10/22/24, 1:44 NR509 Midterm Exam Study
PM Guide
NR 509 Midterm Study Guide
General Study Tips and Recommendations
✓ Topics and content on guides are intended to focus student attention when reading/studying and some topics may be
repeated in multiple chapters.
✓ Multiple test items are derived from the same topic areas to encourage deeper comprehension.
✓ Students must have a broad understanding of content and not simply memorize passages in textbooks or articles.
✓ Information in red letters in the chapters as well as tables and appendices at the end of the chapters may include test
items.
✓ Exam questions represent various levels of cognitive learning. You are expected to analyze, synthesis, and evaluate patient
scenarios in order to answer the questions.
✓ Read all of the answers BEFORE reading the stem of the question. This will help you focus on the key content and not get
distracted by extraneous information.
✓ Be familiar with “Techniques of Examination” and “Recording Your Findings” for all body system chapters in the textbook.
After completing an initial assessment of a patient, the nurse has charted that his respirations are eupneic and his pulse is 58 beats
per minute. These types of data would be
Chapter 1 Approach to the Clinical Encounter
• The interviewing process
o Slide 1: Initiate Encounter
▪ Review the clinical record AKA setting the stage/preparation.
▪ Ensure the client is comfortable; greeting patient
▪ Clarify the goals/agenda for the encounter; balance provider and client goals
▪ Establish rapport
▪ Identify the client’s preferred title, name, and gender pronouns
▪ Use “people first” language (i.e., a person with hearing loss, a person who uses a wheelchair)
o Slide 2: Gather Information
▪ Identify the client’s chief complaint or reason for seeking care; information gathering.
▪ Invite the client’s story using an open-ended approach
▪ Gather information about the client’s perspective of the illness using the mnemonic FIFE; Exploring
patient’s perspective of illness.
▪ Conduct the health history interview
▪ Gather information about past medical history, medications and allergies, family history, personal
and social history, and review of systems, Exploring biomedical perspective of disease including
relevant background and context.
• Interviewing techniques
o Active Listening: Active listening involves closely attending to what the client is communicating, connecting to the
clientfis emotional state, and using verbal and nonverbal skills to encourage the client to expand on their feelings
and concerns.
o Empathy: Empathy encompasses identifying with the client and feeling their pain as one’s own, then responding
to them in a supportive manner.
▪ “I understand this has been difficult for you. Let’s talk about what we can do to help this situation.”
about:bl 1/
,10/22/24, 1:44 NR509 Midterm Exam Study
PM Guide
o Guided Questioning: Guided questions help to elicit more information, while still showing a continued interest in
the client’s feelings and story. Some techniques of guided questioning include moving from open-ended to more
focused questions; clarifying what the client means; encouraging with continuers such as “go on”; using a series
of questions one at a time; and using questions that require a graded response (i.e., how many stairs can you
climb before feeling short of breath?).
▪ “Tell me about your abdominal pain. Where else do you feel it? What makes it worse?”
o Validating: Validation is affirming the legitimacy of the clientfis emotional experience. Examples include:
“That must have been a difficult experience. It’s very common to feel the way you are feeling.”
▪ “That must have been very scary. It is normal to feel this way after an event like that.”
o Empowerment: Empowering clients to ask questions and express their concerns increases the chances that
they will adopt your advice, make lifestyle changes, or take medications as prescribed.
o Partnering: Partnering involves expressing commitment to an ongoing relationship with the clients to
build rapport.
▪ “Thank you for sharing about your anxiety. I think we can come up with a plan together to help you feel
better.”
o Reassuring: Reassurance is an appropriate way to help the client feel that problems have been fully
understood and are being addressed.
o Summarizing: Giving a summary of the clientfis story during the interview helps to communicate that they have
been carefully listening
▪ “You have told me a lot of things. Let me restate what you have shared so you
can verify that I have heard you correctly.”
o Transitions: “Now I would like to ask you some questions about your previous health.”
o Nonverbal Communication: Nonverbal communication includes eye contact, facial expression, posture, head
position, and movement such as shaking or nodding, interpersonal distance, and placement of the arms or
legs (i.e., crossed, neutral, or open).
