NR511 CEA Original Practice Exam (2025–2026
Update)
150 Unique Clinical Vignette Questions with Evidence-Based Rationalized Answers
Chamberlain NR-511 Differential Diagnosis & Primary Care Practicum study alignment | FNP/AGPCNP pre-
certification focus | Original practice material
Exam Structure
This practice guide contains 150 unique multiple-choice and clinical-vignette items spanning differential
diagnosis frameworks, primary care management, diagnostic reasoning, pharmacologic and
nonpharmacologic interventions, patient education, prevention, cultural competency, legal/ethical practice,
and interprofessional collaboration.
Domain Blueprint
Domain Question Count
Differential Diagnosis & Urgent Red Flags 15
Respiratory, HEENT & Infectious Acute Care 20
Cardiovascular, Renal & Endocrine Chronic Disease 30
Gastrointestinal, Genitourinary, Dermatology & 30
Musculoskeletal
Neurology, Mental Health, Substance Use & Pain 20
Women's Health, Men's Health & Reproductive Care 20
Pediatrics, Geriatrics, Prevention, Ethics & 15
Interprofessional Care
,Differential Diagnosis & Urgent Red Flags
1. A 58-year-old man has crushing substernal chest pressure radiating to the left arm,
diaphoresis, and an office ECG showing ST elevation in II, III, and aVF. What is the best
next action in primary care?
A. Give an antacid and recheck in 30 minutes
B. Order outpatient troponin and cardiology follow-up tomorrow
C. Administer chewable aspirin if not contraindicated and activate EMS for ED reperfusion care
D. Start oral beta-blocker only and discharge with precautions
Correct answer: C. Administer chewable aspirin if not contraindicated and activate EMS for
ED reperfusion care
Rationale: Inferior STEMI is a time-sensitive emergency; primary care management is
stabilization, aspirin when appropriate, EMS activation, and rapid transfer for reperfusion
rather than office observation. Door-to-balloon or fibrinolytic decisions occur in the ED/cath-
lab system. Guideline anchor: ACC/AHA acute coronary syndrome guidance; AANP/ANCC
emergency triage competencies.
2. A 71-year-old woman develops sudden right facial droop, arm weakness, and aphasia 45
minutes before arriving at clinic. Blood glucose is 112 mg/dL. What should the NP do first?
A. Schedule outpatient MRI within 24 hours
B. Give aspirin and observe for symptom resolution
C. Activate EMS to a stroke-capable emergency department
D. Start a statin and arrange neurology referral next week
Correct answer: C. Activate EMS to a stroke-capable emergency department
Rationale: New focal neurologic deficits within the thrombolysis/thrombectomy window
require immediate stroke-system activation; outpatient imaging delays treatment. Glucose
assessment helps exclude hypoglycemia, but definitive evaluation belongs in the ED. Guideline
anchor: AHA/ASA stroke guidelines; AANP/ANCC acute neurologic red flags.
3. A 42-year-old patient reports a sudden thunderclap headache described as the worst
headache of life with vomiting and neck stiffness. Neurologic exam is nonfocal. What is
the priority?
A. Treat as migraine with a triptan
B. Send to the ED for emergent noncontrast head CT and further evaluation
C. Prescribe oral antibiotics for sinusitis
D. Reassure because the neurologic exam is normal
Correct answer: B. Send to the ED for emergent noncontrast head CT and further evaluation
Rationale: Thunderclap headache is subarachnoid hemorrhage until proven otherwise, even
with a normal neurologic exam. Emergent imaging and possible lumbar puncture/CTA are
needed, not outpatient migraine treatment. Guideline anchor: ACEP headache policy; AAFP
neurologic emergency review.
4. A 49-year-old warehouse worker has acute low back pain, new urinary retention, saddle
anesthesia, and bilateral leg weakness. Which diagnosis must be ruled out immediately?
A. Mechanical lumbar strain
B. Piriformis syndrome
C. Cauda equina syndrome requiring emergent MRI and surgical consultation
D. Uncomplicated sciatica managed with home exercise
Correct answer: C. Cauda equina syndrome requiring emergent MRI and surgical consultation
Rationale: Urinary retention, saddle anesthesia, and bilateral neurologic deficits are classic
cauda equina red flags. Emergent MRI and neurosurgical evaluation are required to prevent
permanent neurologic injury. Guideline anchor: AAFP low back pain red flags; emergency
neurosurgical standards.
