NR 603 MIDTERM ACTUAL EXAM
NR 603 MIDTERM ACTUAL EXAM 2025/2026 COMPLETE
200 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) WITH RATIONALES |ALREADY
GRADED A+||BRAND NEW VERSION!!
A 44-year-old man presents after an episode what is described as "passing out".
He has a past medical history of hypertension, diabetes mellitus type II, and
osteoarthritis. Earlier in the day, the patient visited his primary care physician for
routine blood work. During his blood draw, the patient had an acute onset of
syncope. The patient never had such an episode before. Vital signs upon
presentation are as follows: BP 124/82 mmHg, P 88 beats/min, R14/min. EKG is
within normal limits. Cardiovascular examination reveals a normal S1 and S2, with
no rubs, murmurs, or gallops. The patient is being treated with atenolol and
hydrochlorothiazide for his hypertension. His blood sugar is 96 mg/dl.
Question
What is the most likely cause of the patient's syncope?
Answer Choices
1 Hypoglycemic episode
2 Arrhythmia
3 Neurogenic shock
4 Vasovagal episode
5 Orthostatic hypotension
ANS:4 - ANSWER-vasovagal episode
This patient is having syncope due to a vasovagal episode. This reaction is
common in patients who are exposed to blood or are having their blood drawn. In
fact, vasovagal episodes are the most common cause of syncope. These
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, NR 603 MIDTERM ACTUAL EXAM
individuals typically present with loss of consciousness when exposed to a certain
trigger. The trigger leads to an activation of the nucleus tract solitarius of the
brainstem, which results in a surge of parasympathetic response, leading to the
cardioinhibitory and vasodepressor effects.
Although this patient has a history of diabetes mellitus, is not currently
hypoglycemic. Hypoglycemia, if severe, can potentially lead to a loss of
consciousness. However, diabetics who are hypoglycemic typically have a
sympathetic response.
Arrhythmia is not the correct answer choice. This patient does not have any
cardiac history of arrhythmia. As the patient had the syncopal episode during the
blood draw, and there were no ECG changes, this answer choice is unlikely.
Orthostatic hypotension is a reasonable answer choice. However, this patient's
acute syncopal episode in response to the blood draw makes a vasovagal reaction
more likely. In addition, this patient has no history of dehydration or any other
cause that would lead to this condition.
A 6-year-old girl presents because her teacher is concerned about behaviors at
school. The teacher has noticed the girl "staring off into space" frequently
throughout the day, and the teacher is able to get her attention only occasionally.
There are also periods when she appears to be talking to herself, but there is no
sound coming from her mouth.
The girl's mother states that there are times when the patient does not seem to
be paying attention to what the mother is saying. Shortly after these "episodes",
the child engages in conversation without any problem; therefore, the mother did
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, NR 603 MIDTERM ACTUAL EXAM
not think the episodes were an issue. There is no concern about other abnormal
behavior or discipline issues at home or at school.
Question
What is the most likely diagnosis?
Answer Choices
1 Attention-deficit disorder (ADD)
2 Syncopal episodes
3 Petit mal (absence seizures)
4 Narcolepsy
5 Childhood disintegration disorder (CDD)
AN - ANSWER-Petit mal (absence) seizures
The patient is probably experiencing petit mal (absence) seizures. Absence
seizures are a form of generalized seizures seen in children, and they usually cease
by age 20. They are characterized by abrupt onset of impaired consciousness and
can be associated with enuresis or automatisms. Patients often appear as though
they are "staring off into space" during the seizure, and the episodes often
terminate as quickly as they came. These children are often categorized as "being
in their own world", leading to a delay in diagnosis or a misdiagnosis of attention
deficit disorder. These types of seizures are diagnosed using an
electroencephalogram (EEG), showing crusts of bilaterally synchronous and
symmetric 3-Hz spike-and-wave activity.
Attention-deficit disorder (ADD) is a form of Attention-deficit hyperactivity
disorder (ADHD) that is characterized more by inattentiveness without the
presence of restless or impulsive behavior. This is the most common emotional,
cognitive, and behavioral disorder treated in children/adolescents. The diagnosis
is made by careful clinical history, revealing a significant level of inattentiveness
3|Page
, NR 603 MIDTERM ACTUAL EXAM
and distractibility, plus-or-minus impulsivity, and hyperactivity that is
inappropriate for the developmental stage of the child. These patients often
change activities frequently, have a hard time with organizational skills, and are
commonly caught daydreaming. The symptoms of ADD are usually pervasive, even
though they may not occur in all settings. ADD/ADHD also does not involve any
impairment of consciousness.
Syncopal episodes are better known as "fainting spells." These are episodes of
diminished or complete loss of consciousness accompanied by flaccidity that
usually occur in relation to postural change, emotional stress, instrumentation,
pain, straining, cardiac
A 45-year-old secretary presents with a 1-month history of paresthesias on the
medial aspect of her right hand. She has no neck pain or shoulder pain, but she
has had some difficulty typing with the right hand. Neurological exam reveals
diminished sensation to pain and light touch on the medial aspect of the palmar
and dorsal surfaces of the hand to the wrist, the 5th finger, and the medial aspect
of the ring finger. Mild weakness of the right abductor minimi digiti is present, but
the other intrinsic hand muscles are of normal strength. The remainder of the
neurological exam is normal.
Question
What condition does patient have?
