NR 603 Week 2 Case Discussion: Pulmonary (Part One) Chamberlain University
NR 603 Week 2 Case Discussion: Pulmonary (Part
One)
Comprehensive Case-Based Examination
Chamberlain University | NR 603 Advanced Pathophysiology/Pharmacology
2026/2027 Edition | Aligned with AACN Essentials and Advanced Practice Nursing Competency Standards
Total Questions 50 Cognitive Distribution 20% Recall / 50% Application / 30% Analysis
Sections 5 Format 80% Scenario-Based / 20% Direct Knowledge
Time Allocation 90 minutes Question Type Multiple Choice (4 options, single best answer)
Instructions to the Candidate: This examination consists of 50 multiple-choice questions divided into five
sections. Each question presents a clinical scenario or knowledge statement followed by four options (A-D).
Select the single best answer for each question. The correct answer is indicated with [CORRECT] and
accompanied by a rationale referencing the Chamberlain NR 603 curriculum and current clinical practice
guidelines including GOLD 2024 (COPD), GINA 2024 (asthma), IDSA/ATS 2019 (pneumonia), and ATS/ERS
standards for interstitial lung disease.
Section 1: Case Presentation & Initial Assessment
Case Presentation: Mr. R is a 68-year-old male with a 45 pack-year smoking history who presents with
progressive dyspnea on exertion over six months. He reports a chronic productive cough and intermittent
wheezing. Vitals: BP 138/86, HR 92, RR 22, SpO2 92% on room air.
Q1: Mr. R, a 68-year-old male, presents with progressive dyspnea on exertion worsening over
six months. He reports occasional wheezing and a chronic productive cough. As the
advanced practice nurse initiating the encounter, which element of the history of present
illness (HPI) is MOST critical to elicit for guiding the subsequent pulmonary workup?
A. Onset, location, duration, characteristics, aggravating/alleviating factors, radiation,
and timing (OLD CART) of the dyspnea [CORRECT]
B. Past surgical history and any prior anesthesia complications
C. Family history of coronary artery disease in first-degree relatives
D. Review of systems for gastroesophageal reflux disease
Correct Answer: A
Rationale: The OLD CART framework is the gold standard for characterizing dyspnea in pulmonary
evaluation per the Chamberlain NR 603 curriculum and AACN Essentials. While past surgical history, family
history, and ROS contribute to a comprehensive encounter, the HPI must first establish the temporal
pattern, characteristics, and aggravating/alleviating factors of the chief complaint to anchor differential
diagnosis. AACN Essentials emphasize systematic symptom characterization as a foundation for clinical
Advanced Pathophysiology/Pharmacology Page 1 2026/2027 Edition
,NR 603 Week 2 Case Discussion: Pulmonary (Part One) Chamberlain University
reasoning.
Case Presentation: Mrs. K is a 54-year-old female with chronic cough for three months and new-onset
streaky hemoptysis. She has a 30 pack-year smoking history and works as a restaurant server. ROS
reveals she has lost 15 pounds unintentionally over two months and experiences drenching night sweats.
Q2: Mrs. K, a 54-year-old female with a chronic cough of three months' duration, reports
streaky hemoptysis for the past week. Which additional review-of-systems (ROS) finding, if
present, requires URGENT escalation of care and immediate diagnostic workup?
A. Unintentional 15-pound weight loss over two months and drenching night sweats
[CORRECT]
B. Mild occasional wheezing with exercise
C. Clear sputum production in the morning
D. Fatigue at the end of her work shift
Correct Answer: A
Rationale: The combination of hemoptysis with constitutional B-symptoms (weight loss, night sweats)
strongly suggests pulmonary malignancy or tuberculosis, mandating urgent imaging and tissue sampling
per ATS guidelines. Chamberlain NR 603 emphasizes recognizing red-flag presentations that shift the
differential toward life-threatening etiologies. Wheezing, clear morning sputum, and end-of-day fatigue are
chronic lower-acuity findings that do not require urgent escalation.