,5. A 27-year-old with 7 weeks of amenorrhea has unilateral pelvic pain, shoulder-tip pain,
dizziness, and a positive urine pregnancy test. Blood pressure is 88/54 mmHg. What is the
safest disposition?
A. Outpatient pelvic ultrasound tomorrow
B. Empiric oral antibiotics for pelvic inflammatory disease
C. Immediate ED transfer for suspected ruptured ectopic pregnancy
D. Reassurance and repeat pregnancy test in one week
Correct answer: C. Immediate ED transfer for suspected ruptured ectopic pregnancy
Rationale: Hemodynamic instability with early pregnancy and unilateral pain suggests
ruptured ectopic pregnancy. The patient needs ED resuscitation, quantitative beta-hCG,
transvaginal ultrasound, and urgent OB/GYN management. Guideline anchor: ACOG ectopic
pregnancy guidance; emergency obstetric triage.
6. A 74-year-old has new unilateral temporal headache, scalp tenderness, jaw
claudication, and transient blurred vision. ESR and CRP are pending. What should the NP
do?
A. Wait for temporal artery biopsy before treatment
B. Begin high-dose glucocorticoids immediately and arrange urgent ophthalmology/rheumatology
evaluation
C. Treat with ibuprofen and follow up in one month
D. Order sinus radiographs and prescribe amoxicillin
Correct answer: B. Begin high-dose glucocorticoids immediately and arrange urgent
ophthalmology/rheumatology evaluation
Rationale: Suspected giant cell arteritis threatens irreversible vision loss; steroids should
begin immediately when clinical suspicion is high, before biopsy confirmation. ESR/CRP and
temporal artery imaging/biopsy support diagnosis but should not delay treatment. Guideline
anchor: ACR/Vasculitis Foundation guidance; AAFP headache in older adults.
7. A 63-year-old has severe unilateral eye pain, headache, halos around lights, mid-dilated
pupil, and nausea. Visual acuity is decreased. What is the most appropriate action?
A. Start artificial tears and schedule routine optometry
B. Treat as conjunctivitis with topical antibiotics
C. Send urgently to the ED/ophthalmology for acute angle-closure glaucoma management
D. Patch the eye and reassess in 48 hours
Correct answer: C. Send urgently to the ED/ophthalmology for acute angle-closure glaucoma
management
Rationale: Painful red eye with halos, nausea, and a fixed mid-dilated pupil is acute angle-
closure glaucoma. Vision-saving treatment requires immediate pressure-lowering therapy by
emergency/ophthalmology services. Guideline anchor: AAO emergency ophthalmology
guidance; primary care red-eye algorithms.
8. A 19-year-old develops diffuse urticaria, wheezing, throat tightness, and hypotension
minutes after eating peanuts. What medication is first-line?
A. Diphenhydramine orally
B. Albuterol only
C. Intramuscular epinephrine in the mid-outer thigh
D. Methylprednisolone orally
Correct answer: C. Intramuscular epinephrine in the mid-outer thigh
Rationale: Anaphylaxis is treated first with IM epinephrine; antihistamines and steroids are
adjuncts and do not reverse airway edema or shock. Delayed epinephrine increases morbidity
and mortality. Guideline anchor: AAAAI/ACAAI anaphylaxis practice parameter; emergency
care standards.
9. A college student presents with fever, severe headache, neck stiffness, photophobia, and
a petechial rash. What should the primary care clinician do?
A. Give oral amoxicillin and send home
, B. Send by EMS to the ED for droplet precautions, blood cultures, and immediate IV antimicrobials
C. Perform spinal manipulation for neck pain
D. Schedule outpatient lumbar puncture next week
Correct answer: B. Send by EMS to the ED for droplet precautions, blood cultures, and
immediate IV antimicrobials
Rationale: Fever, meningismus, and petechiae suggest meningococcemia/meningitis, a life-
threatening infection. ED transfer, isolation, cultures, and prompt empiric IV antibiotics are
indicated. Guideline anchor: IDSA bacterial meningitis guidance; CDC meningococcal disease
guidance.
10. An 82-year-old with diabetes has confusion, fever, dysuria, respiratory rate 26/min,
BP 86/50 mmHg, and cool extremities. What is the priority?
A. Start oral nitrofurantoin and recheck in 48 hours
B. Diagnose delirium only and prescribe haloperidol
C. Activate EMS for suspected sepsis and hypotension
D. Advise increased fluids at home
Correct answer: C. Activate EMS for suspected sepsis and hypotension
Rationale: Infection plus hypotension, tachypnea, and altered mentation indicates possible
sepsis/shock. Primary care should initiate urgent transfer for fluids, cultures, lactate
assessment, and IV antibiotics. Guideline anchor: Surviving Sepsis Campaign; geriatric
emergency triage standards.
