NR607 PRE-DIAGNOSTIC EXAM 200 ACTUAL
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALE LATEST UPDATE ALREADY GRADED A+
ASSURED PASS
This comprehensive examination bank features 200 unique, single-best-
answer multiple-choice questions designed for advanced diagnostic reasoning
and clinical decision-making. Each question presents a realistic patient
scenario across the lifespan, with a correct answer and a detailed, evidence-
based rationale that explains pathophysiology, differential diagnosis, and
appropriate diagnostic test selection. Content covers cardiology, pulmonology,
neurology, rheumatology, endocrinology, gastroenterology, nephrology,
obstetrics, geriatrics, and oncology. No questions are repeated, and all text is
plain for easy study. This bank strengthens clinical judgment, history-taking,
physical examination skills, and diagnostic test interpretation essential for
advanced practice nursing examinations.
Question 1
A 45-year-old male presents with acute onset of severe right upper quadrant pain,
nausea, and vomiting. He reports the pain began 2 hours after a fatty meal. On
examination, he has guarding and a positive Murphy sign. What is the most likely
diagnosis?
A) Acute pancreatitis
B) Acute cholecystitis
C) Peptic ulcer disease
D) Gastroesophageal reflux disease
Answer: B
Rationale: Acute cholecystitis presents with right upper quadrant pain, nausea,
vomiting, and a positive Murphy sign, often triggered by a fatty meal. Pancreatitis
typically causes epigastric pain radiating to the back. Peptic ulcer disease causes
epigastric pain. GERD causes retrosternal burning.
Question 2
,A 68-year-old female with a history of hypertension presents with sudden onset of
severe headache, nausea, and photophobia. She has no fever. Neurological
examination is normal. What is the most appropriate next diagnostic step?
A) Lumbar puncture
B) Non-contrast head computed tomography
C) Magnetic resonance imaging of the brain
D) Carotid ultrasound
Answer: B
Rationale: A non-contrast head CT is the initial test for suspected subarachnoid
hemorrhage. If negative, a lumbar puncture is performed. MRI and carotid
ultrasound are not first-line for acute headache with suspected bleed.
Question 3
A 55-year-old male with a 30-pack-year smoking history presents with a chronic
cough, hemoptysis, and weight loss. Chest x-ray shows a right hilar mass. Which
diagnostic test is most definitive for lung cancer?
A) Sputum cytology
B) Computed tomography of the chest
C) Bronchoscopy with biopsy
D) Positron emission tomography scan
Answer: C
Rationale: Bronchoscopy with biopsy provides tissue for histologic examination,
the gold standard for lung cancer diagnosis. Sputum cytology and imaging are
suggestive but not definitive. PET scans are for staging.
Question 4
A 32-year-old female presents with fatigue, palpitations, heat intolerance, and
weight loss. She has a diffuse goiter. Laboratory tests show low TSH and elevated
free T4. What is the most likely diagnosis?
A) Hashimoto thyroiditis
B) Graves disease
C) Subacute thyroiditis
D) Toxic multinodular goiter
Answer: B
Rationale: Graves disease is the most common cause of hyperthyroidism,
presenting with diffuse goiter, low TSH, and elevated free T4. Hashimoto causes
hypothyroidism. Subacute thyroiditis causes pain. Toxic multinodular goiter
presents with nodules.
Question 5
,A 62-year-old male presents with progressive shortness of breath, orthopnea, and
peripheral edema. He has an S3 gallop and crackles in the lung bases. Which
diagnostic test is most helpful to confirm the diagnosis?
A) Chest x-ray
B) Electrocardiogram
C) Echocardiogram
D) Brain natriuretic peptide level
Answer: C
Rationale: Echocardiogram is the gold standard for diagnosing heart failure,
assessing ejection fraction, and evaluating valvular and structural abnormalities.
BNP and chest x-ray support the diagnosis but are less definitive.
Question 6
A 48-year-old female presents with a painful, swollen left wrist and morning
stiffness lasting over 1 hour. She also has fatigue. Rheumatoid factor is positive.
Which test is most specific for rheumatoid arthritis?
A) Anti-cyclic citrullinated peptide antibodies
B) Erythrocyte sedimentation rate
C) C-reactive protein
D) Antinuclear antibodies
Answer: A
Rationale: Anti-CCP antibodies are highly specific for RA. Rheumatoid factor is
less specific. ESR and CRP are inflammatory markers. ANA is associated with
lupus.