• Setting the stage for the examination
o Occurs in state tt: Initiating the Encounter – building relationship building with patient via respect, trust,
and rapport.
▪ Preparing for the interview, check appearance. Make sure patient is comfortable to create a safe-feeling
environment. Follow the rhythm/sequence and implement societal dimensions. Be aware of biases and
create a therapeutic experience.
▪ See discussion of bias in health care on pp. tt9–20.
• Implicit bias is a set of unconscious beliefs or associations that lead to a negative evaluation of a
person on the basis of their perceived group identity can lead to a structural system of privilege
(institutional bias) that leads to a misallocation of care
• Explicit bias is the conscious or deliberate decisions or preferences founded on beliefs,
stereotypes or associations on the basis of a perceived group identity. Ex. Patient not wanting to
see a colored doctor because they want a “qualified doctor” or a clinician who thinks all gays
have HIV.
• Box tt-tt2. Skills and Practices to Mitigate Bias in Your Clinical Encounters–
o Reflect on patterns of emotion and behavior. Pay attention to how you feel and how you
behave around patients of different identities. The patterns you recognize may reflect
biases that impact your interactions with patients as well as your clinical reasoning.
Being aware of these biases is the first step in reducing their impact on patient care.
o Pause before starting an encounter and prepare for potential triggers of bias. Once you
are aware of your potential biases, pay attention to situations that may trigger them.
Simply being aware of a bias can help minimize its effect. You may take deliberate
actions to reduce the impact of your biases.
o Generate alternative hypotheses for biases anchored in behavior. Many biases are
anchored in clinician assumptions about observed patient behavior (nonadherence,
substance use, etc.). Make it a habit to consider what structural forces
(socioeconomic status, race/racism, homophobia, etc.) impact patient behaviors, and
how they can challenge assumptions you make about patients.
about:bl 2/
,10/22/24, 1:44 NR509 Midterm Exam Study
PM Guide
about:bl 3/
, 10/22/24, 1:44 NR509 Midterm Exam Study
PM Guide
• Young and School-Aged Children. Young (tt to 4 years) – tantrum usually; play is a good way also to
assess milestones such has playing, jumping, drawing, etc. and school-aged children (5 to tt0 years).
Brush up on “kid culture”.
• Adolescents generally want to be treated as adults and to be given respect and choices; balance
the needs of the family and the autonomy of the adolescent. Let the family know that they will
have the opportunity to speak with you; however, you would like to hear from your adolescent
patient first.
• Older Adults. Recall the physiologic changes in aging. Provide a well-lit, moderately warm setting
with minimal background noise, chairs with arms, and access to the examining table. Make sure
there is space to navigate with assistive devices. Open-ended questions and reminiscing, include
family if needed.
• Patients with Physical and Sensory Disabilities. “people-first” language. Presume that the patient is
able to handle their own medical care. Still, ask how you can help and respect their answers.
• Lesbian, Gay, Bisexual, and Transgender Adults. Many times, they are anxious about being judged
and when there is a sense of discrimination, they are less likely to share information. Expand your
knowledge and clinical skills about gay, lesbian, and transgender health as you talk with your
patients and pursue the many resources available
• Gender pronouns
o Clinicians should ask all patients their preferred name and gender pronouns, ideally at the beginning of the visit
and/or on an intake questionnaire. Also, titles such as Mr./Mrs./Professor or Doctor. Establishes report and shows
respect = welcoming environments especially those individuals whose preferred titles or names do not conform
to societal norms.
• Patient-centered medical care
o The approach to a clinical encounter is both
clinician- centered and patient-centered.
▪ Clinician-centered: where the physician is seeking
the information needed to identify the disease.
