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NR509 Final Exam100 QUESTIONS AND ANSWERS 2026
Section 1: Clinical Reasoning & Health History (Questions 1–15)
Question 1
A 58-year-old male presents with a chief complaint of "chest pressure." He
describes it as a dull ache that started 2 hours ago while raking leaves. Which
component of the HPI is represented by "raking leaves"?
• A) Location
• B) Context
• C) Associated factors
• D) Timing
Answer: B) Context
Rationale: Context refers to the activity or situation the patient was engaged in
when the symptom began. "Raking leaves" provides the environmental or
situational context, not the timing (duration) or associated factors (other
symptoms).
Question 2
You are using the "OLDCARTS" mnemonic to gather HPI data. A patient tells you
their abdominal pain is "sharp and stabbing." Which part of OLDCARTS does this
describe?
• A) Onset
• B) Location
• C) Character
• D) Timing
Answer: C) Character
Rationale: Character describes the quality or sensation of the symptom (e.g.,
sharp, dull, burning, stabbing).
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Question 3
A 72-year-old patient is asked about their medical history but cannot recall the
names of their medications. What is the most appropriate next step?
• A) Skip this section and document "non-contributory."
• B) Ask the patient to bring all prescription bottles to the next visit.
• C) Ask the patient to call their pharmacy for a list while in the office.
• D) Document the history as "unknown" and proceed.
Answer: C) Ask the patient to call their pharmacy for a list while in the office.
Rationale: Accurate medication reconciliation is critical for patient safety. The
best immediate step is to obtain the list from the pharmacy during the visit to
ensure accuracy and completeness.
Question 4
Which question is most appropriate for assessing the "severity" of a patient's pain
on a 0-10 scale?
• A) "Does the pain move anywhere?"
• B) "What does the pain feel like?"
• C) "On a scale of 0 to 10, with 0 being no pain and 10 being the worst pain
imaginable, what is your pain now?"
• D) "What were you doing when the pain started?"
Answer: C) "On a scale of 0 to 10, with 0 being no pain and 10 being the worst
pain imaginable, what is your pain now?"
Rationale: This standardized question quantifies severity, allowing for objective
tracking of the symptom over time.
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Question 5
A patient tells you, "I don't need to take my blood pressure medicine because I
feel fine." This statement reflects a barrier in which domain?
• A) Knowledge deficit
• B) Health beliefs
• C) Economic instability
• D) Social support
Answer: B) Health beliefs
Rationale: The patient's perception that lack of symptoms equals absence of
disease is a health belief that directly impacts adherence.
Question 6
Which of the following is considered a "red flag" symptom in a patient presenting
with a headache?
• A) Photophobia
• B) Nausea with vomiting
• C) Thunderclap onset
• D) Unilateral location
Answer: C) Thunderclap onset
Rationale: A sudden, severe headache reaching maximum intensity within
seconds ("thunderclap") is a red flag for subarachnoid hemorrhage and requires
immediate evaluation.
Question 7
The "review of systems" (ROS) differs from the HPI because the ROS:
• A) Is a complete inventory of body systems for positive and negative
responses.
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• B) Focuses solely on the chief complaint.
• C) Is only completed by the patient on a form.
• D) Is a legal document that cannot be modified.
Answer: A) Is a complete inventory of body systems for positive and negative
responses.
Rationale: The ROS is a systematic review of all body systems to identify
symptoms the patient may not have mentioned in the HPI.
Question 8
A patient's family history reveals that her mother was diagnosed with breast
cancer at age 42 and her sister at age 38. What is the most appropriate next step?
• A) Reassure the patient that her risk is not elevated.
• B) Discuss genetic counseling and referral.
• C) Recommend a mammogram starting at age 50.
• D) Document the history and move on.
Answer: B) Discuss genetic counseling and referral.
Rationale: Premature breast cancer in multiple first-degree relatives (under 50)
suggests a possible hereditary breast and ovarian cancer syndrome (e.g., BRCA
mutation), warranting genetic counseling.
Question 9
The CAGE questionnaire assesses which condition?
