NR 509 Final Exam / NR509 Final Exam
(NEW- 2023/2024):Chamberlain college
of Nursing
1. When obtaining a comprehensive health history, what is the purpose of the OLD CARTS
mnemonic in the HPI?
A. To document pain characteristics only
B. To systematically collect all dimensions of a symptom, ensuring no key information is missed
C. To replace the physical examination
D. To be used only for pediatric patients
B OLD CARTS stands for Onset, Location, Duration, Character, Aggravating/Alleviating
factors, Radiation, Timing, and Severity. It is a systematic framework that ensures HPI
completeness.
2. A patient begins to cry during the interview while discussing a recent bereavement. What is
the most appropriate therapeutic communication strategy?
A. Change the subject to avoid emotional escalation
B. Remain silent, offer a supportive presence, and use empathic listening
C. Tell the patient "Don't cry, everything will be fine"
D. Immediately end the interview and arrange a psych referral
B Allowing silence, offering a supportive presence, and empathic listening are core
therapeutic communication techniques during emotional moments. This builds trust and
validates the patient's experience.
3. How should the Chief Complaint be documented?
A. Using precise medical terminology
B. In the patient's own words, in quotation marks
C. Recording only the most severe symptom
D. Summarizing all symptoms in a list
, B The chief complaint must be recorded in the patient's own words and placed in
quotation marks. It represents the primary reason the patient is seeking care, avoiding clinician
interpretation bias.
4. Which of the following are components of the Past Medical History (PMH)? (SATA)
A. Prior hospitalizations
B. Current medications
C. Chronic illnesses
D. Major injuries and surgeries
E. Allergies
A, C, D PMH includes prior hospitalizations, chronic illnesses, and major
injuries/surgeries. Current medications (B) and allergies (E) are documented as separate
categories.
5. When using an interpreter during an interview, where should the interpreter be
positioned?
A. Next to the examiner
B. Next to the patient, so the examiner can maintain eye contact and observe nonverbal cues
C. In the corner of the room
D. Behind the patient
B The interpreter should sit beside the patient while the examiner faces the patient
directly. This maintains eye contact and allows observation of nonverbal communication.
6. A patient is angry and loudly complaining about a long wait time. Which of the following
techniques would NOT be helpful in de-escalating this patient?
A. Accepting the patient's anger without retaliating
B. Avoiding acknowledging any responsibility for the patient's anger
C. Remaining calm
D. Maintaining a relaxed posture
B Avoiding acknowledgment of any responsibility for the patient's anger undermines
trust and escalates frustration. Accepting anger, remaining calm, and maintaining a relaxed
posture are all effective de-escalation techniques.
,7. Upon entering the exam room, the patient's spouse is already present. What is the most
appropriate action?
A. Ask the spouse to leave because of privacy concerns
B. Ask the patient whether they agree to have the spouse present during the interview
C. Begin the interview immediately, ignoring the spouse
D. Speak only to the spouse if the patient introduces them
B The patient's autonomy should be respected by asking whether they consent to the
spouse's presence. The patient's privacy rights and choice should take priority regardless of
whether the spouse is present.
8. Which of the following is an example of an open-ended question?
A. "Is the pain sharp or dull?"
B. "Tell me more about your fatigue."
C. "Do you have chest pain?"
D. "How many times a day do you take your medication?"
B "Tell me more..." is an open-ended question that encourages the patient to describe
symptoms in their own words, yielding richer clinical information.
9. A 72-year-old man presents with a cough. Which question best assesses the aggravating
and alleviating factors of the cough?
A. "When did the cough start?"
B. "What makes the cough better or worse?"
C. "What does the cough sound like?"
D. "Do you produce sputum when you cough?"
B Aggravating/alleviating factors directly ask what worsens or improves the symptom,
corresponding to the A and R dimensions of OLD CARTS.
10. In cardiovascular risk assessment, the CAGE questionnaire is used to screen for what?
A. Depression
B. Alcohol use disorder
, C. Anxiety disorder
D. Nicotine dependence
B CAGE is a screening tool for alcohol use disorder: Cut down, Annoyed, Guilty, Eye-
opener.
11. What does the FIFE model represent in patient-centered communication?
A. Feelings, Ideas, Function, Expectations
B. Family, Illness, Fear, Environment
C. Focus, Interview, Feedback, Evaluation
D. Findings, Interpretation, Follow-up, Education
A The FIFE model includes the patient's Feelings, Ideas, Function, and Expectations. It is
a core framework for patient-centered communication.
12. A patient says, "I'm fine," but has arms crossed, is leaning back, and avoiding eye contact.
What is the most appropriate response?
A. Accept the patient's statement and move to the next question
B. "You seem troubled by this question."
C. "You need to cooperate for me to help you."
D. Ignore the nonverbal cues and focus on verbal content
B Naming and validating the patient's emotional state is a therapeutic communication
technique that helps the patient feel understood.
13. Which of the following is part of the Social History?
A. Smoking and alcohol use
B. Prior surgical history
C. Family history of diabetes
D. Current medication list
A Social history includes smoking, alcohol, drug use, occupation, living situation, and
sexual history. Surgical history is PMH; family history is FH.
