,NR 603 Midterm Exam – Advanced Clinical
Diagnosis – Q&A (2026) PDF | Chamberlain
1. A 55-year-old man with hypertension reports sudden, severe tearing chest pain radiating to
his back. Blood pressure is 180/110 mmHg right arm, 140/90 left arm. The nurse practitioner
suspects:
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Correct Answer: B) Aortic dissection
Rationale: Aortic dissection presents with abrupt, maximal tearing pain and pulse deficit
between arms. MI pain is usually crushing; PE causes dyspnea; pericarditis is positional.
Immediate CT angiography is diagnostic, and blood pressure control is critical to reduce
mortality.
2. A 45-year-old woman with asthma has worsening dyspnea and cough. Spirometry reveals
post-bronchodilator FEV1/FVC 0.65. The nurse practitioner diagnoses:
A) Asthma exacerbation
B) COPD
C) Bronchiectasis
D) Pulmonary fibrosis
Correct Answer: B) COPD
Rationale: A post-bronchodilator FEV1/FVC ratio less than 0.70 confirms persistent airflow
limitation diagnostic of COPD, even in patients with a history of asthma. This finding
distinguishes COPD from asthma, where obstruction is usually reversible.
,3. The nurse practitioner evaluates a 60-year-old with HFrEF and worsening dyspnea,
orthopnea, and edema. Which drug class reduces mortality in HFrEF?
A) Calcium channel blockers
B) Beta-blockers
C) NSAIDs
D) Thiazolidinediones
Correct Answer: B) Beta-blockers
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) are proven to reduce
mortality in HFrEF. Calcium channel blockers (except amlodipine) may worsen heart failure.
NSAIDs cause sodium retention; thiazolidinediones increase fluid retention.
4. A 28-year-old woman has palpitations, weight loss, tremor, and a diffusely enlarged
nontender thyroid. The most likely diagnosis is:
A) Hashimoto thyroiditis
B) Graves' disease
C) Subacute thyroiditis
D) Thyroid nodule
Correct Answer: B) Graves' disease
Rationale: Graves' disease is the most common cause of hyperthyroidism, presenting with
thyrotoxicosis and a diffuse, nontender goiter. Hashimoto's causes hypothyroidism; subacute
thyroiditis is painful. Thyroid nodules are usually focal.
5. A 72-year-old man with diabetes and hypertension has sudden right-sided weakness, facial
droop, and aphasia; symptom onset 2 hours ago. The most appropriate immediate
management is:
, A) Aspirin 325 mg
B) IV tPA (alteplase)
C) Heparin infusion
D) Carotid endarterectomy
Correct Answer: B) IV tPA (alteplase)
Rationale: IV alteplase within 3-4.5 hours of ischemic stroke onset improves outcomes,
provided no contraindications. Aspirin is given later. Heparin is not standard acute stroke
therapy. Carotid endarterectomy is for secondary prevention.
6. A 50-year-old man with alcohol abuse has severe epigastric pain radiating to the back,
nausea, and vomiting. Lipase is markedly elevated. The nurse practitioner diagnoses:
A) Peptic ulcer disease
B) Acute pancreatitis
C) Cholecystitis
D) Gastroenteritis
Correct Answer: B) Acute pancreatitis
Rationale: Epigastric pain radiating to the back with elevated lipase (>3 times upper limit) is
classic for acute pancreatitis. Gallstones and alcohol are common causes. PUD causes
epigastric pain but not lipase elevation; cholecystitis has RUQ pain and fever.
7. A 65-year-old woman with COPD has increased shortness of breath, cough, purulent
sputum, and three exacerbations in the past year. GOLD guidelines recommend:
A) Short-acting bronchodilators only
B) Long-acting bronchodilators and inhaled corticosteroid
C) Antibiotics alone
Diagnosis – Q&A (2026) PDF | Chamberlain
1. A 55-year-old man with hypertension reports sudden, severe tearing chest pain radiating to
his back. Blood pressure is 180/110 mmHg right arm, 140/90 left arm. The nurse practitioner
suspects:
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Correct Answer: B) Aortic dissection
Rationale: Aortic dissection presents with abrupt, maximal tearing pain and pulse deficit
between arms. MI pain is usually crushing; PE causes dyspnea; pericarditis is positional.
Immediate CT angiography is diagnostic, and blood pressure control is critical to reduce
mortality.
2. A 45-year-old woman with asthma has worsening dyspnea and cough. Spirometry reveals
post-bronchodilator FEV1/FVC 0.65. The nurse practitioner diagnoses:
A) Asthma exacerbation
B) COPD
C) Bronchiectasis
D) Pulmonary fibrosis
Correct Answer: B) COPD
Rationale: A post-bronchodilator FEV1/FVC ratio less than 0.70 confirms persistent airflow
limitation diagnostic of COPD, even in patients with a history of asthma. This finding
distinguishes COPD from asthma, where obstruction is usually reversible.
,3. The nurse practitioner evaluates a 60-year-old with HFrEF and worsening dyspnea,
orthopnea, and edema. Which drug class reduces mortality in HFrEF?
A) Calcium channel blockers
B) Beta-blockers
C) NSAIDs
D) Thiazolidinediones
Correct Answer: B) Beta-blockers
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) are proven to reduce
mortality in HFrEF. Calcium channel blockers (except amlodipine) may worsen heart failure.
NSAIDs cause sodium retention; thiazolidinediones increase fluid retention.
4. A 28-year-old woman has palpitations, weight loss, tremor, and a diffusely enlarged
nontender thyroid. The most likely diagnosis is:
A) Hashimoto thyroiditis
B) Graves' disease
C) Subacute thyroiditis
D) Thyroid nodule
Correct Answer: B) Graves' disease
Rationale: Graves' disease is the most common cause of hyperthyroidism, presenting with
thyrotoxicosis and a diffuse, nontender goiter. Hashimoto's causes hypothyroidism; subacute
thyroiditis is painful. Thyroid nodules are usually focal.
5. A 72-year-old man with diabetes and hypertension has sudden right-sided weakness, facial
droop, and aphasia; symptom onset 2 hours ago. The most appropriate immediate
management is:
, A) Aspirin 325 mg
B) IV tPA (alteplase)
C) Heparin infusion
D) Carotid endarterectomy
Correct Answer: B) IV tPA (alteplase)
Rationale: IV alteplase within 3-4.5 hours of ischemic stroke onset improves outcomes,
provided no contraindications. Aspirin is given later. Heparin is not standard acute stroke
therapy. Carotid endarterectomy is for secondary prevention.
6. A 50-year-old man with alcohol abuse has severe epigastric pain radiating to the back,
nausea, and vomiting. Lipase is markedly elevated. The nurse practitioner diagnoses:
A) Peptic ulcer disease
B) Acute pancreatitis
C) Cholecystitis
D) Gastroenteritis
Correct Answer: B) Acute pancreatitis
Rationale: Epigastric pain radiating to the back with elevated lipase (>3 times upper limit) is
classic for acute pancreatitis. Gallstones and alcohol are common causes. PUD causes
epigastric pain but not lipase elevation; cholecystitis has RUQ pain and fever.
7. A 65-year-old woman with COPD has increased shortness of breath, cough, purulent
sputum, and three exacerbations in the past year. GOLD guidelines recommend:
A) Short-acting bronchodilators only
B) Long-acting bronchodilators and inhaled corticosteroid
C) Antibiotics alone
