NR 547 CEA
CONSISTS OF 150 QUESTIONS
Verified Questions & Answers With Rationales
(Differential Diagnosis Across the Lifespan Practicum)
Chamberlain
Page 1
,1. During a post-hospital discharge visit, you notice your 71 year old female patient has been
diagnosed with a "new murmur" found by the hospitalist during their recent hospitalization
for CHF exacerbation. In evaluating the patient, during which phase of the cardiac cycle
would you anticipate auscultation of a S3 or S4 heart sound?
Options:
A. Diastole
B. 53 in systole while S4 in diastole
C. Systole
D. S4 in diastole while S3 in systole
Correct Answer:
A. Diastole.
Expert Rationale:
S3 and S4 are extra heart sounds heard during diastole. S3 occurs in early diastole with rapid
ventricular filling, while S4 occurs in late diastole with atrial contraction into a stiff ventricle.
2. The point of maximum impulse (PMI) is MOST often palpable in healthy adults when
positioned in the supine or left lateral decubitus position. Which one of the following
locations is most commonly described as the PMI in a healthy adult?
Options:
A. Left 2nd intercostal space, midaxillary line.
B. Left 5th intercostal space, midclavicular line.
C. Right 4th intercostal space, midaxillary line.
D. Right 2nd intercostal space, midclavicular line.
Correct Answer:
B. Left 5th intercostal space, midclavicular line.
Expert Rationale:
The PMI is normally located at the left fifth intercostal space near the midclavicular line.
Displacement can suggest ventricular enlargement or other cardiopulmonary pathology.
3. The nurse practitioner assessing the patient with a rapid cardiac rhythm may assess for a
pulse deficit by auscultating the patient's heart while watching the EKG rhythm. Where
would the S1 heart sounds correlate with the electrocardiographic waves?
Options:
A. At the end of the T wave.
B. At the start of the T wave.
C. Peak of the R wave.
D. At the start of the P wave.
Page 2
, Correct Answer:
C. Peak of the R wave.
Expert Rationale:
S1 occurs with closure of the mitral and tricuspid valves at the onset of ventricular systole. It
corresponds closely with ventricular depolarization, represented by the QRS complex/peak R
wave on ECG.
4. Michael, a 72 year old male patient who previously presented with stable cardiac-type
chest pain has underwent a stress test. He presents today to review the stress test results,
which show EKG findings of ST segment depression during the exam in leads V3 and V4 as
well as some concurrent chest discomfort. Based on these findings, which of the following
are NOT priority medical decisions?
Options:
A. Prescribe metoprolol (Lopressor) 12.5mg PO BID
B. Prescribe aspirin 81mg PO daily
C. Refer to cardiology for angiography
D. Check for thyroid dysfunction
Correct Answer:
D. Check for thyroid dysfunction.
Expert Rationale:
Positive stress-test ischemia with ST depression and chest discomfort requires antianginal
therapy, antiplatelet therapy, and cardiology referral. Thyroid testing may be useful in some
rhythm complaints but is not the priority decision here.
5. While examining a 53 year old female patient, you auscultate abnormal breath sounds
over all fields, and now assess transmission of voice sounds by having the patient say "ee"
while auscultating the chest with the diaphragm of your stethoscope. Normally, you should
auscultate a muffled "e" sound, however, you hear hear a nasally "a" sound. Which one of the
following will you document is present?
Options:
A. Positive stereognosis.
B. Positive for egophony.
C. Negative for bronchophony.
D. Negative for egophony
Correct Answer:
B. Positive for egophony.
Expert Rationale:
Egophony is present when the spoken “ee” sound is heard as a nasal “ay/a” sound over
consolidated lung tissue. It suggests increased transmission through fluid-filled or consolidated
lung.
Page 3
,6. While assessing the 19 year old patient for a new onset cough, the nurse practitioner may
inspect, auscultate, palpate, and/or percuss. How does performing percussion of the thorax
assist the provider during the physical examination?
Options:
A. To assist with the confirmation of cardiac origin of angina.
B. To assess for deep-seated lesion and tumors.
C. To assess for any pain or discomfort prior to palpitation of the chest wall.
D. To identify if underlying tissue are air-filled, fluid-filled or consolidated
Correct Answer:
D. To identify if underlying tissue are air-filled, fluid-filled or consolidated.
Expert Rationale:
Percussion helps determine whether underlying thoracic tissue is air-filled, fluid-filled, or
consolidated. Hyperresonance suggests excess air, while dullness suggests fluid or consolidation.
