NR569 Midterm Exam | Differential Diagnosis in Acute Care Practicum Chamberlain University | 2026/2027
NR569 / NR 569 MIDTERM EXAM
DIFFERENTIAL DIAGNOSIS IN ACUTE CARE
PRACTICUM
QUESTIONS AND VERIFIED ANSWERS | 100% CORRECT
Latest Edition
Chamberlain University | College of Nursing & Allied Health Professions
Graduate Nursing - Acute Care Nurse Practitioner Track
Aligned with NR 569 Course Syllabus, AACN Essentials of Master's Education, and Acute Care NP Differential Diagnosis
Competencies
Total Questions: 150 Cognitive Level Distribution:
Format: Multiple Choice (4 options, single best answer)
Recall: 20% / Application: 50% / Analysis: 30%
Time Limit: 180 minutes Question Style:
Passing Score: 78% (Chamberlain NR569 standard) 80% scenario-based / 20% direct knowledge
EXAMINATION STRUCTURE OVERVIEW
Section Content Area Questions
1 Clinical Reasoning & Diagnostic Process in Acute Care Q1-Q20 (20)
2 Cardiovascular Emergencies & Differential Diagnosis Q21-Q40 (20)
3 Respiratory & Pulmonary Emergencies Q41-Q58 (18)
4 Neurological & Neurosurgical Emergencies Q59-Q76 (18)
5 Gastrointestinal, Hepatic, & Renal Emergencies Q77-Q94 (18)
6 Endocrine & Metabolic Emergencies Q95-Q109 (15)
7 Infectious Disease & Sepsis Q110-Q124 (15)
8 Multisystem & Critical Care Differential Diagnosis Q125-Q139 (15)
9 Pharmacology & Therapeutic Management in Acute Care Q140-Q150 (11)
TOTAL 150 Questions
NR569 | Differential Diagnosis in Acute Care Practicum | Midterm Examination Page 1
,NR569 Midterm Exam | Differential Diagnosis in Acute Care Practicum Chamberlain University | 2026/2027
SECTION 1: Clinical Reasoning & Diagnostic Process in Acute Care
Q1: An acute care NP is evaluating a 68-year-old with acute dyspnea. Using Bayesian reasoning,
the NP adjusts the pretest probability of heart failure based on the presence of bilateral
crackles, JVD, and an S3. Which principle best describes this diagnostic approach?
A. The NP is using anchoring bias by overemphasizing physical exam findings
B. The NP applies likelihood ratios to revise disease probability from new clinical data
*[CORRECT]*
C. The NP relies solely on sensitivity of the exam to rule in disease
D. The NP uses availability heuristic because heart failure is commonly seen
Correct Answer: B
Rationale: Bayesian reasoning in clinical diagnosis uses pretest probability modified by likelihood
ratios (LRs) of new findings to produce a post-test probability. The NP integrates prior probability
(e.g., age, HF history) with the LRs of crackles, JVD, and S3 (each with characteristic LRs from
evidence) to update disease probability. Anchoring and availability are cognitive biases, not Bayesian
updating; sensitivity alone cannot rule in disease without considering specificity.
Q2: When constructing a differential diagnosis for acute chest pain, which problem
representation strategy is MOST consistent with the NR 569 curriculum emphasis on semantic
transformation?
A. Listing every possible cause of chest pain from a textbook
B. Translating the patient's presentation into a concise clinical statement using key
qualifiers *[CORRECT]*
C. Ordering a troponin and ECG before formulating any diagnostic hypothesis
D. Documenting the chief complaint verbatim and beginning empiric treatment
Correct Answer: B
Rationale: Problem representation is the semantic reformulation of a clinical presentation into a
concise summary statement (e.g., "68-year-old diabetic with acute, exertional, radiating chest pain
and diaphoresis"). This formulation activates illness scripts and guides hypothesis generation. Listing
all causes or jumping straight to testing bypasses the reasoning process the NR 569 curriculum
develops.
