NRv j 509v j Mid-Termv j Studyvj Questions
1. Chapterv j 1:v j ...
2. 1.v j Av j 23-year-
oldv j physicianv j assistantv j (PA)v j studentv j foundv j thatv j shev j feltv j nervousvjwhenv j calle
dv j uponv j tov j examinev j menv j inv j herv j agev j group.v j Onv j onev j occasion,v j shevjencounte
redv j av j youngv j malev j patientv j whov j appearedv j embarrassedv j tov j seev j herv j walkvjintov
j thev j room.v j Whatv j shouldv j thev j PAv j dov j tov j minimizev j theirv j mutualv j discomfort?:v j a.v
jAdjustvjlightingvjsovjitvjisvjtangentialvjtovjthevjpatient'svjbody.
b. Explainvjhowvjthevjexaminationvjwillvjproceed.
c. Askvjthevjpatientvjwherevjhevjcomesvjfrom.
d. ExplainvjthatvjshevjisvjavjPAvjstudent.
e. Providevj ongoingvj interpretationvj ofvj findings.
3. Avj34-year-oldvjmalevjwithvjavjhistoryvjofvjcomplexvjsocialvjandvjmedicalvjneedsvj(in-
vjcludingvjcurrentvjsubstance vjabuse)vjpresentsvjtovjavjprimaryvjcarevjteachingvjclinic.vj
Thevjpatientvjhasvjexperiencedvjavjnumbervjofvjadversarialvjrelationshipsvjwithvjpriorvj
clinicians,vjincludingvjvoluntarilyvjleavingvjtwovjpracticesvjwithinvjthevjpreviousvjyearvj
andvjbeingvjaskedvjtovjleavevjcarevjatvjavjthirdvjclinicvjduevjtovjmisbehavior.vjThevjattending
vjphysicianvjdesiresvjtovjutilizevjthevjapproaches vjtovjthisvjpatientvjthatvjarevjmostvjlikely
vjleadvjtovjcomprehensive vjcarevjandvjpatientvjcompliance. vjWhichvjofvjthevjfollowing
isv j thev j mostv j appropriatev j interviewv j stylev j forv j thev j attendingv j physicianv j tov j use?:v j a.
Focusingvjonvjthevjneedvjforvjimmediatevjdiagnosticvjcertaintyvjovervjpersonalvjconnection
b. Takingvjchargevjofvjthevjinteractionvjtovjmeetvjthevjclinician'svjdesirevjtovjacquirevjdiagnosticvjinformation
c. Followingvjthevjpatient'svjleadvjtovjunderstandvjtheirvjthoughts,vjideas,vjconcerns,vjandvjrequests
d. Deferringvjrespect,vjempathy,vjhumility,vjandvjsensitivityvjinvjfavorvjofvjthevjacquisitionvjofvjconcretevjdetailsvjaboutvjthevjpatient's
v j condition
e. Takingvjavjsymptom-focusedvjapproachvjtovjreducevjthevjinvolvementvjofvjthevjpatient'svjemotionalvjdiflculties
4. Avj17-year-
oldvjmalevjpresentsvjtovjavjsexuallyvjtransmittedvjdiseasevjclinicvjatvjthevjbehestvjofvjhis
vjbrother,vjwhovjconvinced vjthevjpatientvjtovjattend vjthevjclinicvjaftervjhevjdisclosedv j th
atv j hev j prefersv j homosexualv j partnersv j butv j isv j afraidv j thatv j hisv j lastv j partnervjmayv j ha
vev j givenv j himv j anv j infection.v j Thev j patientv j expressesv j tov j thev j intakev j nursev j thatvjhe
vjisvjunashamed vjofvjhisvjsexualvjorientation vjandvjwillvjnotvjstayvjthrough vjthevjvisitvjifvjh
ev j feelsv j thatv j hev j isv j dismissedv j orv j discriminatedv j againstv j becausev j ofv j it.v j Thev j nu
