NR 511 Differential Diagnosis
And Primary Care Practicum
Questions with complete solutions
A 21-year-old woman comes to your office and reports a history of genital warts. In reference to the
human papillomavirus (HPV) vaccination (ie, Gardasil, Gardasil 9, and Cervarix), she should be educated
that:
She should receive HPV vaccination.
Roger, a healthy 68-year-old man, comes in to see you with a complaint of sudden episodes of an urgent
need to void. He has had several episodes of moderate amounts of unintentional urine loss during these
times. Other than these episodes, he is voiding in amounts "normal" for him, with no leakage when he
coughs or sneezes. The practitioner's initial diagnosis is which type of incontinence?
Urge incontinence.
Josh and Martha have 5 children and do not want any more. Josh said he heard about a no-scalpel
vasectomy (NSV) and asks the nurse practitioner how it works. What would be the best response?
"A loop of vas deferens is delivered through the scrotal skin and occluded."
Susan, age 28, is 9 months pregnant and asks you about using umbilical cord blood after birth for
newborn DNA identification. What do you tell her?
A cord blood sample is identical to the genetic profile of the infant."
Sarah, age 29, complains of premenstrual syndrome (PMS). She states she was told that changing her
diet might help in managing some of the symptoms. What change in her diet do you recommend?
Increased intake of complex carbohydrates.
,Reiter syndrome is a complication of:
Gonorrhea.
Max, age 70, is obese. He is complaining of a bulge in his groin that has been there for months. He states
that it is not painful, but it is annoying. The practitioner notes that the origin of the swelling is above the
inguinal ligament and directly behind and through the external ring. This finding is most indicative of
a(n):
Direct inguinal hernia.
On physical exam, Judy has pubic hair that spreads over her mons pubis with a slight lateral spread. In
addition, her breast development shows breast enlargement with secondary mound formation by the
developing areolae. Which Tanner stage best describes Judy's development?
Stage IV.
The best method to diagnose uterine polyps is a:
Hysteroscopy.
Regular testicular self-exams have not been studied enough to show if they lower the risk of dying from
testicular cancer. This is why the American Cancer Society and other agencies do not have a
recommendation about regular testicular self-exams for all men. Still, some practitioners do recommend
that all men examine their testicles monthly after reaching puberty. If you are teaching a patient how to
do a testicular self-examination, which of the following do you tell him?
"Make an appointment if you note any hard lumps directly on the testicle, regardless of whether
they are tender."
,John asks for a prescription for sildenafil (Viagra). He says that the only medication he takes is isosorbide
mononitrate (Monoket) oral tablets and that he has diabetes that he controls with diet alone. What
should the nurse practitioner tell him?
"Viagra is contraindicated with isosorbide mononitrate; let's discuss other options."
Mr. McKinsey, age 69, was recently given a diagnosis of degenerative joint disease. Which assessment
should the nurse practitioner use to check for effusion of the patient's knee?
Bulge test
A nurse practitioner is driving home from work and stops at the scene of a motorcycle accident that
must have just occurred, as there are no rescue vehicles present. The driver is lying unconscious at the
side of the road with an obvious open fracture of his femur. Which of the following actions should take
priority?
Establishing an airway.
The valgus stress test, varus stress test, Lachman test, and thumb sign are all considered standard tests
to check the integrity of the ligaments of the knee. Which test would the nurse practitioner choose to
assess the anterior cruciate ligament (ACL), which is the most commonly involved structure in severe
knee injury?
Lachman test.
You are assessing Jamal, age 16, after a football injury to his right knee. You elicit a positive
anterior/posterior drawer sign. This test indicates an injury to the:
Cruciate ligament.
Cass, age 67, tells the nurse practitioner (NP) that she has been diagnosed with a condition that causes
sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of
the diagnosis, but she knows it is caused by urate crystals that "get stuck in the joint and cause pain."
She is on hydrochlorothiazide (HCTZ) for management of her hypertension. The NP should suspect a
diagnosis of:
Gout.
, Ethan, age 10, jumped off a 2-foot wall, twisting his foot and ankle upon landing. His ankle x-ray
demonstrates a fracture of the distal tibia, over the articular surface, through the epiphysis and physis.
Based on the Salter-Harris classification of growth plate injuries, you know this is a:
Salter-Harris III fracture.
Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age-related change?
Dorsal kyphosis.
Upon assessment, the nurse practitioner notes unilateral back pain of acute onset that increases when
standing and bending. A straight leg raise test is negative. The most likely diagnosis is:
Muscle strain.
Joyce, age 87, broke her wrist after falling off a curb. She just had a plaster cast applied to her wrist. In
instructing Joyce and her family on allowing the cast to dry properly, tell them to:
Change the position of Joyce's arm every hour.
Anne, age 67, sustained a fall on an outstretched hand. She presents holding her arm against her chest
with her elbow flexed. Based on the specific location of her pain, you suspect a radial head fracture. The
best initial strategy to assess for a radial head fracture would be:
To palpate for tenderness, swelling, and crepitus just distal to the lateral epicondyle
Lillian, age 70, was told that she has osteoporosis. When she asks you what this is, you respond that
osteoporosis:
Develops when loss of bone occurs more rapidly than new bone growth.
