NR-509 ADVANCED
PHYSICAL
ASSESSMENT –
MIDTERM EXAM
Section 1: Health History & Interviewing
1. A 58-year-old woman presents to the clinic as a new patient. Which opening
statement best demonstrates a patient-centered interviewing approach?
A. "You are here about your diabetes and blood pressure, correct?"
B. "Tell me what brought you in today, in your own words."
C. "Is your chest pain worse when you walk uphill or at rest?"
D. "Has anyone in your family ever been diagnosed with heart disease?"
Rationale: NR-509 emphasizes beginning every interview with open-ended, patient-
centered questions that invite the patient's narrative without prematurely narrowing the
agenda. Option B is the only open-ended invitation that allows the patient to voice
concerns in her own priority order. Options A, C, and D are closed questions that impose
the clinician's assumptions and may miss the patient's actual reason for the visit .
2. A 45-year-old man reports chest discomfort that began while shoveling snow.
The NP asks, "What exactly were you doing when the discomfort first started?"
Within the OLDCARTS framework, which element is being explored?
,A. Location
B. Duration
C. Onset
D. Severity
Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating and
Alleviating factors, Radiation, Timing, and Severity. Asking what the patient was doing
when the symptom began explores Onset, including the circumstances and suddenness
of the symptom's start. Location would ask where the symptom is felt; Duration would
ask how long it lasts; Severity would ask its intensity .
3. In the PQRST method of symptom analysis, the letter "P" stands for which of
the following?
A. Perception of the symptom by the patient
B. Provocation and Palliation
C. Position of the patient during the symptom
D. Progression of the disease process
Rationale: In PQRST, P stands for Provocation and Palliation, meaning what brings the
symptom on, makes it worse, or makes it better. The remaining letters address Quality,
Region and Radiation, Severity, and Timing. Perception, Position, and Progression are
not components of this framework .
4. Which question best assesses the patient's perspective using the FIFE model?
A. "What medications are you currently taking?"
B. "How is this problem affecting your daily life?"
C. "Do you have a family history of this condition?"
D. "When did your symptoms first start?"
Rationale: The FIFE model explores Feelings (about illness), Ideas (about cause),
Functioning (impact on daily life), and Expectations (of the encounter). The question
about daily functioning directly addresses the "Functioning" component. The other
options address medication history, family history, and onset but do not assess the
patient's perspective .
5. The NP explains a new anticoagulant regimen to a 72-year-old patient, who
nods throughout but later states he will "take two pills twice a day instead of
one." Which action is most appropriate?
,A. Speak more slowly and loudly, then repeat the dosing instructions verbatim
B. Provide a detailed printed handout written at a twelfth-grade reading level
C. Ask the patient directly whether he understands the instructions
D. Say, "I want to be sure I explained this clearly. Can you tell me in your own
words how you will take this medicine?"
Rationale: The teach-back method is the recommended strategy for verifying health
literacy because it asks the patient to restate the plan while shifting the burden of clarity
onto the clinician. Option C may yield a false-positive "yes." Option A does not address
comprehension. Option B fails if the reading level is too high .
6. A patient presents with a chief complaint of "chest pain." Using OLDCARTS,
which question assesses the "Character" of the pain?
A. "Where is the pain located?"
B. "What does the pain feel like?"
C. "When did the pain start?"
D. "What makes the pain worse?"
Rationale: The "Character" of a symptom refers to its quality or description (e.g., sharp,
burning, aching, pressure-like). Option A assesses Location, Option C assesses Onset,
and Option D assesses Aggravating factors .
7. Which finding is subjective?
A. Blood pressure of 150/90 mm Hg
B. Temperature of 38.5°C
C. Patient reports nausea
D. Heart rate of 110/min
Rationale: Subjective findings are symptoms reported by the patient (what the person
says about himself or herself). Objective findings are observable or measurable by the
examiner, including vital signs and physical examination findings .
8. Which finding is objective?
A. "I feel dizzy."
B. "My stomach hurts."
C. "I am tired."
D. Respiratory rate of 24/min
, Rationale: Objective findings are observable or measurable by the examiner.
Respiratory rate is a measurable vital sign. Options A, B, and C are subjective symptoms
reported by the patient .
9. Which question best assesses alcohol use in a social history?
A. "You don't drink alcohol, correct?"
B. "How much alcohol do you typically drink?"
C. "Why do you drink?"
D. "Alcohol isn't a problem, is it?"
Rationale: Neutral, specific, quantifiable questioning promotes accurate disclosure
without judgment. Options A and D are leading questions that suggest the expected
answer. Option C may feel judgmental and inhibit disclosure .
Section 2: Physical Examination Techniques
10. What is the primary purpose of the inspection phase during a physical
examination?
A. To assess the patient's range of motion
B. To evaluate the patient's vital signs
C. To observe the physical characteristics of the patient
D. To obtain a health history
Rationale: The inspection phase allows the examiner to gather important visual
information about the patient's overall appearance, skin condition, posture, and any
abnormalities. This initial observation can guide further examination steps .
11. Which sequence is generally used for examination of the abdomen?
A. Inspection, percussion, palpation, auscultation
B. Palpation, inspection, auscultation, percussion
C. Inspection, auscultation, percussion, palpation
D. Auscultation, inspection, palpation, percussion
Rationale: For the abdomen, auscultation is performed before percussion and palpation
because these maneuvers can alter bowel sounds. The correct sequence is Inspection →
Auscultation → Percussion → Palpation .
