FINAL EXAM: NR511/NR 511 (LATEST
2026/2027 UPDATE) DIFFERENTIAL
DIAGNOSIS & PRIMARY CARE PRACTICUM |
EXAM REVIEW, WITH CORRECT/ACCURATE
ANSWERS
AT CHAMBERLAIN COLLEGE OF NURSING
DIFFERENTIAL DIAGNOSIS & PRIMARY
CARE PRACTICUM
Question 1
Which physical exam finding is most consistent with benign prostatic hyperplasia (BPH)?
A. Hard, irregular prostate
B. Smooth, symmetrically enlarged prostate
C. Tender boggy prostate
D. Prostate nodules with asymmetry
Correct Answer: B. Smooth, symmetrically enlarged prostate
Rationale:
BPH is characterized by nonmalignant enlargement of the prostate, leading to a smooth, rubbery, and
symmetrically enlarged gland on digital rectal exam. This enlargement causes lower urinary tract symptoms
due to urethral compression. A hard or irregular prostate raises concern for prostate cancer, while a boggy
tender prostate suggests prostatitis. Nodularity is also more consistent with malignancy.
,Question 2
A 67-year-old patient presents with localized low back pain above the lumbar region without radiation to the
legs. Neurological exam is normal. What is the most likely diagnosis?
A. Lumbar disc herniation
B. Spinal stenosis
C. Musculoskeletal strain
D. Cauda equina syndrome
Correct Answer: C. Musculoskeletal strain
Rationale:
Musculoskeletal back pain is the most common cause of localized low back pain without neurological
deficits. The absence of sciatica, weakness, numbness, or bowel/bladder symptoms supports a benign
etiology. Disc herniation and spinal stenosis typically produce radicular symptoms. Cauda equina syndrome
is a medical emergency with severe neurological findings.
Question 3
What is the best instruction for a patient prescribed oral iron supplementation?
A. Take with dairy products
B. Take with meals to reduce absorption
C. Take on an empty stomach
D. Take with antacids
Correct Answer: C. Take on an empty stomach
Rationale:
Iron is best absorbed in an acidic environment, which is optimized when taken on an empty stomach. Dairy
products, antacids, and food decrease iron absorption by binding iron or reducing gastric acidity. Although
taking iron with food may reduce GI upset, it significantly decreases bioavailability. Vitamin C may enhance
absorption.
,Question 4
A 65-year-old homeless woman has iron deficiency anemia. Which of the following is NOT a risk factor for
iron deficiency anemia?
A. Chronic blood loss
B. Malnutrition
C. Gastric ulcer
D. Smoking
Correct Answer: D. Smoking
Rationale:
Iron deficiency anemia is commonly caused by chronic blood loss, malnutrition, and GI pathology such as
ulcers. Smoking itself does not cause iron deficiency anemia and may actually increase hemoglobin levels
due to chronic hypoxia. Alcohol use, poor diet, and homelessness increase risk. Smoking is more associated
with polycythemia than anemia.
Question 5
In which situation is the reticulocyte count expected to be elevated?
A. Iron deficiency anemia
B. Acute blood loss
C. Aplastic anemia
D. Vitamin B12 deficiency
Correct Answer: B. Acute blood loss
Rationale:
Reticulocytes are immature red blood cells released in response to increased erythropoietic demand. Acute
blood loss stimulates bone marrow to increase RBC production, resulting in elevated reticulocyte counts. In
iron deficiency and B12 deficiency, reticulocyte production is impaired. Aplastic anemia causes
pancytopenia with low reticulocytes.
, Question 6
A 29-year-old woman presents with pallor, tachycardia, glossitis, koilonychia, and splenomegaly. What is
the most likely diagnosis?
A. Thalassemia
B. Iron deficiency anemia
C. Sickle cell disease
D. Pernicious anemia
Correct Answer: B. Iron deficiency anemia
Rationale:
Iron deficiency anemia presents with classic findings including pallor, tachycardia, koilonychia (spoon
nails), glossitis, and fatigue. Cheilosis and stomatitis further support nutritional deficiency. Splenomegaly
may occur due to increased RBC destruction. Thalassemia and sickle cell disease have distinct genetic and
hemolytic features.
Question 7
A newborn has hypospadias. The parents request circumcision. What is the appropriate response?
A. Circumcision can proceed as requested
B. Delay circumcision until adolescence
C. Circumcision is contraindicated
D. The foreskin is needed for surgical repair
Correct Answer: D. The foreskin is needed for surgical repair
Rationale:
In hypospadias, the foreskin is often required for reconstructive surgery of the urethra. Circumcision should
not be performed prior to repair. Removing the foreskin may compromise surgical outcomes. Circumcision
may be considered after corrective surgery if desired.