, NRv j 509v j Mid-Termv j Studyvj Questions
rsevjpractitionervjreceivesvjthisvjcommunicationvjpriorvjtovjenteringvjthevjexaminat
ionvjroomvjandvjdecidesvjtovjemployvjactivevjlisteningvjtovjbestvjconnectvjwithvjthevjpa
tient
, NRv j 509v j Mid-Termv j Studyvj Questions
atv j thisv j criticalv j juncturev j inv j hisv j carev j withv j thev j clinic.v j Whichv j ofv j thev j followingv j isv j a
nvjexamplevjofvjanvjactivevjlisteningvjtechnique?:vja.vjIgnoringvjvisualvjcuesvjtovjfocusvjonvjthevjpatient'svjexact
vjwords
b. Settingvjasidevjthevjpatient'svjemotionalvjstatevjtovjfocusvjonvjhisvjmedicalvjneeds
c. Paringvjdownvjthevjpatient'svjconcernsvjtovjconcretevjmedicalvjneeds
d. Usingvjnonverbalvjcommunicationvjtovjencouragevjthevjpatientvjtovjexpandvjtheirvjnarrative
e. Consideringvjavjditterentialvjdiagnosisvjwhilevjthevjpatientvjisvjspeakingvjtovjmaximizevjthevjpatient'svjtimevjwithvjthevjprovider
5. Avj42-year-oldvjfemalevjmathematicianvjpresentsvjforvjfollow-
upvjcarevjregardingvjavjnewvjdiagnosisvjofvjsystemicvjlupusvjerythematosusvj6vjmonth
svjagovjaftervjavjlengthyvjdiagnosticvjprocessvjduringvjwhichvjshevjwasvjdebilitatedvjwit
hvjfatiguevjandvjjointv j pain.vjSincevjhervjdiagnosis,vjshevjhasvjbeenvjminimallyvjcompli
antvjwithvjmedicationsvjandvjhasvjswitchedvjhervjrheumatologyvjprovidervjtwice.vjShevj
continuesvjtovjfeelvjill,vjand,vjinvjexplanationvjforvjhervjlackvjofvjadherencevjtovjthevjpresc
ribedvjtreatment,vjshevjsimplyvjsays,vj"Ivjdon'tvjlikevjit."vjAtvjthisvjinitialvjvisitvjwithvjhervjthi
rdvjrheumatologyv j provider,vjthevjclinicianvjelectsvjtovjexplorevjthevjissuesvjbehindvjh
ervjnoncompliancevjbeforevjengagingvjinvjdiagnosticsvjandvjtreatmentvjusingvjthevjFI
FEvjmodel.vjWhichvjofvjthevjfollowingvjbestvjdefinesvjthevjelementsvjofvjthevjFIFEvjmodel?:vja.vjFoc
us,vjintensity,vjfunction,v j andvjevaluation
b. Facts,vjintensity,vjfocus,vjandvjevidence
c. Feelings,vjideas,vjfunction,vjandvjexpectations
d. Feelings,vjimpression,vjfantasy,vjandvjemotion
e. Facts,vjintelligence,vjfortuity,vjandvjeventuality
6. Chapterv j 2:
7. Avj39-year-oldvjnursevjwhovjisvjavjwell-
establishedvjpatientvjcomplainsvjofvjirregularvjmenstrualvjperiodsvjandvjpelvicvjpain.vj
Shevjsaysvjthatvjshevjisvjhavingvjtroublevjsleepingvjandvjasksvjwhethervjshevjcouldvjbevjg
ivenvjavj"sleepingvjpill."vjThevjpatientvjalsovjsaysvjshevjisvjthinkingvjofvjleavingvjhervjjob.vj
Whatvjisvjthevjbestvj"nextvjstep"vjinvjcaringvjforvjthisvjpatient?:vja.vjPerformvjavjpelvicvjexamination.
b. Obtainvjavjurinevjsamplevjforvjtesting.
c. Obtainvjavjmorevjcompletevjdescriptionvjofvjproblems.
d. Obtainvjbloodvjforvjtesting.
e. Askvjaboutvjrecentvjtravelvjdestinations.
