NR 509
MIDTERM EXAM PREP
(300+ Practice Questions)
(Week’s 1 – 4 Covered)
Verified Questions & Answers With Rationales
(Advanced Physical Assessment)
Chamberlain
, PREVIEW
P
Preview Pages Below
Get the Complete PDF After
Purchase
If you require further clarification or in need of any study
resources, feel free to Message me.
PREVIEW QUESTIONS FOLLOW
,Table of Contents
SECTION 1 ................................................................................. 2
SECTION 2 .............................................................................. 59
SECTION 3 .............................................................................. 99
SECTION 1
.
1. A 63-year-old male presents to establish care at a new primary care clinic to
discuss issues with pain and fatigue. The clinician conducting the visit begins with
general historical questions but quickly becomes suspicious that the patient is
suffering from decompensated heart failure. When the patient mentions that he has
had vague chest pain since last night, the clinician feels that the focus must be
redirected to this potentially emergent condition. Which of the following interview
techniques is the most appropriate to effectively manage this visit?
a. Providing serial reassurances such as, "Don't worry, you're going to be fine."
b. Asking a series of negative questions such as, "You don't have any swelling in your feet,
do you?"
c. Nonverbally cuing the patient to focus on his narrative regarding a motor vehicle accident
that led to back pain
d. Asking leading questions that focus on the presumed diagnosis of chest pain
e. Moving from open-ended to focused questions
Correct Answer: e. Moving from open-ended to focused questions
Rationale: When a potentially life-threatening symptom emerges during a patient
interview, the clinician should transition from broad, open-ended questions to more
focused inquiries that clarify the nature, severity, and urgency of the new complaint. This
ensures that critical information is gathered efficiently without completely abandoning
patient-centered communication.
2. A 59-year-old patient presents to his primary care provider with a history of
several episodes of sharp epigastric pain. His father died of pancreatic cancer at age
52 years, and the patient recalls to the clinician that, "His pain was just like mine is
,now ..." The patient then pauses several seconds. The clinician replies, "Just like?"
after which the patient restarts his narrative. Which of the following is an example of
the interviewing techniques employed by the clinician?
a. Clarifying
b. Echoing
c. Encouraging with continuers
d. Eliciting a graded response
e. Asking a leading question
Correct Answer: b. Echoing
Rationale: Echoing is an interviewing technique in which the clinician repeats the patient's
last few words or a key phrase to encourage elaboration. By saying "Just like?" the clinician
prompted the patient to continue his narrative without directing the content.
3. A 14-year-old male presents to a new primary care provider after his family
relocates to a state. The patient underwent treatment for sarcoma when he was age
11 years, including an above-the-knee amputation. He has learned to successfully
navigate with a prosthetic leg and even engage in competitive athletics at school. He
does not like to speak of his experience with cancer and often makes up humorous
stories to tell new acquaintances about his amputation (such as, "I got bit by a
squirrel and they had to amputate."). Although he is very well engaged in most of the
visit with the new clinician, when the topic of cancer arises, he demurs to his father,
who accompanies him to this appointment. Which of the following statements is
most likely to be helpful in cementing the patient's trust in the new provider?
a. "That sounds like a frightening experience that you are recovering well from."
b. "You are becoming an adult and must be able to talk about your health."
c. "You need to see a counselor since you have not adjusted well to your new condition."
d. "You have recovered well and should start moving on with your life."
e. "You cannot rely on your father for support forever."
Correct Answer: a. "That sounds like a frightening experience that you are recovering well
from."
Rationale: This statement validates the patient's experience, acknowledges the emotional
weight of his cancer history, and recognizes his resilience. It is nonjudgmental and patient-
centered, which helps build trust. The other options are either dismissive, prematurely
push autonomy, or pathologize normal coping behaviors.
,4. 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.
Correct Answer: c. Obtain a more complete description of problems.
Rationale: Before ordering tests or performing procedures, the clinician must gather a
comprehensive history to understand the full scope of the patient's concerns. Sleep
disturbance, menstrual irregularities, pelvic pain, and job dissatisfaction may indicate
depression, anxiety, perimenopause, or another underlying condition. A thorough history
guides appropriate diagnostic and therapeutic decisions.
