NR 569
Final Exam
Differential Diagnosis in Acute Care Practicum
Questions and Verified Answers
100% Correct | Grade A
Chamberlain University
College of Nursing
Latest Update
100 Questions | 9 Sections
Aligned with 2026-2027 Chamberlain University curriculum standards and acute care nurse practitioner competencies for
comprehensive final examination
, Table of Contents
Section 1: Clinical Reasoning and Diagnostic Frameworks
Q1 - Q15
Section 2: Comprehensive Patient Assessment, History Taking, and Documentation Across the
Lifespan
Q16 - Q25
Section 3: Respiratory System Differential Diagnosis
Q26 - Q38
Section 4: Cardiovascular System Differential Diagnosis
Q39 - Q55
Section 5: Gastrointestinal and Abdominal Differential Diagnosis
Q56 - Q65
Section 6: Neurological and Musculoskeletal Differential Diagnosis
Q66 - Q78
Section 7: Genitourinary and Renal Differential Diagnosis
Q79 - Q88
Section 8: Infectious Diseases, Systemic Conditions, and Fever Evaluation
Q89 - Q95
Section 9: Integrated Clinical Scenarios and Diagnostic Decision-Making
Q96 - Q100
Page 2
,NR 569 Final Exam | Differential Diagnosis in Acute Care Practicum | Chamberlain University 2026-2027 100 Questions | Verified Answers
Section 1: Clinical Reasoning and Diagnostic Frameworks
Q1: An acute care nurse practitioner is using the SNAPPS framework to present a clinical case to the
preceptor. Which of the following correctly describes the components of the SNAPPS method in the
proper sequence?
A. Summarize, Narrow, Analyze, Probe, Plan, Select [CORRECT]
B. Subjective, Objective, Assess, Plan, Plan, Select
C. Subjective, Narrow, Analyze, Probe, Plan, Select
D. Summarize, Name, Assess, Probe, Plan, Select
Correct Answer: A
Rationale:
SNAPPS is a clinical reasoning framework for case presentation: Summarize the relevant history and findings, Narrow the
differential diagnosis to 2 or 3 conditions, Analyze the differential by comparing and contrasting diagnoses, Probe the
preceptor with questions about uncertainties, Plan management with the preceptor, and Select a case-related issue for
self-directed learning. Option B incorrectly substitutes the SOAP note format. Options C and D misidentify the first
component as Subjective or Name rather than Summarize, demonstrating a common framework confusion in the NR 569
curriculum.
Q2: A 65-year-old patient presents with acute dyspnea. The nurse practitioner estimates the pretest
probability of pulmonary embolism at 15 percent. A D-dimer assay is ordered and returns negative.
The D-dimer test used has a sensitivity of 95 percent and a specificity of 40 percent for PE. Which
principle best explains the clinical utility of this result?
A. A negative result on a highly sensitive test effectively rules out the disease (SnNout) [CORRECT]
B. A positive result on a highly specific test effectively rules in the disease (SpPin)
C. The positive predictive value is more important than sensitivity in this scenario
D. The negative likelihood ratio of 0.15 means PE is still highly probable
Correct Answer: A
Rationale:
The SnNout principle states that a negative result on a highly sensitive test (sensitivity of 95 percent in this case) effectively
rules out the disease because there are very few false negatives. With a low pretest probability (15 percent) and a negative
highly sensitive D-dimer, PE can be safely excluded without further imaging. SpPin (option B) applies when using a positive
result on a highly specific test to confirm disease, which is not the scenario here. The PPV (option C) depends on disease
prevalence and is less relevant when the test is negative. The LR- for this test is approximately 0.125 (not 0.15), further
supporting disease exclusion.
Q3: Which of the following best describes the concept of positive predictive value (PPV) in diagnostic
testing?