PHYSICAL
ASSESSMENT –
MIDTERM EXAM
Section 1: Health History & Interviewing
1. A 58-year-old woman presents to the clinic as a new patient. Which opening
statement best demonstrates a patient-centered interviewing approach?
A. "You are here about your diabetes and blood pressure, correct?"
B. "Tell me what brought you in today, in your own words."
C. "Is your chest pain worse when you walk uphill or at rest?"
D. "Has anyone in your family ever been diagnosed with heart disease?"
Rationale: NR-509 emphasizes beginning every interview with open-ended, patient-
centered questions that invite the patient's narrative without prematurely narrowing the
agenda. Option B is the only open-ended invitation that allows the patient to voice
concerns in her own priority order. Options A, C, and D are closed questions that impose
the clinician's assumptions and may miss the patient's actual reason for the visit .
2. A 45-year-old man reports chest discomfort that began while shoveling snow.
The NP asks, "What exactly were you doing when the discomfort first started?"
Within the OLDCARTS framework, which element is being explored?
,A. Location
B. Duration
C. Onset
D. Severity
Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating and
Alleviating factors, Radiation, Timing, and Severity. Asking what the patient was doing
when the symptom began explores Onset, including the circumstances and suddenness
of the symptom's start. Location would ask where the symptom is felt; Duration would
ask how long it lasts; Severity would ask its intensity .
3. In the PQRST method of symptom analysis, the letter "P" stands for which of
the following?
A. Perception of the symptom by the patient
B. Provocation and Palliation
C. Position of the patient during the symptom
D. Progression of the disease process
Rationale: In PQRST, P stands for Provocation and Palliation, meaning what brings the
symptom on, makes it worse, or makes it better. The remaining letters address Quality,
Region and Radiation, Severity, and Timing. Perception, Position, and Progression are
not components of this framework .
4. Which question best assesses the patient's perspective using the FIFE model?
A. "What medications are you currently taking?"
B. "How is this problem affecting your daily life?"
C. "Do you have a family history of this condition?"
D. "When did your symptoms first start?"
Rationale: The FIFE model explores Feelings (about illness), Ideas (about cause),
Functioning (impact on daily life), and Expectations (of the encounter). The question
about daily functioning directly addresses the "Functioning" component. The other
options address medication history, family history, and onset but do not assess the
patient's perspective .
5. The NP explains a new anticoagulant regimen to a 72-year-old patient, who
nods throughout but later states he will "take two pills twice a day instead of
one." Which action is most appropriate?
,A. Speak more slowly and loudly, then repeat the dosing instructions verbatim
B. Provide a detailed printed handout written at a twelfth-grade reading level
C. Ask the patient directly whether he understands the instructions
D. Say, "I want to be sure I explained this clearly. Can you tell me in your own
words how you will take this medicine?"
Rationale: The teach-back method is the recommended strategy for verifying health
literacy because it asks the patient to restate the plan while shifting the burden of clarity
onto the clinician. Option C may yield a false-positive "yes." Option A does not address
comprehension. Option B fails if the reading level is too high .
6. A patient presents with a chief complaint of "chest pain." Using OLDCARTS,
which question assesses the "Character" of the pain?
A. "Where is the pain located?"
B. "What does the pain feel like?"
C. "When did the pain start?"
D. "What makes the pain worse?"
Rationale: The "Character" of a symptom refers to its quality or description (e.g., sharp,
burning, aching, pressure-like). Option A assesses Location, Option C assesses Onset,
and Option D assesses Aggravating factors .
7. Which finding is subjective?
A. Blood pressure of 150/90 mm Hg
B. Temperature of 38.5°C
C. Patient reports nausea
D. Heart rate of 110/min
Rationale: Subjective findings are symptoms reported by the patient (what the person
says about himself or herself). Objective findings are observable or measurable by the
examiner, including vital signs and physical examination findings .
8. Which finding is objective?
A. "I feel dizzy."
B. "My stomach hurts."
C. "I am tired."
D. Respiratory rate of 24/min
, Rationale: Objective findings are observable or measurable by the examiner.
Respiratory rate is a measurable vital sign. Options A, B, and C are subjective symptoms
reported by the patient .
9. Which question best assesses alcohol use in a social history?
A. "You don't drink alcohol, correct?"
B. "How much alcohol do you typically drink?"
C. "Why do you drink?"
D. "Alcohol isn't a problem, is it?"
Rationale: Neutral, specific, quantifiable questioning promotes accurate disclosure
without judgment. Options A and D are leading questions that suggest the expected
answer. Option C may feel judgmental and inhibit disclosure .
Section 2: Physical Examination Techniques
10. What is the primary purpose of the inspection phase during a physical
examination?
A. To assess the patient's range of motion
B. To evaluate the patient's vital signs
C. To observe the physical characteristics of the patient
D. To obtain a health history
Rationale: The inspection phase allows the examiner to gather important visual
information about the patient's overall appearance, skin condition, posture, and any
abnormalities. This initial observation can guide further examination steps .
11. Which sequence is generally used for examination of the abdomen?
A. Inspection, percussion, palpation, auscultation
B. Palpation, inspection, auscultation, percussion
C. Inspection, auscultation, percussion, palpation
D. Auscultation, inspection, palpation, percussion
Rationale: For the abdomen, auscultation is performed before percussion and palpation
because these maneuvers can alter bowel sounds. The correct sequence is Inspection →
Auscultation → Percussion → Palpation .
