1
NR 511 MIDTERM EXAM 2026/2027 | Differential
Diagnosis & Primary Care Practicum | Grade A 100%
Correct | Verified Answers | Pass Guaranteed - A+
Graded
[Section 1: Clinical Reasoning & Diagnostic Process (Q1-12)]
1. A 52-year-old male presents with sudden onset right-sided chest pain and
dyspnea. He recently traveled overseas. Vital signs: HR 110, RR 24, BP 128/82, Temp
37.1°C, O₂ sat 92% on room air. On exam, he has unilateral right leg swelling and
tenderness. Using the Wells criteria for pulmonary embolism, he scores 8.5 points.
What is the most appropriate next step?
A. Reassure the patient and schedule follow-up in 2 weeks
B. Obtain a D-dimer and proceed based on results
C. Proceed directly to CT pulmonary angiography or initiate empiric anticoagulation
[CORRECT]
D. Perform a ventilation-perfusion scan as first-line imaging
Rationale: A Wells score >6 indicates high probability of PE, making D-dimer
inappropriate due to low negative predictive value in high-risk patients; immediate
CTPA or empiric anticoagulation is indicated while awaiting imaging.
Correct Answer: C
2. A 28-year-old female presents with a 3-day history of cough, fever of 38.5°C, and
pleuritic chest pain. Vital signs: HR 98, RR 20, BP 110/70, Temp 38.5°C. She is alert
and oriented. Labs show BUN 18 mg/dL. Using CURB-65, what is her score and
recommended disposition?
A. Score 0; outpatient management with oral antibiotics [CORRECT]
B. Score 1; outpatient management with oral antibiotics
,2
C. Score 2; consider short hospitalization or close outpatient follow-up
D. Score 3; hospital admission with IV antibiotics
Rationale: CURB-65 gives 1 point each for Confusion, Urea >20 mg/dL, RR ≥30, SBP
<90 or DBP ≤60, age ≥65; this patient scores 0 (no confusion, BUN <20, RR <30,
normotensive, age <65), supporting outpatient treatment.
Correct Answer: A
3. A 45-year-old male presents with epigastric pain radiating to the back, nausea,
and vomiting. He has a history of alcohol use. On exam, he is tender in the
epigastrium with guarding. Labs show lipase 1,200 U/L. When generating a
differential diagnosis, how should the nurse practitioner rank the possibilities?
A. GERD (most likely), pancreatitis (common), perforated ulcer (must-not-miss)
B. Pancreatitis (most likely), perforated ulcer (must-not-miss), GERD (common)
[CORRECT]
C. Perforated ulcer (most likely), GERD (common), pancreatitis (must-not-miss)
D. GERD (most likely), perforated ulcer (common), pancreatitis (must-not-miss)
Rationale: The elevated lipase and clinical presentation make pancreatitis the most
likely diagnosis, while a perforated ulcer remains a must-not-miss life-threatening
condition; GERD does not present with this severity or lipase elevation.
Correct Answer: B
4. A 35-year-old female twisted her ankle while running. She has tenderness at the
posterior edge of the medial malleolus and is unable to bear weight. According to
the Ottawa Ankle Rules, what is the appropriate management?
A. Apply the Ottawa Knee Rules instead and obtain knee radiographs
B. Obtain ankle radiographs to rule out fracture [CORRECT]
C. Manage conservatively with RICE and no imaging
D. Order an MRI to evaluate for ligamentous injury
,3
Rationale: The Ottawa Ankle Rules indicate ankle radiographs if there is posterior
edge or tip tenderness of either malleolus or inability to bear weight immediately
and in the ED; this patient meets criteria.
Correct Answer: B
5. A 62-year-old male presents with acute knee pain after a fall. He has tenderness at
the fibular head and is unable to flex the knee to 90 degrees. According to the
Ottawa Knee Rules, what is the next step?
A. Order knee radiographs because he meets criteria [CORRECT]
B. Manage conservatively without imaging
C. Order an MRI to assess for meniscal tear
D. Apply the Pittsburgh Knee Rules and reassess
Rationale: The Ottawa Knee Rules require radiographs if there is isolated tenderness
of the patella, tenderness at the fibular head, inability to flex to 90°, or inability to
bear weight; this patient meets fibular head tenderness and flexion criteria.