Question 7
A 70-year-old male presents with sudden, painless loss of vision in his right eye.
Fundoscopic examination shows a pale retina with a cherry-red spot. What is the
most likely diagnosis?
A) Central retinal vein occlusion
B) Central retinal artery occlusion
C) Retinal detachment
D) Vitreous hemorrhage
Answer: B
Rationale: Central retinal artery occlusion presents with sudden, painless vision
loss, a pale retina, and a cherry-red spot. Vein occlusion causes hemorrhages.
Retinal detachment causes floaters. Vitreous hemorrhage causes floaters and
blurred vision.
Question 8
, A 55-year-old female presents with a new lump in her right breast. Mammogram
shows a spiculated mass. Biopsy reveals invasive ductal carcinoma that is estrogen
receptor positive and HER2 negative. Which additional test is most important for
staging?
A) Computed tomography of the chest, abdomen, and pelvis
B) Bone scan
C) Positron emission tomography scan
D) Magnetic resonance imaging of the breast
Answer: A
Rationale: CT of the chest, abdomen, and pelvis is used for staging breast cancer to
detect distant metastases. Bone scan and PET are used selectively. MRI is for local
evaluation.
Question 9
A 40-year-old male presents with a painful, swollen right knee after a fall. He has a
history of hemophilia A. What is the most appropriate diagnostic test?
A) Joint x-ray
B) Magnetic resonance imaging
C) Serum factor VIII level
D) Joint aspiration
Answer: C
Rationale: In a patient with hemophilia A, the diagnosis is confirmed by serum
factor VIII level. Imaging and aspiration are not diagnostic for the underlying
disorder.
Question 10
A 65-year-old female presents with a new onset of confusion, urinary incontinence,
and unsteady gait. Her family reports that she has been falling. What is the most
likely diagnosis?
A) Alzheimer disease
B) Parkinson disease
C) Normal pressure hydrocephalus
D) Vascular dementia
Answer: C
Rationale: The classic triad of normal pressure hydrocephalus is confusion, urinary
incontinence, and gait disturbance. Alzheimer presents with memory loss.
Parkinson presents with tremor and rigidity. Vascular dementia has a stepwise
progression.
Question 11
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALE LATEST UPDATE ALREADY GRADED A+
ASSURED PASS
This comprehensive examination bank features 200 unique, single-best-
answer multiple-choice questions designed for advanced diagnostic reasoning
and clinical decision-making. Each question presents a realistic patient
scenario across the lifespan, with a correct answer and a detailed, evidence-
based rationale that explains pathophysiology, differential diagnosis, and
appropriate diagnostic test selection. Content covers cardiology, pulmonology,
neurology, rheumatology, endocrinology, gastroenterology, nephrology,
obstetrics, geriatrics, and oncology. No questions are repeated, and all text is
plain for easy study. This bank strengthens clinical judgment, history-taking,
physical examination skills, and diagnostic test interpretation essential for
advanced practice nursing examinations.
Question 1
A 45-year-old male presents with acute onset of severe right upper quadrant pain,
nausea, and vomiting. He reports the pain began 2 hours after a fatty meal. On
examination, he has guarding and a positive Murphy sign. What is the most likely
diagnosis?
A) Acute pancreatitis
B) Acute cholecystitis
C) Peptic ulcer disease
D) Gastroesophageal reflux disease
Answer: B
Rationale: Acute cholecystitis presents with right upper quadrant pain, nausea,
vomiting, and a positive Murphy sign, often triggered by a fatty meal. Pancreatitis
typically causes epigastric pain radiating to the back. Peptic ulcer disease causes
epigastric pain. GERD causes retrosternal burning.
Question 2
,A 68-year-old female with a history of hypertension presents with sudden onset of
severe headache, nausea, and photophobia. She has no fever. Neurological
examination is normal. What is the most appropriate next diagnostic step?
A) Lumbar puncture
B) Non-contrast head computed tomography
C) Magnetic resonance imaging of the brain
D) Carotid ultrasound
Answer: B
Rationale: A non-contrast head CT is the initial test for suspected subarachnoid
hemorrhage. If negative, a lumbar puncture is performed. MRI and carotid
ultrasound are not first-line for acute headache with suspected bleed.
Question 3
A 55-year-old male with a 30-pack-year smoking history presents with a chronic
cough, hemoptysis, and weight loss. Chest x-ray shows a right hilar mass. Which
diagnostic test is most definitive for lung cancer?
