NR-511 DIFFERENTIAL DIAGNOSIS EXAM 2 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027 CHAMBERLAIN UNIVERSITY..
Core Domains
1. Abdominal Pain and Gastrointestinal Presentations
2. Chest Pain and Cardiovascular Assessment
3. Headache, Dizziness, and Neurological Red Flags
4. Dyspnea, Cough, and Respiratory Differential Diagnosis
5. Musculoskeletal and Joint Pain Syndromes
6. Dermatologic Conditions and Rash Identification
7. Fever, Fatigue, and Systemic Illnesses
8. Ear, Nose, Throat, and Eye Disorders
9. Clinical Reasoning and Diagnostic Testing
10. Legal, Ethical, and Urgent Referral Criteria
This examination is designed to assess the advanced practice nurse’s ability to formulate precise differential
diagnoses for a wide spectrum of patient presentations encountered in primary care. It measures clinical
reasoning, application of evidence-based guidelines, recognition of life-threatening conditions, and integration of
history, physical examination, and diagnostic data. Comprising 100 multiple-choice and scenario-based questions,
the assessment emphasizes real-world decision-making, prioritization of urgent versus non-urgent conditions, and
patient-centered management. Success requires synthesis of pathophysiology, pharmacology, and ethical practice,
preparing the clinician for safe, competent, and independent advanced nursing practice.
SECTION ONE: QUESTIONS 1–100
,1. A 28-year-old female presents with acute onset of right lower quadrant abdominal pain, nausea, and low-
grade fever. On examination, she has rebound tenderness at McBurney’s point. Which diagnosis is most
likely?
A. Ectopic pregnancy
B. Acute appendicitis
C. Ovarian torsion
D. Pelvic inflammatory disease
🟢 B. Acute appendicitis
🔴 RATIONALE: The classic presentation of acute appendicitis includes periumbilical pain migrating to the right
lower quadrant, nausea, low-grade fever, and rebound tenderness at McBurney’s point. While ectopic
pregnancy and ovarian torsion can cause similar pain, the presence of McBurney’s point rebound tenderness
and lack of adnexal findings make appendicitis most likely.
2. A 65-year-old man with history of hypertension and smoking presents with squeezing substernal chest pain
radiating to the left arm, diaphoresis, and dyspnea. ECG shows ST-segment elevation in leads II, III, and aVF.
What is the immediate diagnosis?
A. Unstable angina
B. Acute pericarditis
C. ST-elevation myocardial infarction
D. Aortic dissection
🟢 C. ST-elevation myocardial infarction
🔴 RATIONALE: Substernal chest pressure with diaphoresis and ST-segment elevation in inferior leads (II, III,
aVF) confirms an acute ST-elevation myocardial infarction. Unstable angina lacks ST elevation; pericarditis often
,shows diffuse ST elevation and pleuritic pain; aortic dissection usually presents with tearing pain and pulse
deficits.
3. A 45-year-old female presents with chronic daily headaches that are bilateral, non-throbbing, and described
as a tight band around her head. She has no nausea, photophobia, or aura. Neurological exam is normal.
What is the most likely headache type?
A. Migraine without aura
B. Cluster headache
C. Tension-type headache
D. Medication overuse headache
🟢 C. Tension-type headache
🔴 RATIONALE: Tension-type headache is characterized by bilateral, pressing/tightening pain without nausea,
photophobia, or aura. Migraine is typically unilateral and throbbing with associated symptoms. Cluster
headaches are severe, unilateral, with autonomic features. Medication overuse headache occurs with frequent
analgesic use.
4. A 34-year-old woman complains of sudden-onset dyspnea and sharp, pleuritic chest pain three days after a
long-haul flight. She is tachycardic and tachypneic, with clear lungs. What is the most likely diagnosis?
A. Pneumonia
B. Spontaneous pneumothorax
C. Pulmonary embolism
D. Acute asthma exacerbation
, 🟢 C. Pulmonary embolism
🔴 RATIONALE: Sudden dyspnea, pleuritic chest pain, and recent immobilization (long flight) are classic for
pulmonary embolism. Clear lung fields and tachycardia support this over pneumonia or pneumothorax. Asthma
would present with wheezing.
5. A 52-year-old man reports gradual onset of bilateral knee pain and stiffness lasting longer than 30 minutes in
the morning, improving with activity. He has Heberden’s nodes. Which condition fits this picture?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Gout
D. Psoriatic arthritis
🟢 B. Osteoarthritis
🔴 RATIONALE: Gradual onset, morning stiffness <30 minutes (though here >30 minutes can occur but typical
OA is <30 min, but Heberden’s nodes are pathognomonic for OA), Heberden’s nodes (distal interphalangeal
joint osteophytes) and knee involvement without systemic symptoms suggest osteoarthritis. Rheumatoid
arthritis typically involves MCP/PIP joints, prolonged stiffness, and systemic inflammation.
6. An 8-year-old child presents with a pruritic, erythematous, scaly patch on the scalp with overlying hair loss
and broken hairs. Wood lamp examination shows green fluorescence. What is the most likely diagnosis?
