NUR 504 Exam 1 (PDF) | (Updated) Advanced Health
Assessment Exam Questions — 200 Questions
Section 1: Health History and Interviewing Techniques (Questions 1-20)
1 A patient presents with vague complaints of fatigue and 'just not feeling right.' The clinician suspects underlying
psychosocial distress but the patient is hesitant to discuss personal issues. Which interviewing technique is most
appropriate to explore this without causing defensiveness?
A) Directly ask 'Are you depressed?' to screen for mood disorders.
B) Use the BATHE technique: ask about Background, Affect, Trouble, Handling, and Empathy.
C) Employ the FIFE approach: explore Feelings, Ideas, Function, and Expectations.
D) Ask 'What do you think is causing your fatigue?' to elicit the patient's explanatory model.
Answer: B
Rationale: The BATHE technique is specifically designed for psychosocial assessment in primary care, using
open-ended questions to explore context and emotions without being confrontational. Directly asking about
depression (A) may feel accusatory. FIFE (C) is patient-centered but less structured for psychosocial distress.
Asking about cause (D) may not address emotional barriers.
2 During a health history interview, a patient consistently provides brief answers and avoids eye contact. The
clinician suspects underlying anxiety or cultural norms. Which approach best balances cultural sensitivity with
the need to gather comprehensive data?
A) Maintain direct eye contact to convey confidence and encourage disclosure.
B) Acknowledge the patient's discomfort and offer to proceed at a slower pace, using open-ended questions.
C) Switch to closed-ended questions to reduce ambiguity and increase response rate.
D) Defer the interview to a later visit when the patient may feel more comfortable.
Answer: B
Rationale: Acknowledging discomfort and adjusting pace respects cultural or individual differences while still
gathering information. Direct eye contact (A) may be culturally inappropriate or increase anxiety. Closed-ended
questions (C) may limit data depth. Deferring (D) delays necessary assessment unnecessarily.
3 Which of the following best describes the primary purpose of the 'review of systems' (ROS) in the context of a
comprehensive health history?
A) To confirm diagnoses suggested by the history of present illness.
B) To screen for symptoms across all body systems that the patient may not have volunteered.
C) To prioritize the physical examination based on reported symptoms.
D) To establish a baseline for future comparisons of disease progression.
Answer: B
Rationale: The ROS is a systematic inventory of symptoms to detect issues the patient may not have mentioned. It is
not diagnostic (A), though it may guide the exam (C). Baseline establishment (D) is a secondary benefit.
4 A clinician is interviewing a patient with limited English proficiency using a professional interpreter. Which
action demonstrates best practice for maintaining patient-centered communication?
A) Direct questions to the interpreter, who then relays them to the patient.
B) Maintain eye contact with the patient while speaking, and address the patient directly.
C) Use short, complex sentences to ensure accuracy through the interpreter.
,D) Ask the interpreter to summarize the patient's responses after each question.
Answer: B
Rationale: Addressing the patient directly and maintaining eye contact preserves rapport and patient-centeredness.
Directing questions to the interpreter (A) alienates the patient. Complex sentences (C) increase misinterpretation
risk. Summarizing after each question (D) is inefficient and disrupts flow.
5 When eliciting a patient's sexual history, which approach is most consistent with current evidence-based
guidelines for obtaining accurate and comprehensive information?
A) Use a standardized questionnaire to be completed privately, then review responses.
B) Ask 'Do you have sex with men, women, or both?' using gender-neutral language.
C) Begin with a normalizing statement such as 'I ask all my patients about their sexual health.'
D) Limit questions to number of partners and condom use to avoid discomfort.
Answer: C
Rationale: Normalizing statements reduce stigma and increase disclosure. Questionnaires (A) lack opportunity for
clarification. Gender-neutral questions (B) are important but should follow normalizing context. Limiting questions
(D) misses important risk factors.
6 A patient reports a history of 'anxiety attacks.' Using the mnemonic OLD CARTS (Onset, Location, Duration,
Character, Aggravating factors, Relieving factors, Timing, Severity) for symptom analysis, which component is
most critical to differentiate panic disorder from other causes?
A) Onset: whether symptoms began suddenly or gradually.
B) Location: whether symptoms are focal or diffuse.
C) Character: description of sensations such as chest tightness or palpitations.
D) Timing: whether episodes occur at specific times or are unpredictable.
