,NR 603 Final Exam | Advanced Clinical Diagnosis
(2026) Actual Q&A PDF | Chamberlain
1. A 64-year-old female presents with progressive dyspnea on exertion and a dry,
unproductive cough over six months. Physical exam reveals fine, Velcro-like late
inspiratory crackles at both lung bases and mild digital clubbing. HRCT shows
subpleural, basal-predominant reticular opacities and honeycombing. What is the most
likely diagnosis?
A) Acute respiratory distress syndrome
B) Idiopathic pulmonary fibrosis
C) Hypersensitivity pneumonitis
D) Sarcoidosis
Correct Answer: Idiopathic pulmonary fibrosis
Rationale: IPF classically presents in older adults with progressive exertional dyspnea,
nonproductive cough, dry "Velcro" crackles, and digital clubbing. The HRCT pattern of
usual interstitial pneumonia with subpleural, basal-predominant reticulation and
honeycombing is diagnostic. ARDS is acute with diffuse ground-glass opacities, and
sarcoidosis features hilar lymphadenopathy.
2. A 58-year-old male with severe persistent asthma presents with an acute
exacerbation. He is tachypneic and using accessory muscles. ABG reveals pH 7.42,
PaCO2 40 mmHg, PaO2 68 mmHg, and HCO3 24 mEq/L. How should the clinician
interpret the PaCO2?
,A) The patient is effectively compensating for metabolic acidosis
B) The patient is in the early stages of a mild exacerbation
C) The "normal" PaCO2 signifies impending respiratory failure and respiratory muscle
fatigue
D) The patient has reached a stable baseline
Correct Answer: The "normal" PaCO2 signifies impending respiratory failure and
respiratory muscle fatigue
Rationale: During an acute asthma exacerbation, hyperventilation typically causes
respiratory alkalosis with a low PaCO2. A "normal" or pseudonormal PaCO2 in a patient
showing significant respiratory distress indicates the patient is tiring and can no longer
sustain hyperventilation, placing them at immediate risk of respiratory arrest.
3. A 72-year-old male presents with sudden-onset, severe, tearing chest pain radiating
to his back between the scapulae. Blood pressure in the right arm is 172/96 mmHg and
in the left arm 142/82 mmHg. A diastolic murmur is noted along the right sternal
border. Which diagnostic modality is the most appropriate next step in a
hemodynamically stable patient?
A) 12-lead electrocardiogram
B) Computed tomography angiography of the chest and abdomen
C) Transthoracic echocardiogram
D) Cardiac catheterization
Correct Answer: Computed tomography angiography of the chest and abdomen
, Rationale: The presentation is highly suggestive of acute aortic dissection, supported
by tearing chest/back pain, a blood pressure differential between arms (>20 mmHg),
and a new aortic regurgitation murmur. CTA of the chest and abdomen is the diagnostic
modality of choice in hemodynamically stable patients to confirm the diagnosis and
define the extent of dissection.
4. A 28-year-old pregnant female at 24 weeks gestation presents with a severe,
throbbing unilateral headache with nausea and photophobia. Which acute migraine
therapy is strictly contraindicated due to the risk of inducing uterine contractions and
miscarriage?
A) Acetaminophen
B) Magnesium oxide
C) Ergotamine tartrate
D) Metoprolol
Correct Answer: Ergotamine tartrate
Rationale: Ergotamine tartrate acts as a powerful vasoconstrictor and is strictly
contraindicated during pregnancy. It stimulates uterine smooth muscle contractions and
reduces uteroplacental blood flow, directly increasing the risk of preterm labor,
spontaneous abortion, or fetal distress. Acetaminophen and metoprolol are generally
considered safe options.
5. A 19-year-old male presents with a painful, erythematous, non-blistering first-degree
burn covering his entire anterior and posterior torso after a full day of sun exposure.
Using the Rule of Palms method, what percentage of total body surface area does the
patient's own palm equal?
