NR 511 Midterm Exam (Latest Update
) Differential Diagnosis and
Primary Care Practicum Questions with
100% Correct Answers [Grade A] –
Chamberlain
A 20-year-old male presents to your primary care clinic. This patient is a college
student. He complains of fatigue, sore throat, and low-grade fever for 3 days. On
physical exam, he has a temperature of 100.7°F. His ear exam is normal. His nose and
throat exam shows mild erythema of the nasal mucosa and edematous, enlarged
tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. He has
inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear
lung exam. What is his most likely diagnosis?
1.Viral pharyngitis.
2.Mononucleosis.
3.Streptococcal pharyngitis.
4.Upper respiratory infection -correct answer Mono
rationale: This presentation could be a viral pharyngitis; however, with posterior
cervical lymphadenitis, you would suspect mononucleosis.
The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure
in children is:
1.Amoxicillin (Amoxil).
2.Amoxicillin and potassium clavulanate (Augmentin).
3.Azithromycin (Zithromax).
4.Prednisone (Deltasone) -correct answer Augmentin
rationale: The antibiotic of choice for recurrent AOM or treatment failure is amoxicillin
and potassium clavulanate (Augmentin)
A 65-year-old man presents complaining of a left-sided, deep, throbbing headache and
mild fatigue. On examination, the client has a tender, tortuous temporal artery. You
suspect giant cell arteritis (GCA), or temporal arteritis. What is the least invasive
procedure to help with diagnosis?
1. Magnetic resonance imaging (MRI) of the head.
2.Erythrocyte sedimentation rate (ESR).
, NR 511 Midterm Exam (Latest Update
) Differential Diagnosis and
Primary Care Practicum Questions with
100% Correct Answers [Grade A] –
Chamberlain
3.Electroencephalogram (EEG).
4.Otoscopy -correct answer ESR
rationale: An elevated ESR—anywhere from 30 to 100 mm/h—may be seen in giant cell
arteritis (temporal arteritis); however, the ESR may also be normal. The temporal
artery supplies the optic nerve; if temporal arteritis is suspected due to the age of the
client (50 and older) and the location and character of the pain, it is essential that a
referral to a surgeon be made for immediate biopsy of the artery before damage to the
optic nerve occurs. A temporal artery biopsy (TAB), an invasive procedure, is the
criterion standard for diagnosing temporal arteritis
Aaron, age 4, is brought in to the clinic by his father. His tympanic membrane is
perforated from otitis media. His father asks about repair of the eardrum. How do you
respond?
1."The eardrum, in most cases, heals within several weeks."
2."We need to schedule Aaron for a surgical repair."
3."He must absolutely stay out of the water for 3 to 6 months."
4."If the eardrum is not healed in several months, it can be surgically repaired." -
correct answer "The eardrum, in most cases, heals within several weeks.
rationale: Most perforated tympanic membranes seen with acute otitis media heal
within several weeks
Martin, age 24, presents to the office with an erythematous ear canal and pain on
manipulation of the auricle. He is on vacation and has been swimming daily at the
resort. What is your diagnosis?
1.Acute otitis media.
2.Chronic otitis media.
3.External otitis.
4.Temporomandibular joint (TMJ) syndrome -correct answer External otitis
, NR 511 Midterm Exam (Latest Update
) Differential Diagnosis and
Primary Care Practicum Questions with
100% Correct Answers [Grade A] –
Chamberlain
rationale: With external otitis, there is pain, an erythematous ear canal, and usually a
history of recent swimming
Max, age 35, states that he thinks he has an ear infection because he just flew back
from a business trip and feels unusual pressure in his ear. You diagnose barotrauma.
What is your next action?
1.Prescribe nasal steroids and oral decongestants.
2.Prescribe antibiotic ear drops.
3.Prescribe systemic antibiotics.
4.Refer Max to an ear, nose, and throat specialist -correct answer Prescribe nasal
steroids and oral decongestants.
rationale: Barotrauma of the auditory canal, causing a sensation of abnormal middle
ear pressure, may be relieved by the use of nasal steroids and oral decongestants.
A 64-year-old obese woman comes in complaining of difficulty swallowing for the past
3 weeks. She states that "some foods get stuck" and she has been having "heartburn"
at night when she lies down, especially if she has had a heavy meal. Occasionally, she
awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or
change in bowel movements or color of stools. She denies alcohol and tobacco use.
There is no pertinent family history or findings on review of systems (ROS). Physical
examination is normal, with no abdominal tenderness, and the stool is occult blood
(OB) negative. What is the most likely diagnosis?
1.Esophageal varices.
2.Esophageal cancer.