7. Your 42 year old male patient has been referred to your clinic for establishing care and on
his intake survey, you note he has documented diagnosis of interstitial lung disease. You
have decided to perform a diaphragmatic excursion test on the patient. Which one of the
following results would you expect to see in this patient?
Options:
A. Approximately equal level of change in the descent of the diaphragm bilaterally during
maximal inspiration and expiration. with a decreased overall inspiratory capacity.
B. Ascension of 8-12 inches of the diaphragm noted bilaterally on expiration, though often
much less on the right side due to the location of the heart and great vessels.
C. Much greater descent of the diaphragm on the right side due to the liver present (two-three
times larger)
D. Absent or no change in movement of the diaphragm noted between full inspiration and full
expiration measurement.
Correct Answer:
A. Approximately equal level of change in the descent of the diaphragm bilaterally during
maximal inspiration and expiration. with a decreased overall inspiratory capacity.
Expert Rationale:
Interstitial lung disease restricts lung expansion, so diaphragmatic movement is usually
symmetric but overall excursion is reduced. This reflects decreased inspiratory capacity from
restrictive physiology.
8. Your 50 year old Caucasian male patient has not seen a primary care giver in 20+ years
and is here for a history and physical examination. While examining the head and face, you
see your patient has nonpitting periorbital edema, particularly underneath their eyes and
very dry, thinned hair, including the lateral third of eyebrows (as pictured below: Sparse
hairline, thin lateral eyebrows, Periobital edema). Which one of the folowing would you
expect to cause this finding?
Page 4
, Options:
A. Severe hypothyroidism
B. Addison's disease
C. Grave's disease
D. Alzhemiers.
Correct Answer:
A. Severe hypothyroidism.
Expert Rationale:
Severe hypothyroidism can cause myxedematous nonpitting periorbital edema, dry skin, coarse
or thinning hair, and loss of the lateral eyebrows.
9. A40 year old, female, African American patient presents for history and physical. Upon
your initial assessment, you notice she has severe exophthalmos as pictured below. Which
one of the following diagnoses below would be the highest on your differential diagnose of
this physical examination finding? (eyes bulging out of her head)
Options:
A. Bilateral conjunctivitis.
B. Hyperthyroidism.
C. hypothyroidism
D. myexedma
Correct Answer:
B. Hyperthyroidism.
Expert Rationale:
Exophthalmos is classically associated with Graves disease, a form of hyperthyroidism. Thyroid
eye disease causes prominent bulging of the eyes.
10. Your patient with a suspected diagnosis of COPD has been seen by pulmonology and has
underwent a pulmonary function test (PFT) with spirometry. As the patient's primary
healthcare provider, you have been asked to explain the findings of the PFT to the patient in
a follow-up visit at which time the patient asks what the study was evaluating. To describe
the PFT to the patient in more useful terms, you state that the large inspiration of air to the
furthest extent they could reasonably accomplish followed by a full exhalation is referred to
as which of the following measurements during the PFT?
Options:
A. Forced Expiratory Volume over 1 second (FEV1)
B. Functional Reserve Capacity.
C. Inspiratory Reserve
D. Forced Vital Capacity.
Correct Answer:
D. Forced Vital Capacity.
Page 5
, Expert Rationale:
Forced vital capacity is the total volume exhaled forcefully after maximal inspiration. Spirometry
uses FVC and FEV1 to help distinguish obstructive and restrictive patterns.
11. Your newly established patient states in the past year, they have progressively developed
a noticeable bump on their neck and when asked about symptoms, they report feeling very
anxious, have developed a tremor, and are commonly feeling palpitations in their chest. On
examination, you identify an enlarged thyroid gland suspicious for a goiter. Of the following
diagnoses, which is most likely for the patient to develop based on these findings above?
Options:
A. Thyrotoxicosis.
B. lodine Excess.
C. Myxedema Coma.
D. Hashimotos Thyroiditis
Correct Answer:
A. Thyrotoxicosis.
Expert Rationale:
Goiter with anxiety, tremor, and palpitations is consistent with excess thyroid hormone effect.
Thyrotoxicosis describes the clinical syndrome caused by elevated thyroid hormone activity.
12. Your 32 year old female patient presented for a routine health exam states they have a
diagnoses of hyperthyroidism by another provider a year ago. In addition to evaluation with
TSH and T4 labwork, which of the following represent typical signs of hyperthyroidism
expected on your exam of this patient?
