NR 511 CEA EXAM CHAMBERLAIN UNIVERSITY NR 511 COMPREHENSIVE CLINICAL EXAM – EXAM-STYLE
QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents with a three-day history
of progressive right lower extremity pain and swelling. He denies any recent trauma. On examination, the
right calf is warm, erythematous, and tender to palpation with a palpable cord. Vital signs are
temperature 37.8°C (100.0°F), heart rate 98 bpm, and blood pressure 148/90 mmHg. What is the most
appropriate initial diagnostic test for this patient?
A. D-dimer assay
B. Duplex venous ultrasonography
C. CT angiography of the lower extremity
D. Venous plethysmography
Correct Answer: B. Duplex venous ultrasonography
*Rationale: * Duplex venous ultrasonography is the initial imaging modality of choice for diagnosing deep vein
thrombosis (DVT) due to its high sensitivity and specificity, non-invasive nature, and ability to visualize the deep
venous system. A D-dimer assay (A) has high sensitivity but low specificity, especially in hospitalized or elderly
,patients, and is often used to rule out DVT in low-probability settings, not as the primary diagnostic test. CT
angiography (C) is used to evaluate for pulmonary embolism, not for the initial diagnosis of DVT. Venous
plethysmography (D) is an older, less specific method that has largely been replaced by ultrasound.
2. A 55-year-old female presents for a routine health maintenance visit. She has a 20-pack-year smoking
history and a family history of breast cancer. She is perimenopausal and reports no significant medical
issues. According to the U.S. Preventive Services Task Force (USPSTF) guidelines, which of the following is
the most appropriate recommendation regarding screening mammography?
A. Begin annual screening mammography immediately.
B. Begin biennial screening mammography immediately.
C. Discuss the potential benefits and harms and decide on a screening schedule based on her values and
preferences.
D. Recommend against screening mammography until she is 55 years old.
Correct Answer: C. Discuss the potential benefits and harms and decide on a screening schedule based on
her values and preferences.
*Rationale: * The USPSTF recommends that clinicians discuss screening mammography with women aged 40 to
49 years and decide on starting the screening based on their values and preferences regarding the balance of
benefits and harms. While options A and B might be considered, the current guideline emphasizes shared
,decision-making for this age group due to the lower incidence of breast cancer and higher false-positive rate.
Option D is incorrect as screening is not universally deferred until age 55; the decision is individualized.
3. A 24-year-old male presents with a chief complaint of a rash on his trunk that has been present for two
weeks. He reports that the rash started as a single large "herald" patch followed by a more widespread,
smaller scaly rash. He denies any systemic symptoms. On examination, you note an erythematous, oval-
shaped, scaly patch on his back and multiple smaller, salmon-colored papules and plaques on his trunk in
a "Christmas tree" pattern. What is the most likely diagnosis?
A. Tinea versicolor
B. Guttate psoriasis
C. Pityriasis rosea
D. Secondary syphilis
Correct Answer: C. Pityriasis rosea
*Rationale: * The clinical presentation of a herald patch followed by a secondary eruption of smaller lesions
along skin tension lines (Christmas tree pattern) is classic for pityriasis rosea. Tinea versicolor (A) is
characterized by hypo- or hyperpigmented macules, typically without a herald patch. Guttate psoriasis (B)
presents with small, teardrop-shaped papules and plaques, often following a streptococcal infection, and lacks
, the herald patch. Secondary syphilis (D) can present with a maculopapular rash that involves the palms and
soles, and patients usually have other systemic symptoms; a herald patch is not a feature.
4. A 45-year-old female presents with complaints of progressive fatigue, cold intolerance, and weight gain
over the past six months. Her past medical history is significant for hypothyroidism, for which she takes
levothyroxine 100 mcg daily. On examination, her pulse is 62 bpm, and she appears slightly pale with dry
skin. Laboratory studies reveal a thyroid-stimulating hormone (TSH) of 12.5 mIU/L (normal 0.4-4.0). Which
of the following is the most appropriate next step in managing this patient?
A. Decrease the levothyroxine dose to 75 mcg daily.
B. Increase the levothyroxine dose to 125 mcg daily.
C. Order a free T4 level.
D. Reassure the patient that this TSH level is acceptable for her age.
Correct Answer: B. Increase the levothyroxine dose to 125 mcg daily.
*Rationale: * An elevated TSH indicates primary hypothyroidism and that the patient is not on a sufficient
replacement dose of levothyroxine. Therefore, increasing the dose is the appropriate action. Decreasing the dose
(A) would worsen the hypothyroidism. While ordering a free T4 level (C) is often done to confirm the etiology,
the clinical picture of hypothyroidism and elevated TSH is clear. The management is to adjust the medication.
QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents with a three-day history
of progressive right lower extremity pain and swelling. He denies any recent trauma. On examination, the
right calf is warm, erythematous, and tender to palpation with a palpable cord. Vital signs are
temperature 37.8°C (100.0°F), heart rate 98 bpm, and blood pressure 148/90 mmHg. What is the most
appropriate initial diagnostic test for this patient?
A. D-dimer assay
B. Duplex venous ultrasonography
C. CT angiography of the lower extremity
D. Venous plethysmography
Correct Answer: B. Duplex venous ultrasonography
*Rationale: * Duplex venous ultrasonography is the initial imaging modality of choice for diagnosing deep vein
thrombosis (DVT) due to its high sensitivity and specificity, non-invasive nature, and ability to visualize the deep
venous system. A D-dimer assay (A) has high sensitivity but low specificity, especially in hospitalized or elderly
,patients, and is often used to rule out DVT in low-probability settings, not as the primary diagnostic test. CT
angiography (C) is used to evaluate for pulmonary embolism, not for the initial diagnosis of DVT. Venous
plethysmography (D) is an older, less specific method that has largely been replaced by ultrasound.
2. A 55-year-old female presents for a routine health maintenance visit. She has a 20-pack-year smoking
history and a family history of breast cancer. She is perimenopausal and reports no significant medical
issues. According to the U.S. Preventive Services Task Force (USPSTF) guidelines, which of the following is
the most appropriate recommendation regarding screening mammography?
A. Begin annual screening mammography immediately.
B. Begin biennial screening mammography immediately.
C. Discuss the potential benefits and harms and decide on a screening schedule based on her values and
preferences.
D. Recommend against screening mammography until she is 55 years old.
Correct Answer: C. Discuss the potential benefits and harms and decide on a screening schedule based on
her values and preferences.
*Rationale: * The USPSTF recommends that clinicians discuss screening mammography with women aged 40 to
49 years and decide on starting the screening based on their values and preferences regarding the balance of
benefits and harms. While options A and B might be considered, the current guideline emphasizes shared
,decision-making for this age group due to the lower incidence of breast cancer and higher false-positive rate.
Option D is incorrect as screening is not universally deferred until age 55; the decision is individualized.
3. A 24-year-old male presents with a chief complaint of a rash on his trunk that has been present for two
weeks. He reports that the rash started as a single large "herald" patch followed by a more widespread,
smaller scaly rash. He denies any systemic symptoms. On examination, you note an erythematous, oval-
shaped, scaly patch on his back and multiple smaller, salmon-colored papules and plaques on his trunk in
a "Christmas tree" pattern. What is the most likely diagnosis?
A. Tinea versicolor
B. Guttate psoriasis
C. Pityriasis rosea
D. Secondary syphilis
Correct Answer: C. Pityriasis rosea
*Rationale: * The clinical presentation of a herald patch followed by a secondary eruption of smaller lesions
along skin tension lines (Christmas tree pattern) is classic for pityriasis rosea. Tinea versicolor (A) is
characterized by hypo- or hyperpigmented macules, typically without a herald patch. Guttate psoriasis (B)
presents with small, teardrop-shaped papules and plaques, often following a streptococcal infection, and lacks
, the herald patch. Secondary syphilis (D) can present with a maculopapular rash that involves the palms and
soles, and patients usually have other systemic symptoms; a herald patch is not a feature.
4. A 45-year-old female presents with complaints of progressive fatigue, cold intolerance, and weight gain
over the past six months. Her past medical history is significant for hypothyroidism, for which she takes
levothyroxine 100 mcg daily. On examination, her pulse is 62 bpm, and she appears slightly pale with dry
skin. Laboratory studies reveal a thyroid-stimulating hormone (TSH) of 12.5 mIU/L (normal 0.4-4.0). Which
of the following is the most appropriate next step in managing this patient?
A. Decrease the levothyroxine dose to 75 mcg daily.
B. Increase the levothyroxine dose to 125 mcg daily.
C. Order a free T4 level.
D. Reassure the patient that this TSH level is acceptable for her age.
Correct Answer: B. Increase the levothyroxine dose to 125 mcg daily.
*Rationale: * An elevated TSH indicates primary hypothyroidism and that the patient is not on a sufficient
replacement dose of levothyroxine. Therefore, increasing the dose is the appropriate action. Decreasing the dose
(A) would worsen the hypothyroidism. While ordering a free T4 level (C) is often done to confirm the etiology,
the clinical picture of hypothyroidism and elevated TSH is clear. The management is to adjust the medication.
