NURS 5433 Primary Care and Diagnostic
Reasoning Practice Exam – Questions,
Answers & Rationales
1.
A 52-year-old patient presents for a routine primary-care visit. Which finding most strongly
suggests that additional cardiovascular risk assessment is warranted?
A. BMI of 21 kg/m²
B. Blood pressure of 148/92 mmHg
C. Resting heart rate of 68/min
D. Oxygen saturation of 98%
Correct Answer: B. Blood pressure of 148/92 mmHg
Rationale:
A blood pressure of 148/92 mmHg is elevated and warrants confirmation with repeat
measurements and assessment of cardiovascular risk factors. The other findings are generally
within expected ranges.
2.
A patient reports substernal chest pressure that began while climbing stairs and improves after
resting. Which diagnosis should be highest on the differential?
A. Gastroesophageal reflux disease
B. Stable angina
C. Costochondritis
D. Panic disorder
Correct Answer: B. Stable angina
Rationale:
Predictable exertional chest pressure that resolves with rest is characteristic of stable angina
caused by myocardial ischemia. Primary care clinicians should assess cardiovascular risk and
determine whether urgent evaluation is necessary.
3.
,Which history element is most important when evaluating a patient with a new headache?
A. Preferred sleeping position
B. Presence of red-flag symptoms
C. Favorite foods
D. Previous vaccination history
Correct Answer: B. Presence of red-flag symptoms
Rationale:
Headache assessment should identify red flags such as sudden onset, neurologic deficits, fever
with meningismus, new headache in an older adult, trauma, cancer/immunosuppression, or
progressive pattern.
4.
A patient develops a sudden, severe headache described as the “worst headache of my life.”
What is the priority concern?
A. Tension headache
B. Migraine without aura
C. Subarachnoid hemorrhage
D. Sinus headache
Correct Answer: C. Subarachnoid hemorrhage
Rationale:
A thunderclap headache reaching maximal intensity rapidly is a classic warning sign for
subarachnoid hemorrhage. This presentation requires urgent evaluation.
5.
Which finding is most suggestive of bacterial pneumonia rather than uncomplicated viral upper
respiratory infection?
A. Rhinorrhea
B. Mild sore throat
C. Focal lung crackles with fever
D. Sneezing
Correct Answer: C. Focal lung crackles with fever
,Rationale:
Fever accompanied by focal auscultatory findings such as crackles or bronchial breath sounds
increases concern for pneumonia. Viral upper respiratory infections commonly produce diffuse
upper-airway symptoms.
6.
A patient with diabetes reports increased thirst and urination. Which laboratory test is most
appropriate for evaluating long-term glycemic control?
A. Serum sodium
B. Hemoglobin A1c
C. Serum amylase
D. Troponin
Correct Answer: B. Hemoglobin A1c
Rationale:
Hemoglobin A1c reflects average blood glucose over approximately the previous 2–3 months
and is useful for diabetes diagnosis and monitoring.
7.
Which symptom is most characteristic of hypothyroidism?
A. Heat intolerance
B. Weight loss
C. Cold intolerance
D. Tremor
Correct Answer: C. Cold intolerance
Rationale:
Hypothyroidism commonly causes fatigue, weight gain, constipation, dry skin, bradycardia, and
cold intolerance. Hyperthyroidism is more commonly associated with heat intolerance, weight
loss, and tremor.
8.
, A patient presents with fatigue, pallor, and exertional dyspnea. Which initial laboratory test is
most useful?
A. CBC
B. Lipase
C. Troponin
D. Serum calcium only
Correct Answer: A. CBC
Rationale:
A complete blood count evaluates hemoglobin, hematocrit, red-cell indices, white-cell count,
and platelets and is an appropriate initial test when anemia is suspected.
9.
Which physical examination finding is most concerning for deep venous thrombosis?
A. Bilateral ankle swelling after prolonged standing
B. Unilateral calf swelling and tenderness
C. Symmetric foot pulses
D. Mild bilateral varicosities
Correct Answer: B. Unilateral calf swelling and tenderness
Rationale:
Unilateral swelling, warmth, tenderness, and erythema can indicate DVT. Clinical probability
should guide further testing, such as D-dimer or ultrasound depending on the presentation.
10.
A patient presents with acute shortness of breath, pleuritic chest pain, tachycardia, and risk
factors for thrombosis. Which diagnosis must be considered?
A. Pulmonary embolism
B. Otitis media
C. Osteoarthritis
D. Migraine
Correct Answer: A. Pulmonary embolism
Reasoning Practice Exam – Questions,
Answers & Rationales
1.