A. The probability that a patient with the disease has a positive test result
B. The probability that a patient with a negative test result does not have the disease
C. The probability that a patient with a positive test result actually has the disease [CORRECT]
D. The proportion of all positive test results that are true positives in a population with high disease
prevalence
Correct Answer: C
Rationale:
Positive predictive value (PPV) is defined as the probability that a patient with a positive test result actually has the disease.
It is calculated as true positives divided by all positive results (true positives plus false positives). Option A describes
sensitivity (true positive rate), not PPV. Option B describes negative predictive value. Option D confuses PPV with an
incomplete description; while PPV does depend on prevalence, the definition itself does not require high disease
prevalence. PPV increases with higher disease prevalence, which is a key concept in NR 569 for interpreting diagnostic
tests in acute care settings.
Page 3
, NR 569 Final Exam | Differential Diagnosis in Acute Care Practicum | Chamberlain University 2026-2027 100 Questions | Verified Answers
Q4: A nurse practitioner is evaluating a 42-year-old patient with acute chest pain. The Wells score for
PE calculates a low pretest probability score of 1.5. Which of the following is the most appropriate
next step in the diagnostic algorithm?
A. Order CTPA immediately
B. Obtain a D-dimer to exclude PE if negative [CORRECT]
C. Initiate therapeutic anticoagulation
D. Perform lower extremity Doppler ultrasound
Correct Answer: B
Rationale:
The Wells criteria stratify patients into low (score less than 2), moderate (2 to 6), and high (greater than 6) probability for
PE. For low pretest probability patients, the recommended approach is to obtain a D-dimer assay; if negative, PE is
effectively excluded without further imaging, following the SnNout principle. Ordering CTPA immediately (option A) is
appropriate for moderate-to-high probability but exposes low-risk patients to unnecessary radiation and contrast.
Therapeutic anticoagulation (option C) requires diagnostic confirmation. Doppler ultrasound (option D) evaluates for DVT
but is not the first step in the PE diagnostic algorithm for low-risk patients.
Q5: A diagnostic test for a condition has a specificity of 92 percent. Which of the following correctly
applies the SpPin principle to this test?
A. A negative result rules in the disease
B. A positive result effectively rules in the disease because very few false positives occur [CORRECT]
C. The test is only useful when prevalence is high
D. The sensitivity must also be above 90 percent for the test to be clinically useful
Correct Answer: B
Rationale:
SpPin stands for Specificity, Positive, Rules IN: a positive result on a highly specific test effectively rules in the disease
because there are very few false positives. A specificity of 92 percent means only 8 percent of patients without the disease
will test positive. Option A incorrectly applies the SnNout principle to specificity. Option C is incorrect because SpPin
applies regardless of prevalence, though PPV does vary with prevalence. Option D is incorrect because sensitivity and
specificity are independent properties; a test can be useful for ruling in disease with high specificity even if sensitivity is
moderate.
Q6: During a clinical encounter, an acute care NP uses the OLDCARTS mnemonic to evaluate a
patient presenting with abdominal pain. Which of the following elements of OLDCARTS is used to
assess what worsens the patient's symptoms?
A. Onset
B. Duration
C. Aggravating factors [CORRECT]
D. Relieving factors
Correct Answer: C
Rationale:
OLDCARTS stands for Onset, Location/Radiation, Duration, Character, Aggravating factors, Relieving factors, Timing,
and Severity. Aggravating factors specifically identify what makes the symptom worse, which is essential for differential
diagnosis in acute care. Onset (option A) assesses when the symptom began. Duration (option B) assesses how long it lasts.
Relieving factors (option D) assess what improves the symptom, which is the opposite of aggravating factors. Both
aggravating and relieving factors are critical in the NR 569 curriculum for constructing and narrowing differential
diagnoses.
