NR511 Week 4 Midterm Exam – Complete Questions 1-
250
Chamberlain University | 2026 | Verified Answers with Detailed
Rationales
1. A 55-year-old female with a history of hypertension and type 2 diabetes
presents with progressive swelling in her lower extremities over the past month.
She reports that the swelling is worse at the end of the day and improves with
elevation. Which of the following is the most likely diagnosis?
A) Lymphedema
B) Chronic venous insufficiency
C) Heart failure
D) Nephrotic syndrome
Correct Answer: B) Chronic venous insufficiency
Rationale: Chronic venous insufficiency typically presents with bilateral lower extremity
edema that worsens with prolonged standing and improves with elevation. Lymphedema
is typically unilateral and does not improve with elevation. Heart failure would present
with other signs like dyspnea; nephrotic syndrome would have significant proteinuria .
2. A 68-year-old man with a history of coronary artery disease presents with a 2-
day history of progressive dyspnea, orthopnea, and paroxysmal nocturnal
dyspnea. On exam, JVP is elevated, and crackles are heard in both lung bases.
Which of the following is the most appropriate initial pharmacotherapy?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Correct Answer: B) Furosemide
Rationale: Acute decompensated heart failure with volume overload requires diuresis with
a loop diuretic such as furosemide to relieve pulmonary congestion. Digoxin is used for
,rate control in atrial fibrillation; metoprolol is for chronic management; spironolactone is
an adjunctive therapy .
3. A 62-year-old woman with a history of osteoarthritis presents with acute onset
of severe right knee pain. She reports that the joint is swollen, warm, and tender.
Joint aspiration reveals 40,000 WBCs with negatively birefringent crystals. Which
of the following is the most likely diagnosis?
A) Gout
B) Pseudogout
C) Septic arthritis
D) Osteoarthritis
Correct Answer: A) Gout
Rationale: Negatively birefringent, needle-shaped crystals are characteristic of gout.
Pseudogout has positively birefringent, rhomboid-shaped crystals. Septic arthritis typically
has >50,000 WBCs; osteoarthritis does not typically cause acute inflammation with
crystals .
4. A 45-year-old woman presents with a 3-week history of fatigue, low-grade
fever, and generalized joint pain. She also reports a rash on her cheeks that
worsens with sun exposure. Which of the following is the most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus
C) Sjögren syndrome
D) Psoriatic arthritis
Correct Answer: B) Systemic lupus erythematosus
Rationale: Malar rash with photosensitivity, fatigue, and arthralgias in a young woman is
classic for SLE. Rheumatoid arthritis typically involves symmetrical joint swelling without
rash; Sjögren syndrome features dry eyes/mouth; psoriatic arthritis has skin lesions .
,5. A 58-year-old man with a 40-pack-year smoking history presents with a 2-
month history of hoarseness and a persistent sore throat. Which of the following is
the most appropriate initial diagnostic test?
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 .
6. A 32-year-old pregnant woman at 28 weeks gestation presents with a 1-day
history of headache, visual changes, and epigastric pain. Blood pressure is 155/95
mm Hg. Urinalysis shows 2+ 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 .
7. A 50-year-old man with a history of hypertension presents with a 2-week history
of acute onset of chest pain, dyspnea, and palpitations. ECG shows atrial
fibrillation with rapid ventricular response. Which of the following is the most
appropriate initial rate control agent?
A) Amiodarone
B) Metoprolol
, C) Digoxin
D) Diltiazem
Correct Answer: B) Metoprolol
Rationale: Beta-blockers such as metoprolol are first-line for rate control in atrial
fibrillation. Diltiazem (calcium channel blocker) is also used, but metoprolol is preferred in
patients with coronary artery disease. Amiodarone is for rhythm control; digoxin is less
effective for acute rate control .
8. A 65-year-old woman with a history of osteoporosis presents with acute onset
of severe back pain after lifting a heavy box. She is unable to stand. Which of the
following is the most likely diagnosis?
A) Lumbar strain
B) Vertebral compression fracture
C) Herniated disc
D) 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. Inability to stand and severe pain are consistent with this
diagnosis .
9. A 42-year-old man with a history of alcohol use disorder presents with acute
onset of severe epigastric pain radiating to the back. He reports nausea and
vomiting. Which of the following is the most likely diagnosis?
A) Cholecystitis
B) Acute pancreatitis
C) Perforated ulcer
D) Gastritis
Correct Answer: B) Acute pancreatitis
Rationale: Severe epigastric pain radiating to the back with nausea and vomiting in a
patient with alcohol use disorder is classic for acute pancreatitis. Alcohol and gallstones
are the two most common causes .
