NR 569 MIDTERM & FINAL EXAMS: DIFFERENTIAL DIAGNOSIS IN ACUTE CARE PRACTICUM – QUESTIONS AND
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM
UPDATE
Core Domains:
Clinical Reasoning and Diagnostic Synthesis
Cardiovascular and Respiratory Emergencies
Neurological and Musculoskeletal Assessment
Gastrointestinal and Renal Acute Conditions
Infectious Diseases and Systemic Inflammatory Response
Endocrine and Metabolic Derangements
Professional Standards, Ethics, and Patient Safety
Introduction
This comprehensive assessment is designed to prepare the advanced practice nursing student for the rigors of the NR
569 Midterm and Final Examinations. It evaluates the synthesis of didactic knowledge with clinical application, focusing
on the nuanced art of differential diagnosis in the acute care setting. The exam is structured to challenge clinical
decision-making across a spectrum of acuity, from the identification of subtle pathophysiological cues to the
prioritization of life-threatening conditions. By integrating foundational science with complex, scenario-based
questions, this guide aims to refine diagnostic acumen, promote evidence-based practice, and ensure readiness for the
,high-stakes environment of acute care practicum. Mastery of these questions signifies a robust capability to formulate
accurate differentials, interpret diagnostic data, and implement safe, patient-centered management plans.
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes presents with acute onset of severe, tearing
chest pain that radiates to his back. His blood pressure is 160/90 mmHg in the right arm and 100/60 mmHg in the
left arm. What is the most critical initial step in management?
A. Administer sublingual nitroglycerin
B. Order a stat CT angiogram of the chest
C. Administer aspirin 324 mg orally
D. Perform a 12-lead ECG
🟢 Correct Answer: B. Order a stat CT angiogram of the chest
🔴 Explanation: This patient's presentation is classic for an acute aortic dissection. The key initial step is to confirm
the diagnosis with a CT angiogram while preparing for surgical or medical management. Nitroglycerin and aspirin
are contraindicated in suspected dissection as they can worsen the condition or increase bleeding risk.
Question 2
A 55-year-old female with a history of COPD presents with worsening dyspnea, increased sputum production, and
confusion. Arterial blood gas shows pH 7.28, PaCO2 68 mmHg, and HCO3- 28 mEq/L. Which intervention is most
appropriate?
A. Administer oxygen via nasal cannula to achieve SpO2 > 95%
B. Initiate non-invasive positive pressure ventilation (NIPPV)
,C. Administer intravenous antibiotics and steroids
D. Prepare for immediate endotracheal intubation
🟢 Correct Answer: B. Initiate non-invasive positive pressure ventilation (NIPPV)
🔴 Explanation: This is an acute exacerbation of COPD with hypercapnic respiratory failure. NIPPV is indicated to
support ventilation and correct acidosis. Oxygen should be titrated to a target SpO2 of 88-92% to avoid suppressing
the hypoxic drive.
Question 3
A 45-year-old male with no significant medical history presents with acute, colicky right upper quadrant pain that
radiates to his right shoulder. He reports nausea and vomiting. He is afebrile and has a normal white blood cell
count. What is the most likely diagnosis?
A. Acute appendicitis
B. Acute cholecystitis
C. Biliary colic
D. Acute pancreatitis
🟢 Correct Answer: C. Biliary colic
🔴 Explanation: Biliary colic presents with classic right upper quadrant pain radiating to the shoulder (phrenic nerve
irritation). The absence of fever and leukocytosis differentiates it from acute cholecystitis, which typically presents
with more systemic signs of inflammation.
, Question 4
A 72-year-old patient presents with sudden onset of painless hematuria. What is the most appropriate initial
diagnostic test?
A. Urinalysis and urine culture
B. CT urography
C. Cystoscopy
D. Renal ultrasound
🟢 Correct Answer: D. Renal ultrasound
🔴 Explanation: Painless hematuria in an older adult is a red flag for malignancy. A renal ultrasound is a non-
invasive initial test to evaluate for renal masses or hydronephrosis and is an appropriate first step in the diagnostic
algorithm.
Question 5
A 32-year-old female presents with palpitations, heat intolerance, and weight loss despite an increased appetite. On
exam, she has a fine tremor and exophthalmos. What is the most likely diagnosis?
A. Hashimoto's thyroiditis
B. Graves' disease
C. Toxic multinodular goiter
D. Thyroid storm
🟢 Correct Answer: B. Graves' disease
🔴 Explanation: Graves' disease is an autoimmune disorder causing hyperthyroidism. The classic triad includes
hyperthyroidism symptoms, diffuse goiter, and ophthalmopathy (exophthalmos).
