NR511 FINAL EXAM 2026/2027 | Differential Diagnosis &
Primary Care Practicum | Latest Q&A Verified | Chamberlain |
Pass Guaranteed - A+ Graded
Q1: A 28-year-old female presents with a 2-day history of right eye redness, mild
discharge, and gritty sensation. She wears contact lenses. Examination reveals
conjunctival injection with watery discharge, no photophobia, and visual acuity 20/20.
Cornea appears clear with fluorescein staining. Which is the most appropriate initial
management?
A. Prescribe topical corticosteroid drops and urgent ophthalmology referral for
suspected iritis
B. Prescribe topical antibiotic drops (fluoroquinolone) and advise discontinuation of
contact lenses [CORRECT]
C. Prescribe oral antiviral therapy for suspected herpes simplex keratitis
D. Initiate topical beta-blocker therapy and urgent referral for acute angle-closure
glaucoma
Correct Answer: B
Rationale: This presentation is classic for bacterial conjunctivitis in a contact lens
wearer. The American Academy of Ophthalmology (AAO) and CDC guidelines
recommend topical fluoroquinolone antibiotics (ciprofloxacin or ofloxacin) for contact
lens wearers due to higher risk of Pseudomonas infection. Contact lens discontinuation
is essential.
Why B is correct: Bacterial conjunctivitis typically presents with mucopurulent
discharge, conjunctival injection, and preserved vision. Contact lens wear increases
,bacterial conjunctivitis risk 10-15 fold. First-line treatment includes topical antibiotics
with coverage for gram-negative organisms.
Why A is incorrect: Iritis (anterior uveitis) presents with ciliary flush, photophobia,
blurred vision, and often pain. Steroids are contraindicated in infectious conjunctivitis
and would worsen herpes simplex keratitis.
Why C is incorrect: Herpes simplex keratitis presents with dendritic lesions on
fluorescein staining, photophobia, and decreased vision. There are no dendritic lesions
here.
Why D is incorrect: Acute angle-closure glaucoma presents with severe eye pain,
headache, nausea, halos around lights, and markedly elevated IOP—none of which are
present here.
Q2: A 45-year-old male with hypertension presents for follow-up. His home BP readings
average 138/88 mmHg over the past 2 weeks. Current medications: lisinopril 10 mg
daily. According to the 2017 ACC/AHA Hypertension Guidelines, what is the most
appropriate next step?
A. Continue current therapy; BP is at goal (<140/90 for adults <60 years)
B. Increase lisinopril to 20 mg daily and reassess in 1 month [CORRECT]
C. Add hydrochlorothiazide 12.5 mg daily to current regimen
D. Order 24-hour ambulatory blood pressure monitoring to confirm diagnosis
Correct Answer: B
Rationale: The 2017 ACC/AHA guidelines define hypertension as ≥130/80 mmHg. This
patient has Stage 1 hypertension (130-139/80-89) with established cardiovascular
disease risk factors. The goal is <130/80 mmHg for most adults.
,Why B is correct: For Stage 1 hypertension with 10-year ASCVD risk <10%, lifestyle
modification is first-line. However, this patient is already on medication with suboptimal
control. The appropriate step is to optimize the current ACE inhibitor before adding
agents. Titrate lisinopril to 20-40 mg daily.
Why A is incorrect: The 2017 guidelines lowered the threshold to <130/80 mmHg for
most adults. 138/88 mmHg is above goal.
Why C is incorrect: While combination therapy is effective, guidelines recommend
optimizing the current medication first (titrating to maximum tolerated dose) before
adding second agents, unless BP is >20/10 mmHg above goal.
Why D is incorrect: Ambulatory monitoring is useful for white coat hypertension
suspicion or resistant hypertension evaluation, not for routine follow-up of known
hypertension with consistent home readings.
Q3: A 62-year-old female presents with 3 weeks of progressive dyspnea on exertion,
orthopnea, and bilateral lower extremity edema. Physical examination reveals JVD, S3
gallop, and pulmonary crackles. ECG shows normal sinus rhythm with left ventricular
hypertrophy. BNP is 850 pg/mL (elevated). Which classification and initial treatment
best fits this presentation?
