NR509 / NR 509 Advanced Physical Assessment Midterm
UPDATED ACTUAL Exam Questions and CORRECT Answers
Question 1.
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,
Correct Answer: c. Following the patient's lead to understand their thoughts,
ideas, concerns, and requests
Question 2.
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
Correct Answer: b. Recognizing the patient's emotions by asking or confirming
how she feels about the event
Question 3.
A 19-year-old student of art history presents to clinic after a syncopal (fainting) episode
at school. He is notably thin; on a thorough review of his medical history, he admits that
he eats only minimally to maintain a very low body weight that he feels is ideal. He is
embarrassed that his issues were discussed by peers after this episode, especially
because he believes that this is a problem that is only faced by girls and women.
Concerning the two most common eating disorders (anorexia nervosa and bulimia
,nervosa), which of the following statements is true?
a. Men and women are both afflicted, but with a female:male prevalence ratio estimated
at ~2:1.
b. Both of these eating disorders are associated with a body mass index (BMI) of <17.5.
c. Both of these eating disorders are associated with a real or imagined fear of
appearing fat.
d. Persons with eating disorders are generally easily identified by their appeara
Correct Answer: c. Both of these eating disorders are associated with a real or
imagined fear of appearing fat.
Question 4.
A 23-year-old physician assistant (PA) student found that she felt nervous when called
upon to examine men in her age group. On one occasion, she encountered a young
male patient who appeared embarrassed to see her walk into the room. What should the
PA do to minimize their mutual discomfort?
a. Adjust lighting so it is tangential to the patient's body.
b. Explain how the examination will proceed.
c. Ask the patient where he comes from.
d. Explain that she is a PA student.
e. Provide ongoing interpretation of findings.
Correct Answer: b. Explain how the examination will proceed.
Question 5.
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
Correct Answer: d. Using nonverbal communication to encourage the patient
to expand their narrative
Question 6.
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
Correct 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. ✓✓c. Obtain a more complete
description of problems.
Question 7.
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
Question 8.
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
Correct Answer: f. Moving from open-ended to focused questions
Question 9.
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
Question 10.
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
Correct Answer: a. "That sounds like a frightening experience that you are
recovering well from."
• A 29-year-old electrician complains of persistent cough and wheezing,
particularly when he exercises. He says he smokes "occasionally" but rarely so
much that he needs to purchase cigarettes: "Mostly, I bum them," he says,
chuckling. Upon hearing this information, what is the best next step on the
part of the clinician?
a. Determine the patient's exercise regimen.
b. Determine the number of pack-years the patient smokes.
UPDATED ACTUAL Exam Questions and CORRECT Answers
Question 1.
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,
Correct Answer: c. Following the patient's lead to understand their thoughts,
ideas, concerns, and requests
Question 2.
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
Correct Answer: b. Recognizing the patient's emotions by asking or confirming
how she feels about the event
Question 3.
A 19-year-old student of art history presents to clinic after a syncopal (fainting) episode
at school. He is notably thin; on a thorough review of his medical history, he admits that
he eats only minimally to maintain a very low body weight that he feels is ideal. He is
embarrassed that his issues were discussed by peers after this episode, especially
because he believes that this is a problem that is only faced by girls and women.
Concerning the two most common eating disorders (anorexia nervosa and bulimia
,nervosa), which of the following statements is true?
a. Men and women are both afflicted, but with a female:male prevalence ratio estimated
at ~2:1.
b. Both of these eating disorders are associated with a body mass index (BMI) of <17.5.
c. Both of these eating disorders are associated with a real or imagined fear of
appearing fat.
d. Persons with eating disorders are generally easily identified by their appeara
Correct Answer: c. Both of these eating disorders are associated with a real or
imagined fear of appearing fat.
Question 4.
A 23-year-old physician assistant (PA) student found that she felt nervous when called
upon to examine men in her age group. On one occasion, she encountered a young
male patient who appeared embarrassed to see her walk into the room. What should the
PA do to minimize their mutual discomfort?
a. Adjust lighting so it is tangential to the patient's body.
b. Explain how the examination will proceed.
c. Ask the patient where he comes from.
d. Explain that she is a PA student.
e. Provide ongoing interpretation of findings.
Correct Answer: b. Explain how the examination will proceed.
Question 5.
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
Correct Answer: d. Using nonverbal communication to encourage the patient
to expand their narrative
Question 6.
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
Correct 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. ✓✓c. Obtain a more complete
description of problems.
Question 7.
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
Question 8.
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
Correct Answer: f. Moving from open-ended to focused questions
Question 9.
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
Question 10.
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
Correct Answer: a. "That sounds like a frightening experience that you are
recovering well from."
• A 29-year-old electrician complains of persistent cough and wheezing,
particularly when he exercises. He says he smokes "occasionally" but rarely so
much that he needs to purchase cigarettes: "Mostly, I bum them," he says,
chuckling. Upon hearing this information, what is the best next step on the
part of the clinician?
a. Determine the patient's exercise regimen.
b. Determine the number of pack-years the patient smokes.
