NR 569 FINAL EXAM – DIFFERENTIAL DIAGNOSIS
IN ACUTE CARE PRACTICUM LATEST QUESTIONS
& ANSWERS STUDY GUIDE (2026) | CHAMBERLAIN
1. Which clinical finding most strongly suggests bacterial conjunctivitis
rather than viral conjunctivitis?
A) Purulent discharge with eyelid crusting
B) Watery discharge with preauricular lymphadenopathy
C) Bilateral itching with clear discharge
D) No discharge with conjunctival injection
Correct Answer: A) Purulent discharge with eyelid crusting
Rationale: Bacterial conjunctivitis typically causes purulent or
mucopurulent discharge and crusting of the eyelids. Viral conjunctivitis
usually causes watery discharge and preauricular lymphadenopathy.
Allergic conjunctivitis causes bilateral itching and watery discharge.
Purulent discharge points toward a bacterial cause.
2. Which finding is most characteristic of acute otitis media on
otoscopic examination?
A) Clear, mobile tympanic membrane
B) Red, bulging tympanic membrane with decreased mobility
C) Pain with pinna manipulation
D) Edematous ear canal with discharge
Correct Answer: B) Red, bulging tympanic membrane with decreased mobility
,Rationale: Acute otitis media causes a red, bulging tympanic membrane with
reduced mobility. A clear, mobile membrane is normal. Pain with pinna
manipulation and edematous ear canal suggest otitis externa rather than otitis
media. Decreased mobility indicates middle ear effusion.
3. A patient has acute diffuse shoulder pain, worse at night, with
progressive loss of both active and passive range of motion. Which
condition is most likely?
A) Rotator cuff tear
B) Shoulder impingement
C) Adhesive capsulitis
D) Subacromial bursitis
Correct Answer: C) Adhesive capsulitis
Rationale: Adhesive capsulitis, or frozen shoulder, presents with diffuse
shoulder pain, often worse at night, and progressive loss of both active and
passive range of motion. Rotator cuff tears cause weakness, impingement
causes painful arc, and bursitis causes localized pain. Frozen shoulder is
characterized by capsular inflammation.
4. Which characteristic is most consistent with a pulmonary embolism
in a postoperative patient?
A) Gradual onset of bilateral wheezing
B) Productive cough with purulent sputum
C) Fever and localized crackles
D) Sudden pleuritic chest pain with dyspnea and tachycardia
,Correct Answer: D) Sudden pleuritic chest pain with dyspnea and tachycardia
Rationale: Pulmonary embolism typically presents with sudden pleuritic
chest pain, dyspnea, tachycardia, and tachypnea, especially in patients
with recent surgery or immobility. Wheezing suggests bronchospasm,
productive cough suggests pneumonia, and fever with localized crackles
suggests infection. CT pulmonary angiography confirms embolism.
5. A 60-year-old has long-standing GERD, heartburn, and progressive
dysphagia. Which test is most appropriate to evaluate for erosive
esophagitis?
A) Esophagogastroduodenoscopy
B) Barium swallow only
C) Chest CT only
D) Ambulatory pH monitoring only
Correct Answer: A) Esophagogastroduodenoscopy
Rationale: Esophagogastroduodenoscopy directly visualizes the
esophageal mucosa and allows biopsy, making it the preferred test for
erosive esophagitis and Barrett esophagus. Barium swallow and pH
monitoring have limited roles. Chest CT does not evaluate mucosal injury
well.
6. Which symptom is most characteristic of viral conjunctivitis?
A) Purulent discharge
B) Watery discharge with preauricular lymphadenopathy
C) Bilateral itching
D) Eyelid crusting only
, Correct Answer: B) Watery discharge with preauricular lymphadenopathy
Rationale: Viral conjunctivitis usually causes watery discharge and may be
associated with preauricular lymphadenopathy. Purulent discharge
suggests bacterial conjunctivitis. Bilateral itching suggests allergy. Viral
conjunctivitis is highly contagious and often follows an upper respiratory
infection.
7. Which factor is considered an intrinsic cause of dyspnea?
A) Bronchospasm
B) Anxiety
C) Deconditioning
D) Poor air quality
Correct Answer: A) Bronchospasm
Rationale: Bronchospasm is an intrinsic pulmonary cause of dyspnea due to
reversible airway narrowing. Anxiety, deconditioning, and poor air quality are
extrinsic or nonpulmonary contributors. Intrinsic causes also include
pneumothorax, pulmonary embolism, and airway obstruction.
