CHAMBERLAIN UNIVERSITY
NR 511 Final Exam
Differential Diagnosis & Primary Care Practicum
Official Practice Exam - 2026/2027 Edition
Questions Minutes Passing Score Sections
100 120 80% 6
Table of Contents
Respiratory Disorders - Questions 1-18 (18)
Cardiovascular Disorders - Questions 19-35 (17)
Gastrointestinal Disorders - Questions 36-52 (17)
Musculoskeletal and Integumentary Disorders - Questions 53-69 (17)
Neurological and Psychiatric Disorders - Questions 70-85 (16)
Endocrine and Reproductive Disorders - Questions 86-100 (15)
Instructions
This practice exam contains 100 multiple-choice questions divided into 6 sections. Select the single best answer for
each question. You have 120 minutes to complete the exam. A score of 80% (80/100 correct) is required to pass. Each
question includes a rationale explaining the correct answer and why the top distractor is incorrect.
NR 511 Final Exam -- 2026/2027 | Passing Score: 80% | Page 1 of {}
,Respiratory Disorders Questions 1-18 | 2026/2027
Q1. Question 1 of 100
Q1. A 45-year-old male presents with acute onset of dyspnea, pleuritic chest pain, and
hemoptysis 10 days after a knee replacement surgery. His heart rate is 112 bpm and
respiratory rate is 24. The most likely diagnosis is
A. Acute myocardial infarction with left ventricular dysfunction
B. Pneumococcal pneumonia with parapneumonic effusion
C. Tension pneumothorax from barotrauma during surgery
D. Pulmonary embolism secondary to deep vein thrombosis
Correct Answer: D
Rationale:
The presentation of dyspnea, pleuritic chest pain, and hemoptysis in the setting of recent orthopedic
surgery is the classic triad for pulmonary embolism. Postoperative immobility creates venous stasis,
promoting DVT formation that can embolize to the pulmonary vasculature. Acute MI would present with
crushing substernal pain rather than pleuritic pain.
Q2. Question 2 of 100
Q2. A 62-year-old female with a 30-pack-year smoking history presents with chronic
productive cough for 3 months per year over the past 2 years, progressive dyspnea on
exertion, and wheezing. Spirometry shows FEV1/FVC ratio of 0.58 and FEV1 65% of predicted.
These findings are most consistent with
A. Severe COPD with chronic respiratory failure
B. Moderate chronic obstructive pulmonary disease
C. Mild intermittent asthma with reversible obstruction
D. Restrictive lung disease from interstitial fibrosis
Correct Answer: B
Rationale:
The GOLD criteria define COPD by FEV1/FVC less than 0.70. An FEV1 of 65% predicted classifies this as
moderate (GOLD Stage II) COPD. Asthma would show reversible obstruction, and restrictive disease
would show reduced FVC with normal or increased FEV1/FVC ratio.
NR 511 Final Exam -- 2026/2027 | Passing Score: 80% | Page 2 of {}
, Q3. Question 3 of 100
Q3. A 34-year-old male presents with sudden onset of right-sided chest pain and dyspnea. He
is tall and thin with a BMI of 18. Physical examination reveals absent breath sounds on the
right and tracheal deviation to the left. The priority intervention is
A. Perform endotracheal intubation to secure the airway
B. Immediate needle decompression of the right hemithorax
C. Obtain a chest radiograph to confirm the diagnosis
D. Administer supplemental oxygen and monitor closely
Correct Answer: B
Rationale:
Tracheal deviation away from the affected side with absent breath sounds indicates tension pneumothorax,
a medical emergency requiring immediate needle decompression (second intercostal space, midclavicular
line) before any imaging. Delaying treatment for a chest radiograph can result in cardiovascular collapse.
Q4. Question 4 of 100
Q4. A 5-year-old child presents with a 3-day history of low-grade fever, barking cough, and
inspiratory stridor that worsens at night. The parent notes the child had mild cold symptoms
before the cough began. The most appropriate initial treatment is
A. Intubation and mechanical ventilation for airway protection
B. Nebulized racemic epinephrine and oral dexamethasone
C. Oral amoxicillin for 10 days to treat bacterial tracheitis
D. Inhaled albuterol with ipratropium for bronchospasm
Correct Answer: B
Rationale:
The barking cough, inspiratory stridor, and preceding viral illness are classic for croup
(laryngotracheobronchitis). Nebulized racemic epinephrine reduces airway edema acutely, and
dexamethasone decreases inflammation and prevents recurrence. Antibiotics are not indicated for this viral
condition.
