NR 509 Midterm Exam (
update) Advanced Physical Assessment –
Chamberlain questions and Correct
answers
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 adversaria
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
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 answerc. 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 denie
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 examp
of an empathetic response to this patient?
a. Assuming that the event caused her to become depressed and expressing the same feeling on beha
of the patient
b. Recognizing the patient's emotions by asking or con - Correct answerb. 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
,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 answerc. Bot
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 examin
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 discomfor
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 answerb. 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 answerd. Using nonverbal communication to encourage t
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 debilitate
with fatigue and joint pain. Since her diagnosis, she has been minimally compliant with medications an
has switched her rheumatology provider twice. She continues to feel ill, and, in explanation for her lac
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 befo
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 answerc. Feelings, ideas, function, and expectations
, 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 answerc. 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 answerb. 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 answerf. 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
update) Advanced Physical Assessment –
Chamberlain questions and Correct
answers
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 adversaria
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
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 answerc. 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 denie
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 examp
of an empathetic response to this patient?
a. Assuming that the event caused her to become depressed and expressing the same feeling on beha
of the patient
b. Recognizing the patient's emotions by asking or con - Correct answerb. 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
,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 answerc. Bot
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 examin
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 discomfor
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 answerb. 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 answerd. Using nonverbal communication to encourage t
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 debilitate
with fatigue and joint pain. Since her diagnosis, she has been minimally compliant with medications an
has switched her rheumatology provider twice. She continues to feel ill, and, in explanation for her lac
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 befo
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 answerc. Feelings, ideas, function, and expectations
, 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 answerc. 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 answerb. 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 answerf. 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