Case Presentation: Mr. T is a 62-year-old male with COPD (FEV1 55% predicted) presenting for routine
follow-up. He reports two hospitalizations for COPD exacerbations in the past year, both requiring
systemic corticosteroids. PMH includes remote appendectomy, seasonal allergic rhinitis, and
well-controlled hypothyroidism.
Q3: Mr. T, a 62-year-old male with established COPD, presents for routine follow-up. Which
past medical history finding MOST significantly impacts his pulmonary prognosis and guides
pharmacologic decision-making?
A. Two prior COPD exacerbations requiring hospitalization in the past year [CORRECT]
B. Remote appendectomy at age 25
C. Seasonal allergic rhinitis managed with cetirizine
D. Well-controlled hypothyroidism on levothyroxine
Correct Answer: A
Rationale: Per the GOLD 2024 report, two or more exacerbations in the prior year (or one leading to
hospitalization) place the patient in Group E (high exacerbation risk), mandating escalation to dual
bronchodilator therapy (LAMA + LABA). Chamberlain NR 603 integrates GOLD classification directly into
pharmacologic decision-making. Appendectomy, allergic rhinitis, and stable hypothyroidism do not
independently alter COPD prognosis or therapy selection.
Case Presentation: Mrs. L is a 45-year-old female who reports progressive dyspnea and dry cough over
18 months. She has never smoked and works as a schoolteacher. Her father was diagnosed with
idiopathic pulmonary fibrosis at age 60 and died at 65 from respiratory failure.
Advanced Pathophysiology/Pharmacology Page 2 2026/2027 Edition
, NR 603 Week 2 Case Discussion: Pulmonary (Part One) Chamberlain University
Q4: Mrs. L, a 45-year-old female, presents with chronic progressive dyspnea and dry cough.
Which family history finding raises the strongest suspicion for familial pulmonary fibrosis and
prompts genetic counseling discussion?
A. Father diagnosed with idiopathic pulmonary fibrosis at age 60 [CORRECT]
B. Mother with postmenopausal osteoporosis
C. Sibling with type 2 diabetes mellitus
D. Paternal aunt with hypertension
Correct Answer: A
Rationale: A first-degree relative with idiopathic pulmonary fibrosis (IPF) suggests familial pulmonary
fibrosis, which carries autosomal dominant inheritance patterns involving telomerase mutations (TERT,
TERC) or surfactant protein mutations (SFTPC, SFTPA2) per ATS/ERS guidelines. Chamberlain NR 603
incorporates genetic predisposition into differential reasoning. Osteoporosis, diabetes, and hypertension are
not pulmonary fibrosis risk factors.
Case Presentation: Mr. J is a 50-year-old male presenting for a wellness visit. He reports smoking 1.5
packs per day for 30 years. He has no current respiratory complaints but is interested in lung cancer
screening. Vitals are within normal limits.
Q5: Mr. J, a 50-year-old male smoker, reports smoking 1.5 packs per day for 30 years. What is
his pack-year history, and what screening implication does this carry?
A. 45 pack-years; meets USPSTF criteria for annual low-dose chest CT screening
[CORRECT]
B. 30 pack-years; no screening indicated
C. 15 pack-years; screening not indicated until age 55
D. 60 pack-years; screening contraindicated due to comorbidities
Correct Answer: A
Rationale: Pack-years = packs per day multiplied by years smoked = 1.5 x 30 = 45 pack-years.
Chamberlain NR 603 requires accurate calculation because >=20 pack-years within the USPSTF age
window (50-80 years) qualifies for annual low-dose CT lung cancer screening. Heavy smoking history also
heightens suspicion for COPD and warrant spirometry evaluation.
Case Presentation: Mr. B is a 55-year-old male who worked in a shipyard from age 20 to 45. He presents
with progressive dyspnea over two years and new pleuritic chest pain. Chest X-ray reveals bilateral
pleural plaques and a right pleural-based mass.
Q6: Mr. B, a 55-year-old former shipyard worker, presents with progressive dyspnea and
pleuritic chest pain. Which occupational exposure is MOST concerning and warrants
investigation for mesothelioma?
