NR-511 | Midterm Practice Exam Page 1
, ]NR 511 Final &midterm Exam | Differential Diagnosis &
Primary Care | Chamberlain | 100 Q&A | 2026/2027
NR-511 MIDTERM EXAM
Differential Diagnosis & Primary Care
Chamberlain University
100-Question Original Practice Examination 2026/2027 Edition
1. A 54-year-old has crushing chest pressure radiating to the left arm and diaphoresis. What is the best next step?
A) Recommend home observation overnight
B) Schedule routine stress testing next month
C) Immediate emergency evaluation with ECG
D) Treat empirically for reflux without assessment
Correct Answer: Immediate emergency evaluation with ECG
Rationale: Possible acute coronary syndrome is time sensitive and cannot be excluded from history alone.
2. A 29-year-old reports pleuritic chest pain, tachycardia and new dyspnea after surgery. Which diagnosis must be considered
urgently?
A) Uncomplicated anxiety
B) Seasonal rhinitis
C) Pulmonary embolism
D) Costochondritis only
Correct Answer: Pulmonary embolism
Rationale: Recent surgery raises venous thromboembolism risk and acute cardiopulmonary symptoms warrant urgent evaluation.
3. A 70-year-old has abrupt tearing chest pain extending to the back with unequal arm blood pressures. What is most
concerning?
A) Stable angina
B) Muscle strain
C) Peptic ulcer disease
D) Acute aortic dissection
Correct Answer: Acute aortic dissection
Rationale: Severe sudden pain and pulse or pressure asymmetry suggest aortic injury requiring emergency assessment.
4. A 24-year-old with fever has headache, photophobia and neck stiffness. What should the clinician prioritize?
A) Emergency evaluation for meningitis
B) An empiric antihistamine trial only
C) Routine follow-up after seven days
D) Physical therapy referral
Correct Answer: Emergency evaluation for meningitis
NR-511 | Midterm Practice Exam Page 2
, Rationale: Possible bacterial meningitis is a medical emergency.
5. A 62-year-old has facial droop, aphasia and unilateral weakness starting 35 minutes ago. What matters immediately?
A) Schedule outpatient brain imaging
B) Start routine memory screening
C) Activate the acute stroke pathway and establish last-known-well time
D) Advise the patient to sleep
Correct Answer: Activate the acute stroke pathway and establish last-known-well time Rationale: Rapid stroke
evaluation determines access to time-sensitive treatment.
6. A 42-year-old reports the worst headache of life reaching peak intensity in seconds. What is the priority differential?
A) Benign positional vertigo
B) Tension headache exclusively
C) Chronic sinusitis
D) Subarachnoid hemorrhage
Correct Answer: Subarachnoid hemorrhage
Rationale: Thunderclap onset is a red flag for intracranial bleeding.
7. A child is drooling, sitting forward and struggling to breathe with high fever. What is safest?
A) Inspect the throat aggressively with a tongue blade
B) Urgent airway-focused evaluation without agitating the child
C) Give oral fluids before airway assessment
D) Send home with lozenges
Correct Answer: Urgent airway-focused evaluation without agitating the child
Rationale: Potential upper airway obstruction can deteriorate with unnecessary manipulation.
8. A woman of reproductive age has lower abdominal pain and a positive pregnancy test with dizziness. Which diagnosis must
be excluded?
A) Uncomplicated cystitis only
B) Ectopic pregnancy
C) Gastroesophageal reflux
D) Irritable bowel syndrome alone
Correct Answer: Ectopic pregnancy
Rationale: Ectopic pregnancy can rupture and cause life-threatening hemorrhage.
9. An older adult with abdominal pain has a pulsatile mass and hypotension. What is most urgent?
A) Chronic gastritis
B) Mild gastroenteritis
C) Simple constipation
D) Possible rupturing abdominal aortic aneurysm
Correct Answer: Possible rupturing abdominal aortic aneurysm Rationale: Aneurysm
rupture may cause rapid fatal bleeding.
