CHAMBERLAIN UNIVERSITY
College of Nursing
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NR 511 — Differential Diagnosis & Primary Care I
Final Examination — Version 2
75 Questions & Verified Solutions
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Page 1
,1. Introduction
The NR 511 — Differential Diagnosis & Primary Care I course at Chamberlain University equips advanced
practice nursing students with the clinical reasoning skills, diagnostic knowledge, and evidence-based
management strategies essential for primary care practice. This final examination (Version 2) assesses
competency across a broad spectrum of domains including differential diagnosis methodology, acute and
chronic condition management, diagnostic test interpretation, pharmacology, patient education, and
ethical-legal responsibilities. Mastery of these topics prepares the student for autonomous clinical
decision-making in diverse primary care settings.
This study resource contains 75 carefully constructed, scenario-based practice questions with verified
answers and detailed rationales. Each rationale incorporates current clinical guidelines from authoritative
bodies such as the Infectious Diseases Society of America (IDSA), American College of Cardiology /
American Heart Association (ACC/AHA), American Diabetes Association (ADA), United States Preventive
Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC), and the American
Academy of Family Physicians (AAFP). The questions are designed to reinforce clinical reasoning, test
application of evidence-based guidelines, and build confidence for the final examination.
2. Exam Structure
The NR 511 Final Examination — Version 2 consists of 75 multiple-choice questions to be completed
within 120-150 minutes. A passing score of 75-80 % is required. The examination employs a variety of
question formats including single-best-answer clinical scenarios, guideline-application questions, and
diagnostic reasoning challenges.
Questions are distributed across the following content domains to ensure comprehensive assessment of
primary care competency:
Domain Questions Key Topics
Differential Diagnosis 1–8 SOAP, PICO, Bayesian Reasoning,
Methodology Clinical Algorithms
Acute Respiratory Conditions 9–16 URI, Pharyngitis, Otitis Media,
Sinusitis, Bronchitis, CAP, Asthma
Acute Non-Respiratory 17–24 UTI, Pyelonephritis, SSTI,
Conditions Gastroenteritis, Appendicitis,
Cellulitis
Cardiovascular Assessment 25–32 HTN Classification, CAD/ACS,
Heart Failure, Dyslipidemia, PAD
Endocrine & Metabolic 33–40 DM Type 2, DKA/HHS,
Hypothyroidism, Hyperthyroidism,
Metabolic Syndrome
Chronic Disease Management 41–48 Asthma/COPD, HTN Follow-up,
DM Monitoring, Hyperlipidemia,
CKD
Diagnostic Testing 49–56 CBC, CMP, UA, Lipid Panel, HbA1c,
Interpretation TSH, CXR, ECG
Patient Education & Health 57–62 MI, Teach-Back, Health Literacy,
Promotion USPSTF, Immunizations
Pharmacologic Considerations 63–67 Antibiotic Stewardship, Drug
Interactions, Renal Dosing,
Polypharmacy
Referral & Interprofessional 68–71 Specialist Criteria, Care Transitions,
Collaboration Scope of Practice
Legal / Ethical Responsibilities 72–75 Informed Consent, Documentation,
Malpractice, HIPAA
Page 2
, 3. Practice Questions
Question 1 A 45-year-old presents with acute sore throat, fever 101°F, tonsillar exudate,
and tender anterior cervical lymphadenopathy. Rapid strep test is positive. Which
diagnostic framework BEST guides the initial evaluation?
A. PICO format
B. SOAP format
C. Bayesian reasoning
D. Hypothetico-deductive reasoning
✓ Answer: D. Hypothetico-deductive reasoning
Rationale: The hypothetico-deductive model is the cornerstone of clinical reasoning: the clinician
generates broad hypotheses (strep pharyngitis, mononucleosis, peritonsillar abscess) early in the
encounter, then systematically collects data (rapid strep, Centor criteria) to test and narrow them.
PICO (A) structures evidence-based questions, not bedside diagnosis. SOAP (B) is a documentation
format. Bayesian reasoning (C) adjusts pretest probabilities post-test but presumes the clinician has
already formed hypotheses.
Question 2 A 62-year-old with a 20-pack-year smoking history has a new 1.5 cm pulmonary
nodule on CT. The pretest probability of malignancy is estimated at 15 %. The PET-CT is
negative. Applying Bayesian reasoning, what is the MOST appropriate next step?
