NR 511 / NR511 Midterm Exam
OBJECTIVE ASSESSMENT - EXAM
Differential Diagnosis &
Primary Care Practicum
2026/2027 Official Exam
A+ Verified 2026/2027 80%
Quality Assurance Edition Passing Score
COVER PAGE - 1
,SECTIONS COVERED
Section 1: Cardiovascular & Respiratory Disorders
Section 2: Dermatology & HEENT
Section 3: Gastrointestinal, Genitourinary & Renal
Section 4: Musculoskeletal, Neurology & Endocrine
Section 5: Hematology, Oncology, Infectious Disease & Special Populations
NR 511 / NR511 Midterm Exam - Differential Diagnosis & Primary Care Practicum - 2026/2027
Section 1: Cardiovascular & Respiratory Disorders
QUESTION 1
Q1. A 58-year-old male presents with crushing substernal chest pain radiating to his left arm that began
45 minutes ago while mowing the lawn. He is diaphoretic and nauseated. Vital signs reveal BP 158/92
mmHg, HR 104 bpm, RR 22/min, and SpO2 94% on room air. ECG shows ST-segment elevation in leads
V1-V4.
A. Administer aspirin, nitroglycerin, and activate the cath lab immediately
B. Order a chest CT angiogram to rule out pulmonary embolism
C. Begin empiric antibiotic therapy for community-acquired pneumonia
D. Schedule an outpatient stress echocardiogram within 48 hours
Correct
Rationale:Answer: A
The presentation is classic for an anterior ST-elevation myocardial infarction (STEMI) requiring immediate
reperfusion therapy. Aspirin and nitroglycerin are appropriate initial interventions, and emergent cardiac catheterization is the
standard of care. Chest CT would delay critical treatment, antibiotics are unnecessary without infectious signs, and
outpatient stress testing is contraindicated in acute MI.
QUESTION 2
Q2. A 72-year-old female with a history of hypertension and type 2 diabetes presents with progressive
dyspnea on exertion, orthopnea, and bilateral lower extremity edema. On examination, she has jugular
venous distension, an S3 gallop, and bilateral pulmonary crackles. BNP is 1,850 pg/mL.
A. Initiate furosemide 40 mg IV and obtain an urgent echocardiogram
B. Start empiric levofloxacin for suspected atypical pneumonia
C. Administer albuterol nebulizer for presumed COPD exacerbation
D. Order a V/Q scan to evaluate for pulmonary embolism
Correct
Rationale:Answer: A
The constellation of dyspnea, orthopnea, JVD, S3 gallop, pulmonary crackles, and markedly elevated BNP is
diagnostic of acute decompensated heart failure. Loop diuretics and echocardiography to assess ejection fraction are priority
interventions. Antibiotics, bronchodilators, and V/Q scanning do not address the underlying pathophysiology.
, NR 511 / NR511 Midterm Exam - Differential Diagnosis & Primary Care Practicum - 2026/2027
QUESTION 3
Q3. A 34-year-old female presents with sudden-onset pleuritic chest pain and dyspnea after a 10-hour
transatlantic flight. She has no fever or cough. Vital signs show HR 118 bpm, RR 24/min, BP 132/78
mmHg, and SpO2 89% on room air. D-dimer is 1,240 ng/mL.
A. Obtain a CT pulmonary angiogram immediately
B. Begin empiric azithromycin for community-acquired pneumonia
C. Order a ventilation-perfusion scan as the initial test
D. Start high-dose aspirin and schedule cardiac catheterization
Correct
Rationale:Answer:
The WellsAcriteria for pulmonary embolism are strongly positive given the clinical presentation and elevated
D-dimer. CT pulmonary angiography is the gold standard diagnostic test with high sensitivity and specificity. Antibiotics are
not indicated without infectious symptoms, V/Q scanning is reserved for patients with contrast allergies or renal impairment,
and cardiac catheterization is inappropriate for this presentation.
