NR 509 Midterm Comprehensive Exam |
Advanced Physical Assessment | Expanded
Version
Course: NR 509 – Advanced Physical Assessment
Institution: Chamberlain University College of Nursing
Format: 150 multiple-choice questions (including select-all-that-apply)
Time Allotted: 180 minutes
Exam Type: Non-cumulative, closed book, proctored
SECTION 1: Advanced Interviewing and Comprehensive Health
History
(Questions 1–15)
Q1. A 62-year-old Vietnamese American patient presents with persistent
epigastric pain rated 7/10 for the past three weeks. When the APRN asks
about the onset of symptoms, the patient avoids eye contact and responds
briefly, deferring to his adult daughter who accompanied him. Which
advanced interviewing technique is MOST appropriate at this moment?
A. Ask the daughter to translate the chief complaint since she seems most
engaged.
B. Pose a series of direct yes/no questions to the patient to elicit precise
responses efficiently.
C. Use silence and an open, unhurried posture to invite the patient to share
at his own pace.
D. Redirect the patient firmly but warmly, explaining that clinical accuracy
requires his direct input.
Correct Answer: C. Silence is a deliberate therapeutic communication
technique that conveys respect, lowers anxiety, and gives patients space to
organize their thoughts, particularly in cross-cultural encounters where
direct eye contact or assertiveness may be discouraged. Using the
daughter as translator violates interpreter standards because family
members may editorialize or omit sensitive content .
,Q2. During a comprehensive health history, a 45-year-old woman states, "I
just feel so tired all the time, like I can't keep up anymore." Which response
by the APRN BEST demonstrates the interviewing technique of reflection?
A. "You feel exhausted and unable to maintain your usual daily routine."
B. "Can you tell me more about when the fatigue first began?"
C. "I understand how frustrating fatigue can be for patients."
D. "It sounds like you've been under a lot of stress lately."
Correct Answer: A. Reflection mirrors the patient's own words or feelings
back to them without distortion, encouraging further exploration and
confirming the APRN has accurately heard the message .
Q3. When obtaining a health history from an adult patient, which
assessment approach is most appropriate to establish rapport and gather
information?
A. Begin with open-ended questions, then progress to closed-ended
questions for clarification
B. Start with closed-ended questions to establish structure and efficiency
C. Use only open-ended questions throughout the entire interview
D. Conduct the history in a rapid manner to respect the patient's time
E. Use leading questions to guide the patient toward relevant information
Correct Answer: A. The funnel technique is the gold standard for history
taking. Starting with open-ended questions encourages patients to provide
narrative information and establishes rapport. Transitioning to closed-ended
questions allows for clarification of specific details .
Q4. Which of the following statements is most accurate regarding the
documentation of a patient's functional status in the history of present
illness?
A. Functional status is only relevant for elderly patients with chronic
conditions
B. Activities of daily living (ADLs) and instrumental activities of daily living
(IADLs) should be assessed as part of routine history taking
C. Functional status assessment is a nursing responsibility and should not
,be documented by advanced practice nurses
D. Functional status is determined primarily by the patient's diagnosis
rather than their self-report
E. Documentation of functional status is optional and does not affect clinical
decision-making
Correct Answer: B. Assessment of functional status, including both ADLs
and IADLs, is essential for all patients regardless of age or diagnosis. This
information reveals the patient's actual level of function and independence .
Q5. When documenting the past medical history for a patient with multiple
comorbidities, what is the most important principle?
A. List all diagnoses in chronological order regardless of relevance to
current presentation
B. Focus only on diagnoses directly related to the chief complaint
C. Include all significant past illnesses, surgeries, hospitalizations, and
treatments with dates and outcomes
D. Obtain this information only from the electronic health record without
asking the patient
E. Document only conditions requiring current medication management
Correct Answer: C. The past medical history should include all significant
past illnesses, surgeries, hospitalizations, and treatments with dates and
outcomes .
Q6. 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. He has experienced adversarial relationships with prior clinicians.
Which interview style is most likely to lead to comprehensive care and
patient compliance?
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, humility, and sensitivity in favor of the
acquisition of concrete details
E. Taking a symptom-focused approach to reduce the involvement of the
patient's emotional difficulties
Correct Answer: C. Following the patient's lead demonstrates respect,
empathy, and humility, which are essential for building trust with patients
who have had adversarial healthcare experiences .
Q7. A 17-year-old male presents to a sexually transmitted disease clinic
after disclosing that he prefers homosexual partners but is afraid his last
partner may have given him an infection. He states he will not stay through
the visit if he feels dismissed or discriminated against. 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 concerns to concrete medical needs
D. Using nonverbal communication to convey attentiveness
Correct Answer: D. Active listening includes nonverbal communication
such as maintaining eye contact, nodding, and open body posture, which
conveys attentiveness and respect .
