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

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NR 511 FInal Exam 2026 A+ GRADE ASSURED COMPLE
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TE SOLUTIONS AND VERIFIED ANSWERS (521E3)
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QUESTION 1 zm




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

Cholecystitis A rapid onset of severe right upper quadrant (RUQ) abdominal cramping pain with nau
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sea and vomiting is a classic presentation of acute cholecystitis; 90% to 95% of patients with acute
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cholecystitis 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 (M
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urphy sign). The 7 Fs of cholecystitis are fair, fat, 40, female, fertile, fat intolerant, and flatulent.
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QUESTION 2 zm




You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and
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plan 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
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the 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 met
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ronidazole (Flagyl) has consistently produced eradication rates of approximately 95% and is the leas
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t expensive therapy.
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QUESTION 3 zm




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

Inflammation of the kidney Costovertebral angle tenderness is tenderness or sharp pain that is elicit
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ed when one hand is "thumped" with the ulnar edge of the other fist over the 12th rib at the costo
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,vertebral angle on the back. It indicates inflammation of the kidney (and possible associated renal c
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alculi, renal artery or vein occlusion, and perirenal abscess).
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QUESTION 4 zm




To differentiate among the different diagnoses of inflammatory bowel diseases, you lo
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ok at the patient's histological, culture, and radiological features. Mary has transmural
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inflammation, granulomas, focal involvement of the colon with some skipped areas, a
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nd sparing 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
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of the colon with some skipped areas, and sparing of the rectal mucosa. The key words are "skippe
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d areas of mucosal involvement."
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QUESTION 5 zm




Margie, age 52, has an extremely stressful job and was just given a diagnosis of gastri
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c ulcer. 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. zm zm zm zm zm




QUESTION 6 zm




Rose has gastroesophageal reflux disease (GERD). Which statement by the patient indi
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cates 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." R
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ose should not have a snack before retiring. Patients with GERD should be instructed to avoid coffee
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, alcohol, chocolate, peppermint, and spicy foods; eat smaller meals; stop smoking; remain upright fo
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r 2 hours 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 zm




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

An IgA- zm



tTG test, followed by a biopsy of the small intestine There are several serologic tests available that s
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creen 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 recomme
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nded that a biopsy of the small intestine be done to confirm the diagnosis.
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QUESTION 8 zm




Susan, age 59, has no specific complaints when she comes in for her annual examinati
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on. She does, however, have type 2 diabetes mellitus (DM), slight hypertension, dyslipi
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demia, 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 P
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anel III (NCEP ATP III), and International Diabetes Federation (IDF) have slightly different criteria fo
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r this diagnosis. They all, however, include hypertension, dyslipidemia, and central obesity.
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QUESTION 9 zm




Which gastrointestinal disease below could theoretically be completely eradicated wit
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h 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 treatmen
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t choice, total colectomy is a treatment option that can completely resolve this problem.
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QUESTION 10 zm




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

Clostridium botulinum C botulinum is an anaerobic, gram-
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positive bacillus that produces toxins. It is widely distributed in the soil and vegetation. Improperly
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processed home-canned low-acid vegetables and contaminated meats are the usual cause of food-
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borne botulism. zm




QUESTION 11 zm




Melva, age 63, presents with an acute exacerbation of pancreatitis, and you are going
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to admit her to the hospital. Which is the most important factor in determining a neg
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ative long-term outcome for her?
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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
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massociated with severe acute pancreatitis remains approximately 20% to 25% because of systemic c
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omplications.



QUESTION 12 zm




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

Weight loss zm




QUESTION 13 zm




Stacy, a nursing student, is to begin her series of hepatitis B vaccinations. You test her
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for a serological marker, and the results show hepatitis B surface antibodies (HBsAb)
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. What 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 he
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patitis B surface antibodies indicates that Stacy is permanently immune to hepatitis B.
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QUESTION 14 zm




Shelby has recently been diagnosed with pancreatitis. Of the following objective findin
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gs that can result from the pancreatic inflammatory process, which is known as Grey
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Turner sign? zm




ANSWER

Bluish discoloration over the flanks
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QUESTION 15 zm




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

Escherichia coli zm




QUESTION 16 zm




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