NR 511 CEA COMPREHENSIVE EXAMINATION
Differential Diagnosis & Primary Care Practicum –
200-Question Practice Test Bank with Detailed
Rationales
Exam Title: NR 511 Clinical Encounter Assessment (CEA) Comprehensive Examination –
Differential Diagnosis & Primary Care Practicum – 2026/2027 Edition with NGN-Style Clinical
Judgment Questions
SECTION 1: CLINICAL DECISION-MAKING & DIFFERENTIAL DIAGNOSIS (Questions 1–40)
1. A 45-year-old male presents with chest pain that is pressure-like, radiating to the left arm,
associated with diaphoresis and nausea. The pain started 30 minutes ago while shoveling
snow. What is the MOST appropriate initial action?
a) Obtain a detailed cardiac history
b) Administer aspirin 324 mg PO
c) Activate EMS for immediate transport
d) Perform an EKG in the office
Correct Answer: c) Activate EMS for immediate transport
Rationale: This patient has symptoms concerning for acute coronary syndrome (ACS). The most
appropriate initial action is to activate EMS for immediate transport to an emergency
,department. While aspirin and EKG are important, they should not delay emergency transport.
The "golden hour" for myocardial salvage is critical.
2. A 65-year-old female presents with acute onset of severe, tearing chest pain radiating to
the back. Blood pressure is 160/90 in the right arm and 100/60 in the left arm. What is the
MOST likely diagnosis?
a) Acute myocardial infarction
b) Pulmonary embolism
c) Aortic dissection
d) Pericarditis
Correct Answer: c) Aortic dissection
Rationale: The differential blood pressure between arms, tearing chest pain radiating to the
back, and acute onset are classic findings of aortic dissection. This is a surgical emergency
requiring immediate intervention.
3. A 32-year-old patient exhibits mood changes with a cyclical nature of euphoria and bliss
then troughs of depression and anhedonia. In addition to working them up for metabolic
causes, you refer them to psychiatry. What is the MOST likely diagnosis?
a) Schizophrenia
,b) Borderline personality disorder
c) Bipolar disorder
d) Bulimia nervosa
Correct Answer: c) Bipolar disorder
Rationale: Cyclical mood changes with alternating euphoria and depressive episodes are
characteristic of bipolar disorder. The cyclical nature distinguishes it from other mood
disorders.
4. A 22-year-old male patient states during his review of systems that his scrotum is very
enlarged and feels like it is "full." He works as a powerlifter and a trash collector. You suspect
the patient has:
a) Testicular torsion
b) Hydrocele
c) Inguinal hernia
d) Varicocele
Correct Answer: b) Hydrocele
Rationale: The patient's occupation involving heavy lifting and the description of a "full" feeling
, scrotum suggests a hydrocele. Hydroceles are fluid collections in the scrotum that can develop
from trauma or heavy lifting.
5. A 41-year-old female presents with complaints of palpitations, heat intolerance, and
weight loss despite increased appetite. On examination, you note a fine tremor and mild
exophthalmos. What diagnosis would be HIGHEST on your differential?
a) Bilateral conjunctivitis
b) Hyperthyroidism (Graves' disease)
c) Anxiety disorder
d) Hypothyroidism
Correct Answer: b) Hyperthyroidism (Graves' disease)
Rationale: The symptoms of palpitations, heat intolerance, weight loss, tremor, and
exophthalmos are classic for hyperthyroidism. Graves' disease is the most common cause of
hyperthyroidism in young women.
6. A patient with a suspected diagnosis of COPD has undergone pulmonary function testing
with spirometry. Which of the following measurements during the PFT is MOST indicative of
COPD?
a) Decreased FEV1/FVC ratio
Differential Diagnosis & Primary Care Practicum –
200-Question Practice Test Bank with Detailed
Rationales
Exam Title: NR 511 Clinical Encounter Assessment (CEA) Comprehensive Examination –
Differential Diagnosis & Primary Care Practicum – 2026/2027 Edition with NGN-Style Clinical
Judgment Questions
SECTION 1: CLINICAL DECISION-MAKING & DIFFERENTIAL DIAGNOSIS (Questions 1–40)
1. A 45-year-old male presents with chest pain that is pressure-like, radiating to the left arm,
associated with diaphoresis and nausea. The pain started 30 minutes ago while shoveling
snow. What is the MOST appropriate initial action?
a) Obtain a detailed cardiac history
b) Administer aspirin 324 mg PO
c) Activate EMS for immediate transport
d) Perform an EKG in the office
Correct Answer: c) Activate EMS for immediate transport
Rationale: This patient has symptoms concerning for acute coronary syndrome (ACS). The most
appropriate initial action is to activate EMS for immediate transport to an emergency
,department. While aspirin and EKG are important, they should not delay emergency transport.
The "golden hour" for myocardial salvage is critical.
2. A 65-year-old female presents with acute onset of severe, tearing chest pain radiating to
the back. Blood pressure is 160/90 in the right arm and 100/60 in the left arm. What is the
MOST likely diagnosis?
a) Acute myocardial infarction
b) Pulmonary embolism
c) Aortic dissection
d) Pericarditis
Correct Answer: c) Aortic dissection
Rationale: The differential blood pressure between arms, tearing chest pain radiating to the
back, and acute onset are classic findings of aortic dissection. This is a surgical emergency
requiring immediate intervention.
3. A 32-year-old patient exhibits mood changes with a cyclical nature of euphoria and bliss
then troughs of depression and anhedonia. In addition to working them up for metabolic
causes, you refer them to psychiatry. What is the MOST likely diagnosis?
a) Schizophrenia
,b) Borderline personality disorder
c) Bipolar disorder
d) Bulimia nervosa
Correct Answer: c) Bipolar disorder
Rationale: Cyclical mood changes with alternating euphoria and depressive episodes are
characteristic of bipolar disorder. The cyclical nature distinguishes it from other mood
disorders.
4. A 22-year-old male patient states during his review of systems that his scrotum is very
enlarged and feels like it is "full." He works as a powerlifter and a trash collector. You suspect
the patient has:
a) Testicular torsion
b) Hydrocele
c) Inguinal hernia
d) Varicocele
Correct Answer: b) Hydrocele
Rationale: The patient's occupation involving heavy lifting and the description of a "full" feeling
, scrotum suggests a hydrocele. Hydroceles are fluid collections in the scrotum that can develop
from trauma or heavy lifting.
5. A 41-year-old female presents with complaints of palpitations, heat intolerance, and
weight loss despite increased appetite. On examination, you note a fine tremor and mild
exophthalmos. What diagnosis would be HIGHEST on your differential?
a) Bilateral conjunctivitis
b) Hyperthyroidism (Graves' disease)
c) Anxiety disorder
d) Hypothyroidism
Correct Answer: b) Hyperthyroidism (Graves' disease)
Rationale: The symptoms of palpitations, heat intolerance, weight loss, tremor, and
exophthalmos are classic for hyperthyroidism. Graves' disease is the most common cause of
hyperthyroidism in young women.
6. A patient with a suspected diagnosis of COPD has undergone pulmonary function testing
with spirometry. Which of the following measurements during the PFT is MOST indicative of
COPD?
a) Decreased FEV1/FVC ratio
