NR 511 CEA Final Exam Prep: Advanced Practice Nursing
Assessment & Diagnosis
Chamberlain University Clinical Evaluation Assessment
Preparation
QUESTION 1
A 45-year-old male presents with a 3-day history of productive cough, fever, and pleuritic chest pain. He
reports rust-colored sputum. Vital signs: T 102.2°F, HR 110, RR 24, BP 138/86, SpO2 91% on room air.
Lung auscultation reveals crackles in the right lower lobe. What is the most likely diagnosis?
Answer: Community-acquired pneumonia (CAP), likely Streptococcus pneumoniae
Rationale: The patient presents with classic symptoms of community-acquired pneumonia: fever,
productive cough with rust-colored sputum, pleuritic chest pain, and crackles on auscultation. Rust-colored
sputum is particularly associated with Streptococcus pneumoniae, the most common bacterial cause of
CAP. The presence of hypoxia (SpO2 91%) indicates moderate severity. Risk factors for CAP include age,
smoking, and comorbidities. Diagnosis is confirmed by chest X-ray showing infiltrates. Empiric antibiotic
therapy should be initiated based on local resistance patterns and severity. Outpatient treatment is
appropriate if the patient has no significant comorbidities or signs of sepsis. The CURB-65 score would
help assess severity (confusion, urea >7 mmol/L, RR >30, low BP, age >65).
QUESTION 2
A 68-year-old female with a history of hypertension and type 2 diabetes presents with a 2-week history of
progressive dyspnea on exertion, orthopnea, and bilateral lower extremity edema. She reports waking up at
night gasping for air. Physical exam reveals JVD, crackles in both lung bases, and 2+ pitting edema in the
lower extremities. What is the most likely diagnosis?
Answer: Heart failure with reduced ejection fraction (HFrEF)
Rationale: The patient presents with classic signs of left-sided heart failure (dyspnea, orthopnea,
paroxysmal nocturnal dyspnea, crackles) and right-sided heart failure (JVD, peripheral edema). The
combination of both suggests biventricular failure. Common causes include ischemic heart disease,
hypertension, valvular disease, and diabetes. Diagnosis is confirmed by echocardiogram showing reduced
ejection fraction (<40%). Treatment includes diuretics, ACE inhibitors, beta-blockers, and aldosterone
antagonists. Lifestyle modifications, including sodium restriction, are essential. BNP or NT-proBNP levels
are typically elevated in heart failure and can help with diagnosis and prognosis. A thorough history should
be taken to identify underlying causes and triggers.
,QUESTION 3
A 55-year-old male with a 30-pack-year smoking history presents with a 3-month history of progressive
hoarseness, a sensation of a lump in the throat, and occasional hemoptysis. He has a history of
gastroesophageal reflux disease (GERD). On physical exam, there is no lymphadenopathy. Flexible
laryngoscopy shows a lesion on the vocal cord. What is the most appropriate next step?
Answer: Biopsy of the laryngeal lesion
Rationale: The patient presents with progressive hoarseness, a risk factor for laryngeal cancer (smoking),
and a visible laryngeal lesion. The most appropriate next step is a biopsy to confirm the diagnosis.
Laryngeal cancer is the most common head and neck cancer. Risk factors include smoking, heavy alcohol
consumption, and GERD. Early diagnosis is critical for preserving voice function and survival. Hoarseness
persisting for more than 3 weeks in a high-risk patient warrants direct laryngoscopy and biopsy. If
malignant, treatment may include surgery, radiation, or chemoradiation, depending on the stage. The
patient should be referred to an otolaryngologist for further evaluation. Smoking cessation should be
strongly advised.
QUESTION 4
A 34-year-old female with a history of systemic lupus erythematosus (SLE) presents with a 1-week history
of fever, malar rash, oral ulcers, and joint pain. She reports increasing fatigue and a 5-lb weight loss over
the past month. Laboratory tests show leukopenia, thrombocytopenia, and elevated anti-dsDNA antibodies.
