NR 576 Exam 1 V1 | NR 576 Differential Diagnosis in Adult-
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
1) | Chamberlain University
1. A 68-year-old male presents with right upper quadrant pain, fever, and a positive Murphy’s
sign. Which of the following is the most likely differential diagnosis?
A. Acute Cholecystitis
B. Acute Pancreatitis
C. Nephrolithiasis
D. Appendicitis
Answer: A
Explanation: A positive Murphy’s sign is highly specific for acute cholecystitis in patients
presenting with right upper quadrant pain. This sign is elicited when the patient halts
inspiration due to pain while the examiner palpates the gallbladder area. Further
diagnostic imaging such as an ultrasound is usually required to confirm the presence of
stones or wall thickening.
2. When interpreting laboratory results for a patient suspected of having iron deficiency
anemia, which finding is most characteristic?
A. Low Mean Corpuscular Volume (MCV)
B. Macrocytic RBCs
C. High Ferritin level
D. Low Total Iron Binding Capacity (TIBC)
Answer: A
Explanation: Iron deficiency anemia is classified as a microcytic, hypochromic anemia
which results in a low Mean Corpuscular Volume. In this condition, the body lacks sufficient
iron to produce hemoglobin, leading to smaller red blood cells. Serum ferritin levels are
typically low and TIBC is usually elevated as the body attempts to compensate for low iron
stores.
3. A 72-year-old patient presents with new-onset atrial fibrillation. What is the primary
concern regarding long-term management in this age group?
A. Increasing heart rate
B. Ventricular hypertrophy
C. Risk of thromboembolic stroke
,D. Development of pneumonia
Answer: C
Explanation: The most significant complication of atrial fibrillation in the elderly
population is the formation of thrombi in the left atrium. These thrombi can embolize to
the brain, leading to an ischemic stroke. Management must include an assessment of stroke
risk using tools like CHA2DS2-VASc to determine the need for anticoagulation.
4. In the diagnostic reasoning process, ‘SNOOP’ is an acronym used to identify red flags for
which condition?
A. Asthma
B. Headache
C. Lower back pain
D. Congestive heart failure
Answer: B
Explanation: The SNOOP mnemonic stands for Systemic signs, Neurologic signs, Onset
sudden, Older age of onset, and Progression of pattern. It is a clinical tool used by primary
care providers to identify secondary causes of headaches that may require urgent
neuroimaging. Recognizing these red flags helps differentiate benign primary headaches
from life-threatening secondary conditions.
5. A patient presents with a TSH of 12.5 mIU/L and a low Free T4 level. How should the nurse
practitioner interpret these findings?
A. Secondary Hyperthyroidism
B. Subclinical Hypothyroidism
C. Euthyroid Sick Syndrome
D. Primary Hypothyroidism
Answer: D
Explanation: Primary hypothyroidism is characterized by an elevated Thyroid Stimulating
Hormone (TSH) and a decreased Free T4 level. This indicates that the thyroid gland is not
producing enough hormone despite maximal stimulation from the pituitary gland.
Treatment typically involves hormone replacement therapy with levothyroxine to
normalize levels.
6. Which physical exam finding is most suggestive of community-acquired pneumonia in an
adult patient?
A. Hyperresonance on percussion
B. Vesicular breath sounds
, C. Increased tactile fremitus
D. Wheezing in all lung fields
Answer: C
Explanation: Increased tactile fremitus occurs when there is consolidation in the lung
tissue, such as in pneumonia. As sound travels better through solid or fluid-filled medium
than through air, the vibrations are felt more strongly over the affected area. Other findings
may include dullness to percussion and late inspiratory crackles.
7. According to the JNC 8 guidelines, what is the target blood pressure for a 65-year-old
patient without diabetes or chronic kidney disease?
A. < 120/80 mmHg
B. < 130/80 mmHg
C. < 140/90 mmHg
D. < 150/90 mmHg
Answer: D
Explanation: JNC 8 guidelines specifically recommend a higher threshold for initiating
treatment in adults aged 60 and older. For this population without comorbidities, the goal
is to keep blood pressure below 150/90 mmHg. Maintaining this target helps balance the
benefits of stroke reduction with the risks of orthostatic hypotension and falls in the
elderly.
8. A 55-year-old female reports a history of heartburn and regurgitation. Which symptom
would be considered an ‘alarm symptom’ requiring immediate endoscopy?
A. Dysphagia
B. Occasional bloating
C. Sour taste in mouth
D. Belching after meals
Answer: A
Explanation: Dysphagia, or difficulty swallowing, is a significant alarm symptom in
patients with GERD symptoms. It may indicate a complication such as an esophageal
stricture or esophageal cancer. Other alarm symptoms include weight loss, anemia, or
persistent vomiting, all of which warrant prompt referral for endoscopy.