5. 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
Correct Answer: b. Validating and empathetic with open-ended questions
Rationale: Patient-centered care requires acknowledging the patient's experience,
validating her concerns, and using open-ended questions to explore her unique situation.
This approach builds trust and encourages the patient to share important details that may
have been previously overlooked.
, SECTION 2
1. An 80-year-old woman is visiting the clinic for a check-up. She states "I can't walk
as much as I used to." The FNP is observing for motor dysfunction in her hip and
should have her:
A. internally rotate her hip while she is sitting
B. abduct her hip while she is lying on her back
C. adduct her hip while she is lying on her back
D. externally rotate her hip while she is sitting
Correct Answer: B. abduct her hip while she is lying on her back
Rationale: Hip abduction while supine tests the gluteus medius and minimus muscles,
which are essential for ambulation and pelvic stability during walking. Weakness in these
muscles commonly causes gait disturbances in older adults.
2. A patient has been diagnosed with osteoporosis and asked the FNP "what is
osteoporosis?" The FNP explains to the patient that osteoporosis is defined as:
,A. increased bone matrix
B. loss of bone density
C. new, weaker bone growth
D. increased phagocytic activity
Correct Answer: B. loss of bone density
Rationale: Osteoporosis is characterized by decreased bone mass and density resulting
from loss of bone matrix and mineralization, leading to fragile bones and increased fracture
risk. It is not defined by increased bone matrix or phagocytic activity.
3. Patient states, "I can hear a crunching or grating sound when I kneel." She also
states "that it is very difficult to get out of bed in the morning because of stiffness and
pain in my joints." The FNP should assess for signs of what problem?
A. Crepitation
B. A bone spur
C. A loose tendon
D. Fluid in the knee joint
Correct Answer: A. Crepitation
Rationale: Crepitation (crepitus) refers to the grinding, crunching, or grating
sound/sensation produced when bone surfaces rub against each other, often due to
damaged cartilage. Morning stiffness combined with crepitus is characteristic of
degenerative joint disease.
4. When taking the history on a patient with a seizure disorder the FNP assesses
whether the patient has an aura. Which of these would be the best question for
obtaining this information?
A. "Does your muscle tone seem to tense or limp?"
B. "After the seizure, do you spend a lot of time sleeping?"
C. "Do you have any warning sign before your seizure starts?"
D. "Do you experience any color change or incontinence during the seizure?"
Correct Answer: C. "Do you have any warning sign before your seizure starts?"
Rationale: An aura is a subjective sensation or warning sign that precedes a seizure. It may
manifest as visual disturbances, unusual smells, or emotional changes. Asking about
warning signs before the seizure is the most direct way to assess for aura presence.
, SECTION 3
1. Mr. Larson is a 42-year-old widowed father of two children, ages 4 and 11. He
works in a sales office to support his family. Recently he has injured his back and you
are thinking he would benefit from physical therapy, three times a week, for an hour
per session. What would be your next step?
A) Write the physical therapy prescription.
B) Have your office staff explain directions to the physical therapy center.
C) Discuss the plan with Mr. Larson.
D) Tell Mr. Larson that he will be going to physical therapy three times a week.
Correct Answer: C) Discuss the plan with Mr. Larson.
Rationale: You should discuss your proposed plan with the patient before implementing it.
In this case, you and Mr. Larson will need to weigh the benefit of physical therapy against
the ability to provide for his family. You may need to consider other ways of helping the
patient, perhaps through prescribed back exercises he can do at home. It is a common
mistake to implement a plan without coming to an agreement with the patient first.
2. You are seeing an elderly man with multiple complaints. He has chronic arthritis,
pain from an old war injury, and headaches. Today he complains of these pains, as
well as dull chest pain under his sternum. What would the order of priority be for
your problem list?
A) Arthritis, war injury pain, headaches, chest pain
B) War injury pain, arthritis, headaches, chest pain
C) Headaches, arthritis, war injury pain, chest pain
D) Chest pain, headaches, arthritis, war injury pain
Correct Answer: D) Chest pain, headaches, arthritis, war injury pain
Rationale: The problem list should have the most active and serious problem first. This
new complaint of chest pain is almost certainly a higher priority than his other, more
chronic problems.
