NR 509 Mid-Term Study Questions with
all correct solutions
NR 509 Mid-Term Study Questions with
all correct solutions
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? - CORRECT ANSWER 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.
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? - CORRECT ANSWER 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
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? - CORRECT ANSWER 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
,NR 509 Mid-Term Study Questions with
all correct solutions
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
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? - CORRECT
ANSWER 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
Chapter 2 - CORRECT ANSWER
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? - CORRECT ANSWER 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.
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? - CORRECT ANSWER 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
,NR 509 Mid-Term Study Questions with
all correct solutions
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? -
CORRECT ANSWER 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 confirming how she feels about the
event
c. By allowing the crying patient to look around the room for tissues to permit her an
excuse to hide her face and defer her emotions
d. Presuming that the patient's emotions meet social expectations, such as being
depressed and even traumatized by her spouse's death
e. Narrowing the understanding of the patient's emotional response to only thoughts and
feelings that have been verbalized
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? - CORRECT ANSWER 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 diagnosis of chest pain
f. 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? - CORRECT ANSWER a. Clarifying
b. Echoing
c. Encouraging with continuers
, NR 509 Mid-Term Study Questions with
all correct solutions
d. Eliciting a graded response
e. Asking a leading question
A 14-year-old male presents to a new primary care provider after his family relocates to
a state. The patient underwent treatment for sarcoma when he was age 11 years,
including an above-the-knee amputation. He has learned to successfully navigate with a
prosthetic leg and even engage in competitive athletics at school. He does not like to
speak of his experience with cancer and often makes up humorous stories to tell new
acquaintances about his amputation (such as, "I got bit by a squirrel and they had to
amputate."). Although he is very well engaged in most of the visit with the new clinician,
when the topic of cancer arises, he demurs to his father, who accompanies him to this
appointment. Which of the following statements is most likely to be helpful in cementing
the patient's trust in the new provider? - CORRECT ANSWER a. "That sounds like a
frightening experience that you are recovering well from."
b. "You are becoming an adult and must be able to talk about your health."
c. "You need to see a counselor since you have not adjusted well to your new
condition."
d. "You have recovered well and should start moving on with your life."
e. "You cannot rely on your father for support forever."
Chapter 3 - CORRECT ANSWER ....
A 54-year-old diplomat working at the United Nations reports occasional chest pain and
a sense of tightness in his chest when particularly stressed over work deadlines. The
patient is 6 feet 4 inches tall. He has a temperature of 98.6ºF and blood pressure of
140/78. He has a cut over one eye that he says is "from shaving." Which of the following
represents subjective information about this patient? - CORRECT ANSWER a.
Temperature of 98.6ºF
b. Blood pressure of 140/78
c. Employment at the United Nations
d. Cut over eye from shaving
e. Height of 6 feet 4 inches
A 32-year-old office worker reports excessive stress at work and pain in the right lower
quadrant. She states that last night she vomited twice. Her blood pressure is 120/75,
heart rate 93 bpm. The patient looks pale and is sweating lightly. Which of the following
is an objective finding? - CORRECT ANSWER a. Pain in the right lower quadrant
b. History of vomiting
c. Pale appearance
d. High stress level
e. Accelerated heart rate
A 29-year-old electrician complains of persistent cough and wheezing, particularly when
he exercises. He says he smokes "occasionally" but rarely so much that he needs to
