NR511 Midterm Exam: Comprehensive Practice Test
(Latest 2026 Update) Institution: Chamberlain
University Course: NR511 Differential Diagnosis &
Primary Care Practicum
Midterm (Practice Questions with Rationales)
Section 1: Foundations of Diagnostic Reasoning & Evidence-Based Practice
Question 1
A 42-year-old woman presents with fatigue and intermittent abdominal discomfort. You ask her to
describe when the discomfort started, what makes it better or worse, and how long each episode lasts.
Which part of diagnostic reasoning are you actively gathering?
A. Functional health patterns
B. Review of systems
C. History of present illness (HPI) using OLDCARTS
D. Past medical history
Correct Answer: C. History of present illness (HPI) using OLDCARTS
Rationale: The HPI is a detailed, focused breakdown of the chief complaint. The OLDCARTS mnemonic
(Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatments, Severity)
is the standard framework for gathering this subjective data .
Question 2
What is the definition of diagnostic reasoning?
A. The ability to memorize medical facts
B. Reflective thinking that questions one's thinking to determine if all possible avenues have been
explored
C. The process of coding medical diagnoses
D. The documentation of patient history
Correct Answer: B. Reflective thinking that questions one's thinking to determine if all possible
avenues have been explored
Rationale: Diagnostic reasoning is a form of critical thinking where the clinician questions their own
thought process to avoid premature closure and ensure all possibilities are considered .
,Question 3
A screening test correctly identifies 80 individuals who do not have colon cancer out of 100 individuals
who are disease-free (true negatives). The test fails to recognize 20 individuals who do not have colon
cancer. What is the specificity of the screening test?
A. 20%
B. 80%
C. 100%
D. 60%
Correct Answer: B. 80%
Rationale: Specificity is the ability of a test to correctly identify those without the condition (True
Negatives / Total Without Disease). Here, 80/100 = 80%. High specificity helps "rule in" a disease (SPIN) .
Question 4
A diagnostic test has very few false negatives. What is the best way to describe this test?
A. High specificity
B. Low specificity
C. High sensitivity
D. Low sensitivity
Correct Answer: C. High sensitivity
Rationale: Sensitivity is the ability to correctly identify those with the disease. A high-sensitivity test
yields very few false negatives, making it excellent for "ruling out" disease (SNOUT) .
Question 5
You strongly suspect a patient has a specific condition, but the test result is negative. This negative
result may be attributed to:
A. High positive predictive value
B. High specificity
C. A false-negative result due to low negative predictive value
D. A true negative
Correct Answer: C. A false-negative result due to low negative predictive value
Rationale: If your clinical suspicion (pre-test probability) is high, the negative predictive value (NPV)
decreases. This means a negative result is more likely to be a false negative .
Question 6
What is the key difference between medical coding and medical billing?
A. Coding is for hospitals; billing is for clinics.
B. Coding uses codes to communicate with payers about procedures; billing is the process of submitting
and following up on claims.
, C. There is no difference between the two.
D. Coding is done by physicians; billing is done by nurses.
Correct Answer: B. Coding uses codes to communicate with payers about procedures; billing is
the process of submitting and following up on claims.
Rationale: Coding translates services into standardized codes (CPT/ICD-10). Billing is the financial
process of submitting claims and obtaining payment .
Question 7
Which of the following is a required component in determining an outpatient Evaluation & Management
(E&M) office visit code?
A. Practice overhead costs
B. Patient satisfaction scores
C. Plan of service, type of service, and patient status (new vs. established)
D. Insurance company preferences
Correct Answer: C. Plan of service, type of service, and patient status (new vs. established)
Rationale: E&M coding levels are determined by the complexity of History, Exam, and Medical Decision
Making (MDM). Patient status (new vs. established) is foundational to selecting the code set .
Question 8
For new patients, which E&M code represents the MOST complex office visit?
A. 99201
B. 99203
C. 99204
D. 99205
Correct Answer: D. 99205
Rationale: For new patient office visits, codes range from 99201 (minimal) to 99205
(comprehensive/high complexity) .
Question 9
Which part of Medicare covers hospital services?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Correct Answer: A. Medicare Part A
Rationale: Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and
some home health care. Part B covers outpatient services .
