NR 509 MIDTERM EXAM REVISION HANDBOOK
2026 HISTORY TAKING AND DIAGNOSTIC
FINDINGS INTERPRETATION
◉ Informed Consent - 5 Elements.
Answer: Nature of procedure, Risks and benefits, Alternatives, Risks
and benefits of alternatives, Patient understanding (requires
decisional capacity).
◉ Angry.
Answer: stay calm, validate, ensure safety.
◉ Confused/cognitively impaired.
Answer: clarify, involve caregiver.
◉ Emotional/tearful.
Answer: allow expression, respond with empathy.
◉ Low literacy.
Answer: use plain language + teach-back.
◉ Discriminatory or flirtatious.
,Answer: set professional boundaries.
◉ Risk in EHR and Communication.
Answer: loss of eye contact, fragmented rapport.
◉ Strategies for EHR and Communication.
Answer: review before, face patient, share screen, narrate typing,
pause during sensitive topics.
◉ FIFE - Patient's Perspective.
Answer: Feelings → "How has this made you feel?" "What worries
you most?"
◉ NURSE - Responding to Emotions.
Answer: Name → "It sounds like this has been very stressful for you."
◉ Teach-Back - Confirming Understanding.
Answer: "I want to make sure I explained things clearly. Can you tell
me in your own words how you'll take this medication?"
◉ Shared Decision-Making (3-Talk Model).
Answer: Team Talk → "There are a few different ways we could
approach this, and I'd like us to decide together."
, ◉ SBAR - Interprofessional Communication.
Answer: Situation: "This is Ms. Jones, she came in today with chest
pain."
◉ INTERPRET - Using an Interpreter.
Answer: Introduce → "This is [interpreter's name]; they'll help us
communicate today."
◉ SPIKES - Delivering Serious News.
Answer: Setting → "I'd like to talk in private. Would you like a family
member here with you?"
◉ Open-ended question.
Answer: A question that cannot be answered with a simple 'yes' or
'no', such as 'What concerns you about your smoking?'
◉ Affirmation.
Answer: Acknowledging a patient's efforts, e.g., 'It sounds like you've
already taken steps by cutting down.'
◉ Reflection.
2026 HISTORY TAKING AND DIAGNOSTIC
FINDINGS INTERPRETATION
◉ Informed Consent - 5 Elements.
Answer: Nature of procedure, Risks and benefits, Alternatives, Risks
and benefits of alternatives, Patient understanding (requires
decisional capacity).
◉ Angry.
Answer: stay calm, validate, ensure safety.
◉ Confused/cognitively impaired.
Answer: clarify, involve caregiver.
◉ Emotional/tearful.
Answer: allow expression, respond with empathy.
◉ Low literacy.
Answer: use plain language + teach-back.
◉ Discriminatory or flirtatious.
,Answer: set professional boundaries.
◉ Risk in EHR and Communication.
Answer: loss of eye contact, fragmented rapport.
◉ Strategies for EHR and Communication.
Answer: review before, face patient, share screen, narrate typing,
pause during sensitive topics.
◉ FIFE - Patient's Perspective.
Answer: Feelings → "How has this made you feel?" "What worries
you most?"
◉ NURSE - Responding to Emotions.
Answer: Name → "It sounds like this has been very stressful for you."
◉ Teach-Back - Confirming Understanding.
Answer: "I want to make sure I explained things clearly. Can you tell
me in your own words how you'll take this medication?"
◉ Shared Decision-Making (3-Talk Model).
Answer: Team Talk → "There are a few different ways we could
approach this, and I'd like us to decide together."
, ◉ SBAR - Interprofessional Communication.
Answer: Situation: "This is Ms. Jones, she came in today with chest
pain."
◉ INTERPRET - Using an Interpreter.
Answer: Introduce → "This is [interpreter's name]; they'll help us
communicate today."
◉ SPIKES - Delivering Serious News.
Answer: Setting → "I'd like to talk in private. Would you like a family
member here with you?"
◉ Open-ended question.
Answer: A question that cannot be answered with a simple 'yes' or
'no', such as 'What concerns you about your smoking?'
◉ Affirmation.
Answer: Acknowledging a patient's efforts, e.g., 'It sounds like you've
already taken steps by cutting down.'
◉ Reflection.
