Chamberlain University Nursing
NR-511 Differential Diagnosis
and Primary Care Practicum
Comprehensive Final Exam Test Bank
100 Questions with Detailed Rationales | Latest
2025/2026
, FOR THE NURSE GRADE
DOMAIN 1: HEENT (Head, Eyes, Ears, Nose, Throat)
(Questions 1-15)
Question 1
A 35-year-old female presents with a sore throat, fever, and tender anterior
cervical lymphadenopathy. On examination, the tonsils are erythematous with
exudate. There is no cough. What is the most likely diagnosis?
A. Viral pharyngitis
B. Streptococcal pharyngitis
C. Infectious mononucleosis
D. Peritonsillar abscess
Correct Answer: B
Rationale: The presence of fever, exudative tonsillitis, tender anterior
cervical lymphadenopathy, and absence of cough is classic for streptococcal
pharyngitis (Centor criteria). Viral pharyngitis (A) typically presents with
cough and rhinorrhea. Infectious mononucleosis (C) presents with posterior
cervical lymphadenopathy and fatigue. Peritonsillar abscess (D) presents with
deviation of the uvula and "hot potato" voice .
,Question 2
A 28-year-old female presents with acute onset of severe, unilateral
periorbital pain, decreased vision, and a fixed, dilated pupil. What is the most
likely diagnosis?
A. Migraine
B. Cluster headache
C. Acute angle-closure glaucoma
D. Optic neuritis
Correct Answer: C
Rationale: Acute angle-closure glaucoma presents with sudden, severe
unilateral eye pain, decreased vision, headache, nausea, and a fixed, mid-
dilated pupil. This is an ophthalmic emergency. Migraine (A) and cluster
headache (B) do not cause a fixed pupil. Optic neuritis (D) causes vision loss
but is not typically painful and does not cause a fixed pupil .
Question 3
A 45-year-old male presents with a complaint of "my ear hurts." On
examination, the tragus is tender to palpation, and the ear canal is
erythematous and swollen. The tympanic membrane is normal. What is the
most likely diagnosis?
A. Acute otitis media
B. Otitis externa
C. Mastoiditis
D. Temporomandibular joint disorder
, Correct Answer: B
Rationale: Tenderness of the tragus and erythema/swelling of the ear canal
with a normal tympanic membrane is classic for otitis externa (swimmer's
ear) . Acute otitis media (A) would have a bulging, erythematous tympanic
membrane. Mastoiditis (C) would have postauricular swelling. TMJ disorder
(D) causes pain with jaw movement .
Question 4
A 55-year-old female presents with a complaint of "I have a lump in my
throat." On examination, you note a palpable thyroid nodule. What is the most
appropriate next step?
A. Order a TSH level
B. Order a thyroid ultrasound
C. Prescribe levothyroxine
D. Reassure the patient
Correct Answer: B
Rationale: A palpable thyroid nodule requires thyroid ultrasound to
characterize the nodule (size, morphology, suspicious features). TSH (A) is
appropriate to assess function but does not characterize the nodule.
Levothyroxine (C) is not indicated without hypothyroidism. Reassurance (D)
is inappropriate without imaging .
NR-511 Differential Diagnosis
and Primary Care Practicum
Comprehensive Final Exam Test Bank
100 Questions with Detailed Rationales | Latest
2025/2026
, FOR THE NURSE GRADE
DOMAIN 1: HEENT (Head, Eyes, Ears, Nose, Throat)
(Questions 1-15)
Question 1
A 35-year-old female presents with a sore throat, fever, and tender anterior
cervical lymphadenopathy. On examination, the tonsils are erythematous with
exudate. There is no cough. What is the most likely diagnosis?
A. Viral pharyngitis
B. Streptococcal pharyngitis
C. Infectious mononucleosis
D. Peritonsillar abscess
Correct Answer: B
Rationale: The presence of fever, exudative tonsillitis, tender anterior
cervical lymphadenopathy, and absence of cough is classic for streptococcal
pharyngitis (Centor criteria). Viral pharyngitis (A) typically presents with
cough and rhinorrhea. Infectious mononucleosis (C) presents with posterior
cervical lymphadenopathy and fatigue. Peritonsillar abscess (D) presents with
deviation of the uvula and "hot potato" voice .
,Question 2
A 28-year-old female presents with acute onset of severe, unilateral
periorbital pain, decreased vision, and a fixed, dilated pupil. What is the most
likely diagnosis?
A. Migraine
B. Cluster headache
C. Acute angle-closure glaucoma
D. Optic neuritis
Correct Answer: C
Rationale: Acute angle-closure glaucoma presents with sudden, severe
unilateral eye pain, decreased vision, headache, nausea, and a fixed, mid-
dilated pupil. This is an ophthalmic emergency. Migraine (A) and cluster
headache (B) do not cause a fixed pupil. Optic neuritis (D) causes vision loss
but is not typically painful and does not cause a fixed pupil .
Question 3
A 45-year-old male presents with a complaint of "my ear hurts." On
examination, the tragus is tender to palpation, and the ear canal is
erythematous and swollen. The tympanic membrane is normal. What is the
most likely diagnosis?
A. Acute otitis media
B. Otitis externa
C. Mastoiditis
D. Temporomandibular joint disorder
, Correct Answer: B
Rationale: Tenderness of the tragus and erythema/swelling of the ear canal
with a normal tympanic membrane is classic for otitis externa (swimmer's
ear) . Acute otitis media (A) would have a bulging, erythematous tympanic
membrane. Mastoiditis (C) would have postauricular swelling. TMJ disorder
(D) causes pain with jaw movement .
Question 4
A 55-year-old female presents with a complaint of "I have a lump in my
throat." On examination, you note a palpable thyroid nodule. What is the most
appropriate next step?
A. Order a TSH level
B. Order a thyroid ultrasound
C. Prescribe levothyroxine
D. Reassure the patient
Correct Answer: B
Rationale: A palpable thyroid nodule requires thyroid ultrasound to
characterize the nodule (size, morphology, suspicious features). TSH (A) is
appropriate to assess function but does not characterize the nodule.
Levothyroxine (C) is not indicated without hypothyroidism. Reassurance (D)
is inappropriate without imaging .
