NR 569 Midterm Final Exams ACTUAL EXAM
2026/2027 | Differential Diagnosis Acute Care
Practicum Chamberlain | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Approach to Differential Diagnosis & Clinical Reasoning (10 Questions)
Q1: A 45-year-old female presents with acute chest pain. The NP uses the "most dangerous first"
approach to differential diagnosis. Which condition must be ruled out immediately before considering
less life-threatening causes?
A. Costochondritis
B. Gastroesophageal reflux disease
C. Acute coronary syndrome. [CORRECT]
D. Panic disorder
Correct Answer: C
Rationale: In acute chest pain, acute coronary syndrome (ACS) represents the most dangerous
differential and must be excluded first through ECG and troponins before attributing symptoms to
benign causes like GERD or costochondritis.
Q2: A 62-year-old male with HTN and hyperlipidemia presents with acute-onset severe headache. The
NP applies Bayesian reasoning with a pretest probability of 15% for subarachnoid hemorrhage. Which
clinical feature most significantly increases the post-test probability?
A. Gradual onset over 2 hours
B. Pain relieved by acetaminophen
C. "Thunderclap" onset with meningismus. [CORRECT]
D. Bilateral frontal location
Correct Answer: C
Rationale: Thunderclap headache with meningismus is the classic presentation of subarachnoid
hemorrhage; this finding dramatically increases post-test probability and mandates immediate non-
contrast head CT.
,Q3: A 38-year-old female presents with dyspnea and pleuritic chest pain. The NP constructs a
differential using the VINDICATE mnemonic. Which condition represents the "I"
(inflammatory/infectious) category that is both common and potentially life-threatening?
A. Pulmonary embolism
B. Pneumonia. [CORRECT]
C. Pneumothorax
D. Pericarditis
Correct Answer: B
Rationale: Pneumonia is an infectious/inflammatory cause of dyspnea and pleuritic chest pain that is
both common in acute care and potentially life-threatening if severe or complicated by sepsis.
Q4: A 55-year-old male with DM presents with fever, hypotension, and altered mental status. The NP
prioritizes differentials using the "sepsis bundle" framework. What is the first diagnostic step?
A. CT abdomen with contrast
B. Blood cultures × 2 and lactate level. [CORRECT]
C. Urinalysis and culture
D. Chest X-ray
Correct Answer: B
Rationale: In suspected sepsis, obtaining two sets of blood cultures and a serum lactate level within the
first hour is the priority per Surviving Sepsis Campaign guidelines to identify the source and severity of
infection.
Q5: A 28-year-old female presents with acute abdominal pain. The NP uses the "pain pattern" approach.
Which historical feature most reliably suggests a surgical abdomen?
A. Colicky pain that waxes and wanes
B. Pain that improves with position changes
C. Constant, progressive pain with peritoneal signs. [CORRECT]
D. Pain that radiates to the back
Correct Answer: C
Rationale: Constant, progressive pain with peritoneal signs (rebound, guarding, rigidity) indicates
peritoneal irritation, which is the hallmark of a surgical abdomen requiring urgent surgical consultation.
Q6: A 70-year-old male presents with syncope. The NP applies the "systems-based" differential
approach. Which system is most likely responsible in a patient with a history of aortic stenosis?
,A. Neurologic
B. Cardiovascular. [CORRECT]
C. Endocrine
D. Hematologic
Correct Answer: B
Rationale: Aortic stenosis causes exertional syncope due to fixed cardiac output and cerebral
hypoperfusion; in patients with known valvular disease, cardiovascular causes must be prioritized in the
syncope workup.
Q7: A 50-year-old female presents with acute right upper quadrant pain after a fatty meal. The NP uses
"diagnostic parsimony" (Occam's razor). Which single diagnosis best explains all findings?
A. Peptic ulcer disease
B. Acute cholecystitis. [CORRECT]
C. Hepatitis
D. Pancreatitis
Correct Answer: B
Rationale: Acute cholecystitis classically presents with postprandial RUQ pain after fatty meals due to
cystic duct obstruction by a gallstone, making it the most parsimonious diagnosis fitting the clinical
picture.
Q8: A 35-year-old male presents with acute headache and neck stiffness. The NP must distinguish
between "most likely" and "most dangerous" diagnoses. Which combination correctly pairs these
categories?
