Chamberlain University NR-603
Advanced Clinical Diagnosis & Practice
Across the Lifespan Practicum
Comprehensive 100-Question Test Bank
Latest update. | Advanced Practice | Detailed
Rationales
,DOMAIN 1: CARDIOVASCULAR DISORDERS
(Questions 1-15)
Question 1
A 55-year-old male presents with substernal chest pressure that began 2 hours
ago while shoveling snow. The pain radiates to his left arm and is accompanied by
diaphoresis and nausea. His ECG shows ST-segment elevation in leads V1-V4.
What is the most appropriate next step?
A. Administer sublingual nitroglycerin and repeat ECG in 15 minutes
B. Obtain cardiac enzymes and admit for observation
C. Activate the cardiac catheterization lab for emergent percutaneous coronary
intervention
D. Administer morphine and oxygen and reassess
Correct Answer: C
Rationale: This patient presents with classic symptoms of an acute ST-segment
elevation myocardial infarction (STEMI) with ST elevation in the anterior leads
(V1-V4). The standard of care for STEMI is emergent reperfusion via percutaneous
coronary intervention (PCI) within 90 minutes of arrival . While nitroglycerin (A),
oxygen, and morphine (D) are supportive, they are not substitutes for
reperfusion. Delaying intervention (B) increases mortality .
Question 2
A 68-year-old female with a history of hypertension and type 2 diabetes presents
,with shortness of breath, orthopnea, and bilateral lower extremity edema. She
reports waking up at night gasping for air. On examination, she has crackles in
both lung bases, jugular venous distention, and an S3 gallop. What is the most
likely diagnosis?
A. Chronic obstructive pulmonary disease exacerbation
B. Left-sided heart failure with pulmonary congestion
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Rationale: This patient presents with classic signs of left-sided heart failure:
dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles, and an S3 gallop.
Jugular venous distention suggests right-sided involvement as well (biventricular
failure). COPD (A) would not present with JVD or S3. Pulmonary embolism (C)
typically presents with acute dyspnea and hypoxia. Pneumonia (D) would present
with fever and productive cough .
Question 3
A 72-year-old male with a history of atrial fibrillation presents with sudden-onset,
severe left leg pain, pallor, and paresthesia. The left lower extremity is cool to
touch and pulses are absent. What is the most likely diagnosis?
A. Deep vein thrombosis
B. Acute arterial occlusion
C. Chronic venous insufficiency
D. Cellulitis
Correct Answer: B
, Rationale: The acute onset of the "6 Ps" (pain, pallor, pulselessness, paresthesia,
paralysis, poikilothermia) is characteristic of acute arterial occlusion. This is a
medical emergency, often caused by emboli from the heart in patients with atrial
fibrillation. Deep vein thrombosis (A) presents with swelling and warmth, not
pallor and pulselessness. Chronic venous insufficiency (C) has gradual onset.
Cellulitis (D) presents with erythema and warmth .
Question 4
A 45-year-old female presents with palpitations, fatigue, and heat intolerance.
She has noticed weight loss despite increased appetite. On examination, she has
tachycardia, fine tremor, and a diffusely enlarged thyroid gland. What is the most
appropriate initial diagnostic test?
A. Thyroid ultrasound
B. TSH, free T4, and T3 levels
C. Thyroid biopsy
D. Radioactive iodine uptake scan
Correct Answer: B
Rationale: The initial diagnostic test for suspected hyperthyroidism is TSH, free
T4, and T3 levels. A low TSH with elevated free T4 and/or T3 confirms
hyperthyroidism. Thyroid ultrasound (A) is used for nodules, not initial diagnosis.
Biopsy (C) is for suspicious nodules. Radioactive iodine uptake (D) helps
differentiate causes after diagnosis is confirmed .
Question 5
A 60-year-old male with a history of coronary artery disease presents with chest
pain that occurs with exertion and is relieved by rest. The pain is substernal and
radiates to the jaw. What is the most likely diagnosis?