A 52-year-old patient presents for a routine primary-care visit. Which finding most strongly
suggests that additional cardiovascular risk assessment is warranted?
A. BMI of 21 kg/m²
B. Blood pressure of 148/92 mmHg
C. Resting heart rate of 68/min
D. Oxygen saturation of 98%
Correct Answer: B. Blood pressure of 148/92 mmHg
Rationale:
A blood pressure of 148/92 mmHg is elevated and warrants confirmation with repeat
measurements and assessment of cardiovascular risk factors. The other findings are generally
within expected ranges.
2.
A patient reports substernal chest pressure that began while climbing stairs and improves after
resting. Which diagnosis should be highest on the differential?
A. Gastroesophageal reflux disease
B. Stable angina
C. Costochondritis
D. Panic disorder
Correct Answer: B. Stable angina
Rationale:
Predictable exertional chest pressure that resolves with rest is characteristic of stable angina
caused by myocardial ischemia. Primary care clinicians should assess cardiovascular risk and
determine whether urgent evaluation is necessary.
3.
,Which history element is most important when evaluating a patient with a new headache?
A. Preferred sleeping position
B. Presence of red-flag symptoms
C. Favorite foods
D. Previous vaccination history
Correct Answer: B. Presence of red-flag symptoms
Rationale:
Headache assessment should identify red flags such as sudden onset, neurologic deficits, fever
with meningismus, new headache in an older adult, trauma, cancer/immunosuppression, or
progressive pattern.
4.
A patient develops a sudden, severe headache described as the “worst headache of my life.”
What is the priority concern?
A. Tension headache
B. Migraine without aura
C. Subarachnoid hemorrhage
D. Sinus headache
Correct Answer: C. Subarachnoid hemorrhage
Rationale:
A thunderclap headache reaching maximal intensity rapidly is a classic warning sign for
subarachnoid hemorrhage. This presentation requires urgent evaluation.
5.
Which finding is most suggestive of bacterial pneumonia rather than uncomplicated viral upper
respiratory infection?
A. Rhinorrhea
B. Mild sore throat
C. Focal lung crackles with fever
D. Sneezing
Correct Answer: C. Focal lung crackles with fever
,Rationale:
Fever accompanied by focal auscultatory findings such as crackles or bronchial breath sounds
increases concern for pneumonia. Viral upper respiratory infections commonly produce diffuse
upper-airway symptoms.
6.
A patient with diabetes reports increased thirst and urination. Which laboratory test is most
appropriate for evaluating long-term glycemic control?
A. Serum sodium
B. Hemoglobin A1c
C. Serum amylase
D. Troponin
Correct Answer: B. Hemoglobin A1c
Rationale:
Hemoglobin A1c reflects average blood glucose over approximately the previous 2–3 months
and is useful for diabetes diagnosis and monitoring.
7.
Which symptom is most characteristic of hypothyroidism?
A. Heat intolerance
B. Weight loss
C. Cold intolerance
D. Tremor
Correct Answer: C. Cold intolerance
Rationale:
Hypothyroidism commonly causes fatigue, weight gain, constipation, dry skin, bradycardia, and
cold intolerance. Hyperthyroidism is more commonly associated with heat intolerance, weight
loss, and tremor.
8.
, A patient presents with fatigue, pallor, and exertional dyspnea. Which initial laboratory test is
most useful?
A. CBC
B. Lipase
C. Troponin
D. Serum calcium only
Correct Answer: A. CBC
Rationale:
A complete blood count evaluates hemoglobin, hematocrit, red-cell indices, white-cell count,
and platelets and is an appropriate initial test when anemia is suspected.
9.
Which physical examination finding is most concerning for deep venous thrombosis?
A. Bilateral ankle swelling after prolonged standing
B. Unilateral calf swelling and tenderness
C. Symmetric foot pulses
D. Mild bilateral varicosities
Correct Answer: B. Unilateral calf swelling and tenderness
Rationale:
Unilateral swelling, warmth, tenderness, and erythema can indicate DVT. Clinical probability
should guide further testing, such as D-dimer or ultrasound depending on the presentation.
10.
A patient presents with acute shortness of breath, pleuritic chest pain, tachycardia, and risk
factors for thrombosis. Which diagnosis must be considered?
A. Pulmonary embolism
B. Otitis media
C. Osteoarthritis
D. Migraine
Correct Answer: A. Pulmonary embolism
