NR 511 CEA Midterm Exam – Differential Diagnosis & Primary
Care (2026)
Chamberlain University – 100 Questions with ANSWERs &
Rationales
Section 1: Clinical Decision-Making & Diagnostic Reasoning (Questions 1-20)
Question 1: A 55-year-old male presents with a chief complaint of "fatigue." Which of the following is
the MOST appropriate initial step in the clinical reasoning process?
A. Order a complete blood count
B. Perform a comprehensive physical examination
C. Obtain a detailed history, including onset, duration, and associated symptoms
D. Prescribe a multivitamin
ANSWER: C
Rationale: The clinical reasoning process begins with a thorough history. Fatigue has a broad differential
diagnosis; the history guides the differential and subsequent focused physical exam and testing.
Ordering tests before obtaining a history leads to inefficient and potentially inappropriate testing .
Question 2: The NP is using the differential diagnosis process for a patient with abdominal pain. Which
of the following represents the correct sequence?
A. Hypothesis generation → Data collection → Data interpretation → Problem identification →
Management
B. Data collection → Hypothesis generation → Data interpretation → Problem identification →
Management
,C. Data collection → Data interpretation → Hypothesis generation → Problem identification →
Management
D. Hypothesis generation → Data interpretation → Data collection → Problem identification →
Management
ANSWER: B
Rationale: The correct sequence is data collection (history, physical) → hypothesis generation
(developing differential diagnoses) → data interpretation (analyzing findings) → problem identification
→ management .
Question 3: A 28-year-old female presents with acute-onset severe headache. Which historical feature
would be a "red flag" requiring immediate evaluation?
A. Headache lasting 4 hours with nausea
B. Headache associated with menstruation
C. Sudden-onset "thunderclap" headache
D. Headache with mild photophobia
ANSWER: C
Rationale: A sudden-onset "thunderclap" headache is a red flag that may indicate subarachnoid
hemorrhage. This requires immediate neuroimaging (non-contrast CT) and possibly lumbar puncture .
Question 4: Which of the following is an example of a pathognomonic sign?
A. Fever in pneumonia
B. Koplik spots in measles
C. Wheezing in asthma
D. Rash in chickenpox
,ANSWER: B
Rationale: Koplik spots (small white spots on the buccal mucosa) are pathognomonic for measles
(rubeola). Pathognomonic signs are uniquely characteristic of a specific disease .
Question 5: The NP understands that "pretest probability" of a disease is influenced by all of the
following EXCEPT:
A. Prevalence of the disease in the population
B. Patient's age and gender
C. The cost of diagnostic testing
D. Clinical presentation and risk factors
ANSWER: C
Rationale: Pretest probability is influenced by disease prevalence, patient demographics, clinical
presentation, and risk factors. Cost of testing does not affect the probability of disease but may
influence whether testing is pursued .
Question 6: A 62-year-old male presents with unintentional weight loss and night sweats. These
symptoms are classified as:
A. Local symptoms
B. Constitutional symptoms
C. Psychosomatic symptoms
D. Acute symptoms
ANSWER: B
Rationale: Constitutional symptoms are systemic symptoms that affect the entire body, including
unintentional weight loss, fever, night sweats, and fatigue .
, Question 7: The NP understands that "anchoring bias" in clinical reasoning refers to:
A. Ordering too many diagnostic tests
B. Relying on the most recent information available
C. Focusing on one diagnosis too early and failing to consider alternatives
D. Being influenced by a patient's demographic characteristics
ANSWER: C
Rationale: Anchoring bias is a cognitive bias in which the clinician latches onto a single diagnosis early in
the evaluation and fails to adequately consider alternative diagnoses .
Question 8: Which of the following is a "cardinal sign" of inflammation?
A. Pallor
B. Paresthesia
C. Tumor (swelling)
D. Anhidrosis
ANSWER: C
Rationale: The cardinal signs of inflammation are rubor (redness), calor (heat), tumor (swelling), dolor
(pain), and functio laesa (loss of function) .
Question 9: A 50-year-old male presents with a chief complaint of "cough." Which of the following
would be classified as a "sign" rather than a "symptom"?
