Midterm Exam Study Guide
NR 509 / NUR 509
Advanced Physical Assessment
Chamberlain University | College of Nursing
Comprehensive Chapters 1–4 & Beyond | 67 Pages
Comprehensive Study Resource
✓ Complete Coverage — Clinical Encounter, Interviewing & Health History
✓ Physical Examination Techniques: Inspection, Palpation, Percussion & Auscultation
✓ FIFE Model, OLDCARTS/Seven Attributes of Symptoms — Fully Explained
✓ Bias in Healthcare: Implicit vs Explicit Bias with Mitigation Strategies
✓ Challenging Patient Situations: Silent, Talkative, Angry & Cognitively Impaired
✓ Subjective vs Objective Data, Focused vs Comprehensive Assessment
✓ Perfect for NR509 Midterm Exam Preparation — Verified & Accurate
For educational examination preparation purposes only
,12/1/23, 3:34 PM NR509 Midterm Exam Study Guide
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.
After completing an initial assessment of a patient, the nurse has charted that his respirations are eupneic and his pulse is 58 beats
per minute. These types of data would be
Chapter 1 Approach to the Clinical Encounter
The interviewing process
o Slide 1: Initiate Encounter
Review the clinical record AKA setting the stage/preparation.
Ensure the client is comfortable; greeting patient
Clarify the goals/agenda for the encounter; balance provider and client goals
Establish rapport
Identify the client’s preferred title, name, and gender pronouns
Use “people first” language (i.e., a person with hearing loss, a person who uses a wheelchair)
o Slide 2: Gather Information
Identify the client’s chief complaint or reason for seeking care; information gathering.
Invite the client’s story using an open-ended approach
Gather information about the client’s perspective of the illness using the mnemonic FIFE; Exploring
patient’s perspective of illness.
Conduct the health history interview
Gather information about past medical history, medications and allergies, family history, personal and
social history, and review of systems, Exploring biomedical perspective of disease including relevant
background and context.
Interviewing techniques
o Active Listening: Active listening involves closely attending to what the client is communicating, connecting to the
client's emotional state, and using verbal and nonverbal skills to encourage the client to expand on their feelings
and concerns.
o Empathy: Empathy encompasses identifying with the client and feeling their pain as one’s own, then responding
to them in a supportive manner.
“I understand this has been difficult for you. Let’s talk about what we can do to help this situation.”
about:blank 1/67
,12/1/23, 3:34 PM NR509 Midterm Exam Study Guide
o Guided Questioning: Guided questions help to elicit more information, while still showing a continued interest in
the client’s feelings and story. Some techniques of guided questioning include moving from open-ended to more
focused questions; clarifying what the client means; encouraging with continuers such as “go on”; using a series of
questions one at a time; and using questions that require a graded response (i.e., how many stairs can you climb
before feeling short of breath?).
“Tell me about your abdominal pain. Where else do you feel it? What makes it worse?”
o Validating: Validation is affirming the legitimacy of the client's emotional experience. Examples include: “That
must have been a difficult experience. It’s very common to feel the way you are feeling.”
“That must have been very scary. It is normal to feel this way after an event like that.”
o Empowerment: Empowering clients to ask questions and express their concerns increases the chances that they
will adopt your advice, make lifestyle changes, or take medications as prescribed.
o Partnering: Partnering involves expressing commitment to an ongoing relationship with the clients to build
rapport.
“Thank you for sharing about your anxiety. I think we can come up with a plan together to help you feel
better.”
o Reassuring: Reassurance is an appropriate way to help the client feel that problems have been fully understood
and are being addressed.
o Summarizing: Giving a summary of the client's story during the interview helps to communicate that they have
been carefully listening
“You have told me a lot of things. Let me restate what you have shared so you can
verify that I have heard you correctly.”
o Transitions: “Now I would like to ask you some questions about your previous health.”
o Nonverbal Communication: Nonverbal communication includes eye contact, facial expression, posture, head
position, and movement such as shaking or nodding, interpersonal distance, and placement of the arms or legs
(i.e., crossed, neutral, or open).
Setting the stage for the examination
o Occurs in state 1: Initiating the Encounter – building relationship building with patient via respect, trust, and
rapport.
Preparing for the interview, check appearance. Make sure patient is comfortable to create a safe-feeling
environment. Follow the rhythm/sequence and implement societal dimensions. Be aware of biases and
create a therapeutic experience.
See discussion of bias in health care on pp. 19–20.
Implicit bias is a set of unconscious beliefs or associations that lead to a negative evaluation of a
person on the basis of their perceived group identity can lead to a structural system of privilege
(institutional bias) that leads to a misallocation of care
Explicit bias is the conscious or deliberate decisions or preferences founded on beliefs,
stereotypes or associations on the basis of a perceived group identity. Ex. Patient not wanting to
see a colored doctor because they want a “qualified doctor” or a clinician who thinks all gays have
HIV.