What is the most appropriate management?
Answer: Increase immunosuppressive therapy, consider corticosteroids, and monitor for signs of lupus
flare
Rationale: The patient is experiencing a lupus flare, characterized by fever, malar rash, oral ulcers, and
joint pain, along with cytopenias (leukopenia, thrombocytopenia) and elevated anti-dsDNA antibodies. This
is a classic presentation of active SLE. Management includes corticosteroids (prednisone) to reduce
inflammation, and possibly immunosuppressive agents (azathioprine, mycophenolate mofetil).
Hydroxychloroquine is a mainstay of therapy for SLE. The patient should be monitored for signs of end-
organ involvement, including renal disease (lupus nephritis), neuropsychiatric symptoms, and cytopenias.
The flare may be triggered by infection or stress, so a thorough evaluation is needed. This patient should
be referred to a rheumatologist for further management. Sun protection and avoidance of triggers are
essential.
QUESTION 5
A 72-year-old male with a history of coronary artery disease presents with a 2-day history of chest pressure
that occurs with minimal exertion and is relieved by rest. The pain is not associated with nausea,
diaphoresis, or dyspnea. The patient reports a similar pattern over the past week but is now having more
frequent episodes. What is the most likely diagnosis?
, Answer: Unstable angina
Rationale: The patient presents with chest pressure that is exertional and relieved by rest, consistent with
angina. However, the increasing frequency and occurrence with minimal exertion suggest unstable angina
or a non-ST-elevation myocardial infarction (NSTEMI). Unstable angina is a medical emergency and
requires immediate evaluation and treatment to prevent progression to MI. The patient should be admitted,
and treatment includes antiplatelet agents (aspirin, ticagrelor), anticoagulation, and anti-ischemic agents
(nitrates, beta-blockers). A 12-lead ECG should be obtained to assess for ischemic changes. Troponin
levels should be measured to rule out MI. Early percutaneous coronary intervention (PCI) is indicated in
high-risk patients. The patient should be counseled on risk factor modification.
QUESTION 6
A 28-year-old female presents with a 2-week history of a rash on her face and arms. The rash is
erythematous, scaly, and worsens with sun exposure. She also reports mild joint pain and fatigue. She is
not taking any medications. Physical exam reveals a malar rash and a scaly rash on the upper extremities.
What is the most appropriate next step?
Answer: Order antinuclear antibody (ANA) and anti-dsDNA testing
Rationale: The patient presents with a photosensitive rash, malar rash, joint pain, and fatigue, which are
classic features of systemic lupus erythematosus (SLE). The presence of a malar rash (butterfly rash) and
photosensitivity is highly suggestive of SLE. The ANA test is positive in nearly all patients with SLE, while
anti-dsDNA antibodies are more specific and correlate with disease activity. A positive ANA and anti-
dsDNA would support the diagnosis of SLE. The patient should be referred to a rheumatologist for further
evaluation. Other tests include complement levels (C3, C4), CBC, and urinalysis to assess for renal
involvement. SLE is more common in women of childbearing age. The patient should be counseled on sun
protection.
QUESTION 7
A 60-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with
worsening dyspnea, increased sputum production, and purulent sputum. He reports a 2-day history of fever
and chills. Vital signs: T 101.5°F, HR 110, RR 28, BP 142/88. On exam, there are crackles and wheezes
throughout the lung fields. What is the most likely diagnosis?
Answer: Acute exacerbation of COPD (AECOPD) with possible pneumonia
Rationale: The patient presents with a classic acute exacerbation of COPD characterized by worsening
dyspnea, increased sputum production, purulent sputum, fever, and signs of infection. This is often
triggered by infection (viral or bacterial). Treatment includes bronchodilators (nebulized albuterol and
ipratropium), corticosteroids, and antibiotics if infection is suspected. The patient should be assessed for
signs of respiratory failure (hypoxia, hypercapnia). A chest X-ray should be obtained to rule out pneumonia.
