NR 509 Midterm Exam
Advanced Physical Assessment
100 + Questions and Answers
Chamberlain
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
d. (MVA) that led to back pain
e. Asking leading questions that focus on the presumed diag - ANSWER-f. Moving
from open-ended to focused questions
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?
a. Assuming that the event caused her to become depressed and expressing the
same feeling on behalf of the patient
b. Recognizing the patient's emotions by asking or con - ANSWER-b. Recognizing
the patient's emotions by asking or confirming how she feels about the event
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 - ANSWER-b. Echoing
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 - ANSWER-a. "That sounds like a frightening
Advanced Physical Assessment
100 + Questions and Answers
Chamberlain
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
d. (MVA) that led to back pain
e. Asking leading questions that focus on the presumed diag - ANSWER-f. Moving
from open-ended to focused questions
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?
a. Assuming that the event caused her to become depressed and expressing the
same feeling on behalf of the patient
b. Recognizing the patient's emotions by asking or con - ANSWER-b. Recognizing
the patient's emotions by asking or confirming how she feels about the event
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 - ANSWER-b. Echoing
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 - ANSWER-a. "That sounds like a frightening