Options:
A. Hypersomnia
B. Tachycardia.
C. Lethargy.
D. Recent unplanned weight gain.
Correct Answer:
B. Tachycardia.
Expert Rationale:
Hyperthyroidism increases metabolic and sympathetic activity, commonly causing tachycardia,
palpitations, tremor, anxiety, heat intolerance, and weight loss.
13. Your patient has a diagnosis of Addison's disease. Which of the following might you
expect to find during examination?
Options:
A. Abdominal striae.
Page 6
, B. Dowager hump.
C. Low body temperature.
D. Moon face
Correct Answer:
C. Low body temperature.
Expert Rationale:
Addison disease is adrenal insufficiency and may cause low temperature, weight loss, fatigue,
hypotension, and hyperpigmentation. Moon face, striae, and dowager hump are more consistent
with Cushing syndrome.
14. The nurse practitioner's evaluation of apatient with Diabetes Mellitus type 2 should
include which of the folowing while evaluating for end organ dysfunction of the disease?
Options:
A. Renal function panel.
B. Urinalysis.
C. Non-dilated eye exam.
D. All of these are appropriate options.
Correct Answer:
D. All of these are appropriate options.
Expert Rationale:
Diabetes can damage eyes, kidneys, nerves, and vascular systems. Renal studies,
urinalysis/albumin screening, and eye evaluation help assess end-organ dysfunction.
15. Your patient with a diagnosis of autoimmune hepatitis is being seen in your clinic for
routine liver serology and follow-up examination. Which of the following correctly identifies
the normal liver span when percussing the liver of a HEALTHY adult?
Options:
A. 6-12 cm in the midsternal line
B. 4-8 in the left midclavicular line
C. 4-8 cm in the right midclavicular line
D. 6-12 cm in the right midclavicular line.
Correct Answer:
D. 6-12 cm in the right midclavicular line.
Expert Rationale:
Normal liver span in a healthy adult is commonly about 6-12 cm in the right midclavicular line.
Increased span may suggest hepatomegaly.
16. The 33 year old male patient presents with complaints of abdominal pain after a recent
birthday party where other guests also suspected food borne illness and gastroenteritis. To
Page 7
CONSISTS OF 150 QUESTIONS
Verified Questions & Answers With Rationales
(Differential Diagnosis Across the Lifespan Practicum)
Chamberlain
Page 1
,1. During a post-hospital discharge visit, you notice your 71 year old female patient has been
diagnosed with a "new murmur" found by the hospitalist during their recent hospitalization
for CHF exacerbation. In evaluating the patient, during which phase of the cardiac cycle
would you anticipate auscultation of a S3 or S4 heart sound?
Options:
A. Diastole
B. 53 in systole while S4 in diastole
C. Systole
D. S4 in diastole while S3 in systole
Correct Answer:
A. Diastole.
Expert Rationale:
S3 and S4 are extra heart sounds heard during diastole. S3 occurs in early diastole with rapid
ventricular filling, while S4 occurs in late diastole with atrial contraction into a stiff ventricle.
2. The point of maximum impulse (PMI) is MOST often palpable in healthy adults when
positioned in the supine or left lateral decubitus position. Which one of the following
locations is most commonly described as the PMI in a healthy adult?
Options:
A. Left 2nd intercostal space, midaxillary line.
B. Left 5th intercostal space, midclavicular line.
C. Right 4th intercostal space, midaxillary line.
D. Right 2nd intercostal space, midclavicular line.
Correct Answer:
B. Left 5th intercostal space, midclavicular line.
Expert Rationale:
The PMI is normally located at the left fifth intercostal space near the midclavicular line.
Displacement can suggest ventricular enlargement or other cardiopulmonary pathology.
3. The nurse practitioner assessing the patient with a rapid cardiac rhythm may assess for a
pulse deficit by auscultating the patient's heart while watching the EKG rhythm. Where
would the S1 heart sounds correlate with the electrocardiographic waves?
Options:
A. At the end of the T wave.
B. At the start of the T wave.
C. Peak of the R wave.
D. At the start of the P wave.
Page 2
, Correct Answer:
C. Peak of the R wave.
Expert Rationale:
S1 occurs with closure of the mitral and tricuspid valves at the onset of ventricular systole. It
corresponds closely with ventricular depolarization, represented by the QRS complex/peak R
wave on ECG.
