NR 603 MIDTERM EXAM
ADVANCED CLINICAL DIAGNOSIS
CHAMBERLAIN UNIVERSITY
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
1.
A 58-year-old patient with hypertension remains above goal despite lifestyle
modification and hydrochlorothiazide. Blood pressure is 152/94 mmHg. Which is
the most appropriate next step?
A. Discontinue hydrochlorothiazide and start beta-blocker
B. Add ACE inhibitor
C. Start loop diuretic
D. Initiate dual antiplatelet therapy
Answer: B
Rationale: Combination therapy is recommended when BP remains uncontrolled.
ACE inhibitors are first-line add-on agents in hypertension, especially with
metabolic or renal protective benefits.
,2.
A patient reports persistent wheezing, nighttime symptoms 3 times per week, and
SABA use daily. What is the best step in management?
A. Continue SABA only
B. Start low-dose inhaled corticosteroid
C. Start oral prednisone daily
D. Add leukotriene modifier only
Answer: B
Rationale: Symptoms indicate persistent asthma requiring step-up therapy with
inhaled corticosteroids.
3.
A patient with COPD has FEV1/FVC of 0.62 and FEV1 48% predicted. Which
GOLD stage is this?
A. GOLD 1
B. GOLD 2
C. GOLD 3
D. GOLD 4
Answer: C
Rationale: FEV1 30–49% predicted indicates GOLD 3 (severe COPD).
4.
A patient with type 2 diabetes has HbA1c of 9.1% despite metformin therapy.
What is the next best medication?
A. Insulin therapy
B. Discontinue metformin
C. Start aspirin
D. Start antibiotic therapy
,Answer: A
Rationale: HbA1c >9% with inadequate control on oral agents often requires
insulin initiation.
5.
A 70-year-old reports progressive memory loss and impaired executive function.
Which condition is most likely?
A. Delirium
B. Alzheimer’s disease
C. Schizophrenia
D. Generalized anxiety disorder
Answer: B
Rationale: Gradual cognitive decline with executive dysfunction is consistent with
Alzheimer’s disease.
6.
A patient presents with BP 180/110 and no end-organ damage. What is the best
initial management?
A. Immediate IV antihypertensive therapy
B. Oral antihypertensive adjustment and outpatient follow-up
C. Thrombolysis
D. ICU admission
Answer: B
Rationale: This is hypertensive urgency, managed with oral medications and close
follow-up.
, 7.
Which lab value best reflects long-term glycemic control?
A. Random glucose
B. Fasting glucose
C. HbA1c
D. Urine glucose
Answer: C
Rationale: HbA1c reflects average glucose over 2–3 months.
8.
A patient with heart failure reports weight gain, dyspnea, and edema. What
medication is most appropriate for symptom relief?
A. Furosemide
B. Atorvastatin
C. Metformin
D. Amoxicillin
Answer: A
Rationale: Loop diuretics reduce fluid overload in heart failure.
9.
A patient has TSH elevated and low T4. Diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Thyroid storm
D. Euthyroid sick syndrome
Answer: B
Rationale: High TSH with low T4 indicates primary hypothyroidism.
ADVANCED CLINICAL DIAGNOSIS
CHAMBERLAIN UNIVERSITY
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
1.
A 58-year-old patient with hypertension remains above goal despite lifestyle
modification and hydrochlorothiazide. Blood pressure is 152/94 mmHg. Which is
the most appropriate next step?
A. Discontinue hydrochlorothiazide and start beta-blocker
B. Add ACE inhibitor
C. Start loop diuretic
D. Initiate dual antiplatelet therapy
Answer: B
Rationale: Combination therapy is recommended when BP remains uncontrolled.
ACE inhibitors are first-line add-on agents in hypertension, especially with
metabolic or renal protective benefits.
,2.
A patient reports persistent wheezing, nighttime symptoms 3 times per week, and
SABA use daily. What is the best step in management?
A. Continue SABA only
B. Start low-dose inhaled corticosteroid
C. Start oral prednisone daily
D. Add leukotriene modifier only
Answer: B
Rationale: Symptoms indicate persistent asthma requiring step-up therapy with
inhaled corticosteroids.
3.
A patient with COPD has FEV1/FVC of 0.62 and FEV1 48% predicted. Which
GOLD stage is this?
A. GOLD 1
B. GOLD 2
C. GOLD 3
D. GOLD 4
Answer: C
Rationale: FEV1 30–49% predicted indicates GOLD 3 (severe COPD).
4.
A patient with type 2 diabetes has HbA1c of 9.1% despite metformin therapy.
What is the next best medication?
A. Insulin therapy
B. Discontinue metformin
C. Start aspirin
D. Start antibiotic therapy
,Answer: A
Rationale: HbA1c >9% with inadequate control on oral agents often requires
insulin initiation.
5.
A 70-year-old reports progressive memory loss and impaired executive function.
Which condition is most likely?
A. Delirium
B. Alzheimer’s disease
C. Schizophrenia
D. Generalized anxiety disorder
Answer: B
Rationale: Gradual cognitive decline with executive dysfunction is consistent with
Alzheimer’s disease.
6.
A patient presents with BP 180/110 and no end-organ damage. What is the best
initial management?
A. Immediate IV antihypertensive therapy
B. Oral antihypertensive adjustment and outpatient follow-up
C. Thrombolysis
D. ICU admission
Answer: B
Rationale: This is hypertensive urgency, managed with oral medications and close
follow-up.
, 7.
Which lab value best reflects long-term glycemic control?
A. Random glucose
B. Fasting glucose
C. HbA1c
D. Urine glucose
Answer: C
Rationale: HbA1c reflects average glucose over 2–3 months.
8.
A patient with heart failure reports weight gain, dyspnea, and edema. What
medication is most appropriate for symptom relief?
A. Furosemide
B. Atorvastatin
C. Metformin
D. Amoxicillin
Answer: A
Rationale: Loop diuretics reduce fluid overload in heart failure.
9.
A patient has TSH elevated and low T4. Diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Thyroid storm
D. Euthyroid sick syndrome
Answer: B
Rationale: High TSH with low T4 indicates primary hypothyroidism.
