NR 603 Week 2 Case Discussion: Pulmonary (Part One) | Chamberlain University Verified 50 Q&A | Advanced Practice Nursing
NR 603 WEEK 2 CASE DISCUSSION: PULMONARY
(PART ONE)
Complete Questions & Verified Answers
Chamberlain NR 603 | AACN Essentials | Advanced Practice Nursing (2026/2027)
This case-based examination is aligned with Chamberlain University NR 603 Advanced
Pathophysiology/Pharmacology curriculum, AACN Essentials of Master's Education in Nursing, and Advanced
Practice Nursing Competency Standards (2026/2027 Edition). The 50 questions are organized across five core
subject areas: Case Presentation & Initial Assessment, Differential Diagnosis & Diagnostic Reasoning, Diagnostic
Testing & Interpretation, Pathophysiology of Pulmonary Conditions, and Pharmacological & Non-Pharmacological
Management. Each question integrates clinical practice guidelines (GOLD for COPD, GINA for asthma, IDSA/ATS
for pneumonia, NCCN for lung cancer, ESC for pulmonary embolism) and emphasizes clinical reasoning,
differential diagnosis, and case management consistent with advanced practice nursing scope.
Total Questions 50
Time Allotted (Recommended) 75 minutes
Passing Score (Standard) 80% (40/50 correct)
Cognitive Level Mix 20% Recall / 50% Application / 30% Analysis
Question Style 80% Scenario-Based / 20% Direct Knowledge
Special Inclusions 10 Differential Dx / 10 Diagnostic Test / 10 Pharmacologic Management
Examination Structure
Section Subject Area Questions
1 Case Presentation & Initial Assessment 10
2 Differential Diagnosis & Diagnostic Reasoning 10
3 Diagnostic Testing & Interpretation 10
4 Pathophysiology of Pulmonary Conditions 10
5 Pharmacological & Non-Pharmacological Management 10
TOTAL 50
How to Use This Exam: Attempt each question before reviewing the answer and rationale. Focus on understanding
why the distractors are incorrect - NR 603 exam writers frequently build distractors from common diagnostic errors,
management missteps, pharmacological pitfalls, and guideline misinterpretations. A score of 40/50 (80%) or higher
indicates readiness for the NR 603 Week 2 case discussion. Each rationale references the relevant clinical practice
guideline (GOLD, GINA, IDSA/ATS, NCCN, ESC) or Chamberlain NR 603 curriculum standard.
NR 603 Advanced Pathophysiology & Pharmacology Page 1
,NR 603 Week 2 Case Discussion: Pulmonary (Part One) | Chamberlain University Verified 50 Q&A | Advanced Practice Nursing
Section 1: Case Presentation & Initial Assessment
Q1: A 62-year-old male presents to the clinic with progressive dyspnea on exertion over the past 3
months, accompanied by a chronic productive cough with clear sputum, worse in the mornings. He
reports a 40-pack-year smoking history and works as a construction worker. Based on the initial
presentation, which element of the history is MOST important to elicit next to guide the differential
diagnosis?
A. Dietary preferences and recent weight changes
B. Occupational exposures (asbestos, silica, dust), exacerbation triggers, exercise tolerance, and any prior
pulmonary function testing or imaging *[CORRECT]*
C. Family history of diabetes mellitus
D. Recent travel history to tropical regions
Correct Answer: B
Rationale: Per Chamberlain NR 603 curriculum, comprehensive pulmonary history for a smoking-related symptom
presentation must include occupational/environmental exposures (asbestos, silica, dust are key for mesothelioma,
asbestosis, pneumoconiosis differentials), exacerbation triggers, exercise tolerance (functional capacity), and prior PFTs
or imaging to establish a baseline. Dietary (A) and family history (C) are secondary; travel (D) is relevant if infection is
suspected but less pertinent than occupational exposure in this smoker.
Q2: During the physical examination of a 58-year-old female with chronic dyspnea, the nurse
practitioner auscultates high-pitched, musical, polyphonic whistling sounds heard primarily during
expiration bilaterally across the lung fields. Which interpretation is MOST accurate?