QUESTION 4
Q4. A 45-year-old male with a 30 pack-year smoking history presents with worsening cough, increased
sputum production, and dyspnea over the past 3 days. He has a barrel-shaped chest and distant heart
sounds. Pulmonary function tests from last year showed an FEV1/FVC ratio of 0.62.
A. Prescribe a short course of oral prednisone and augment bronchodilator therapy
B. Initiate empiric amoxicillin-clavulanate for 14 days
C. Order an urgent chest CT to evaluate for lung malignancy
D. Begin home oxygen therapy at 4 L/min via nasal cannula
Correct
Rationale:Answer: A of smoking, barrel chest, distant heart sounds, and previously documented obstructive pattern on
The history
PFTs establishes COPD. The acute worsening of symptoms represents a COPD exacerbation best managed with systemic
corticosteroids and intensified bronchodilation. Antibiotics are reserved for exacerbations with increased purulence or
mechanical ventilation needs, chest CT is not emergently indicated, and oxygen should be titrated to SpO2 88-92% rather
than fixed dosing.
QUESTION 5
Q5. A 28-year-old female with a history of asthma presents with wheezing, chest tightness, and cough
for the past 6 hours. She used her albuterol inhaler twice with minimal relief. On examination, she has
diffuse wheezing, a prolonged expiratory phase, and is using accessory muscles. Peak flow is 180 L/min
(35% of predicted).
A. Administer systemic corticosteroids and continuous albuterol nebulization
B. Start a 5-day course of oral levofloxacin
C. Order a chest X-ray to rule out pneumothorax
D. Begin subcutaneous epinephrine and observe for 30 minutes
Correct
Rationale:Answer: A has a moderate-to-severe asthma exacerbation with poor response to initial bronchodilator therapy
This patient
and significantly reduced peak flow. Systemic corticosteroids to reduce airway inflammation and continuous beta-agonist
nebulization are first-line management. Antibiotics are not indicated without evidence of bacterial infection, chest X-ray is
unnecessary without focal findings or trauma, and epinephrine is reserved for anaphylaxis rather than asthma.
OBJECTIVE ASSESSMENT - EXAM
Differential Diagnosis &
Primary Care Practicum
2026/2027 Official Exam
A+ Verified 2026/2027 80%
Quality Assurance Edition Passing Score
COVER PAGE - 1
,SECTIONS COVERED
Section 1: Cardiovascular & Respiratory Disorders
Section 2: Dermatology & HEENT
Section 3: Gastrointestinal, Genitourinary & Renal
Section 4: Musculoskeletal, Neurology & Endocrine
Section 5: Hematology, Oncology, Infectious Disease & Special Populations
NR 511 / NR511 Midterm Exam - Differential Diagnosis & Primary Care Practicum - 2026/2027
Section 1: Cardiovascular & Respiratory Disorders
QUESTION 1
Q1. A 58-year-old male presents with crushing substernal chest pain radiating to his left arm that began
45 minutes ago while mowing the lawn. He is diaphoretic and nauseated. Vital signs reveal BP 158/92
mmHg, HR 104 bpm, RR 22/min, and SpO2 94% on room air. ECG shows ST-segment elevation in leads
V1-V4.
A. Administer aspirin, nitroglycerin, and activate the cath lab immediately
B. Order a chest CT angiogram to rule out pulmonary embolism
C. Begin empiric antibiotic therapy for community-acquired pneumonia
D. Schedule an outpatient stress echocardiogram within 48 hours
Correct
Rationale:Answer: A
The presentation is classic for an anterior ST-elevation myocardial infarction (STEMI) requiring immediate
reperfusion therapy. Aspirin and nitroglycerin are appropriate initial interventions, and emergent cardiac catheterization is the
standard of care. Chest CT would delay critical treatment, antibiotics are unnecessary without infectious signs, and
outpatient stress testing is contraindicated in acute MI.
QUESTION 2
Q2. A 72-year-old female with a history of hypertension and type 2 diabetes presents with progressive
dyspnea on exertion, orthopnea, and bilateral lower extremity edema. On examination, she has jugular
venous distension, an S3 gallop, and bilateral pulmonary crackles. BNP is 1,850 pg/mL.
