NR-581 NR581: Nurse Practitioner Assessment and
Clinical Placement – Comprehensive Patient Evaluation,
Advanced Diagnostic Reasoning, and Evidence-Based
Management
1. A 45-year-old male presents with sudden-onset chest pain
radiating to his left arm. Which is the most important initial
diagnostic test?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Echocardiogram
D. Troponin in 24 hours
Rationale: ECG is the first-line diagnostic tool to evaluate
suspected acute coronary syndrome for immediate
management.
2. Which of the following is the most appropriate method to
assess liver size on physical exam?
A. Percussion in the right midclavicular line
B. Percussion and palpation from the right costal margin
upward
C. Palpation of the left upper quadrant
D. Auscultation for liver sounds
Rationale: Liver size is best assessed using percussion and
palpation from the right costal margin upward.
,3. A 28-year-old female presents with fever, malaise, and a
fine maculopapular rash that started on the face. Which
infection should be considered first?
A. Varicella
B. Rubella
C. Measles
D. Scarlet fever
Rationale: Rubella often presents with a fine maculopapular
rash starting on the face and spreading downward, along with
mild fever.
4. During a neurological exam, you ask the patient to close
their eyes and touch your finger with their index finger
alternately. This tests:
A. Reflexes
B. Coordination (finger-to-nose test)
C. Cranial nerve function
D. Strength
Rationale: The finger-to-nose test assesses cerebellar
coordination.
5. Which of the following is the most sensitive screening test
for hypothyroidism?
A. T3
,B. T4
C. TSH
D. Free T4 index
Rationale: TSH is the most sensitive indicator of primary
hypothyroidism.
6. A patient has a blood pressure of 160/102 mmHg on two
separate visits. The next step should be:
A. Lifestyle modifications only
B. Initiate antihypertensive therapy
C. Repeat BP in 6 months
D. Check ECG only
Rationale: Stage 2 hypertension requires pharmacologic
therapy in addition to lifestyle modifications.
7. A patient presents with polyuria, polydipsia, and
polyphagia. Labs reveal fasting glucose 165 mg/dL. The most
likely diagnosis is:
A. Type 1 diabetes
B. Type 2 diabetes
C. Diabetes mellitus (need further classification)
D. Diabetes insipidus
Rationale: Classic symptoms and fasting hyperglycemia suggest
diabetes mellitus; type classification may require further testing
(autoantibodies, C-peptide).
, 8. During abdominal examination, dullness in the flanks that
shifts with position suggests:
A. Mass
B. Ascites
C. Obesity
D. Hepatomegaly
Rationale: Shifting dullness is a key physical finding indicating
ascites.
9. A 65-year-old male smoker presents with hematuria and
flank pain. The most concerning differential is:
A. Urinary tract infection
B. Nephrolithiasis
C. Renal cell carcinoma
D. Benign prostatic hyperplasia
Rationale: In older adults, painless hematuria, especially with
risk factors like smoking, warrants evaluation for renal cell
carcinoma.
10. Which cranial nerve is responsible for shoulder shrug?
A. CN X
B. CN IX
C. CN XI
D. CN XII
Clinical Placement – Comprehensive Patient Evaluation,
Advanced Diagnostic Reasoning, and Evidence-Based
Management
1. A 45-year-old male presents with sudden-onset chest pain
radiating to his left arm. Which is the most important initial
diagnostic test?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Echocardiogram
D. Troponin in 24 hours
Rationale: ECG is the first-line diagnostic tool to evaluate
suspected acute coronary syndrome for immediate
management.
2. Which of the following is the most appropriate method to
assess liver size on physical exam?
A. Percussion in the right midclavicular line
B. Percussion and palpation from the right costal margin
upward
C. Palpation of the left upper quadrant
D. Auscultation for liver sounds
Rationale: Liver size is best assessed using percussion and
palpation from the right costal margin upward.
,3. A 28-year-old female presents with fever, malaise, and a
fine maculopapular rash that started on the face. Which
infection should be considered first?
A. Varicella
B. Rubella
C. Measles
D. Scarlet fever
Rationale: Rubella often presents with a fine maculopapular
rash starting on the face and spreading downward, along with
mild fever.
4. During a neurological exam, you ask the patient to close
their eyes and touch your finger with their index finger
alternately. This tests:
A. Reflexes
B. Coordination (finger-to-nose test)
C. Cranial nerve function
D. Strength
Rationale: The finger-to-nose test assesses cerebellar
coordination.
5. Which of the following is the most sensitive screening test
for hypothyroidism?
A. T3
,B. T4
C. TSH
D. Free T4 index
Rationale: TSH is the most sensitive indicator of primary
hypothyroidism.
6. A patient has a blood pressure of 160/102 mmHg on two
separate visits. The next step should be:
A. Lifestyle modifications only
B. Initiate antihypertensive therapy
C. Repeat BP in 6 months
D. Check ECG only
Rationale: Stage 2 hypertension requires pharmacologic
therapy in addition to lifestyle modifications.
7. A patient presents with polyuria, polydipsia, and
polyphagia. Labs reveal fasting glucose 165 mg/dL. The most
likely diagnosis is:
A. Type 1 diabetes
B. Type 2 diabetes
C. Diabetes mellitus (need further classification)
D. Diabetes insipidus
Rationale: Classic symptoms and fasting hyperglycemia suggest
diabetes mellitus; type classification may require further testing
(autoantibodies, C-peptide).
, 8. During abdominal examination, dullness in the flanks that
shifts with position suggests:
A. Mass
B. Ascites
C. Obesity
D. Hepatomegaly
Rationale: Shifting dullness is a key physical finding indicating
ascites.
9. A 65-year-old male smoker presents with hematuria and
flank pain. The most concerning differential is:
A. Urinary tract infection
B. Nephrolithiasis
C. Renal cell carcinoma
D. Benign prostatic hyperplasia
Rationale: In older adults, painless hematuria, especially with
risk factors like smoking, warrants evaluation for renal cell
carcinoma.
10. Which cranial nerve is responsible for shoulder shrug?
A. CN X
B. CN IX
C. CN XI
D. CN XII
