NR 511 MIDTERM EXAM DIFFERENTIAL
DIAGNOSIS & PRIMARY CARE PRACTICUM QUESTIONS
& CORRECT VERIFIED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!! LATEST VERSION
1. A 47-year-old woman presents for evaluation of intermittent epigastric
discomfort that began 3 weeks ago. When asked about the problem, she says, "It
just bothers me after I eat sometimes." Which approach by the nurse practitioner
is most appropriate initially?
A. Ask whether the discomfort improves with antacids
B. Ask the patient to describe the problem in her own words before using
focused questions
C. Order a comprehensive metabolic panel and lipase immediately
D. Ask whether she has a history of peptic ulcer disease
Answer: B
Rationale: An effective diagnostic evaluation begins with an open-ended
invitation that allows the patient to provide the story in her own words. The
clinician can then use focused questions to distinguish among competing
diagnoses. Starting with highly specific questions or testing too early may
prematurely narrow the differential.
,2. During an office visit, a patient reports right knee pain. The clinician
documents that the pain began after a fall 4 days ago, occurs intermittently, is
located over the lateral knee, is described as aching, worsens when climbing
stairs, and is relieved with rest. Which component of OLDCARTS is
represented by the statement, "The pain is worse when climbing stairs"?
A. Onset
B. Character
C. Aggravating factors
D. Radiation
Answer: C
Rationale: Aggravating factors identify activities or circumstances that make a
symptom worse. In OLDCARTS, this information helps distinguish
mechanically induced pain from other causes.
3. A screening test is evaluated in 200 patients. Of the 100 patients who truly
have the disease, 90 test positive. What is the sensitivity of the test?
A. 45%
B. 80%
C. 90%
D. 95%
Answer: C
Rationale: Sensitivity measures the proportion of patients with the disease who
test positive. The calculation is true positives ÷ (true positives + false
negatives). Here, 90 ÷ (90 + 10) = 90%. A highly sensitive test is useful when
the goal is to reduce the likelihood of missing disease.
,4. A diagnostic test produces the following results in 250 patients: 120 true
negatives, 30 false positives, 90 true positives, and 10 false negatives. What is
the specificity of the test?
A. 75%
B. 80%
C. 90%
D. 92%
Answer: B
Rationale: Specificity measures the proportion of patients without the disease
who correctly test negative. The calculation is true negatives ÷ (true negatives +
false positives). Thus, 120 ÷ (120 + 30) = 80%.
5. A 72-year-old patient asks which Medicare component generally covers
outpatient physician services, office visits, and medically necessary outpatient
care.
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C only
D. Medicare Part D
Answer: B
Rationale: Medicare Part B generally covers medically necessary outpatient
services, including physician services and many preventive services. Part A
primarily addresses inpatient hospital and certain facility-based services, while
Part D primarily provides prescription drug coverage.
, 6. A 39-year-old man presents with a new headache. The headache started
suddenly while he was exercising and reached maximal intensity within
seconds. He also reports neck stiffness and vomiting. Which action is most
appropriate?
A. Treat presumptive tension headache and reassess in 2 weeks
B. Recommend increased oral fluids and rest
C. Recognize a potentially life-threatening secondary headache and arrange
urgent evaluation
D. Begin a daily migraine prophylactic medication
Answer: C
Rationale: A sudden, severe headache reaching maximal intensity almost
immediately is a red-flag presentation for a secondary cause, including
subarachnoid hemorrhage. Diagnostic reasoning requires considering dangerous
diagnoses early rather than assuming a benign primary headache.
7. A 31-year-old woman has a small, soft, mobile mass beneath the skin of her
upper arm. The mass is painless, has been present for several years, and has not
changed in size. The overlying skin is normal. Which diagnosis is most likely?
A. Lipoma
B. Melanoma
C. Abscess
D. Actinic keratosis
Answer: A
Rationale: Lipomas are commonly soft, mobile, slow-growing subcutaneous
masses and are usually asymptomatic. Their mobility and benign chronic course
distinguish them from many inflammatory or malignant lesions.