▪ Patient-centered: being aware of the patient’s
body language, more personal to understand their
about:bl 4/
PM Guide
NR 509 Midterm Study Guide
General Study Tips and Recommendations
✓ Topics and content on guides are intended to focus student attention when reading/studying and some topics may be
repeated in multiple chapters.
✓ Multiple test items are derived from the same topic areas to encourage deeper comprehension.
✓ Students must have a broad understanding of content and not simply memorize passages in textbooks or articles.
✓ Information in red letters in the chapters as well as tables and appendices at the end of the chapters may include test
items.
✓ Exam questions represent various levels of cognitive learning. You are expected to analyze, synthesis, and evaluate patient
scenarios in order to answer the questions.
✓ Read all of the answers BEFORE reading the stem of the question. This will help you focus on the key content and not get
distracted by extraneous information.
✓ Be familiar with “Techniques of Examination” and “Recording Your Findings” for all body system chapters in the textbook.
After completing an initial assessment of a patient, the nurse has charted that his respirations are eupneic and his pulse is 58 beats
per minute. These types of data would be
Chapter 1 Approach to the Clinical Encounter
• The interviewing process
o Slide 1: Initiate Encounter
▪ Review the clinical record AKA setting the stage/preparation.
▪ Ensure the client is comfortable; greeting patient
▪ Clarify the goals/agenda for the encounter; balance provider and client goals
▪ Establish rapport
▪ Identify the client’s preferred title, name, and gender pronouns
▪ Use “people first” language (i.e., a person with hearing loss, a person who uses a wheelchair)
o Slide 2: Gather Information
▪ Identify the client’s chief complaint or reason for seeking care; information gathering.
▪ Invite the client’s story using an open-ended approach
▪ Gather information about the client’s perspective of the illness using the mnemonic FIFE; Exploring
patient’s perspective of illness.
▪ Conduct the health history interview
▪ Gather information about past medical history, medications and allergies, family history, personal
and social history, and review of systems, Exploring biomedical perspective of disease including
relevant background and context.
• Interviewing techniques
o Active Listening: Active listening involves closely attending to what the client is communicating, connecting to the
clientfis emotional state, and using verbal and nonverbal skills to encourage the client to expand on their feelings
and concerns.
o Empathy: Empathy encompasses identifying with the client and feeling their pain as one’s own, then responding
to them in a supportive manner.
▪ “I understand this has been difficult for you. Let’s talk about what we can do to help this situation.”
about:bl 1/
,10/22/24, 1:44 NR509 Midterm Exam Study
PM Guide
o Guided Questioning: Guided questions help to elicit more information, while still showing a continued interest in
the client’s feelings and story. Some techniques of guided questioning include moving from open-ended to more
focused questions; clarifying what the client means; encouraging with continuers such as “go on”; using a series
of questions one at a time; and using questions that require a graded response (i.e., how many stairs can you
climb before feeling short of breath?).
▪ “Tell me about your abdominal pain. Where else do you feel it? What makes it worse?”
o Validating: Validation is affirming the legitimacy of the clientfis emotional experience. Examples include:
“That must have been a difficult experience. It’s very common to feel the way you are feeling.”
▪ “That must have been very scary. It is normal to feel this way after an event like that.”
o Empowerment: Empowering clients to ask questions and express their concerns increases the chances that
they will adopt your advice, make lifestyle changes, or take medications as prescribed.
o Partnering: Partnering involves expressing commitment to an ongoing relationship with the clients to
build rapport.
▪ “Thank you for sharing about your anxiety. I think we can come up with a plan together to help you feel
better.”
o Reassuring: Reassurance is an appropriate way to help the client feel that problems have been fully
understood and are being addressed.
o Summarizing: Giving a summary of the clientfis story during the interview helps to communicate that they have
been carefully listening
▪ “You have told me a lot of things. Let me restate what you have shared so you
can verify that I have heard you correctly.”
o Transitions: “Now I would like to ask you some questions about your previous health.”
o Nonverbal Communication: Nonverbal communication includes eye contact, facial expression, posture, head
position, and movement such as shaking or nodding, interpersonal distance, and placement of the arms or
legs (i.e., crossed, neutral, or open).
