NR509 / NR 509 Midter m Exam |! |! |! |! |! |!
(Latest u pdate): Advanced Physical |! |! |! |!
Assessm ent - Cham ber lain |! |!
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
|! |! |! |! |! |! |! |!
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 |! |!
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.
|! |! |! |! |! |! |! |!
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.
|! |! |! |!
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 |! |! |! |! |! |! |! |!
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 |! |!
(Latest u pdate): Advanced Physical |! |! |! |!
Assessm ent - Cham ber lain |! |!
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
|! |! |! |! |! |! |! |!
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 |! |!
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.
|! |! |! |! |! |! |! |!
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.
|! |! |! |!
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 |! |! |! |! |! |! |! |!
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 |! |!