A. HFrEF (EF <40%); initiate ACE inhibitor, beta-blocker, and loop diuretic
B. HFpEF (EF ≥50%); initiate loop diuretic and manage comorbidities aggressively
[CORRECT]
C. HFmrEF (EF 41-49%); initiate ARNI and SGLT2 inhibitor immediately
D. Acute decompensated heart failure requiring IV inotropes and invasive hemodynamic
monitoring
Correct Answer: B
, Rationale: This presentation is consistent with heart failure with preserved ejection
fraction (HFpEF), which accounts for approximately 50% of heart failure cases,
particularly in older women with hypertension. The 2022 AHA/ACC/HFSA Heart Failure
Guidelines emphasize the importance of EF classification.
Why B is correct: HFpEF is characterized by preserved EF (≥50%) with impaired diastolic
filling. Clinical features include dyspnea, orthopnea, edema, and elevated BNP. Initial
management focuses on volume control with loop diuretics and aggressive
management of comorbidities (hypertension, diabetes, obesity, atrial fibrillation). No
mortality-reducing medications have been proven for HFpEF specifically.
Why A is incorrect: HFrEF management includes ACE inhibitors/ARBs/ARNIs,
evidence-based beta-blockers, MRAs, and SGLT2 inhibitors. However, without knowing
the EF, we cannot assume HFrEF. The presence of LVH and hypertension history
suggests preserved EF is likely.
Why C is incorrect: HFmrEF (mid-range EF) is a newer category, but ARNIs are primarily
indicated for HFrEF or chronic stable HFpEF in specific populations, not as first-line for
new presentations.
Why D is incorrect: While the patient has decompensated features, there's no evidence
of cardiogenic shock, severe hypoperfusion, or respiratory failure requiring invasive
monitoring. This is not an immediate ICU admission scenario.
Q4: A 35-year-old female presents with recurrent episodes of unilateral throbbing
headache associated with nausea, photophobia, and phonophobia. Attacks last 4-72
hours and are disabling. She has 8-10 attacks per month. Which preventive therapy is
most appropriate according to the 2021 AHS/AAN Headache Guidelines?
A. Sumatriptan 100 mg as needed; no preventive therapy indicated
Primary Care Practicum | Latest Q&A Verified | Chamberlain |
Pass Guaranteed - A+ Graded
Q1: A 28-year-old female presents with a 2-day history of right eye redness, mild
discharge, and gritty sensation. She wears contact lenses. Examination reveals
conjunctival injection with watery discharge, no photophobia, and visual acuity 20/20.
Cornea appears clear with fluorescein staining. Which is the most appropriate initial
management?
A. Prescribe topical corticosteroid drops and urgent ophthalmology referral for
suspected iritis
B. Prescribe topical antibiotic drops (fluoroquinolone) and advise discontinuation of
contact lenses [CORRECT]
C. Prescribe oral antiviral therapy for suspected herpes simplex keratitis
D. Initiate topical beta-blocker therapy and urgent referral for acute angle-closure
glaucoma
Correct Answer: B
Rationale: This presentation is classic for bacterial conjunctivitis in a contact lens
wearer. The American Academy of Ophthalmology (AAO) and CDC guidelines
recommend topical fluoroquinolone antibiotics (ciprofloxacin or ofloxacin) for contact
lens wearers due to higher risk of Pseudomonas infection. Contact lens discontinuation
is essential.
Why B is correct: Bacterial conjunctivitis typically presents with mucopurulent
discharge, conjunctival injection, and preserved vision. Contact lens wear increases
,bacterial conjunctivitis risk 10-15 fold. First-line treatment includes topical antibiotics
with coverage for gram-negative organisms.
Why A is incorrect: Iritis (anterior uveitis) presents with ciliary flush, photophobia,
blurred vision, and often pain. Steroids are contraindicated in infectious conjunctivitis
and would worsen herpes simplex keratitis.
Why C is incorrect: Herpes simplex keratitis presents with dendritic lesions on
fluorescein staining, photophobia, and decreased vision. There are no dendritic lesions
here.
Why D is incorrect: Acute angle-closure glaucoma presents with severe eye pain,
headache, nausea, halos around lights, and markedly elevated IOP—none of which are
present here.
