NR 603 Midterm Practice Exam - Advanced Clinical Diagnosis
2026/2027 Chamberlain
1. A 55-year-old male presents with a blood pressure of 152/94 mmHg. On a
subsequent visit one week later, his blood pressure is 154/96 mmHg. According
to current guidelines, what is the most appropriate initial management?
A. Initiate lifestyle modifications only and recheck in 6 months.
B. Diagnose Stage 2 Hypertension and prescribe a high-dose beta-blocker.
C. Refer to a cardiologist for immediate workup.
D. Initiate an ACE inhibitor or Calcium Channel Blocker and lifestyle modifications.
Answer: D
Rationale: Stage 2 Hypertension (>=140/90) requires lifestyle changes and
pharmacological intervention, typically with an ACE inhibitor, ARB, CCB, or thiazide
diuretic.
2. Which of the following findings on a pulmonary function test (PFT) is
diagnostic for Chronic Obstructive Pulmonary Disease (COPD)?
A. Post-bronchodilator FEV1/FVC ratio < 0.70
B. Increase in FEV1 by 12% after bronchodilator use
C. Total lung capacity (TLC) less than 80% predicted
D. FEV1/FVC ratio > 0.85
Answer: A
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the presence
of persistent airflow limitation and is the gold standard for COPD diagnosis.
,3. A 62-year-old female presents with fatigue and cold intolerance. Her TSH is
12.4 mIU/L (High) and her Free T4 is 0.6 ng/dL (Low). What is the most likely
diagnosis?
A. Secondary Hypothyroidism
B. Subclinical Hypothyroidism
C. Primary Hypothyroidism
D. Graves’ Disease
Answer: C
Rationale: Primary hypothyroidism is characterized by an elevated TSH and a low Free T4,
indicating the thyroid gland is failing to produce enough hormone.
4. Which physical exam maneuver is specifically used to assess for acute
cholecystitis?
A. Murphy’s sign
B. McBurney’s Point tenderness
C. Rovsing’s sign
D. Psoas sign
Answer: A
Rationale: Murphy’s sign is performed by palpating the right upper quadrant while the
patient inhales; a sharp halt in inspiration due to pain is a positive sign for cholecystitis.
5. According to the ADA guidelines, what is the diagnostic threshold for
Hemoglobin A1C for Diabetes Mellitus?
A. Greater than or equal to 6.5%
B. Greater than or equal to 6.0%
C. Greater than or equal to 5.7%
D. Greater than or equal to 7.0%
Answer: A
, Rationale: An A1C level of 6.5% or higher, confirmed on two separate occasions (or with a
matching glucose test), is diagnostic for Diabetes.
6. A patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is
currently on Lisinopril and Carvedilol. Which medication should be added next
to improve mortality, according to current guidelines?
A. Aldosterone Antagonist (e.g., Spironolactone)
B. Furosemide
C. Amlodipine
D. Digoxin
Answer: A
Rationale: Aldosterone antagonists are indicated for patients with HFrEF who are
symptomatic despite ACE/ARB and Beta-blocker therapy to further reduce mortality.
7. A 24-year-old female presents with dysuria and frequency. A urinalysis shows
positive nitrites and leukocyte esterase. She has no fever or flank pain. What is
the most common causative organism?
A. Staphylococcus saprophyticus
B. Klebsiella pneumoniae
C. Escherichia coli
D. Proteus mirabilis
Answer: C
Rationale: E. coli is responsible for approximately 75-90% of uncomplicated urinary tract
infections in community settings.
2026/2027 Chamberlain
1. A 55-year-old male presents with a blood pressure of 152/94 mmHg. On a
subsequent visit one week later, his blood pressure is 154/96 mmHg. According
to current guidelines, what is the most appropriate initial management?
A. Initiate lifestyle modifications only and recheck in 6 months.
B. Diagnose Stage 2 Hypertension and prescribe a high-dose beta-blocker.
C. Refer to a cardiologist for immediate workup.
D. Initiate an ACE inhibitor or Calcium Channel Blocker and lifestyle modifications.
Answer: D
Rationale: Stage 2 Hypertension (>=140/90) requires lifestyle changes and
pharmacological intervention, typically with an ACE inhibitor, ARB, CCB, or thiazide
diuretic.
2. Which of the following findings on a pulmonary function test (PFT) is
diagnostic for Chronic Obstructive Pulmonary Disease (COPD)?
A. Post-bronchodilator FEV1/FVC ratio < 0.70
B. Increase in FEV1 by 12% after bronchodilator use
C. Total lung capacity (TLC) less than 80% predicted
D. FEV1/FVC ratio > 0.85
Answer: A
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the presence
of persistent airflow limitation and is the gold standard for COPD diagnosis.
,3. A 62-year-old female presents with fatigue and cold intolerance. Her TSH is
12.4 mIU/L (High) and her Free T4 is 0.6 ng/dL (Low). What is the most likely
diagnosis?
A. Secondary Hypothyroidism
B. Subclinical Hypothyroidism
C. Primary Hypothyroidism
D. Graves’ Disease
Answer: C
Rationale: Primary hypothyroidism is characterized by an elevated TSH and a low Free T4,
indicating the thyroid gland is failing to produce enough hormone.
4. Which physical exam maneuver is specifically used to assess for acute
cholecystitis?
A. Murphy’s sign
B. McBurney’s Point tenderness
C. Rovsing’s sign
D. Psoas sign
Answer: A
Rationale: Murphy’s sign is performed by palpating the right upper quadrant while the
patient inhales; a sharp halt in inspiration due to pain is a positive sign for cholecystitis.
5. According to the ADA guidelines, what is the diagnostic threshold for
Hemoglobin A1C for Diabetes Mellitus?
A. Greater than or equal to 6.5%
B. Greater than or equal to 6.0%
C. Greater than or equal to 5.7%
D. Greater than or equal to 7.0%
Answer: A
, Rationale: An A1C level of 6.5% or higher, confirmed on two separate occasions (or with a
matching glucose test), is diagnostic for Diabetes.
6. A patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is
currently on Lisinopril and Carvedilol. Which medication should be added next
to improve mortality, according to current guidelines?
A. Aldosterone Antagonist (e.g., Spironolactone)
B. Furosemide
C. Amlodipine
D. Digoxin
Answer: A
Rationale: Aldosterone antagonists are indicated for patients with HFrEF who are
symptomatic despite ACE/ARB and Beta-blocker therapy to further reduce mortality.
7. A 24-year-old female presents with dysuria and frequency. A urinalysis shows
positive nitrites and leukocyte esterase. She has no fever or flank pain. What is
the most common causative organism?
A. Staphylococcus saprophyticus
B. Klebsiella pneumoniae
C. Escherichia coli
D. Proteus mirabilis
Answer: C
Rationale: E. coli is responsible for approximately 75-90% of uncomplicated urinary tract
infections in community settings.