Assessment & Diagnosis
Chamberlain University Clinical Evaluation Assessment
Preparation
QUESTION 1
A 45-year-old male presents with a 3-day history of productive cough, fever, and pleuritic chest pain. He
reports rust-colored sputum. Vital signs: T 102.2°F, HR 110, RR 24, BP 138/86, SpO2 91% on room air.
Lung auscultation reveals crackles in the right lower lobe. What is the most likely diagnosis?
Answer: Community-acquired pneumonia (CAP), likely Streptococcus pneumoniae
Rationale: The patient presents with classic symptoms of community-acquired pneumonia: fever,
productive cough with rust-colored sputum, pleuritic chest pain, and crackles on auscultation. Rust-colored
sputum is particularly associated with Streptococcus pneumoniae, the most common bacterial cause of
CAP. The presence of hypoxia (SpO2 91%) indicates moderate severity. Risk factors for CAP include age,
smoking, and comorbidities. Diagnosis is confirmed by chest X-ray showing infiltrates. Empiric antibiotic
therapy should be initiated based on local resistance patterns and severity. Outpatient treatment is
appropriate if the patient has no significant comorbidities or signs of sepsis. The CURB-65 score would
help assess severity (confusion, urea >7 mmol/L, RR >30, low BP, age >65).
QUESTION 2
A 68-year-old female with a history of hypertension and type 2 diabetes presents with a 2-week history of
progressive dyspnea on exertion, orthopnea, and bilateral lower extremity edema. She reports waking up at
night gasping for air. Physical exam reveals JVD, crackles in both lung bases, and 2+ pitting edema in the
lower extremities. What is the most likely diagnosis?
Answer: Heart failure with reduced ejection fraction (HFrEF)
Rationale: The patient presents with classic signs of left-sided heart failure (dyspnea, orthopnea,
paroxysmal nocturnal dyspnea, crackles) and right-sided heart failure (JVD, peripheral edema). The
combination of both suggests biventricular failure. Common causes include ischemic heart disease,
hypertension, valvular disease, and diabetes. Diagnosis is confirmed by echocardiogram showing reduced
ejection fraction (<40%). Treatment includes diuretics, ACE inhibitors, beta-blockers, and aldosterone
antagonists. Lifestyle modifications, including sodium restriction, are essential. BNP or NT-proBNP levels
are typically elevated in heart failure and can help with diagnosis and prognosis. A thorough history should
be taken to identify underlying causes and triggers.
,QUESTION 3
A 55-year-old male with a 30-pack-year smoking history presents with a 3-month history of progressive
hoarseness, a sensation of a lump in the throat, and occasional hemoptysis. He has a history of
gastroesophageal reflux disease (GERD). On physical exam, there is no lymphadenopathy. Flexible
laryngoscopy shows a lesion on the vocal cord. What is the most appropriate next step?
Answer: Biopsy of the laryngeal lesion
Rationale: The patient presents with progressive hoarseness, a risk factor for laryngeal cancer (smoking),
and a visible laryngeal lesion. The most appropriate next step is a biopsy to confirm the diagnosis.
Laryngeal cancer is the most common head and neck cancer. Risk factors include smoking, heavy alcohol
consumption, and GERD. Early diagnosis is critical for preserving voice function and survival. Hoarseness
persisting for more than 3 weeks in a high-risk patient warrants direct laryngoscopy and biopsy. If
malignant, treatment may include surgery, radiation, or chemoradiation, depending on the stage. The
patient should be referred to an otolaryngologist for further evaluation. Smoking cessation should be
strongly advised.
QUESTION 4
A 34-year-old female with a history of systemic lupus erythematosus (SLE) presents with a 1-week history
of fever, malar rash, oral ulcers, and joint pain. She reports increasing fatigue and a 5-lb weight loss over
the past month. Laboratory tests show leukopenia, thrombocytopenia, and elevated anti-dsDNA antibodies.