9. Which of the following is a classic clinical presentation of Rheumatoid Arthritis?
A. Asymmetrical joint involvement
B. Symmetrical joint swelling and pain
Gerontology Primary Care | Actual Q&A with Rationale (NR576 Exam
1) | Chamberlain University
1. A 68-year-old male presents with right upper quadrant pain, fever, and a positive Murphy’s
sign. Which of the following is the most likely differential diagnosis?
A. Acute Cholecystitis
B. Acute Pancreatitis
C. Nephrolithiasis
D. Appendicitis
Answer: A
Explanation: A positive Murphy’s sign is highly specific for acute cholecystitis in patients
presenting with right upper quadrant pain. This sign is elicited when the patient halts
inspiration due to pain while the examiner palpates the gallbladder area. Further
diagnostic imaging such as an ultrasound is usually required to confirm the presence of
stones or wall thickening.
2. When interpreting laboratory results for a patient suspected of having iron deficiency
anemia, which finding is most characteristic?
A. Low Mean Corpuscular Volume (MCV)
B. Macrocytic RBCs
C. High Ferritin level
D. Low Total Iron Binding Capacity (TIBC)
Answer: A
Explanation: Iron deficiency anemia is classified as a microcytic, hypochromic anemia
which results in a low Mean Corpuscular Volume. In this condition, the body lacks sufficient
iron to produce hemoglobin, leading to smaller red blood cells. Serum ferritin levels are
typically low and TIBC is usually elevated as the body attempts to compensate for low iron
stores.
3. A 72-year-old patient presents with new-onset atrial fibrillation. What is the primary
concern regarding long-term management in this age group?
A. Increasing heart rate
B. Ventricular hypertrophy
C. Risk of thromboembolic stroke
,D. Development of pneumonia
Answer: C
Explanation: The most significant complication of atrial fibrillation in the elderly
population is the formation of thrombi in the left atrium. These thrombi can embolize to
the brain, leading to an ischemic stroke. Management must include an assessment of stroke
risk using tools like CHA2DS2-VASc to determine the need for anticoagulation.
4. In the diagnostic reasoning process, ‘SNOOP’ is an acronym used to identify red flags for
which condition?
A. Asthma
B. Headache
C. Lower back pain
D. Congestive heart failure
Answer: B
Explanation: The SNOOP mnemonic stands for Systemic signs, Neurologic signs, Onset
sudden, Older age of onset, and Progression of pattern. It is a clinical tool used by primary
care providers to identify secondary causes of headaches that may require urgent
neuroimaging. Recognizing these red flags helps differentiate benign primary headaches
from life-threatening secondary conditions.
5. A patient presents with a TSH of 12.5 mIU/L and a low Free T4 level. How should the nurse
practitioner interpret these findings?
A. Secondary Hyperthyroidism
B. Subclinical Hypothyroidism
C. Euthyroid Sick Syndrome
D. Primary Hypothyroidism
Answer: D
Explanation: Primary hypothyroidism is characterized by an elevated Thyroid Stimulating
Hormone (TSH) and a decreased Free T4 level. This indicates that the thyroid gland is not
producing enough hormone despite maximal stimulation from the pituitary gland.
Treatment typically involves hormone replacement therapy with levothyroxine to
normalize levels.
6. Which physical exam finding is most suggestive of community-acquired pneumonia in an
adult patient?
A. Hyperresonance on percussion
B. Vesicular breath sounds
, C. Increased tactile fremitus
D. Wheezing in all lung fields
Answer: C
Explanation: Increased tactile fremitus occurs when there is consolidation in the lung
tissue, such as in pneumonia. As sound travels better through solid or fluid-filled medium
than through air, the vibrations are felt more strongly over the affected area. Other findings
may include dullness to percussion and late inspiratory crackles.
7. According to the JNC 8 guidelines, what is the target blood pressure for a 65-year-old
patient without diabetes or chronic kidney disease?
A. < 120/80 mmHg
B. < 130/80 mmHg
C. < 140/90 mmHg
D. < 150/90 mmHg
Answer: D
Explanation: JNC 8 guidelines specifically recommend a higher threshold for initiating
treatment in adults aged 60 and older. For this population without comorbidities, the goal
is to keep blood pressure below 150/90 mmHg. Maintaining this target helps balance the
benefits of stroke reduction with the risks of orthostatic hypotension and falls in the
elderly.
8. A 55-year-old female reports a history of heartburn and regurgitation. Which symptom
would be considered an ‘alarm symptom’ requiring immediate endoscopy?
A. Dysphagia
B. Occasional bloating
C. Sour taste in mouth
D. Belching after meals
Answer: A
Explanation: Dysphagia, or difficulty swallowing, is a significant alarm symptom in
patients with GERD symptoms. It may indicate a complication such as an esophageal
stricture or esophageal cancer. Other alarm symptoms include weight loss, anemia, or
persistent vomiting, all of which warrant prompt referral for endoscopy.
9. Which of the following is a classic clinical presentation of Rheumatoid Arthritis?
A. Asymmetrical joint involvement
B. Symmetrical joint swelling and pain