Box 1-12. Skills and Practices to Mitigate Bias in Your Clinical Encounters–
o Reflect on patterns of emotion and behavior. Pay attention to how you feel and how you
behave around patients of different identities. The patterns you recognize may reflect
biases that impact your interactions with patients as well as your clinical reasoning. Being
aware of these biases is the first step in reducing their impact on patient care.
o Pause before starting an encounter and prepare for potential triggers of bias. Once you
are aware of your potential biases, pay attention to situations that may trigger them.
Simply being aware of a bias can help minimize its effect. You may take deliberate actions
to reduce the impact of your biases.
o Generate alternative hypotheses for biases anchored in behavior. Many biases are
anchored in clinician assumptions about observed patient behavior (nonadherence,
substance use, etc.). Make it a habit to consider what structural forces (socioeconomic
status, race/racism, homophobia, etc.) impact patient behaviors, and how they can
challenge assumptions you make about patients.
about:blank 2/67
, 12/1/23, 3:34 PM NR509 Midterm Exam Study Guide
o Practice universal communication and interpersonal skills. Often, clinicians will not
recognize when a bias is at play in a clinical encounter. The foundational communication
and interpersonal skills described in this book (see Chapter 2, Interviewing,
Communication, and Interpersonal Skills, p. 43) can reduce the impact of such truly
unconscious biases on the way you interact with patients.
o Explore your patients’ identities. Many biases are anchored in clinician assumptions about
patient identities. By simply asking patients to clarify what their identities mean to them,
clinicians can dismantle their assumptions and better understand their patients. Many
approaches to exploring patient identities are presented in this book (see pp. 2–3).
o Explore your patients’ experiences of bias. Clinical encounters are influenced by patients’
prior experiences of implicit and explicit bias in their health care. Exploring and
understanding these experiences can help you be a better partner with your patients.
“Unfortunately, many of my patients have had negative experiences with health care.
What have been your experiences with health care?”
Establishing rapport
o How you greet patient and others in the room lays the foundation of an ongoing relationship. Everything creates
first impressions.
o As you begin, welcome the patient by introducing yourself, giving your own first and last name. If possible, shake
hands with the patient.
o With specific populations:
Newborns/infants: congratulate the family on the new baby if appropriate for the circumstances.
Encourage feeding and holding to make family comfortable and welcomed.
about:blank 3/67
NR 509 / NUR 509
Advanced Physical Assessment
Chamberlain University | College of Nursing
Comprehensive Chapters 1–4 & Beyond | 67 Pages
Comprehensive Study Resource
✓ Complete Coverage — Clinical Encounter, Interviewing & Health History
✓ Physical Examination Techniques: Inspection, Palpation, Percussion & Auscultation
✓ FIFE Model, OLDCARTS/Seven Attributes of Symptoms — Fully Explained
✓ Bias in Healthcare: Implicit vs Explicit Bias with Mitigation Strategies
✓ Challenging Patient Situations: Silent, Talkative, Angry & Cognitively Impaired
✓ Subjective vs Objective Data, Focused vs Comprehensive Assessment
✓ Perfect for NR509 Midterm Exam Preparation — Verified & Accurate
For educational examination preparation purposes only
,12/1/23, 3:34 PM NR509 Midterm Exam Study Guide
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.
After completing an initial assessment of a patient, the nurse has charted that his respirations are eupneic and his pulse is 58 beats
per minute. These types of data would be
Chapter 1 Approach to the Clinical Encounter
The interviewing process
o Slide 1: Initiate Encounter
Review the clinical record AKA setting the stage/preparation.
Ensure the client is comfortable; greeting patient
Clarify the goals/agenda for the encounter; balance provider and client goals
Establish rapport
Identify the client’s preferred title, name, and gender pronouns
Use “people first” language (i.e., a person with hearing loss, a person who uses a wheelchair)
o Slide 2: Gather Information
Identify the client’s chief complaint or reason for seeking care; information gathering.
Invite the client’s story using an open-ended approach
Gather information about the client’s perspective of the illness using the mnemonic FIFE; Exploring
patient’s perspective of illness.
Conduct the health history interview
Gather information about past medical history, medications and allergies, family history, personal and
social history, and review of systems, Exploring biomedical perspective of disease including relevant
background and context.
Interviewing techniques
o Active Listening: Active listening involves closely attending to what the client is communicating, connecting to the
client's emotional state, and using verbal and nonverbal skills to encourage the client to expand on their feelings
and concerns.
o Empathy: Empathy encompasses identifying with the client and feeling their pain as one’s own, then responding
to them in a supportive manner.
