ASSESSMENT ACTUAL EXAM GRADED A+ – Comprehensive
NP-Level Physical Examination and Clinical Reasoning –
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Taking the History: Interviewing, Screening, and Psychosocial Assessment
Q1: You are conducting the initial visit with a 34-year-old patient who presents with
vague abdominal discomfort. To structure the history of present illness efficiently, which
mnemonic best guides your questioning about symptom characteristics?
A. OPQRST (Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Timing)
B. AVPU (Alert, Verbal, Pain, Unresponsive)
C. SAMPLE (Signs/Symptoms, Allergies, Medications, Past history, Last meal, Events)
D. DCAP-BTLS (Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness,
Lacerations, Swelling)
Correct Answer: A
Rationale: The best answer is A. OPQRST is the standard mnemonic for characterizing
symptoms during the history of present illness; it gives you a systematic way to
understand what the patient is experiencing.
Q2: During a well-woman visit, you need to obtain a sexual history. Which framework is
recommended by CDC guidelines for organizing questions about sexual health in a
nonjudgmental manner?
A. The 5 Ps (Partners, Practices, Protection from STIs, Past history of STIs, Pregnancy
intention)
B. The ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure)
C. The CAGE questionnaire (Cut down, Annoyed, Guilty, Eye-opener)
D. The OLDCARTS mnemonic (Onset, Location, Duration, Characteristics,
Aggravating/Alleviating factors, Radiation, Timing, Severity)
Correct Answer: A
Rationale: The best answer is A. The 5 Ps provide a structured, respectful way to gather
sexual history and identify risk factors for STIs and unintended pregnancy.
,Q3: A 16-year-old presents alone for a sports physical. Which interviewing framework is
specifically designed to assess adolescent risk behaviors including home environment,
education, activities, drugs, sexuality, and suicide/depression?
A. HEADSS (Home, Education/Employment, Activities, Drugs, Sexuality,
Suicide/Depression)
B. SLUMS (Saint Louis University Mental Status)
C. BEERS Criteria
D. APGAR scoring
Correct Answer: A
Rationale: The best answer is A. HEADSS is the gold standard psychosocial interview
for adolescents; it helps you identify risk behaviors in a developmentally appropriate
way.
Q4: You are screening a 45-year-old patient for depression during an annual wellness
visit. Which two-question tool is commonly used as an initial screen before proceeding
to a longer instrument if positive?
A. PHQ-2 (Patient Health Questionnaire-2)
B. GAD-7 (Generalized Anxiety Disorder-7)
C. SLUMS (Saint Louis University Mental Status Exam)
D. CAGE-AID
Correct Answer: A
Rationale: The best answer is A. The PHQ-2 asks about depressed mood and anhedonia
over the past two weeks; if positive, you follow up with the PHQ-9.
Q5: A patient becomes tearful while discussing recent job loss. Which response best
demonstrates the motivational interviewing technique of expressing empathy?
A. "It sounds like this has been an incredibly difficult time for you. I'm glad you felt
comfortable sharing this with me."
B. "You should start applying for new jobs immediately so you don't fall behind."
C. "At least you still have your health—many people have it worse."
D. "Let me refer you to psychiatry right now before we address your physical concerns."
Correct Answer: A
Rationale: The best answer is A. Reflective listening and affirming the patient's courage
to share demonstrates empathy, which is foundational to motivational interviewing.
, Q6: During a geriatric assessment, you ask a 78-year-old patient to stand from a seated
position without using their arms, walk 10 feet, turn around, and sit back down. What are
you primarily assessing with this maneuver?
A. Fall risk and functional mobility
B. Cardiac ejection fraction
C. Pulmonary diffusion capacity
D. Cognitive impairment only
Correct Answer: A
Rationale: The best answer is A. The Timed Up and Go (TUG) or Get Up and Go test
evaluates balance, gait, and functional mobility to identify fall risk in older adults.
Q7: A patient with chronic pain frequently interrupts the interview to describe unrelated
symptoms in excessive detail. Which technique is most appropriate to redirect the
conversation while maintaining rapport?
A. Use gentle interruption with summarization and transition back to the focused
agenda
B. Allow the patient to continue indefinitely to ensure all concerns are heard
C. Tell the patient firmly that you only have 15 minutes and must move on
D. Document everything silently and avoid redirecting to prevent offending the patient
Correct Answer: A
Rationale: The best answer is A. Summarizing what you've heard and gently redirecting
shows respect for the patient's concerns while keeping the visit focused and efficient.
Q8: When assessing alcohol use in a patient who initially denies drinking problems,
which screening tool specifically evaluates for alcohol use disorder through questions
about guilt, blackouts, and need for morning drinking?
A. CAGE questionnaire
B. PHQ-9
C. GAD-7
D. Mini-Cog
Correct Answer: A
Rationale: The best answer is A. The CAGE questionnaire is a validated four-question
screen for alcohol use disorder; positive responses warrant further evaluation.
Q9: You are evaluating a 72-year-old patient who lives alone. Which assessment tool
measures the ability to perform complex tasks such as managing finances,
medications, transportation, and household maintenance?