A. Asbestos exposure [CORRECT]
B. Cotton dust exposure
C. Silica exposure
D. Coal dust exposure
Advanced Pathophysiology/Pharmacology Page 3 2026/2027 Edition
NR 603 Week 2 Case Discussion: Pulmonary (Part
One)
Comprehensive Case-Based Examination
Chamberlain University | NR 603 Advanced Pathophysiology/Pharmacology
2026/2027 Edition | Aligned with AACN Essentials and Advanced Practice Nursing Competency Standards
Total Questions 50 Cognitive Distribution 20% Recall / 50% Application / 30% Analysis
Sections 5 Format 80% Scenario-Based / 20% Direct Knowledge
Time Allocation 90 minutes Question Type Multiple Choice (4 options, single best answer)
Instructions to the Candidate: This examination consists of 50 multiple-choice questions divided into five
sections. Each question presents a clinical scenario or knowledge statement followed by four options (A-D).
Select the single best answer for each question. The correct answer is indicated with [CORRECT] and
accompanied by a rationale referencing the Chamberlain NR 603 curriculum and current clinical practice
guidelines including GOLD 2024 (COPD), GINA 2024 (asthma), IDSA/ATS 2019 (pneumonia), and ATS/ERS
standards for interstitial lung disease.
Section 1: Case Presentation & Initial Assessment
Case Presentation: Mr. R is a 68-year-old male with a 45 pack-year smoking history who presents with
progressive dyspnea on exertion over six months. He reports a chronic productive cough and intermittent
wheezing. Vitals: BP 138/86, HR 92, RR 22, SpO2 92% on room air.
Q1: Mr. R, a 68-year-old male, presents with progressive dyspnea on exertion worsening over
six months. He reports occasional wheezing and a chronic productive cough. As the
advanced practice nurse initiating the encounter, which element of the history of present
illness (HPI) is MOST critical to elicit for guiding the subsequent pulmonary workup?
A. Onset, location, duration, characteristics, aggravating/alleviating factors, radiation,
and timing (OLD CART) of the dyspnea [CORRECT]
B. Past surgical history and any prior anesthesia complications
C. Family history of coronary artery disease in first-degree relatives
D. Review of systems for gastroesophageal reflux disease
Correct Answer: A
Rationale: The OLD CART framework is the gold standard for characterizing dyspnea in pulmonary
evaluation per the Chamberlain NR 603 curriculum and AACN Essentials. While past surgical history, family
history, and ROS contribute to a comprehensive encounter, the HPI must first establish the temporal
pattern, characteristics, and aggravating/alleviating factors of the chief complaint to anchor differential
diagnosis. AACN Essentials emphasize systematic symptom characterization as a foundation for clinical
Advanced Pathophysiology/Pharmacology Page 1 2026/2027 Edition
,NR 603 Week 2 Case Discussion: Pulmonary (Part One) Chamberlain University
reasoning.
Case Presentation: Mrs. K is a 54-year-old female with chronic cough for three months and new-onset
streaky hemoptysis. She has a 30 pack-year smoking history and works as a restaurant server. ROS
reveals she has lost 15 pounds unintentionally over two months and experiences drenching night sweats.
Q2: Mrs. K, a 54-year-old female with a chronic cough of three months' duration, reports
streaky hemoptysis for the past week. Which additional review-of-systems (ROS) finding, if
present, requires URGENT escalation of care and immediate diagnostic workup?
A. Unintentional 15-pound weight loss over two months and drenching night sweats
[CORRECT]
B. Mild occasional wheezing with exercise
C. Clear sputum production in the morning
D. Fatigue at the end of her work shift
Correct Answer: A
Rationale: The combination of hemoptysis with constitutional B-symptoms (weight loss, night sweats)
strongly suggests pulmonary malignancy or tuberculosis, mandating urgent imaging and tissue sampling
per ATS guidelines. Chamberlain NR 603 emphasizes recognizing red-flag presentations that shift the
differential toward life-threatening etiologies. Wheezing, clear morning sputum, and end-of-day fatigue are
chronic lower-acuity findings that do not require urgent escalation.
Case Presentation: Mr. T is a 62-year-old male with COPD (FEV1 55% predicted) presenting for routine
follow-up. He reports two hospitalizations for COPD exacerbations in the past year, both requiring
systemic corticosteroids. PMH includes remote appendectomy, seasonal allergic rhinitis, and
well-controlled hypothyroidism.