Correct Answer: A
6. A 4-year-old child falls from a height of 4 feet, striking the head. There is no loss of
consciousness, no vomiting, and the child is acting normally. The parent reports no
scalp hematoma. According to the PECARN head trauma decision rule for children
≥2 years, what is the recommendation?
A. Immediate CT scan of the head
B. Observation for 4-6 hours in the emergency department
C. Safe to discharge with parental instructions for home observation [CORRECT]
D. MRI preferred over CT for pediatric head trauma
Rationale: For children ≥2 years, PECARN low-risk criteria include no abnormal
mental status, no signs of basal skull fracture, no vomiting, no severe mechanism,
, 4
and no severe headache; this child meets low-risk criteria allowing discharge with
observation instructions.
Correct Answer: C
7. A 48-year-old female presents with unilateral leg swelling, calf tenderness, and
warmth. D-dimer is 850 ng/mL (elevated). Using Bayesian reasoning, if the pretest
probability by Wells score is intermediate and the D-dimer is positive, how should
the nurse practitioner interpret the posttest probability?
A. The elevated D-dimer alone confirms DVT; start anticoagulation immediately
B. A positive D-dimer in intermediate probability requires compression ultrasound to
confirm [CORRECT]
C. The negative predictive value of D-dimer makes DVT unlikely despite the score
D. Repeat D-dimer in 48 hours to observe for trend
Rationale: D-dimer has high negative predictive value but poor specificity; in
intermediate pretest probability, a positive D-dimer does not confirm DVT and
requires compression ultrasound for definitive diagnosis.
Correct Answer: B
8. A 55-year-old male presents with fever, productive cough, and pleuritic chest pain.
Chest X-ray shows a right lower lobe infiltrate. He is otherwise healthy. In generating
a differential diagnosis, which ranking is most appropriate?
A. Community-acquired pneumonia (most likely), pulmonary embolism (must-not-
miss), lung cancer (common) [CORRECT]
B. Lung cancer (most likely), community-acquired pneumonia (common), tuberculosis
(must-not-miss)
C. Pulmonary embolism (most likely), community-acquired pneumonia (common),
lung abscess (must-not-miss)
D. Tuberculosis (most likely), community-acquired pneumonia (must-not-miss),
pulmonary embolism (common)
NR 511 MIDTERM EXAM 2026/2027 | Differential
Diagnosis & Primary Care Practicum | Grade A 100%
Correct | Verified Answers | Pass Guaranteed - A+
Graded
[Section 1: Clinical Reasoning & Diagnostic Process (Q1-12)]
1. A 52-year-old male presents with sudden onset right-sided chest pain and
dyspnea. He recently traveled overseas. Vital signs: HR 110, RR 24, BP 128/82, Temp
37.1°C, O₂ sat 92% on room air. On exam, he has unilateral right leg swelling and
tenderness. Using the Wells criteria for pulmonary embolism, he scores 8.5 points.
What is the most appropriate next step?
A. Reassure the patient and schedule follow-up in 2 weeks
B. Obtain a D-dimer and proceed based on results
C. Proceed directly to CT pulmonary angiography or initiate empiric anticoagulation
[CORRECT]
D. Perform a ventilation-perfusion scan as first-line imaging
Rationale: A Wells score >6 indicates high probability of PE, making D-dimer
inappropriate due to low negative predictive value in high-risk patients; immediate
CTPA or empiric anticoagulation is indicated while awaiting imaging.
Correct Answer: C
2. A 28-year-old female presents with a 3-day history of cough, fever of 38.5°C, and
pleuritic chest pain. Vital signs: HR 98, RR 20, BP 110/70, Temp 38.5°C. She is alert
and oriented. Labs show BUN 18 mg/dL. Using CURB-65, what is her score and
recommended disposition?
A. Score 0; outpatient management with oral antibiotics [CORRECT]
B. Score 1; outpatient management with oral antibiotics
,2
C. Score 2; consider short hospitalization or close outpatient follow-up
D. Score 3; hospital admission with IV antibiotics
Rationale: CURB-65 gives 1 point each for Confusion, Urea >20 mg/dL, RR ≥30, SBP
<90 or DBP ≤60, age ≥65; this patient scores 0 (no confusion, BUN <20, RR <30,
normotensive, age <65), supporting outpatient treatment.