, NRv j 509v j Mid-Termv j Studyvj Questions
8. Avj29-year-
oldvjfemalevjprofessionalvjathletevjpresentsvjtovjavjnewvjprimaryvjcarevjprovidervjwithvj
chronicvjmenstrualvjcomplaints.vjShevjremarksvjtovjthevjnursingvjstaffv j that,vjinvjthevjp
ast,vjshevjhasvjexperiencedvjavjdismissalvjofvjhervjcomplaintsvjbecausev j ofvjhervjhighvjl
evelvjofvjphysicalvjfitnessvjandvjconditioning.vjShevjisvjseekingvjavjcarevjprovidervjwhovj
willvjexplorevjthevjissuevjinvjmorevjdetailvjandvjworkvjwithvjhervjparticularv j concerns.vjW
hichvjofvjthevjfollowingvjisvjthevjdescriptionvjofvjthevjpatient-
centeredvjcarevjthisvjindividualvjseeks?:vja.vjStructuredvjandvjclinician-centeredvjwithvjopen-
endedvjquestions
b. Validatingvj andv j empatheticv j withvj open-endedv j questions
c. Dismissivevjandvjconcretevjwithvjopen-endedvjquestions
d. Aflrmingvjandvjreassuringvjwithvjclose-endedvjquestions
e. Factualvjandvjstructuredvjwithvjactivevjlistening
9. Av j 36-year-
oldv j femalev j airv j trafficv j controllerv j presentsv j tov j herv j primaryv j carev j providerv j forv j a
v j routinev j visitv j 3v j monthsv j afterv j losingv j herv j spousev j tov j av j lengthyvjbattlev j with
v j av j neurodegenerativev j disease.v j Thev j patientv j deniesv j anyv j psychiatricv j symptoms
v j onv j reviewv j ofv j systemsv j and,v j inv j fact,v j statesv j thatv j shev j hasv j sleptv j bettervjinv j
thev j lastv j monthv j thanv j shev j hadv j inv j thev j previousv j years.v j Shev j endorsesv j av j health
yvjsupportv j system,v j includingv j thev j extendedv j familyv j ofv j herv j deceasedv j spouse,v j w
ithv j whomv j shev j isv j stillv j close.v j Shev j becomesv j wistfulv j andv j brieflyv j tearfulv j whenv j
speakingvjofv j thev j plansv j thatv j theyv j hadv j whenv j theyv j firstv j marriedv j thatv j werev j neve
rv j fulfilled;v j shevjthenv j changesv j thev j subjectv j rapidlyv j tov j whetherv j herv j Papv j smearv j is
v j due.v j Whichv j ofv j thevjfollowingvjisvjanvjexamplevjofvjanvjempatheticvjresponsevjtovjthisvjpat
ient?:vja.vjAssumingvjthatvjthevjeventvjcausedvjhervjtovjbecomevjdepressedvjandvjexpressingvjthevjsamevjfeelingvjonvjbe
halfvjofvjthevjpatient
b. Recognizingvjthevjpatient'svjemotionsvjbyvjaskingvjorvjconfirmingvjhowvjshevjfeelsvjaboutvjthevjevent
c. Byvjallowingvjthevjcryingvjpatientvjtovjlookvjaroundvjthevjroomvjforvjtissuesvjtovjpermitvjhervjanvjexcusevjtovjhidevjhervjfacevjandvjdef
ervjhervjemotions
d. Presumingvjthatvjthevjpatient'svjemotionsvjmeetvjsocialvjexpectations,vjsuchvjasvjbeingvjdepressedvjandvjevenvjtraumatizedvj
byvjhervjspouse'svjdeath
e. Narrowingvjthevjunderstandingvjofvjthevjpatient'svjemotionalvjresponsevjtovjonlyvjthoughtsvjandvjfeelingsvjthatvjhavevjbee
