NR 509 Final Exam / NR509 Final Exam
(NEW- 2023/2024):Chamberlain college
of Nursing
SECTION 1: Health History, Interviewing & Clinical Reasoning
1. An example of objective data obtained during a physical assessment includes:
A. Patient's history of allergies
B. Patient's use of medications at home
C. Last menstrual period 1 month ago
D. 2.5 cm scar on the right lower forearm
Rationale: Objective data are directly observable and measurable by the examiner. A scar
can be seen, measured, and documented, making it objective. History of allergies, medication
use, and menstrual history are subjective data obtained from the patient's verbal report.
2. Which of the following is an example of subjective data?
A. Decreased range of motion
B. Crepitation in the left knee joint
C. Left knee has been swollen and hot for 3 days
D. Joint deformity noted on inspection
Rationale: Subjective data are what the patient reports or describes. The patient's report of
swelling and heat duration is subjective. Range of motion and crepitation are objective findings
determined by the examiner, while joint deformity is directly observed.
3. The nursing process is a sequential method of problem-solving that includes which steps?
A. Assessment, treatment, planning, evaluation, discharge, and follow-up
B. Admission, assessment, diagnosis, treatment, and discharge planning
C. Assessment, diagnosis, treatment, evaluation, and documentation
D. Assessment, diagnosis, outcome identification, planning, implementation, and evaluation
, Rationale: The nursing process consists of six distinct steps: Assessment (data collection),
Diagnosis (identification of health problems), Outcome Identification (goal setting), Planning
(intervention development), Implementation (carrying out interventions), and Evaluation
(measuring outcomes). This systematic approach guides clinical reasoning.
4. What step of the nursing process includes data collection by health history, physical
examination, and interview?
A. Assessment
B. Diagnosis
C. Planning
D. Evaluation
Rationale: Assessment is the first and foundational step of the nursing process, involving
systematic data collection through health history taking, physical examination, and patient
interviewing. All subsequent steps depend on accurate assessment data.
5. A nursing diagnosis is best described as:
A. A determination of the etiology of a disease
B. A pattern of coping
C. An individual's perception of health
D. A clinical judgment about individual, family, or community responses to actual or
potential health problems
Rationale: A nursing diagnosis is a clinical judgment concerning a human response to health
conditions/life processes, or a vulnerability for that response. It guides the selection of nursing
interventions. Medical diagnoses focus on disease pathology.
6. A 52-year-old woman presents stating she does not feel like herself. She reports fatigue,
weight gain, and poor concentration for three months. The NP begins with open-ended
questions before focused inquiry. This sequencing is most consistent with which principle of
effective interviewing?
A. Building a therapeutic relationship and gathering the patient's narrative before narrowing
to specific details
B. Immediately obtaining a complete review of systems to save time
,C. Relying exclusively on closed-ended questions to increase efficiency
D. Deferring all psychosocial inquiry until the physical examination is complete
Rationale: Effective interviewing begins with open-ended questions that invite the patient's
story and establish rapport. Focused questions follow to clarify details, supporting accurate
history-taking and patient-centered care.
7. A 68-year-old man lists seven prescription medications, two OTC analgesics, and a daily
herbal supplement. He says he takes whatever the bottle says. The most appropriate next
step is to:
A. Assume full adherence and proceed to the physical examination
B. Perform detailed medication reconciliation including timing, dose, and missed doses
while assessing polypharmacy risks
C. Advise immediate cessation of all herbal products without discussion
D. Limit the review to prescription drugs only
Rationale: Polypharmacy is common in older adults. Systematic reconciliation of all
products is essential to identify adherence issues, interactions, and deprescribing opportunities.
