NR 509 MIDTERM BATE’S INTERACTIVE QUESTIONS
WITH RATIONLES (LATEST 2026/2027 UPDATE) A+ SCORE
SOLUTION
Chapter 1 Approach to the Clinical Encounter
1. 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.
Rationale: Patient comfort is a primary concern in setting the stage for the examination, and, if
patients know how the exam will proceed, they are likely to feel more relaxed. In addition,
explaining a routine may help remind the PA student of the routine she will follow. Adjusting
lighting so that it is tangential to the patient’s body is important for accurate visualization of
body structures but does not necessarily reduce the patient’s embarrassment. Asking the
patient where he comes from would move the situation away from the professional to the
personal, which could enhance discomfort. Explaining that she is a PA student may reduce the
PA’s own anxiety but will not necessarily calm the patient. Providing ongoing interpretation of
findings is not advisable for beginners, who are not primary caregivers and may make errors.
2. 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, humility, and sensitivity in favor of the acquisition of concrete
details about the patient’s condition
e. Taking a symptom-focused approach to reduce the involvement of the patient’s emotional
difficulties.
Rationale: Following the patient’s lead is the key concept of patient-centered medical care. This
approach helps to identify the personal context and address concerns as well as concrete
maladies. Current evidence suggests that this technique is not only very satisfying to the patient
and the clinician, but also leads to optimal outcomes. Focusing on the need for immediate
diagnostic certainty over personal connection and taking charge of the interaction to meet the
clinician’s desire to acquire diagnostic information are incorrect because diagnostic certainty
may be required in emergent conditions, whereas establishing personal connection with
patients first may lead to improved long-term care. Ignoring the personal connection with
patients can lead to alienation and missed diagnoses as the patient is less likely to engage in
care. Deferring respect, empathy, humility, and sensitivity in favor of the acquisition of concrete
details about the patient’s condition is incorrect because deferring respect for the patient in
favor of concrete details is unlikely to engage the patient in his or her care. Taking a symptom-
focused approach to reduce the involvement of the patient’s emotional difficulties is incorrect
because emotional issues may be at the forefront of a patient’s issues (such as a diabetic who is
unmotivated to control his diabetes due to concurrent depression) and sidelining the emotional
needs may sabotage progress on medical issues.
3. 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 concerns to concrete medical needs.
d. Using nonverbal communication to encourage the patient to expand their narrative.
e. Considering a differential diagnosis while the patient is speaking to maximize the patient’s
time with the provider.
Rationale: Active listening is the core of the interview technique and demands such skills as
setting aside diagnostic priorities in favor of open discussion; using verbal and non-verbal skills
to encourage the patient to engage fully with their own narrative and being aware of the
patient’s emotional state. Ignoring visual cues to focus on the patient’s exact words is incorrect
because focusing on the patient’s words is important, and other cues to concerns and
discomforts may be gleaned from nonverbal cues such as posture and facial expression. Setting
aside the patient’s emotional state to focus on his medical needs is incorrect because except in
emergent circumstances, laying a foundation of trust and emotional connection is critical prior
to engaging in specific medical needs. Paring down the patient’s concerns to concrete medical
needs is incorrect because addressing the concrete medical needs at hand is a vital part of
medical visits, without a greater understanding of the patient’s concerns, fears, and anxieties,
the patient is unlikely to feel satisfied on the end of the visit. Considering a differential diagnosis
while the patient is speaking to maximize the patient’s time with the provider is incorrect
because this may save time for the provider, but it is unlikely to serve the patient best if the
provider is distracted with complex thoughts and conjectures.
4. 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 emotion
e. Facts, intelligence, fortuity, and eventuality
, Rationale: This model captures the patient’s emotional landscape, intellectual landscape,
current situation (function), and thoughts about future conditions. This breadth is important as
aspects of a patient’s illness experience may be missed without a wide exploration. For
example, a clinician may deeply engage with a patient’s emotional experience, but the lack of
attention to a patient’s ideas surrounding their care and treatment may be perceived as
condescending—especially to a very well-educated patient. Focus, intensity, function, and
evaluation and facts, intensity, focus, and evidence are incorrect because these elements are
very concrete in nature and may miss the emotional aspects of the patient’s illness. Feelings,
impression, fantasy, and emotion is incorrect because, in contrary to the above two answers,
these elements are almost entirely rooted in the emotional landscape with little attention paid
to the intellectual side of a patient’s experience. Facts, intelligence, fortuity, and eventuality are
incorrect because this group of elements (especially the latter two) does not clearly specify the
topics that the clinician should explore.
Chapter 2: Interviewing, Communication, and Interpersonal Skills
1. 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.
Rationale: It is critical to thoroughly understand the patient’s problem in order to narrow the
focus of the examination. This is particularly true when symptoms are reported in multiple body
systems, as in this case. To the extent possible, the seven attributes of each symptom should be
explored. Although it may be necessary to perform a pelvic examination, the exam will yield
more information if the clinician has determined, for example, the patient’s pregnancy history.
The clinician may need to obtain a urine sample for testing later but should have a possible
diagnosis in mind when doing so. A similar argument applies regarding obtaining blood for
testing—testing for what? Recent travel destinations should be elicited if there is a suspicion
that an infectious agent was acquired somewhere else, but more information is needed to
determine whether this would be a realistic suspicion.