“I understand this has been difficult for you. Let’s talk about what we can do to help this situation.”
about:blank 1/67
,12/1/23, 3:34 PM NR509 Midterm Exam Study Guide
o Guided Questioning: Guided questions help to elicit more information, while still showing a continued interest in
the client’s feelings and story. Some techniques of guided questioning include moving from open-ended to more
focused questions; clarifying what the client means; encouraging with continuers such as “go on”; using a series of
questions one at a time; and using questions that require a graded response (i.e., how many stairs can you climb
before feeling short of breath?).
“Tell me about your abdominal pain. Where else do you feel it? What makes it worse?”
o Validating: Validation is affirming the legitimacy of the client's emotional experience. Examples include: “That
must have been a difficult experience. It’s very common to feel the way you are feeling.”
“That must have been very scary. It is normal to feel this way after an event like that.”
o Empowerment: Empowering clients to ask questions and express their concerns increases the chances that they
will adopt your advice, make lifestyle changes, or take medications as prescribed.
o Partnering: Partnering involves expressing commitment to an ongoing relationship with the clients to build
rapport.
“Thank you for sharing about your anxiety. I think we can come up with a plan together to help you feel
better.”
o Reassuring: Reassurance is an appropriate way to help the client feel that problems have been fully understood
and are being addressed.
o Summarizing: Giving a summary of the client's story during the interview helps to communicate that they have
been carefully listening
“You have told me a lot of things. Let me restate what you have shared so you can
verify that I have heard you correctly.”
o Transitions: “Now I would like to ask you some questions about your previous health.”
o Nonverbal Communication: Nonverbal communication includes eye contact, facial expression, posture, head
position, and movement such as shaking or nodding, interpersonal distance, and placement of the arms or legs
(i.e., crossed, neutral, or open).
Setting the stage for the examination
o Occurs in state 1: Initiating the Encounter – building relationship building with patient via respect, trust, and
rapport.
Preparing for the interview, check appearance. Make sure patient is comfortable to create a safe-feeling
environment. Follow the rhythm/sequence and implement societal dimensions. Be aware of biases and
create a therapeutic experience.
See discussion of bias in health care on pp. 19–20.
Implicit bias is a set of unconscious beliefs or associations that lead to a negative evaluation of a
person on the basis of their perceived group identity can lead to a structural system of privilege
(institutional bias) that leads to a misallocation of care
Explicit bias is the conscious or deliberate decisions or preferences founded on beliefs,
stereotypes or associations on the basis of a perceived group identity. Ex. Patient not wanting to
see a colored doctor because they want a “qualified doctor” or a clinician who thinks all gays have
HIV.
Box 1-12. Skills and Practices to Mitigate Bias in Your Clinical Encounters–
o Reflect on patterns of emotion and behavior. Pay attention to how you feel and how you
behave around patients of different identities. The patterns you recognize may reflect
biases that impact your interactions with patients as well as your clinical reasoning. Being
aware of these biases is the first step in reducing their impact on patient care.
o Pause before starting an encounter and prepare for potential triggers of bias. Once you
are aware of your potential biases, pay attention to situations that may trigger them.
Simply being aware of a bias can help minimize its effect. You may take deliberate actions
to reduce the impact of your biases.
o Generate alternative hypotheses for biases anchored in behavior. Many biases are
anchored in clinician assumptions about observed patient behavior (nonadherence,
substance use, etc.). Make it a habit to consider what structural forces (socioeconomic
status, race/racism, homophobia, etc.) impact patient behaviors, and how they can
challenge assumptions you make about patients.
about:blank 2/67
, 12/1/23, 3:34 PM NR509 Midterm Exam Study Guide
o Practice universal communication and interpersonal skills. Often, clinicians will not
recognize when a bias is at play in a clinical encounter. The foundational communication
and interpersonal skills described in this book (see Chapter 2, Interviewing,
Communication, and Interpersonal Skills, p. 43) can reduce the impact of such truly
unconscious biases on the way you interact with patients.
o Explore your patients’ identities. Many biases are anchored in clinician assumptions about
patient identities. By simply asking patients to clarify what their identities mean to them,
clinicians can dismantle their assumptions and better understand their patients. Many
approaches to exploring patient identities are presented in this book (see pp. 2–3).
o Explore your patients’ experiences of bias. Clinical encounters are influenced by patients’
prior experiences of implicit and explicit bias in their health care. Exploring and
understanding these experiences can help you be a better partner with your patients.
“Unfortunately, many of my patients have had negative experiences with health care.
What have been your experiences with health care?”
Establishing rapport
o How you greet patient and others in the room lays the foundation of an ongoing relationship. Everything creates
first impressions.
o As you begin, welcome the patient by introducing yourself, giving your own first and last name. If possible, shake
hands with the patient.
o With specific populations:
Newborns/infants: congratulate the family on the new baby if appropriate for the circumstances.
Encourage feeding and holding to make family comfortable and welcomed.
about:blank 3/67
