NR 511 differential diagnosis primary care EXAM A+ GRADE ASSURED COMPLETE SOLUTIONS AND VERIFIED ANSWERS

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Exam Solution uy




NR 511 FInal Exam 2026 A+ GRADE ASSURED COMPLET
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E SOLUTIONS AND VERIFIED ANSWERS (0D703)
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QUESTION 1 uy




Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant
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abdominal cramping pain, nausea, and vomiting. What is your leading differential diagn
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osis?
ANSWER

Cholecystitis A rapid onset of severe right upper quadrant (RUQ) abdominal cramping pain with nause
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a and vomiting is a classic presentation of acute cholecystitis; 90% to 95% of patients with acute chole
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cystitis also have gallstones. Other symptoms include low-
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grade fever, epigastric tenderness, guarding, and pain on inspiration during palpation of the RUQ (Mur
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phy sign). The 7 Fs of cholecystitis are fair, fat, 40, female, fertile, fat intolerant, and flatulent.
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QUESTION 2 uy




You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and pl
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an to treat her empirically. What medications should you order?
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ANSWER

A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl) All of th
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e drugs listed are used in the eradication of H pylori. Traditional 14-
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day "triple therapy" with a proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metro
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nidazole (Flagyl) has consistently produced eradication rates of approximately 95% and is the least ex
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pensive therapy. uy




QUESTION 3 uy




You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you su
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spect?
ANSWER

Inflammation of the kidney Costovertebral angle tenderness is tenderness or sharp pain that is elicited
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when one hand is "thumped" with the ulnar edge of the other fist over the 12th rib at the costoverteb
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,ral angle on the back. It indicates inflammation of the kidney (and possible associated renal calculi, ren
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al artery or vein occlusion, and perirenal abscess).
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QUESTION 4 uy




To differentiate among the different diagnoses of inflammatory bowel diseases, you loo
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k at the patient's histological, culture, and radiological features. Mary has transmural in
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flammation, granulomas, focal involvement of the colon with some skipped areas, and s
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paring of the rectal mucosa. What do you suspect?
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ANSWER

Crohn's disease Crohn's disease would show transmural inflammation, granulomas, focal involvement o
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f the colon with some skipped areas, and sparing of the rectal mucosa. The key words are "skipped are
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as of mucosal involvement."
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QUESTION 5 uy




Margie, age 52, has an extremely stressful job and was just given a diagnosis of gastric u
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lcer. She tells you she is sure it is going to be malignant. How do you respond?
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ANSWER

About 95% of gastric ulcers are benign." About 3% to 5% of gastric ulcers of benign-
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appearing ulcers prove to be cancer. uy uy uy uy uy




QUESTION 6 uy




Rose has gastroesophageal reflux disease (GERD). Which statement by the patient indic
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ates that she misunderstands your teaching?
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ANSWER

"I will have a snack before retiring so that the esophagus and stomach are not empty at bedtime." Ros
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e should not have a snack before retiring. Patients with GERD should be instructed to avoid coffee, alc
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ohol, chocolate, peppermint, and spicy foods; eat smaller meals; stop smoking; remain upright for 2 ho
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urs after meals; elevate the head of the bed on 6- to 8-
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inch blocks; and refrain from eating for 3 hours before retiring.
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QUESTION 7 uy




Which is the most important diagnostic test for celiac disease?
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ANSWER

An IgA- uy



tTG test, followed by a biopsy of the small intestine There are several serologic tests available that scre
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en for celiac disease antibodies, but the most important diagnostic test is called an IgA-
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,tTG test. Although it may be falsely negative, if the test results suggest celiac disease, it is recommende
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d that a biopsy of the small intestine be done to confirm the diagnosis.
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QUESTION 8 uy




Susan, age 59, has no specific complaints when she comes in for her annual examination
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. She does, however, have type 2 diabetes mellitus (DM), slight hypertension, dyslipidem
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ia, and central obesity. How would you diagnose her?
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ANSWER

As having metabolic syndrome Susan has a constellation of symptoms known as metabolic syndrome.
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The World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel
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III (NCEP ATP III), and International Diabetes Federation (IDF) have slightly different criteria for this
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diagnosis. They all, however, include hypertension, dyslipidemia, and central obesity.
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QUESTION 9 uy




Which gastrointestinal disease below could theoretically be completely eradicated with
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a total colectomy?
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ANSWER

Ulcerative colitis Ulcerative colitis is a disease only of the colon. Although it is not the first treatment c
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hoice, total colectomy is a treatment option that can completely resolve this problem.
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QUESTION 10 uy




Matt, age 26, recently returned from a camping trip and has gastroenteritis. He says tha
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t he has been eating only canned food. Which of the following pathogens do you suspect
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?
ANSWER

Clostridium botulinum C botulinum is an anaerobic, gram- uy uy uy uy uy uy uy



positive bacillus that produces toxins. It is widely distributed in the soil and vegetation. Improperly pr
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ocessed home-canned low-acid vegetables and contaminated meats are the usual cause of food-
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borne botulism. uy




QUESTION 11 uy




Melva, age 63, presents with an acute exacerbation of pancreatitis, and you are going to
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admit her to the hospital. Which is the most important factor in determining a negative
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long-term outcome for her? uy uy uy




ANSWER

, Infection The most important factor in determining long-
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term negative outcomes for pancreatitis is the presence of infection. Despite best practices, mortality a
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ssociated with severe acute pancreatitis remains approximately 20% to 25% because of systemic comp
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lications.



QUESTION 12 uy




Which is the most common presenting symptom of gastric cancer?
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ANSWER

Weight loss uy




QUESTION 13 uy




Stacy, a nursing student, is to begin her series of hepatitis B vaccinations. You test her f
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or a serological marker, and the results show hepatitis B surface antibodies (HBsAb). W
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hat do you tell Stacy?
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ANSWER

"You need to be tested again because one reading is not indicative of immunity." The presence of hepa
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titis B surface antibodies indicates that Stacy is permanently immune to hepatitis B.
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QUESTION 14 uy




Shelby has recently been diagnosed with pancreatitis. Of the following objective finding
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s that can result from the pancreatic inflammatory process, which is known as Grey Tur
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ner sign? uy




ANSWER

Bluish discoloration over the flanks
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QUESTION 15 uy




What is the most common bacterial cause of traveler's diarrhea?
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ANSWER

Escherichia coli uy




QUESTION 16 uy




Olive has an acute exacerbation of Crohn's disease. Which laboratory test value(s) woul
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d you expect to be decreased?
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ANSWER