CHAMBERLAIN UNIVERSITY · 2026-2027
NR 569 Final Exam
Study Guide
Differential Diagnosis in Acute Care Practicum
Comprehensive 100-Question Review · Weeks 5-8
Aligned with 2026-2027 Curriculum Standards
Course: NR 569 / NR569
Focus: Acute Care Differential Diagnosis
Questions: 100 Multiple-Choice with Verified Rationales
Format: 25% Recall · 50% Application · 25% Analysis
Acute Care Differential Dx Weeks 5-8 Evidence-Based
A CUTE CA RE N URSE PRA CTI TI O N ER EDUCATI O N · STUDY GUI DE
,Section 1: Gastrointestinal and Abdominal Differential Diagnosis (Q1-20)
Q1: A 24-year-old male presents with periumbilical pain that migrated to the right lower quadrant over the
past 12 hours. He reports anorexia, nausea, and one episode of vomiting. Examination reveals localized
tenderness at McBurney's point with rebound tenderness and voluntary guarding. Temperature is 100.8
degrees F. Which is the most likely diagnosis?
A. Acute cholecystitis
B. Acute appendicitis [CORRECT]
C. Diverticulitis
D. Peptic ulcer disease
Correct Answer: B
Rationale: The migration of pain from the periumbilical area to the RLQ, along with anorexia, nausea, and McBurney's point
tenderness with rebound, is the classic presentation of acute appendicitis. Cholecystitis presents with RUQ pain radiating to the
shoulder and a positive Murphy's sign. Diverticulitis typically occurs in older patients with LLQ pain. PUD presents with
epigastric pain rather than RLQ pain.
Q2: A 42-year-old woman presents with severe right upper quadrant pain radiating to her right shoulder,
nausea, vomiting, and fever of 101.2 degrees F. On examination, inspiratory arrest occurs during deep
palpation of the RUQ. Which clinical finding is most specific for this condition?
A. Murphy's sign [CORRECT]
B. McBurney's point tenderness
C. Rovsing's sign
D. Psoas sign
Correct Answer: A
Rationale: Murphy's sign (inspiratory arrest during RUQ palpation due to pain) is most specific for acute cholecystitis,
indicating inflammation of the gallbladder. McBurney's point tenderness is for appendicitis. Rovsing's sign (RLQ pain with
palpation of the LLQ) and the psoas sign (RLQ pain with right hip extension) are also associated with appendicitis.
Q3: A 50-year-old man with a history of alcohol abuse presents with severe epigastric pain radiating to the
back, nausea, vomiting, and diaphoresis. Laboratory results show lipase elevated at 850 U/L (normal < 60).
Which factor is most important for determining prognosis using Ranson criteria?
A. Age at presentation
B. Serum lipase level at admission
C. Blood glucose on admission
D. All of the above are Ranson criteria components [CORRECT]
Correct Answer: D
Rationale: Ranson criteria include multiple factors assessed at admission (age > 55, WBC > 16,000, glucose > 250, LDH > 350,
AST > 250) and at 48 hours (HCT drop > 10%, calcium < 8, PaO2 < 60, base deficit > 4, fluid sequestration > 6 L). The lipase
level itself is not part of Ranson criteria; it is diagnostic. All listed factors (age, glucose, along with other lab and clinical
parameters) are components used to predict severity and prognosis.
Q4: A 68-year-old woman presents with melena and hematemesis. She reports chronic NSAID use for
osteoarthritis. Her blood pressure is 98/60 mmHg and heart rate is 110 bpm. Which is the most likely source
of upper GI bleeding in this patient?
A. Esophageal varices
B. Peptic ulcer disease [CORRECT]NR 569 Final Exam Study Guide | Page 1
C. Mallory-Weiss tear
, D. Angiodysplasia
Correct Answer: B
Rationale: Chronic NSAID use is a major risk factor for peptic ulcer disease, which is the most common cause of upper GI
bleeding (proximal to the ligament of Treitz). Esophageal varices are associated with portal hypertension and cirrhosis.
Mallory-Weiss tears occur from forceful retching. Angiodysplasia typically causes lower GI bleeding. The hemodynamic
instability (hypotension, tachycardia) indicates significant blood loss requiring resuscitation.
Q5: A 30-year-old man presents with crampy abdominal pain, nausea, vomiting, abdominal distension, and
obstipation for 2 days. Auscultation reveals high-pitched, hyperactive bowel sounds. CT scan shows a
transition point in the small bowel with proximal dilatation. Which type of bowel obstruction is most likely
based on the CT finding?
