patient
recalls to the clinician that, "His pain was just like mine is now ..." The patient then pauses
several seconds. The clinician replies, "Just like?" after which the patient restarts his
Page 4
Original Questions • Correct Answers • Expert Rationales
Question 1
1. A 23-year-old physician assistant (PA) student found that she felt nervous when called
upon to examine men in her age group. On one occasion, she encountered a young male
patient who appeared embarrassed to see her walk into the room. What should the PA do to
minimize their mutual discomfort?
a. Adjust lighting so it is tangential to the patient's body.
b. Explain how the examination will proceed.
c. Ask the patient where he comes from.
d. Explain that she is a PA student.
e. Provide ongoing interpretation of findings.
Correct Answer: b. Explain how the examination will proceed.
Expert Rationale: Explaining the sequence of the examination reduces uncertainty, preserves the
patient's sense of control, and normalizes the encounter. It is more effective than focusing on lighting,
the student's status, or unrelated small talk because it directly addresses embarrassment while
maintaining professional boundaries.
Question 2
A 34-year-old male with a history of complex social and medical needs (including current
substance abuse) presents to a primary care teaching clinic. The patient has experienced a
number of adversarial relationships with prior clinicians, including voluntarily leaving two
practices within the previous year and being asked to leave care at a third clinic due to
misbehavior. The attending physician desires to utilize the approaches to this patient that
are most likely lead to comprehensive care and patient compliance. Which of the following is
the most appropriate interview style for the attending physician to use?
a. Focusing on the need for immediate diagnostic certainty over personal connection
b. Taking charge of the interaction to meet the clinician's desire to acquire diagnostic information
c. Following the patient's lead to understand their thoughts, ideas, concerns, and requests
d. Deferring respect, empathy, humility, and sensitivity in favor of the acquisition of concrete details
about the patient's condition
e. Taking a symptom-focused approach to reduce the involvement of the patient's emotional
difficulties
Correct Answer: c. Following the patient's lead to understand their thoughts, ideas, concerns, and
requests
Expert Rationale: A patient-centered style follows the patient's narrative and explores ideas, concerns,
expectations, and priorities. This approach is especially useful when prior clinician relationships have
been adversarial because it promotes trust, shared decision-making, and adherence rather than control
or premature diagnostic closure.
Question 3
A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his
brother, who convinced the patient to attend the clinic after he disclosed that he prefers
homosexual partners but is afraid that his last partner may have given him an infection. The
patient expresses to the intake nurse that he is unashamed of his sexual orientation and will
Page 1
,not stay through the visit if he feels that he is dismissed or discriminated against because of
it. The nurse practitioner receives this communication prior to entering the examination
room and decides to employ active listening to best connect with the patient at this critical
juncture in his care with the clinic. Which of the following is an example of an active listening
technique?
a. Ignoring visual cues to focus on the patient's exact words
b. Setting aside the patient's emotional state to focus on his medical needs
c. Paring down the patient's concerns to concrete medical needs
d. Using nonverbal communication to encourage the patient to expand their narrative
e. Considering a differential diagnosis while the patient is speaking to maximize the patient's time
with the provider
Correct Answer: d. Using nonverbal communication to encourage the patient to expand their narrative
Expert Rationale: Active listening includes attentive posture, eye contact, appropriate facial expression,
silence, nodding, and other nonverbal cues that invite the patient to continue. Ignoring emotional or
visual cues weakens rapport and can cause important psychosocial information to be missed.
Question 4
A 42-year-old female mathematician presents for follow-up care regarding a new diagnosis of
systemic lupus erythematosus 6 months ago after a lengthy diagnostic process during
which she was debilitated with fatigue and joint pain. Since her diagnosis, she has been
minimally compliant with medications and has switched her rheumatology provider twice.
She continues to feel ill, and, in explanation for her lack of adherence to the prescribed
treatment, she simply says, "I don't like it." At this initial visit with her third rheumatology
provider, the clinician elects to explore the issues behind her noncompliance before
engaging in diagnostics and treatment using the FIFE model. Which of the following best
defines the elements of the FIFE model?
a. Focus, intensity, function, and evaluation
b. Facts, intensity, focus, and evidence
c. Feelings, ideas, function, and expectations
d. Feelings, impression, fantasy, and emotion
e. Facts, intelligence, fortuity, and eventuality
Correct Answer: c. Feelings, ideas, function, and expectations
Expert Rationale: FIFE stands for Feelings, Ideas, Function, and Expectations. It is used to understand
the patient's personal experience of illness, including emotional response, beliefs about the problem,
effect on daily life, and expectations for care.