Answer Choices
1 Compressive ulnar neuropathy at the elbow
2 Compressive median neuropathy at the wrist
3 Compressive radial neuropathy at the mid-humerus
4 Compressive C8-radiculopathy
4|Page
NR 603 MIDTERM ACTUAL EXAM 2025/2026 COMPLETE
200 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) WITH RATIONALES |ALREADY
GRADED A+||BRAND NEW VERSION!!
A 44-year-old man presents after an episode what is described as "passing out".
He has a past medical history of hypertension, diabetes mellitus type II, and
osteoarthritis. Earlier in the day, the patient visited his primary care physician for
routine blood work. During his blood draw, the patient had an acute onset of
syncope. The patient never had such an episode before. Vital signs upon
presentation are as follows: BP 124/82 mmHg, P 88 beats/min, R14/min. EKG is
within normal limits. Cardiovascular examination reveals a normal S1 and S2, with
no rubs, murmurs, or gallops. The patient is being treated with atenolol and
hydrochlorothiazide for his hypertension. His blood sugar is 96 mg/dl.
Question
What is the most likely cause of the patient's syncope?
Answer Choices
1 Hypoglycemic episode
2 Arrhythmia
3 Neurogenic shock
4 Vasovagal episode
5 Orthostatic hypotension
ANS:4 - ANSWER-vasovagal episode
This patient is having syncope due to a vasovagal episode. This reaction is
common in patients who are exposed to blood or are having their blood drawn. In
fact, vasovagal episodes are the most common cause of syncope. These
1|Page
, NR 603 MIDTERM ACTUAL EXAM
individuals typically present with loss of consciousness when exposed to a certain
trigger. The trigger leads to an activation of the nucleus tract solitarius of the
brainstem, which results in a surge of parasympathetic response, leading to the
cardioinhibitory and vasodepressor effects.
Although this patient has a history of diabetes mellitus, is not currently
hypoglycemic. Hypoglycemia, if severe, can potentially lead to a loss of
consciousness. However, diabetics who are hypoglycemic typically have a
sympathetic response.
Arrhythmia is not the correct answer choice. This patient does not have any
cardiac history of arrhythmia. As the patient had the syncopal episode during the
blood draw, and there were no ECG changes, this answer choice is unlikely.
Orthostatic hypotension is a reasonable answer choice. However, this patient's
acute syncopal episode in response to the blood draw makes a vasovagal reaction
more likely. In addition, this patient has no history of dehydration or any other
cause that would lead to this condition.
A 6-year-old girl presents because her teacher is concerned about behaviors at
school. The teacher has noticed the girl "staring off into space" frequently
throughout the day, and the teacher is able to get her attention only occasionally.
There are also periods when she appears to be talking to herself, but there is no
sound coming from her mouth.
The girl's mother states that there are times when the patient does not seem to
be paying attention to what the mother is saying. Shortly after these "episodes",
the child engages in conversation without any problem; therefore, the mother did
2|Page
, NR 603 MIDTERM ACTUAL EXAM
not think the episodes were an issue. There is no concern about other abnormal
behavior or discipline issues at home or at school.
Question
What is the most likely diagnosis?
Answer Choices
1 Attention-deficit disorder (ADD)
2 Syncopal episodes
3 Petit mal (absence seizures)
4 Narcolepsy
5 Childhood disintegration disorder (CDD)
AN - ANSWER-Petit mal (absence) seizures
The patient is probably experiencing petit mal (absence) seizures. Absence
seizures are a form of generalized seizures seen in children, and they usually cease
by age 20. They are characterized by abrupt onset of impaired consciousness and
can be associated with enuresis or automatisms. Patients often appear as though
they are "staring off into space" during the seizure, and the episodes often
terminate as quickly as they came. These children are often categorized as "being
in their own world", leading to a delay in diagnosis or a misdiagnosis of attention
deficit disorder. These types of seizures are diagnosed using an
electroencephalogram (EEG), showing crusts of bilaterally synchronous and
symmetric 3-Hz spike-and-wave activity.
Attention-deficit disorder (ADD) is a form of Attention-deficit hyperactivity
disorder (ADHD) that is characterized more by inattentiveness without the
presence of restless or impulsive behavior. This is the most common emotional,
cognitive, and behavioral disorder treated in children/adolescents. The diagnosis
is made by careful clinical history, revealing a significant level of inattentiveness
3|Page
, NR 603 MIDTERM ACTUAL EXAM
and distractibility, plus-or-minus impulsivity, and hyperactivity that is
inappropriate for the developmental stage of the child. These patients often
change activities frequently, have a hard time with organizational skills, and are
commonly caught daydreaming. The symptoms of ADD are usually pervasive, even
though they may not occur in all settings. ADD/ADHD also does not involve any
impairment of consciousness.
Syncopal episodes are better known as "fainting spells." These are episodes of
diminished or complete loss of consciousness accompanied by flaccidity that
usually occur in relation to postural change, emotional stress, instrumentation,
pain, straining, cardiac
A 45-year-old secretary presents with a 1-month history of paresthesias on the
medial aspect of her right hand. She has no neck pain or shoulder pain, but she
has had some difficulty typing with the right hand. Neurological exam reveals
diminished sensation to pain and light touch on the medial aspect of the palmar
and dorsal surfaces of the hand to the wrist, the 5th finger, and the medial aspect
of the ring finger. Mild weakness of the right abductor minimi digiti is present, but
the other intrinsic hand muscles are of normal strength. The remainder of the
neurological exam is normal.
Question
What condition does patient have?
Answer Choices
1 Compressive ulnar neuropathy at the elbow
2 Compressive median neuropathy at the wrist
3 Compressive radial neuropathy at the mid-humerus
4 Compressive C8-radiculopathy
4|Page
