NR509 2024-2025 UPDATE/NR509 / NR 509 MIDTERM
EXAM (LATEST ): ADVANCED PHYSICAL
ASSESSMENT - CHAMBERLAIN/GET IT 100%
ACCURATE! /GRADED A+
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. - (ANSWER)b. Explain how the examination will
proceed.
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, - (ANSWER)c. Following the patient's lead to understand their
thoughts, ideas, concerns, and requests
,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 - (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 - (ANSWER)c. Feelings, ideas, function, and
expectations
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. - (ANSWER)c. 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 - (ANSWER)b. Validating and empathetic with
open-ended questions
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 - (ANSWER)b. Recognizing the patient's
emotions by asking or confirming how she feels about the event
, 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 - (ANSWER)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?
a. Clarifying
b. Echoing
c. Encouraging with continuers d. Eliciting a graded response
e. Asking a leading question - (ANSWER)b. Echoing
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