3. You are excited about a positive test finding you have just noticed on physical
examination of your patient. You go on to do more examination, laboratory work, and
,diagnostic tests, only to find that there is no sign of the disease you thought would
correlate with the finding. This same experience happens several times. What should
you conclude?
A) Consider not doing this test routinely.
B) Use this test when you have a higher suspicion for a certain correlating condition.
C) Continue using the test, perhaps doing less laboratory work and diagnostics.
D) Omit this test from future examinations.
Correct Answer: C) Continue using the test, perhaps doing less laboratory work and
diagnostics.
Rationale: This is an example of a specific test that lacks sensitivity. With this scenario,
when you finally find a positive, you might be very certain that a given condition is present.
We generally develop our examinations to fit our clinical experiences. Sensitive tests are
performed routinely on the screening examination, while specific tests are usually saved for
the detailed or "branched" examinations. Branched examinations are further maneuvers we
can perform to investigate positive findings on our screening examinations. Save this type
of maneuver to confirm your hypothesis.
4. A patient presents for evaluation of a sharp, aching chest pain which increases
with breathing. Which anatomic area would you localize the symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine
Correct Answer: A) Musculoskeletal
Rationale: Chest pain may be due to a musculoskeletal condition, such as costochondritis
or intercostal muscle cramp. This would be worsened by motion of the chest wall. Pleuritic
chest pain is also a sharp chest pain which increases with a deep breath. This type of pain
can occur with inflammation of the pleura from pneumonia or other conditions and
pulmonary embolus.
5. A 62-year-old teacher presents to the clinic for evaluation of the following
symptoms: fever, headache, sinus congestion, sore throat, green nasal discharge, and
cough. This cluster of symptoms is best explained by:
, NR 509
MIDTERM EXAM PREP
(300+ Practice Questions)
(Week’s 1 – 4 Covered)
Verified Questions & Answers With Rationales
(Advanced Physical Assessment)
Chamberlain
MIDTERM EXAM PREP
(300+ Practice Questions)
(Week’s 1 – 4 Covered)
Verified Questions & Answers With Rationales
(Advanced Physical Assessment)
Chamberlain
, PREVIEW
P
Preview Pages Below
Get the Complete PDF After
Purchase
If you require further clarification or in need of any study
resources, feel free to Message me.
PREVIEW QUESTIONS FOLLOW
,Table of Contents
SECTION 1 ................................................................................. 2
SECTION 2 .............................................................................. 59
SECTION 3 .............................................................................. 99
SECTION 1
.
1. A 63-year-old male presents to establish care at a new primary care clinic to
discuss issues with pain and fatigue. The clinician conducting the visit begins with
general historical questions but quickly becomes suspicious that the patient is
suffering from decompensated heart failure. When the patient mentions that he has
had vague chest pain since last night, the clinician feels that the focus must be
redirected to this potentially emergent condition. Which of the following interview
techniques is the most appropriate to effectively manage this visit?
a. Providing serial reassurances such as, "Don't worry, you're going to be fine."
b. Asking a series of negative questions such as, "You don't have any swelling in your feet,
do you?"
c. Nonverbally cuing the patient to focus on his narrative regarding a motor vehicle accident
that led to back pain
d. Asking leading questions that focus on the presumed diagnosis of chest pain
e. Moving from open-ended to focused questions
Correct Answer: e. Moving from open-ended to focused questions
Rationale: When a potentially life-threatening symptom emerges during a patient
interview, the clinician should transition from broad, open-ended questions to more
focused inquiries that clarify the nature, severity, and urgency of the new complaint. This
ensures that critical information is gathered efficiently without completely abandoning
patient-centered communication.