3.Gastroesophageal reflux disease (GERD).
4.Peptic ulcer disease (PUD) -correct answer Gastroesophageal reflux disease (GERD)
rationale: Though the historical data are incomplete, this client has no obvious risk
factors for esophageal varices or esophageal cancer. She is a nondrinker and denies
weight loss and changes in bowel function or color of stools, which could be a clue to a
gastrointestinal bleed. The fact that her worst symptoms occur at night with
, NR 511 Midterm Exam (Latest Update
) Differential Diagnosis and
Primary Care Practicum Questions with
100% Correct Answers [Grade A] –
Chamberlain
regurgitation and heartburn is classic for GERD. Dysphagia is frequently a prominent
symptom of GERD. She has no abdominal tenderness, and aside from the nighttime
symptoms and dysphagia, she reports no symptoms with food or lack of food
Mr. Clark, age 78, is being treated with timolol maleate (Timoptic) drops for his chronic
open-angle glaucoma. While performing a new client history and physical, you note
that he is taking other medications. Which medication would you be most concerned
about?
1.Aspirin therapy as prophylaxis for heart attack.
2.Ranitidine (Zantac) for gastroesophageal reflux disease.
3.Alprazolam (Xanax), an anxiolytic.
4.Atenolol (Tenormin), a beta blocker for high blood pressure -correct answer Atenolol
(Tenormin), a beta blocker for high blood pressure
rationale: If a client is taking timolol maleate (Timoptic) drops for chronic open-angle
glaucoma, you should be most concerned if the client is also taking atenolol
(Tenormin), a beta blocker, for high blood pressure. Because timolol maleate drops are
beta-adrenergic blockers, additional beta blockers can cause worsening of congestive
heart failure or reactive airway disease, as well as acute delirium.
Mario, a 17-year-old high school student, came to the office for evaluation. He is
complaining of persistent sore throat, fever, and malaise not relieved by the penicillin
therapy prescribed recently at the urgent care center. As the nurse practitioner, what
would you order next?
1.A throat culture.
2.A Monospot test.
3.A rapid antigen test.
4. Thayer-Martin plate test. -correct answer A Monospot test
rationale: If a client has a persistent sore throat, fever, and malaise not relieved by
penicillin therapy, a Monospot test should be performed to rule out mononucleosis
(Epstein-Barr virus)
) Differential Diagnosis and
Primary Care Practicum Questions with
100% Correct Answers [Grade A] –
Chamberlain
A 20-year-old male presents to your primary care clinic. This patient is a college
student. He complains of fatigue, sore throat, and low-grade fever for 3 days. On
physical exam, he has a temperature of 100.7°F. His ear exam is normal. His nose and
throat exam shows mild erythema of the nasal mucosa and edematous, enlarged
tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. He has
inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear
lung exam. What is his most likely diagnosis?
1.Viral pharyngitis.
2.Mononucleosis.
3.Streptococcal pharyngitis.
4.Upper respiratory infection -correct answer Mono
rationale: This presentation could be a viral pharyngitis; however, with posterior
cervical lymphadenitis, you would suspect mononucleosis.
The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure
in children is:
1.Amoxicillin (Amoxil).
2.Amoxicillin and potassium clavulanate (Augmentin).
3.Azithromycin (Zithromax).
4.Prednisone (Deltasone) -correct answer Augmentin
rationale: The antibiotic of choice for recurrent AOM or treatment failure is amoxicillin
and potassium clavulanate (Augmentin)
A 65-year-old man presents complaining of a left-sided, deep, throbbing headache and
mild fatigue. On examination, the client has a tender, tortuous temporal artery. You
suspect giant cell arteritis (GCA), or temporal arteritis. What is the least invasive
procedure to help with diagnosis?
1. Magnetic resonance imaging (MRI) of the head.
2.Erythrocyte sedimentation rate (ESR).
, NR 511 Midterm Exam (Latest Update
) Differential Diagnosis and
Primary Care Practicum Questions with
100% Correct Answers [Grade A] –
Chamberlain
3.Electroencephalogram (EEG).
4.Otoscopy -correct answer ESR
rationale: An elevated ESR—anywhere from 30 to 100 mm/h—may be seen in giant cell
arteritis (temporal arteritis); however, the ESR may also be normal. The temporal
artery supplies the optic nerve; if temporal arteritis is suspected due to the age of the
client (50 and older) and the location and character of the pain, it is essential that a
referral to a surgeon be made for immediate biopsy of the artery before damage to the
optic nerve occurs. A temporal artery biopsy (TAB), an invasive procedure, is the
criterion standard for diagnosing temporal arteritis
Aaron, age 4, is brought in to the clinic by his father. His tympanic membrane is
perforated from otitis media. His father asks about repair of the eardrum. How do you
respond?
