NR511 / NR 511 Midterm Exam Q & A (Latest 2023 / 2024): Differential Diagnosis & Primary Care Practicum – Chamberlain
NR-511 Differential Diagnosis & Primary Care Practicum
NR511 Midterm Exam Q & A
When you are assessing the internal structure of the eye of your 59-year-old patient, the
absence of a red reflex may indicate:
- A cataract or hemorrhage into the vitreous humor.
What significant finding(s) in a 3-year-old child with otitis media with effusion would prompt
more - There is a change in the child’s hearing threshold to greater than 25 dB.
Max, age 35, states that he thinks he has an ear infection because he just flew back from a
business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next
action? - Prescribe nasal steroids and oral decongestants.
Susan is a 19-year-old college student and avid swimmer. She frequently gets swimmer’s ear
and asks if there is anything, she can do to help prevent it other than wearing earplugs, which
do not really work for her. What do you suggest? - Start using a cotton-tipped applicator to dry the ears after swimming.
Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after
swimming.
Mary, age 82, presents with several eye problems. She states that her eyes are always dry and
look “sunken in.” What do you suspect? - Normal age-related changes.
Nystatin (Mycostatin) is ordered for Michael, a 56-year-old banker who has an oral fungal
infection. What instructions for taking the medication do you give Michael?
- “Swish and swallow the medication.”
The most common cause of a white pupil (leukokoria or leukocoria) in a newborn is: - A congenital cataract.
You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergency
room. Which of the following symptoms would indicate that an airway obstruction is
imminent? - Stridor.
A 27-year-old female comes in to your primary care office complaining of a perioral rash. The
patient noticed burning around her lips a couple days ago that quickly went away. She awoke
from sleep yesterday and noticed a group of vesicles with erythematous bases where the
burning had been before. There is no burning today. She is afebrile and has no difficulty eating
or swallowing. What test would confirm her diagnosis? - Tzanck smear.
Which condition is not included in the atopic triad? - Aspirin sensitivity.
The ABCDEs of melanoma identification include which of the following? - Asymmetry: one half does not match the other half.
Your 24-year-old client whose varicella rash just erupted yesterday asks you when she can go
back to work. What do you tell her? - “Once all the vesicles are crusted over.”
Tom, age 50, is complaining of an itchy rash that occurred about a half hour after putting on his
leather jacket. He recalls having a slightly similar rash last year when he wore his jacket. The
annular lesions are on his neck and both arms. They are erythematous, sharply circumscribed,
and both flat and elevated. His voice seems a little raspy, although he states that his breathing
is normal. What is your first action?
- Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously.
You suspect a platelet abnormality in a 40-year-old woman who presents to your clinic with: - Red, flat, nonblanchable petechiae.
Justin, an obese 42-year-old, cut his right leg 3 days ago while climbing a ladder. Today his right
lower leg is warm, reddened, and painful, without a sharply demarcated border. What do you
suspect? - Cellulitis
During a camping trip, Jim, age 35, abruptly developed fever, headache, and joint pain. A few
days after the onset of the fever, a blanchable macular rash began on his wrists and ankles and
quickly spread to the palms and soles before becoming generalized. The rash is now petechial.
You suspect Jim has: - Rocky Mountain spotted fever.
You’re teaching Mitch, age 18, about his tinea pedis. You know he doesn’t understand your
directions when he tells you which of the following? - “I should wear rubber shoes in the shower to prevent transmission to others.”
A 75-year-old female presents to your office complaining of dizziness and hearing loss. The
patient states she awoke yesterday with dizziness, which she described as feeling the room
spinning. She also notes intermittent ringing in her ears. On physical exam, the patient has
lateralization of her hearing loss to the unaffected ear. Rinne test shows air conduction lasts
longer than bone conduction. What is the next step in helping this patient’s symptoms? - Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo
attacks.
Which of the following is not recommended for hoarseness?
- Oral steroids.
Kevin, a 56-year-old lawyer, has throbbing pain in the left eye, an irregular pupil shape, marked
photophobia, and redness around the iris. What is your initial diagnosis? - Iritis
You are the nurse practitioner caring for Martha, a 47-year-old accountant. You have made a
diagnosis of acute sinusitis based on Martha’s history and the fact that she complains of pain
behind her eye. Which sinuses are affected? - Ethmoid
Marlene, a 57-year-old cashier, comes to the clinic because she is unable to differentiate
between sharp and dull stimulation on both sides of her face. You suspect: - A lesion affecting the trigeminal nerve.
While doing a face, head, and neck examination on a 16-year-old patient, you note that the
palpebral fissures are abnormally narrow. What are you examining? - The openings between the margins of the upper and lower eyelids.
A 44-year-old banker comes to your office for evaluation of a pulsating headache over the left
temporal region, and he rates the pain as an 8 on a scale of 1 to 10. The pain has been constant
for the past several hours and is accompanied by nausea and sensitivity to light. He has had
frequent, though less severe, headaches for many years, and they are usually relieved by overthe-counter medicines. He is unclear as to a precipitating event but notes that he has had visual
disturbances before each headache and he has been under a lot of stress in his job. Based on
this description, what is the most likely diagnosis of this type of headache? - Migraine
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