Question 5
A 39-year-old nurse who is a well-established patient complains of irregular menstrual
periods and pelvic pain. She says that she is having trouble sleeping and asks whether she
Page 2
,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.
Correct Answer: c. Obtain a more complete description of problems.
Expert Rationale: Before ordering tests or performing a focused examination, the clinician should clarify
the patient's concerns and obtain a fuller history. Multiple symptoms and major life changes may be
related, and a complete description helps determine what physical examination and testing are actually
indicated.
Question 6
A 29-year-old female professional athlete presents to a new primary care provider with
chronic menstrual complaints. She remarks to the nursing staff that, in the past, she has
experienced a dismissal of her complaints because of her high level of physical fitness and
conditioning. She is seeking a care provider who will explore the issue in more detail and
work with her particular concerns. 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
Correct Answer: b. Validating and empathetic with open-ended questions
Expert Rationale: Patient-centered care is validating, empathetic, and driven by open-ended questions
that allow the patient to explain concerns in her own words. A rigid clinician-centered or predominantly
closed-question approach risks repeating the dismissive experience she is specifically trying to avoid.
Question 7
A 36-year-old female air traffic controller presents to her primary care provider for a routine
visit 3 months after losing her spouse to a lengthy battle with a neurodegenerative disease.
The patient denies any psychiatric symptoms on review of systems and, in fact, states that
she has slept better in the last month than she had in the previous years. She endorses a
healthy support system, including the extended family of her deceased spouse, with whom
she is still close. She becomes wistful and briefly tearful when speaking of the plans that
they had when they first married that were never fulfilled; she then changes the subject
Page 3
, rapidly to whether her Pap smear is due. Which of the following is an example of an
empathetic response to this patient?
a. Assuming that the event caused her to become depressed and expressing the same feeling on
behalf of the patient
b. Recognizing the patient's emotions by asking or confirming how she feels about the event
c. By allowing the crying patient to look around the room for tissues to permit her an excuse to hide
her face and defer her emotions
d. Presuming that the patient's emotions meet social expectations, such as being depressed and
even traumatized by her spouse's death
e. Narrowing the understanding of the patient's emotional response to only thoughts and feelings that
have been verbalized
Correct Answer: b. Recognizing the patient's emotions by asking or confirming how she feels about the
event
Expert Rationale: Empathy begins by recognizing and validating the patient's emotion rather than
assuming what she feels. Asking or confirming the meaning of her tearfulness acknowledges grief while
allowing her to define her own emotional experience.
Question 8
A 63-year-old male presents to establish care at a new primary care clinic to discuss issues
with pain and fatigue. The clinician conducting the visit begins with general historical
questions but quickly becomes suspicious that the patient is suffering from decompensated
heart failure. When the patient mentions that he has had vague chest pain since last night,
the clinician feels that the focus must be redirected to this potentially emergent condition.
Which of the following interview techniques is the most appropriate to effectively manage
this visit?
a. Providing serial reassurances such as, "Don't worry, you're going to be fine."
b. Asking a series of negative questions such as, "You don't have any swelling in your feet, do you?"
c. Nonverbally cuing the patient to focus on his narrative regarding a motor vehicle accident
d. (MVA) that led to back pain
e. Asking leading questions that focus on the presumed diagnosis of chest pain
f. Moving from open-ended to focused questions
Correct Answer: f. Moving from open-ended to focused questions
Expert Rationale: When a potentially urgent symptom emerges, the interview should narrow from open-
ended exploration to focused questions that quickly clarify severity, timing, associated symptoms, and
immediate risk. Leading or negatively phrased questions can bias the history and should be avoided.
Question 9
A 59-year-old patient presents to his primary care provider with a history of several episodes
of sharp epigastric pain. His father died of pancreatic cancer at age 52 years, and the patient
recalls to the clinician that, "His pain was just like mine is now ..." The patient then pauses
several seconds. The clinician replies, "Just like?" after which the patient restarts his
Page 4
