Midterm Exam: NR511 / NR 511 (Latest
2023/ 2024) Differential Diagnosis and
Primary Care Exam Study Guide| Weeks 1-4
Covered| Guide with Verified Answers| 100%
Correct- Chamberlain
❖ Gastrointestinal Disorders: Appendicitis
- Constant periumbilical pain shifting to the right lower quadrant; vomiting following
the pain; a small volume of diarrhea; - Fecalith: most common cause—stone made of feces typically found in the colon
- no systemic symptoms, such as a headache, malaise, or myalgia;
- a mild elevation of the white blood cell count with an early left shift; and white blood
cells (WBCs) or red blood cells (RBCs) in the urine are indications of appendicitis. - The WBC count becomes high only with gangrene or perforation of the appendix.
The urine may have WBCs or RBCs if the bladder is irritated and ketonuria if there is
prolonged vomiting. - Obturator sign: is elicited when, with the patient’s right hip and knee flexed, the
examiner slowly rotates the right leg internally, which stretches the obturator muscle.
Pain over the right lower quadrant (RLQ) is considered a positive sign.
❖ Gastrointestinal Disorders: Inflammatory Bowel Disease - Crohn disease show’s transmural inflammation, granulomas, focal involvement of the
colon with some skipped areas, and sparing of the rectal mucosa. the inflammation
extends deeper into the intestinal wall. - Crohn’s disease can involve all or any layer of the bowel wall and any portion of the
GI tract from the mouth to the anus. Any portion of the GI tract can be affected but
80% of patients have small bowel involvement. In advanced disease, perianal lesions,
fistulas, strictures and obstructions are common in CD. Folic acid and serum levels of
most vitamins, including A, B complex, C, and the fat-soluble vitamins, are decreased
in Crohn’s disease as a result of malabsorption. Sed rate, bilirubin and liver enzymes
are increased.
- Ulcerative colitis is a disease only of the colon. While it is not the first treatment
choice, total colectomy is a treatment option that can completely resolve this problem. - In UC, the mucosal surface of the colon is inflamed. This ultimately results in
friability, erosions, and bleeding. It most often occurs in the rectosigmoid areas but
can involve the entire colon. In Crohn’s disease, Patients with UC are more at risk for
colon perforation and should be followed closely by a surgeon.
❖ Gastrointestinal Disorders: GERD - Symptoms occur at night with regurgitation; heartburn is classic for GERD (mild to
severe). Dysphagia is frequently a prominent symptom of GERD. It is usually
associated with other symptoms, including regurgitation, water brash (reflex
salivation), sour taste in the mouth in the morning, odynophagia, belching, coughing,
hoarseness, or wheezing, usually at night. - If patient has been treated with diet modifications and 6 weeks of omeprazole without
improvement of symptoms, the next step is an endoscopy - a biopsy can be done and sent for H pylori at that time.
- Diverticular disease has been shown to be significantly increased with a low fiber diet
and diet that is high in fat and red meats. Obesity is associated with a higher risk for
diverticular disease. - Clients with GERD should be instructed to avoid coffee, alcohol, chocolate,
peppermint, and spicy foods; eat smaller meals; stop smoking; remain upright for 2
hours after meals; elevate the head of the bed on 6- to 8-in blocks; and refrain from
eating for 3 hours before retiring.
❖ Gastrointestinal Disorders: Irritable Bowel Syndrome - Antidiarrheals (Lomotil), laxatives, antispasmodics (Bentyl), Tricyclic
antidepressants, SSRIs (Prozac), and medications to increase the intestinal fluid
secretion and improve fecal transit (Linzess) are all used to treat IBS.