(Latest 2026 Update) Institution: Chamberlain
University Course: NR511 Differential Diagnosis &
Primary Care Practicum
Midterm (Practice Questions with Rationales)
Section 1: Foundations of Diagnostic Reasoning & Evidence-Based Practice
Question 1
A 42-year-old woman presents with fatigue and intermittent abdominal discomfort. You ask her to
describe when the discomfort started, what makes it better or worse, and how long each episode lasts.
Which part of diagnostic reasoning are you actively gathering?
A. Functional health patterns
B. Review of systems
C. History of present illness (HPI) using OLDCARTS
D. Past medical history
Correct Answer: C. History of present illness (HPI) using OLDCARTS
Rationale: The HPI is a detailed, focused breakdown of the chief complaint. The OLDCARTS mnemonic
(Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatments, Severity)
is the standard framework for gathering this subjective data .
Question 2
What is the definition of diagnostic reasoning?
A. The ability to memorize medical facts
B. Reflective thinking that questions one's thinking to determine if all possible avenues have been
explored
C. The process of coding medical diagnoses
D. The documentation of patient history
Correct Answer: B. Reflective thinking that questions one's thinking to determine if all possible
avenues have been explored
Rationale: Diagnostic reasoning is a form of critical thinking where the clinician questions their own
thought process to avoid premature closure and ensure all possibilities are considered .
,Question 3
A screening test correctly identifies 80 individuals who do not have colon cancer out of 100 individuals
who are disease-free (true negatives). The test fails to recognize 20 individuals who do not have colon
cancer. What is the specificity of the screening test?
A. 20%
B. 80%
C. 100%
D. 60%
Correct Answer: B. 80%
Rationale: Specificity is the ability of a test to correctly identify those without the condition (True
Negatives / Total Without Disease). Here, 80/100 = 80%. High specificity helps "rule in" a disease (SPIN) .
Question 4
A diagnostic test has very few false negatives. What is the best way to describe this test?
A. High specificity
B. Low specificity
C. High sensitivity
D. Low sensitivity
Correct Answer: C. High sensitivity
Rationale: Sensitivity is the ability to correctly identify those with the disease. A high-sensitivity test
yields very few false negatives, making it excellent for "ruling out" disease (SNOUT) .
Question 5
You strongly suspect a patient has a specific condition, but the test result is negative. This negative
result may be attributed to:
A. High positive predictive value
B. High specificity
C. A false-negative result due to low negative predictive value
D. A true negative
Correct Answer: C. A false-negative result due to low negative predictive value
Rationale: If your clinical suspicion (pre-test probability) is high, the negative predictive value (NPV)
decreases. This means a negative result is more likely to be a false negative .
Question 6
What is the key difference between medical coding and medical billing?
A. Coding is for hospitals; billing is for clinics.
B. Coding uses codes to communicate with payers about procedures; billing is the process of submitting
and following up on claims.
, C. There is no difference between the two.
D. Coding is done by physicians; billing is done by nurses.
Correct Answer: B. Coding uses codes to communicate with payers about procedures; billing is
the process of submitting and following up on claims.
Rationale: Coding translates services into standardized codes (CPT/ICD-10). Billing is the financial
process of submitting claims and obtaining payment .
Question 7
Which of the following is a required component in determining an outpatient Evaluation & Management
(E&M) office visit code?
A. Practice overhead costs
B. Patient satisfaction scores
C. Plan of service, type of service, and patient status (new vs. established)
D. Insurance company preferences
Correct Answer: C. Plan of service, type of service, and patient status (new vs. established)
Rationale: E&M coding levels are determined by the complexity of History, Exam, and Medical Decision
Making (MDM). Patient status (new vs. established) is foundational to selecting the code set .
Question 8
For new patients, which E&M code represents the MOST complex office visit?
A. 99201
B. 99203
C. 99204
D. 99205
Correct Answer: D. 99205
Rationale: For new patient office visits, codes range from 99201 (minimal) to 99205
(comprehensive/high complexity) .
Question 9
Which part of Medicare covers hospital services?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Correct Answer: A. Medicare Part A
Rationale: Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and
some home health care. Part B covers outpatient services .