(NEW- 2023/2024):Chamberlain college
of Nursing
1. When obtaining a comprehensive health history, what is the purpose of the OLD CARTS
mnemonic in the HPI?
A. To document pain characteristics only
B. To systematically collect all dimensions of a symptom, ensuring no key information is missed
C. To replace the physical examination
D. To be used only for pediatric patients
B OLD CARTS stands for Onset, Location, Duration, Character, Aggravating/Alleviating
factors, Radiation, Timing, and Severity. It is a systematic framework that ensures HPI
completeness.
2. A patient begins to cry during the interview while discussing a recent bereavement. What is
the most appropriate therapeutic communication strategy?
A. Change the subject to avoid emotional escalation
B. Remain silent, offer a supportive presence, and use empathic listening
C. Tell the patient "Don't cry, everything will be fine"
D. Immediately end the interview and arrange a psych referral
B Allowing silence, offering a supportive presence, and empathic listening are core
therapeutic communication techniques during emotional moments. This builds trust and
validates the patient's experience.
3. How should the Chief Complaint be documented?
A. Using precise medical terminology
B. In the patient's own words, in quotation marks
C. Recording only the most severe symptom
D. Summarizing all symptoms in a list
, B The chief complaint must be recorded in the patient's own words and placed in
quotation marks. It represents the primary reason the patient is seeking care, avoiding clinician
interpretation bias.
4. Which of the following are components of the Past Medical History (PMH)? (SATA)
A. Prior hospitalizations
B. Current medications
C. Chronic illnesses
D. Major injuries and surgeries
E. Allergies
A, C, D PMH includes prior hospitalizations, chronic illnesses, and major
injuries/surgeries. Current medications (B) and allergies (E) are documented as separate
categories.
5. When using an interpreter during an interview, where should the interpreter be
positioned?
A. Next to the examiner
B. Next to the patient, so the examiner can maintain eye contact and observe nonverbal cues
C. In the corner of the room
D. Behind the patient
B The interpreter should sit beside the patient while the examiner faces the patient
directly. This maintains eye contact and allows observation of nonverbal communication.
6. A patient is angry and loudly complaining about a long wait time. Which of the following
techniques would NOT be helpful in de-escalating this patient?
A. Accepting the patient's anger without retaliating
B. Avoiding acknowledging any responsibility for the patient's anger
C. Remaining calm
D. Maintaining a relaxed posture
B Avoiding acknowledgment of any responsibility for the patient's anger undermines
trust and escalates frustration. Accepting anger, remaining calm, and maintaining a relaxed
posture are all effective de-escalation techniques.
,7. Upon entering the exam room, the patient's spouse is already present. What is the most
appropriate action?
A. Ask the spouse to leave because of privacy concerns
B. Ask the patient whether they agree to have the spouse present during the interview
C. Begin the interview immediately, ignoring the spouse
D. Speak only to the spouse if the patient introduces them
B The patient's autonomy should be respected by asking whether they consent to the
spouse's presence. The patient's privacy rights and choice should take priority regardless of
whether the spouse is present.
8. Which of the following is an example of an open-ended question?
A. "Is the pain sharp or dull?"
B. "Tell me more about your fatigue."
C. "Do you have chest pain?"
D. "How many times a day do you take your medication?"
B "Tell me more..." is an open-ended question that encourages the patient to describe
symptoms in their own words, yielding richer clinical information.
9. A 72-year-old man presents with a cough. Which question best assesses the aggravating
and alleviating factors of the cough?
A. "When did the cough start?"
B. "What makes the cough better or worse?"
C. "What does the cough sound like?"
D. "Do you produce sputum when you cough?"
B Aggravating/alleviating factors directly ask what worsens or improves the symptom,
corresponding to the A and R dimensions of OLD CARTS.
10. In cardiovascular risk assessment, the CAGE questionnaire is used to screen for what?
A. Depression
B. Alcohol use disorder
, C. Anxiety disorder
D. Nicotine dependence
B CAGE is a screening tool for alcohol use disorder: Cut down, Annoyed, Guilty, Eye-
opener.
11. What does the FIFE model represent in patient-centered communication?
A. Feelings, Ideas, Function, Expectations
B. Family, Illness, Fear, Environment
C. Focus, Interview, Feedback, Evaluation
D. Findings, Interpretation, Follow-up, Education
A The FIFE model includes the patient's Feelings, Ideas, Function, and Expectations. It is
a core framework for patient-centered communication.
12. A patient says, "I'm fine," but has arms crossed, is leaning back, and avoiding eye contact.
What is the most appropriate response?
A. Accept the patient's statement and move to the next question
B. "You seem troubled by this question."
C. "You need to cooperate for me to help you."
D. Ignore the nonverbal cues and focus on verbal content
B Naming and validating the patient's emotional state is a therapeutic communication
technique that helps the patient feel understood.
13. Which of the following is part of the Social History?
A. Smoking and alcohol use
B. Prior surgical history
C. Family history of diabetes
D. Current medication list
A Social history includes smoking, alcohol, drug use, occupation, living situation, and
sexual history. Surgical history is PMH; family history is FH.
