NR 603 Advanced Clinical Diagnosis and Practice
Across the Lifespan ACTUAL EXAM 2026 |
Midterm Exam Practice Set | Chamberlain
University | Examplify Online Proctored | 100%
Pass Guaranteed | Verified Q&A - A+ Graded
DOMAIN 1: CLINICAL PRESENTATION AND DIFFERENTIAL
DIAGNOSIS (35 Questions)
Cardiovascular Presentations
Q1: A 55-year-old male presents with sudden onset of sharp, tearing chest pain radiating to the
back. He has a history of hypertension and Marfan syndrome. Blood pressure is 160/95 in the right
arm and 110/70 in the left arm. Which condition is most likely?
A. Acute coronary syndrome
B. Pulmonary embolism
C. Aortic dissection [CORRECT]
D. Pericarditis
,Correct Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing chest pain radiating to the back.
Risk factors include hypertension and connective tissue disorders (Marfan syndrome). Asymmetric
blood pressures between arms (>20 mmHg difference) are characteristic. Acute coronary
syndrome (A) presents with pressure-like, substernal chest pain. Pulmonary embolism (B) presents
with pleuritic chest pain, dyspnea, and tachycardia. Pericarditis (D) presents with pleuritic chest
pain that worsens lying flat and improves leaning forward.
Chamberlain Note: Remember the "tearing" quality and pulse deficits for aortic
dissection—high-yield for Examplify.
Q2: A 62-year-old female presents with chest pressure described as "elephant sitting on my chest"
radiating to the left arm and jaw. Symptoms began 30 minutes ago at rest. She is diaphoretic and
nauseated. Vital signs: BP 150/90, HR 98, RR 18, SpO2 94%. Which is the priority differential
diagnosis?
A. Stable angina
B. Acute myocardial infarction [CORRECT]
C. Costochondritis
D. Anxiety attack
Correct Answer: B
Rationale: The presentation is classic for acute MI: pressure-like chest pain, radiation to arm/jaw,
diaphoretic, nausea, and symptoms at rest. Stable angina (A) is exertional and relieved by rest.
,Costochondritis (C) is reproducible with palpation and localized. Anxiety (D) may cause chest
discomfort but not typical radiation pattern with diaphoresis.
Q3: A 45-year-old male presents with sharp, pleuritic chest pain that worsens when lying flat and
improves when leaning forward. He had a viral upper respiratory infection last week. On exam, a
friction rub is heard. Which diagnosis is most likely?
A. Myocardial infarction
B. Acute pericarditis [CORRECT]
C. Pulmonary embolism
D. Pneumothorax
Correct Answer: B
Rationale: Acute pericarditis presents with pleuritic chest pain that worsens supine and improves
leaning forward (positional pain), often following viral illness. The pericardial friction rub is
pathognomonic. MI (A) is pressure-like, not positional. PE (C) causes pleuritic pain but no friction
rub or positional variation. Pneumothorax (D) presents with sudden dyspnea and decreased breath
sounds.
Q4: A 38-year-old female presents with sudden onset dyspnea, pleuritic chest pain, and
tachycardia (HR 118). She recently returned from a 12-hour flight. D-dimer is elevated. Which
diagnostic test is most appropriate next step?
A. Chest X-ray
, B. CT pulmonary angiography (CTPA) [CORRECT]
C. Ventilation-perfusion scan
D. Echocardiogram
Correct Answer: B
Rationale: CTPA is the gold standard for diagnosing pulmonary embolism in hemodynamically
stable patients with intermediate/high pretest probability. Recent long-distance travel is a major risk
factor for venous thromboembolism. Chest X-ray (A) is often normal in PE. V/Q scan (C) is used
when CTPA is contraindicated (renal failure, contrast allergy). Echo (D) assesses for right heart
strain but doesn't confirm PE.
Q5: A 72-year-old male with heart failure presents with worsening dyspnea, orthopnea, and
bilateral lower extremity edema. He gained 5 pounds in 3 days. On exam: JVD, crackles bilaterally,
S3 gallop. Which is the most likely cause of his acute decompensation?
