NR 603 Advanced Clinical Diagnosis Final Exam Prep 2026
Chamberlain College
1. A 55-year-old African American male presents with a blood pressure of
150/94. He has no history of chronic kidney disease or diabetes. According to
JNC 8 guidelines, which class of medication should be initiated first?
A. ACE Inhibitor
B. Beta-Blocker
C. Angiotensin Receptor Blocker
D. Calcium Channel Blocker
Answer: D
Rationale: For African American patients without CKD, initial antihypertensive treatment
should include a thiazide-type diuretic or a calcium channel blocker (CCB).
2. Which of the following is the gold standard for diagnosing Chronic
Obstructive Pulmonary Disease (COPD)?
A. Spirometry
B. Chest X-ray
C. Arterial Blood Gas
D. Peak Flow Meter
Answer: A
Rationale: Spirometry is required to make the clinical diagnosis of COPD; a post-
bronchodilator FEV1/FVC ratio < 0.70 confirms persistent airflow limitation.
,3. A patient presents with a TSH level of 12.5 mIU/L and a low Free T4. Which
condition is most likely?
A. Hyperthyroidism
B. Primary Hypothyroidism
C. Subclinical Hypothyroidism
D. Secondary Hyperthyroidism
Answer: B
Rationale: Primary hypothyroidism is characterized by an elevated TSH and a low Free T4
level.
4. A 45-year-old female complains of RUQ pain that radiates to her right
shoulder, occurring after eating a fatty meal. What is the most likely physical
exam finding?
A. Positive Psoas Sign
B. Positive McBurney’s Sign
C. Positive Rovsing’s Sign
D. Positive Murphy’s Sign
Answer: D
Rationale: Murphy’s sign is associated with acute cholecystitis, often triggered by fatty
meals.
5. Which medication is considered first-line for a patient newly diagnosed with
Type 2 Diabetes Mellitus and an A1c of 7.5%?
A. Metformin
B. Glipizide
C. Insulin Glargine
D. Sitagliptin
Answer: A
, Rationale: Metformin is the preferred initial pharmacologic agent for the treatment of type
2 diabetes unless contraindicated.
6. A patient presents with a ‘barking’ cough and stridor. This is most
characteristic of which pediatric condition?
A. Epiglottitis
B. Bronchiolitis
C. Croup
D. Pertussis
Answer: C
Rationale: Croup (laryngotracheobronchitis) is typically caused by parainfluenza virus and
presents with a barking cough and inspiratory stridor.
7. What is the primary diagnostic indicator for Iron Deficiency Anemia on a CBC?
A. Macrocytic, Hyperchromic
B. Macrocytic, Normochromic
C. Normocytic, Normochromic
D. Microcytic, Hypochromic
Answer: D
Rationale: Iron deficiency anemia is characterized by small (microcytic) and pale
(hypochromic) red blood cells.
8. Which of the following is a classic sign of Atrial Fibrillation on an EKG?
A. Sawtooth P-waves
B. Absence of P-waves and irregularly irregular rhythm
C. Prolonged PR interval
D. Delta wave
Answer: B
Rationale: Atrial Fibrillation is defined by the absence of discrete P-waves and an
irregularly irregular ventricular response.
Chamberlain College
1. A 55-year-old African American male presents with a blood pressure of
150/94. He has no history of chronic kidney disease or diabetes. According to
JNC 8 guidelines, which class of medication should be initiated first?
A. ACE Inhibitor
B. Beta-Blocker
C. Angiotensin Receptor Blocker
D. Calcium Channel Blocker
Answer: D
Rationale: For African American patients without CKD, initial antihypertensive treatment
should include a thiazide-type diuretic or a calcium channel blocker (CCB).
2. Which of the following is the gold standard for diagnosing Chronic
Obstructive Pulmonary Disease (COPD)?
A. Spirometry
B. Chest X-ray
C. Arterial Blood Gas
D. Peak Flow Meter
Answer: A
Rationale: Spirometry is required to make the clinical diagnosis of COPD; a post-
bronchodilator FEV1/FVC ratio < 0.70 confirms persistent airflow limitation.
,3. A patient presents with a TSH level of 12.5 mIU/L and a low Free T4. Which
condition is most likely?
A. Hyperthyroidism
B. Primary Hypothyroidism
C. Subclinical Hypothyroidism
D. Secondary Hyperthyroidism
Answer: B
Rationale: Primary hypothyroidism is characterized by an elevated TSH and a low Free T4
level.
4. A 45-year-old female complains of RUQ pain that radiates to her right
shoulder, occurring after eating a fatty meal. What is the most likely physical
exam finding?
A. Positive Psoas Sign
B. Positive McBurney’s Sign
C. Positive Rovsing’s Sign
D. Positive Murphy’s Sign
Answer: D
Rationale: Murphy’s sign is associated with acute cholecystitis, often triggered by fatty
meals.
5. Which medication is considered first-line for a patient newly diagnosed with
Type 2 Diabetes Mellitus and an A1c of 7.5%?
A. Metformin
B. Glipizide
C. Insulin Glargine
D. Sitagliptin
Answer: A
, Rationale: Metformin is the preferred initial pharmacologic agent for the treatment of type
2 diabetes unless contraindicated.
6. A patient presents with a ‘barking’ cough and stridor. This is most
characteristic of which pediatric condition?
A. Epiglottitis
B. Bronchiolitis
C. Croup
D. Pertussis
Answer: C
Rationale: Croup (laryngotracheobronchitis) is typically caused by parainfluenza virus and
presents with a barking cough and inspiratory stridor.
7. What is the primary diagnostic indicator for Iron Deficiency Anemia on a CBC?
A. Macrocytic, Hyperchromic
B. Macrocytic, Normochromic
C. Normocytic, Normochromic
D. Microcytic, Hypochromic
Answer: D
Rationale: Iron deficiency anemia is characterized by small (microcytic) and pale
(hypochromic) red blood cells.
8. Which of the following is a classic sign of Atrial Fibrillation on an EKG?
A. Sawtooth P-waves
B. Absence of P-waves and irregularly irregular rhythm
C. Prolonged PR interval
D. Delta wave
Answer: B
Rationale: Atrial Fibrillation is defined by the absence of discrete P-waves and an
irregularly irregular ventricular response.