A. Large bowel obstruction from colon cancer
B. Small bowel obstruction from adhesions [CORRECT]
C. Paralytic ileus
D. Volvulus
Correct Answer: B
Rationale: Small bowel obstruction (SBO) from adhesions is the most common cause of mechanical bowel obstruction in
patients with prior abdominal surgery. The transition point with proximal dilatation on CT confirms a mechanical obstruction.
Large bowel obstruction typically presents with a more gradual onset and distal obstruction. Paralytic ileus would show diffuse
distension without a transition point. Volvulus would show a specific twisting pattern on imaging.
Q6: A 35-year-old woman presents with chronic bloody diarrhea, abdominal pain, weight loss, and perianal
fistulas. Colonoscopy shows skip lesions with transmural inflammation involving the terminal ileum and
ascending colon. Which finding most differentiates this condition from ulcerative colitis?
A. Bloody diarrhea
B. Skip lesions with transmural involvement and terminal ileum disease [CORRECT]
C. Abdominal pain and weight loss
D. Inflammation limited to the colonic mucosa
Correct Answer: B
Rationale: Crohn's disease is differentiated from ulcerative colitis by several key features: it can affect any part of the GI tract
(skip lesions), has transmural inflammation (leading to fistulas and strictures), and commonly involves the terminal ileum.
Ulcerative colitis is limited to the colon and rectum with continuous, mucosal inflammation. Both can present with bloody
diarrhea, pain, and weight loss, making the pattern of involvement the distinguishing feature.
Q7: A 55-year-old man with known cirrhosis presents with ascites, asterixis, and confusion. Laboratory
results show ammonia level of 120 mcg/dL (elevated). Which is the most appropriate management for this
condition?
A. Lactulose and rifaximin [CORRECT]
B. Loop diuretics only
C. High-protein diet
D. IV antibiotics for spontaneous bacterial peritonitis
Correct Answer: A
Rationale: Hepatic encephalopathy in cirrhotic patients is managed with lactulose (reduces ammonia absorption by converting to
lactic and acetic acid, lowering colonic pH) and rifaximin (reduces ammonia-producing gut bacteria). Diuretics treat ascites but
not encephalopathy. Protein restriction is no longer routinely recommended. Antibiotics treat SBP, which is a separate
complication of cirrhosis.
Q8: A 45-year-old woman presents with left lower quadrant abdominal pain, fever of 100.6 degrees F, and
change in bowel habits for 3 days. She NR
reports nausea
569 Final but Guide
Exam Study no vomiting.
| Page 2 Which diagnostic test is most
NR 569 Final Exam
Study Guide
Differential Diagnosis in Acute Care Practicum
Comprehensive 100-Question Review · Weeks 5-8
Aligned with 2026-2027 Curriculum Standards
Course: NR 569 / NR569
Focus: Acute Care Differential Diagnosis
Questions: 100 Multiple-Choice with Verified Rationales
Format: 25% Recall · 50% Application · 25% Analysis
Acute Care Differential Dx Weeks 5-8 Evidence-Based
A CUTE CA RE N URSE PRA CTI TI O N ER EDUCATI O N · STUDY GUI DE
,Section 1: Gastrointestinal and Abdominal Differential Diagnosis (Q1-20)
Q1: A 24-year-old male presents with periumbilical pain that migrated to the right lower quadrant over the
past 12 hours. He reports anorexia, nausea, and one episode of vomiting. Examination reveals localized
tenderness at McBurney's point with rebound tenderness and voluntary guarding. Temperature is 100.8
degrees F. Which is the most likely diagnosis?
A. Acute cholecystitis
B. Acute appendicitis [CORRECT]
C. Diverticulitis
D. Peptic ulcer disease
Correct Answer: B
Rationale: The migration of pain from the periumbilical area to the RLQ, along with anorexia, nausea, and McBurney's point
tenderness with rebound, is the classic presentation of acute appendicitis. Cholecystitis presents with RUQ pain radiating to the
shoulder and a positive Murphy's sign. Diverticulitis typically occurs in older patients with LLQ pain. PUD presents with
epigastric pain rather than RLQ pain.
Q2: A 42-year-old woman presents with severe right upper quadrant pain radiating to her right shoulder,
nausea, vomiting, and fever of 101.2 degrees F. On examination, inspiratory arrest occurs during deep
palpation of the RUQ. Which clinical finding is most specific for this condition?
A. Murphy's sign [CORRECT]
B. McBurney's point tenderness
C. Rovsing's sign
D. Psoas sign
Correct Answer: A
Rationale: Murphy's sign (inspiratory arrest during RUQ palpation due to pain) is most specific for acute cholecystitis,
indicating inflammation of the gallbladder. McBurney's point tenderness is for appendicitis. Rovsing's sign (RLQ pain with
palpation of the LLQ) and the psoas sign (RLQ pain with right hip extension) are also associated with appendicitis.