DIAGNOSIS & PRIMARY CARE PRACTICUM QUESTIONS
& CORRECT VERIFIED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!! LATEST VERSION
1. A 47-year-old woman presents for evaluation of intermittent epigastric
discomfort that began 3 weeks ago. When asked about the problem, she says, "It
just bothers me after I eat sometimes." Which approach by the nurse practitioner
is most appropriate initially?
A. Ask whether the discomfort improves with antacids
B. Ask the patient to describe the problem in her own words before using
focused questions
C. Order a comprehensive metabolic panel and lipase immediately
D. Ask whether she has a history of peptic ulcer disease
Answer: B
Rationale: An effective diagnostic evaluation begins with an open-ended
invitation that allows the patient to provide the story in her own words. The
clinician can then use focused questions to distinguish among competing
diagnoses. Starting with highly specific questions or testing too early may
prematurely narrow the differential.
,2. During an office visit, a patient reports right knee pain. The clinician
documents that the pain began after a fall 4 days ago, occurs intermittently, is
located over the lateral knee, is described as aching, worsens when climbing
stairs, and is relieved with rest. Which component of OLDCARTS is
represented by the statement, "The pain is worse when climbing stairs"?
A. Onset
B. Character
C. Aggravating factors
D. Radiation
Answer: C
Rationale: Aggravating factors identify activities or circumstances that make a
symptom worse. In OLDCARTS, this information helps distinguish
mechanically induced pain from other causes.
3. A screening test is evaluated in 200 patients. Of the 100 patients who truly
have the disease, 90 test positive. What is the sensitivity of the test?
A. 45%
B. 80%
C. 90%
D. 95%
Answer: C
Rationale: Sensitivity measures the proportion of patients with the disease who
test positive. The calculation is true positives ÷ (true positives + false
negatives). Here, 90 ÷ (90 + 10) = 90%. A highly sensitive test is useful when
the goal is to reduce the likelihood of missing disease.
,4. A diagnostic test produces the following results in 250 patients: 120 true
negatives, 30 false positives, 90 true positives, and 10 false negatives. What is
the specificity of the test?
A. 75%
B. 80%
C. 90%
D. 92%
Answer: B
Rationale: Specificity measures the proportion of patients without the disease
who correctly test negative. The calculation is true negatives ÷ (true negatives +
false positives). Thus, 120 ÷ (120 + 30) = 80%.
5. A 72-year-old patient asks which Medicare component generally covers
outpatient physician services, office visits, and medically necessary outpatient
care.
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C only
D. Medicare Part D
Answer: B
Rationale: Medicare Part B generally covers medically necessary outpatient
services, including physician services and many preventive services. Part A
primarily addresses inpatient hospital and certain facility-based services, while
Part D primarily provides prescription drug coverage.
, 6. A 39-year-old man presents with a new headache. The headache started
suddenly while he was exercising and reached maximal intensity within
seconds. He also reports neck stiffness and vomiting. Which action is most
appropriate?
A. Treat presumptive tension headache and reassess in 2 weeks
B. Recommend increased oral fluids and rest
C. Recognize a potentially life-threatening secondary headache and arrange
urgent evaluation
D. Begin a daily migraine prophylactic medication
Answer: C
Rationale: A sudden, severe headache reaching maximal intensity almost
immediately is a red-flag presentation for a secondary cause, including
subarachnoid hemorrhage. Diagnostic reasoning requires considering dangerous
diagnoses early rather than assuming a benign primary headache.
7. A 31-year-old woman has a small, soft, mobile mass beneath the skin of her
upper arm. The mass is painless, has been present for several years, and has not
changed in size. The overlying skin is normal. Which diagnosis is most likely?
A. Lipoma
B. Melanoma
C. Abscess
D. Actinic keratosis
Answer: A
Rationale: Lipomas are commonly soft, mobile, slow-growing subcutaneous
masses and are usually asymptomatic. Their mobility and benign chronic course
distinguish them from many inflammatory or malignant lesions.