Q8. 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.
Advanced Physical Assessment | Expanded
Version
Course: NR 509 – Advanced Physical Assessment
Institution: Chamberlain University College of Nursing
Format: 150 multiple-choice questions (including select-all-that-apply)
Time Allotted: 180 minutes
Exam Type: Non-cumulative, closed book, proctored
SECTION 1: Advanced Interviewing and Comprehensive Health
History
(Questions 1–15)
Q1. A 62-year-old Vietnamese American patient presents with persistent
epigastric pain rated 7/10 for the past three weeks. When the APRN asks
about the onset of symptoms, the patient avoids eye contact and responds
briefly, deferring to his adult daughter who accompanied him. Which
advanced interviewing technique is MOST appropriate at this moment?
A. Ask the daughter to translate the chief complaint since she seems most
engaged.
B. Pose a series of direct yes/no questions to the patient to elicit precise
responses efficiently.
C. Use silence and an open, unhurried posture to invite the patient to share
at his own pace.
D. Redirect the patient firmly but warmly, explaining that clinical accuracy
requires his direct input.
Correct Answer: C. Silence is a deliberate therapeutic communication
technique that conveys respect, lowers anxiety, and gives patients space to
organize their thoughts, particularly in cross-cultural encounters where
direct eye contact or assertiveness may be discouraged. Using the
daughter as translator violates interpreter standards because family
members may editorialize or omit sensitive content .
,Q2. During a comprehensive health history, a 45-year-old woman states, "I
just feel so tired all the time, like I can't keep up anymore." Which response
by the APRN BEST demonstrates the interviewing technique of reflection?
A. "You feel exhausted and unable to maintain your usual daily routine."
B. "Can you tell me more about when the fatigue first began?"
C. "I understand how frustrating fatigue can be for patients."
D. "It sounds like you've been under a lot of stress lately."
Correct Answer: A. Reflection mirrors the patient's own words or feelings
back to them without distortion, encouraging further exploration and
confirming the APRN has accurately heard the message .
Q3. When obtaining a health history from an adult patient, which
assessment approach is most appropriate to establish rapport and gather
information?
A. Begin with open-ended questions, then progress to closed-ended
questions for clarification
B. Start with closed-ended questions to establish structure and efficiency
C. Use only open-ended questions throughout the entire interview
D. Conduct the history in a rapid manner to respect the patient's time
E. Use leading questions to guide the patient toward relevant information
Correct Answer: A. The funnel technique is the gold standard for history
taking. Starting with open-ended questions encourages patients to provide
narrative information and establishes rapport. Transitioning to closed-ended
questions allows for clarification of specific details .
Q4. Which of the following statements is most accurate regarding the
documentation of a patient's functional status in the history of present
illness?
A. Functional status is only relevant for elderly patients with chronic
conditions
B. Activities of daily living (ADLs) and instrumental activities of daily living
(IADLs) should be assessed as part of routine history taking
C. Functional status assessment is a nursing responsibility and should not
,be documented by advanced practice nurses
D. Functional status is determined primarily by the patient's diagnosis
rather than their self-report
E. Documentation of functional status is optional and does not affect clinical
decision-making
Correct Answer: B. Assessment of functional status, including both ADLs
and IADLs, is essential for all patients regardless of age or diagnosis. This
information reveals the patient's actual level of function and independence .
Q5. When documenting the past medical history for a patient with multiple
comorbidities, what is the most important principle?
A. List all diagnoses in chronological order regardless of relevance to
current presentation
B. Focus only on diagnoses directly related to the chief complaint
C. Include all significant past illnesses, surgeries, hospitalizations, and
treatments with dates and outcomes
D. Obtain this information only from the electronic health record without
asking the patient
E. Document only conditions requiring current medication management
Correct Answer: C. The past medical history should include all significant
past illnesses, surgeries, hospitalizations, and treatments with dates and
outcomes .
Q6. 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. He has experienced adversarial relationships with prior clinicians.
Which interview style is most likely to lead to comprehensive care and
patient compliance?
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, humility, and sensitivity in favor of the
acquisition of concrete details
E. Taking a symptom-focused approach to reduce the involvement of the
patient's emotional difficulties
Correct Answer: C. Following the patient's lead demonstrates respect,
empathy, and humility, which are essential for building trust with patients
who have had adversarial healthcare experiences .
Q7. A 17-year-old male presents to a sexually transmitted disease clinic
after disclosing that he prefers homosexual partners but is afraid his last
partner may have given him an infection. He states he will not stay through
the visit if he feels dismissed or discriminated against. 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 concerns to concrete medical needs
D. Using nonverbal communication to convey attentiveness
Correct Answer: D. Active listening includes nonverbal communication
such as maintaining eye contact, nodding, and open body posture, which
conveys attentiveness and respect .
Q8. 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.