11. A 36-year-old has worsening abdominal pain, rigid abdomen, rebound tenderness,
fever, and tachycardia. What is the most appropriate plan?
A. Oral laxative and outpatient follow-up
B. Immediate ED transfer for surgical abdomen evaluation
C. Begin a proton pump inhibitor and observe
D. Schedule elective abdominal ultrasound in two weeks
Correct answer: B. Immediate ED transfer for surgical abdomen evaluation
Rationale: Peritoneal signs indicate a possible perforation, ischemia, appendicitis, or other
surgical emergency. The patient needs ED imaging, labs, resuscitation, and surgical
consultation. Guideline anchor: AAFP acute abdominal pain evaluation; emergency surgery
principles.
12. A 31-year-old postpartum patient has unilateral calf swelling, warmth, tenderness, and
dyspnea on exertion. What is the best next step?
A. Massage the calf and prescribe NSAIDs
B. Order outpatient D-dimer only and wait for results
C. Urgent ED evaluation for venous thromboembolism with compression ultrasound/PE assessment
D. Reassure because postpartum edema is normal
Correct answer: C. Urgent ED evaluation for venous thromboembolism with compression
ultrasound/PE assessment
Rationale: Postpartum status is hypercoagulable, and unilateral leg findings with dyspnea
raise concern for DVT and pulmonary embolism. Urgent imaging and anticoagulation
decisions are needed. Guideline anchor: ACCP/CHEST VTE guidance; obstetric VTE safety
standards.
13. A 29-year-old using combined oral contraceptives has pleuritic chest pain, hemoptysis,
tachycardia, and oxygen saturation of 91%. What should the NP do?
A. Treat costochondritis with ibuprofen
B. Send to the ED for pulmonary embolism evaluation and stabilization
C. Prescribe azithromycin for bronchitis
D. Perform spirometry before making a decision
Correct answer: B. Send to the ED for pulmonary embolism evaluation and stabilization
Rationale: Hypoxemia, pleuritic pain, tachycardia, hemoptysis, and estrogen exposure are
concerning for PE. ED evaluation allows risk stratification, CT pulmonary angiography/VQ
Update)
150 Unique Clinical Vignette Questions with Evidence-Based Rationalized Answers
Chamberlain NR-511 Differential Diagnosis & Primary Care Practicum study alignment | FNP/AGPCNP pre-
certification focus | Original practice material
Exam Structure
This practice guide contains 150 unique multiple-choice and clinical-vignette items spanning differential
diagnosis frameworks, primary care management, diagnostic reasoning, pharmacologic and
nonpharmacologic interventions, patient education, prevention, cultural competency, legal/ethical practice,
and interprofessional collaboration.
Domain Blueprint
Domain Question Count
Differential Diagnosis & Urgent Red Flags 15
Respiratory, HEENT & Infectious Acute Care 20
Cardiovascular, Renal & Endocrine Chronic Disease 30
Gastrointestinal, Genitourinary, Dermatology & 30
Musculoskeletal
Neurology, Mental Health, Substance Use & Pain 20
Women's Health, Men's Health & Reproductive Care 20
Pediatrics, Geriatrics, Prevention, Ethics & 15
Interprofessional Care
,Differential Diagnosis & Urgent Red Flags
1. A 58-year-old man has crushing substernal chest pressure radiating to the left arm,
diaphoresis, and an office ECG showing ST elevation in II, III, and aVF. What is the best
next action in primary care?
A. Give an antacid and recheck in 30 minutes
B. Order outpatient troponin and cardiology follow-up tomorrow
C. Administer chewable aspirin if not contraindicated and activate EMS for ED reperfusion care
D. Start oral beta-blocker only and discharge with precautions
Correct answer: C. Administer chewable aspirin if not contraindicated and activate EMS for
ED reperfusion care
Rationale: Inferior STEMI is a time-sensitive emergency; primary care management is
stabilization, aspirin when appropriate, EMS activation, and rapid transfer for reperfusion
rather than office observation. Door-to-balloon or fibrinolytic decisions occur in the ED/cath-
lab system. Guideline anchor: ACC/AHA acute coronary syndrome guidance; AANP/ANCC
emergency triage competencies.
2. A 71-year-old woman develops sudden right facial droop, arm weakness, and aphasia 45
minutes before arriving at clinic. Blood glucose is 112 mg/dL. What should the NP do first?
