NR 509 Final Exam / NR509 Final Exam
(NEW- 2023/2024):Chamberlain college
of Nursing
Section 1: Health History, Communication & Cultural Competence
Question 1
When performing a comprehensive health history, which component is typically assessed
immediately after the chief complaint?
A. Family history
B. History of present illness (HPI)
C. Past medical history
D. Review of systems
Correct Answer: B. History of present illness (HPI)
Rationale: The HPI expands on the chief complaint using the OLDCARTS framework (Onset,
Location, Duration, Characteristics, Aggravating/Alleviating factors, Relieving factors, Timing,
Severity). This guides the remainder of the history and physical exam. Family history (A), past
medical history (C), and review of systems (D) are assessed after the HPI.
Question 2
The primary purpose of the "review of systems" (ROS) in a health history is to:
A. Confirm the physician's initial diagnosis
B. Provide a complete list of the patient's current medications
C. Identify any health problems that may have been overlooked in the HPI
D. Document the patient's family medical history in detail
Correct Answer: C. Identify any health problems that may have been overlooked in the
HPI
Rationale: The ROS is a systematic head-to-toe review of body systems designed to uncover
symptoms or concerns the patient may not have volunteered during the HPI. It is not used to
confirm a diagnosis (A), list medications (B), or document family history (D)—those belong to
other history components.
,Question 3
A patient states, "I've been feeling really down lately." The best response from the nurse
practitioner to facilitate a more detailed description is:
A. "You should consider seeing a therapist."
B. "Tell me more about what 'feeling down' means for you."
C. "How long has this been going on?"
D. "Are you taking any medication for that?"
Correct Answer: B. "Tell me more about what 'feeling down' means for you."
Rationale: This open-ended, patient-centered response encourages the patient to elaborate
on their subjective experience without imposing assumptions. Option A is premature advice, C
is closed-ended and focuses on duration prematurely, and D is closed-ended and medication-
focused.
Question 4
Which statement best reflects a culturally competent assessment approach?
A. "I will treat every patient exactly the same to ensure fairness."
B. "I will ask about the patient's health beliefs and practices that might influence care."
C. "I will rely on my knowledge of their ethnic group to guide my questions."
D. "I will avoid discussing culture as it is not relevant to physical health."
Correct Answer: B. "I will ask about the patient's health beliefs and practices that might
influence care."
Rationale: Culturally competent care involves inquiring about the patient's individual health
beliefs, practices, and values rather than making assumptions based on ethnicity. Treating
everyone identically (A) ignores cultural differences, relying on ethnic stereotypes (C) is
inappropriate, and avoiding culture (D) overlooks its impact on health.
Question 5
The "CAGE" questionnaire is a validated screening tool used to assess for problems related to:
A. Geriatric depression
B. Tobacco use
,C. Alcohol use
D. Exercise tolerance
Correct Answer: C. Alcohol use
Rationale: The CAGE questionnaire consists of four questions: Cut down, Annoyed, Guilty,
Eye-opener. It is a validated screening tool for alcohol use disorders. It does not screen for
depression (A), tobacco (B), or exercise tolerance (D).
Question 6 (SATA)
Which of the following are components of the OLDCARTS mnemonic used for the History of
Present Illness? Select all that apply.
A. Onset
B. Location
C. Allergies
D. Duration
E. Severity
F. Family history
Correct Answers: A, B, D, E
Rationale: OLDCARTS stands for Onset, Location, Duration, Characteristics,
Aggravating/Alleviating factors, Relieving factors, Timing, and Severity. Allergies (C) and family
history (F) are separate components of the comprehensive health history, not part of
OLDCARTS.
Question 7
A 39-year-old nurse who is an established patient presents complaining of irregular menstrual
periods and pelvic pain. She notes difficulty sleeping, requests a sleeping pill, and mentions she
is considering resigning from her job. Which of the following is the most appropriate next step
in the clinical encounter?
A. Perform an immediate bimanual pelvic examination
B. Obtain a urine sample for rapid pregnancy and toxicology testing
C. Obtain a more complete description of her presenting problems and psychosocial concerns
D. Order a comprehensive metabolic panel and complete blood count
, Correct Answer: C. Obtain a more complete description of her presenting problems and
psychosocial concerns
Rationale: The patient presents with multiple concerns (menstrual irregularities, pelvic pain,
sleep difficulty, occupational stress) that require further exploration before jumping to physical
examination or diagnostic testing. A comprehensive history is the appropriate first step.
Immediate pelvic exam (A) may be indicated later but not before understanding the full context.
Question 8
When interviewing an adolescent patient, it is best practice to:
A. Interview the parent alone first to get the full story
B. Spend part of the interview time alone with the adolescent
C. Avoid sensitive topics to maintain trust
D. Rely primarily on the parent for the medical history
Correct Answer: B. Spend part of the interview time alone with the adolescent
Rationale: Adolescents require confidential time with the provider to discuss sensitive
topics such as sexual activity, substance use, and mental health. Interviewing the parent alone
first (A) or relying on the parent (D) undermines the adolescent's autonomy. Avoiding sensitive
topics (C) misses critical health information.
Question 9
The "5 Rs of Cultural Humility" include all of the following EXCEPT:
A. Reflection
B. Respect
C. Regard
D. Revenue
Correct Answer: D. Revenue
Rationale: The 5 Rs of Cultural Humility are Reflection, Respect, Regard, Relevance, and
Resilience. Revenue is not part of this framework.