250
Chamberlain University | 2026 | Verified Answers with Detailed
Rationales
1. A 55-year-old female with a history of hypertension and type 2 diabetes
presents with progressive swelling in her lower extremities over the past month.
She reports that the swelling is worse at the end of the day and improves with
elevation. Which of the following is the most likely diagnosis?
A) Lymphedema
B) Chronic venous insufficiency
C) Heart failure
D) Nephrotic syndrome
Correct Answer: B) Chronic venous insufficiency
Rationale: Chronic venous insufficiency typically presents with bilateral lower extremity
edema that worsens with prolonged standing and improves with elevation. Lymphedema
is typically unilateral and does not improve with elevation. Heart failure would present
with other signs like dyspnea; nephrotic syndrome would have significant proteinuria .
2. A 68-year-old man with a history of coronary artery disease presents with a 2-
day history of progressive dyspnea, orthopnea, and paroxysmal nocturnal
dyspnea. On exam, JVP is elevated, and crackles are heard in both lung bases.
Which of the following is the most appropriate initial pharmacotherapy?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Correct Answer: B) Furosemide
Rationale: Acute decompensated heart failure with volume overload requires diuresis with
a loop diuretic such as furosemide to relieve pulmonary congestion. Digoxin is used for
,rate control in atrial fibrillation; metoprolol is for chronic management; spironolactone is
an adjunctive therapy .
3. A 62-year-old woman with a history of osteoarthritis presents with acute onset
of severe right knee pain. She reports that the joint is swollen, warm, and tender.
Joint aspiration reveals 40,000 WBCs with negatively birefringent crystals. Which
of the following is the most likely diagnosis?
A) Gout
B) Pseudogout
C) Septic arthritis
D) Osteoarthritis
Correct Answer: A) Gout
Rationale: Negatively birefringent, needle-shaped crystals are characteristic of gout.
Pseudogout has positively birefringent, rhomboid-shaped crystals. Septic arthritis typically
has >50,000 WBCs; osteoarthritis does not typically cause acute inflammation with
crystals .
4. A 45-year-old woman presents with a 3-week history of fatigue, low-grade
fever, and generalized joint pain. She also reports a rash on her cheeks that
worsens with sun exposure. Which of the following is the most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus
C) Sjögren syndrome
D) Psoriatic arthritis
Correct Answer: B) Systemic lupus erythematosus
Rationale: Malar rash with photosensitivity, fatigue, and arthralgias in a young woman is
classic for SLE. Rheumatoid arthritis typically involves symmetrical joint swelling without
rash; Sjögren syndrome features dry eyes/mouth; psoriatic arthritis has skin lesions .
,5. A 58-year-old man with a 40-pack-year smoking history presents with a 2-
month history of hoarseness and a persistent sore throat. Which of the following is
the most appropriate initial diagnostic test?
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 .
6. A 32-year-old pregnant woman at 28 weeks gestation presents with a 1-day
history of headache, visual changes, and epigastric pain. Blood pressure is 155/95
mm Hg. Urinalysis shows 2+ 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 .
7. A 50-year-old man with a history of hypertension presents with a 2-week history
of acute onset of chest pain, dyspnea, and palpitations. ECG shows atrial
fibrillation with rapid ventricular response. Which of the following is the most
appropriate initial rate control agent?
A) Amiodarone
B) Metoprolol
, C) Digoxin
D) Diltiazem
Correct Answer: B) Metoprolol
Rationale: Beta-blockers such as metoprolol are first-line for rate control in atrial
fibrillation. Diltiazem (calcium channel blocker) is also used, but metoprolol is preferred in
patients with coronary artery disease. Amiodarone is for rhythm control; digoxin is less
effective for acute rate control .
8. A 65-year-old woman with a history of osteoporosis presents with acute onset
of severe back pain after lifting a heavy box. She is unable to stand. Which of the
following is the most likely diagnosis?
A) Lumbar strain
B) Vertebral compression fracture
C) Herniated disc
D) 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. Inability to stand and severe pain are consistent with this
diagnosis .
9. A 42-year-old man with a history of alcohol use disorder presents with acute
onset of severe epigastric pain radiating to the back. He reports nausea and
vomiting. Which of the following is the most likely diagnosis?
A) Cholecystitis
B) Acute pancreatitis
C) Perforated ulcer
D) Gastritis
Correct Answer: B) Acute pancreatitis
Rationale: Severe epigastric pain radiating to the back with nausea and vomiting in a
patient with alcohol use disorder is classic for acute pancreatitis. Alcohol and gallstones
are the two most common causes .