A. Immediate surgical resection
B. CT surveillance in 3-6 months
C. Bronchoscopic biopsy regardless
D. Discharge with no follow-up
✓ Answer: B. CT surveillance in 3-6 months
Rationale: A negative PET-CT has a high negative predictive value (~95 %) when pretest
probability is low-to-moderate (< 65 %). Post-test probability falls below 5 %, making CT
surveillance per Fleischner Society guidelines the evidence-based choice. Surgical resection (A)
carries morbidity disproportionate to risk. Biopsy (C) is not indicated with a low post-test
probability. Discharging without follow-up (D) is inappropriate; surveillance is still needed.
Question 3 A primary care NP wants to evaluate the evidence on low-dose CT screening for
lung cancer in asymptomatic smokers. Which PICO component is CORRECTLY paired for
this clinical question?
A. P = All adults; I = Chest X-ray; C = No screening; O = Mortality reduction
B. P = Asymptomatic adults age 50-80 with ≥20 pack-year history; I = Annual low-dose CT; C = No
screening; O = Lung cancer mortality
C. P = Patients with known lung cancer; I = Chemotherapy; C = Radiation; O = Tumor response
D. P = Smokers with cough; I = Sputum cytology; C = Low-dose CT; O = Diagnostic yield
✓ Answer: B. P = Asymptomatic adults age 50-80 with ≥20 pack-year history; I = Annual
low-dose CT; C = No screening; O = Lung cancer mortality
Rationale: PICO requires precise definition of each element. USPSTF (2021) recommends LDCT for
adults age 50-80 with ≥20 pack-years who currently smoke or quit within 15 years. Option B
captures the correct population, intervention, comparator, and clinically meaningful outcome
(mortality, not diagnostic yield). Options A, C, and D mis-specify the population, intervention, or
outcome.
Question 4 When documenting a new patient encounter, which SOAP section contains the
clinician's synthesis of subjective and objective findings into a prioritized list of problems?
A. Subjective
B. Objective
C. Assessment
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College of Nursing
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━
NR 511 — Differential Diagnosis & Primary Care I
Final Examination — Version 2
75 Questions & Verified Solutions
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━
Page 1
,1. Introduction
The NR 511 — Differential Diagnosis & Primary Care I course at Chamberlain University equips advanced
practice nursing students with the clinical reasoning skills, diagnostic knowledge, and evidence-based
management strategies essential for primary care practice. This final examination (Version 2) assesses
competency across a broad spectrum of domains including differential diagnosis methodology, acute and
chronic condition management, diagnostic test interpretation, pharmacology, patient education, and
ethical-legal responsibilities. Mastery of these topics prepares the student for autonomous clinical
decision-making in diverse primary care settings.
This study resource contains 75 carefully constructed, scenario-based practice questions with verified
answers and detailed rationales. Each rationale incorporates current clinical guidelines from authoritative
bodies such as the Infectious Diseases Society of America (IDSA), American College of Cardiology /
American Heart Association (ACC/AHA), American Diabetes Association (ADA), United States Preventive
Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC), and the American
Academy of Family Physicians (AAFP). The questions are designed to reinforce clinical reasoning, test
application of evidence-based guidelines, and build confidence for the final examination.
2. Exam Structure
The NR 511 Final Examination — Version 2 consists of 75 multiple-choice questions to be completed
within 120-150 minutes. A passing score of 75-80 % is required. The examination employs a variety of
question formats including single-best-answer clinical scenarios, guideline-application questions, and
diagnostic reasoning challenges.