Q3: Mr. T, a 62-year-old male with established COPD, presents for routine follow-up. Which
past medical history finding MOST significantly impacts his pulmonary prognosis and guides
pharmacologic decision-making?
A. Two prior COPD exacerbations requiring hospitalization in the past year [CORRECT]
B. Remote appendectomy at age 25
C. Seasonal allergic rhinitis managed with cetirizine
D. Well-controlled hypothyroidism on levothyroxine
Correct Answer: A
Rationale: Per the GOLD 2024 report, two or more exacerbations in the prior year (or one leading to
hospitalization) place the patient in Group E (high exacerbation risk), mandating escalation to dual
bronchodilator therapy (LAMA + LABA). Chamberlain NR 603 integrates GOLD classification directly into
pharmacologic decision-making. Appendectomy, allergic rhinitis, and stable hypothyroidism do not
independently alter COPD prognosis or therapy selection.
Case Presentation: Mrs. L is a 45-year-old female who reports progressive dyspnea and dry cough over
18 months. She has never smoked and works as a schoolteacher. Her father was diagnosed with
idiopathic pulmonary fibrosis at age 60 and died at 65 from respiratory failure.
Advanced Pathophysiology/Pharmacology Page 2 2026/2027 Edition
, NR 603 Week 2 Case Discussion: Pulmonary (Part One) Chamberlain University
Q4: Mrs. L, a 45-year-old female, presents with chronic progressive dyspnea and dry cough.
Which family history finding raises the strongest suspicion for familial pulmonary fibrosis and
prompts genetic counseling discussion?
A. Father diagnosed with idiopathic pulmonary fibrosis at age 60 [CORRECT]
B. Mother with postmenopausal osteoporosis
C. Sibling with type 2 diabetes mellitus
D. Paternal aunt with hypertension
Correct Answer: A
Rationale: A first-degree relative with idiopathic pulmonary fibrosis (IPF) suggests familial pulmonary
fibrosis, which carries autosomal dominant inheritance patterns involving telomerase mutations (TERT,
TERC) or surfactant protein mutations (SFTPC, SFTPA2) per ATS/ERS guidelines. Chamberlain NR 603
incorporates genetic predisposition into differential reasoning. Osteoporosis, diabetes, and hypertension are
not pulmonary fibrosis risk factors.
Case Presentation: Mr. J is a 50-year-old male presenting for a wellness visit. He reports smoking 1.5
packs per day for 30 years. He has no current respiratory complaints but is interested in lung cancer
screening. Vitals are within normal limits.
Q5: Mr. J, a 50-year-old male smoker, reports smoking 1.5 packs per day for 30 years. What is
his pack-year history, and what screening implication does this carry?
A. 45 pack-years; meets USPSTF criteria for annual low-dose chest CT screening
[CORRECT]
B. 30 pack-years; no screening indicated
C. 15 pack-years; screening not indicated until age 55
D. 60 pack-years; screening contraindicated due to comorbidities
Correct Answer: A
Rationale: Pack-years = packs per day multiplied by years smoked = 1.5 x 30 = 45 pack-years.
Chamberlain NR 603 requires accurate calculation because >=20 pack-years within the USPSTF age
window (50-80 years) qualifies for annual low-dose CT lung cancer screening. Heavy smoking history also
heightens suspicion for COPD and warrant spirometry evaluation.
Case Presentation: Mr. B is a 55-year-old male who worked in a shipyard from age 20 to 45. He presents
with progressive dyspnea over two years and new pleuritic chest pain. Chest X-ray reveals bilateral
pleural plaques and a right pleural-based mass.
Q6: Mr. B, a 55-year-old former shipyard worker, presents with progressive dyspnea and
pleuritic chest pain. Which occupational exposure is MOST concerning and warrants
investigation for mesothelioma?
A. Asbestos exposure [CORRECT]
B. Cotton dust exposure
C. Silica exposure
D. Coal dust exposure
Advanced Pathophysiology/Pharmacology Page 3 2026/2027 Edition
