NURS 5315 UTA EXAM 2 QUESTIONS AND ANSWERS
WITH SOLUTIONS 2026
NR 547 Differential Diagnosis Practicum – Comprehensive Exam
Course Code and Name: NURS 5315 UTA – Differential Diagnosis /
Advanced Assessment
Institution: Chamberlain University
Academic Year: 2026
Author/Creator: Prepared by [Edunursepro]
Document Type: Comprehensive Practice Exam — 100 Questions With
Answers and Detailed Rationales
Table of Contents
1. Cardiovascular System — Questions 1–12
2. Respiratory System — Questions 13–24
3. Gastrointestinal System — Questions 25–36
4. Neurologic System — Questions 37–48
5. Renal and Genitourinary Systems — Questions 49–58
6. Endocrine and Metabolic Systems — Questions 59–68
7. Musculoskeletal System — Questions 69–78
8. Dermatologic System — Questions 79–86
9. Hematologic and Infectious Conditions — Questions 87–94
10. Multisystem and Emergency Differential Diagnosis — Questions 95–100
Instructions
• This is an original study/practice examination designed for graduate-level differential-
diagnosis preparation.
, • Select the single best answer for multiple-choice questions.
• Short-answer questions require the most appropriate diagnosis, differential diagnosis,
next diagnostic step, or clinical interpretation requested.
• Each question is followed by the correct answer and a detailed rationale.
• Clinical decisions should always be interpreted in the context of the complete patient
presentation, current evidence, institutional protocols, and applicable clinical guidelines.
Section I — Cardiovascular System
Question 1
A 62-year-old patient reports substernal chest pressure that began while climbing stairs. The
discomfort radiates to the left arm and improves after several minutes of rest. Which diagnosis is
most likely?
A. Acute pericarditis
B. Stable angina
C. Gastroesophageal reflux disease
D. Costochondritis
Correct answer: B. Stable angina
Rationale: Stable angina typically presents as predictable substernal pressure or tightness
precipitated by exertion or emotional stress and relieved by rest. Acute pericarditis more
commonly produces sharp, pleuritic pain that improves when the patient sits forward. GERD
may cause burning retrosternal discomfort but is not classically reproducibly triggered by
exertion. Costochondritis is generally associated with reproducible chest-wall tenderness.
Question 2
A patient presents with sudden severe chest pain described as tearing and radiating to the back.
Blood pressure is substantially higher in the right arm than the left. Which condition should be
suspected?
A. Aortic dissection
B. Stable angina
C. Pulmonary hypertension
D. Mitral stenosis
Correct answer: A. Aortic dissection
,Rationale: Aortic dissection classically causes abrupt, severe chest or back pain that may be
described as tearing or ripping. A pulse or blood-pressure differential between extremities can
occur when the dissection involves branches of the aorta. This is a medical emergency requiring
immediate evaluation.
Question 3
A 70-year-old patient has progressive dyspnea, orthopnea, bilateral lower-extremity edema, and
bibasilar crackles. Which diagnosis best explains the findings?
A. Left- and right-sided heart failure
B. Panic disorder
C. Pneumothorax
D. Acute bronchitis
Correct answer: A. Left- and right-sided heart failure
Rationale: Orthopnea and pulmonary crackles suggest pulmonary congestion associated with
left-sided heart failure, while peripheral edema is characteristic of systemic venous congestion
and right-sided involvement. The combination strongly supports congestive heart failure.
Question 4
A patient develops sharp chest pain after a recent viral illness. The pain worsens when lying
down and improves when sitting forward. What is the most likely diagnosis?
A. Pericarditis
B. Myocardial infarction
C. Stable angina
D. Aortic stenosis
Correct answer: A. Pericarditis
Rationale: Acute pericarditis often follows a viral or inflammatory illness. Its characteristic pain
is sharp and positional, typically worsening when supine and improving when leaning forward.
Diffuse ST-segment changes may also occur on ECG.
Question 5
A patient has exertional syncope, angina, and dyspnea. Examination reveals a harsh crescendo-
decrescendo systolic murmur at the right upper sternal border radiating toward the carotids.
Which diagnosis is most likely?
, A. Mitral regurgitation
B. Aortic stenosis
C. Aortic regurgitation
D. Tricuspid stenosis
Correct answer: B. Aortic stenosis
Rationale: The classic triad of symptomatic aortic stenosis is angina, syncope, and dyspnea. The
murmur is a systolic crescendo-decrescendo murmur best heard at the right upper sternal border
with radiation to the carotids.
Question 6
Which finding is most characteristic of mitral regurgitation?
A. Holosystolic murmur radiating toward the axilla
B. Diastolic murmur at the right upper sternal border
C. Continuous machinery murmur
D. Ejection click followed by a diastolic murmur
Correct answer: A. Holosystolic murmur radiating toward the axilla
Rationale: Mitral regurgitation produces a holosystolic murmur best heard at the cardiac apex
and commonly radiating to the left axilla. Regurgitation allows blood to flow backward from the
left ventricle into the left atrium during systole.
Question 7
A patient presents with palpitations and an irregularly irregular pulse. ECG demonstrates no
consistent P waves. What is the most likely diagnosis?
A. Atrial fibrillation
B. Atrial flutter
C. Sinus tachycardia
D. First-degree AV block
Correct answer: A. Atrial fibrillation
Rationale: Atrial fibrillation is characterized by chaotic atrial electrical activity, absent
organized P waves, and an irregularly irregular ventricular rhythm. It is clinically important
because it increases the risk of thromboembolic stroke.