2. A 59-year-old patient presents to his primary care provider with a history of
several episodes of sharp epigastric pain. His father died of pancreatic cancer at age
52 years, and the patient recalls to the clinician that, "His pain was just like mine is
,now ..." The patient then pauses several seconds. The clinician replies, "Just like?"
after which the patient restarts his narrative. Which of the following is an example of
the interviewing techniques employed by the clinician?
a. Clarifying
b. Echoing
c. Encouraging with continuers
d. Eliciting a graded response
e. Asking a leading question
Correct Answer: b. Echoing
Rationale: Echoing is an interviewing technique in which the clinician repeats the patient's
last few words or a key phrase to encourage elaboration. By saying "Just like?" the clinician
prompted the patient to continue his narrative without directing the content.
3. A 14-year-old male presents to a new primary care provider after his family
relocates to a state. The patient underwent treatment for sarcoma when he was age
11 years, including an above-the-knee amputation. He has learned to successfully
navigate with a prosthetic leg and even engage in competitive athletics at school. He
does not like to speak of his experience with cancer and often makes up humorous
stories to tell new acquaintances about his amputation (such as, "I got bit by a
squirrel and they had to amputate."). Although he is very well engaged in most of the
visit with the new clinician, when the topic of cancer arises, he demurs to his father,
who accompanies him to this appointment. Which of the following statements is
most likely to be helpful in cementing the patient's trust in the new provider?
a. "That sounds like a frightening experience that you are recovering well from."
b. "You are becoming an adult and must be able to talk about your health."
c. "You need to see a counselor since you have not adjusted well to your new condition."
d. "You have recovered well and should start moving on with your life."
e. "You cannot rely on your father for support forever."
Correct Answer: a. "That sounds like a frightening experience that you are recovering well
from."
Rationale: This statement validates the patient's experience, acknowledges the emotional
weight of his cancer history, and recognizes his resilience. It is nonjudgmental and patient-
centered, which helps build trust. The other options are either dismissive, prematurely
push autonomy, or pathologize normal coping behaviors.
,4. 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.
Correct Answer: c. Obtain a more complete description of problems.
Rationale: Before ordering tests or performing procedures, the clinician must gather a
comprehensive history to understand the full scope of the patient's concerns. Sleep
disturbance, menstrual irregularities, pelvic pain, and job dissatisfaction may indicate
depression, anxiety, perimenopause, or another underlying condition. A thorough history
guides appropriate diagnostic and therapeutic decisions.
5. 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
Correct Answer: b. Validating and empathetic with open-ended questions
Rationale: Patient-centered care requires acknowledging the patient's experience,
validating her concerns, and using open-ended questions to explore her unique situation.
This approach builds trust and encourages the patient to share important details that may
have been previously overlooked.
, SECTION 2
1. An 80-year-old woman is visiting the clinic for a check-up. She states "I can't walk
as much as I used to." The FNP is observing for motor dysfunction in her hip and
should have her:
A. internally rotate her hip while she is sitting
B. abduct her hip while she is lying on her back
C. adduct her hip while she is lying on her back
D. externally rotate her hip while she is sitting
Correct Answer: B. abduct her hip while she is lying on her back
Rationale: Hip abduction while supine tests the gluteus medius and minimus muscles,
which are essential for ambulation and pelvic stability during walking. Weakness in these
muscles commonly causes gait disturbances in older adults.
2. A patient has been diagnosed with osteoporosis and asked the FNP "what is
osteoporosis?" The FNP explains to the patient that osteoporosis is defined as:
,A. increased bone matrix
B. loss of bone density
C. new, weaker bone growth
D. increased phagocytic activity
Correct Answer: B. loss of bone density
Rationale: Osteoporosis is characterized by decreased bone mass and density resulting
from loss of bone matrix and mineralization, leading to fragile bones and increased fracture
risk. It is not defined by increased bone matrix or phagocytic activity.
3. Patient states, "I can hear a crunching or grating sound when I kneel." She also
states "that it is very difficult to get out of bed in the morning because of stiffness and
pain in my joints." The FNP should assess for signs of what problem?
A. Crepitation
B. A bone spur
C. A loose tendon
D. Fluid in the knee joint
Correct Answer: A. Crepitation
Rationale: Crepitation (crepitus) refers to the grinding, crunching, or grating
sound/sensation produced when bone surfaces rub against each other, often due to
damaged cartilage. Morning stiffness combined with crepitus is characteristic of
degenerative joint disease.