A) Sputum cytology
B) Computed tomography of the chest
C) Bronchoscopy with biopsy
D) Positron emission tomography scan
Answer: C
Rationale: Bronchoscopy with biopsy provides tissue for histologic examination,
the gold standard for lung cancer diagnosis. Sputum cytology and imaging are
suggestive but not definitive. PET scans are for staging.
Question 4
A 32-year-old female presents with fatigue, palpitations, heat intolerance, and
weight loss. She has a diffuse goiter. Laboratory tests show low TSH and elevated
free T4. What is the most likely diagnosis?
A) Hashimoto thyroiditis
B) Graves disease
C) Subacute thyroiditis
D) Toxic multinodular goiter
Answer: B
Rationale: Graves disease is the most common cause of hyperthyroidism,
presenting with diffuse goiter, low TSH, and elevated free T4. Hashimoto causes
hypothyroidism. Subacute thyroiditis causes pain. Toxic multinodular goiter
presents with nodules.
Question 5
,A 62-year-old male presents with progressive shortness of breath, orthopnea, and
peripheral edema. He has an S3 gallop and crackles in the lung bases. Which
diagnostic test is most helpful to confirm the diagnosis?
A) Chest x-ray
B) Electrocardiogram
C) Echocardiogram
D) Brain natriuretic peptide level
Answer: C
Rationale: Echocardiogram is the gold standard for diagnosing heart failure,
assessing ejection fraction, and evaluating valvular and structural abnormalities.
BNP and chest x-ray support the diagnosis but are less definitive.
Question 6
A 48-year-old female presents with a painful, swollen left wrist and morning
stiffness lasting over 1 hour. She also has fatigue. Rheumatoid factor is positive.
Which test is most specific for rheumatoid arthritis?
A) Anti-cyclic citrullinated peptide antibodies
B) Erythrocyte sedimentation rate
C) C-reactive protein
D) Antinuclear antibodies
Answer: A
Rationale: Anti-CCP antibodies are highly specific for RA. Rheumatoid factor is
less specific. ESR and CRP are inflammatory markers. ANA is associated with
lupus.
Question 7
A 70-year-old male presents with sudden, painless loss of vision in his right eye.
Fundoscopic examination shows a pale retina with a cherry-red spot. What is the
most likely diagnosis?
A) Central retinal vein occlusion
B) Central retinal artery occlusion
C) Retinal detachment
D) Vitreous hemorrhage
Answer: B
Rationale: Central retinal artery occlusion presents with sudden, painless vision
loss, a pale retina, and a cherry-red spot. Vein occlusion causes hemorrhages.
Retinal detachment causes floaters. Vitreous hemorrhage causes floaters and
blurred vision.
Question 8
, A 55-year-old female presents with a new lump in her right breast. Mammogram
shows a spiculated mass. Biopsy reveals invasive ductal carcinoma that is estrogen
receptor positive and HER2 negative. Which additional test is most important for
staging?
A) Computed tomography of the chest, abdomen, and pelvis
B) Bone scan
C) Positron emission tomography scan
D) Magnetic resonance imaging of the breast
Answer: A
Rationale: CT of the chest, abdomen, and pelvis is used for staging breast cancer to
detect distant metastases. Bone scan and PET are used selectively. MRI is for local
evaluation.
Question 9
A 40-year-old male presents with a painful, swollen right knee after a fall. He has a
history of hemophilia A. What is the most appropriate diagnostic test?
A) Joint x-ray
B) Magnetic resonance imaging
C) Serum factor VIII level
D) Joint aspiration
Answer: C
Rationale: In a patient with hemophilia A, the diagnosis is confirmed by serum
factor VIII level. Imaging and aspiration are not diagnostic for the underlying
disorder.
Question 10
A 65-year-old female presents with a new onset of confusion, urinary incontinence,
and unsteady gait. Her family reports that she has been falling. What is the most
likely diagnosis?
A) Alzheimer disease
B) Parkinson disease
C) Normal pressure hydrocephalus
D) Vascular dementia
Answer: C
Rationale: The classic triad of normal pressure hydrocephalus is confusion, urinary
incontinence, and gait disturbance. Alzheimer presents with memory loss.
Parkinson presents with tremor and rigidity. Vascular dementia has a stepwise
progression.
Question 11