A. These are crackles, indicating interstitial fluid or secretion accumulation
B. These are wheezes, suggesting airway narrowing due to bronchoconstriction or obstruction, consistent
with asthma, COPD, or other obstructive pathology *[CORRECT]*
C. These are rhonchi, suggesting secretions in larger airways
D. These are stridor, indicating upper airway obstruction
Correct Answer: B
Rationale: High-pitched, musical, polyphonic whistling sounds on expiration are wheezes, indicating airway narrowing
from bronchoconstriction, mucosal edema, or obstruction - commonly heard in asthma and COPD per GOLD guidelines.
Crackles (A) are discontinuous, non-musical sounds from fluid/secretions in small airways. Rhonchi (C) are low-pitched
snoring sounds from larger airway secretions. Stridor (D) is a harsh, monophonic inspiratory sound indicating upper
airway obstruction.
NR 603 Advanced Pathophysiology & Pharmacology Page 2
, NR 603 Week 2 Case Discussion: Pulmonary (Part One) | Chamberlain University Verified 50 Q&A | Advanced Practice Nursing
Q3: A 45-year-old male presents with acute onset of pleuritic chest pain and dyspnea following a
long-haul flight. On examination, the NP notes tachycardia (HR 112), tachypnea (RR 24), and SpO2 of
91% on room air. Which physical examination finding would MOST strongly support the suspected
diagnosis of pulmonary embolism?
A. Diffuse expiratory wheezing bilaterally
B. Unilateral leg swelling and tenderness (suggesting DVT as the source), with diminished breath sounds
and pleural friction rub on the affected side *[CORRECT]*
C. Bilateral basilar crackles and JVD
D. Hyperresonance to percussion bilaterally
Correct Answer: B
Rationale: Pulmonary embolism often arises from a DVT; the Wells criteria incorporate unilateral leg swelling as a major
risk factor. Diminished breath sounds and pleural friction rub may also be present. Wheezing (A) suggests asthma/COPD;
bilateral crackles with JVD (C) suggests heart failure; hyperresonance (D) suggests pneumothorax or COPD
hyperinflation. NR 603 curriculum emphasizes recognizing PE risk factors and clinical presentation.
Q4: A 70-year-old female presents with acute onset of fever (102.5°F), productive cough with rusty
sputum, pleuritic chest pain, and shortness of breath. On examination, the NP notes crackles and
decreased breath sounds in the right lower lobe with increased tactile fremitus and dullness to
percussion. Which finding is MOST consistent with the suspected diagnosis?
A. These findings suggest lobar pneumonia with consolidation *[CORRECT]*
B. These findings suggest a tension pneumothorax
C. These findings suggest a pulmonary embolism
D. These findings suggest an acute asthma exacerbation
Correct Answer: A
Rationale: Fever, productive cough with rusty sputum, pleuritic chest pain, crackles, increased tactile fremitus, and
dullness to percussion are classic findings of lobar pneumonia with consolidation (typical bacterial pneumonia, often
Streptococcus pneumoniae). Tension pneumothorax (B) shows hyperresonance, tracheal deviation, and absent breath
sounds. PE (C) typically does not cause fever or consolidation. Asthma (D) presents with wheezing, not consolidation.
IDSA/ATS guidelines emphasize this presentation.
Q5: A 55-year-old male with a 30-pack-year smoking history presents with chronic progressive dyspnea.
On inspection, the NP notes an increased anteroposterior (AP) chest diameter, use of accessory muscles,
and pursed-lip breathing. Which condition is MOST likely?
A. Asthma
B. COPD with emphysema (barrel chest from hyperinflation and air trapping) *[CORRECT]*
C. Pulmonary embolism
D. Lobar pneumonia
Correct Answer: B
Rationale: Increased AP diameter (barrel chest), accessory muscle use, and pursed-lip breathing are hallmark signs of
COPD with emphysema, resulting from chronic air trapping and loss of elastic recoil. Asthma (A) is episodic and
reversible, not typically causing barrel chest. PE (C) presents acutely. Pneumonia (D) presents with consolidation
findings. GOLD guidelines define COPD by persistent respiratory symptoms and airflow limitation.