Q3: A 72-year-old presents with confusion, BP 88/52, HR 124, and lactate 5.2 mmol/L. The NP
places septic shock at the top of the differential. Which cognitive bias is MOST likely if the NP
then fails to consider aortic dissection as a competing diagnosis?
A. Premature closure
B. Anchoring bias *[CORRECT]*
C. Base rate neglect
D. Confirmation bias
Correct Answer: B
Rationale: Anchoring bias occurs when the clinician fixes on the initial impression (septic shock)
and fails to adjust sufficiently to incorporate alternative explanations such as aortic dissection, which
can present with hypotension, tachycardia, and altered mental status. Premature closure is
acceptance of a diagnosis before full verification; base rate neglect is failing to consider disease
prevalence; confirmation bias is seeking data that supports the leading diagnosis.
NR569 | Differential Diagnosis in Acute Care Practicum | Midterm Examination Page 2
,NR569 Midterm Exam | Differential Diagnosis in Acute Care Practicum Chamberlain University | 2026/2027
Q4: In the diagnostic process, which "red flag" finding in a 55-year-old with acute back pain
should prompt immediate cross-sectional imaging rather than conservative management?
A. Pain worsening with prolonged sitting relieved by standing
B. New urinary retention, saddle anesthesia, and bilateral leg weakness *[CORRECT]*
C. Pain radiating to the posterior thigh with negative straight leg raise
D. Morning stiffness improving with activity in a younger adult
Correct Answer: B
Rationale: New urinary retention, saddle anesthesia, and bilateral leg weakness are classic red flags
for cauda equina syndrome, a time-sensitive neurosurgical emergency requiring urgent MRI and
surgical decompression to prevent permanent paraplegia and bowel/bladder dysfunction. The other
options describe non-emergent presentations consistent with mechanical or radicular back pain that
does not mandate immediate imaging.
Q5: When prioritizing differential diagnoses in acute care, which framework emphasizes
"life-threatening, common, and cannot-miss" diagnoses as the foundation of the differential list?
A. VINDICATE mnemonic
B. AILMENT framework (Anatomic, Infectious, Life-threatening, Metabolic, Endocrine,
Neoplastic, Traumatic)
C. Surgical sieve and MMADD (Must-not-miss, Mortality, Age, Disease pattern,
Definitive therapy) *[CORRECT]*
D. OldCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating, Radiation,
Timing, Severity)
Correct Answer: C
Rationale: The MMADD framework and similar "cannot-miss" prioritization schemas explicitly rank
diagnoses by acuity, mortality risk, and time-sensitivity—central to acute care NP training in NR 569.
VINDICATE generates a comprehensive etiologic list but does not prioritize by threat level. OldCARTS
is a symptom characterization tool, not a prioritization framework.
Q6: A patient is brought to the acute care setting with acute confusion. The NP correctly
identifies that "rule-in" and "rule-out" testing depends on the test's likelihood ratio. A test with
LR+ = 10 and LR- = 0.1 would best be described as:
A. A poor test with minimal impact on disease probability
B. A strong rule-in test only
C. A strong rule-out test only
D. A strong rule-in AND strong rule-out test *[CORRECT]*
Correct Answer: D
Rationale: LR+ ≥ 10 strongly rules in disease; LR- ≤ 0.1 strongly rules out disease. A test with LR+ =
10 and LR- = 0.1 has both strong rule-in and rule-out capability, making it highly informative for
clinical decision-making. Tests with LRs near 1 minimally change pretest probability and are
considered unhelpful for diagnostic reasoning.
NR569 | Differential Diagnosis in Acute Care Practicum | Midterm Examination Page 3
, NR569 Midterm Exam | Differential Diagnosis in Acute Care Practicum Chamberlain University | 2026/2027
Q7: Which of the following is the BEST example of a "pretest probability" estimate for acute
pulmonary embolism using validated clinical prediction?
