lOMoAR cPSD| 63316909
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 o Active listening, guided questioning, empathic responses,
summarization, transitions, partnering, validation, empowering the patient, reassurance,
appropriate verbal and nonverbal communication
• Setting the stage for the examination
• Establishing rapport o Blind- always identify yourself and others in the room o HOH- ask how
best to communicate, minimize background noise o Dead- talk to the patient not the
interpreter and do not use family to interpret o Wheelchairs- provide assistance as needed
• Gender pronouns
• Patient-centered medical care
• The FIFE model o The patient’s Feelings about the problem o The patient’s Ideas about the
cause and nature of the problem o The effect of the problem on the patient’s life and Function
o The patient’s Expectations of the disease
Chapter 2 Interviewing, Communication, and Interpersonal Skills
• Fundamentals of skilled interviewing o Use open-ended
questions
• Verbal and nonverbal communication o Use
understandable and nonstigmatizing language o Eye
contact, body language, nodding
• Challenging patient situations and behaviors
o Silent- ask them what they are thinking about o
Talkative- allow 5-10 min in the beginning
, lOMoAR cPSD| 63316909
Chapter 3 Health History
• Focused and comprehensive health histories o Comprehensive: NEW patients
o Focused: ESTABLISHED patients, used in routine or urgent care visits
• Determining the scope of the patient assessment o Adjust based on the magnitude and
severity of the patient’s problems, the need for thoroughness, the clinical setting—
inpatient or outpatient, primary or subspecialty care; and the time available
• The seven attributes of a patient’s principal symptoms o OLDCARTS: Onset, Location,
Duration, Characteristics, Aggrivating factors, relieving factors, timing, severity
• Subjective versus objective data o Subjective: symptoms that the patient tells you. CC
through the Review of Systems o Objective: physical exam findings, lab & diagnostic
testing results
• Modifying of the clinical interview for various clinical settings o ICU, Nursing Home, ER,
PCP office, Home
Chapter 4 Physical Examination
• Determining the scope of the physical examination o Comprehensive vs Focused
• Techniques of examination (Note: Be familiar with specific techniques in body system chapters)
o Inspection o Palpation
o Percussion- use of the striking or plexor fingers (usually #3). Used for chest, abdomen,
and lungs
o Auscultation
• The head-to-toe physical assessment o Recommended examining from the right side, moving
to the opposite side or foot of the bed. Estimates JVD, palpating hand rests better on apical
impulse, right kidney more palpable than the left
o Close observation begins at the outset of the patient encounter & continues throughout
the hx and physical exam
o Room should be darkened for the ophthalmoscopic exam. Promotes pupil dilation &
improved visibility of the fundi
o Move behind the sitting patient to feel the thyroid gland and examine the back,
posterior thorax, and lungs
o Elevate HOB to -30 degrees for the cardiovascular exam. Ask patient to roll partly to left
side to listen for S3 (mitral stenosis). Sit, lean forward, and exhale for aortic
regurgitation Supine for abdomen
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 o Active listening, guided questioning, empathic responses,
summarization, transitions, partnering, validation, empowering the patient, reassurance,
appropriate verbal and nonverbal communication
• Setting the stage for the examination
• Establishing rapport o Blind- always identify yourself and others in the room o HOH- ask how
best to communicate, minimize background noise o Dead- talk to the patient not the
interpreter and do not use family to interpret o Wheelchairs- provide assistance as needed
• Gender pronouns
• Patient-centered medical care
• The FIFE model o The patient’s Feelings about the problem o The patient’s Ideas about the
cause and nature of the problem o The effect of the problem on the patient’s life and Function
o The patient’s Expectations of the disease
Chapter 2 Interviewing, Communication, and Interpersonal Skills
• Fundamentals of skilled interviewing o Use open-ended
questions
• Verbal and nonverbal communication o Use
understandable and nonstigmatizing language o Eye
contact, body language, nodding
• Challenging patient situations and behaviors
o Silent- ask them what they are thinking about o
Talkative- allow 5-10 min in the beginning
, lOMoAR cPSD| 63316909
Chapter 3 Health History
• Focused and comprehensive health histories o Comprehensive: NEW patients
o Focused: ESTABLISHED patients, used in routine or urgent care visits
• Determining the scope of the patient assessment o Adjust based on the magnitude and
severity of the patient’s problems, the need for thoroughness, the clinical setting—
inpatient or outpatient, primary or subspecialty care; and the time available
• The seven attributes of a patient’s principal symptoms o OLDCARTS: Onset, Location,
Duration, Characteristics, Aggrivating factors, relieving factors, timing, severity
• Subjective versus objective data o Subjective: symptoms that the patient tells you. CC
through the Review of Systems o Objective: physical exam findings, lab & diagnostic
testing results
• Modifying of the clinical interview for various clinical settings o ICU, Nursing Home, ER,
PCP office, Home
Chapter 4 Physical Examination
• Determining the scope of the physical examination o Comprehensive vs Focused
• Techniques of examination (Note: Be familiar with specific techniques in body system chapters)
o Inspection o Palpation
o Percussion- use of the striking or plexor fingers (usually #3). Used for chest, abdomen,
and lungs
o Auscultation
• The head-to-toe physical assessment o Recommended examining from the right side, moving
to the opposite side or foot of the bed. Estimates JVD, palpating hand rests better on apical
impulse, right kidney more palpable than the left
o Close observation begins at the outset of the patient encounter & continues throughout
the hx and physical exam
o Room should be darkened for the ophthalmoscopic exam. Promotes pupil dilation &
improved visibility of the fundi
o Move behind the sitting patient to feel the thyroid gland and examine the back,
posterior thorax, and lungs
o Elevate HOB to -30 degrees for the cardiovascular exam. Ask patient to roll partly to left
side to listen for S3 (mitral stenosis). Sit, lean forward, and exhale for aortic
regurgitation Supine for abdomen
