NR 603 Midterm Exam Practice: Advanced Clinical Diagnosis 2026
Chamberlain College
1. Which diagnostic test is considered the gold standard for confirming a
diagnosis of Chronic Obstructive Pulmonary Disease (COPD)?
A. Spirometry
B. Chest X-ray
C. Arterial Blood Gas (ABG)
D. Peak Flow Meter
Answer: A
Rationale: Spirometry is essential for the diagnosis of COPD. A post-bronchodilator
FEV1/FVC ratio of less than 0.70 is required to confirm the presence of persistent airflow
limitation.
2. According to JNC 8 guidelines, what is the initial recommended blood
pressure medication for a 55-year-old African American male with no chronic
kidney disease?
A. ACE Inhibitor
B. Calcium Channel Blocker
C. Beta Blocker
D. Angiotensin Receptor Blocker
Answer: B
Rationale: For the general African American population, including those with diabetes,
initial antihypertensive treatment should include a thiazide-type diuretic or a calcium
channel blocker (CCB).
,3. A patient presents with a TSH of 0.1 mIU/L and a high Free T4 level. Which
condition is most likely?
A. Hypothyroidism
B. Hyperthyroidism
C. Euthyroid Sick Syndrome
D. Secondary Hypothyroidism
Answer: B
Rationale: Hyperthyroidism is characterized by a suppressed TSH (low) and an elevated
Free T4 level due to the overproduction of thyroid hormones.
4. Which of the following physical exam findings is most suggestive of Acute
Cholecystitis?
A. Rovsing’s Sign
B. Murphy’s Sign
C. Psoas Sign
D. McBurney’s Point tenderness
Answer: B
Rationale: Murphy’s sign, which is inspiratory arrest during deep palpation of the right
upper quadrant, is highly sensitive for acute cholecystitis.
5. Which classification of anemia is characterized by a Mean Corpuscular
Volume (MCV) of less than 80 fL?
A. Macrocytic Anemia
B. Microcytic Anemia
C. Normocytic Anemia
D. Pernicious Anemia
Answer: B
Rationale: Microcytic anemia refers to anemias where the red blood cells are smaller than
normal, indicated by an MCV < 80 fL, often caused by iron deficiency.
, 6. A 65-year-old patient with heart failure presents with an S3 gallop. This
finding is most likely associated with:
A. Ventricular Overload or Failure
B. Stiff Left Ventricle
C. Normal Aging
D. Aortic Stenosis
Answer: A
Rationale: An S3 heart sound is often a sign of systolic heart failure and ventricular volume
overload, occurring early in diastole.
7. What is the first-line pharmacologic treatment for a patient newly diagnosed
with Type 2 Diabetes and an A1c of 7.5%?
A. Glipizide
B. Insulin Glargine
C. Metformin
D. Sitagliptin
Answer: C
Rationale: Metformin is the preferred initial pharmacologic agent for the treatment of type
2 diabetes, provided there are no contraindications like severe renal impairment.
8. Which of the following is a classic symptom of Peripheral Arterial Disease
(PAD)?
A. Intermittent Claudication
B. Pitting Edema
C. Varicose Veins
D. Warmth and Redness
Answer: A
Rationale: Intermittent claudication, defined as muscle pain or cramping during exercise
that is relieved by rest, is a hallmark symptom of PAD.
Chamberlain College
1. Which diagnostic test is considered the gold standard for confirming a
diagnosis of Chronic Obstructive Pulmonary Disease (COPD)?
A. Spirometry
B. Chest X-ray
C. Arterial Blood Gas (ABG)
D. Peak Flow Meter
Answer: A
Rationale: Spirometry is essential for the diagnosis of COPD. A post-bronchodilator
FEV1/FVC ratio of less than 0.70 is required to confirm the presence of persistent airflow
limitation.
2. According to JNC 8 guidelines, what is the initial recommended blood
pressure medication for a 55-year-old African American male with no chronic
kidney disease?
A. ACE Inhibitor
B. Calcium Channel Blocker
C. Beta Blocker
D. Angiotensin Receptor Blocker
Answer: B
Rationale: For the general African American population, including those with diabetes,
initial antihypertensive treatment should include a thiazide-type diuretic or a calcium
channel blocker (CCB).
,3. A patient presents with a TSH of 0.1 mIU/L and a high Free T4 level. Which
condition is most likely?
A. Hypothyroidism
B. Hyperthyroidism
C. Euthyroid Sick Syndrome
D. Secondary Hypothyroidism
Answer: B
Rationale: Hyperthyroidism is characterized by a suppressed TSH (low) and an elevated
Free T4 level due to the overproduction of thyroid hormones.
4. Which of the following physical exam findings is most suggestive of Acute
Cholecystitis?
A. Rovsing’s Sign
B. Murphy’s Sign
C. Psoas Sign
D. McBurney’s Point tenderness
Answer: B
Rationale: Murphy’s sign, which is inspiratory arrest during deep palpation of the right
upper quadrant, is highly sensitive for acute cholecystitis.
5. Which classification of anemia is characterized by a Mean Corpuscular
Volume (MCV) of less than 80 fL?
A. Macrocytic Anemia
B. Microcytic Anemia
C. Normocytic Anemia
D. Pernicious Anemia
Answer: B
Rationale: Microcytic anemia refers to anemias where the red blood cells are smaller than
normal, indicated by an MCV < 80 fL, often caused by iron deficiency.
, 6. A 65-year-old patient with heart failure presents with an S3 gallop. This
finding is most likely associated with:
A. Ventricular Overload or Failure
B. Stiff Left Ventricle
C. Normal Aging
D. Aortic Stenosis
Answer: A
Rationale: An S3 heart sound is often a sign of systolic heart failure and ventricular volume
overload, occurring early in diastole.
7. What is the first-line pharmacologic treatment for a patient newly diagnosed
with Type 2 Diabetes and an A1c of 7.5%?
A. Glipizide
B. Insulin Glargine
C. Metformin
D. Sitagliptin
Answer: C
Rationale: Metformin is the preferred initial pharmacologic agent for the treatment of type
2 diabetes, provided there are no contraindications like severe renal impairment.
8. Which of the following is a classic symptom of Peripheral Arterial Disease
(PAD)?
A. Intermittent Claudication
B. Pitting Edema
C. Varicose Veins
D. Warmth and Redness
Answer: A
Rationale: Intermittent claudication, defined as muscle pain or cramping during exercise
that is relieved by rest, is a hallmark symptom of PAD.