A. The Wells PE score applied to a patient with pleuritic chest pain and calf swelling
*[CORRECT]*
B. A D-dimer value alone without clinical context
C. The clinician's "gut feeling" that PE is unlikely
D. The number of risk factors the patient has, counted out of context
Correct Answer: A
Rationale: Validated prediction rules like the Wells score combine clinical findings (clinical
suspicion, tachycardia, DVT signs, alternative diagnosis less likely, hemoptysis, immobilization,
malignancy) to stratify pretest probability of PE. D-dimer alone depends on pretest probability to be
interpretable; gut feeling is susceptible to bias; raw risk factor counts without weighting are
unvalidated.
Q8: Diagnostic stewardship in acute care refers to:
A. Limiting the number of tests ordered to reduce hospital costs primarily
B. Using diagnostic tests judiciously to improve patient outcomes and reduce
overdiagnosis/harm *[CORRECT]*
C. Ensuring all patients receive the same standard testing panel regardless of presentation
D. Delegating diagnostic decision-making entirely to subspecialty consultants
Correct Answer: B
Rationale: Diagnostic stewardship is the systematic, evidence-based approach to test selection,
timing, and interpretation to maximize clinical benefit while minimizing harm, overdiagnosis, false
positives, and cost. It is patient-centered, not cost-driven alone. Blanket panels and over-delegation
to consultants contradict stewardship principles.
Q9: A 64-year-old with productive cough and fever has a CURB-65 score of 3. The NP
understands this score is BEST used to:
A. Identify the specific causative pathogen of pneumonia
B. Stratify CAP severity and guide site-of-care disposition (inpatient vs ICU)
*[CORRECT]*
C. Determine the appropriate duration of antibiotic therapy
D. Predict the development of antibiotic resistance
Correct Answer: B
Rationale: CURB-65 (Confusion, Urea >7 mmol/L, Respiratory rate ≥30, BP <90 systolic or ≤60
diastolic, Age ≥65) stratifies community-acquired pneumonia severity and guides disposition: score
0-1 outpatient, 2 inpatient, ≥3 ICU consideration. It does not identify pathogens, determine antibiotic
duration, or predict resistance.
NR569 | Differential Diagnosis in Acute Care Practicum | Midterm Examination Page 4
NR569 / NR 569 MIDTERM EXAM
DIFFERENTIAL DIAGNOSIS IN ACUTE CARE
PRACTICUM
QUESTIONS AND VERIFIED ANSWERS | 100% CORRECT
Latest Edition
Chamberlain University | College of Nursing & Allied Health Professions
Graduate Nursing - Acute Care Nurse Practitioner Track
Aligned with NR 569 Course Syllabus, AACN Essentials of Master's Education, and Acute Care NP Differential Diagnosis
Competencies
Total Questions: 150 Cognitive Level Distribution:
Format: Multiple Choice (4 options, single best answer)
Recall: 20% / Application: 50% / Analysis: 30%
Time Limit: 180 minutes Question Style:
Passing Score: 78% (Chamberlain NR569 standard) 80% scenario-based / 20% direct knowledge
EXAMINATION STRUCTURE OVERVIEW
Section Content Area Questions
1 Clinical Reasoning & Diagnostic Process in Acute Care Q1-Q20 (20)
2 Cardiovascular Emergencies & Differential Diagnosis Q21-Q40 (20)
3 Respiratory & Pulmonary Emergencies Q41-Q58 (18)
4 Neurological & Neurosurgical Emergencies Q59-Q76 (18)
5 Gastrointestinal, Hepatic, & Renal Emergencies Q77-Q94 (18)
6 Endocrine & Metabolic Emergencies Q95-Q109 (15)
7 Infectious Disease & Sepsis Q110-Q124 (15)
8 Multisystem & Critical Care Differential Diagnosis Q125-Q139 (15)
9 Pharmacology & Therapeutic Management in Acute Care Q140-Q150 (11)
TOTAL 150 Questions
NR569 | Differential Diagnosis in Acute Care Practicum | Midterm Examination Page 1
,NR569 Midterm Exam | Differential Diagnosis in Acute Care Practicum Chamberlain University | 2026/2027
SECTION 1: Clinical Reasoning & Diagnostic Process in Acute Care
Q1: An acute care NP is evaluating a 68-year-old with acute dyspnea. Using Bayesian reasoning,
the NP adjusts the pretest probability of heart failure based on the presence of bilateral
crackles, JVD, and an S3. Which principle best describes this diagnostic approach?