Q7: A patient presents with pleuritic chest pain. The NP considers pneumonia, pulmonary embolism,
and costochondritis in the differential. The patient reports that the pain worsens with deep
inspiration but is relieved when sitting forward and does not worsen with exertion. Which of the
Page 4
Final Exam
Differential Diagnosis in Acute Care Practicum
Questions and Verified Answers
100% Correct | Grade A
Chamberlain University
College of Nursing
Latest Update
100 Questions | 9 Sections
Aligned with 2026-2027 Chamberlain University curriculum standards and acute care nurse practitioner competencies for
comprehensive final examination
, Table of Contents
Section 1: Clinical Reasoning and Diagnostic Frameworks
Q1 - Q15
Section 2: Comprehensive Patient Assessment, History Taking, and Documentation Across the
Lifespan
Q16 - Q25
Section 3: Respiratory System Differential Diagnosis
Q26 - Q38
Section 4: Cardiovascular System Differential Diagnosis
Q39 - Q55
Section 5: Gastrointestinal and Abdominal Differential Diagnosis
Q56 - Q65
Section 6: Neurological and Musculoskeletal Differential Diagnosis
Q66 - Q78
Section 7: Genitourinary and Renal Differential Diagnosis
Q79 - Q88
Section 8: Infectious Diseases, Systemic Conditions, and Fever Evaluation
Q89 - Q95
Section 9: Integrated Clinical Scenarios and Diagnostic Decision-Making
Q96 - Q100
Page 2
,NR 569 Final Exam | Differential Diagnosis in Acute Care Practicum | Chamberlain University 2026-2027 100 Questions | Verified Answers
Section 1: Clinical Reasoning and Diagnostic Frameworks
Q1: An acute care nurse practitioner is using the SNAPPS framework to present a clinical case to the
preceptor. Which of the following correctly describes the components of the SNAPPS method in the
proper sequence?
A. Summarize, Narrow, Analyze, Probe, Plan, Select [CORRECT]
B. Subjective, Objective, Assess, Plan, Plan, Select
C. Subjective, Narrow, Analyze, Probe, Plan, Select
D. Summarize, Name, Assess, Probe, Plan, Select
Correct Answer: A
Rationale:
SNAPPS is a clinical reasoning framework for case presentation: Summarize the relevant history and findings, Narrow the
differential diagnosis to 2 or 3 conditions, Analyze the differential by comparing and contrasting diagnoses, Probe the
preceptor with questions about uncertainties, Plan management with the preceptor, and Select a case-related issue for
self-directed learning. Option B incorrectly substitutes the SOAP note format. Options C and D misidentify the first
component as Subjective or Name rather than Summarize, demonstrating a common framework confusion in the NR 569
curriculum.
Q2: A 65-year-old patient presents with acute dyspnea. The nurse practitioner estimates the pretest
probability of pulmonary embolism at 15 percent. A D-dimer assay is ordered and returns negative.
The D-dimer test used has a sensitivity of 95 percent and a specificity of 40 percent for PE. Which
principle best explains the clinical utility of this result?
A. A negative result on a highly sensitive test effectively rules out the disease (SnNout) [CORRECT]
B. A positive result on a highly specific test effectively rules in the disease (SpPin)
C. The positive predictive value is more important than sensitivity in this scenario
D. The negative likelihood ratio of 0.15 means PE is still highly probable
Correct Answer: A
Rationale:
The SnNout principle states that a negative result on a highly sensitive test (sensitivity of 95 percent in this case) effectively
rules out the disease because there are very few false negatives. With a low pretest probability (15 percent) and a negative
highly sensitive D-dimer, PE can be safely excluded without further imaging. SpPin (option B) applies when using a positive
result on a highly specific test to confirm disease, which is not the scenario here. The PPV (option C) depends on disease
prevalence and is less relevant when the test is negative. The LR- for this test is approximately 0.125 (not 0.15), further
supporting disease exclusion.
Q3: Which of the following best describes the concept of positive predictive value (PPV) in diagnostic
testing?
