Final Exams) NR 511 Chamberlain – Complete
Package Bundle
1. A 45-year-old male presents with epigastric pain that
worsens after meals and improves with antacids. He
denies hematemesis or melena. What is the most
appropriate next step?
A) Start a proton pump inhibitor (PPI) empirically
B) Refer for upper endoscopy immediately
C) Test for H. pylori
D) Order abdominal ultrasound
Correct Answer: C
Rationale: Given the symptoms (epigastric pain relieved
by antacids, worse after meals), peptic ulcer disease is
likely. Testing for H. pylori (non-invasive: stool antigen or
urea breath test) is first-line before starting therapy.
Empiric PPI without testing is acceptable only if testing is
not available, but testing guides antibiotic therapy.
1
,2. A 30-year-old female reports fatigue, dizziness when
standing, and heavy menstrual periods. Vital signs: BP
100/70, HR 110 bpm supine, 130 bpm standing. What is
the best initial diagnostic test?
A) TSH
B) Complete blood count (CBC)
C) Serum ferritin
D) Electrocardiogram
Correct Answer: B
Rationale: Symptoms suggest anemia due to menorrhagia.
CBC is the first test to assess hemoglobin and hematocrit.
Ferritin is useful after confirming anemia to determine iron
deficiency.
3. Which clinical decision rule is most appropriate for
evaluating a patient with possible anterior cruciate
ligament (ACL) tear after a sports injury?
A) Ottawa Knee Rules
B) Pittsburgh Knee Rules
2
,C) Lachman test
D) McMurray test
Correct Answer: C
Rationale: The Lachman test is the most sensitive and
specific physical exam maneuver for ACL tear. Ottawa
Knee Rules help decide if X-ray is needed for fracture,
not ligament injury.
4. A 60-year-old diabetic with hypertension reports
sudden onset of severe, tearing chest pain radiating to
the back. BP 180/110 in right arm, 100/70 in left arm.
What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Musculoskeletal pain
Correct Answer: C
Rationale: Blood pressure differential between arms and
tearing chest pain radiating to back is classic for aortic
3
, dissection. Immediate imaging (CT angiography) is
needed.
5. You are evaluating a patient with suspected
community-acquired pneumonia. Which of the following
CURB-65 criteria indicates need for hospitalization?
A) Age >60 years
B) Respiratory rate 25/min
C) Uremia (BUN >20 mg/dL)
D) Confusion and RR 30/min
Correct Answer: D
Rationale: CURB-65: Confusion, Uremia (BUN >19), RR
≥30, BP low (SBP <90 or DBP ≤60), age ≥65. Score ≥2
suggests hospital admission; D gives 2 points.
6. A 25-year-old with recurrent sinusitis, pneumonia, and
chronic diarrhea. Which screening test is most
appropriate?
A) HIV test
B) Immunoglobulin levels (IgG, IgA, IgM)
4
Package Bundle
1. A 45-year-old male presents with epigastric pain that
worsens after meals and improves with antacids. He
denies hematemesis or melena. What is the most
appropriate next step?
A) Start a proton pump inhibitor (PPI) empirically
B) Refer for upper endoscopy immediately
C) Test for H. pylori
D) Order abdominal ultrasound
Correct Answer: C
Rationale: Given the symptoms (epigastric pain relieved
by antacids, worse after meals), peptic ulcer disease is
likely. Testing for H. pylori (non-invasive: stool antigen or
urea breath test) is first-line before starting therapy.
Empiric PPI without testing is acceptable only if testing is
not available, but testing guides antibiotic therapy.
1
,2. A 30-year-old female reports fatigue, dizziness when
standing, and heavy menstrual periods. Vital signs: BP
100/70, HR 110 bpm supine, 130 bpm standing. What is
the best initial diagnostic test?
A) TSH
B) Complete blood count (CBC)
C) Serum ferritin
D) Electrocardiogram
Correct Answer: B
Rationale: Symptoms suggest anemia due to menorrhagia.
CBC is the first test to assess hemoglobin and hematocrit.
Ferritin is useful after confirming anemia to determine iron
deficiency.
3. Which clinical decision rule is most appropriate for
evaluating a patient with possible anterior cruciate
ligament (ACL) tear after a sports injury?
A) Ottawa Knee Rules
B) Pittsburgh Knee Rules
2
,C) Lachman test
D) McMurray test
Correct Answer: C
Rationale: The Lachman test is the most sensitive and
specific physical exam maneuver for ACL tear. Ottawa
Knee Rules help decide if X-ray is needed for fracture,
not ligament injury.
4. A 60-year-old diabetic with hypertension reports
sudden onset of severe, tearing chest pain radiating to
the back. BP 180/110 in right arm, 100/70 in left arm.
What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Musculoskeletal pain
Correct Answer: C
Rationale: Blood pressure differential between arms and
tearing chest pain radiating to back is classic for aortic
3
, dissection. Immediate imaging (CT angiography) is
needed.
5. You are evaluating a patient with suspected
community-acquired pneumonia. Which of the following
CURB-65 criteria indicates need for hospitalization?
A) Age >60 years
B) Respiratory rate 25/min
C) Uremia (BUN >20 mg/dL)
D) Confusion and RR 30/min
Correct Answer: D
Rationale: CURB-65: Confusion, Uremia (BUN >19), RR
≥30, BP low (SBP <90 or DBP ≤60), age ≥65. Score ≥2
suggests hospital admission; D gives 2 points.
6. A 25-year-old with recurrent sinusitis, pneumonia, and
chronic diarrhea. Which screening test is most
appropriate?
A) HIV test
B) Immunoglobulin levels (IgG, IgA, IgM)
4