1. Chapterv j 1:v j ...
2. 1.v j Av j 23-year-
oldv j physicianv j assistantv j (PA)v j studentv j foundv j thatv j shev j feltv j nervousvjwhenv j calle
dv j uponv j tov j examinev j menv j inv j herv j agev j group.v j Onv j onev j occasion,v j shevjencounte
redv j av j youngv j malev j patientv j whov j appearedv j embarrassedv j tov j seev j herv j walkvjintov
j thev j room.v j Whatv j shouldv j thev j PAv j dov j tov j minimizev j theirv j mutualv j discomfort?:v j a.v
jAdjustvjlightingvjsovjitvjisvjtangentialvjtovjthevjpatient'svjbody.
b. Explainvjhowvjthevjexaminationvjwillvjproceed.
c. Askvjthevjpatientvjwherevjhevjcomesvjfrom.
d. ExplainvjthatvjshevjisvjavjPAvjstudent.
e. Providevj ongoingvj interpretationvj ofvj findings.
3. Avj34-year-oldvjmalevjwithvjavjhistoryvjofvjcomplexvjsocialvjandvjmedicalvjneedsvj(in-
vjcludingvjcurrentvjsubstance vjabuse)vjpresentsvjtovjavjprimaryvjcarevjteachingvjclinic.vj
Thevjpatientvjhasvjexperiencedvjavjnumbervjofvjadversarialvjrelationshipsvjwithvjpriorvj
clinicians,vjincludingvjvoluntarilyvjleavingvjtwovjpracticesvjwithinvjthevjpreviousvjyearvj
andvjbeingvjaskedvjtovjleavevjcarevjatvjavjthirdvjclinicvjduevjtovjmisbehavior.vjThevjattending
vjphysicianvjdesiresvjtovjutilizevjthevjapproaches vjtovjthisvjpatientvjthatvjarevjmostvjlikely
vjleadvjtovjcomprehensive vjcarevjandvjpatientvjcompliance. vjWhichvjofvjthevjfollowing
isv j thev j mostv j appropriatev j interviewv j stylev j forv j thev j attendingv j physicianv j tov j use?:v j a.
Focusingvjonvjthevjneedvjforvjimmediatevjdiagnosticvjcertaintyvjovervjpersonalvjconnection
b. Takingvjchargevjofvjthevjinteractionvjtovjmeetvjthevjclinician'svjdesirevjtovjacquirevjdiagnosticvjinformation
c. Followingvjthevjpatient'svjleadvjtovjunderstandvjtheirvjthoughts,vjideas,vjconcerns,vjandvjrequests
d. Deferringvjrespect,vjempathy,vjhumility,vjandvjsensitivityvjinvjfavorvjofvjthevjacquisitionvjofvjconcretevjdetailsvjaboutvjthevjpatient's
v j condition
e. Takingvjavjsymptom-focusedvjapproachvjtovjreducevjthevjinvolvementvjofvjthevjpatient'svjemotionalvjdiflculties
4. Avj17-year-
oldvjmalevjpresentsvjtovjavjsexuallyvjtransmittedvjdiseasevjclinicvjatvjthevjbehestvjofvjhis
vjbrother,vjwhovjconvinced vjthevjpatientvjtovjattend vjthevjclinicvjaftervjhevjdisclosedv j th
atv j hev j prefersv j homosexualv j partnersv j butv j isv j afraidv j thatv j hisv j lastv j partnervjmayv j ha
vev j givenv j himv j anv j infection.v j Thev j patientv j expressesv j tov j thev j intakev j nursev j thatvjhe
vjisvjunashamed vjofvjhisvjsexualvjorientation vjandvjwillvjnotvjstayvjthrough vjthevjvisitvjifvjh
ev j feelsv j thatv j hev j isv j dismissedv j orv j discriminatedv j againstv j becausev j ofv j it.v j Thev j nu