Answer: A
Rationale: Sudden onset is hallmark of panic attacks, whereas gradual onset suggests other anxiety disorders.
Location (B) and character (C) are nonspecific. Timing (D) can be relevant but onset is more differentiating.
7 Which interviewing technique is most effective for exploring a patient's health beliefs and explanatory model in
a culturally diverse population?
A) Use the LEARN model: Listen, Explain, Acknowledge, Recommend, Negotiate.
B) Ask 'What do you think caused your illness?' and 'How do you think it should be treated?'
C) Provide biomedical explanations first to correct misconceptions.
D) Use the ETHNIC model: Explanation, Treatment, Healers, Negotiate, Intervention, Collaboration.
Answer: B
Rationale: Directly asking about cause and treatment elicits the patient's explanatory model. LEARN (A) and
ETHNIC (D) are frameworks for cross-cultural negotiation, not initial exploration. Providing biomedical
explanations first (C) may dismiss patient beliefs.
8 A patient with chronic pain describes their pain as '8/10' but appears calm and in no distress. The clinician
suspects a discrepancy. What is the best initial response to clarify the situation while maintaining rapport?
A) Document the patient's reported intensity and proceed with the history.
B) Ask 'Can you tell me more about what makes it an 8? What does it feel like?'
C) Explain that pain is what the patient says it is and avoid further questioning.
D) Suggest that the patient may be exaggerating and encourage honest reporting.
Answer: B
,Rationale: Exploring the patient's experience with open-ended questions clarifies the meaning of the rating and
identifies functional impact. Simply documenting (A) misses context. Avoiding exploration (C) may overlook
important issues. Challenging the patient (D) damages trust.
9 When taking a family history, which approach best identifies hereditary risk for common chronic diseases?
A) Ask about specific diseases in first-degree relatives only.
B) Construct a three-generation pedigree including age and cause of death.
C) Ask 'Does anyone in your family have high blood pressure or diabetes?'
D) Focus on maternal lineage for X-linked conditions.
Answer: B
Rationale: A three-generation pedigree provides comprehensive risk assessment for multifactorial diseases.
First-degree only (A) misses second-degree risks. Asking about specific diseases (C) may miss others. Maternal
lineage (D) is too narrow.
10 A patient reveals during the interview that they use marijuana weekly for anxiety. Which response best aligns
with a nonjudgmental, therapeutic approach?
A) Advise the patient that marijuana is illegal and recommend cessation.
B) Ask 'How does marijuana affect your anxiety? Have you noticed any negative effects?'
C) Document the disclosure and refer to a substance abuse specialist immediately.
D) Explain that marijuana can worsen anxiety long-term and suggest alternatives.
Answer: B
Rationale: Exploring the patient's perspective and effects maintains therapeutic alliance and gathers crucial
information. Immediate advice (A) or referral (C) may be premature and dismissive. Educating (D) is important but
should follow understanding the patient's experience.
11 During a comprehensive health history interview, a patient provides detailed information about their current
symptoms but becomes visibly uncomfortable and avoids eye contact when asked about alcohol use. Which
interviewing technique is most appropriate to maintain rapport while gathering necessary information?
A) Proceed to the next topic and return to the sensitive question later in the interview
B) Directly confront the patient's discomfort and insist on an answer
C) Rephrase the question using more technical medical terminology
D) Ignore the nonverbal cues and continue with the current line of questioning
Answer: A
Rationale: The correct approach is to defer the sensitive topic and return later, allowing the patient to build trust.
Confrontation (B) may damage rapport; rephrasing with jargon (C) may confuse; ignoring cues (D) misses
important nonverbal information.
12 A clinician is using the BATHE technique during a health history interview. Which patient statement best
indicates that the clinician has effectively elicited the 'B' component?
A) I've been having chest pain when I exercise.
B) My mother had a heart attack at age 50.
C) I'm really stressed about my job and my marriage.
D) The pain started about three weeks ago.
Answer: C
Rationale: BATHE stands for Background, Affect, Trouble, Handling, Empathy. The 'B' (Background) asks about
the context of the patient's life stressors. Option C provides a life context, while A, B, and D are medical history
details.
, 13 A patient reports 'dizziness' but cannot elaborate further. Which open-ended question best facilitates a more
detailed description of the symptom?
A) Is it a spinning sensation or a feeling of lightheadedness?
B) Do you feel like you might faint?
