NR 511 CEA Exam | Chamberlain University | NR 511
Comprehensive Clinical Exam (CEA) | Complete Questions,
Verified Answers & Rationales | Grade A+
Course NR 511 – Differential Diagnosis and Primary Care Practicum
Exam Comprehensive Clinical Exam (CEA)
Institution Chamberlain University
Format Multiple-choice, scenario-based questions
Core Advanced health assessment, differential diagnosis, primary care management,
Topics pathophysiology, pharmacology, evidence-based practice, clinical reasoning
Question 1
A 45-year-old male presents with epigastric burning pain after meals. You suspect peptic
ulcer disease (PUD). Which is the most appropriate next step in diagnostic reasoning?
A) Prescribe a PPI and follow up in 4 weeks
B) Order an upper endoscopy immediately
C) Test for H. pylori
D) Start antacids and reassess in 1 week
Rationale: In suspected PUD without alarm symptoms (bleeding, weight loss, dysphagia),
noninvasive H. pylori testing (stool antigen or urea breath test) is first-line. Endoscopy is
reserved for alarm features or treatment failure. PPIs can be started but should not precede
testing (false negatives). Antacids are symptomatic only and delay diagnosis.
Question 2
,A 62-year-old woman with no prior mammogram asks about breast cancer screening.
According to current USPSTF guidelines, what is the strongest recommendation?
A) Begin screening at age 40 biennially
B) Begin screening at age 50 biennially
C) Screen biennially from age 50-74
D) Shared decision-making for ages 40-49, biennial screening 50-74
Rationale: USPSTF (2024 update) recommends biennial screening for women ages 50-74
(Grade B). For ages 40-49, the recommendation is individualized (Grade C). Option D
accurately reflects this two-tiered approach.
Question 3
A patient reports palpitations. Which accompanying symptom most strongly suggests a
cardiac arrhythmia rather than a benign cause?
A) Symptoms worsen with positional changes
B) Concurrent dizziness
C) Symptoms occur only during stressful events
D) Palpitations are described as "skipped beats"
Rationale: Palpitations concurrent with dizziness strongly suggest cardiac arrhythmia (e.g.,
SVT, AF, PVCs). Positional dizziness points to BPPV. Stressors suggest panic but do not rule
out arrhythmia.
Question 4
A previously healthy 35-year-old man has 2 weeks of nonproductive cough, low-grade
fever, and chest tightness. He is afebrile now, lungs clear. Which is the most appropriate
next step?
A) Chest X-ray
B) Empiric azithromycin
C) Symptomatic care with follow-up
D) Pertussis PCR
,Rationale: Acute bronchitis in healthy adults is viral in >90% of cases; antibiotics are not
indicated. Chest X-ray is not needed without abnormal vital signs or focal findings.
Symptomatic care (hydration, honey, dextromethorphan) with return precautions is
appropriate. Pertussis is unlikely without paroxysmal cough or post-tussive emesis.
Question 5
A 68-year-old with diabetes and HTN has a BP of 148/86 in office, repeated 146/84.
Home readings average 142/82. Which best reflects current hypertension management
guidelines?
A) Start amlodipine 5 mg daily
B) Start lisinopril 10 mg daily
C) Recommend lifestyle changes only, recheck in 6 months
D) Start low-dose HCTZ
Rationale: In diabetic patients with BP >140/90 despite lifestyle, start an ACEi (lisinopril) or
ARB for renal and cardiovascular protection (ADA/ACC/AHA). Goal BP <130/80. Lifestyle
alone is insufficient. Amlodipine or HCTZ can be added later but not first-line in diabetes.
Question 6
A 22-year-old male patient states during his review of systems that his scrotum is very
enlarged and feels like it is full. He is a powerlifter and works as a trash collector. You
suspect the patient likely has which diagnosis?
A) Varicocele
B) Meningocele
C) Rectocele
D) Hydrocele
Rationale: A hydrocele presents as a painless, enlarged scrotum that feels like a "bag of
water." Varicoceles feel like a "bag of worms" and are associated with infertility.
Meningocele and rectocele are not scrotal conditions. The patient's occupation and
physical activity are risk factors for hydrocele.
, Question 7
The point of maximum impulse (PMI) is MOST often palpable in healthy adults when
positioned in the supine or left lateral decubitus position. Which location is most
commonly described as the PMI in a healthy adult?
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
Rationale: The PMI is normally located at the 5th intercostal space, midclavicular line,
corresponding to the apex of the left ventricle. Displacement may indicate cardiomegaly or
other cardiac pathology.
Question 8
A 40-year-old female, African American patient presents for history and physical. Upon
initial assessment, you notice she has severe exophthalmos. Which diagnosis would be
highest on your differential?
A) Bilateral conjunctivitis
B) Hyperthyroidism
C) Hypothyroidism
D) Myxedema
Rationale: Exophthalmos (protruding eyes) is a classic finding in Graves' disease
(hyperthyroidism). It is caused by autoimmune inflammation of orbital tissues.
Hypothyroidism and myxedema do not cause exophthalmos. Conjunctivitis would present
with redness and discharge, not protrusion.