4. Michael, a 72 year old male patient who previously presented with stable cardiac-type
chest pain has underwent a stress test. He presents today to review the stress test results,
which show EKG findings of ST segment depression during the exam in leads V3 and V4 as
well as some concurrent chest discomfort. Based on these findings, which of the following
are NOT priority medical decisions?
Options:
A. Prescribe metoprolol (Lopressor) 12.5mg PO BID
B. Prescribe aspirin 81mg PO daily
C. Refer to cardiology for angiography
D. Check for thyroid dysfunction
Correct Answer:
D. Check for thyroid dysfunction.
Expert Rationale:
Positive stress-test ischemia with ST depression and chest discomfort requires antianginal
therapy, antiplatelet therapy, and cardiology referral. Thyroid testing may be useful in some
rhythm complaints but is not the priority decision here.
5. While examining a 53 year old female patient, you auscultate abnormal breath sounds
over all fields, and now assess transmission of voice sounds by having the patient say "ee"
while auscultating the chest with the diaphragm of your stethoscope. Normally, you should
auscultate a muffled "e" sound, however, you hear hear a nasally "a" sound. Which one of the
following will you document is present?
Options:
A. Positive stereognosis.
B. Positive for egophony.
C. Negative for bronchophony.
D. Negative for egophony
Correct Answer:
B. Positive for egophony.
Expert Rationale:
Egophony is present when the spoken “ee” sound is heard as a nasal “ay/a” sound over
consolidated lung tissue. It suggests increased transmission through fluid-filled or consolidated
lung.
Page 3
,6. While assessing the 19 year old patient for a new onset cough, the nurse practitioner may
inspect, auscultate, palpate, and/or percuss. How does performing percussion of the thorax
assist the provider during the physical examination?
Options:
A. To assist with the confirmation of cardiac origin of angina.
B. To assess for deep-seated lesion and tumors.
C. To assess for any pain or discomfort prior to palpitation of the chest wall.
D. To identify if underlying tissue are air-filled, fluid-filled or consolidated
Correct Answer:
D. To identify if underlying tissue are air-filled, fluid-filled or consolidated.
Expert Rationale:
Percussion helps determine whether underlying thoracic tissue is air-filled, fluid-filled, or
consolidated. Hyperresonance suggests excess air, while dullness suggests fluid or consolidation.
7. Your 42 year old male patient has been referred to your clinic for establishing care and on
his intake survey, you note he has documented diagnosis of interstitial lung disease. You
have decided to perform a diaphragmatic excursion test on the patient. Which one of the
following results would you expect to see in this patient?
Options:
A. Approximately equal level of change in the descent of the diaphragm bilaterally during
maximal inspiration and expiration. with a decreased overall inspiratory capacity.
B. Ascension of 8-12 inches of the diaphragm noted bilaterally on expiration, though often
much less on the right side due to the location of the heart and great vessels.
C. Much greater descent of the diaphragm on the right side due to the liver present (two-three
times larger)
D. Absent or no change in movement of the diaphragm noted between full inspiration and full
expiration measurement.
Correct Answer:
A. Approximately equal level of change in the descent of the diaphragm bilaterally during
maximal inspiration and expiration. with a decreased overall inspiratory capacity.
Expert Rationale:
Interstitial lung disease restricts lung expansion, so diaphragmatic movement is usually
symmetric but overall excursion is reduced. This reflects decreased inspiratory capacity from
restrictive physiology.
8. Your 50 year old Caucasian male patient has not seen a primary care giver in 20+ years
and is here for a history and physical examination. While examining the head and face, you
see your patient has nonpitting periorbital edema, particularly underneath their eyes and
very dry, thinned hair, including the lateral third of eyebrows (as pictured below: Sparse
hairline, thin lateral eyebrows, Periobital edema). Which one of the folowing would you
expect to cause this finding?
Page 4
, Options:
A. Severe hypothyroidism
B. Addison's disease
C. Grave's disease
D. Alzhemiers.
Correct Answer:
A. Severe hypothyroidism.
Expert Rationale:
Severe hypothyroidism can cause myxedematous nonpitting periorbital edema, dry skin, coarse
or thinning hair, and loss of the lateral eyebrows.