What is the most appropriate management?
Answer: Increase immunosuppressive therapy, consider corticosteroids, and monitor for signs of lupus
flare
Rationale: The patient is experiencing a lupus flare, characterized by fever, malar rash, oral ulcers, and
joint pain, along with cytopenias (leukopenia, thrombocytopenia) and elevated anti-dsDNA antibodies. This
is a classic presentation of active SLE. Management includes corticosteroids (prednisone) to reduce
inflammation, and possibly immunosuppressive agents (azathioprine, mycophenolate mofetil).
Hydroxychloroquine is a mainstay of therapy for SLE. The patient should be monitored for signs of end-
organ involvement, including renal disease (lupus nephritis), neuropsychiatric symptoms, and cytopenias.
The flare may be triggered by infection or stress, so a thorough evaluation is needed. This patient should
be referred to a rheumatologist for further management. Sun protection and avoidance of triggers are
essential.
QUESTION 5
A 72-year-old male with a history of coronary artery disease presents with a 2-day history of chest pressure
that occurs with minimal exertion and is relieved by rest. The pain is not associated with nausea,
diaphoresis, or dyspnea. The patient reports a similar pattern over the past week but is now having more
frequent episodes. What is the most likely diagnosis?
, Answer: Unstable angina
Rationale: The patient presents with chest pressure that is exertional and relieved by rest, consistent with
angina. However, the increasing frequency and occurrence with minimal exertion suggest unstable angina
or a non-ST-elevation myocardial infarction (NSTEMI). Unstable angina is a medical emergency and
requires immediate evaluation and treatment to prevent progression to MI. The patient should be admitted,
and treatment includes antiplatelet agents (aspirin, ticagrelor), anticoagulation, and anti-ischemic agents
(nitrates, beta-blockers). A 12-lead ECG should be obtained to assess for ischemic changes. Troponin
levels should be measured to rule out MI. Early percutaneous coronary intervention (PCI) is indicated in
high-risk patients. The patient should be counseled on risk factor modification.
QUESTION 6
A 28-year-old female presents with a 2-week history of a rash on her face and arms. The rash is
erythematous, scaly, and worsens with sun exposure. She also reports mild joint pain and fatigue. She is
not taking any medications. Physical exam reveals a malar rash and a scaly rash on the upper extremities.
What is the most appropriate next step?
Answer: Order antinuclear antibody (ANA) and anti-dsDNA testing
Rationale: The patient presents with a photosensitive rash, malar rash, joint pain, and fatigue, which are
classic features of systemic lupus erythematosus (SLE). The presence of a malar rash (butterfly rash) and
photosensitivity is highly suggestive of SLE. The ANA test is positive in nearly all patients with SLE, while
anti-dsDNA antibodies are more specific and correlate with disease activity. A positive ANA and anti-
dsDNA would support the diagnosis of SLE. The patient should be referred to a rheumatologist for further
evaluation. Other tests include complement levels (C3, C4), CBC, and urinalysis to assess for renal
involvement. SLE is more common in women of childbearing age. The patient should be counseled on sun
protection.
QUESTION 7
A 60-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with
worsening dyspnea, increased sputum production, and purulent sputum. He reports a 2-day history of fever
and chills. Vital signs: T 101.5°F, HR 110, RR 28, BP 142/88. On exam, there are crackles and wheezes
throughout the lung fields. What is the most likely diagnosis?
Answer: Acute exacerbation of COPD (AECOPD) with possible pneumonia
Rationale: The patient presents with a classic acute exacerbation of COPD characterized by worsening
dyspnea, increased sputum production, purulent sputum, fever, and signs of infection. This is often
triggered by infection (viral or bacterial). Treatment includes bronchodilators (nebulized albuterol and
ipratropium), corticosteroids, and antibiotics if infection is suspected. The patient should be assessed for
signs of respiratory failure (hypoxia, hypercapnia). A chest X-ray should be obtained to rule out pneumonia.