Q2: A 45-year-old male with hypertension presents for follow-up. His home BP readings
average 138/88 mmHg over the past 2 weeks. Current medications: lisinopril 10 mg
daily. According to the 2017 ACC/AHA Hypertension Guidelines, what is the most
appropriate next step?
A. Continue current therapy; BP is at goal (<140/90 for adults <60 years)
B. Increase lisinopril to 20 mg daily and reassess in 1 month [CORRECT]
C. Add hydrochlorothiazide 12.5 mg daily to current regimen
D. Order 24-hour ambulatory blood pressure monitoring to confirm diagnosis
Correct Answer: B
Rationale: The 2017 ACC/AHA guidelines define hypertension as ≥130/80 mmHg. This
patient has Stage 1 hypertension (130-139/80-89) with established cardiovascular
disease risk factors. The goal is <130/80 mmHg for most adults.
,Why B is correct: For Stage 1 hypertension with 10-year ASCVD risk <10%, lifestyle
modification is first-line. However, this patient is already on medication with suboptimal
control. The appropriate step is to optimize the current ACE inhibitor before adding
agents. Titrate lisinopril to 20-40 mg daily.
Why A is incorrect: The 2017 guidelines lowered the threshold to <130/80 mmHg for
most adults. 138/88 mmHg is above goal.
Why C is incorrect: While combination therapy is effective, guidelines recommend
optimizing the current medication first (titrating to maximum tolerated dose) before
adding second agents, unless BP is >20/10 mmHg above goal.
Why D is incorrect: Ambulatory monitoring is useful for white coat hypertension
suspicion or resistant hypertension evaluation, not for routine follow-up of known
hypertension with consistent home readings.
Q3: A 62-year-old female presents with 3 weeks of progressive dyspnea on exertion,
orthopnea, and bilateral lower extremity edema. Physical examination reveals JVD, S3
gallop, and pulmonary crackles. ECG shows normal sinus rhythm with left ventricular
hypertrophy. BNP is 850 pg/mL (elevated). Which classification and initial treatment
best fits this presentation?
A. HFrEF (EF <40%); initiate ACE inhibitor, beta-blocker, and loop diuretic
B. HFpEF (EF ≥50%); initiate loop diuretic and manage comorbidities aggressively
[CORRECT]
C. HFmrEF (EF 41-49%); initiate ARNI and SGLT2 inhibitor immediately
D. Acute decompensated heart failure requiring IV inotropes and invasive hemodynamic
monitoring
Correct Answer: B
, Rationale: This presentation is consistent with heart failure with preserved ejection
fraction (HFpEF), which accounts for approximately 50% of heart failure cases,
particularly in older women with hypertension. The 2022 AHA/ACC/HFSA Heart Failure
Guidelines emphasize the importance of EF classification.
Why B is correct: HFpEF is characterized by preserved EF (≥50%) with impaired diastolic
filling. Clinical features include dyspnea, orthopnea, edema, and elevated BNP. Initial
management focuses on volume control with loop diuretics and aggressive
management of comorbidities (hypertension, diabetes, obesity, atrial fibrillation). No
mortality-reducing medications have been proven for HFpEF specifically.
Why A is incorrect: HFrEF management includes ACE inhibitors/ARBs/ARNIs,
evidence-based beta-blockers, MRAs, and SGLT2 inhibitors. However, without knowing
the EF, we cannot assume HFrEF. The presence of LVH and hypertension history
suggests preserved EF is likely.
Why C is incorrect: HFmrEF (mid-range EF) is a newer category, but ARNIs are primarily
indicated for HFrEF or chronic stable HFpEF in specific populations, not as first-line for
new presentations.
Why D is incorrect: While the patient has decompensated features, there's no evidence
of cardiogenic shock, severe hypoperfusion, or respiratory failure requiring invasive
monitoring. This is not an immediate ICU admission scenario.
Q4: A 35-year-old female presents with recurrent episodes of unilateral throbbing
headache associated with nausea, photophobia, and phonophobia. Attacks last 4-72
hours and are disabling. She has 8-10 attacks per month. Which preventive therapy is
most appropriate according to the 2021 AHS/AAN Headache Guidelines?
A. Sumatriptan 100 mg as needed; no preventive therapy indicated
