Final Exam: NR 569 / NR569 (Latest Update 2026/2027) Differential Diagnosis in Acute Care Practicum |
Questions & Verified Answers | 100% Correct | Grade A - Chamberlain 2026/2027 - 2026/2027 Official
Exam
OBJECTIVE ASSESSMENT - EXAM
Final Exam: NR 569 / NR569 (Latest Update 2026/2027) Differential Diagnosis
in Acute Care Practicum | Questions & Verified Answers | 100% Correct |
Grade A - Chamberlain 2026/2027 - 2026/2027 Official Exam
100 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Acute Care Differential Diagnosis Patient History & Physical Exam
Clinical Decision-Making Evidence-Based Clinical Reasoning
Diagnostic Testing & Interpretation
COVER PAGE - 1
, SECTION 1 | Cardiovascular & Respiratory Differential Diagnosis | Q1-Q20 | Final Exam: NR 569 / NR569 (Latest Update 2026/2027) Differential Diagnosis in Acute Care Practicum | Questio
Q1 Question 1 of 100
A 58-year-old male presents to the emergency department with substernal chest
pressure that began after shoveling snow, radiating to his left arm, accompanied by
diaphoresis. His ECG shows 2 mm of ST-segment elevation in leads II, III, and aVF. The
acute care NP suspects acute coronary syndrome. Which intervention should be initiated
first?
A. Administer aspirin 325 mg chewed and activate the catheterization laboratory for
primary PCI
B. Administer a proton pump inhibitor and order an upper endoscopy
C. Administer intravenous metoprolol 5 mg push immediately
D. Administer sublingual nitroglycerin every 5 minutes for three doses
Correct Answer: A
Rationale:
ST-segment elevation in inferior leads with radiating chest pressure and diaphoresis strongly suggests
an acute STEMI requiring immediate aspirin and activation of the catheterization laboratory for primary
PCI within 90 minutes of first medical contact. Endoscopy would delay reperfusion and is inappropriate
for ACS. Beta-blockers are contraindicated in acute heart failure or with signs of cardiogenic shock often
seen with inferior MI. Nitroglycerin may help symptoms but does not address the critical need for
reperfusion therapy in STEMI.
Final Exam: NR 569 / NR569 (Latest Update 2026/2027) Differential Diagnosis in Acute Care Pract -- 2026/2027 | Passing Score: 80% | Page 2 of 54
, Q2 Question 2 of 100
A 65-year-old male presents with sharp, pleuritic chest pain that worsens when lying flat
and improves when leaning forward. He recently had a viral upper respiratory infection.
His ECG shows diffuse ST-segment elevations with PR-segment depressions. Troponin
is mildly elevated. Which diagnosis best explains these findings?
A. Acute ST-elevation myocardial infarction of the anterior wall
B. Acute pericarditis
C. Pulmonary embolism with right heart strain
D. Stable angina pectoris
Correct Answer: B
Rationale:
Diffuse ST-segment elevations with PR-segment depressions, pleuritic chest pain that improves with
leaning forward, and a recent viral illness are classic for acute pericarditis. The pain pattern and diffuse
ECG changes distinguish pericarditis from focal STEMI, which would show localized ST elevations and
reciprocal changes. Pulmonary embolism typically causes tachycardia, hypoxia, and right heart strain
patterns rather than diffuse ST elevation. Stable angina is exertional and resolves with rest, not pleuritic
or positional.
Q3 Question 3 of 100
A 72-year-old female with a history of COPD and heart failure presents with progressive
dyspnea, bilateral lower extremity edema, and orthopnea. Her BNP is 1,200 pg/mL.
Chest X-ray shows cardiomegaly and bilateral cephalization of pulmonary vasculature.
Which finding most strongly supports decompensated heart failure as the primary cause
of her symptoms?
A. Increased residual volume on pulmonary function testing
B. Pulsus paradoxus greater than 12 mmHg
C. Bilateral rales on lung auscultation and an S3 gallop
D. Pursed-lip breathing and prolonged expiratory phase
Correct Answer: C
Rationale:
Bilateral rales, an S3 gallop, and elevated BNP strongly support decompensated heart failure as the
primary diagnosis. Pulsus paradoxus suggests severe asthma or cardiac tamponade, not heart failure.
Pursed-lip breathing and prolonged expiration are classic COPD findings that do not explain the
elevated BNP or pulmonary edema. Increased residual volume reflects COPD physiology but does not
account for the heart failure signs present.