(2026) Actual Q&A PDF | Chamberlain
1. A 64-year-old female presents with progressive dyspnea on exertion and a dry,
unproductive cough over six months. Physical exam reveals fine, Velcro-like late
inspiratory crackles at both lung bases and mild digital clubbing. HRCT shows
subpleural, basal-predominant reticular opacities and honeycombing. What is the most
likely diagnosis?
A) Acute respiratory distress syndrome
B) Idiopathic pulmonary fibrosis
C) Hypersensitivity pneumonitis
D) Sarcoidosis
Correct Answer: Idiopathic pulmonary fibrosis
Rationale: IPF classically presents in older adults with progressive exertional dyspnea,
nonproductive cough, dry "Velcro" crackles, and digital clubbing. The HRCT pattern of
usual interstitial pneumonia with subpleural, basal-predominant reticulation and
honeycombing is diagnostic. ARDS is acute with diffuse ground-glass opacities, and
sarcoidosis features hilar lymphadenopathy.
2. A 58-year-old male with severe persistent asthma presents with an acute
exacerbation. He is tachypneic and using accessory muscles. ABG reveals pH 7.42,
PaCO2 40 mmHg, PaO2 68 mmHg, and HCO3 24 mEq/L. How should the clinician
interpret the PaCO2?
,A) The patient is effectively compensating for metabolic acidosis
B) The patient is in the early stages of a mild exacerbation
C) The "normal" PaCO2 signifies impending respiratory failure and respiratory muscle
fatigue
D) The patient has reached a stable baseline
Correct Answer: The "normal" PaCO2 signifies impending respiratory failure and
respiratory muscle fatigue
Rationale: During an acute asthma exacerbation, hyperventilation typically causes
respiratory alkalosis with a low PaCO2. A "normal" or pseudonormal PaCO2 in a patient
showing significant respiratory distress indicates the patient is tiring and can no longer
sustain hyperventilation, placing them at immediate risk of respiratory arrest.
3. A 72-year-old male presents with sudden-onset, severe, tearing chest pain radiating
to his back between the scapulae. Blood pressure in the right arm is 172/96 mmHg and
in the left arm 142/82 mmHg. A diastolic murmur is noted along the right sternal
border. Which diagnostic modality is the most appropriate next step in a
hemodynamically stable patient?
A) 12-lead electrocardiogram
B) Computed tomography angiography of the chest and abdomen
C) Transthoracic echocardiogram
D) Cardiac catheterization
Correct Answer: Computed tomography angiography of the chest and abdomen
, Rationale: The presentation is highly suggestive of acute aortic dissection, supported
by tearing chest/back pain, a blood pressure differential between arms (>20 mmHg),
and a new aortic regurgitation murmur. CTA of the chest and abdomen is the diagnostic
modality of choice in hemodynamically stable patients to confirm the diagnosis and
define the extent of dissection.
4. A 28-year-old pregnant female at 24 weeks gestation presents with a severe,
throbbing unilateral headache with nausea and photophobia. Which acute migraine
therapy is strictly contraindicated due to the risk of inducing uterine contractions and
miscarriage?
A) Acetaminophen
B) Magnesium oxide
C) Ergotamine tartrate
D) Metoprolol
Correct Answer: Ergotamine tartrate
Rationale: Ergotamine tartrate acts as a powerful vasoconstrictor and is strictly
contraindicated during pregnancy. It stimulates uterine smooth muscle contractions and
reduces uteroplacental blood flow, directly increasing the risk of preterm labor,
spontaneous abortion, or fetal distress. Acetaminophen and metoprolol are generally
considered safe options.
5. A 19-year-old male presents with a painful, erythematous, non-blistering first-degree
burn covering his entire anterior and posterior torso after a full day of sun exposure.
Using the Rule of Palms method, what percentage of total body surface area does the
patient's own palm equal?