A. Schedule outpatient MRI within 24 hours
B. Give aspirin and observe for symptom resolution
C. Activate EMS to a stroke-capable emergency department
D. Start a statin and arrange neurology referral next week
Correct answer: C. Activate EMS to a stroke-capable emergency department
Rationale: New focal neurologic deficits within the thrombolysis/thrombectomy window
require immediate stroke-system activation; outpatient imaging delays treatment. Glucose
assessment helps exclude hypoglycemia, but definitive evaluation belongs in the ED. Guideline
anchor: AHA/ASA stroke guidelines; AANP/ANCC acute neurologic red flags.
3. A 42-year-old patient reports a sudden thunderclap headache described as the worst
headache of life with vomiting and neck stiffness. Neurologic exam is nonfocal. What is
the priority?
A. Treat as migraine with a triptan
B. Send to the ED for emergent noncontrast head CT and further evaluation
C. Prescribe oral antibiotics for sinusitis
D. Reassure because the neurologic exam is normal
Correct answer: B. Send to the ED for emergent noncontrast head CT and further evaluation
Rationale: Thunderclap headache is subarachnoid hemorrhage until proven otherwise, even
with a normal neurologic exam. Emergent imaging and possible lumbar puncture/CTA are
needed, not outpatient migraine treatment. Guideline anchor: ACEP headache policy; AAFP
neurologic emergency review.
4. A 49-year-old warehouse worker has acute low back pain, new urinary retention, saddle
anesthesia, and bilateral leg weakness. Which diagnosis must be ruled out immediately?
A. Mechanical lumbar strain
B. Piriformis syndrome
C. Cauda equina syndrome requiring emergent MRI and surgical consultation
D. Uncomplicated sciatica managed with home exercise
Correct answer: C. Cauda equina syndrome requiring emergent MRI and surgical consultation
Rationale: Urinary retention, saddle anesthesia, and bilateral neurologic deficits are classic
cauda equina red flags. Emergent MRI and neurosurgical evaluation are required to prevent
permanent neurologic injury. Guideline anchor: AAFP low back pain red flags; emergency
neurosurgical standards.
,5. A 27-year-old with 7 weeks of amenorrhea has unilateral pelvic pain, shoulder-tip pain,
dizziness, and a positive urine pregnancy test. Blood pressure is 88/54 mmHg. What is the
safest disposition?
A. Outpatient pelvic ultrasound tomorrow
B. Empiric oral antibiotics for pelvic inflammatory disease
C. Immediate ED transfer for suspected ruptured ectopic pregnancy
D. Reassurance and repeat pregnancy test in one week
Correct answer: C. Immediate ED transfer for suspected ruptured ectopic pregnancy
Rationale: Hemodynamic instability with early pregnancy and unilateral pain suggests
ruptured ectopic pregnancy. The patient needs ED resuscitation, quantitative beta-hCG,
transvaginal ultrasound, and urgent OB/GYN management. Guideline anchor: ACOG ectopic
pregnancy guidance; emergency obstetric triage.
6. A 74-year-old has new unilateral temporal headache, scalp tenderness, jaw
claudication, and transient blurred vision. ESR and CRP are pending. What should the NP
do?
A. Wait for temporal artery biopsy before treatment
B. Begin high-dose glucocorticoids immediately and arrange urgent ophthalmology/rheumatology
evaluation
C. Treat with ibuprofen and follow up in one month
D. Order sinus radiographs and prescribe amoxicillin
Correct answer: B. Begin high-dose glucocorticoids immediately and arrange urgent
ophthalmology/rheumatology evaluation
Rationale: Suspected giant cell arteritis threatens irreversible vision loss; steroids should
begin immediately when clinical suspicion is high, before biopsy confirmation. ESR/CRP and
temporal artery imaging/biopsy support diagnosis but should not delay treatment. Guideline
anchor: ACR/Vasculitis Foundation guidance; AAFP headache in older adults.
7. A 63-year-old has severe unilateral eye pain, headache, halos around lights, mid-dilated
pupil, and nausea. Visual acuity is decreased. What is the most appropriate action?
A. Start artificial tears and schedule routine optometry
B. Treat as conjunctivitis with topical antibiotics
C. Send urgently to the ED/ophthalmology for acute angle-closure glaucoma management
D. Patch the eye and reassess in 48 hours
Correct answer: C. Send urgently to the ED/ophthalmology for acute angle-closure glaucoma
management
Rationale: Painful red eye with halos, nausea, and a fixed mid-dilated pupil is acute angle-
closure glaucoma. Vision-saving treatment requires immediate pressure-lowering therapy by
emergency/ophthalmology services. Guideline anchor: AAO emergency ophthalmology
guidance; primary care red-eye algorithms.