• A) Depression
• B) Alcohol misuse
• C) Anxiety
• D) Bipolar disorder
NR509 Final Exam100 QUESTIONS AND ANSWERS 2026
Section 1: Clinical Reasoning & Health History (Questions 1–15)
Question 1
A 58-year-old male presents with a chief complaint of "chest pressure." He
describes it as a dull ache that started 2 hours ago while raking leaves. Which
component of the HPI is represented by "raking leaves"?
• A) Location
• B) Context
• C) Associated factors
• D) Timing
Answer: B) Context
Rationale: Context refers to the activity or situation the patient was engaged in
when the symptom began. "Raking leaves" provides the environmental or
situational context, not the timing (duration) or associated factors (other
symptoms).
Question 2
You are using the "OLDCARTS" mnemonic to gather HPI data. A patient tells you
their abdominal pain is "sharp and stabbing." Which part of OLDCARTS does this
describe?
• A) Onset
• B) Location
• C) Character
• D) Timing
Answer: C) Character
Rationale: Character describes the quality or sensation of the symptom (e.g.,
sharp, dull, burning, stabbing).
,2
Question 3
A 72-year-old patient is asked about their medical history but cannot recall the
names of their medications. What is the most appropriate next step?
• A) Skip this section and document "non-contributory."
• B) Ask the patient to bring all prescription bottles to the next visit.
• C) Ask the patient to call their pharmacy for a list while in the office.
• D) Document the history as "unknown" and proceed.
Answer: C) Ask the patient to call their pharmacy for a list while in the office.
Rationale: Accurate medication reconciliation is critical for patient safety. The
best immediate step is to obtain the list from the pharmacy during the visit to
ensure accuracy and completeness.
Question 4
Which question is most appropriate for assessing the "severity" of a patient's pain
on a 0-10 scale?
• A) "Does the pain move anywhere?"
• B) "What does the pain feel like?"
• C) "On a scale of 0 to 10, with 0 being no pain and 10 being the worst pain
imaginable, what is your pain now?"
• D) "What were you doing when the pain started?"
Answer: C) "On a scale of 0 to 10, with 0 being no pain and 10 being the worst
pain imaginable, what is your pain now?"
Rationale: This standardized question quantifies severity, allowing for objective
tracking of the symptom over time.
,3
Question 5
A patient tells you, "I don't need to take my blood pressure medicine because I
feel fine." This statement reflects a barrier in which domain?
• A) Knowledge deficit
• B) Health beliefs
• C) Economic instability
• D) Social support
Answer: B) Health beliefs
Rationale: The patient's perception that lack of symptoms equals absence of
disease is a health belief that directly impacts adherence.
Question 6
Which of the following is considered a "red flag" symptom in a patient presenting
with a headache?
• A) Photophobia
• B) Nausea with vomiting
• C) Thunderclap onset
• D) Unilateral location
Answer: C) Thunderclap onset
Rationale: A sudden, severe headache reaching maximum intensity within
seconds ("thunderclap") is a red flag for subarachnoid hemorrhage and requires
immediate evaluation.
Question 7
The "review of systems" (ROS) differs from the HPI because the ROS:
• A) Is a complete inventory of body systems for positive and negative
responses.
, 4
• B) Focuses solely on the chief complaint.
• C) Is only completed by the patient on a form.
• D) Is a legal document that cannot be modified.
Answer: A) Is a complete inventory of body systems for positive and negative
responses.
Rationale: The ROS is a systematic review of all body systems to identify
symptoms the patient may not have mentioned in the HPI.
Question 8
A patient's family history reveals that her mother was diagnosed with breast
cancer at age 42 and her sister at age 38. What is the most appropriate next step?
• A) Reassure the patient that her risk is not elevated.
• B) Discuss genetic counseling and referral.
• C) Recommend a mammogram starting at age 50.
• D) Document the history and move on.
Answer: B) Discuss genetic counseling and referral.
Rationale: Premature breast cancer in multiple first-degree relatives (under 50)
suggests a possible hereditary breast and ovarian cancer syndrome (e.g., BRCA
mutation), warranting genetic counseling.
Question 9
The CAGE questionnaire assesses which condition?
• A) Depression
• B) Alcohol misuse
• C) Anxiety
• D) Bipolar disorder
