NR511 Week 4 Midterm
Exam
Chamberlain University | 2026 | Verified Answers with Detailed
Rationales
1. A 68-year-old male with a history of benign prostatic hyperplasia presents with
a 2-day history of suprapubic pain and inability to void. On exam, he has a
distended bladder. What is the most appropriate initial intervention?
A) Alpha-blocker therapy
B) Urinary catheterization
C) Transurethral resection of the prostate
D) Antibiotic therapy
Correct Answer: B) Urinary catheterization
Rationale: Acute urinary retention with pain requires immediate bladder decompression.
Catheterization relieves obstruction and prevents complications. Alpha-blockers are
adjunctive but not emergent; TURP is surgical; antibiotics are not indicated without
infection .
2. A 58-year-old female presents with a 3-month history of progressive fatigue,
weight gain, and cold intolerance. She also reports constipation and dry skin. TSH
is 15.8 mIU/L. What is the most likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Adrenal insufficiency
D) Diabetes mellitus
,Correct Answer: B) Hypothyroidism
Rationale: Fatigue, weight gain, cold intolerance, constipation, and dry skin with elevated
TSH are classic for primary hypothyroidism. Hyperthyroidism presents with weight loss
and heat intolerance; adrenal insufficiency presents with hypotension; diabetes presents
with polyuria .
3. A 45-year-old male with no significant medical history presents with acute onset
of severe right flank pain radiating to the groin, accompanied by nausea.
Urinalysis shows gross hematuria. Which of the following is the most appropriate
initial imaging study?
A) Abdominal X-ray (KUB)
B) Non-contrast CT scan
C) Renal ultrasound
D) MRI
Correct Answer: B) Non-contrast CT scan
Rationale: Non-contrast CT is the gold standard for diagnosing nephrolithiasis. It has high
sensitivity for detecting stones of all sizes. KUB has lower sensitivity; ultrasound is used in
pregnant patients; MRI is not routinely used for stone detection .
4. A 52-year-old male with a history of hypertension and hyperlipidemia presents
with acute onset of substernal chest pain, diaphoresis, and shortness of breath.
ECG shows ST-segment elevation in leads II, III, and aVF. Which of the following is
the most likely location of the infarction?
A) Anterior wall
B) Inferior wall
C) Lateral wall
D) Posterior wall
Correct Answer: B) Inferior wall
Rationale: ST elevation in leads II, III, and aVF indicates inferior wall myocardial infarction,
which is typically caused by occlusion of the right coronary artery. Anterior wall involves
V1-V4; lateral wall involves I, aVL, V5-V6; posterior wall involves reciprocal changes .
,5. A 62-year-old female with a history of osteoporosis presents with sudden onset
of severe back pain after bending over to pick up a newspaper. She is unable to
stand. What is the most likely diagnosis?
A) Lumbar muscle strain
B) Vertebral compression fracture
C) Herniated nucleus pulposus
D) Lumbar spinal stenosis
Correct Answer: B) Vertebral compression fracture
Rationale: Acute back pain after minor trauma in a patient with osteoporosis is classic for
vertebral compression fracture. The inability to stand supports this diagnosis. Muscle strain
typically does not cause inability to stand; herniated disc causes radicular symptoms;
spinal stenosis is chronic .
6. A 38-year-old female with a history of systemic lupus erythematosus presents
with a 1-week history of progressive weakness in her right hand. On exam, she has
wrist drop and decreased sensation in the radial nerve distribution. Which of the
following is the most likely diagnosis?
A) Carpal tunnel syndrome
B) Rheumatoid arthritis
C) Lupus vasculitis causing mononeuritis multiplex
D) Cervical radiculopathy
Correct Answer: C) Lupus vasculitis causing mononeuritis multiplex
Rationale: Mononeuritis multiplex in a patient with SLE suggests vasculitis causing
peripheral nerve ischemia. Carpal tunnel causes median nerve symptoms; rheumatoid
arthritis causes joint pain; cervical radiculopathy causes neck pain .
7. A 55-year-old male with a 40-pack-year smoking history presents with a 3-
month history of progressive hoarseness and a sensation of a lump in the throat.
Which of the following is the most appropriate initial diagnostic step?
, A) CT scan of the neck
B) Laryngoscopy
C) Barium swallow
D) Ultrasound of the thyroid
Correct Answer: B) Laryngoscopy
Rationale: Hoarseness with a history of smoking requires direct visualization of the larynx
to rule out malignancy. Laryngoscopy is the initial diagnostic step .
8. A 28-year-old pregnant woman at 34 weeks gestation presents with headache,
visual changes, and epigastric pain. Blood pressure is 160/100 mm Hg. Urinalysis
shows 3+ protein. Which of the following is the most appropriate management?
A) Outpatient monitoring with home blood pressure checks
B) Admission for magnesium sulfate and antihypertensive therapy
C) Immediate delivery
D) Oral labetalol and discharge
Correct Answer: B) Admission for magnesium sulfate and antihypertensive therapy
Rationale: Preeclampsia with severe features requires hospital admission for seizure
prophylaxis with magnesium sulfate and blood pressure control. Outpatient management
is not appropriate; immediate delivery is not indicated unless there are severe features or
gestational age ≥37 weeks .
9. A 62-year-old male with a history of diabetes presents with a 2-day history of
right foot pain, swelling, and erythema. The foot is warm to the touch. Which of
the following is the most important initial diagnostic test?
A) MRI of the foot
B) Plain radiograph
C) Bone scan
D) Duplex ultrasound
Correct Answer: B) Plain radiograph
Rationale: Plain radiograph is the initial imaging study to evaluate for osteomyelitis,
Charcot arthropathy, or foreign bodies in the diabetic foot .