, NRv j 509v j Mid-Termv j Studyvj Questions
rsevjpractitionervjreceivesvjthisvjcommunicationvjpriorvjtovjenteringvjthevjexaminat
ionvjroomvjandvjdecidesvjtovjemployvjactivevjlisteningvjtovjbestvjconnectvjwithvjthevjpa
tient
, NRv j 509v j Mid-Termv j Studyvj Questions
atv j thisv j criticalv j juncturev j inv j hisv j carev j withv j thev j clinic.v j Whichv j ofv j thev j followingv j isv j a
nvjexamplevjofvjanvjactivevjlisteningvjtechnique?:vja.vjIgnoringvjvisualvjcuesvjtovjfocusvjonvjthevjpatient'svjexact
vjwords
b. Settingvjasidevjthevjpatient'svjemotionalvjstatevjtovjfocusvjonvjhisvjmedicalvjneeds
c. Paringvjdownvjthevjpatient'svjconcernsvjtovjconcretevjmedicalvjneeds
d. Usingvjnonverbalvjcommunicationvjtovjencouragevjthevjpatientvjtovjexpandvjtheirvjnarrative
e. Consideringvjavjditterentialvjdiagnosisvjwhilevjthevjpatientvjisvjspeakingvjtovjmaximizevjthevjpatient'svjtimevjwithvjthevjprovider
5. Avj42-year-oldvjfemalevjmathematicianvjpresentsvjforvjfollow-
upvjcarevjregardingvjavjnewvjdiagnosisvjofvjsystemicvjlupusvjerythematosusvj6vjmonth
svjagovjaftervjavjlengthyvjdiagnosticvjprocessvjduringvjwhichvjshevjwasvjdebilitatedvjwit
hvjfatiguevjandvjjointv j pain.vjSincevjhervjdiagnosis,vjshevjhasvjbeenvjminimallyvjcompli
antvjwithvjmedicationsvjandvjhasvjswitchedvjhervjrheumatologyvjprovidervjtwice.vjShevj
continuesvjtovjfeelvjill,vjand,vjinvjexplanationvjforvjhervjlackvjofvjadherencevjtovjthevjpresc
ribedvjtreatment,vjshevjsimplyvjsays,vj"Ivjdon'tvjlikevjit."vjAtvjthisvjinitialvjvisitvjwithvjhervjthi
rdvjrheumatologyv j provider,vjthevjclinicianvjelectsvjtovjexplorevjthevjissuesvjbehindvjh
ervjnoncompliancevjbeforevjengagingvjinvjdiagnosticsvjandvjtreatmentvjusingvjthevjFI
FEvjmodel.vjWhichvjofvjthevjfollowingvjbestvjdefinesvjthevjelementsvjofvjthevjFIFEvjmodel?:vja.vjFoc
us,vjintensity,vjfunction,v j andvjevaluation
b. Facts,vjintensity,vjfocus,vjandvjevidence
c. Feelings,vjideas,vjfunction,vjandvjexpectations
d. Feelings,vjimpression,vjfantasy,vjandvjemotion
e. Facts,vjintelligence,vjfortuity,vjandvjeventuality
6. Chapterv j 2:
7. Avj39-year-oldvjnursevjwhovjisvjavjwell-
establishedvjpatientvjcomplainsvjofvjirregularvjmenstrualvjperiodsvjandvjpelvicvjpain.vj
Shevjsaysvjthatvjshevjisvjhavingvjtroublevjsleepingvjandvjasksvjwhethervjshevjcouldvjbevjg
ivenvjavj"sleepingvjpill."vjThevjpatientvjalsovjsaysvjshevjisvjthinkingvjofvjleavingvjhervjjob.vj
Whatvjisvjthevjbestvj"nextvjstep"vjinvjcaringvjforvjthisvjpatient?:vja.vjPerformvjavjpelvicvjexamination.
b. Obtainvjavjurinevjsamplevjforvjtesting.
c. Obtainvjavjmorevjcompletevjdescriptionvjofvjproblems.
d. Obtainvjbloodvjforvjtesting.
e. Askvjaboutvjrecentvjtravelvjdestinations.