C) Tell me more about what you mean by 'dizziness'.
D) Have you ever had this before?
Answer: C
Rationale: Open-ended questions encourage the patient to describe symptoms in their own words, providing richer
data. Options A and B are closed-ended and lead the patient; D is also closed-ended and may not elicit a detailed
description.
14 A clinician is taking a health history from a patient who uses a wheelchair and has a speech impediment. Which
approach best ensures effective communication and patient-centered care?
A) Conduct the interview while standing to maintain authority
B) Speak loudly and slowly to compensate for the speech impediment
C) Sit at eye level and ask questions that allow for yes/no responses
D) Focus only on the patient's primary caregiver for information
Answer: C
Rationale: Sitting at eye level promotes equality and respect. Using yes/no questions can facilitate communication
for patients with speech difficulties. Standing (A) may be perceived as condescending; speaking loudly (B) is
unnecessary; deferring to caregiver (D) undermines patient autonomy.
15 During a health history, a patient reveals they use herbal supplements, but when asked about medications, they
only list prescription drugs. Which interviewing technique is most effective for obtaining a complete
medication list?
A) Ask specifically about over-the-counter and herbal medications after the prescription list
B) Assume the patient considers supplements unimportant and omit them
C) Explain that herbal supplements are not considered medications
D) Wait for the patient to volunteer information about supplements
Answer: A
Rationale: Explicitly asking about OTC and herbal supplements ensures completeness. Assuming they are
unimportant (B) or not medications (C) is incorrect; waiting (D) risks missing crucial information.
16 A clinician is using the mnemonic OLD CARTS to assess a patient's symptom. Which component is assessed
by the question 'What makes it better or worse?'
A) Onset
B) Location
C) Aggravating/Relieving factors
D) Timing
Answer: C
Rationale: OLD CARTS stands for Onset, Location, Duration, Character, Aggravating/Relieving factors, Timing,
Severity. The question about what makes it better or worse directly addresses aggravating/relieving factors.
17 A patient who is a recent immigrant and speaks limited English is accompanied by a family member who offers
to translate. What is the most appropriate action for the clinician?
A) Use the family member as the interpreter to build trust
B) Use a professional medical interpreter, either in-person or via video
Assessment Exam Questions — 200 Questions
Section 1: Health History and Interviewing Techniques (Questions 1-20)
1 A patient presents with vague complaints of fatigue and 'just not feeling right.' The clinician suspects underlying
psychosocial distress but the patient is hesitant to discuss personal issues. Which interviewing technique is most
appropriate to explore this without causing defensiveness?
A) Directly ask 'Are you depressed?' to screen for mood disorders.
B) Use the BATHE technique: ask about Background, Affect, Trouble, Handling, and Empathy.
C) Employ the FIFE approach: explore Feelings, Ideas, Function, and Expectations.
D) Ask 'What do you think is causing your fatigue?' to elicit the patient's explanatory model.
Answer: B
Rationale: The BATHE technique is specifically designed for psychosocial assessment in primary care, using
open-ended questions to explore context and emotions without being confrontational. Directly asking about
depression (A) may feel accusatory. FIFE (C) is patient-centered but less structured for psychosocial distress.
Asking about cause (D) may not address emotional barriers.
2 During a health history interview, a patient consistently provides brief answers and avoids eye contact. The
clinician suspects underlying anxiety or cultural norms. Which approach best balances cultural sensitivity with
the need to gather comprehensive data?
A) Maintain direct eye contact to convey confidence and encourage disclosure.
B) Acknowledge the patient's discomfort and offer to proceed at a slower pace, using open-ended questions.
C) Switch to closed-ended questions to reduce ambiguity and increase response rate.
D) Defer the interview to a later visit when the patient may feel more comfortable.
Answer: B
Rationale: Acknowledging discomfort and adjusting pace respects cultural or individual differences while still
gathering information. Direct eye contact (A) may be culturally inappropriate or increase anxiety. Closed-ended
questions (C) may limit data depth. Deferring (D) delays necessary assessment unnecessarily.
3 Which of the following best describes the primary purpose of the 'review of systems' (ROS) in the context of a
comprehensive health history?
A) To confirm diagnoses suggested by the history of present illness.
B) To screen for symptoms across all body systems that the patient may not have volunteered.
C) To prioritize the physical examination based on reported symptoms.