Correct Answer: A
3. A 45-year-old male presents with epigastric pain radiating to the back, nausea,
and vomiting. He has a history of alcohol use. On exam, he is tender in the
epigastrium with guarding. Labs show lipase 1,200 U/L. When generating a
differential diagnosis, how should the nurse practitioner rank the possibilities?
A. GERD (most likely), pancreatitis (common), perforated ulcer (must-not-miss)
B. Pancreatitis (most likely), perforated ulcer (must-not-miss), GERD (common)
[CORRECT]
C. Perforated ulcer (most likely), GERD (common), pancreatitis (must-not-miss)
D. GERD (most likely), perforated ulcer (common), pancreatitis (must-not-miss)
Rationale: The elevated lipase and clinical presentation make pancreatitis the most
likely diagnosis, while a perforated ulcer remains a must-not-miss life-threatening
condition; GERD does not present with this severity or lipase elevation.
Correct Answer: B
4. A 35-year-old female twisted her ankle while running. She has tenderness at the
posterior edge of the medial malleolus and is unable to bear weight. According to
the Ottawa Ankle Rules, what is the appropriate management?
A. Apply the Ottawa Knee Rules instead and obtain knee radiographs
B. Obtain ankle radiographs to rule out fracture [CORRECT]
C. Manage conservatively with RICE and no imaging
D. Order an MRI to evaluate for ligamentous injury
,3
Rationale: The Ottawa Ankle Rules indicate ankle radiographs if there is posterior
edge or tip tenderness of either malleolus or inability to bear weight immediately
and in the ED; this patient meets criteria.
Correct Answer: B
5. A 62-year-old male presents with acute knee pain after a fall. He has tenderness at
the fibular head and is unable to flex the knee to 90 degrees. According to the
Ottawa Knee Rules, what is the next step?
A. Order knee radiographs because he meets criteria [CORRECT]
B. Manage conservatively without imaging
C. Order an MRI to assess for meniscal tear
D. Apply the Pittsburgh Knee Rules and reassess
Rationale: The Ottawa Knee Rules require radiographs if there is isolated tenderness
of the patella, tenderness at the fibular head, inability to flex to 90°, or inability to
bear weight; this patient meets fibular head tenderness and flexion criteria.
Correct Answer: A
6. A 4-year-old child falls from a height of 4 feet, striking the head. There is no loss of
consciousness, no vomiting, and the child is acting normally. The parent reports no
scalp hematoma. According to the PECARN head trauma decision rule for children
≥2 years, what is the recommendation?
A. Immediate CT scan of the head
B. Observation for 4-6 hours in the emergency department
C. Safe to discharge with parental instructions for home observation [CORRECT]
D. MRI preferred over CT for pediatric head trauma
Rationale: For children ≥2 years, PECARN low-risk criteria include no abnormal
mental status, no signs of basal skull fracture, no vomiting, no severe mechanism,
, 4
and no severe headache; this child meets low-risk criteria allowing discharge with
observation instructions.
Correct Answer: C
7. A 48-year-old female presents with unilateral leg swelling, calf tenderness, and
warmth. D-dimer is 850 ng/mL (elevated). Using Bayesian reasoning, if the pretest
probability by Wells score is intermediate and the D-dimer is positive, how should
the nurse practitioner interpret the posttest probability?
A. The elevated D-dimer alone confirms DVT; start anticoagulation immediately
B. A positive D-dimer in intermediate probability requires compression ultrasound to
confirm [CORRECT]
C. The negative predictive value of D-dimer makes DVT unlikely despite the score
D. Repeat D-dimer in 48 hours to observe for trend
Rationale: D-dimer has high negative predictive value but poor specificity; in
intermediate pretest probability, a positive D-dimer does not confirm DVT and
requires compression ultrasound for definitive diagnosis.
Correct Answer: B
8. A 55-year-old male presents with fever, productive cough, and pleuritic chest pain.
Chest X-ray shows a right lower lobe infiltrate. He is otherwise healthy. In generating
a differential diagnosis, which ranking is most appropriate?
A. Community-acquired pneumonia (most likely), pulmonary embolism (must-not-
miss), lung cancer (common) [CORRECT]
B. Lung cancer (most likely), community-acquired pneumonia (common), tuberculosis
(must-not-miss)
C. Pulmonary embolism (most likely), community-acquired pneumonia (common),
lung abscess (must-not-miss)
D. Tuberculosis (most likely), community-acquired pneumonia (must-not-miss),
pulmonary embolism (common)