And Primary Care Practicum
Questions with complete solutions
A 21-year-old woman comes to your office and reports a history of genital warts. In reference to the
human papillomavirus (HPV) vaccination (ie, Gardasil, Gardasil 9, and Cervarix), she should be educated
that:
She should receive HPV vaccination.
Roger, a healthy 68-year-old man, comes in to see you with a complaint of sudden episodes of an urgent
need to void. He has had several episodes of moderate amounts of unintentional urine loss during these
times. Other than these episodes, he is voiding in amounts "normal" for him, with no leakage when he
coughs or sneezes. The practitioner's initial diagnosis is which type of incontinence?
Urge incontinence.
Josh and Martha have 5 children and do not want any more. Josh said he heard about a no-scalpel
vasectomy (NSV) and asks the nurse practitioner how it works. What would be the best response?
"A loop of vas deferens is delivered through the scrotal skin and occluded."
Susan, age 28, is 9 months pregnant and asks you about using umbilical cord blood after birth for
newborn DNA identification. What do you tell her?
A cord blood sample is identical to the genetic profile of the infant."
Sarah, age 29, complains of premenstrual syndrome (PMS). She states she was told that changing her
diet might help in managing some of the symptoms. What change in her diet do you recommend?
Increased intake of complex carbohydrates.
,Reiter syndrome is a complication of:
Gonorrhea.
Max, age 70, is obese. He is complaining of a bulge in his groin that has been there for months. He states
that it is not painful, but it is annoying. The practitioner notes that the origin of the swelling is above the
inguinal ligament and directly behind and through the external ring. This finding is most indicative of
a(n):
Direct inguinal hernia.
On physical exam, Judy has pubic hair that spreads over her mons pubis with a slight lateral spread. In
addition, her breast development shows breast enlargement with secondary mound formation by the
developing areolae. Which Tanner stage best describes Judy's development?
Stage IV.
The best method to diagnose uterine polyps is a:
Hysteroscopy.
Regular testicular self-exams have not been studied enough to show if they lower the risk of dying from
testicular cancer. This is why the American Cancer Society and other agencies do not have a
recommendation about regular testicular self-exams for all men. Still, some practitioners do recommend
that all men examine their testicles monthly after reaching puberty. If you are teaching a patient how to
do a testicular self-examination, which of the following do you tell him?
"Make an appointment if you note any hard lumps directly on the testicle, regardless of whether
they are tender."
,John asks for a prescription for sildenafil (Viagra). He says that the only medication he takes is isosorbide
mononitrate (Monoket) oral tablets and that he has diabetes that he controls with diet alone. What
should the nurse practitioner tell him?
"Viagra is contraindicated with isosorbide mononitrate; let's discuss other options."
Mr. McKinsey, age 69, was recently given a diagnosis of degenerative joint disease. Which assessment
should the nurse practitioner use to check for effusion of the patient's knee?
Bulge test
A nurse practitioner is driving home from work and stops at the scene of a motorcycle accident that
must have just occurred, as there are no rescue vehicles present. The driver is lying unconscious at the
side of the road with an obvious open fracture of his femur. Which of the following actions should take
priority?
Establishing an airway.
The valgus stress test, varus stress test, Lachman test, and thumb sign are all considered standard tests
to check the integrity of the ligaments of the knee. Which test would the nurse practitioner choose to
assess the anterior cruciate ligament (ACL), which is the most commonly involved structure in severe
knee injury?
Lachman test.
You are assessing Jamal, age 16, after a football injury to his right knee. You elicit a positive
anterior/posterior drawer sign. This test indicates an injury to the:
Cruciate ligament.
Cass, age 67, tells the nurse practitioner (NP) that she has been diagnosed with a condition that causes
sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of
the diagnosis, but she knows it is caused by urate crystals that "get stuck in the joint and cause pain."
She is on hydrochlorothiazide (HCTZ) for management of her hypertension. The NP should suspect a
diagnosis of:
Gout.
, Ethan, age 10, jumped off a 2-foot wall, twisting his foot and ankle upon landing. His ankle x-ray
demonstrates a fracture of the distal tibia, over the articular surface, through the epiphysis and physis.
Based on the Salter-Harris classification of growth plate injuries, you know this is a:
Salter-Harris III fracture.
Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age-related change?
Dorsal kyphosis.
Upon assessment, the nurse practitioner notes unilateral back pain of acute onset that increases when
standing and bending. A straight leg raise test is negative. The most likely diagnosis is:
Muscle strain.
Joyce, age 87, broke her wrist after falling off a curb. She just had a plaster cast applied to her wrist. In
instructing Joyce and her family on allowing the cast to dry properly, tell them to:
Change the position of Joyce's arm every hour.
Anne, age 67, sustained a fall on an outstretched hand. She presents holding her arm against her chest
with her elbow flexed. Based on the specific location of her pain, you suspect a radial head fracture. The
best initial strategy to assess for a radial head fracture would be:
To palpate for tenderness, swelling, and crepitus just distal to the lateral epicondyle
Lillian, age 70, was told that she has osteoporosis. When she asks you what this is, you respond that
osteoporosis:
Develops when loss of bone occurs more rapidly than new bone growth.