A. The NP is using anchoring bias by overemphasizing physical exam findings
B. The NP applies likelihood ratios to revise disease probability from new clinical data
*[CORRECT]*
C. The NP relies solely on sensitivity of the exam to rule in disease
D. The NP uses availability heuristic because heart failure is commonly seen
Correct Answer: B
Rationale: Bayesian reasoning in clinical diagnosis uses pretest probability modified by likelihood
ratios (LRs) of new findings to produce a post-test probability. The NP integrates prior probability
(e.g., age, HF history) with the LRs of crackles, JVD, and S3 (each with characteristic LRs from
evidence) to update disease probability. Anchoring and availability are cognitive biases, not Bayesian
updating; sensitivity alone cannot rule in disease without considering specificity.
Q2: When constructing a differential diagnosis for acute chest pain, which problem
representation strategy is MOST consistent with the NR 569 curriculum emphasis on semantic
transformation?
A. Listing every possible cause of chest pain from a textbook
B. Translating the patient's presentation into a concise clinical statement using key
qualifiers *[CORRECT]*
C. Ordering a troponin and ECG before formulating any diagnostic hypothesis
D. Documenting the chief complaint verbatim and beginning empiric treatment
Correct Answer: B
Rationale: Problem representation is the semantic reformulation of a clinical presentation into a
concise summary statement (e.g., "68-year-old diabetic with acute, exertional, radiating chest pain
and diaphoresis"). This formulation activates illness scripts and guides hypothesis generation. Listing
all causes or jumping straight to testing bypasses the reasoning process the NR 569 curriculum
develops.
Q3: A 72-year-old presents with confusion, BP 88/52, HR 124, and lactate 5.2 mmol/L. The NP
places septic shock at the top of the differential. Which cognitive bias is MOST likely if the NP
then fails to consider aortic dissection as a competing diagnosis?
A. Premature closure
B. Anchoring bias *[CORRECT]*
C. Base rate neglect
D. Confirmation bias
Correct Answer: B
Rationale: Anchoring bias occurs when the clinician fixes on the initial impression (septic shock)
and fails to adjust sufficiently to incorporate alternative explanations such as aortic dissection, which
can present with hypotension, tachycardia, and altered mental status. Premature closure is
acceptance of a diagnosis before full verification; base rate neglect is failing to consider disease
prevalence; confirmation bias is seeking data that supports the leading diagnosis.
NR569 | Differential Diagnosis in Acute Care Practicum | Midterm Examination Page 2
,NR569 Midterm Exam | Differential Diagnosis in Acute Care Practicum Chamberlain University | 2026/2027
Q4: In the diagnostic process, which "red flag" finding in a 55-year-old with acute back pain
should prompt immediate cross-sectional imaging rather than conservative management?
A. Pain worsening with prolonged sitting relieved by standing
B. New urinary retention, saddle anesthesia, and bilateral leg weakness *[CORRECT]*
C. Pain radiating to the posterior thigh with negative straight leg raise
D. Morning stiffness improving with activity in a younger adult
Correct Answer: B
Rationale: New urinary retention, saddle anesthesia, and bilateral leg weakness are classic red flags
for cauda equina syndrome, a time-sensitive neurosurgical emergency requiring urgent MRI and
surgical decompression to prevent permanent paraplegia and bowel/bladder dysfunction. The other
options describe non-emergent presentations consistent with mechanical or radicular back pain that
does not mandate immediate imaging.
Q5: When prioritizing differential diagnoses in acute care, which framework emphasizes
"life-threatening, common, and cannot-miss" diagnoses as the foundation of the differential list?
