NR 569 Midterm & Final Exam Bundle Differential Diagnosis in Acute
Care Practicum Chamberlain College of Nursing Question Bank (Latest
2026/2027 Edition) – 100% Correct Questions, Answers & Detailed
Rationales
Total Questions: 50
Time Allowed: 120 Minutes
Passing Score: 80%
Instructions: Select the BEST answer for each question based on acute care
assessment principles, differential diagnosis strategies, and evidence-based practice.
For SATA questions, select all that apply. Pay careful attention to priority words (INITIAL,
MOST LIKELY, BEST, PRIORITY).
SECTION 1: PATIENT ASSESSMENT & CLINICAL DECISION-MAKING
Questions 1–6
1. A 68-year-old male presents to the emergency department with acute onset of chest
pain. The ACNP is conducting a focused history. Which components of the history are
most critical for differentiating cardiac from non-cardiac chest pain? Select all that
apply.
A. Character of the pain (pressure, sharp, burning)
,B. Radiation of the pain to arm, jaw, or back
C. Relief with nitroglycerin
D. Association with exertion or meals
E. Patient's favorite foods
Correct Answers: A, B, C, D
Rationale: A comprehensive pain history is essential for differential diagnosis. Cardiac
pain is typically described as pressure, squeezing, or heaviness; may radiate to the left
arm, jaw, neck, or back; is often precipitated by exertion or emotional stress; and may be
relieved by rest or nitroglycerin (though esophageal spasm may also respond).
Non-cardiac causes have different patterns: pleuritic pain worsens with inspiration,
musculoskeletal pain is reproducible with palpation, and GERD-related pain may worsen
after meals. Patient food preferences are not relevant to acute chest pain differential
diagnosis.
2. A 72-year-old female with a history of heart failure presents with dyspnea, orthopnea,
and bilateral crackles on auscultation. The ACNP assesses fluid status. Which findings
would support a diagnosis of acute decompensated heart failure? Select all that apply.
A. Elevated jugular venous pressure
B. Peripheral edema
C. S3 gallop on cardiac auscultation
D. Clear lung fields bilaterally
E. Weight gain of 3 kg over 2 days
,Correct Answers: A, B, C, E
Rationale: Acute decompensated heart failure is characterized by fluid overload.
Elevated JVP indicates increased central venous pressure. Peripheral edema results
from increased hydrostatic pressure and sodium/water retention. An S3 gallop reflects
rapid ventricular filling into a non-compliant, volume-overloaded ventricle. Rapid weight
gain indicates fluid retention (1 kg ≈ 1 L of fluid). Clear lung fields would argue against
pulmonary congestion and are not consistent with acute decompensated heart failure
with pulmonary edema.
3. A 45-year-old patient presents with altered mental status. The ACNP performs a rapid
neurological assessment using the Glasgow Coma Scale (GCS). The patient opens eyes
to verbal command, is confused but uses inappropriate words, and localizes to painful
stimuli. What is the GCS score?
A. 9
B. 10
C. 11
D. 12
Correct Answer: D
Rationale: GCS scoring: Eye opening = 3 (to verbal command). Verbal response = 4
(confused conversation). Motor response = 5 (localizes to pain). Total GCS = 3 + 4 + 5 =
12. A GCS of 12 indicates moderate traumatic brain injury. The ACNP must recognize
that any GCS < 15 in a patient with altered mental status warrants further investigation
for causes including hypoxia, hypoglycemia, stroke, sepsis, or toxic/metabolic
encephalopathy.
, 4. A patient in the ICU has the following vital signs: BP 88/52 mmHg, HR 128 bpm, RR
28/min, SpO₂ 91% on room air, temperature 38.9°C. The ACNP recognizes this as a
systemic inflammatory response. Which criteria for SIRS are met? Select all that apply.
A. Temperature > 38°C or < 36°C
B. Heart rate > 90 bpm
C. Respiratory rate > 20/min or PaCO₂ < 32 mmHg
D. White blood cell count > 12,000 or < 4,000/mm³
E. Blood pressure < 90 mmHg systolic
Correct Answers: A, B, C
Rationale: SIRS (Systemic Inflammatory Response Syndrome) criteria include:
temperature > 38°C or < 36°C; heart rate > 90 bpm; respiratory rate > 20/min or PaCO₂ <
32 mmHg; and WBC > 12,000 or < 4,000/mm³ or > 10% bands. This patient meets three
SIRS criteria (temperature, heart rate, respiratory rate). Hypotension (SBP < 90) is a
criterion for septic shock, not SIRS. WBC count is not provided in the stem, so D cannot
be confirmed from the given data.
5. A patient with acute abdominal pain is being assessed. The ACNP notes rebound
tenderness, guarding, and rigidity. Which pathophysiological process do these findings
indicate?