A. Most likely: migraine; Most dangerous: tension headache
B. Most likely: migraine; Most dangerous: subarachnoid hemorrhage. [CORRECT]
C. Most likely: cluster headache; Most dangerous: sinusitis
D. Most likely: tension headache; Most dangerous: migraine
Correct Answer: B
Rationale: While migraine is the most common cause of acute headache, subarachnoid hemorrhage is
the most dangerous and must be ruled out in any thunderclap or atypical presentation before
attributing symptoms to benign causes.
Q9: A 48-year-old female presents with acute dyspnea. The NP uses the "Wells criteria" as a pretest
probability tool. Which finding is assigned the highest point value?
, A. Heart rate >100 bpm
B. Clinical signs of DVT
C. PE as most likely diagnosis. [CORRECT]
D. Immobilization ≥3 days
Correct Answer: C
Rationale: In the Wells criteria for PE, "alternative diagnosis less likely than PE" (PE as most likely
diagnosis) carries 3 points, the highest value, because clinical gestalt that PE is the primary diagnosis
significantly increases pretest probability.
Q10: A 60-year-old male with COPD presents with worsening dyspnea. The NP applies "diagnostic
momentum" critically. What is the primary risk of accepting a previous diagnosis without re-evaluation?
A. Delayed treatment of the correct diagnosis
B. Unnecessary testing
C. Missed new pathology or alternative diagnosis. [CORRECT]
D. Patient dissatisfaction
Correct Answer: C
Rationale: Diagnostic momentum—the tendency to accept a previous diagnosis without critical re-
evaluation—risks missing new or alternative pathology; in acute care, every presentation must be
independently assessed with fresh clinical reasoning.
Section 2: Respiratory Differentials (12 Questions)
Q11: A 68-year-old male with COPD presents with acute worsening dyspnea, increased sputum
purulence, and fever. His oxygen saturation is 88% on room air. Which is the most appropriate initial
diagnostic step?
A. CT pulmonary angiography
B. Arterial blood gas analysis. [CORRECT]
C. Bronchoscopy
D. Ventilation-perfusion scan
Correct Answer: B
Rationale: In acute COPD exacerbation with hypoxemia, arterial blood gas analysis is essential to assess
pH, PaCO2, and PaO2, which guide decisions about ventilatory support and distinguish Type I vs. Type II
respiratory failure.
2026/2027 | Differential Diagnosis Acute Care
Practicum Chamberlain | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Approach to Differential Diagnosis & Clinical Reasoning (10 Questions)
Q1: A 45-year-old female presents with acute chest pain. The NP uses the "most dangerous first"
approach to differential diagnosis. Which condition must be ruled out immediately before considering
less life-threatening causes?
A. Costochondritis
B. Gastroesophageal reflux disease
C. Acute coronary syndrome. [CORRECT]
D. Panic disorder
Correct Answer: C
Rationale: In acute chest pain, acute coronary syndrome (ACS) represents the most dangerous
differential and must be excluded first through ECG and troponins before attributing symptoms to
benign causes like GERD or costochondritis.
Q2: A 62-year-old male with HTN and hyperlipidemia presents with acute-onset severe headache. The
NP applies Bayesian reasoning with a pretest probability of 15% for subarachnoid hemorrhage. Which
clinical feature most significantly increases the post-test probability?
A. Gradual onset over 2 hours
B. Pain relieved by acetaminophen
C. "Thunderclap" onset with meningismus. [CORRECT]
D. Bilateral frontal location
Correct Answer: C
Rationale: Thunderclap headache with meningismus is the classic presentation of subarachnoid
hemorrhage; this finding dramatically increases post-test probability and mandates immediate non-
contrast head CT.
,Q3: A 38-year-old female presents with dyspnea and pleuritic chest pain. The NP constructs a
differential using the VINDICATE mnemonic. Which condition represents the "I"
(inflammatory/infectious) category that is both common and potentially life-threatening?
A. Pulmonary embolism
B. Pneumonia. [CORRECT]
C. Pneumothorax
D. Pericarditis
Correct Answer: B
Rationale: Pneumonia is an infectious/inflammatory cause of dyspnea and pleuritic chest pain that is
both common in acute care and potentially life-threatening if severe or complicated by sepsis.
Q4: A 55-year-old male with DM presents with fever, hypotension, and altered mental status. The NP
prioritizes differentials using the "sepsis bundle" framework. What is the first diagnostic step?