Final Exam: NR 569 / NR569 (Latest Update 2026/2027) Differential Diagnosis in Acute Care Pract -- 2026/2027 | Passing Score: 80% | Page 3 of 54
, Q4 Question 4 of 100
A 45-year-old male presents to the emergency department three days after total knee
replacement with sudden onset dyspnea, pleuritic chest pain, and a heart rate of 118. His
SpO2 is 91% on room air. A D-dimer is elevated. Which diagnostic test is most
appropriate to confirm the suspected diagnosis?
A. Ventilation-perfusion lung scan
B. Pulmonary angiography
C. Chest computed tomography without contrast
D. CT pulmonary angiography
Correct Answer: D
Rationale:
CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism in a
hemodynamically stable patient with sudden dyspnea, pleuritic chest pain, tachycardia, and elevated
D-dimer following surgery. V/Q scan is reserved for patients with contrast allergy or renal failure.
Pulmonary angiography is invasive and rarely used. CT without contrast cannot evaluate the pulmonary
vasculature for embolus.
Q5 Question 5 of 100
A 55-year-old male with a history of uncontrolled hypertension presents with sudden,
tearing chest pain radiating to his back between the shoulder blades. His blood pressure
is 180/100 in the right arm and 145/85 in the left arm. A chest X-ray shows a widened
mediastinum. Which diagnostic study is most definitive for confirming the suspected
diagnosis?
A. Computed tomography angiography of the chest
B. Transthoracic echocardiography
C. Exercise stress test
D. Coronary angiography
Correct Answer: A
Rationale:
Sudden tearing chest pain radiating to the back, blood pressure discrepancy between arms, and a
widened mediastinum on chest X-ray strongly suggest aortic dissection, which is best confirmed by CT
angiography of the chest. Transthoracic echocardiography has limited sensitivity for the ascending aorta
and cannot reliably identify the dissection flap. Stress testing is contraindicated in acute dissection.
Coronary angiography does not evaluate the aortic wall.
Final Exam: NR 569 / NR569 (Latest Update 2026/2027) Differential Diagnosis in Acute Care Pract -- 2026/2027 | Passing Score: 80% | Page 4 of 54
Questions & Verified Answers | 100% Correct | Grade A - Chamberlain 2026/2027 - 2026/2027 Official
Exam
OBJECTIVE ASSESSMENT - EXAM
Final Exam: NR 569 / NR569 (Latest Update 2026/2027) Differential Diagnosis
in Acute Care Practicum | Questions & Verified Answers | 100% Correct |
Grade A - Chamberlain 2026/2027 - 2026/2027 Official Exam
100 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Acute Care Differential Diagnosis Patient History & Physical Exam
Clinical Decision-Making Evidence-Based Clinical Reasoning
Diagnostic Testing & Interpretation
COVER PAGE - 1
, SECTION 1 | Cardiovascular & Respiratory Differential Diagnosis | Q1-Q20 | Final Exam: NR 569 / NR569 (Latest Update 2026/2027) Differential Diagnosis in Acute Care Practicum | Questio
Q1 Question 1 of 100
A 58-year-old male presents to the emergency department with substernal chest
pressure that began after shoveling snow, radiating to his left arm, accompanied by
diaphoresis. His ECG shows 2 mm of ST-segment elevation in leads II, III, and aVF. The
acute care NP suspects acute coronary syndrome. Which intervention should be initiated
first?
A. Administer aspirin 325 mg chewed and activate the catheterization laboratory for
primary PCI
B. Administer a proton pump inhibitor and order an upper endoscopy
C. Administer intravenous metoprolol 5 mg push immediately
D. Administer sublingual nitroglycerin every 5 minutes for three doses
Correct Answer: A
Rationale:
ST-segment elevation in inferior leads with radiating chest pressure and diaphoresis strongly suggests
an acute STEMI requiring immediate aspirin and activation of the catheterization laboratory for primary
PCI within 90 minutes of first medical contact. Endoscopy would delay reperfusion and is inappropriate
for ACS. Beta-blockers are contraindicated in acute heart failure or with signs of cardiogenic shock often
seen with inferior MI. Nitroglycerin may help symptoms but does not address the critical need for
reperfusion therapy in STEMI.