Question 9
Comprehensive Clinical Exam (CEA) | Complete Questions,
Verified Answers & Rationales | Grade A+
Course NR 511 – Differential Diagnosis and Primary Care Practicum
Exam Comprehensive Clinical Exam (CEA)
Institution Chamberlain University
Format Multiple-choice, scenario-based questions
Core Advanced health assessment, differential diagnosis, primary care management,
Topics pathophysiology, pharmacology, evidence-based practice, clinical reasoning
Question 1
A 45-year-old male presents with epigastric burning pain after meals. You suspect peptic
ulcer disease (PUD). Which is the most appropriate next step in diagnostic reasoning?
A) Prescribe a PPI and follow up in 4 weeks
B) Order an upper endoscopy immediately
C) Test for H. pylori
D) Start antacids and reassess in 1 week
Rationale: In suspected PUD without alarm symptoms (bleeding, weight loss, dysphagia),
noninvasive H. pylori testing (stool antigen or urea breath test) is first-line. Endoscopy is
reserved for alarm features or treatment failure. PPIs can be started but should not precede
testing (false negatives). Antacids are symptomatic only and delay diagnosis.
Question 2
,A 62-year-old woman with no prior mammogram asks about breast cancer screening.
According to current USPSTF guidelines, what is the strongest recommendation?
A) Begin screening at age 40 biennially
B) Begin screening at age 50 biennially
C) Screen biennially from age 50-74
D) Shared decision-making for ages 40-49, biennial screening 50-74
Rationale: USPSTF (2024 update) recommends biennial screening for women ages 50-74
(Grade B). For ages 40-49, the recommendation is individualized (Grade C). Option D
accurately reflects this two-tiered approach.
Question 3
A patient reports palpitations. Which accompanying symptom most strongly suggests a
cardiac arrhythmia rather than a benign cause?
A) Symptoms worsen with positional changes
B) Concurrent dizziness
C) Symptoms occur only during stressful events
D) Palpitations are described as "skipped beats"
Rationale: Palpitations concurrent with dizziness strongly suggest cardiac arrhythmia (e.g.,
SVT, AF, PVCs). Positional dizziness points to BPPV. Stressors suggest panic but do not rule
out arrhythmia.
Question 4
A previously healthy 35-year-old man has 2 weeks of nonproductive cough, low-grade
fever, and chest tightness. He is afebrile now, lungs clear. Which is the most appropriate
next step?
A) Chest X-ray
B) Empiric azithromycin
C) Symptomatic care with follow-up
D) Pertussis PCR
,Rationale: Acute bronchitis in healthy adults is viral in >90% of cases; antibiotics are not
indicated. Chest X-ray is not needed without abnormal vital signs or focal findings.
Symptomatic care (hydration, honey, dextromethorphan) with return precautions is
appropriate. Pertussis is unlikely without paroxysmal cough or post-tussive emesis.
Question 5
A 68-year-old with diabetes and HTN has a BP of 148/86 in office, repeated 146/84.
Home readings average 142/82. Which best reflects current hypertension management
guidelines?
A) Start amlodipine 5 mg daily
B) Start lisinopril 10 mg daily
C) Recommend lifestyle changes only, recheck in 6 months
D) Start low-dose HCTZ
Rationale: In diabetic patients with BP >140/90 despite lifestyle, start an ACEi (lisinopril) or
ARB for renal and cardiovascular protection (ADA/ACC/AHA). Goal BP <130/80. Lifestyle
alone is insufficient. Amlodipine or HCTZ can be added later but not first-line in diabetes.
Question 6
A 22-year-old male patient states during his review of systems that his scrotum is very
enlarged and feels like it is full. He is a powerlifter and works as a trash collector. You
suspect the patient likely has which diagnosis?
A) Varicocele
B) Meningocele
C) Rectocele
D) Hydrocele
Rationale: A hydrocele presents as a painless, enlarged scrotum that feels like a "bag of
water." Varicoceles feel like a "bag of worms" and are associated with infertility.
Meningocele and rectocele are not scrotal conditions. The patient's occupation and
physical activity are risk factors for hydrocele.
, Question 7
The point of maximum impulse (PMI) is MOST often palpable in healthy adults when
positioned in the supine or left lateral decubitus position. Which location is most
commonly described as the PMI in a healthy adult?
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
Rationale: The PMI is normally located at the 5th intercostal space, midclavicular line,
corresponding to the apex of the left ventricle. Displacement may indicate cardiomegaly or
other cardiac pathology.
Question 8
A 40-year-old female, African American patient presents for history and physical. Upon
initial assessment, you notice she has severe exophthalmos. Which diagnosis would be
highest on your differential?
A) Bilateral conjunctivitis
B) Hyperthyroidism
C) Hypothyroidism
D) Myxedema
Rationale: Exophthalmos (protruding eyes) is a classic finding in Graves' disease
(hyperthyroidism). It is caused by autoimmune inflammation of orbital tissues.
Hypothyroidism and myxedema do not cause exophthalmos. Conjunctivitis would present
with redness and discharge, not protrusion.
Question 9