Exam
Chamberlain University | 2026 | Verified Answers with Detailed
Rationales
1. A 68-year-old male with a history of benign prostatic hyperplasia presents with
a 2-day history of suprapubic pain and inability to void. On exam, he has a
distended bladder. What is the most appropriate initial intervention?
A) Alpha-blocker therapy
B) Urinary catheterization
C) Transurethral resection of the prostate
D) Antibiotic therapy
Correct Answer: B) Urinary catheterization
Rationale: Acute urinary retention with pain requires immediate bladder decompression.
Catheterization relieves obstruction and prevents complications. Alpha-blockers are
adjunctive but not emergent; TURP is surgical; antibiotics are not indicated without
infection .
2. A 58-year-old female presents with a 3-month history of progressive fatigue,
weight gain, and cold intolerance. She also reports constipation and dry skin. TSH
is 15.8 mIU/L. What is the most likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Adrenal insufficiency
D) Diabetes mellitus
,Correct Answer: B) Hypothyroidism
Rationale: Fatigue, weight gain, cold intolerance, constipation, and dry skin with elevated
TSH are classic for primary hypothyroidism. Hyperthyroidism presents with weight loss
and heat intolerance; adrenal insufficiency presents with hypotension; diabetes presents
with polyuria .
3. A 45-year-old male with no significant medical history presents with acute onset
of severe right flank pain radiating to the groin, accompanied by nausea.
Urinalysis shows gross hematuria. Which of the following is the most appropriate
initial imaging study?
A) Abdominal X-ray (KUB)
B) Non-contrast CT scan
C) Renal ultrasound
D) MRI
Correct Answer: B) Non-contrast CT scan
Rationale: Non-contrast CT is the gold standard for diagnosing nephrolithiasis. It has high
sensitivity for detecting stones of all sizes. KUB has lower sensitivity; ultrasound is used in
pregnant patients; MRI is not routinely used for stone detection .
4. A 52-year-old male with a history of hypertension and hyperlipidemia presents
with acute onset of substernal chest pain, diaphoresis, and shortness of breath.
ECG shows ST-segment elevation in leads II, III, and aVF. Which of the following is
the most likely location of the infarction?
A) Anterior wall
B) Inferior wall
C) Lateral wall
D) Posterior wall
Correct Answer: B) Inferior wall
Rationale: ST elevation in leads II, III, and aVF indicates inferior wall myocardial infarction,
which is typically caused by occlusion of the right coronary artery. Anterior wall involves
V1-V4; lateral wall involves I, aVL, V5-V6; posterior wall involves reciprocal changes .
,5. A 62-year-old female with a history of osteoporosis presents with sudden onset
of severe back pain after bending over to pick up a newspaper. She is unable to
stand. What is the most likely diagnosis?
A) Lumbar muscle strain
B) Vertebral compression fracture
C) Herniated nucleus pulposus
D) Lumbar spinal stenosis
Correct Answer: B) Vertebral compression fracture
Rationale: Acute back pain after minor trauma in a patient with osteoporosis is classic for
vertebral compression fracture. The inability to stand supports this diagnosis. Muscle strain
typically does not cause inability to stand; herniated disc causes radicular symptoms;
spinal stenosis is chronic .
6. A 38-year-old female with a history of systemic lupus erythematosus presents
with a 1-week history of progressive weakness in her right hand. On exam, she has
wrist drop and decreased sensation in the radial nerve distribution. Which of the
following is the most likely diagnosis?
A) Carpal tunnel syndrome
B) Rheumatoid arthritis
C) Lupus vasculitis causing mononeuritis multiplex
D) Cervical radiculopathy
Correct Answer: C) Lupus vasculitis causing mononeuritis multiplex
Rationale: Mononeuritis multiplex in a patient with SLE suggests vasculitis causing
peripheral nerve ischemia. Carpal tunnel causes median nerve symptoms; rheumatoid
arthritis causes joint pain; cervical radiculopathy causes neck pain .
7. A 55-year-old male with a 40-pack-year smoking history presents with a 3-
month history of progressive hoarseness and a sensation of a lump in the throat.
Which of the following is the most appropriate initial diagnostic step?
, A) CT scan of the neck
B) Laryngoscopy
C) Barium swallow
D) Ultrasound of the thyroid
Correct Answer: B) Laryngoscopy
Rationale: Hoarseness with a history of smoking requires direct visualization of the larynx
to rule out malignancy. Laryngoscopy is the initial diagnostic step .
8. A 28-year-old pregnant woman at 34 weeks gestation presents with headache,
visual changes, and epigastric pain. Blood pressure is 160/100 mm Hg. Urinalysis
shows 3+ protein. Which of the following is the most appropriate management?
A) Outpatient monitoring with home blood pressure checks
B) Admission for magnesium sulfate and antihypertensive therapy
C) Immediate delivery
D) Oral labetalol and discharge
Correct Answer: B) Admission for magnesium sulfate and antihypertensive therapy
Rationale: Preeclampsia with severe features requires hospital admission for seizure
prophylaxis with magnesium sulfate and blood pressure control. Outpatient management
is not appropriate; immediate delivery is not indicated unless there are severe features or
gestational age ≥37 weeks .
9. A 62-year-old male with a history of diabetes presents with a 2-day history of
right foot pain, swelling, and erythema. The foot is warm to the touch. Which of
the following is the most important initial diagnostic test?
A) MRI of the foot
B) Plain radiograph
C) Bone scan
D) Duplex ultrasound
Correct Answer: B) Plain radiograph
Rationale: Plain radiograph is the initial imaging study to evaluate for osteomyelitis,
Charcot arthropathy, or foreign bodies in the diabetic foot .