8. A 34-year-old woman describes episodic chest tightness at rest lasting 10-15 minutes with a
sense of impending doom. She denies radiation, diaphoresis, or exertional triggers. The NP
prioritizes panic disorder over ACS. This reasoning is best described as:
A. Pattern recognition based solely on age and gender
B. Exhaustive testing of every possible diagnosis
C. Probabilistic reasoning that weighs likelihood according to symptom characteristics and
epidemiologic risk
D. Deferring any differential until laboratory results are available
Rationale: Probabilistic reasoning integrates symptom quality and timing with pretest
probability. Episodic non-exertional tightness with autonomic features in a young woman is far
more consistent with panic than ischemic disease.
9. A 45-year-old construction worker smokes one pack daily, drinks six beers on weekends,
lives alone, and reports no exercise. The most clinically useful way to act on this information
is to:
, A. Record the data without further comment
B. Order immediate PFTs and liver enzymes solely on the social history
C. Focus only on smoking and ignore alcohol and activity
D. Incorporate findings into a problem list and negotiate health-promotion goals using
motivational interviewing
Rationale: Social history elements that affect risk should become an actionable problem list.
Motivational interviewing supports collaborative goal-setting more effectively than didactic
advice.
10. A 29-year-old woman with poorly controlled asthma says she only uses her inhaler when
she feels tight. The most effective communication strategy is to:
A. Use reflective listening and explore understanding and barriers before jointly problem-
solving
B. Lecture on the importance of daily controller medication
C. Switch inhalers without addressing the underlying issue
D. Document non-adherence and reschedule in six months
Rationale: Reflective listening validates experience and surfaces barriers. Collaborative
problem-solving improves long-term adherence better than didactic instruction alone.
11. When constructing a problem list the NP includes both biomedical and psychosocial
issues. The rationale is that:
A. Insurance requires a minimum number of entries
B. Psychosocial factors frequently modify disease risk, symptom expression, and adherence
and must be managed comprehensively
C. Psychosocial issues are always the primary cause of medical problems
D. Biomedical issues take precedence and should be listed first
Rationale: Comprehensive care requires addressing both biomedical and psychosocial
factors that influence health outcomes and treatment adherence.
12. During an initial adult visit, which opening question is most likely to identify the patient's
agenda without prematurely narrowing the history?
(NEW- 2023/2024):Chamberlain college
of Nursing
SECTION 1: Health History, Interviewing & Clinical Reasoning
1. An example of objective data obtained during a physical assessment includes:
A. Patient's history of allergies
B. Patient's use of medications at home
C. Last menstrual period 1 month ago
D. 2.5 cm scar on the right lower forearm
Rationale: Objective data are directly observable and measurable by the examiner. A scar
can be seen, measured, and documented, making it objective. History of allergies, medication
use, and menstrual history are subjective data obtained from the patient's verbal report.
2. Which of the following is an example of subjective data?
A. Decreased range of motion
B. Crepitation in the left knee joint
C. Left knee has been swollen and hot for 3 days
D. Joint deformity noted on inspection
Rationale: Subjective data are what the patient reports or describes. The patient's report of
swelling and heat duration is subjective. Range of motion and crepitation are objective findings
determined by the examiner, while joint deformity is directly observed.
3. The nursing process is a sequential method of problem-solving that includes which steps?
A. Assessment, treatment, planning, evaluation, discharge, and follow-up
B. Admission, assessment, diagnosis, treatment, and discharge planning
C. Assessment, diagnosis, treatment, evaluation, and documentation
D. Assessment, diagnosis, outcome identification, planning, implementation, and evaluation
, Rationale: The nursing process consists of six distinct steps: Assessment (data collection),
Diagnosis (identification of health problems), Outcome Identification (goal setting), Planning
(intervention development), Implementation (carrying out interventions), and Evaluation
(measuring outcomes). This systematic approach guides clinical reasoning.
4. What step of the nursing process includes data collection by health history, physical
examination, and interview?
A. Assessment
B. Diagnosis
C. Planning
D. Evaluation
Rationale: Assessment is the first and foundational step of the nursing process, involving
systematic data collection through health history taking, physical examination, and patient
interviewing. All subsequent steps depend on accurate assessment data.