10. A 58-year-old notes progressive exertional dyspnea, ankle edema and orthopnea. Which diagnosis fits?
NR-511 | Midterm Practice Exam Page 3
, A) Migraine
B) Simple allergic rhinitis
C) Heart failure
D) Acute appendicitis
Correct Answer: Heart failure
Rationale: Congestion and exertional intolerance are characteristic of heart failure.
11. A 37-year-old has episodic palpitations with presyncope. What initial test is useful?
A) 12-lead ECG
B) Screening mammogram
C) Bone density scan
D) Routine stool culture
Correct Answer: 12-lead ECG
Rationale: An ECG evaluates rhythm or conduction abnormalities in symptomatic palpitations.
12. A 21-year-old has episodic wheeze, nighttime cough and symptoms with exercise. What diagnostic study can confirm
variable obstruction?
A) Electroencephalogram
B) Spirometry with bronchodilator response
C) Routine abdominal ultrasound
D) Serum lipase alone
Correct Answer: Spirometry with bronchodilator response
Rationale: Reversible airflow limitation supports an asthma diagnosis.
13. A 64-year-old smoker has persistent sputum and progressive dyspnea. Which test confirms chronic airflow obstruction?
A) Only a chest percussion exam
B) Pulse palpation alone
C) Post-bronchodilator spirometry
D) Urinalysis
Correct Answer: Post-bronchodilator spirometry
Rationale: COPD requires demonstration of persistent airflow limitation on spirometry.
14. A 25-year-old develops cough, rhinorrhea and sore throat without fever or respiratory distress. What is generally most
appropriate?
A) Routine antibiotics for all colds
B) Systemic steroids without indication
C) Immediate CT pulmonary angiography
D) Assess for viral illness and provide supportive care
Correct Answer: Assess for viral illness and provide supportive care
Rationale: Common viral upper respiratory illness is usually self-limited and antibiotics offer no benefit.
15. A 33-year-old has fever, exudative tonsils, tender anterior cervical nodes and no cough. What approach guides treatment?
A) Use a validated clinical score and appropriate streptococcal testing
B) Order a brain MRI
NR-511 | Midterm Practice Exam Page 4
, ]NR 511 Final &midterm Exam | Differential Diagnosis &
Primary Care | Chamberlain | 100 Q&A | 2026/2027
NR-511 MIDTERM EXAM
Differential Diagnosis & Primary Care
Chamberlain University
100-Question Original Practice Examination 2026/2027 Edition
1. A 54-year-old has crushing chest pressure radiating to the left arm and diaphoresis. What is the best next step?
A) Recommend home observation overnight
B) Schedule routine stress testing next month
C) Immediate emergency evaluation with ECG
D) Treat empirically for reflux without assessment
Correct Answer: Immediate emergency evaluation with ECG
Rationale: Possible acute coronary syndrome is time sensitive and cannot be excluded from history alone.
2. A 29-year-old reports pleuritic chest pain, tachycardia and new dyspnea after surgery. Which diagnosis must be considered
urgently?
A) Uncomplicated anxiety
B) Seasonal rhinitis
C) Pulmonary embolism
D) Costochondritis only
Correct Answer: Pulmonary embolism
Rationale: Recent surgery raises venous thromboembolism risk and acute cardiopulmonary symptoms warrant urgent evaluation.
3. A 70-year-old has abrupt tearing chest pain extending to the back with unequal arm blood pressures. What is most
concerning?
A) Stable angina
B) Muscle strain
C) Peptic ulcer disease
D) Acute aortic dissection
Correct Answer: Acute aortic dissection
Rationale: Severe sudden pain and pulse or pressure asymmetry suggest aortic injury requiring emergency assessment.
4. A 24-year-old with fever has headache, photophobia and neck stiffness. What should the clinician prioritize?
A) Emergency evaluation for meningitis
B) An empiric antihistamine trial only
C) Routine follow-up after seven days
D) Physical therapy referral
Correct Answer: Emergency evaluation for meningitis
NR-511 | Midterm Practice Exam Page 2
, Rationale: Possible bacterial meningitis is a medical emergency.