NR 511 Final Exam -- 2026/2027 | Passing Score: 80% | Page 3 of {}
, Q5. Question 5 of 100
Q5. A 58-year-old female with a history of GERD presents with chronic nonproductive cough
for 8 weeks that is worse at night and after meals. She has no wheezing, fever, or weight loss.
Chest radiograph is normal. The most likely etiology of her cough is
A. Eosinophilic bronchitis without asthma features
B. Gastroesophageal reflux disease with microaspiration
C. Chronic bronchitis from undiagnosed COPD
D. Bordetella pertussis infection with prolonged cough
Correct Answer: B
Rationale:
GERD is one of the three most common causes of chronic cough (along with postnasal drip and asthma).
The temporal relationship with meals and nighttime worsening, combined with a normal chest radiograph
and absence of wheezing, points to GERD-related cough from microaspiration and vagal stimulation.
Q6. Question 6 of 100
Q6. A 72-year-old nursing home resident is admitted with fever, productive cough, and
confusion. Chest radiograph shows a right lower lobe consolidation. Sputum Gram stain
shows Gram-negative rods. The most likely causative organism is
A. Mycoplasma pneumoniae
B. Legionella pneumophila
C. Klebsiella pneumoniae
D. Streptococcus pneumoniae
Correct Answer: C
Rationale:
Gram-negative rods on sputum Gram stain in a nursing home resident with lobar consolidation strongly
suggest Klebsiella pneumoniae, a common nosocomial pathogen. S. pneumoniae appears as
Gram-positive diplococci, Mycoplasma lacks a cell wall and does not stain, and Legionella requires special
culture media.
NR 511 Final Exam -- 2026/2027 | Passing Score: 80% | Page 4 of {}
NR 511 Final Exam
Differential Diagnosis & Primary Care Practicum
Official Practice Exam - 2026/2027 Edition
Questions Minutes Passing Score Sections
100 120 80% 6
Table of Contents
Respiratory Disorders - Questions 1-18 (18)
Cardiovascular Disorders - Questions 19-35 (17)
Gastrointestinal Disorders - Questions 36-52 (17)
Musculoskeletal and Integumentary Disorders - Questions 53-69 (17)
Neurological and Psychiatric Disorders - Questions 70-85 (16)
Endocrine and Reproductive Disorders - Questions 86-100 (15)
Instructions
This practice exam contains 100 multiple-choice questions divided into 6 sections. Select the single best answer for
each question. You have 120 minutes to complete the exam. A score of 80% (80/100 correct) is required to pass. Each
question includes a rationale explaining the correct answer and why the top distractor is incorrect.
NR 511 Final Exam -- 2026/2027 | Passing Score: 80% | Page 1 of {}
,Respiratory Disorders Questions 1-18 | 2026/2027
Q1. Question 1 of 100
Q1. A 45-year-old male presents with acute onset of dyspnea, pleuritic chest pain, and
hemoptysis 10 days after a knee replacement surgery. His heart rate is 112 bpm and
respiratory rate is 24. The most likely diagnosis is
A. Acute myocardial infarction with left ventricular dysfunction
B. Pneumococcal pneumonia with parapneumonic effusion
C. Tension pneumothorax from barotrauma during surgery
D. Pulmonary embolism secondary to deep vein thrombosis
Correct Answer: D
Rationale:
The presentation of dyspnea, pleuritic chest pain, and hemoptysis in the setting of recent orthopedic
surgery is the classic triad for pulmonary embolism. Postoperative immobility creates venous stasis,
promoting DVT formation that can embolize to the pulmonary vasculature. Acute MI would present with
crushing substernal pain rather than pleuritic pain.