Final Exam: NR 569 / NR569 (Latest Update 2026/2027) Differential Diagnosis in Acute Care Pract -- 2026/2027 | Passing Score: 80% | Page 2 of 54
, Q2 Question 2 of 100
A 65-year-old male presents with sharp, pleuritic chest pain that worsens when lying flat
and improves when leaning forward. He recently had a viral upper respiratory infection.
His ECG shows diffuse ST-segment elevations with PR-segment depressions. Troponin
is mildly elevated. Which diagnosis best explains these findings?
A. Acute ST-elevation myocardial infarction of the anterior wall
B. Acute pericarditis
C. Pulmonary embolism with right heart strain
D. Stable angina pectoris
Correct Answer: B
Rationale:
Diffuse ST-segment elevations with PR-segment depressions, pleuritic chest pain that improves with
leaning forward, and a recent viral illness are classic for acute pericarditis. The pain pattern and diffuse
ECG changes distinguish pericarditis from focal STEMI, which would show localized ST elevations and
reciprocal changes. Pulmonary embolism typically causes tachycardia, hypoxia, and right heart strain
patterns rather than diffuse ST elevation. Stable angina is exertional and resolves with rest, not pleuritic
or positional.
Q3 Question 3 of 100
A 72-year-old female with a history of COPD and heart failure presents with progressive
dyspnea, bilateral lower extremity edema, and orthopnea. Her BNP is 1,200 pg/mL.
Chest X-ray shows cardiomegaly and bilateral cephalization of pulmonary vasculature.
Which finding most strongly supports decompensated heart failure as the primary cause
of her symptoms?
A. Increased residual volume on pulmonary function testing
B. Pulsus paradoxus greater than 12 mmHg
C. Bilateral rales on lung auscultation and an S3 gallop
D. Pursed-lip breathing and prolonged expiratory phase
Correct Answer: C
Rationale:
Bilateral rales, an S3 gallop, and elevated BNP strongly support decompensated heart failure as the
primary diagnosis. Pulsus paradoxus suggests severe asthma or cardiac tamponade, not heart failure.
Pursed-lip breathing and prolonged expiration are classic COPD findings that do not explain the
elevated BNP or pulmonary edema. Increased residual volume reflects COPD physiology but does not
account for the heart failure signs present.
Final Exam: NR 569 / NR569 (Latest Update 2026/2027) Differential Diagnosis in Acute Care Pract -- 2026/2027 | Passing Score: 80% | Page 3 of 54
, Q4 Question 4 of 100
A 45-year-old male presents to the emergency department three days after total knee
replacement with sudden onset dyspnea, pleuritic chest pain, and a heart rate of 118. His
SpO2 is 91% on room air. A D-dimer is elevated. Which diagnostic test is most
appropriate to confirm the suspected diagnosis?
A. Ventilation-perfusion lung scan
B. Pulmonary angiography
C. Chest computed tomography without contrast
D. CT pulmonary angiography
Correct Answer: D
Rationale:
CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism in a
hemodynamically stable patient with sudden dyspnea, pleuritic chest pain, tachycardia, and elevated
D-dimer following surgery. V/Q scan is reserved for patients with contrast allergy or renal failure.
Pulmonary angiography is invasive and rarely used. CT without contrast cannot evaluate the pulmonary
vasculature for embolus.
Q5 Question 5 of 100
A 55-year-old male with a history of uncontrolled hypertension presents with sudden,
tearing chest pain radiating to his back between the shoulder blades. His blood pressure
is 180/100 in the right arm and 145/85 in the left arm. A chest X-ray shows a widened
mediastinum. Which diagnostic study is most definitive for confirming the suspected
diagnosis?
A. Computed tomography angiography of the chest
B. Transthoracic echocardiography
C. Exercise stress test
D. Coronary angiography
Correct Answer: A
Rationale:
Sudden tearing chest pain radiating to the back, blood pressure discrepancy between arms, and a
widened mediastinum on chest X-ray strongly suggest aortic dissection, which is best confirmed by CT
angiography of the chest. Transthoracic echocardiography has limited sensitivity for the ascending aorta
and cannot reliably identify the dissection flap. Stress testing is contraindicated in acute dissection.
Coronary angiography does not evaluate the aortic wall.
Final Exam: NR 569 / NR569 (Latest Update 2026/2027) Differential Diagnosis in Acute Care Pract -- 2026/2027 | Passing Score: 80% | Page 4 of 54