Advanced Clinical Diagnosis & Practice
Across the Lifespan Practicum
Comprehensive 100-Question Test Bank
Latest update. | Advanced Practice | Detailed
Rationales
,DOMAIN 1: CARDIOVASCULAR DISORDERS
(Questions 1-15)
Question 1
A 55-year-old male presents with substernal chest pressure that began 2 hours
ago while shoveling snow. The pain radiates to his left arm and is accompanied by
diaphoresis and nausea. His ECG shows ST-segment elevation in leads V1-V4.
What is the most appropriate next step?
A. Administer sublingual nitroglycerin and repeat ECG in 15 minutes
B. Obtain cardiac enzymes and admit for observation
C. Activate the cardiac catheterization lab for emergent percutaneous coronary
intervention
D. Administer morphine and oxygen and reassess
Correct Answer: C
Rationale: This patient presents with classic symptoms of an acute ST-segment
elevation myocardial infarction (STEMI) with ST elevation in the anterior leads
(V1-V4). The standard of care for STEMI is emergent reperfusion via percutaneous
coronary intervention (PCI) within 90 minutes of arrival . While nitroglycerin (A),
oxygen, and morphine (D) are supportive, they are not substitutes for
reperfusion. Delaying intervention (B) increases mortality .
Question 2
A 68-year-old female with a history of hypertension and type 2 diabetes presents
,with shortness of breath, orthopnea, and bilateral lower extremity edema. She
reports waking up at night gasping for air. On examination, she has crackles in
both lung bases, jugular venous distention, and an S3 gallop. What is the most
likely diagnosis?
A. Chronic obstructive pulmonary disease exacerbation
B. Left-sided heart failure with pulmonary congestion
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Rationale: This patient presents with classic signs of left-sided heart failure:
dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles, and an S3 gallop.
Jugular venous distention suggests right-sided involvement as well (biventricular
failure). COPD (A) would not present with JVD or S3. Pulmonary embolism (C)
typically presents with acute dyspnea and hypoxia. Pneumonia (D) would present
with fever and productive cough .
Question 3
A 72-year-old male with a history of atrial fibrillation presents with sudden-onset,
severe left leg pain, pallor, and paresthesia. The left lower extremity is cool to
touch and pulses are absent. What is the most likely diagnosis?
A. Deep vein thrombosis
B. Acute arterial occlusion
C. Chronic venous insufficiency
D. Cellulitis
Correct Answer: B
, Rationale: The acute onset of the "6 Ps" (pain, pallor, pulselessness, paresthesia,
paralysis, poikilothermia) is characteristic of acute arterial occlusion. This is a
medical emergency, often caused by emboli from the heart in patients with atrial
fibrillation. Deep vein thrombosis (A) presents with swelling and warmth, not
pallor and pulselessness. Chronic venous insufficiency (C) has gradual onset.
Cellulitis (D) presents with erythema and warmth .
Question 4
A 45-year-old female presents with palpitations, fatigue, and heat intolerance.
She has noticed weight loss despite increased appetite. On examination, she has
tachycardia, fine tremor, and a diffusely enlarged thyroid gland. What is the most
appropriate initial diagnostic test?
A. Thyroid ultrasound
B. TSH, free T4, and T3 levels
C. Thyroid biopsy
D. Radioactive iodine uptake scan
Correct Answer: B
Rationale: The initial diagnostic test for suspected hyperthyroidism is TSH, free
T4, and T3 levels. A low TSH with elevated free T4 and/or T3 confirms
hyperthyroidism. Thyroid ultrasound (A) is used for nodules, not initial diagnosis.
Biopsy (C) is for suspicious nodules. Radioactive iodine uptake (D) helps
differentiate causes after diagnosis is confirmed .
Question 5
A 60-year-old male with a history of coronary artery disease presents with chest
pain that occurs with exertion and is relieved by rest. The pain is substernal and
radiates to the jaw. What is the most likely diagnosis?
