NR509 / NR 509 Midterm Exam 2024 (Latest update):
Advanced Physical Assessment with Complete Solutions
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. - ANSWER>>>b. Explain how the examination will proceed.
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 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 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 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.
c. Conduct a mental status examination.
d. Explain the relationship between smoking and cancer.
e. Determine the patient's immunization history. - ANSWER>>>b. Determine the number of pack-years
the patient smokes.
A 47-year-old fitness trainer visits the physician assistant (PA) because of skin dryness, night sweats, and
irregular menstrual periods. It is the PA's first contact with this patient. The patient notes that "My sex
life has really gone downhill lately" and says that she is considering divorcing her husband of 20 years,
Advanced Physical Assessment with Complete Solutions
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. - ANSWER>>>b. Explain how the examination will proceed.
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 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 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 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.
c. Conduct a mental status examination.
d. Explain the relationship between smoking and cancer.
e. Determine the patient's immunization history. - ANSWER>>>b. Determine the number of pack-years
the patient smokes.
A 47-year-old fitness trainer visits the physician assistant (PA) because of skin dryness, night sweats, and
irregular menstrual periods. It is the PA's first contact with this patient. The patient notes that "My sex
life has really gone downhill lately" and says that she is considering divorcing her husband of 20 years,