(NEW- 2023/2024):Chamberlain college
of Nursing
Section 1: Health History, Communication & Cultural Competence
Question 1
When performing a comprehensive health history, which component is typically assessed
immediately after the chief complaint?
A. Family history
B. History of present illness (HPI)
C. Past medical history
D. Review of systems
Correct Answer: B. History of present illness (HPI)
Rationale: The HPI expands on the chief complaint using the OLDCARTS framework (Onset,
Location, Duration, Characteristics, Aggravating/Alleviating factors, Relieving factors, Timing,
Severity). This guides the remainder of the history and physical exam. Family history (A), past
medical history (C), and review of systems (D) are assessed after the HPI.
Question 2
The primary purpose of the "review of systems" (ROS) in a health history is to:
A. Confirm the physician's initial diagnosis
B. Provide a complete list of the patient's current medications
C. Identify any health problems that may have been overlooked in the HPI
D. Document the patient's family medical history in detail
Correct Answer: C. Identify any health problems that may have been overlooked in the
HPI
Rationale: The ROS is a systematic head-to-toe review of body systems designed to uncover
symptoms or concerns the patient may not have volunteered during the HPI. It is not used to
confirm a diagnosis (A), list medications (B), or document family history (D)—those belong to
other history components.
,Question 3
A patient states, "I've been feeling really down lately." The best response from the nurse
practitioner to facilitate a more detailed description is:
A. "You should consider seeing a therapist."
B. "Tell me more about what 'feeling down' means for you."
C. "How long has this been going on?"
D. "Are you taking any medication for that?"
Correct Answer: B. "Tell me more about what 'feeling down' means for you."
Rationale: This open-ended, patient-centered response encourages the patient to elaborate
on their subjective experience without imposing assumptions. Option A is premature advice, C
is closed-ended and focuses on duration prematurely, and D is closed-ended and medication-
focused.
Question 4
Which statement best reflects a culturally competent assessment approach?
A. "I will treat every patient exactly the same to ensure fairness."
B. "I will ask about the patient's health beliefs and practices that might influence care."
C. "I will rely on my knowledge of their ethnic group to guide my questions."
D. "I will avoid discussing culture as it is not relevant to physical health."
Correct Answer: B. "I will ask about the patient's health beliefs and practices that might
influence care."
Rationale: Culturally competent care involves inquiring about the patient's individual health
beliefs, practices, and values rather than making assumptions based on ethnicity. Treating
everyone identically (A) ignores cultural differences, relying on ethnic stereotypes (C) is
inappropriate, and avoiding culture (D) overlooks its impact on health.
Question 5
The "CAGE" questionnaire is a validated screening tool used to assess for problems related to:
A. Geriatric depression
B. Tobacco use
,C. Alcohol use
D. Exercise tolerance
Correct Answer: C. Alcohol use
Rationale: The CAGE questionnaire consists of four questions: Cut down, Annoyed, Guilty,
Eye-opener. It is a validated screening tool for alcohol use disorders. It does not screen for
depression (A), tobacco (B), or exercise tolerance (D).
Question 6 (SATA)
Which of the following are components of the OLDCARTS mnemonic used for the History of
Present Illness? Select all that apply.
A. Onset
B. Location
C. Allergies
D. Duration
E. Severity
F. Family history
Correct Answers: A, B, D, E
Rationale: OLDCARTS stands for Onset, Location, Duration, Characteristics,
Aggravating/Alleviating factors, Relieving factors, Timing, and Severity. Allergies (C) and family
history (F) are separate components of the comprehensive health history, not part of
OLDCARTS.
Question 7
A 39-year-old nurse who is an established patient presents complaining of irregular menstrual
periods and pelvic pain. She notes difficulty sleeping, requests a sleeping pill, and mentions she
is considering resigning from her job. Which of the following is the most appropriate next step
in the clinical encounter?
A. Perform an immediate bimanual pelvic examination
B. Obtain a urine sample for rapid pregnancy and toxicology testing
C. Obtain a more complete description of her presenting problems and psychosocial concerns
D. Order a comprehensive metabolic panel and complete blood count
, Correct Answer: C. Obtain a more complete description of her presenting problems and
psychosocial concerns
Rationale: The patient presents with multiple concerns (menstrual irregularities, pelvic pain,
sleep difficulty, occupational stress) that require further exploration before jumping to physical
examination or diagnostic testing. A comprehensive history is the appropriate first step.
Immediate pelvic exam (A) may be indicated later but not before understanding the full context.
Question 8
When interviewing an adolescent patient, it is best practice to:
A. Interview the parent alone first to get the full story
B. Spend part of the interview time alone with the adolescent
C. Avoid sensitive topics to maintain trust
D. Rely primarily on the parent for the medical history
Correct Answer: B. Spend part of the interview time alone with the adolescent
Rationale: Adolescents require confidential time with the provider to discuss sensitive
topics such as sexual activity, substance use, and mental health. Interviewing the parent alone
first (A) or relying on the parent (D) undermines the adolescent's autonomy. Avoiding sensitive
topics (C) misses critical health information.
Question 9
The "5 Rs of Cultural Humility" include all of the following EXCEPT:
A. Reflection
B. Respect
C. Regard
D. Revenue
Correct Answer: D. Revenue
Rationale: The 5 Rs of Cultural Humility are Reflection, Respect, Regard, Relevance, and
Resilience. Revenue is not part of this framework.