D) To establish a baseline for future comparisons of disease progression.
Answer: B
Rationale: The ROS is a systematic inventory of symptoms to detect issues the patient may not have mentioned. It is
not diagnostic (A), though it may guide the exam (C). Baseline establishment (D) is a secondary benefit.
4 A clinician is interviewing a patient with limited English proficiency using a professional interpreter. Which
action demonstrates best practice for maintaining patient-centered communication?
A) Direct questions to the interpreter, who then relays them to the patient.
B) Maintain eye contact with the patient while speaking, and address the patient directly.
C) Use short, complex sentences to ensure accuracy through the interpreter.
,D) Ask the interpreter to summarize the patient's responses after each question.
Answer: B
Rationale: Addressing the patient directly and maintaining eye contact preserves rapport and patient-centeredness.
Directing questions to the interpreter (A) alienates the patient. Complex sentences (C) increase misinterpretation
risk. Summarizing after each question (D) is inefficient and disrupts flow.
5 When eliciting a patient's sexual history, which approach is most consistent with current evidence-based
guidelines for obtaining accurate and comprehensive information?
A) Use a standardized questionnaire to be completed privately, then review responses.
B) Ask 'Do you have sex with men, women, or both?' using gender-neutral language.
C) Begin with a normalizing statement such as 'I ask all my patients about their sexual health.'
D) Limit questions to number of partners and condom use to avoid discomfort.
Answer: C
Rationale: Normalizing statements reduce stigma and increase disclosure. Questionnaires (A) lack opportunity for
clarification. Gender-neutral questions (B) are important but should follow normalizing context. Limiting questions
(D) misses important risk factors.
6 A patient reports a history of 'anxiety attacks.' Using the mnemonic OLD CARTS (Onset, Location, Duration,
Character, Aggravating factors, Relieving factors, Timing, Severity) for symptom analysis, which component is
most critical to differentiate panic disorder from other causes?
A) Onset: whether symptoms began suddenly or gradually.
B) Location: whether symptoms are focal or diffuse.
C) Character: description of sensations such as chest tightness or palpitations.
D) Timing: whether episodes occur at specific times or are unpredictable.
Answer: A
Rationale: Sudden onset is hallmark of panic attacks, whereas gradual onset suggests other anxiety disorders.
Location (B) and character (C) are nonspecific. Timing (D) can be relevant but onset is more differentiating.
7 Which interviewing technique is most effective for exploring a patient's health beliefs and explanatory model in
a culturally diverse population?
A) Use the LEARN model: Listen, Explain, Acknowledge, Recommend, Negotiate.
B) Ask 'What do you think caused your illness?' and 'How do you think it should be treated?'
C) Provide biomedical explanations first to correct misconceptions.
D) Use the ETHNIC model: Explanation, Treatment, Healers, Negotiate, Intervention, Collaboration.
Answer: B
Rationale: Directly asking about cause and treatment elicits the patient's explanatory model. LEARN (A) and
ETHNIC (D) are frameworks for cross-cultural negotiation, not initial exploration. Providing biomedical
explanations first (C) may dismiss patient beliefs.
8 A patient with chronic pain describes their pain as '8/10' but appears calm and in no distress. The clinician
suspects a discrepancy. What is the best initial response to clarify the situation while maintaining rapport?
A) Document the patient's reported intensity and proceed with the history.
B) Ask 'Can you tell me more about what makes it an 8? What does it feel like?'
C) Explain that pain is what the patient says it is and avoid further questioning.
D) Suggest that the patient may be exaggerating and encourage honest reporting.
Answer: B
,Rationale: Exploring the patient's experience with open-ended questions clarifies the meaning of the rating and
identifies functional impact. Simply documenting (A) misses context. Avoiding exploration (C) may overlook
important issues. Challenging the patient (D) damages trust.
9 When taking a family history, which approach best identifies hereditary risk for common chronic diseases?
A) Ask about specific diseases in first-degree relatives only.
B) Construct a three-generation pedigree including age and cause of death.
C) Ask 'Does anyone in your family have high blood pressure or diabetes?'
D) Focus on maternal lineage for X-linked conditions.
Answer: B
Rationale: A three-generation pedigree provides comprehensive risk assessment for multifactorial diseases.
First-degree only (A) misses second-degree risks. Asking about specific diseases (C) may miss others. Maternal
lineage (D) is too narrow.