2. 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
WITH RATIONLES (LATEST 2026/2027 UPDATE) A+ SCORE
SOLUTION
Chapter 1 Approach to the Clinical Encounter
1. 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.
Rationale: Patient comfort is a primary concern in setting the stage for the examination, and, if
patients know how the exam will proceed, they are likely to feel more relaxed. In addition,
explaining a routine may help remind the PA student of the routine she will follow. Adjusting
lighting so that it is tangential to the patient’s body is important for accurate visualization of
body structures but does not necessarily reduce the patient’s embarrassment. Asking the
patient where he comes from would move the situation away from the professional to the
personal, which could enhance discomfort. Explaining that she is a PA student may reduce the
PA’s own anxiety but will not necessarily calm the patient. Providing ongoing interpretation of
findings is not advisable for beginners, who are not primary caregivers and may make errors.
2. 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, humility, and sensitivity in favor of the acquisition of concrete
details about the patient’s condition
e. Taking a symptom-focused approach to reduce the involvement of the patient’s emotional
difficulties.
Rationale: Following the patient’s lead is the key concept of patient-centered medical care. This
approach helps to identify the personal context and address concerns as well as concrete
maladies. Current evidence suggests that this technique is not only very satisfying to the patient
and the clinician, but also leads to optimal outcomes. Focusing on the need for immediate
diagnostic certainty over personal connection and taking charge of the interaction to meet the
clinician’s desire to acquire diagnostic information are incorrect because diagnostic certainty
may be required in emergent conditions, whereas establishing personal connection with
patients first may lead to improved long-term care. Ignoring the personal connection with
patients can lead to alienation and missed diagnoses as the patient is less likely to engage in
care. Deferring respect, empathy, humility, and sensitivity in favor of the acquisition of concrete
details about the patient’s condition is incorrect because deferring respect for the patient in
favor of concrete details is unlikely to engage the patient in his or her care. Taking a symptom-
focused approach to reduce the involvement of the patient’s emotional difficulties is incorrect
because emotional issues may be at the forefront of a patient’s issues (such as a diabetic who is
unmotivated to control his diabetes due to concurrent depression) and sidelining the emotional
needs may sabotage progress on medical issues.
3. 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 concerns to concrete medical needs.
d. Using nonverbal communication to encourage the patient to expand their narrative.
e. Considering a differential diagnosis while the patient is speaking to maximize the patient’s
time with the provider.
Rationale: Active listening is the core of the interview technique and demands such skills as
setting aside diagnostic priorities in favor of open discussion; using verbal and non-verbal skills
to encourage the patient to engage fully with their own narrative and being aware of the
patient’s emotional state. Ignoring visual cues to focus on the patient’s exact words is incorrect
because focusing on the patient’s words is important, and other cues to concerns and
discomforts may be gleaned from nonverbal cues such as posture and facial expression. Setting
aside the patient’s emotional state to focus on his medical needs is incorrect because except in
emergent circumstances, laying a foundation of trust and emotional connection is critical prior
to engaging in specific medical needs. Paring down the patient’s concerns to concrete medical
needs is incorrect because addressing the concrete medical needs at hand is a vital part of
medical visits, without a greater understanding of the patient’s concerns, fears, and anxieties,
the patient is unlikely to feel satisfied on the end of the visit. Considering a differential diagnosis
while the patient is speaking to maximize the patient’s time with the provider is incorrect
because this may save time for the provider, but it is unlikely to serve the patient best if the
provider is distracted with complex thoughts and conjectures.
4. 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 emotion
e. Facts, intelligence, fortuity, and eventuality
, Rationale: This model captures the patient’s emotional landscape, intellectual landscape,
current situation (function), and thoughts about future conditions. This breadth is important as
aspects of a patient’s illness experience may be missed without a wide exploration. For
example, a clinician may deeply engage with a patient’s emotional experience, but the lack of
attention to a patient’s ideas surrounding their care and treatment may be perceived as
condescending—especially to a very well-educated patient. Focus, intensity, function, and
evaluation and facts, intensity, focus, and evidence are incorrect because these elements are
very concrete in nature and may miss the emotional aspects of the patient’s illness. Feelings,
impression, fantasy, and emotion is incorrect because, in contrary to the above two answers,
these elements are almost entirely rooted in the emotional landscape with little attention paid
to the intellectual side of a patient’s experience. Facts, intelligence, fortuity, and eventuality are
incorrect because this group of elements (especially the latter two) does not clearly specify the
topics that the clinician should explore.
Chapter 2: Interviewing, Communication, and Interpersonal Skills
1. 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.
Rationale: It is critical to thoroughly understand the patient’s problem in order to narrow the
focus of the examination. This is particularly true when symptoms are reported in multiple body
systems, as in this case. To the extent possible, the seven attributes of each symptom should be
explored. Although it may be necessary to perform a pelvic examination, the exam will yield
more information if the clinician has determined, for example, the patient’s pregnancy history.
The clinician may need to obtain a urine sample for testing later but should have a possible
diagnosis in mind when doing so. A similar argument applies regarding obtaining blood for
testing—testing for what? Recent travel destinations should be elicited if there is a suspicion
that an infectious agent was acquired somewhere else, but more information is needed to
determine whether this would be a realistic suspicion.
2. 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