9. A40 year old, female, African American patient presents for history and physical. Upon
your initial assessment, you notice she has severe exophthalmos as pictured below. Which
one of the following diagnoses below would be the highest on your differential diagnose of
this physical examination finding? (eyes bulging out of her head)
Options:
A. Bilateral conjunctivitis.
B. Hyperthyroidism.
C. hypothyroidism
D. myexedma
Correct Answer:
B. Hyperthyroidism.
Expert Rationale:
Exophthalmos is classically associated with Graves disease, a form of hyperthyroidism. Thyroid
eye disease causes prominent bulging of the eyes.
10. Your patient with a suspected diagnosis of COPD has been seen by pulmonology and has
underwent a pulmonary function test (PFT) with spirometry. As the patient's primary
healthcare provider, you have been asked to explain the findings of the PFT to the patient in
a follow-up visit at which time the patient asks what the study was evaluating. To describe
the PFT to the patient in more useful terms, you state that the large inspiration of air to the
furthest extent they could reasonably accomplish followed by a full exhalation is referred to
as which of the following measurements during the PFT?
Options:
A. Forced Expiratory Volume over 1 second (FEV1)
B. Functional Reserve Capacity.
C. Inspiratory Reserve
D. Forced Vital Capacity.
Correct Answer:
D. Forced Vital Capacity.
Page 5
, Expert Rationale:
Forced vital capacity is the total volume exhaled forcefully after maximal inspiration. Spirometry
uses FVC and FEV1 to help distinguish obstructive and restrictive patterns.
11. Your newly established patient states in the past year, they have progressively developed
a noticeable bump on their neck and when asked about symptoms, they report feeling very
anxious, have developed a tremor, and are commonly feeling palpitations in their chest. On
examination, you identify an enlarged thyroid gland suspicious for a goiter. Of the following
diagnoses, which is most likely for the patient to develop based on these findings above?
Options:
A. Thyrotoxicosis.
B. lodine Excess.
C. Myxedema Coma.
D. Hashimotos Thyroiditis
Correct Answer:
A. Thyrotoxicosis.
Expert Rationale:
Goiter with anxiety, tremor, and palpitations is consistent with excess thyroid hormone effect.
Thyrotoxicosis describes the clinical syndrome caused by elevated thyroid hormone activity.
12. Your 32 year old female patient presented for a routine health exam states they have a
diagnoses of hyperthyroidism by another provider a year ago. In addition to evaluation with
TSH and T4 labwork, which of the following represent typical signs of hyperthyroidism
expected on your exam of this patient?
Options:
A. Hypersomnia
B. Tachycardia.
C. Lethargy.
D. Recent unplanned weight gain.
Correct Answer:
B. Tachycardia.
Expert Rationale:
Hyperthyroidism increases metabolic and sympathetic activity, commonly causing tachycardia,
palpitations, tremor, anxiety, heat intolerance, and weight loss.
13. Your patient has a diagnosis of Addison's disease. Which of the following might you
expect to find during examination?
Options:
A. Abdominal striae.
Page 6
, B. Dowager hump.
C. Low body temperature.
D. Moon face
Correct Answer:
C. Low body temperature.
Expert Rationale:
Addison disease is adrenal insufficiency and may cause low temperature, weight loss, fatigue,
hypotension, and hyperpigmentation. Moon face, striae, and dowager hump are more consistent
with Cushing syndrome.
14. The nurse practitioner's evaluation of apatient with Diabetes Mellitus type 2 should
include which of the folowing while evaluating for end organ dysfunction of the disease?
Options:
A. Renal function panel.
B. Urinalysis.
C. Non-dilated eye exam.
D. All of these are appropriate options.
Correct Answer:
D. All of these are appropriate options.
Expert Rationale:
Diabetes can damage eyes, kidneys, nerves, and vascular systems. Renal studies,
urinalysis/albumin screening, and eye evaluation help assess end-organ dysfunction.
15. Your patient with a diagnosis of autoimmune hepatitis is being seen in your clinic for
routine liver serology and follow-up examination. Which of the following correctly identifies
the normal liver span when percussing the liver of a HEALTHY adult?
Options:
A. 6-12 cm in the midsternal line
B. 4-8 in the left midclavicular line
C. 4-8 cm in the right midclavicular line
D. 6-12 cm in the right midclavicular line.
Correct Answer:
D. 6-12 cm in the right midclavicular line.
Expert Rationale:
Normal liver span in a healthy adult is commonly about 6-12 cm in the right midclavicular line.
Increased span may suggest hepatomegaly.
16. The 33 year old male patient presents with complaints of abdominal pain after a recent
birthday party where other guests also suspected food borne illness and gastroenteritis. To
Page 7