10 A patient reveals during the interview that they use marijuana weekly for anxiety. Which response best aligns
with a nonjudgmental, therapeutic approach?
A) Advise the patient that marijuana is illegal and recommend cessation.
B) Ask 'How does marijuana affect your anxiety? Have you noticed any negative effects?'
C) Document the disclosure and refer to a substance abuse specialist immediately.
D) Explain that marijuana can worsen anxiety long-term and suggest alternatives.
Answer: B
Rationale: Exploring the patient's perspective and effects maintains therapeutic alliance and gathers crucial
information. Immediate advice (A) or referral (C) may be premature and dismissive. Educating (D) is important but
should follow understanding the patient's experience.
11 During a comprehensive health history interview, a patient provides detailed information about their current
symptoms but becomes visibly uncomfortable and avoids eye contact when asked about alcohol use. Which
interviewing technique is most appropriate to maintain rapport while gathering necessary information?
A) Proceed to the next topic and return to the sensitive question later in the interview
B) Directly confront the patient's discomfort and insist on an answer
C) Rephrase the question using more technical medical terminology
D) Ignore the nonverbal cues and continue with the current line of questioning
Answer: A
Rationale: The correct approach is to defer the sensitive topic and return later, allowing the patient to build trust.
Confrontation (B) may damage rapport; rephrasing with jargon (C) may confuse; ignoring cues (D) misses
important nonverbal information.
12 A clinician is using the BATHE technique during a health history interview. Which patient statement best
indicates that the clinician has effectively elicited the 'B' component?
A) I've been having chest pain when I exercise.
B) My mother had a heart attack at age 50.
C) I'm really stressed about my job and my marriage.
D) The pain started about three weeks ago.
Answer: C
Rationale: BATHE stands for Background, Affect, Trouble, Handling, Empathy. The 'B' (Background) asks about
the context of the patient's life stressors. Option C provides a life context, while A, B, and D are medical history
details.
, 13 A patient reports 'dizziness' but cannot elaborate further. Which open-ended question best facilitates a more
detailed description of the symptom?
A) Is it a spinning sensation or a feeling of lightheadedness?
B) Do you feel like you might faint?
C) Tell me more about what you mean by 'dizziness'.
D) Have you ever had this before?
Answer: C
Rationale: Open-ended questions encourage the patient to describe symptoms in their own words, providing richer
data. Options A and B are closed-ended and lead the patient; D is also closed-ended and may not elicit a detailed
description.
14 A clinician is taking a health history from a patient who uses a wheelchair and has a speech impediment. Which
approach best ensures effective communication and patient-centered care?
A) Conduct the interview while standing to maintain authority
B) Speak loudly and slowly to compensate for the speech impediment
C) Sit at eye level and ask questions that allow for yes/no responses
D) Focus only on the patient's primary caregiver for information
Answer: C
Rationale: Sitting at eye level promotes equality and respect. Using yes/no questions can facilitate communication
for patients with speech difficulties. Standing (A) may be perceived as condescending; speaking loudly (B) is
unnecessary; deferring to caregiver (D) undermines patient autonomy.
15 During a health history, a patient reveals they use herbal supplements, but when asked about medications, they
only list prescription drugs. Which interviewing technique is most effective for obtaining a complete
medication list?
A) Ask specifically about over-the-counter and herbal medications after the prescription list
B) Assume the patient considers supplements unimportant and omit them
C) Explain that herbal supplements are not considered medications
D) Wait for the patient to volunteer information about supplements
Answer: A
Rationale: Explicitly asking about OTC and herbal supplements ensures completeness. Assuming they are
unimportant (B) or not medications (C) is incorrect; waiting (D) risks missing crucial information.
16 A clinician is using the mnemonic OLD CARTS to assess a patient's symptom. Which component is assessed
by the question 'What makes it better or worse?'
A) Onset
B) Location
C) Aggravating/Relieving factors
D) Timing
Answer: C
Rationale: OLD CARTS stands for Onset, Location, Duration, Character, Aggravating/Relieving factors, Timing,
Severity. The question about what makes it better or worse directly addresses aggravating/relieving factors.
17 A patient who is a recent immigrant and speaks limited English is accompanied by a family member who offers
to translate. What is the most appropriate action for the clinician?
A) Use the family member as the interpreter to build trust
B) Use a professional medical interpreter, either in-person or via video