A. VINDICATE mnemonic
B. AILMENT framework (Anatomic, Infectious, Life-threatening, Metabolic, Endocrine,
Neoplastic, Traumatic)
C. Surgical sieve and MMADD (Must-not-miss, Mortality, Age, Disease pattern,
Definitive therapy) *[CORRECT]*
D. OldCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating, Radiation,
Timing, Severity)
Correct Answer: C
Rationale: The MMADD framework and similar "cannot-miss" prioritization schemas explicitly rank
diagnoses by acuity, mortality risk, and time-sensitivity—central to acute care NP training in NR 569.
VINDICATE generates a comprehensive etiologic list but does not prioritize by threat level. OldCARTS
is a symptom characterization tool, not a prioritization framework.
Q6: A patient is brought to the acute care setting with acute confusion. The NP correctly
identifies that "rule-in" and "rule-out" testing depends on the test's likelihood ratio. A test with
LR+ = 10 and LR- = 0.1 would best be described as:
A. A poor test with minimal impact on disease probability
B. A strong rule-in test only
C. A strong rule-out test only
D. A strong rule-in AND strong rule-out test *[CORRECT]*
Correct Answer: D
Rationale: LR+ ≥ 10 strongly rules in disease; LR- ≤ 0.1 strongly rules out disease. A test with LR+ =
10 and LR- = 0.1 has both strong rule-in and rule-out capability, making it highly informative for
clinical decision-making. Tests with LRs near 1 minimally change pretest probability and are
considered unhelpful for diagnostic reasoning.
NR569 | Differential Diagnosis in Acute Care Practicum | Midterm Examination Page 3
, NR569 Midterm Exam | Differential Diagnosis in Acute Care Practicum Chamberlain University | 2026/2027
Q7: Which of the following is the BEST example of a "pretest probability" estimate for acute
pulmonary embolism using validated clinical prediction?
A. The Wells PE score applied to a patient with pleuritic chest pain and calf swelling
*[CORRECT]*
B. A D-dimer value alone without clinical context
C. The clinician's "gut feeling" that PE is unlikely
D. The number of risk factors the patient has, counted out of context
Correct Answer: A
Rationale: Validated prediction rules like the Wells score combine clinical findings (clinical
suspicion, tachycardia, DVT signs, alternative diagnosis less likely, hemoptysis, immobilization,
malignancy) to stratify pretest probability of PE. D-dimer alone depends on pretest probability to be
interpretable; gut feeling is susceptible to bias; raw risk factor counts without weighting are
unvalidated.
Q8: Diagnostic stewardship in acute care refers to:
A. Limiting the number of tests ordered to reduce hospital costs primarily
B. Using diagnostic tests judiciously to improve patient outcomes and reduce
overdiagnosis/harm *[CORRECT]*
C. Ensuring all patients receive the same standard testing panel regardless of presentation
D. Delegating diagnostic decision-making entirely to subspecialty consultants
Correct Answer: B
Rationale: Diagnostic stewardship is the systematic, evidence-based approach to test selection,
timing, and interpretation to maximize clinical benefit while minimizing harm, overdiagnosis, false
positives, and cost. It is patient-centered, not cost-driven alone. Blanket panels and over-delegation
to consultants contradict stewardship principles.
Q9: A 64-year-old with productive cough and fever has a CURB-65 score of 3. The NP
understands this score is BEST used to:
A. Identify the specific causative pathogen of pneumonia
B. Stratify CAP severity and guide site-of-care disposition (inpatient vs ICU)
*[CORRECT]*
C. Determine the appropriate duration of antibiotic therapy
D. Predict the development of antibiotic resistance
Correct Answer: B
Rationale: CURB-65 (Confusion, Urea >7 mmol/L, Respiratory rate ≥30, BP <90 systolic or ≤60
diastolic, Age ≥65) stratifies community-acquired pneumonia severity and guides disposition: score
0-1 outpatient, 2 inpatient, ≥3 ICU consideration. It does not identify pathogens, determine antibiotic
duration, or predict resistance.
NR569 | Differential Diagnosis in Acute Care Practicum | Midterm Examination Page 4