4. When taking the history on a patient with a seizure disorder the FNP assesses
whether the patient has an aura. Which of these would be the best question for
obtaining this information?
A. "Does your muscle tone seem to tense or limp?"
B. "After the seizure, do you spend a lot of time sleeping?"
C. "Do you have any warning sign before your seizure starts?"
D. "Do you experience any color change or incontinence during the seizure?"
Correct Answer: C. "Do you have any warning sign before your seizure starts?"
Rationale: An aura is a subjective sensation or warning sign that precedes a seizure. It may
manifest as visual disturbances, unusual smells, or emotional changes. Asking about
warning signs before the seizure is the most direct way to assess for aura presence.
, SECTION 3
1. Mr. Larson is a 42-year-old widowed father of two children, ages 4 and 11. He
works in a sales office to support his family. Recently he has injured his back and you
are thinking he would benefit from physical therapy, three times a week, for an hour
per session. What would be your next step?
A) Write the physical therapy prescription.
B) Have your office staff explain directions to the physical therapy center.
C) Discuss the plan with Mr. Larson.
D) Tell Mr. Larson that he will be going to physical therapy three times a week.
Correct Answer: C) Discuss the plan with Mr. Larson.
Rationale: You should discuss your proposed plan with the patient before implementing it.
In this case, you and Mr. Larson will need to weigh the benefit of physical therapy against
the ability to provide for his family. You may need to consider other ways of helping the
patient, perhaps through prescribed back exercises he can do at home. It is a common
mistake to implement a plan without coming to an agreement with the patient first.
2. You are seeing an elderly man with multiple complaints. He has chronic arthritis,
pain from an old war injury, and headaches. Today he complains of these pains, as
well as dull chest pain under his sternum. What would the order of priority be for
your problem list?
A) Arthritis, war injury pain, headaches, chest pain
B) War injury pain, arthritis, headaches, chest pain
C) Headaches, arthritis, war injury pain, chest pain
D) Chest pain, headaches, arthritis, war injury pain
Correct Answer: D) Chest pain, headaches, arthritis, war injury pain
Rationale: The problem list should have the most active and serious problem first. This
new complaint of chest pain is almost certainly a higher priority than his other, more
chronic problems.
3. You are excited about a positive test finding you have just noticed on physical
examination of your patient. You go on to do more examination, laboratory work, and
,diagnostic tests, only to find that there is no sign of the disease you thought would
correlate with the finding. This same experience happens several times. What should
you conclude?
A) Consider not doing this test routinely.
B) Use this test when you have a higher suspicion for a certain correlating condition.
C) Continue using the test, perhaps doing less laboratory work and diagnostics.
D) Omit this test from future examinations.
Correct Answer: C) Continue using the test, perhaps doing less laboratory work and
diagnostics.
Rationale: This is an example of a specific test that lacks sensitivity. With this scenario,
when you finally find a positive, you might be very certain that a given condition is present.
We generally develop our examinations to fit our clinical experiences. Sensitive tests are
performed routinely on the screening examination, while specific tests are usually saved for
the detailed or "branched" examinations. Branched examinations are further maneuvers we
can perform to investigate positive findings on our screening examinations. Save this type
of maneuver to confirm your hypothesis.
4. A patient presents for evaluation of a sharp, aching chest pain which increases
with breathing. Which anatomic area would you localize the symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine
Correct Answer: A) Musculoskeletal
Rationale: Chest pain may be due to a musculoskeletal condition, such as costochondritis
or intercostal muscle cramp. This would be worsened by motion of the chest wall. Pleuritic
chest pain is also a sharp chest pain which increases with a deep breath. This type of pain
can occur with inflammation of the pleura from pneumonia or other conditions and
pulmonary embolus.
5. A 62-year-old teacher presents to the clinic for evaluation of the following
symptoms: fever, headache, sinus congestion, sore throat, green nasal discharge, and
cough. This cluster of symptoms is best explained by:
, NR 509
MIDTERM EXAM PREP
(300+ Practice Questions)
(Week’s 1 – 4 Covered)
Verified Questions & Answers With Rationales
(Advanced Physical Assessment)
Chamberlain
