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NR511 Comprehensive End Assessment (CEA) Examination 200
Multiple-Choice Questions Covering Advanced Health
Assessment, Differential Diagnosis, Pathophysiology,
Pharmacology, Clinical Decision-Making, and Primary Care
Management Across the Lifespan for Advanced Practice
Nursing Students
SECTION 1: CLINICAL REASONING, ASSESSMENT, AND DIFFERENTIAL DIAGNOSIS (Questions
1–25)
Question 1
A 45-year-old male presents with a 3-week history of progressive weakness, fatigue, and a 10-
pound unintentional weight loss. He reports night sweats and a persistent dry cough. His past
medical history is unremarkable, and he has a 20-pack-year smoking history. Which differential
diagnosis should the nurse practitioner prioritize?
A) Community-acquired pneumonia
B) Lung malignancy
C) Gastroesophageal reflux disease
D) Viral upper respiratory infection
,2
Correct Answer: B
Rationale: This patient presents with constitutional symptoms (weight loss, fatigue, night
sweats) along with a persistent cough in a smoker, which raises concern for lung malignancy.
Pneumonia typically presents more acutely with fever and productive cough. GERD and viral
URI would not explain the systemic symptoms or weight loss.
Question 2
A 32-year-old female presents with complaints of bilateral hand pain, stiffness, and swelling
that is worse in the morning and lasts for more than one hour. She also reports fatigue and
occasional low-grade fever. Which condition is most consistent with this presentation?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Carpal tunnel syndrome
D) Gout
Correct Answer: B
,3
Rationale: Rheumatoid arthritis is an autoimmune inflammatory condition characterized by
symmetric joint pain, swelling, and morning stiffness lasting more than one hour. Osteoarthritis
typically involves asymmetric joint pain that worsens with use and improves with rest, with
stiffness lasting less than 30 minutes. Carpal tunnel syndrome causes paresthesias in the
median nerve distribution, and gout typically presents with acute monoarticular pain.
Question 3
A 55-year-old patient with a history of hypertension and type 2 diabetes presents with a 2-day
history of severe, crushing substernal chest pain that radiates to the left arm, accompanied by
diaphoresis and nausea. The pain began at rest and is not relieved by nitroglycerin. What is the
most appropriate initial diagnostic test?
A) Chest X-ray
B) Troponin and 12-lead ECG
C) Complete blood count
D) D-dimer
Correct Answer: B
, 4
Rationale: This patient's presentation is concerning for acute myocardial infarction. The most
appropriate initial diagnostic tests are a 12-lead ECG to evaluate for ST-segment elevation and
cardiac troponin to detect myocardial injury. Chest X-ray is not diagnostic for acute MI, and D-
dimer is used for pulmonary embolism evaluation.
Question 4
A 28-year-old female presents with a 6-month history of intermittent episodes of palpitations,
sweating, tremors, and anxiety. She reports that these episodes occur spontaneously and are
associated with a feeling of impending doom. Between episodes, she feels well. What is the
most likely diagnosis?
A) Generalized anxiety disorder
B) Panic disorder
C) Hyperthyroidism
D) Pheochromocytoma
Correct Answer: B
Rationale: Panic disorder is characterized by recurrent, unexpected panic attacks with
symptoms including palpitations, sweating, tremors, and fear of losing control or dying. The
NR511 Comprehensive End Assessment (CEA) Examination 200
Multiple-Choice Questions Covering Advanced Health
Assessment, Differential Diagnosis, Pathophysiology,
Pharmacology, Clinical Decision-Making, and Primary Care
Management Across the Lifespan for Advanced Practice
Nursing Students
SECTION 1: CLINICAL REASONING, ASSESSMENT, AND DIFFERENTIAL DIAGNOSIS (Questions
1–25)
Question 1
A 45-year-old male presents with a 3-week history of progressive weakness, fatigue, and a 10-
pound unintentional weight loss. He reports night sweats and a persistent dry cough. His past
medical history is unremarkable, and he has a 20-pack-year smoking history. Which differential
diagnosis should the nurse practitioner prioritize?
A) Community-acquired pneumonia
B) Lung malignancy
C) Gastroesophageal reflux disease
D) Viral upper respiratory infection
,2
Correct Answer: B
Rationale: This patient presents with constitutional symptoms (weight loss, fatigue, night
sweats) along with a persistent cough in a smoker, which raises concern for lung malignancy.
Pneumonia typically presents more acutely with fever and productive cough. GERD and viral
URI would not explain the systemic symptoms or weight loss.
Question 2
A 32-year-old female presents with complaints of bilateral hand pain, stiffness, and swelling
that is worse in the morning and lasts for more than one hour. She also reports fatigue and
occasional low-grade fever. Which condition is most consistent with this presentation?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Carpal tunnel syndrome
D) Gout
Correct Answer: B
,3
Rationale: Rheumatoid arthritis is an autoimmune inflammatory condition characterized by
symmetric joint pain, swelling, and morning stiffness lasting more than one hour. Osteoarthritis
typically involves asymmetric joint pain that worsens with use and improves with rest, with
stiffness lasting less than 30 minutes. Carpal tunnel syndrome causes paresthesias in the
median nerve distribution, and gout typically presents with acute monoarticular pain.
Question 3
A 55-year-old patient with a history of hypertension and type 2 diabetes presents with a 2-day
history of severe, crushing substernal chest pain that radiates to the left arm, accompanied by
diaphoresis and nausea. The pain began at rest and is not relieved by nitroglycerin. What is the
most appropriate initial diagnostic test?
A) Chest X-ray
B) Troponin and 12-lead ECG
C) Complete blood count
D) D-dimer
Correct Answer: B
, 4
Rationale: This patient's presentation is concerning for acute myocardial infarction. The most
appropriate initial diagnostic tests are a 12-lead ECG to evaluate for ST-segment elevation and
cardiac troponin to detect myocardial injury. Chest X-ray is not diagnostic for acute MI, and D-
dimer is used for pulmonary embolism evaluation.
Question 4
A 28-year-old female presents with a 6-month history of intermittent episodes of palpitations,
sweating, tremors, and anxiety. She reports that these episodes occur spontaneously and are
associated with a feeling of impending doom. Between episodes, she feels well. What is the
most likely diagnosis?
A) Generalized anxiety disorder
B) Panic disorder
C) Hyperthyroidism
D) Pheochromocytoma
Correct Answer: B
Rationale: Panic disorder is characterized by recurrent, unexpected panic attacks with
symptoms including palpitations, sweating, tremors, and fear of losing control or dying. The