A. Visceral pain from organ distension
B. Peritoneal irritation and inflammation
C. Referred pain from a distant source
Care Practicum Chamberlain College of Nursing Question Bank (Latest
2026/2027 Edition) – 100% Correct Questions, Answers & Detailed
Rationales
Total Questions: 50
Time Allowed: 120 Minutes
Passing Score: 80%
Instructions: Select the BEST answer for each question based on acute care
assessment principles, differential diagnosis strategies, and evidence-based practice.
For SATA questions, select all that apply. Pay careful attention to priority words (INITIAL,
MOST LIKELY, BEST, PRIORITY).
SECTION 1: PATIENT ASSESSMENT & CLINICAL DECISION-MAKING
Questions 1–6
1. A 68-year-old male presents to the emergency department with acute onset of chest
pain. The ACNP is conducting a focused history. Which components of the history are
most critical for differentiating cardiac from non-cardiac chest pain? Select all that
apply.
A. Character of the pain (pressure, sharp, burning)
,B. Radiation of the pain to arm, jaw, or back
C. Relief with nitroglycerin
D. Association with exertion or meals
E. Patient's favorite foods
Correct Answers: A, B, C, D
Rationale: A comprehensive pain history is essential for differential diagnosis. Cardiac
pain is typically described as pressure, squeezing, or heaviness; may radiate to the left
arm, jaw, neck, or back; is often precipitated by exertion or emotional stress; and may be
relieved by rest or nitroglycerin (though esophageal spasm may also respond).
Non-cardiac causes have different patterns: pleuritic pain worsens with inspiration,
musculoskeletal pain is reproducible with palpation, and GERD-related pain may worsen
after meals. Patient food preferences are not relevant to acute chest pain differential
diagnosis.
2. A 72-year-old female with a history of heart failure presents with dyspnea, orthopnea,
and bilateral crackles on auscultation. The ACNP assesses fluid status. Which findings
would support a diagnosis of acute decompensated heart failure? Select all that apply.
A. Elevated jugular venous pressure
B. Peripheral edema
C. S3 gallop on cardiac auscultation
D. Clear lung fields bilaterally
E. Weight gain of 3 kg over 2 days
,Correct Answers: A, B, C, E
Rationale: Acute decompensated heart failure is characterized by fluid overload.
Elevated JVP indicates increased central venous pressure. Peripheral edema results
from increased hydrostatic pressure and sodium/water retention. An S3 gallop reflects
rapid ventricular filling into a non-compliant, volume-overloaded ventricle. Rapid weight
gain indicates fluid retention (1 kg ≈ 1 L of fluid). Clear lung fields would argue against
pulmonary congestion and are not consistent with acute decompensated heart failure
with pulmonary edema.
3. A 45-year-old patient presents with altered mental status. The ACNP performs a rapid
neurological assessment using the Glasgow Coma Scale (GCS). The patient opens eyes
to verbal command, is confused but uses inappropriate words, and localizes to painful
stimuli. What is the GCS score?
A. 9
B. 10
C. 11
D. 12
Correct Answer: D
Rationale: GCS scoring: Eye opening = 3 (to verbal command). Verbal response = 4
(confused conversation). Motor response = 5 (localizes to pain). Total GCS = 3 + 4 + 5 =
12. A GCS of 12 indicates moderate traumatic brain injury. The ACNP must recognize
that any GCS < 15 in a patient with altered mental status warrants further investigation
for causes including hypoxia, hypoglycemia, stroke, sepsis, or toxic/metabolic
encephalopathy.
, 4. A patient in the ICU has the following vital signs: BP 88/52 mmHg, HR 128 bpm, RR
28/min, SpO₂ 91% on room air, temperature 38.9°C. The ACNP recognizes this as a
systemic inflammatory response. Which criteria for SIRS are met? Select all that apply.
A. Temperature > 38°C or < 36°C
B. Heart rate > 90 bpm
C. Respiratory rate > 20/min or PaCO₂ < 32 mmHg
D. White blood cell count > 12,000 or < 4,000/mm³
E. Blood pressure < 90 mmHg systolic
Correct Answers: A, B, C
Rationale: SIRS (Systemic Inflammatory Response Syndrome) criteria include:
temperature > 38°C or < 36°C; heart rate > 90 bpm; respiratory rate > 20/min or PaCO₂ <
32 mmHg; and WBC > 12,000 or < 4,000/mm³ or > 10% bands. This patient meets three
SIRS criteria (temperature, heart rate, respiratory rate). Hypotension (SBP < 90) is a
criterion for septic shock, not SIRS. WBC count is not provided in the stem, so D cannot
be confirmed from the given data.
5. A patient with acute abdominal pain is being assessed. The ACNP notes rebound
tenderness, guarding, and rigidity. Which pathophysiological process do these findings
indicate?
A. Visceral pain from organ distension
B. Peritoneal irritation and inflammation
C. Referred pain from a distant source
