NR 509 PHYSICAL ASSESSMENT REVIEW
SCRIPT TESTED QUESTIONS AND VERIFIED
ANSWERS
●● 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,
Answer: c. Following the patient's lead to understand their thoughts,
ideas, concerns, and requests
,●● 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 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 conce
Answer: d. Using nonverbal communication to encourage the patient to
expand their narrative
●● 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 em
Answer: c. Feelings, ideas, function, and expectations
●● 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 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. Obtain a more complete description of problems.
, ●● 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
Answer: b. Validating and empathetic with open-ended questions
●● 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 rapidly to
whether her Pap smear is due. Which of the following is an example of
an empathetic response to this patient?
SCRIPT TESTED QUESTIONS AND VERIFIED
ANSWERS
●● 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,
Answer: c. Following the patient's lead to understand their thoughts,
ideas, concerns, and requests
,●● 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 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 conce
Answer: d. Using nonverbal communication to encourage the patient to
expand their narrative
●● 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 em
Answer: c. Feelings, ideas, function, and expectations
●● 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 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. Obtain a more complete description of problems.
, ●● 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
Answer: b. Validating and empathetic with open-ended questions
●● 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 rapidly to
whether her Pap smear is due. Which of the following is an example of
an empathetic response to this patient?