Q3: A 50-year-old man with a history of alcohol abuse presents with severe epigastric pain radiating to the
back, nausea, vomiting, and diaphoresis. Laboratory results show lipase elevated at 850 U/L (normal < 60).
Which factor is most important for determining prognosis using Ranson criteria?
A. Age at presentation
B. Serum lipase level at admission
C. Blood glucose on admission
D. All of the above are Ranson criteria components [CORRECT]
Correct Answer: D
Rationale: Ranson criteria include multiple factors assessed at admission (age > 55, WBC > 16,000, glucose > 250, LDH > 350,
AST > 250) and at 48 hours (HCT drop > 10%, calcium < 8, PaO2 < 60, base deficit > 4, fluid sequestration > 6 L). The lipase
level itself is not part of Ranson criteria; it is diagnostic. All listed factors (age, glucose, along with other lab and clinical
parameters) are components used to predict severity and prognosis.
Q4: A 68-year-old woman presents with melena and hematemesis. She reports chronic NSAID use for
osteoarthritis. Her blood pressure is 98/60 mmHg and heart rate is 110 bpm. Which is the most likely source
of upper GI bleeding in this patient?
A. Esophageal varices
B. Peptic ulcer disease [CORRECT]NR 569 Final Exam Study Guide | Page 1
C. Mallory-Weiss tear
, D. Angiodysplasia
Correct Answer: B
Rationale: Chronic NSAID use is a major risk factor for peptic ulcer disease, which is the most common cause of upper GI
bleeding (proximal to the ligament of Treitz). Esophageal varices are associated with portal hypertension and cirrhosis.
Mallory-Weiss tears occur from forceful retching. Angiodysplasia typically causes lower GI bleeding. The hemodynamic
instability (hypotension, tachycardia) indicates significant blood loss requiring resuscitation.
Q5: A 30-year-old man presents with crampy abdominal pain, nausea, vomiting, abdominal distension, and
obstipation for 2 days. Auscultation reveals high-pitched, hyperactive bowel sounds. CT scan shows a
transition point in the small bowel with proximal dilatation. Which type of bowel obstruction is most likely
based on the CT finding?
A. Large bowel obstruction from colon cancer
B. Small bowel obstruction from adhesions [CORRECT]
C. Paralytic ileus
D. Volvulus
Correct Answer: B
Rationale: Small bowel obstruction (SBO) from adhesions is the most common cause of mechanical bowel obstruction in
patients with prior abdominal surgery. The transition point with proximal dilatation on CT confirms a mechanical obstruction.
Large bowel obstruction typically presents with a more gradual onset and distal obstruction. Paralytic ileus would show diffuse
distension without a transition point. Volvulus would show a specific twisting pattern on imaging.
Q6: A 35-year-old woman presents with chronic bloody diarrhea, abdominal pain, weight loss, and perianal
fistulas. Colonoscopy shows skip lesions with transmural inflammation involving the terminal ileum and
ascending colon. Which finding most differentiates this condition from ulcerative colitis?
A. Bloody diarrhea
B. Skip lesions with transmural involvement and terminal ileum disease [CORRECT]
C. Abdominal pain and weight loss
D. Inflammation limited to the colonic mucosa
Correct Answer: B
Rationale: Crohn's disease is differentiated from ulcerative colitis by several key features: it can affect any part of the GI tract
(skip lesions), has transmural inflammation (leading to fistulas and strictures), and commonly involves the terminal ileum.
Ulcerative colitis is limited to the colon and rectum with continuous, mucosal inflammation. Both can present with bloody
diarrhea, pain, and weight loss, making the pattern of involvement the distinguishing feature.
Q7: A 55-year-old man with known cirrhosis presents with ascites, asterixis, and confusion. Laboratory
results show ammonia level of 120 mcg/dL (elevated). Which is the most appropriate management for this
condition?
A. Lactulose and rifaximin [CORRECT]
B. Loop diuretics only
C. High-protein diet
D. IV antibiotics for spontaneous bacterial peritonitis
Correct Answer: A
Rationale: Hepatic encephalopathy in cirrhotic patients is managed with lactulose (reduces ammonia absorption by converting to
lactic and acetic acid, lowering colonic pH) and rifaximin (reduces ammonia-producing gut bacteria). Diuretics treat ascites but
not encephalopathy. Protein restriction is no longer routinely recommended. Antibiotics treat SBP, which is a separate
complication of cirrhosis.
Q8: A 45-year-old woman presents with left lower quadrant abdominal pain, fever of 100.6 degrees F, and
change in bowel habits for 3 days. She NR
reports nausea
569 Final but Guide
Exam Study no vomiting.
| Page 2 Which diagnostic test is most
