NR 509 Midterm Study Guide FALL 2025

NR 509 Midterm Study Guide

General Study Tips and Recommendations

 Topics and content on guides are intended to focus student attention when reading/studying
and some topics may be repeated in multiple chapters.
 Multiple test items are derived from the same topic areas to encourage deeper comprehension.
 Students must have a broad understanding of content and not simply memorize passages in
textbooks or articles.
 Information in red letters in the chapters as well as tables and appendices at the end of the
chapters may include test items.
 Exam questions represent various levels of cognitive learning. You are expected to analyze,
synthesis, and evaluate patient scenarios in order to answer the questions.
 Read all of the answers BEFORE reading the stem of the question. This will help you focus on the
key content and not get distracted by extraneous information.
 Be familiar with “Techniques of Examination” and “Recording Your Findings” for all body
system chapters in the textbook.

Chapter 1 Approach to the Clinical Encounter

 The interviewing process
 Interviewing techniques 44
Active or attentive listening
Guided questioning
Empathic responses
Summarization
Transitions
Partnering
Validation
Empowering the patient
Reassurance
Appropriate verbal communication
Appropriate nonverbal communication

 Setting the stage for the examination
 Establishing rapport
 Gender pronouns
 Patient-centered medical care
 The FIFE model: FIFE—Feelings, Ideas, effect on Function, and Expectations

Chapter 2 Interviewing, Communication, and Interpersonal Skills

 Fundamentals of skilled interviewing
 Verbal and nonverbal communication
 Challenging patient situations and behaviors

Chapter 3 Health History

,  Focused and comprehensive health histories
 Determining the scope of the patient assessment
 The seven attributes of a patient’s principal symptoms 83
OLD CARTS
Onset, location, duration, character, aggravating/alleviating, Radiation, Timing, severity

 Subjective versus objective data
 Modifying of the clinical interview for various clinical settings 106

Chapter 4 Physical Examination

 Determining the scope of the physical examination
 Techniques of examination (Note: Be familiar with specific techniques in body system chapters)
 The head-to-toe physical assessment

Chapter 5 Clinical Reasoning, Assessment, and Plan

 The clinical reasoning process
 The problem list
 The differential diagnosis (DDx) list
 The summary statement
 Assessment (medical diagnoses)
 Planning (treatment and interventions)

Chapter 7 Evaluating Clinical Evidence 195

 Using elements of the physical examination as diagnostic tests
 Evaluating diagnostic tests
This is represented by the mnemonic SnNOUT—a Sensitive test with a Negative result rules OUT
disease. Conversely, a positive result in a test with high specificity (e.g., a very low–false-positive
rate) usually indicates disease. This is represented by the mnemonic SpPIN—a Specific test with
a Positive result rules IN disease.
 Critically appraising clinical evidence ; 205
 Communicating clinical evidence to patients 208
Several approaches for these discussions include the five As (ask, advise, assess, assist, and
arrange) and FRAMES (feedback about personal risk, responsibility of patient, advice to change,
empathetic style, promote self-efficacy).

Chapter 8 General Survey, Vital Signs, and Pain

 General survey
 Vital signs
 Classifying normal and abnormal blood pressures
 Acute and chronic pain 234
 Exploring weight loss (including anorexia nervosa and bulimia nervosa) 213

Chapter 9 Cognition, Behavior, and Mental Status 247

,  Techniques of examination
 Speech patterns 254 (including aphasia) Dysarthria refers to defective articulation. Aphasia is a
disorder of language. A person who can write a correct sentence does not have aphasia.
There are two common kinds of aphasia—expressive, or Broca aphasia, with preserved
comprehension with slow, nonfluent speech and receptive, or Wernicke aphasia, with impaired
comprehension with fluent speech. These are co
 Assessing abstract thinking: 261
Test the capacity to think abstractly in two ways.
Proverbs. To assess for concrete or abstract understanding,
Or Similarities. Ask the patient to tell you how the following are alike:
 Mental status examination 252
The mental status examination consists of six components: appearance and behavior; speech
and language; mood; thoughts and perceptions; insight and judgment; and cognitive function.
 Screening for depression: 274, 263 Screening for Depression: The Patient Health Questionnaire
(PHQ-9)
Scoring
Count the number (#) of boxes checked in a column. Multiply that number by the value
indicated below, then add the subtotal to produce a total score. The possible range is 0–27.
Use the table below to interpret the PHQ-9 score.
Not at all (#) _____ × 0 = _____
Several days (#) _____ × 1 = _____
More than half the days (#) _____ × 2 = _____
Nearly every day (#) _____ × 3 = _____

Screening for Depression
Adults
 Screening Tests
o Patient Health Questionnaire (PHQ)
o Beck Depression Scale
o Geriatric Depression Scale in older adults
o Edinburg post-natal depression scale in postpartum and pregnant women

 Professional Organization Screening Recommendations
o USPSTF: All adults 18 and over
o The American Academy of Family Physicians: General adult population, including
pregnant and postpartum women
o The American Academy of Pediatrics: Mothers for postpartum depression at the infant's
1-, 2-, and 4-month visits
o The American College of Preventative Medicine: All adults by primary care providers
Adolescents
 Screening Tests
o Beck Depression Inventory (BDI)
o Center for Epidemiological Studies Depression Scale
o EQ-SD
o Montgomery-Asberg Depression Rating Scale