5. A nursing diagnosis is best described as:
A. A determination of the etiology of a disease
B. A pattern of coping
C. An individual's perception of health
D. A clinical judgment about individual, family, or community responses to actual or
potential health problems
Rationale: A nursing diagnosis is a clinical judgment concerning a human response to health
conditions/life processes, or a vulnerability for that response. It guides the selection of nursing
interventions. Medical diagnoses focus on disease pathology.
6. A 52-year-old woman presents stating she does not feel like herself. She reports fatigue,
weight gain, and poor concentration for three months. The NP begins with open-ended
questions before focused inquiry. This sequencing is most consistent with which principle of
effective interviewing?
A. Building a therapeutic relationship and gathering the patient's narrative before narrowing
to specific details
B. Immediately obtaining a complete review of systems to save time
,C. Relying exclusively on closed-ended questions to increase efficiency
D. Deferring all psychosocial inquiry until the physical examination is complete
Rationale: Effective interviewing begins with open-ended questions that invite the patient's
story and establish rapport. Focused questions follow to clarify details, supporting accurate
history-taking and patient-centered care.
7. A 68-year-old man lists seven prescription medications, two OTC analgesics, and a daily
herbal supplement. He says he takes whatever the bottle says. The most appropriate next
step is to:
A. Assume full adherence and proceed to the physical examination
B. Perform detailed medication reconciliation including timing, dose, and missed doses
while assessing polypharmacy risks
C. Advise immediate cessation of all herbal products without discussion
D. Limit the review to prescription drugs only
Rationale: Polypharmacy is common in older adults. Systematic reconciliation of all
products is essential to identify adherence issues, interactions, and deprescribing opportunities.
8. A 34-year-old woman describes episodic chest tightness at rest lasting 10-15 minutes with a
sense of impending doom. She denies radiation, diaphoresis, or exertional triggers. The NP
prioritizes panic disorder over ACS. This reasoning is best described as:
A. Pattern recognition based solely on age and gender
B. Exhaustive testing of every possible diagnosis
C. Probabilistic reasoning that weighs likelihood according to symptom characteristics and
epidemiologic risk
D. Deferring any differential until laboratory results are available
Rationale: Probabilistic reasoning integrates symptom quality and timing with pretest
probability. Episodic non-exertional tightness with autonomic features in a young woman is far
more consistent with panic than ischemic disease.
9. A 45-year-old construction worker smokes one pack daily, drinks six beers on weekends,
lives alone, and reports no exercise. The most clinically useful way to act on this information
is to:
, A. Record the data without further comment
B. Order immediate PFTs and liver enzymes solely on the social history
C. Focus only on smoking and ignore alcohol and activity
D. Incorporate findings into a problem list and negotiate health-promotion goals using
motivational interviewing
Rationale: Social history elements that affect risk should become an actionable problem list.
Motivational interviewing supports collaborative goal-setting more effectively than didactic
advice.
10. A 29-year-old woman with poorly controlled asthma says she only uses her inhaler when
she feels tight. The most effective communication strategy is to:
A. Use reflective listening and explore understanding and barriers before jointly problem-
solving
B. Lecture on the importance of daily controller medication
C. Switch inhalers without addressing the underlying issue
D. Document non-adherence and reschedule in six months
Rationale: Reflective listening validates experience and surfaces barriers. Collaborative
problem-solving improves long-term adherence better than didactic instruction alone.
11. When constructing a problem list the NP includes both biomedical and psychosocial
issues. The rationale is that:
A. Insurance requires a minimum number of entries
B. Psychosocial factors frequently modify disease risk, symptom expression, and adherence
and must be managed comprehensively
C. Psychosocial issues are always the primary cause of medical problems
D. Biomedical issues take precedence and should be listed first
Rationale: Comprehensive care requires addressing both biomedical and psychosocial
factors that influence health outcomes and treatment adherence.
12. During an initial adult visit, which opening question is most likely to identify the patient's
agenda without prematurely narrowing the history?