A. CT abdomen with contrast
B. Blood cultures × 2 and lactate level. [CORRECT]
C. Urinalysis and culture
D. Chest X-ray
Correct Answer: B
Rationale: In suspected sepsis, obtaining two sets of blood cultures and a serum lactate level within the
first hour is the priority per Surviving Sepsis Campaign guidelines to identify the source and severity of
infection.
Q5: A 28-year-old female presents with acute abdominal pain. The NP uses the "pain pattern" approach.
Which historical feature most reliably suggests a surgical abdomen?
A. Colicky pain that waxes and wanes
B. Pain that improves with position changes
C. Constant, progressive pain with peritoneal signs. [CORRECT]
D. Pain that radiates to the back
Correct Answer: C
Rationale: Constant, progressive pain with peritoneal signs (rebound, guarding, rigidity) indicates
peritoneal irritation, which is the hallmark of a surgical abdomen requiring urgent surgical consultation.
Q6: A 70-year-old male presents with syncope. The NP applies the "systems-based" differential
approach. Which system is most likely responsible in a patient with a history of aortic stenosis?
,A. Neurologic
B. Cardiovascular. [CORRECT]
C. Endocrine
D. Hematologic
Correct Answer: B
Rationale: Aortic stenosis causes exertional syncope due to fixed cardiac output and cerebral
hypoperfusion; in patients with known valvular disease, cardiovascular causes must be prioritized in the
syncope workup.
Q7: A 50-year-old female presents with acute right upper quadrant pain after a fatty meal. The NP uses
"diagnostic parsimony" (Occam's razor). Which single diagnosis best explains all findings?
A. Peptic ulcer disease
B. Acute cholecystitis. [CORRECT]
C. Hepatitis
D. Pancreatitis
Correct Answer: B
Rationale: Acute cholecystitis classically presents with postprandial RUQ pain after fatty meals due to
cystic duct obstruction by a gallstone, making it the most parsimonious diagnosis fitting the clinical
picture.
Q8: A 35-year-old male presents with acute headache and neck stiffness. The NP must distinguish
between "most likely" and "most dangerous" diagnoses. Which combination correctly pairs these
categories?
A. Most likely: migraine; Most dangerous: tension headache
B. Most likely: migraine; Most dangerous: subarachnoid hemorrhage. [CORRECT]
C. Most likely: cluster headache; Most dangerous: sinusitis
D. Most likely: tension headache; Most dangerous: migraine
Correct Answer: B
Rationale: While migraine is the most common cause of acute headache, subarachnoid hemorrhage is
the most dangerous and must be ruled out in any thunderclap or atypical presentation before
attributing symptoms to benign causes.
Q9: A 48-year-old female presents with acute dyspnea. The NP uses the "Wells criteria" as a pretest
probability tool. Which finding is assigned the highest point value?
, A. Heart rate >100 bpm
B. Clinical signs of DVT
C. PE as most likely diagnosis. [CORRECT]
D. Immobilization ≥3 days
Correct Answer: C
Rationale: In the Wells criteria for PE, "alternative diagnosis less likely than PE" (PE as most likely
diagnosis) carries 3 points, the highest value, because clinical gestalt that PE is the primary diagnosis
significantly increases pretest probability.
Q10: A 60-year-old male with COPD presents with worsening dyspnea. The NP applies "diagnostic
momentum" critically. What is the primary risk of accepting a previous diagnosis without re-evaluation?
A. Delayed treatment of the correct diagnosis
B. Unnecessary testing
C. Missed new pathology or alternative diagnosis. [CORRECT]
D. Patient dissatisfaction
Correct Answer: C
Rationale: Diagnostic momentum—the tendency to accept a previous diagnosis without critical re-
evaluation—risks missing new or alternative pathology; in acute care, every presentation must be
independently assessed with fresh clinical reasoning.
Section 2: Respiratory Differentials (12 Questions)
Q11: A 68-year-old male with COPD presents with acute worsening dyspnea, increased sputum
purulence, and fever. His oxygen saturation is 88% on room air. Which is the most appropriate initial
diagnostic step?
A. CT pulmonary angiography
B. Arterial blood gas analysis. [CORRECT]
C. Bronchoscopy
D. Ventilation-perfusion scan
Correct Answer: B
Rationale: In acute COPD exacerbation with hypoxemia, arterial blood gas analysis is essential to assess
pH, PaCO2, and PaO2, which guide decisions about ventilatory support and distinguish Type I vs. Type II
respiratory failure.