, NRv j 509v j Mid-Termv j Studyvj Questions
8. Avj29-year-
oldvjfemalevjprofessionalvjathletevjpresentsvjtovjavjnewvjprimaryvjcarevjprovidervjwithvj
chronicvjmenstrualvjcomplaints.vjShevjremarksvjtovjthevjnursingvjstaffv j that,vjinvjthevjp
ast,vjshevjhasvjexperiencedvjavjdismissalvjofvjhervjcomplaintsvjbecausev j ofvjhervjhighvjl
evelvjofvjphysicalvjfitnessvjandvjconditioning.vjShevjisvjseekingvjavjcarevjprovidervjwhovj
willvjexplorevjthevjissuevjinvjmorevjdetailvjandvjworkvjwithvjhervjparticularv j concerns.vjW
hichvjofvjthevjfollowingvjisvjthevjdescriptionvjofvjthevjpatient-
centeredvjcarevjthisvjindividualvjseeks?:vja.vjStructuredvjandvjclinician-centeredvjwithvjopen-
endedvjquestions
b. Validatingvj andv j empatheticv j withvj open-endedv j questions
c. Dismissivevjandvjconcretevjwithvjopen-endedvjquestions
d. Aflrmingvjandvjreassuringvjwithvjclose-endedvjquestions
e. Factualvjandvjstructuredvjwithvjactivevjlistening
9. Av j 36-year-
oldv j femalev j airv j trafficv j controllerv j presentsv j tov j herv j primaryv j carev j providerv j forv j a
v j routinev j visitv j 3v j monthsv j afterv j losingv j herv j spousev j tov j av j lengthyvjbattlev j with
v j av j neurodegenerativev j disease.v j Thev j patientv j deniesv j anyv j psychiatricv j symptoms
v j onv j reviewv j ofv j systemsv j and,v j inv j fact,v j statesv j thatv j shev j hasv j sleptv j bettervjinv j
thev j lastv j monthv j thanv j shev j hadv j inv j thev j previousv j years.v j Shev j endorsesv j av j health
yvjsupportv j system,v j includingv j thev j extendedv j familyv j ofv j herv j deceasedv j spouse,v j w
ithv j whomv j shev j isv j stillv j close.v j Shev j becomesv j wistfulv j andv j brieflyv j tearfulv j whenv j
speakingvjofv j thev j plansv j thatv j theyv j hadv j whenv j theyv j firstv j marriedv j thatv j werev j neve
rv j fulfilled;v j shevjthenv j changesv j thev j subjectv j rapidlyv j tov j whetherv j herv j Papv j smearv j is
v j due.v j Whichv j ofv j thevjfollowingvjisvjanvjexamplevjofvjanvjempatheticvjresponsevjtovjthisvjpat
ient?:vja.vjAssumingvjthatvjthevjeventvjcausedvjhervjtovjbecomevjdepressedvjandvjexpressingvjthevjsamevjfeelingvjonvjbe
halfvjofvjthevjpatient
b. Recognizingvjthevjpatient'svjemotionsvjbyvjaskingvjorvjconfirmingvjhowvjshevjfeelsvjaboutvjthevjevent
c. Byvjallowingvjthevjcryingvjpatientvjtovjlookvjaroundvjthevjroomvjforvjtissuesvjtovjpermitvjhervjanvjexcusevjtovjhidevjhervjfacevjandvjdef
ervjhervjemotions
d. Presumingvjthatvjthevjpatient'svjemotionsvjmeetvjsocialvjexpectations,vjsuchvjasvjbeingvjdepressedvjandvjevenvjtraumatizedvj
byvjhervjspouse'svjdeath
e. Narrowingvjthevjunderstandingvjofvjthevjpatient'svjemotionalvjresponsevjtovjonlyvjthoughtsvjandvjfeelingsvjthatvjhavevjbee