A. Seborrheic dermatitis
B. Tinea capitis
C. Psoriasis
D. Alopecia areata
PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027 CHAMBERLAIN UNIVERSITY..
Core Domains
1. Abdominal Pain and Gastrointestinal Presentations
2. Chest Pain and Cardiovascular Assessment
3. Headache, Dizziness, and Neurological Red Flags
4. Dyspnea, Cough, and Respiratory Differential Diagnosis
5. Musculoskeletal and Joint Pain Syndromes
6. Dermatologic Conditions and Rash Identification
7. Fever, Fatigue, and Systemic Illnesses
8. Ear, Nose, Throat, and Eye Disorders
9. Clinical Reasoning and Diagnostic Testing
10. Legal, Ethical, and Urgent Referral Criteria
This examination is designed to assess the advanced practice nurse’s ability to formulate precise differential
diagnoses for a wide spectrum of patient presentations encountered in primary care. It measures clinical
reasoning, application of evidence-based guidelines, recognition of life-threatening conditions, and integration of
history, physical examination, and diagnostic data. Comprising 100 multiple-choice and scenario-based questions,
the assessment emphasizes real-world decision-making, prioritization of urgent versus non-urgent conditions, and
patient-centered management. Success requires synthesis of pathophysiology, pharmacology, and ethical practice,
preparing the clinician for safe, competent, and independent advanced nursing practice.
SECTION ONE: QUESTIONS 1–100
,1. A 28-year-old female presents with acute onset of right lower quadrant abdominal pain, nausea, and low-
grade fever. On examination, she has rebound tenderness at McBurney’s point. Which diagnosis is most
likely?
A. Ectopic pregnancy
B. Acute appendicitis
C. Ovarian torsion
D. Pelvic inflammatory disease
🟢 B. Acute appendicitis
🔴 RATIONALE: The classic presentation of acute appendicitis includes periumbilical pain migrating to the right
lower quadrant, nausea, low-grade fever, and rebound tenderness at McBurney’s point. While ectopic
pregnancy and ovarian torsion can cause similar pain, the presence of McBurney’s point rebound tenderness
and lack of adnexal findings make appendicitis most likely.
2. A 65-year-old man with history of hypertension and smoking presents with squeezing substernal chest pain
radiating to the left arm, diaphoresis, and dyspnea. ECG shows ST-segment elevation in leads II, III, and aVF.
What is the immediate diagnosis?
A. Unstable angina
B. Acute pericarditis
C. ST-elevation myocardial infarction
D. Aortic dissection
🟢 C. ST-elevation myocardial infarction
🔴 RATIONALE: Substernal chest pressure with diaphoresis and ST-segment elevation in inferior leads (II, III,
aVF) confirms an acute ST-elevation myocardial infarction. Unstable angina lacks ST elevation; pericarditis often
,shows diffuse ST elevation and pleuritic pain; aortic dissection usually presents with tearing pain and pulse
deficits.
3. A 45-year-old female presents with chronic daily headaches that are bilateral, non-throbbing, and described
as a tight band around her head. She has no nausea, photophobia, or aura. Neurological exam is normal.
What is the most likely headache type?
A. Migraine without aura
B. Cluster headache
C. Tension-type headache
D. Medication overuse headache
🟢 C. Tension-type headache
🔴 RATIONALE: Tension-type headache is characterized by bilateral, pressing/tightening pain without nausea,
photophobia, or aura. Migraine is typically unilateral and throbbing with associated symptoms. Cluster
headaches are severe, unilateral, with autonomic features. Medication overuse headache occurs with frequent
analgesic use.
4. A 34-year-old woman complains of sudden-onset dyspnea and sharp, pleuritic chest pain three days after a
long-haul flight. She is tachycardic and tachypneic, with clear lungs. What is the most likely diagnosis?
A. Pneumonia
B. Spontaneous pneumothorax
C. Pulmonary embolism
D. Acute asthma exacerbation
, 🟢 C. Pulmonary embolism
🔴 RATIONALE: Sudden dyspnea, pleuritic chest pain, and recent immobilization (long flight) are classic for
pulmonary embolism. Clear lung fields and tachycardia support this over pneumonia or pneumothorax. Asthma
would present with wheezing.
5. A 52-year-old man reports gradual onset of bilateral knee pain and stiffness lasting longer than 30 minutes in
the morning, improving with activity. He has Heberden’s nodes. Which condition fits this picture?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Gout
D. Psoriatic arthritis
🟢 B. Osteoarthritis
🔴 RATIONALE: Gradual onset, morning stiffness <30 minutes (though here >30 minutes can occur but typical
OA is <30 min, but Heberden’s nodes are pathognomonic for OA), Heberden’s nodes (distal interphalangeal
joint osteophytes) and knee involvement without systemic symptoms suggest osteoarthritis. Rheumatoid
arthritis typically involves MCP/PIP joints, prolonged stiffness, and systemic inflammation.
6. An 8-year-old child presents with a pruritic, erythematous, scaly patch on the scalp with overlying hair loss
and broken hairs. Wood lamp examination shows green fluorescence. What is the most likely diagnosis?
A. Seborrheic dermatitis
B. Tinea capitis
C. Psoriasis
D. Alopecia areata
