NR 509 MID-TERM PRACTICE EXAM PREPARATION
NR 509 MID-TERM PRACTICE EXAM PREPARATION FOR 2025/2026
WITH COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |BRAND NEW VERSION!!
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
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.
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, NR 509 MID-TERM PRACTICE EXAM PREPARATION
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?
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
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 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
2|Page
, NR 509 MID-TERM PRACTICE EXAM PREPARATION
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?
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?
a. Clarifying
b. Echoing
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, NR 509 MID-TERM PRACTICE EXAM PREPARATION
c. Encouraging with continuers
d. Eliciting a graded response
e. Asking a leading question
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.
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
4|Page
NR 509 MID-TERM PRACTICE EXAM PREPARATION FOR 2025/2026
WITH COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |BRAND NEW VERSION!!
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
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.
1|Page
, NR 509 MID-TERM PRACTICE EXAM PREPARATION
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?
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
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 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
2|Page
, NR 509 MID-TERM PRACTICE EXAM PREPARATION
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?
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?
a. Clarifying
b. Echoing
3|Page
, NR 509 MID-TERM PRACTICE EXAM PREPARATION
c. Encouraging with continuers
d. Eliciting a graded response
e. Asking a leading question
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.
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
4|Page