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM
UPDATE
Core Domains:
Clinical Reasoning and Diagnostic Synthesis
Cardiovascular and Respiratory Emergencies
Neurological and Musculoskeletal Assessment
Gastrointestinal and Renal Acute Conditions
Infectious Diseases and Systemic Inflammatory Response
Endocrine and Metabolic Derangements
Professional Standards, Ethics, and Patient Safety
Introduction
This comprehensive assessment is designed to prepare the advanced practice nursing student for the rigors of the NR
569 Midterm and Final Examinations. It evaluates the synthesis of didactic knowledge with clinical application, focusing
on the nuanced art of differential diagnosis in the acute care setting. The exam is structured to challenge clinical
decision-making across a spectrum of acuity, from the identification of subtle pathophysiological cues to the
prioritization of life-threatening conditions. By integrating foundational science with complex, scenario-based
questions, this guide aims to refine diagnostic acumen, promote evidence-based practice, and ensure readiness for the
,high-stakes environment of acute care practicum. Mastery of these questions signifies a robust capability to formulate
accurate differentials, interpret diagnostic data, and implement safe, patient-centered management plans.
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes presents with acute onset of severe, tearing
chest pain that radiates to his back. His blood pressure is 160/90 mmHg in the right arm and 100/60 mmHg in the
left arm. What is the most critical initial step in management?
A. Administer sublingual nitroglycerin
B. Order a stat CT angiogram of the chest
C. Administer aspirin 324 mg orally
D. Perform a 12-lead ECG
🟢 Correct Answer: B. Order a stat CT angiogram of the chest
🔴 Explanation: This patient's presentation is classic for an acute aortic dissection. The key initial step is to confirm
the diagnosis with a CT angiogram while preparing for surgical or medical management. Nitroglycerin and aspirin
are contraindicated in suspected dissection as they can worsen the condition or increase bleeding risk.
Question 2
A 55-year-old female with a history of COPD presents with worsening dyspnea, increased sputum production, and
confusion. Arterial blood gas shows pH 7.28, PaCO2 68 mmHg, and HCO3- 28 mEq/L. Which intervention is most
appropriate?
A. Administer oxygen via nasal cannula to achieve SpO2 > 95%
B. Initiate non-invasive positive pressure ventilation (NIPPV)
,C. Administer intravenous antibiotics and steroids
D. Prepare for immediate endotracheal intubation
🟢 Correct Answer: B. Initiate non-invasive positive pressure ventilation (NIPPV)
🔴 Explanation: This is an acute exacerbation of COPD with hypercapnic respiratory failure. NIPPV is indicated to
support ventilation and correct acidosis. Oxygen should be titrated to a target SpO2 of 88-92% to avoid suppressing
the hypoxic drive.
Question 3
A 45-year-old male with no significant medical history presents with acute, colicky right upper quadrant pain that
radiates to his right shoulder. He reports nausea and vomiting. He is afebrile and has a normal white blood cell
count. What is the most likely diagnosis?
A. Acute appendicitis
B. Acute cholecystitis
C. Biliary colic
D. Acute pancreatitis
🟢 Correct Answer: C. Biliary colic
🔴 Explanation: Biliary colic presents with classic right upper quadrant pain radiating to the shoulder (phrenic nerve
irritation). The absence of fever and leukocytosis differentiates it from acute cholecystitis, which typically presents
with more systemic signs of inflammation.
, Question 4
A 72-year-old patient presents with sudden onset of painless hematuria. What is the most appropriate initial
diagnostic test?
A. Urinalysis and urine culture
B. CT urography
C. Cystoscopy
D. Renal ultrasound
🟢 Correct Answer: D. Renal ultrasound
🔴 Explanation: Painless hematuria in an older adult is a red flag for malignancy. A renal ultrasound is a non-
invasive initial test to evaluate for renal masses or hydronephrosis and is an appropriate first step in the diagnostic
algorithm.
Question 5
A 32-year-old female presents with palpitations, heat intolerance, and weight loss despite an increased appetite. On
exam, she has a fine tremor and exophthalmos. What is the most likely diagnosis?
A. Hashimoto's thyroiditis
B. Graves' disease
C. Toxic multinodular goiter
D. Thyroid storm
🟢 Correct Answer: B. Graves' disease
🔴 Explanation: Graves' disease is an autoimmune disorder causing hyperthyroidism. The classic triad includes
hyperthyroidism symptoms, diffuse goiter, and ophthalmopathy (exophthalmos).