Questions are distributed across the following content domains to ensure comprehensive assessment of
primary care competency:
Domain Questions Key Topics
Differential Diagnosis 1–8 SOAP, PICO, Bayesian Reasoning,
Methodology Clinical Algorithms
Acute Respiratory Conditions 9–16 URI, Pharyngitis, Otitis Media,
Sinusitis, Bronchitis, CAP, Asthma
Acute Non-Respiratory 17–24 UTI, Pyelonephritis, SSTI,
Conditions Gastroenteritis, Appendicitis,
Cellulitis
Cardiovascular Assessment 25–32 HTN Classification, CAD/ACS,
Heart Failure, Dyslipidemia, PAD
Endocrine & Metabolic 33–40 DM Type 2, DKA/HHS,
Hypothyroidism, Hyperthyroidism,
Metabolic Syndrome
Chronic Disease Management 41–48 Asthma/COPD, HTN Follow-up,
DM Monitoring, Hyperlipidemia,
CKD
Diagnostic Testing 49–56 CBC, CMP, UA, Lipid Panel, HbA1c,
Interpretation TSH, CXR, ECG
Patient Education & Health 57–62 MI, Teach-Back, Health Literacy,
Promotion USPSTF, Immunizations
Pharmacologic Considerations 63–67 Antibiotic Stewardship, Drug
Interactions, Renal Dosing,
Polypharmacy
Referral & Interprofessional 68–71 Specialist Criteria, Care Transitions,
Collaboration Scope of Practice
Legal / Ethical Responsibilities 72–75 Informed Consent, Documentation,
Malpractice, HIPAA
Page 2
, 3. Practice Questions
Question 1 A 45-year-old presents with acute sore throat, fever 101°F, tonsillar exudate,
and tender anterior cervical lymphadenopathy. Rapid strep test is positive. Which
diagnostic framework BEST guides the initial evaluation?
A. PICO format
B. SOAP format
C. Bayesian reasoning
D. Hypothetico-deductive reasoning
✓ Answer: D. Hypothetico-deductive reasoning
Rationale: The hypothetico-deductive model is the cornerstone of clinical reasoning: the clinician
generates broad hypotheses (strep pharyngitis, mononucleosis, peritonsillar abscess) early in the
encounter, then systematically collects data (rapid strep, Centor criteria) to test and narrow them.
PICO (A) structures evidence-based questions, not bedside diagnosis. SOAP (B) is a documentation
format. Bayesian reasoning (C) adjusts pretest probabilities post-test but presumes the clinician has
already formed hypotheses.
Question 2 A 62-year-old with a 20-pack-year smoking history has a new 1.5 cm pulmonary
nodule on CT. The pretest probability of malignancy is estimated at 15 %. The PET-CT is
negative. Applying Bayesian reasoning, what is the MOST appropriate next step?
A. Immediate surgical resection
B. CT surveillance in 3-6 months
C. Bronchoscopic biopsy regardless
D. Discharge with no follow-up
✓ Answer: B. CT surveillance in 3-6 months
Rationale: A negative PET-CT has a high negative predictive value (~95 %) when pretest
probability is low-to-moderate (< 65 %). Post-test probability falls below 5 %, making CT
surveillance per Fleischner Society guidelines the evidence-based choice. Surgical resection (A)
carries morbidity disproportionate to risk. Biopsy (C) is not indicated with a low post-test
probability. Discharging without follow-up (D) is inappropriate; surveillance is still needed.
Question 3 A primary care NP wants to evaluate the evidence on low-dose CT screening for
lung cancer in asymptomatic smokers. Which PICO component is CORRECTLY paired for
this clinical question?
A. P = All adults; I = Chest X-ray; C = No screening; O = Mortality reduction
B. P = Asymptomatic adults age 50-80 with ≥20 pack-year history; I = Annual low-dose CT; C = No
screening; O = Lung cancer mortality
C. P = Patients with known lung cancer; I = Chemotherapy; C = Radiation; O = Tumor response
D. P = Smokers with cough; I = Sputum cytology; C = Low-dose CT; O = Diagnostic yield
✓ Answer: B. P = Asymptomatic adults age 50-80 with ≥20 pack-year history; I = Annual
low-dose CT; C = No screening; O = Lung cancer mortality
Rationale: PICO requires precise definition of each element. USPSTF (2021) recommends LDCT for
adults age 50-80 with ≥20 pack-years who currently smoke or quit within 15 years. Option B
captures the correct population, intervention, comparator, and clinically meaningful outcome
(mortality, not diagnostic yield). Options A, C, and D mis-specify the population, intervention, or
outcome.
Question 4 When documenting a new patient encounter, which SOAP section contains the
clinician's synthesis of subjective and objective findings into a prioritized list of problems?
A. Subjective
B. Objective
C. Assessment
Page 3