Q2. Question 2 of 100
Q2. A 62-year-old female with a 30-pack-year smoking history presents with chronic
productive cough for 3 months per year over the past 2 years, progressive dyspnea on
exertion, and wheezing. Spirometry shows FEV1/FVC ratio of 0.58 and FEV1 65% of predicted.
These findings are most consistent with
A. Severe COPD with chronic respiratory failure
B. Moderate chronic obstructive pulmonary disease
C. Mild intermittent asthma with reversible obstruction
D. Restrictive lung disease from interstitial fibrosis
Correct Answer: B
Rationale:
The GOLD criteria define COPD by FEV1/FVC less than 0.70. An FEV1 of 65% predicted classifies this as
moderate (GOLD Stage II) COPD. Asthma would show reversible obstruction, and restrictive disease
would show reduced FVC with normal or increased FEV1/FVC ratio.
NR 511 Final Exam -- 2026/2027 | Passing Score: 80% | Page 2 of {}
, Q3. Question 3 of 100
Q3. A 34-year-old male presents with sudden onset of right-sided chest pain and dyspnea. He
is tall and thin with a BMI of 18. Physical examination reveals absent breath sounds on the
right and tracheal deviation to the left. The priority intervention is
A. Perform endotracheal intubation to secure the airway
B. Immediate needle decompression of the right hemithorax
C. Obtain a chest radiograph to confirm the diagnosis
D. Administer supplemental oxygen and monitor closely
Correct Answer: B
Rationale:
Tracheal deviation away from the affected side with absent breath sounds indicates tension pneumothorax,
a medical emergency requiring immediate needle decompression (second intercostal space, midclavicular
line) before any imaging. Delaying treatment for a chest radiograph can result in cardiovascular collapse.
Q4. Question 4 of 100
Q4. A 5-year-old child presents with a 3-day history of low-grade fever, barking cough, and
inspiratory stridor that worsens at night. The parent notes the child had mild cold symptoms
before the cough began. The most appropriate initial treatment is
A. Intubation and mechanical ventilation for airway protection
B. Nebulized racemic epinephrine and oral dexamethasone
C. Oral amoxicillin for 10 days to treat bacterial tracheitis
D. Inhaled albuterol with ipratropium for bronchospasm
Correct Answer: B
Rationale:
The barking cough, inspiratory stridor, and preceding viral illness are classic for croup
(laryngotracheobronchitis). Nebulized racemic epinephrine reduces airway edema acutely, and
dexamethasone decreases inflammation and prevents recurrence. Antibiotics are not indicated for this viral
condition.
NR 511 Final Exam -- 2026/2027 | Passing Score: 80% | Page 3 of {}
, Q5. Question 5 of 100
Q5. A 58-year-old female with a history of GERD presents with chronic nonproductive cough
for 8 weeks that is worse at night and after meals. She has no wheezing, fever, or weight loss.
Chest radiograph is normal. The most likely etiology of her cough is
A. Eosinophilic bronchitis without asthma features
B. Gastroesophageal reflux disease with microaspiration
C. Chronic bronchitis from undiagnosed COPD
D. Bordetella pertussis infection with prolonged cough
Correct Answer: B
Rationale:
GERD is one of the three most common causes of chronic cough (along with postnasal drip and asthma).
The temporal relationship with meals and nighttime worsening, combined with a normal chest radiograph
and absence of wheezing, points to GERD-related cough from microaspiration and vagal stimulation.
Q6. Question 6 of 100
Q6. A 72-year-old nursing home resident is admitted with fever, productive cough, and
confusion. Chest radiograph shows a right lower lobe consolidation. Sputum Gram stain
shows Gram-negative rods. The most likely causative organism is
A. Mycoplasma pneumoniae
B. Legionella pneumophila
C. Klebsiella pneumoniae
D. Streptococcus pneumoniae
Correct Answer: C
Rationale:
Gram-negative rods on sputum Gram stain in a nursing home resident with lobar consolidation strongly
suggest Klebsiella pneumoniae, a common nosocomial pathogen. S. pneumoniae appears as
Gram-positive diplococci, Mycoplasma lacks a cell wall and does not stain, and Legionella requires special
culture media.
NR 511 Final Exam -- 2026/2027 | Passing Score: 80% | Page 4 of {}