A. Fluid volume overload [CORRECT]
B. Acute coronary syndrome
C. Pneumonia
D. Pulmonary embolism
Correct Answer: A
Across the Lifespan ACTUAL EXAM 2026 |
Midterm Exam Practice Set | Chamberlain
University | Examplify Online Proctored | 100%
Pass Guaranteed | Verified Q&A - A+ Graded
DOMAIN 1: CLINICAL PRESENTATION AND DIFFERENTIAL
DIAGNOSIS (35 Questions)
Cardiovascular Presentations
Q1: A 55-year-old male presents with sudden onset of sharp, tearing chest pain radiating to the
back. He has a history of hypertension and Marfan syndrome. Blood pressure is 160/95 in the right
arm and 110/70 in the left arm. Which condition is most likely?
A. Acute coronary syndrome
B. Pulmonary embolism
C. Aortic dissection [CORRECT]
D. Pericarditis
,Correct Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing chest pain radiating to the back.
Risk factors include hypertension and connective tissue disorders (Marfan syndrome). Asymmetric
blood pressures between arms (>20 mmHg difference) are characteristic. Acute coronary
syndrome (A) presents with pressure-like, substernal chest pain. Pulmonary embolism (B) presents
with pleuritic chest pain, dyspnea, and tachycardia. Pericarditis (D) presents with pleuritic chest
pain that worsens lying flat and improves leaning forward.
Chamberlain Note: Remember the "tearing" quality and pulse deficits for aortic
dissection—high-yield for Examplify.
Q2: A 62-year-old female presents with chest pressure described as "elephant sitting on my chest"
radiating to the left arm and jaw. Symptoms began 30 minutes ago at rest. She is diaphoretic and
nauseated. Vital signs: BP 150/90, HR 98, RR 18, SpO2 94%. Which is the priority differential
diagnosis?
A. Stable angina
B. Acute myocardial infarction [CORRECT]
C. Costochondritis
D. Anxiety attack
Correct Answer: B
Rationale: The presentation is classic for acute MI: pressure-like chest pain, radiation to arm/jaw,
diaphoretic, nausea, and symptoms at rest. Stable angina (A) is exertional and relieved by rest.
,Costochondritis (C) is reproducible with palpation and localized. Anxiety (D) may cause chest
discomfort but not typical radiation pattern with diaphoresis.
Q3: A 45-year-old male presents with sharp, pleuritic chest pain that worsens when lying flat and
improves when leaning forward. He had a viral upper respiratory infection last week. On exam, a
friction rub is heard. Which diagnosis is most likely?
A. Myocardial infarction
B. Acute pericarditis [CORRECT]
C. Pulmonary embolism
D. Pneumothorax
Correct Answer: B
Rationale: Acute pericarditis presents with pleuritic chest pain that worsens supine and improves
leaning forward (positional pain), often following viral illness. The pericardial friction rub is
pathognomonic. MI (A) is pressure-like, not positional. PE (C) causes pleuritic pain but no friction
rub or positional variation. Pneumothorax (D) presents with sudden dyspnea and decreased breath
sounds.
Q4: A 38-year-old female presents with sudden onset dyspnea, pleuritic chest pain, and
tachycardia (HR 118). She recently returned from a 12-hour flight. D-dimer is elevated. Which
diagnostic test is most appropriate next step?
A. Chest X-ray
, B. CT pulmonary angiography (CTPA) [CORRECT]
C. Ventilation-perfusion scan
D. Echocardiogram
Correct Answer: B
Rationale: CTPA is the gold standard for diagnosing pulmonary embolism in hemodynamically
stable patients with intermediate/high pretest probability. Recent long-distance travel is a major risk
factor for venous thromboembolism. Chest X-ray (A) is often normal in PE. V/Q scan (C) is used
when CTPA is contraindicated (renal failure, contrast allergy). Echo (D) assesses for right heart
strain but doesn't confirm PE.
Q5: A 72-year-old male with heart failure presents with worsening dyspnea, orthopnea, and
bilateral lower extremity edema. He gained 5 pounds in 3 days. On exam: JVD, crackles bilaterally,
S3 gallop. Which is the most likely cause of his acute decompensation?
A. Fluid volume overload [CORRECT]
B. Acute coronary syndrome
C. Pneumonia
D. Pulmonary embolism
Correct Answer: A