Midterm Exam: NR511 / NR 511 (Latest
2022-2023) Differential Diagnosis and
Primary Care Exam Review | |Questions and
Answers |100% Correct- Chamberlain
- What is the normal number for the Glasgow Coma Scale?
a. 7
b. 9
c. 10
d. 15
✓ Answer: d. 15 - Which solution should be used when irrigating lacerated tissue over a wound on the
arm?
a. Dilute povidone-iodine solution
b. Hydrogen peroxide (H2O2)
c. Saline solution infused with an antibiotic
d. Saline irrigation or soapy water
✓ Answer: d. Saline irrigation or soapy water - Which ethical principle reflects respect for all persons and their self-determination?
a. Autonomy
b. Beneficence
c. Justice
d. Veracity
✓ Answer: a. Autonomy - George, aged 59, complains of a flulike illness, including fever, chills, and myalgia after
returning from visiting his grandchildren in New England. He reports having discovered
a rash or red spot that grew in size on his right leg. What disease are you considering?
a. A viral syndromes
b. Lyme disease
c. Rocky Mountain spotted fever
d. Relapsing fever
✓ Answer: b. Lyme disease - What is usually the first sign or symptom that a patient would present with that would
make you suspect herpes zoster?
a. A stabbing type of pain on one small area of the body
b. A vesicular skin lesion on one side of the body
c. A pain that is worse upon awakening
d. A lesion on the exterior ear canal
✓ Answer: A vesicular skin lesion on one side of the body - Which drug commonly prescribed for burns is active against a wide spectrum of
microbial pathogens and is the most frequently used agent for partial- and full-thickness
thermal injuries?
a. Clotrimazole cream (Lotrimen)
b. Mafenide acetate (Sulfamylon)
c. Silver nitrate
d. Silver sulfadiazine (Silvadene)
✓ Answer: d. Silver sulfadiazine (Silvadene) - Which of the following is a role of the advanced practice nurse in palliative cancer care?
a. Detecting cancer in asymptomatic patients or those with specific symptoms
b. Arranging for follow-up care, including psychosocial and spiritual support
c. Identifying and managing complications of care
d. All of the above
✓ Answer: d. All of the above
- The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of
the following neurotransmitters plays a role in anxiety?
a. Acetylcholine
b. Gamma-aminobutyric acid (GABA)
c. Dopamine
d. Serotonin
✓ Answer: Gamma-aminobutyric acid (GABA) - A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of
the following tests should be the first priority?
a. Pregnancy test
b. Pelvic ultrasound
c. Endometrial biopsy
d. Platelet count
✓ Answer: a. Pregnancy test - A bulla is:
a. A vesicle larger than 1 cm in diameter.
b. An elevated solid mass with a hard texture, and the shape and borders can be
regular or irregular.
c. A superficial elevated lesion filled with purulent fluid.
d. Thinning of the skin (epidermis and dermis) that appears white or translucent.
✓ Answer: a. A vesicle larger than 1 cm in diameter. - Sam is a 25-year-old man who has been diagnosed with low back strain based on his
history of localized low back pain and muscle spasm along with a normal neurological
examination. As the clinician, you explain to Sam that low back pain is a diagnosis of
exclusion. Which of the following symptoms would alert the clinician to the more
serious finding of a herniated nucleus pulposus or ruptured disc?
a. Morning stiffness and limited mobility of the lumbar spine
b. Unilateral radicular pain symptoms that extend below the knee and are equal to or
greater than the back pain
c. Fever, chills, and elevated erythrocyte sedimentation rate
d. Pathologic fractures, severe night pain, weight loss, and fatigue
✓ Answer: Unilateral radicular pain symptoms that extend below the knee
and are equal to or greater than the back pain
- Which of the following statements is true concerning the musculoskeletal exam?
a. The uninvolved side should be examined initially and compared to the involved
side.
b. The part of the body that is causing the patient pain should be examined first.
c. The patient should not be asked to perform active range-of-motion (ROM)
exercises whenever possible to avoid causing pain.
d. Radiographs should always be obtained prior to examination so as not to cause
further injury to the patient.
✓ Answer: The uninvolved side should be examined initially and
compared to the involved side - The current goal of treatment for a patient with HIV infection is which of the following?
a. Viral suppression of HIV to undetectable levels in the peripheral blood
b. Compete eradication of the virus
c. Encouraging the person to have no contact with uninfected individuals
d. Complete abstinence
✓ Answer: Viral suppression of HIV to undetectable levels in the
peripheral blood
Midterm Exam: NR511 / NR 511 (Latest 2022-2023)
Differential Diagnosis and Primary Care Exam Review |
|Questions and Verified Answers | Grade A- Chamberlain
- Clinicians who learn how to code and document Evaluation and Management and
clinician services will be more successful in gaining timely payment for care delivery.
