Clinical Evaluation Assessment
– NR 511 – Nursing Program –
Practice Questions and
Answers Exam Preparation
Material
NR 511 Practice Questions (with Answers & Rationales)
1. Cardiology / Hematology
Question: A 68-year-old male with a history of hypertension and smoking
presents with sudden onset of severe "tearing" chest pain radiating to the back.
His blood pressure is 210/110 in the right arm but 130/80 in the left arm. What is
the most likely diagnosis?
• A) Myocardial Infarction
• B) Pulmonary Embolism
, • C) Aortic Dissection
• D) Pericarditis
Answer: C) Aortic Dissection
Rationale: Aortic dissection presents with sudden, severe, tearing chest pain that
often radiates to the back. A key physical exam finding is a significant difference in
blood pressure readings between the arms (pulse deficit), which is highly specific
for this condition.
2. Endocrinology
Question: A 45-year-old female presents with fatigue, weight gain, constipation,
and dry skin. Vital signs are stable. A TSH is drawn and results show a level of 12.0
mIU/L (Normal 0.5–5.0). What is the most appropriate next step in management?
• A) Immediately start levothyroxine
• B) Repeat TSH in 6 months
• C) Order a free T4 level
• D) Order a thyroid ultrasound
Answer: C) Order a free T4 level
Rationale: This patient has an elevated TSH, indicating primary hypothyroidism.
However, to confirm the diagnosis and determine if it is "overt" or "subclinical,"
you must order a Free T4 level. Starting medication (A) is premature without
confirming the T4 level.
3. Musculoskeletal
Question: A 30-year-old runner complains of anterior knee pain that worsens
when climbing stairs or sitting for long periods. On exam, there is tenderness
around the patella, but no joint effusion or instability. The pain is reproduced
when you press the patella against the femur while asking the patient to contract
the quadriceps. What is the likely diagnosis?
, • A) Meniscal tear
• B) Patellofemoral pain syndrome (Chondromalacia patellae)
• C) Osgood-Schlatter disease
• D) Prepatellar bursitis
Answer: B) Patellofemoral pain syndrome
Rationale: The patient's age, activity level, and description of pain (stairs, sitting)
are classic for patellofemoral pain syndrome. The provocation test described is
the "Clarke's sign" or patellar grind test, which indicates irritation of the
patellofemoral joint.
4. Neurology
Question: A 55-year-old diabetic male presents with a sudden onset of vertigo,
nausea, vomiting, and difficulty walking. He reports the sensation that the room is
spinning. Symptoms are constant and severe. On exam, you note horizontal
nystagmus. He is unable to stand without falling. What finding would differentiate
Central Vertigo from Peripheral Vertigo in this patient?
• A) Tinnitus
• B) Severe Nausea
• C) Negative Dix-Hallpike test
• D) Neurological deficits (like dysarthria or diplopia)
Answer: D) Neurological deficits (like dysarthria or diplopia)
Rationale: Peripheral vertigo (like labyrinthitis or BPPV) causes intense spinning
and nausea. Central vertigo (like a brainstem stroke or TIA) is less intense but is
accompanied by "brainstem signs" such as double vision (diplopia), slurred speech
(dysarthria), or numbness. Since this patient is diabetic (high vascular risk), you
must rule out a stroke.
5. Dermatology / Infectious Disease
Question: A child presents with a honey-crusted lesion on the face surrounding
the nares and upper lip. What is the first-line pharmacologic treatment?
• A) Oral Acyclovir
– NR 511 – Nursing Program –
Practice Questions and
Answers Exam Preparation
Material
NR 511 Practice Questions (with Answers & Rationales)
1. Cardiology / Hematology
Question: A 68-year-old male with a history of hypertension and smoking
presents with sudden onset of severe "tearing" chest pain radiating to the back.
His blood pressure is 210/110 in the right arm but 130/80 in the left arm. What is
the most likely diagnosis?
• A) Myocardial Infarction
• B) Pulmonary Embolism
, • C) Aortic Dissection
• D) Pericarditis
Answer: C) Aortic Dissection
Rationale: Aortic dissection presents with sudden, severe, tearing chest pain that
often radiates to the back. A key physical exam finding is a significant difference in
blood pressure readings between the arms (pulse deficit), which is highly specific
for this condition.
2. Endocrinology
Question: A 45-year-old female presents with fatigue, weight gain, constipation,
and dry skin. Vital signs are stable. A TSH is drawn and results show a level of 12.0
mIU/L (Normal 0.5–5.0). What is the most appropriate next step in management?
• A) Immediately start levothyroxine
• B) Repeat TSH in 6 months
• C) Order a free T4 level
• D) Order a thyroid ultrasound
Answer: C) Order a free T4 level
Rationale: This patient has an elevated TSH, indicating primary hypothyroidism.
However, to confirm the diagnosis and determine if it is "overt" or "subclinical,"
you must order a Free T4 level. Starting medication (A) is premature without
confirming the T4 level.
3. Musculoskeletal
Question: A 30-year-old runner complains of anterior knee pain that worsens
when climbing stairs or sitting for long periods. On exam, there is tenderness
around the patella, but no joint effusion or instability. The pain is reproduced
when you press the patella against the femur while asking the patient to contract
the quadriceps. What is the likely diagnosis?
, • A) Meniscal tear
• B) Patellofemoral pain syndrome (Chondromalacia patellae)
• C) Osgood-Schlatter disease
• D) Prepatellar bursitis
Answer: B) Patellofemoral pain syndrome
Rationale: The patient's age, activity level, and description of pain (stairs, sitting)
are classic for patellofemoral pain syndrome. The provocation test described is
the "Clarke's sign" or patellar grind test, which indicates irritation of the
patellofemoral joint.
4. Neurology
Question: A 55-year-old diabetic male presents with a sudden onset of vertigo,
nausea, vomiting, and difficulty walking. He reports the sensation that the room is
spinning. Symptoms are constant and severe. On exam, you note horizontal
nystagmus. He is unable to stand without falling. What finding would differentiate
Central Vertigo from Peripheral Vertigo in this patient?
• A) Tinnitus
• B) Severe Nausea
• C) Negative Dix-Hallpike test
• D) Neurological deficits (like dysarthria or diplopia)
Answer: D) Neurological deficits (like dysarthria or diplopia)
Rationale: Peripheral vertigo (like labyrinthitis or BPPV) causes intense spinning
and nausea. Central vertigo (like a brainstem stroke or TIA) is less intense but is
accompanied by "brainstem signs" such as double vision (diplopia), slurred speech
(dysarthria), or numbness. Since this patient is diabetic (high vascular risk), you
must rule out a stroke.
5. Dermatology / Infectious Disease
Question: A child presents with a honey-crusted lesion on the face surrounding
the nares and upper lip. What is the first-line pharmacologic treatment?
• A) Oral Acyclovir