A. The probability that a patient with the disease has a positive test result
B. The probability that a patient with a negative test result does not have the disease
C. The probability that a patient with a positive test result actually has the disease [CORRECT]
D. The proportion of all positive test results that are true positives in a population with high disease
prevalence
Correct Answer: C
Rationale:
Positive predictive value (PPV) is defined as the probability that a patient with a positive test result actually has the disease.
It is calculated as true positives divided by all positive results (true positives plus false positives). Option A describes
sensitivity (true positive rate), not PPV. Option B describes negative predictive value. Option D confuses PPV with an
incomplete description; while PPV does depend on prevalence, the definition itself does not require high disease
prevalence. PPV increases with higher disease prevalence, which is a key concept in NR 569 for interpreting diagnostic
tests in acute care settings.
Page 3
, NR 569 Final Exam | Differential Diagnosis in Acute Care Practicum | Chamberlain University 2026-2027 100 Questions | Verified Answers
Q4: A nurse practitioner is evaluating a 42-year-old patient with acute chest pain. The Wells score for
PE calculates a low pretest probability score of 1.5. Which of the following is the most appropriate
next step in the diagnostic algorithm?
A. Order CTPA immediately
B. Obtain a D-dimer to exclude PE if negative [CORRECT]
C. Initiate therapeutic anticoagulation
D. Perform lower extremity Doppler ultrasound
Correct Answer: B
Rationale:
The Wells criteria stratify patients into low (score less than 2), moderate (2 to 6), and high (greater than 6) probability for
PE. For low pretest probability patients, the recommended approach is to obtain a D-dimer assay; if negative, PE is
effectively excluded without further imaging, following the SnNout principle. Ordering CTPA immediately (option A) is
appropriate for moderate-to-high probability but exposes low-risk patients to unnecessary radiation and contrast.
Therapeutic anticoagulation (option C) requires diagnostic confirmation. Doppler ultrasound (option D) evaluates for DVT
but is not the first step in the PE diagnostic algorithm for low-risk patients.
Q5: A diagnostic test for a condition has a specificity of 92 percent. Which of the following correctly
applies the SpPin principle to this test?
A. A negative result rules in the disease
B. A positive result effectively rules in the disease because very few false positives occur [CORRECT]
C. The test is only useful when prevalence is high
D. The sensitivity must also be above 90 percent for the test to be clinically useful
Correct Answer: B
Rationale:
SpPin stands for Specificity, Positive, Rules IN: a positive result on a highly specific test effectively rules in the disease
because there are very few false positives. A specificity of 92 percent means only 8 percent of patients without the disease
will test positive. Option A incorrectly applies the SnNout principle to specificity. Option C is incorrect because SpPin
applies regardless of prevalence, though PPV does vary with prevalence. Option D is incorrect because sensitivity and
specificity are independent properties; a test can be useful for ruling in disease with high specificity even if sensitivity is
moderate.
Q6: During a clinical encounter, an acute care NP uses the OLDCARTS mnemonic to evaluate a
patient presenting with abdominal pain. Which of the following elements of OLDCARTS is used to
assess what worsens the patient's symptoms?
A. Onset
B. Duration
C. Aggravating factors [CORRECT]
D. Relieving factors
Correct Answer: C
Rationale:
OLDCARTS stands for Onset, Location/Radiation, Duration, Character, Aggravating factors, Relieving factors, Timing,
and Severity. Aggravating factors specifically identify what makes the symptom worse, which is essential for differential
diagnosis in acute care. Onset (option A) assesses when the symptom began. Duration (option B) assesses how long it lasts.
Relieving factors (option D) assess what improves the symptom, which is the opposite of aggravating factors. Both
aggravating and relieving factors are critical in the NR 569 curriculum for constructing and narrowing differential
diagnoses.
Q7: A patient presents with pleuritic chest pain. The NP considers pneumonia, pulmonary embolism,
and costochondritis in the differential. The patient reports that the pain worsens with deep
inspiration but is relieved when sitting forward and does not worsen with exertion. Which of the
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