NR 603 Advanced Pathophysiology & Pharmacology Page 3
NR 603 WEEK 2 CASE DISCUSSION: PULMONARY
(PART ONE)
Complete Questions & Verified Answers
Chamberlain NR 603 | AACN Essentials | Advanced Practice Nursing (2026/2027)
This case-based examination is aligned with Chamberlain University NR 603 Advanced
Pathophysiology/Pharmacology curriculum, AACN Essentials of Master's Education in Nursing, and Advanced
Practice Nursing Competency Standards (2026/2027 Edition). The 50 questions are organized across five core
subject areas: Case Presentation & Initial Assessment, Differential Diagnosis & Diagnostic Reasoning, Diagnostic
Testing & Interpretation, Pathophysiology of Pulmonary Conditions, and Pharmacological & Non-Pharmacological
Management. Each question integrates clinical practice guidelines (GOLD for COPD, GINA for asthma, IDSA/ATS
for pneumonia, NCCN for lung cancer, ESC for pulmonary embolism) and emphasizes clinical reasoning,
differential diagnosis, and case management consistent with advanced practice nursing scope.
Total Questions 50
Time Allotted (Recommended) 75 minutes
Passing Score (Standard) 80% (40/50 correct)
Cognitive Level Mix 20% Recall / 50% Application / 30% Analysis
Question Style 80% Scenario-Based / 20% Direct Knowledge
Special Inclusions 10 Differential Dx / 10 Diagnostic Test / 10 Pharmacologic Management
Examination Structure
Section Subject Area Questions
1 Case Presentation & Initial Assessment 10
2 Differential Diagnosis & Diagnostic Reasoning 10
3 Diagnostic Testing & Interpretation 10
4 Pathophysiology of Pulmonary Conditions 10
5 Pharmacological & Non-Pharmacological Management 10
TOTAL 50
How to Use This Exam: Attempt each question before reviewing the answer and rationale. Focus on understanding
why the distractors are incorrect - NR 603 exam writers frequently build distractors from common diagnostic errors,
management missteps, pharmacological pitfalls, and guideline misinterpretations. A score of 40/50 (80%) or higher
indicates readiness for the NR 603 Week 2 case discussion. Each rationale references the relevant clinical practice
guideline (GOLD, GINA, IDSA/ATS, NCCN, ESC) or Chamberlain NR 603 curriculum standard.
NR 603 Advanced Pathophysiology & Pharmacology Page 1
,NR 603 Week 2 Case Discussion: Pulmonary (Part One) | Chamberlain University Verified 50 Q&A | Advanced Practice Nursing
Section 1: Case Presentation & Initial Assessment
Q1: A 62-year-old male presents to the clinic with progressive dyspnea on exertion over the past 3
months, accompanied by a chronic productive cough with clear sputum, worse in the mornings. He
reports a 40-pack-year smoking history and works as a construction worker. Based on the initial
presentation, which element of the history is MOST important to elicit next to guide the differential
diagnosis?
A. Dietary preferences and recent weight changes
B. Occupational exposures (asbestos, silica, dust), exacerbation triggers, exercise tolerance, and any prior
pulmonary function testing or imaging *[CORRECT]*
C. Family history of diabetes mellitus
D. Recent travel history to tropical regions
Correct Answer: B
Rationale: Per Chamberlain NR 603 curriculum, comprehensive pulmonary history for a smoking-related symptom
presentation must include occupational/environmental exposures (asbestos, silica, dust are key for mesothelioma,
asbestosis, pneumoconiosis differentials), exacerbation triggers, exercise tolerance (functional capacity), and prior PFTs
or imaging to establish a baseline. Dietary (A) and family history (C) are secondary; travel (D) is relevant if infection is
suspected but less pertinent than occupational exposure in this smoker.
Q2: During the physical examination of a 58-year-old female with chronic dyspnea, the nurse
practitioner auscultates high-pitched, musical, polyphonic whistling sounds heard primarily during
expiration bilaterally across the lung fields. Which interpretation is MOST accurate?