8. Which cranial nerve palsy presents with ptosis, dilated pupil, and diplopia?
A) Cranial nerve II
B) Cranial nerve IV
C) Cranial nerve VI
D) Cranial nerve III
IN ACUTE CARE PRACTICUM LATEST QUESTIONS
& ANSWERS STUDY GUIDE (2026) | CHAMBERLAIN
1. Which clinical finding most strongly suggests bacterial conjunctivitis
rather than viral conjunctivitis?
A) Purulent discharge with eyelid crusting
B) Watery discharge with preauricular lymphadenopathy
C) Bilateral itching with clear discharge
D) No discharge with conjunctival injection
Correct Answer: A) Purulent discharge with eyelid crusting
Rationale: Bacterial conjunctivitis typically causes purulent or
mucopurulent discharge and crusting of the eyelids. Viral conjunctivitis
usually causes watery discharge and preauricular lymphadenopathy.
Allergic conjunctivitis causes bilateral itching and watery discharge.
Purulent discharge points toward a bacterial cause.
2. Which finding is most characteristic of acute otitis media on
otoscopic examination?
A) Clear, mobile tympanic membrane
B) Red, bulging tympanic membrane with decreased mobility
C) Pain with pinna manipulation
D) Edematous ear canal with discharge
Correct Answer: B) Red, bulging tympanic membrane with decreased mobility
,Rationale: Acute otitis media causes a red, bulging tympanic membrane with
reduced mobility. A clear, mobile membrane is normal. Pain with pinna
manipulation and edematous ear canal suggest otitis externa rather than otitis
media. Decreased mobility indicates middle ear effusion.
3. A patient has acute diffuse shoulder pain, worse at night, with
progressive loss of both active and passive range of motion. Which
condition is most likely?
A) Rotator cuff tear
B) Shoulder impingement
C) Adhesive capsulitis
D) Subacromial bursitis
Correct Answer: C) Adhesive capsulitis
Rationale: Adhesive capsulitis, or frozen shoulder, presents with diffuse
shoulder pain, often worse at night, and progressive loss of both active and
passive range of motion. Rotator cuff tears cause weakness, impingement
causes painful arc, and bursitis causes localized pain. Frozen shoulder is
characterized by capsular inflammation.
4. Which characteristic is most consistent with a pulmonary embolism
in a postoperative patient?
A) Gradual onset of bilateral wheezing
B) Productive cough with purulent sputum
C) Fever and localized crackles
D) Sudden pleuritic chest pain with dyspnea and tachycardia
,Correct Answer: D) Sudden pleuritic chest pain with dyspnea and tachycardia
Rationale: Pulmonary embolism typically presents with sudden pleuritic
chest pain, dyspnea, tachycardia, and tachypnea, especially in patients
with recent surgery or immobility. Wheezing suggests bronchospasm,
productive cough suggests pneumonia, and fever with localized crackles
suggests infection. CT pulmonary angiography confirms embolism.
5. A 60-year-old has long-standing GERD, heartburn, and progressive
dysphagia. Which test is most appropriate to evaluate for erosive
esophagitis?
A) Esophagogastroduodenoscopy
B) Barium swallow only
C) Chest CT only
D) Ambulatory pH monitoring only
Correct Answer: A) Esophagogastroduodenoscopy
Rationale: Esophagogastroduodenoscopy directly visualizes the
esophageal mucosa and allows biopsy, making it the preferred test for
erosive esophagitis and Barrett esophagus. Barium swallow and pH
monitoring have limited roles. Chest CT does not evaluate mucosal injury
well.
6. Which symptom is most characteristic of viral conjunctivitis?
A) Purulent discharge
B) Watery discharge with preauricular lymphadenopathy
C) Bilateral itching
D) Eyelid crusting only
, Correct Answer: B) Watery discharge with preauricular lymphadenopathy
Rationale: Viral conjunctivitis usually causes watery discharge and may be
associated with preauricular lymphadenopathy. Purulent discharge
suggests bacterial conjunctivitis. Bilateral itching suggests allergy. Viral
conjunctivitis is highly contagious and often follows an upper respiratory
infection.
7. Which factor is considered an intrinsic cause of dyspnea?
A) Bronchospasm
B) Anxiety
C) Deconditioning
D) Poor air quality
Correct Answer: A) Bronchospasm
Rationale: Bronchospasm is an intrinsic pulmonary cause of dyspnea due to
reversible airway narrowing. Anxiety, deconditioning, and poor air quality are
extrinsic or nonpulmonary contributors. Intrinsic causes also include
pneumothorax, pulmonary embolism, and airway obstruction.
8. Which cranial nerve palsy presents with ptosis, dilated pupil, and diplopia?
A) Cranial nerve II
B) Cranial nerve IV
C) Cranial nerve VI
D) Cranial nerve III