A. Initiate furosemide 40 mg IV and obtain an urgent echocardiogram
B. Start empiric levofloxacin for suspected atypical pneumonia
C. Administer albuterol nebulizer for presumed COPD exacerbation
D. Order a V/Q scan to evaluate for pulmonary embolism
Correct
Rationale:Answer: A
The constellation of dyspnea, orthopnea, JVD, S3 gallop, pulmonary crackles, and markedly elevated BNP is
diagnostic of acute decompensated heart failure. Loop diuretics and echocardiography to assess ejection fraction are priority
interventions. Antibiotics, bronchodilators, and V/Q scanning do not address the underlying pathophysiology.
, NR 511 / NR511 Midterm Exam - Differential Diagnosis & Primary Care Practicum - 2026/2027
QUESTION 3
Q3. A 34-year-old female presents with sudden-onset pleuritic chest pain and dyspnea after a 10-hour
transatlantic flight. She has no fever or cough. Vital signs show HR 118 bpm, RR 24/min, BP 132/78
mmHg, and SpO2 89% on room air. D-dimer is 1,240 ng/mL.
A. Obtain a CT pulmonary angiogram immediately
B. Begin empiric azithromycin for community-acquired pneumonia
C. Order a ventilation-perfusion scan as the initial test
D. Start high-dose aspirin and schedule cardiac catheterization
Correct
Rationale:Answer:
The WellsAcriteria for pulmonary embolism are strongly positive given the clinical presentation and elevated
D-dimer. CT pulmonary angiography is the gold standard diagnostic test with high sensitivity and specificity. Antibiotics are
not indicated without infectious symptoms, V/Q scanning is reserved for patients with contrast allergies or renal impairment,
and cardiac catheterization is inappropriate for this presentation.
QUESTION 4
Q4. A 45-year-old male with a 30 pack-year smoking history presents with worsening cough, increased
sputum production, and dyspnea over the past 3 days. He has a barrel-shaped chest and distant heart
sounds. Pulmonary function tests from last year showed an FEV1/FVC ratio of 0.62.
A. Prescribe a short course of oral prednisone and augment bronchodilator therapy
B. Initiate empiric amoxicillin-clavulanate for 14 days
C. Order an urgent chest CT to evaluate for lung malignancy
D. Begin home oxygen therapy at 4 L/min via nasal cannula
Correct
Rationale:Answer: A of smoking, barrel chest, distant heart sounds, and previously documented obstructive pattern on
The history
PFTs establishes COPD. The acute worsening of symptoms represents a COPD exacerbation best managed with systemic
corticosteroids and intensified bronchodilation. Antibiotics are reserved for exacerbations with increased purulence or
mechanical ventilation needs, chest CT is not emergently indicated, and oxygen should be titrated to SpO2 88-92% rather
than fixed dosing.
QUESTION 5
Q5. A 28-year-old female with a history of asthma presents with wheezing, chest tightness, and cough
for the past 6 hours. She used her albuterol inhaler twice with minimal relief. On examination, she has
diffuse wheezing, a prolonged expiratory phase, and is using accessory muscles. Peak flow is 180 L/min
(35% of predicted).
A. Administer systemic corticosteroids and continuous albuterol nebulization
B. Start a 5-day course of oral levofloxacin
C. Order a chest X-ray to rule out pneumothorax
D. Begin subcutaneous epinephrine and observe for 30 minutes
Correct
Rationale:Answer: A has a moderate-to-severe asthma exacerbation with poor response to initial bronchodilator therapy
This patient
and significantly reduced peak flow. Systemic corticosteroids to reduce airway inflammation and continuous beta-agonist
nebulization are first-line management. Antibiotics are not indicated without evidence of bacterial infection, chest X-ray is
unnecessary without focal findings or trauma, and epinephrine is reserved for anaphylaxis rather than asthma.