WITH SOLUTIONS 2026
NR 547 Differential Diagnosis Practicum – Comprehensive Exam
Course Code and Name: NURS 5315 UTA – Differential Diagnosis /
Advanced Assessment
Institution: Chamberlain University
Academic Year: 2026
Author/Creator: Prepared by [Edunursepro]
Document Type: Comprehensive Practice Exam — 100 Questions With
Answers and Detailed Rationales
Table of Contents
1. Cardiovascular System — Questions 1–12
2. Respiratory System — Questions 13–24
3. Gastrointestinal System — Questions 25–36
4. Neurologic System — Questions 37–48
5. Renal and Genitourinary Systems — Questions 49–58
6. Endocrine and Metabolic Systems — Questions 59–68
7. Musculoskeletal System — Questions 69–78
8. Dermatologic System — Questions 79–86
9. Hematologic and Infectious Conditions — Questions 87–94
10. Multisystem and Emergency Differential Diagnosis — Questions 95–100
Instructions
• This is an original study/practice examination designed for graduate-level differential-
diagnosis preparation.
, • Select the single best answer for multiple-choice questions.
• Short-answer questions require the most appropriate diagnosis, differential diagnosis,
next diagnostic step, or clinical interpretation requested.
• Each question is followed by the correct answer and a detailed rationale.
• Clinical decisions should always be interpreted in the context of the complete patient
presentation, current evidence, institutional protocols, and applicable clinical guidelines.
Section I — Cardiovascular System
Question 1
A 62-year-old patient reports substernal chest pressure that began while climbing stairs. The
discomfort radiates to the left arm and improves after several minutes of rest. Which diagnosis is
most likely?
A. Acute pericarditis
B. Stable angina
C. Gastroesophageal reflux disease
D. Costochondritis
Correct answer: B. Stable angina
Rationale: Stable angina typically presents as predictable substernal pressure or tightness
precipitated by exertion or emotional stress and relieved by rest. Acute pericarditis more
commonly produces sharp, pleuritic pain that improves when the patient sits forward. GERD
may cause burning retrosternal discomfort but is not classically reproducibly triggered by
exertion. Costochondritis is generally associated with reproducible chest-wall tenderness.
Question 2
A patient presents with sudden severe chest pain described as tearing and radiating to the back.
Blood pressure is substantially higher in the right arm than the left. Which condition should be
suspected?
A. Aortic dissection
B. Stable angina
C. Pulmonary hypertension
D. Mitral stenosis
Correct answer: A. Aortic dissection
,Rationale: Aortic dissection classically causes abrupt, severe chest or back pain that may be
described as tearing or ripping. A pulse or blood-pressure differential between extremities can
occur when the dissection involves branches of the aorta. This is a medical emergency requiring
immediate evaluation.
Question 3
A 70-year-old patient has progressive dyspnea, orthopnea, bilateral lower-extremity edema, and
bibasilar crackles. Which diagnosis best explains the findings?
A. Left- and right-sided heart failure
B. Panic disorder
C. Pneumothorax
D. Acute bronchitis
Correct answer: A. Left- and right-sided heart failure
Rationale: Orthopnea and pulmonary crackles suggest pulmonary congestion associated with
left-sided heart failure, while peripheral edema is characteristic of systemic venous congestion
and right-sided involvement. The combination strongly supports congestive heart failure.
Question 4
A patient develops sharp chest pain after a recent viral illness. The pain worsens when lying
down and improves when sitting forward. What is the most likely diagnosis?
A. Pericarditis
B. Myocardial infarction
C. Stable angina
D. Aortic stenosis
Correct answer: A. Pericarditis
Rationale: Acute pericarditis often follows a viral or inflammatory illness. Its characteristic pain
is sharp and positional, typically worsening when supine and improving when leaning forward.
Diffuse ST-segment changes may also occur on ECG.
Question 5
A patient has exertional syncope, angina, and dyspnea. Examination reveals a harsh crescendo-
decrescendo systolic murmur at the right upper sternal border radiating toward the carotids.
Which diagnosis is most likely?
, A. Mitral regurgitation
B. Aortic stenosis
C. Aortic regurgitation
D. Tricuspid stenosis
Correct answer: B. Aortic stenosis
Rationale: The classic triad of symptomatic aortic stenosis is angina, syncope, and dyspnea. The
murmur is a systolic crescendo-decrescendo murmur best heard at the right upper sternal border
with radiation to the carotids.
Question 6
Which finding is most characteristic of mitral regurgitation?
A. Holosystolic murmur radiating toward the axilla
B. Diastolic murmur at the right upper sternal border
C. Continuous machinery murmur
D. Ejection click followed by a diastolic murmur
Correct answer: A. Holosystolic murmur radiating toward the axilla
Rationale: Mitral regurgitation produces a holosystolic murmur best heard at the cardiac apex
and commonly radiating to the left axilla. Regurgitation allows blood to flow backward from the
left ventricle into the left atrium during systole.
Question 7
A patient presents with palpitations and an irregularly irregular pulse. ECG demonstrates no
consistent P waves. What is the most likely diagnosis?
A. Atrial fibrillation
B. Atrial flutter
C. Sinus tachycardia
D. First-degree AV block
Correct answer: A. Atrial fibrillation
Rationale: Atrial fibrillation is characterized by chaotic atrial electrical activity, absent
organized P waves, and an irregularly irregular ventricular rhythm. It is clinically important
because it increases the risk of thromboembolic stroke.