2026/2027 UPDATE) DIFFERENTIAL
DIAGNOSIS & PRIMARY CARE PRACTICUM |
EXAM REVIEW, WITH CORRECT/ACCURATE
ANSWERS
AT CHAMBERLAIN COLLEGE OF NURSING
DIFFERENTIAL DIAGNOSIS & PRIMARY
CARE PRACTICUM
Question 1
Which physical exam finding is most consistent with benign prostatic hyperplasia (BPH)?
A. Hard, irregular prostate
B. Smooth, symmetrically enlarged prostate
C. Tender boggy prostate
D. Prostate nodules with asymmetry
Correct Answer: B. Smooth, symmetrically enlarged prostate
Rationale:
BPH is characterized by nonmalignant enlargement of the prostate, leading to a smooth, rubbery, and
symmetrically enlarged gland on digital rectal exam. This enlargement causes lower urinary tract symptoms
due to urethral compression. A hard or irregular prostate raises concern for prostate cancer, while a boggy
tender prostate suggests prostatitis. Nodularity is also more consistent with malignancy.
,Question 2
A 67-year-old patient presents with localized low back pain above the lumbar region without radiation to the
legs. Neurological exam is normal. What is the most likely diagnosis?
A. Lumbar disc herniation
B. Spinal stenosis
C. Musculoskeletal strain
D. Cauda equina syndrome
Correct Answer: C. Musculoskeletal strain
Rationale:
Musculoskeletal back pain is the most common cause of localized low back pain without neurological
deficits. The absence of sciatica, weakness, numbness, or bowel/bladder symptoms supports a benign
etiology. Disc herniation and spinal stenosis typically produce radicular symptoms. Cauda equina syndrome
is a medical emergency with severe neurological findings.
Question 3
What is the best instruction for a patient prescribed oral iron supplementation?
A. Take with dairy products
B. Take with meals to reduce absorption
C. Take on an empty stomach
D. Take with antacids
Correct Answer: C. Take on an empty stomach
Rationale:
Iron is best absorbed in an acidic environment, which is optimized when taken on an empty stomach. Dairy
products, antacids, and food decrease iron absorption by binding iron or reducing gastric acidity. Although
taking iron with food may reduce GI upset, it significantly decreases bioavailability. Vitamin C may enhance
absorption.
,Question 4
A 65-year-old homeless woman has iron deficiency anemia. Which of the following is NOT a risk factor for
iron deficiency anemia?
A. Chronic blood loss
B. Malnutrition
C. Gastric ulcer
D. Smoking
Correct Answer: D. Smoking
Rationale:
Iron deficiency anemia is commonly caused by chronic blood loss, malnutrition, and GI pathology such as
ulcers. Smoking itself does not cause iron deficiency anemia and may actually increase hemoglobin levels
due to chronic hypoxia. Alcohol use, poor diet, and homelessness increase risk. Smoking is more associated
with polycythemia than anemia.
Question 5
In which situation is the reticulocyte count expected to be elevated?
A. Iron deficiency anemia
B. Acute blood loss
C. Aplastic anemia
D. Vitamin B12 deficiency
Correct Answer: B. Acute blood loss
Rationale:
Reticulocytes are immature red blood cells released in response to increased erythropoietic demand. Acute
blood loss stimulates bone marrow to increase RBC production, resulting in elevated reticulocyte counts. In
iron deficiency and B12 deficiency, reticulocyte production is impaired. Aplastic anemia causes
pancytopenia with low reticulocytes.
, Question 6
A 29-year-old woman presents with pallor, tachycardia, glossitis, koilonychia, and splenomegaly. What is
the most likely diagnosis?
A. Thalassemia
B. Iron deficiency anemia
C. Sickle cell disease
D. Pernicious anemia
Correct Answer: B. Iron deficiency anemia
Rationale:
Iron deficiency anemia presents with classic findings including pallor, tachycardia, koilonychia (spoon
nails), glossitis, and fatigue. Cheilosis and stomatitis further support nutritional deficiency. Splenomegaly
may occur due to increased RBC destruction. Thalassemia and sickle cell disease have distinct genetic and
hemolytic features.
Question 7
A newborn has hypospadias. The parents request circumcision. What is the appropriate response?
A. Circumcision can proceed as requested
B. Delay circumcision until adolescence
C. Circumcision is contraindicated
D. The foreskin is needed for surgical repair
Correct Answer: D. The foreskin is needed for surgical repair
Rationale:
In hypospadias, the foreskin is often required for reconstructive surgery of the urethra. Circumcision should
not be performed prior to repair. Removing the foreskin may compromise surgical outcomes. Circumcision
may be considered after corrective surgery if desired.