1."The eardrum, in most cases, heals within several weeks."
2."We need to schedule Aaron for a surgical repair."
3."He must absolutely stay out of the water for 3 to 6 months."
4."If the eardrum is not healed in several months, it can be surgically repaired." -
correct answer "The eardrum, in most cases, heals within several weeks.
rationale: Most perforated tympanic membranes seen with acute otitis media heal
within several weeks
Martin, age 24, presents to the office with an erythematous ear canal and pain on
manipulation of the auricle. He is on vacation and has been swimming daily at the
resort. What is your diagnosis?
1.Acute otitis media.
2.Chronic otitis media.
3.External otitis.
4.Temporomandibular joint (TMJ) syndrome -correct answer External otitis
, NR 511 Midterm Exam (Latest Update
) Differential Diagnosis and
Primary Care Practicum Questions with
100% Correct Answers [Grade A] –
Chamberlain
rationale: With external otitis, there is pain, an erythematous ear canal, and usually a
history of recent swimming
Max, age 35, states that he thinks he has an ear infection because he just flew back
from a business trip and feels unusual pressure in his ear. You diagnose barotrauma.
What is your next action?
1.Prescribe nasal steroids and oral decongestants.
2.Prescribe antibiotic ear drops.
3.Prescribe systemic antibiotics.
4.Refer Max to an ear, nose, and throat specialist -correct answer Prescribe nasal
steroids and oral decongestants.
rationale: Barotrauma of the auditory canal, causing a sensation of abnormal middle
ear pressure, may be relieved by the use of nasal steroids and oral decongestants.
A 64-year-old obese woman comes in complaining of difficulty swallowing for the past
3 weeks. She states that "some foods get stuck" and she has been having "heartburn"
at night when she lies down, especially if she has had a heavy meal. Occasionally, she
awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or
change in bowel movements or color of stools. She denies alcohol and tobacco use.
There is no pertinent family history or findings on review of systems (ROS). Physical
examination is normal, with no abdominal tenderness, and the stool is occult blood
(OB) negative. What is the most likely diagnosis?
1.Esophageal varices.
2.Esophageal cancer.
3.Gastroesophageal reflux disease (GERD).
4.Peptic ulcer disease (PUD) -correct answer Gastroesophageal reflux disease (GERD)
rationale: Though the historical data are incomplete, this client has no obvious risk
factors for esophageal varices or esophageal cancer. She is a nondrinker and denies
weight loss and changes in bowel function or color of stools, which could be a clue to a
gastrointestinal bleed. The fact that her worst symptoms occur at night with
, NR 511 Midterm Exam (Latest Update
) Differential Diagnosis and
Primary Care Practicum Questions with
100% Correct Answers [Grade A] –
Chamberlain
regurgitation and heartburn is classic for GERD. Dysphagia is frequently a prominent
symptom of GERD. She has no abdominal tenderness, and aside from the nighttime
symptoms and dysphagia, she reports no symptoms with food or lack of food
Mr. Clark, age 78, is being treated with timolol maleate (Timoptic) drops for his chronic
open-angle glaucoma. While performing a new client history and physical, you note
that he is taking other medications. Which medication would you be most concerned
about?
1.Aspirin therapy as prophylaxis for heart attack.
2.Ranitidine (Zantac) for gastroesophageal reflux disease.
3.Alprazolam (Xanax), an anxiolytic.
4.Atenolol (Tenormin), a beta blocker for high blood pressure -correct answer Atenolol
(Tenormin), a beta blocker for high blood pressure
rationale: If a client is taking timolol maleate (Timoptic) drops for chronic open-angle
glaucoma, you should be most concerned if the client is also taking atenolol
(Tenormin), a beta blocker, for high blood pressure. Because timolol maleate drops are
beta-adrenergic blockers, additional beta blockers can cause worsening of congestive
heart failure or reactive airway disease, as well as acute delirium.
Mario, a 17-year-old high school student, came to the office for evaluation. He is
complaining of persistent sore throat, fever, and malaise not relieved by the penicillin
therapy prescribed recently at the urgent care center. As the nurse practitioner, what
would you order next?
1.A throat culture.
2.A Monospot test.
3.A rapid antigen test.
4. Thayer-Martin plate test. -correct answer A Monospot test
rationale: If a client has a persistent sore throat, fever, and malaise not relieved by
penicillin therapy, a Monospot test should be performed to rule out mononucleosis
(Epstein-Barr virus)