A. These are crackles, indicating interstitial fluid or secretion accumulation
B. These are wheezes, suggesting airway narrowing due to bronchoconstriction or obstruction, consistent
with asthma, COPD, or other obstructive pathology *[CORRECT]*
C. These are rhonchi, suggesting secretions in larger airways
D. These are stridor, indicating upper airway obstruction
Correct Answer: B
Rationale: High-pitched, musical, polyphonic whistling sounds on expiration are wheezes, indicating airway narrowing
from bronchoconstriction, mucosal edema, or obstruction - commonly heard in asthma and COPD per GOLD guidelines.
Crackles (A) are discontinuous, non-musical sounds from fluid/secretions in small airways. Rhonchi (C) are low-pitched
snoring sounds from larger airway secretions. Stridor (D) is a harsh, monophonic inspiratory sound indicating upper
airway obstruction.
NR 603 Advanced Pathophysiology & Pharmacology Page 2
, NR 603 Week 2 Case Discussion: Pulmonary (Part One) | Chamberlain University Verified 50 Q&A | Advanced Practice Nursing
Q3: A 45-year-old male presents with acute onset of pleuritic chest pain and dyspnea following a
long-haul flight. On examination, the NP notes tachycardia (HR 112), tachypnea (RR 24), and SpO2 of
91% on room air. Which physical examination finding would MOST strongly support the suspected
diagnosis of pulmonary embolism?
A. Diffuse expiratory wheezing bilaterally
B. Unilateral leg swelling and tenderness (suggesting DVT as the source), with diminished breath sounds
and pleural friction rub on the affected side *[CORRECT]*
C. Bilateral basilar crackles and JVD
D. Hyperresonance to percussion bilaterally
Correct Answer: B
Rationale: Pulmonary embolism often arises from a DVT; the Wells criteria incorporate unilateral leg swelling as a major
risk factor. Diminished breath sounds and pleural friction rub may also be present. Wheezing (A) suggests asthma/COPD;
bilateral crackles with JVD (C) suggests heart failure; hyperresonance (D) suggests pneumothorax or COPD
hyperinflation. NR 603 curriculum emphasizes recognizing PE risk factors and clinical presentation.
Q4: A 70-year-old female presents with acute onset of fever (102.5°F), productive cough with rusty
sputum, pleuritic chest pain, and shortness of breath. On examination, the NP notes crackles and
decreased breath sounds in the right lower lobe with increased tactile fremitus and dullness to
percussion. Which finding is MOST consistent with the suspected diagnosis?
A. These findings suggest lobar pneumonia with consolidation *[CORRECT]*
B. These findings suggest a tension pneumothorax
C. These findings suggest a pulmonary embolism
D. These findings suggest an acute asthma exacerbation
Correct Answer: A
Rationale: Fever, productive cough with rusty sputum, pleuritic chest pain, crackles, increased tactile fremitus, and
dullness to percussion are classic findings of lobar pneumonia with consolidation (typical bacterial pneumonia, often
Streptococcus pneumoniae). Tension pneumothorax (B) shows hyperresonance, tracheal deviation, and absent breath
sounds. PE (C) typically does not cause fever or consolidation. Asthma (D) presents with wheezing, not consolidation.
IDSA/ATS guidelines emphasize this presentation.
Q5: A 55-year-old male with a 30-pack-year smoking history presents with chronic progressive dyspnea.
On inspection, the NP notes an increased anteroposterior (AP) chest diameter, use of accessory muscles,
and pursed-lip breathing. Which condition is MOST likely?
A. Asthma
B. COPD with emphysema (barrel chest from hyperinflation and air trapping) *[CORRECT]*
C. Pulmonary embolism
D. Lobar pneumonia
Correct Answer: B
Rationale: Increased AP diameter (barrel chest), accessory muscle use, and pursed-lip breathing are hallmark signs of
COPD with emphysema, resulting from chronic air trapping and loss of elastic recoil. Asthma (A) is episodic and
reversible, not typically causing barrel chest. PE (C) presents acutely. Pneumonia (D) presents with consolidation
findings. GOLD guidelines define COPD by persistent respiratory symptoms and airflow limitation.
NR 603 Advanced Pathophysiology & Pharmacology Page 3