Which of the following CMS practices is designed to financially penalize clinicians who
do not bill according to CMS guidelines?
~ Answer: Audits and probes - In the United States, what is the second most common connective tissue disease and the
most destructive to the joints?
~ Answer: Rheumatoid Arthritis - If you suspect diverticulitis in a patient, you can treat with antibiotics alone, no imaging
is necessary.
True
False
~ Answer: False - It is safe to use laxatives long term for the treatment of constipation.
True
False
~ Answer: T - According to the American Cancer Society guidelines, African Americans with no other
risk factors for colon cancer should begin routine colon cancer screening at age 45.
True
False
~ Answer: T
- In ulcerative colitis, typical symptoms include abdominal cramping, fever, anorexia,
weight loss, spasm, flatulence, and RLQ pain or mass. Stools may contain blood, mucus,
and/or pus.
True
False
~ Answer: F - In diverticulitis, typical symptoms include bleeding, cramping pain, and the urge to
defecate. Stools are characteristically watery diarrhea with blood and mucus.
True
False
~ Answer: F - In diverticulitis, typical symptoms include LLQ pain and tenderness, fever, change in
bowel habits (usually diarrhea), and sometimes nausea/vomiting.
True
False
~ Answer: T - Acute gastroenteritis is the most common cause of nausea and vomiting.
True
False
~ Answer: T
Midterm Exam: NR511 / NR 511 (Latest 2023
/ 2024): Differential Diagnosis & Primary
Care Practicum Quiz Bank | Questions and
Verified Answers| 100% CorrectChamberlain
A useful maneuver test to confirm a cervical spine sprain/pain is:
Spurling’s Test
Patrick’s Test
Obrien’s Test
Neer’s Test
Answer:
Acute low back pain does not warrant radiographic imaging unless there is evidence of
neurological dysfunction.
True
False
Answer: True
The preferred imaging to determine the degree of spinal canal narrowing and facet arthroplasty
resulting in nerve impingement is what?
X-ray
Magnetic resonance imaging
Ultasound
Computed tomography
Answer: Magnetic resonance imaging
Which of the following is not a maneuver test to assess for lumbosacral pain?
Straight leg raise
Gaenslen’s
Hawkins
Faber
Answer: Hawkins
auda equina syndrome should prompt a yellow flag for the provider.
True
False
Answer: False
To determine whether the patient has normal thyroid function, the initial test should be _.
thyroglobulin antibodies
thyroperoxidase antibodies
TSH with reflex to FT4
TT3
Answer: TSH with reflex to FT4
Your patient is symptomatic with complains of fatigue, weight gain, constipation, and hair loss.
The patient’s labs return with a TSH of 7 and a normal FT4. Without considering a patient’s
weight (she refuses to get on the scale today), what dose of medication would you chose based
on the lab values?
Synthroid 75 mcg
Synthroid 50 mcg
Synthroid 25 mcg
I would not medicate this patient.
Answer: Synthroid 25 mcg
A maximum of 20 alternative hours can be used as part of the 125 hour practicum requirement
for each clinical course–> T/F
Answer: Fasle- Can use only 15
Maddie has a history of asthma that is classified as mild, intermittent asthma. She comes to the
office today with wheezing which is not improving with her inhaler. Which would be the best
ICD-10 code to apply wiith only the information given?
A. Severe persistent asthma (J45.5)
B. Mild intermittent asthma with acute exacerbation (J45.21)
C. Unspecified asthma with acute exacerbation (J45.901)
D. Other asthma (J45.998)
Answer: Mild intermittent asthma with acute exacerbation (J45.21)
Morbidity refers to the number of people who have died from a particular disease T/F
Answer: False
The number of new cases of a particular disease in a population at a given time is known as:
A. Prevalence
B. Risk
C. Incidence
D. Morbidity
Answer: Incidence
Seat belt use is considered _____ prevention:
A. Primary
B. Secondary
C. Tertiary
D. Unnessary