A. Cough
B. Sputum production
Care (2026)
Chamberlain University – 100 Questions with ANSWERs &
Rationales
Section 1: Clinical Decision-Making & Diagnostic Reasoning (Questions 1-20)
Question 1: A 55-year-old male presents with a chief complaint of "fatigue." Which of the following is
the MOST appropriate initial step in the clinical reasoning process?
A. Order a complete blood count
B. Perform a comprehensive physical examination
C. Obtain a detailed history, including onset, duration, and associated symptoms
D. Prescribe a multivitamin
ANSWER: C
Rationale: The clinical reasoning process begins with a thorough history. Fatigue has a broad differential
diagnosis; the history guides the differential and subsequent focused physical exam and testing.
Ordering tests before obtaining a history leads to inefficient and potentially inappropriate testing .
Question 2: The NP is using the differential diagnosis process for a patient with abdominal pain. Which
of the following represents the correct sequence?
A. Hypothesis generation → Data collection → Data interpretation → Problem identification →
Management
B. Data collection → Hypothesis generation → Data interpretation → Problem identification →
Management
,C. Data collection → Data interpretation → Hypothesis generation → Problem identification →
Management
D. Hypothesis generation → Data interpretation → Data collection → Problem identification →
Management
ANSWER: B
Rationale: The correct sequence is data collection (history, physical) → hypothesis generation
(developing differential diagnoses) → data interpretation (analyzing findings) → problem identification
→ management .
Question 3: A 28-year-old female presents with acute-onset severe headache. Which historical feature
would be a "red flag" requiring immediate evaluation?
A. Headache lasting 4 hours with nausea
B. Headache associated with menstruation
C. Sudden-onset "thunderclap" headache
D. Headache with mild photophobia
ANSWER: C
Rationale: A sudden-onset "thunderclap" headache is a red flag that may indicate subarachnoid
hemorrhage. This requires immediate neuroimaging (non-contrast CT) and possibly lumbar puncture .
Question 4: Which of the following is an example of a pathognomonic sign?
A. Fever in pneumonia
B. Koplik spots in measles
C. Wheezing in asthma
D. Rash in chickenpox
,ANSWER: B
Rationale: Koplik spots (small white spots on the buccal mucosa) are pathognomonic for measles
(rubeola). Pathognomonic signs are uniquely characteristic of a specific disease .
Question 5: The NP understands that "pretest probability" of a disease is influenced by all of the
following EXCEPT:
A. Prevalence of the disease in the population
B. Patient's age and gender
C. The cost of diagnostic testing
D. Clinical presentation and risk factors
ANSWER: C
Rationale: Pretest probability is influenced by disease prevalence, patient demographics, clinical
presentation, and risk factors. Cost of testing does not affect the probability of disease but may
influence whether testing is pursued .
Question 6: A 62-year-old male presents with unintentional weight loss and night sweats. These
symptoms are classified as:
A. Local symptoms
B. Constitutional symptoms
C. Psychosomatic symptoms
D. Acute symptoms
ANSWER: B
Rationale: Constitutional symptoms are systemic symptoms that affect the entire body, including
unintentional weight loss, fever, night sweats, and fatigue .
, Question 7: The NP understands that "anchoring bias" in clinical reasoning refers to:
A. Ordering too many diagnostic tests
B. Relying on the most recent information available
C. Focusing on one diagnosis too early and failing to consider alternatives
D. Being influenced by a patient's demographic characteristics
ANSWER: C
Rationale: Anchoring bias is a cognitive bias in which the clinician latches onto a single diagnosis early in
the evaluation and fails to adequately consider alternative diagnoses .
Question 8: Which of the following is a "cardinal sign" of inflammation?
A. Pallor
B. Paresthesia
C. Tumor (swelling)
D. Anhidrosis
ANSWER: C
Rationale: The cardinal signs of inflammation are rubor (redness), calor (heat), tumor (swelling), dolor
(pain), and functio laesa (loss of function) .
Question 9: A 50-year-old male presents with a chief complaint of "cough." Which of the following
would be classified as a "sign" rather than a "symptom"?
A. Cough
B. Sputum production