5. A 62-year-old has facial droop, aphasia and unilateral weakness starting 35 minutes ago. What matters immediately?
A) Schedule outpatient brain imaging
B) Start routine memory screening
C) Activate the acute stroke pathway and establish last-known-well time
D) Advise the patient to sleep
Correct Answer: Activate the acute stroke pathway and establish last-known-well time Rationale: Rapid stroke
evaluation determines access to time-sensitive treatment.
6. A 42-year-old reports the worst headache of life reaching peak intensity in seconds. What is the priority differential?
A) Benign positional vertigo
B) Tension headache exclusively
C) Chronic sinusitis
D) Subarachnoid hemorrhage
Correct Answer: Subarachnoid hemorrhage
Rationale: Thunderclap onset is a red flag for intracranial bleeding.
7. A child is drooling, sitting forward and struggling to breathe with high fever. What is safest?
A) Inspect the throat aggressively with a tongue blade
B) Urgent airway-focused evaluation without agitating the child
C) Give oral fluids before airway assessment
D) Send home with lozenges
Correct Answer: Urgent airway-focused evaluation without agitating the child
Rationale: Potential upper airway obstruction can deteriorate with unnecessary manipulation.
8. A woman of reproductive age has lower abdominal pain and a positive pregnancy test with dizziness. Which diagnosis must
be excluded?
A) Uncomplicated cystitis only
B) Ectopic pregnancy
C) Gastroesophageal reflux
D) Irritable bowel syndrome alone
Correct Answer: Ectopic pregnancy
Rationale: Ectopic pregnancy can rupture and cause life-threatening hemorrhage.
9. An older adult with abdominal pain has a pulsatile mass and hypotension. What is most urgent?
A) Chronic gastritis
B) Mild gastroenteritis
C) Simple constipation
D) Possible rupturing abdominal aortic aneurysm
Correct Answer: Possible rupturing abdominal aortic aneurysm Rationale: Aneurysm
rupture may cause rapid fatal bleeding.
10. A 58-year-old notes progressive exertional dyspnea, ankle edema and orthopnea. Which diagnosis fits?
NR-511 | Midterm Practice Exam Page 3
, A) Migraine
B) Simple allergic rhinitis
C) Heart failure
D) Acute appendicitis
Correct Answer: Heart failure
Rationale: Congestion and exertional intolerance are characteristic of heart failure.
11. A 37-year-old has episodic palpitations with presyncope. What initial test is useful?
A) 12-lead ECG
B) Screening mammogram
C) Bone density scan
D) Routine stool culture
Correct Answer: 12-lead ECG
Rationale: An ECG evaluates rhythm or conduction abnormalities in symptomatic palpitations.
12. A 21-year-old has episodic wheeze, nighttime cough and symptoms with exercise. What diagnostic study can confirm
variable obstruction?
A) Electroencephalogram
B) Spirometry with bronchodilator response
C) Routine abdominal ultrasound
D) Serum lipase alone
Correct Answer: Spirometry with bronchodilator response
Rationale: Reversible airflow limitation supports an asthma diagnosis.
13. A 64-year-old smoker has persistent sputum and progressive dyspnea. Which test confirms chronic airflow obstruction?
A) Only a chest percussion exam
B) Pulse palpation alone
C) Post-bronchodilator spirometry
D) Urinalysis
Correct Answer: Post-bronchodilator spirometry
Rationale: COPD requires demonstration of persistent airflow limitation on spirometry.
14. A 25-year-old develops cough, rhinorrhea and sore throat without fever or respiratory distress. What is generally most
appropriate?
A) Routine antibiotics for all colds
B) Systemic steroids without indication
C) Immediate CT pulmonary angiography
D) Assess for viral illness and provide supportive care
Correct Answer: Assess for viral illness and provide supportive care
Rationale: Common viral upper respiratory illness is usually self-limited and antibiotics offer no benefit.
15. A 33-year-old has fever, exudative tonsils, tender anterior cervical nodes and no cough. What approach guides treatment?
A) Use a validated clinical score and appropriate streptococcal testing
B) Order a brain MRI
NR-511 | Midterm Practice Exam Page 4
