NR509 2024-2025 update/NR509 / NR 509 Midterm Exam
(Latest ): Advanced Physical Assessment -
Chamberlain/GET IT 100% ACCURATE! /GRADED A+
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 answers c. Following the patient's lead to understand their
thoughts, ideas, concerns, and requests
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 answers b. Recognizing the
patient's emotions by asking or confirming how she feels about the event
,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 answers c.
Both of these eating disorders are associated with a real or imagined fear of appearing fat.
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 answers b. Explain how the examination
will proceed.
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 answers 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 correct answers 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. correct answers 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 correct answers b. Validating and empathetic with
open-ended questions
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 answers f. Moving from
open-ended to focused questions
(Latest ): Advanced Physical Assessment -
Chamberlain/GET IT 100% ACCURATE! /GRADED A+
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 answers c. Following the patient's lead to understand their
thoughts, ideas, concerns, and requests
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 answers b. Recognizing the
patient's emotions by asking or confirming how she feels about the event
,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 answers c.
Both of these eating disorders are associated with a real or imagined fear of appearing fat.
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 answers b. Explain how the examination
will proceed.
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 answers 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 correct answers 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. correct answers 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 correct answers b. Validating and empathetic with
open-ended questions
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 answers f. Moving from
open-ended to focused questions