8. A 19-year-old develops diffuse urticaria, wheezing, throat tightness, and hypotension
minutes after eating peanuts. What medication is first-line?
A. Diphenhydramine orally
B. Albuterol only
C. Intramuscular epinephrine in the mid-outer thigh
D. Methylprednisolone orally
Correct answer: C. Intramuscular epinephrine in the mid-outer thigh
Rationale: Anaphylaxis is treated first with IM epinephrine; antihistamines and steroids are
adjuncts and do not reverse airway edema or shock. Delayed epinephrine increases morbidity
and mortality. Guideline anchor: AAAAI/ACAAI anaphylaxis practice parameter; emergency
care standards.
9. A college student presents with fever, severe headache, neck stiffness, photophobia, and
a petechial rash. What should the primary care clinician do?
A. Give oral amoxicillin and send home
, B. Send by EMS to the ED for droplet precautions, blood cultures, and immediate IV antimicrobials
C. Perform spinal manipulation for neck pain
D. Schedule outpatient lumbar puncture next week
Correct answer: B. Send by EMS to the ED for droplet precautions, blood cultures, and
immediate IV antimicrobials
Rationale: Fever, meningismus, and petechiae suggest meningococcemia/meningitis, a life-
threatening infection. ED transfer, isolation, cultures, and prompt empiric IV antibiotics are
indicated. Guideline anchor: IDSA bacterial meningitis guidance; CDC meningococcal disease
guidance.
10. An 82-year-old with diabetes has confusion, fever, dysuria, respiratory rate 26/min,
BP 86/50 mmHg, and cool extremities. What is the priority?
A. Start oral nitrofurantoin and recheck in 48 hours
B. Diagnose delirium only and prescribe haloperidol
C. Activate EMS for suspected sepsis and hypotension
D. Advise increased fluids at home
Correct answer: C. Activate EMS for suspected sepsis and hypotension
Rationale: Infection plus hypotension, tachypnea, and altered mentation indicates possible
sepsis/shock. Primary care should initiate urgent transfer for fluids, cultures, lactate
assessment, and IV antibiotics. Guideline anchor: Surviving Sepsis Campaign; geriatric
emergency triage standards.
11. A 36-year-old has worsening abdominal pain, rigid abdomen, rebound tenderness,
fever, and tachycardia. What is the most appropriate plan?
A. Oral laxative and outpatient follow-up
B. Immediate ED transfer for surgical abdomen evaluation
C. Begin a proton pump inhibitor and observe
D. Schedule elective abdominal ultrasound in two weeks
Correct answer: B. Immediate ED transfer for surgical abdomen evaluation
Rationale: Peritoneal signs indicate a possible perforation, ischemia, appendicitis, or other
surgical emergency. The patient needs ED imaging, labs, resuscitation, and surgical
consultation. Guideline anchor: AAFP acute abdominal pain evaluation; emergency surgery
principles.
12. A 31-year-old postpartum patient has unilateral calf swelling, warmth, tenderness, and
dyspnea on exertion. What is the best next step?
A. Massage the calf and prescribe NSAIDs
B. Order outpatient D-dimer only and wait for results
C. Urgent ED evaluation for venous thromboembolism with compression ultrasound/PE assessment
D. Reassure because postpartum edema is normal
Correct answer: C. Urgent ED evaluation for venous thromboembolism with compression
ultrasound/PE assessment
Rationale: Postpartum status is hypercoagulable, and unilateral leg findings with dyspnea
raise concern for DVT and pulmonary embolism. Urgent imaging and anticoagulation
decisions are needed. Guideline anchor: ACCP/CHEST VTE guidance; obstetric VTE safety
standards.
13. A 29-year-old using combined oral contraceptives has pleuritic chest pain, hemoptysis,
tachycardia, and oxygen saturation of 91%. What should the NP do?
A. Treat costochondritis with ibuprofen
B. Send to the ED for pulmonary embolism evaluation and stabilization
C. Prescribe azithromycin for bronchitis
D. Perform spirometry before making a decision
Correct answer: B. Send to the ED for pulmonary embolism evaluation and stabilization
Rationale: Hypoxemia, pleuritic pain, tachycardia, hemoptysis, and estrogen exposure are
concerning for PE. ED evaluation allows risk stratification, CT pulmonary angiography/VQ