• Setting the stage for the examination
o Occurs in state tt: Initiating the Encounter – building relationship building with patient via respect, trust,
and rapport.
▪ Preparing for the interview, check appearance. Make sure patient is comfortable to create a safe-feeling
environment. Follow the rhythm/sequence and implement societal dimensions. Be aware of biases and
create a therapeutic experience.
▪ See discussion of bias in health care on pp. tt9–20.
• Implicit bias is a set of unconscious beliefs or associations that lead to a negative evaluation of a
person on the basis of their perceived group identity can lead to a structural system of privilege
(institutional bias) that leads to a misallocation of care
• Explicit bias is the conscious or deliberate decisions or preferences founded on beliefs,
stereotypes or associations on the basis of a perceived group identity. Ex. Patient not wanting to
see a colored doctor because they want a “qualified doctor” or a clinician who thinks all gays
have HIV.
• Box tt-tt2. Skills and Practices to Mitigate Bias in Your Clinical Encounters–
o Reflect on patterns of emotion and behavior. Pay attention to how you feel and how you
behave around patients of different identities. The patterns you recognize may reflect
biases that impact your interactions with patients as well as your clinical reasoning.
Being aware of these biases is the first step in reducing their impact on patient care.
o Pause before starting an encounter and prepare for potential triggers of bias. Once you
are aware of your potential biases, pay attention to situations that may trigger them.
Simply being aware of a bias can help minimize its effect. You may take deliberate
actions to reduce the impact of your biases.
o Generate alternative hypotheses for biases anchored in behavior. Many biases are
anchored in clinician assumptions about observed patient behavior (nonadherence,
substance use, etc.). Make it a habit to consider what structural forces
(socioeconomic status, race/racism, homophobia, etc.) impact patient behaviors, and
how they can challenge assumptions you make about patients.
about:bl 2/
,10/22/24, 1:44 NR509 Midterm Exam Study
PM Guide
about:bl 3/
, 10/22/24, 1:44 NR509 Midterm Exam Study
PM Guide
• Young and School-Aged Children. Young (tt to 4 years) – tantrum usually; play is a good way also to
assess milestones such has playing, jumping, drawing, etc. and school-aged children (5 to tt0 years).
Brush up on “kid culture”.
• Adolescents generally want to be treated as adults and to be given respect and choices; balance
the needs of the family and the autonomy of the adolescent. Let the family know that they will
have the opportunity to speak with you; however, you would like to hear from your adolescent
patient first.
• Older Adults. Recall the physiologic changes in aging. Provide a well-lit, moderately warm setting
with minimal background noise, chairs with arms, and access to the examining table. Make sure
there is space to navigate with assistive devices. Open-ended questions and reminiscing, include
family if needed.
• Patients with Physical and Sensory Disabilities. “people-first” language. Presume that the patient is
able to handle their own medical care. Still, ask how you can help and respect their answers.
• Lesbian, Gay, Bisexual, and Transgender Adults. Many times, they are anxious about being judged
and when there is a sense of discrimination, they are less likely to share information. Expand your
knowledge and clinical skills about gay, lesbian, and transgender health as you talk with your
patients and pursue the many resources available
• Gender pronouns
o Clinicians should ask all patients their preferred name and gender pronouns, ideally at the beginning of the visit
and/or on an intake questionnaire. Also, titles such as Mr./Mrs./Professor or Doctor. Establishes report and shows
respect = welcoming environments especially those individuals whose preferred titles or names do not conform
to societal norms.
• Patient-centered medical care
o The approach to a clinical encounter is both
clinician- centered and patient-centered.
▪ Clinician-centered: where the physician is seeking
the information needed to identify the disease.
▪ Patient-centered: being aware of the patient’s
body language, more personal to understand their
about:bl 4/
