NSG 550
Exam 3
Diagnostic Reasoning for Nurse Practitioners
Questions and Verified Answers
100% Correct | Grade A
Wilkes University
Passan School of Nursing
Latest Update
75 Questions | 6 Sections
Aligned with 2026-2027 Wilkes University Passan School of Nursing curriculum standards and diagnostic reasoning
competencies for nurse practitioners
, Table of Contents
Section 1: Neurological Diagnostic Reasoning
Questions 1 - 18
Section 2: Musculoskeletal Diagnostic Reasoning
Questions 19 - 32
Section 3: Dermatologic Diagnostic Reasoning
Questions 33 - 42
Section 4: Psychiatric and Mental Health Diagnostic Reasoning
Questions 43 - 55
Section 5: Infectious Disease and Immunologic Diagnostic Reasoning
Questions 56 - 65
Section 6: Integrated Clinical Scenarios and NGN-Style Prioritization
Questions 66 - 75
Page 2
,NSG 550 Exam 3 | Diagnostic Reasoning for Nurse Practitioners | Wilkes University 2026-2027 75 Questions | Verified Answers
Section 1: Neurological Diagnostic Reasoning
Q1: A 32-year-old female presents to the primary care clinic complaining of a headache that
began 6 hours ago. She describes the pain as unilateral, throbbing, and severe, located behind
her left eye. She reports associated nausea, photophobia, and noted visual scintillations prior
to the onset of the headache. She has a history of similar headaches since her early twenties.
Which of the following is the most likely diagnosis?
A. Tension-type headache
B. Migraine with aura [CORRECT]
C. Cluster headache
D. Sinus headache
Correct Answer: B
Rationale:
This patient presents with classic migraine features: unilateral, throbbing pain with nausea, photophobia, and a
visual aura (scintillations) preceding the headache. Migraines are more common in females and often begin in
early adulthood. Tension-type headaches are typically bilateral and band-like without nausea or photophobia.
Cluster headaches are severe, unilateral, and periorbital with autonomic symptoms (lacrimation, nasal
congestion) but lack aura. Sinus headaches present with facial pressure that worsens with bending forward and
are associated with nasal congestion.
Q2: A 58-year-old male with no prior headache history presents to the emergency department
reporting the sudden onset of the worst headache of his life that peaked in intensity within
seconds. He describes it as an explosive, thunderclap pain. He appears anxious and has mild
nuchal rigidity on examination. Vital signs are BP 168/96 mmHg, HR 88 bpm, RR 20
breaths/min, Temp 37.1 degrees C. Which of the following is the most appropriate initial
diagnostic test?
A. MRI brain with contrast
B. CT head without contrast [CORRECT]
C. Lumbar puncture
D. CT angiography of the head
Correct Answer: B
Rationale:
The sudden onset of a severe thunderclap headache described as the worst headache of life is the hallmark
presentation of a subarachnoid hemorrhage (SAH). The initial diagnostic test of choice is a non-contrast CT
head, which has high sensitivity for detecting acute blood within the first 6 hours. MRI brain is more sensitive for
ischemia and small lesions but is not the first-line test for acute hemorrhage. Lumbar puncture is performed if the
CT is negative but clinical suspicion remains high, looking for xanthochromia. CT angiography may follow to
identify an aneurysm source but is not the initial study.
Q3: A 72-year-old female presents with a new-onset headache over the past 3 weeks. She
describes the pain as a persistent, dull aching over her temples. She also reports jaw pain
when chewing and some visual blurring in her left eye. On examination, the temporal arteries
are tender and thickened on palpation bilaterally. Which of the following laboratory findings
would most strongly support the suspected diagnosis?
A. Elevated white blood cell count
Page 3
, NSG 550 Exam 3 | Diagnostic Reasoning for Nurse Practitioners | Wilkes University 2026-2027 75 Questions | Verified Answers
B. Elevated erythrocyte sedimentation rate (ESR) [CORRECT]
C. Elevated thyroid-stimulating hormone (TSH)
D. Elevated serum creatinine
Correct Answer: B
Rationale:
This patient presents with classic signs of temporal (giant cell) arteritis: new-onset headache in an elderly
patient, jaw claudication, visual changes, and temporal artery tenderness. An elevated ESR is the most
characteristic laboratory finding, often markedly elevated above 50 mm/hr. Temporal arteritis is a medical
emergency because of the risk of irreversible vision loss from anterior ischemic optic neuropathy. Treatment with
high-dose corticosteroids should begin immediately, even before confirmatory temporal artery biopsy. WBC
count may be mildly elevated but is not diagnostic. TSH and creatinine are unrelated to this condition.
Q4: A nurse practitioner is evaluating a 45-year-old patient who reports a headache. Which
of the following findings would be considered a red flag requiring urgent further evaluation?
A. Bilateral band-like pressure without nausea
B. Headache that worsens with physical activity and is accompanied by fever and neck stiffness
[CORRECT]
C. Recurrent headaches triggered by stress with photophobia
D. Unilateral throbbing headache with associated nausea and vomiting
Correct Answer: B
Rationale:
Headache accompanied by fever and neck stiffness (nuchal rigidity) is a red flag for meningitis, which requires
urgent evaluation with lumbar puncture and empiric antibiotics. Red flags for headache include sudden onset
thunderclap pain, worst headache of life, fever with neck stiffness, focal neurological deficits, new onset in elderly
patients, changes in vision, and immunocompromised state. Bilateral band-like pressure is typical of tension-type
headache. Recurrent headaches with photophobia suggest migraine. Unilateral throbbing pain with nausea is
also characteristic of migraine, neither of which requires urgent workup in a stable patient with a known pattern.
Q5: A 65-year-old male presents with acute-onset vertigo, nausea, and vomiting that began 2
hours ago. He reports feeling like the room is spinning. On examination, the nurse
practitioner performs the HINTS (Head Impulse, Nystagmus, Test of Skew) examination.
Findings include a normal head impulse test, direction-changing nystagmus in eccentric gaze,
and a positive skew deviation (one eye appears higher than the other). Which of the following
is the most appropriate next step in management?
A. Perform Dix-Hallpike maneuver
B. Prescribe meclizine and reassure the patient
C. Order urgent MRI brain [CORRECT]
D. Refer for audiometry testing
Correct Answer: C
Rationale:
A positive HINTS examination (normal head impulse, direction-changing nystagmus, and positive skew deviation)
strongly suggests a central cause of vertigo, such as a posterior circulation stroke or TIA, rather than a
peripheral cause like BPPV or vestibular neuritis. Central vertigo requires urgent neuroimaging with MRI brain
to rule out cerebellar or brainstem infarction. The Dix-Hallpike maneuver is used to diagnose BPPV (a
peripheral cause), which would typically show an abnormal head impulse test and unidirectional nystagmus.
Prescribing meclizine without imaging would be inappropriate when central causes have not been excluded.
Audiometry evaluates hearing but does not address the acute risk of stroke.
Page 4
Exam 3
Diagnostic Reasoning for Nurse Practitioners
Questions and Verified Answers
100% Correct | Grade A
Wilkes University
Passan School of Nursing
Latest Update
75 Questions | 6 Sections
Aligned with 2026-2027 Wilkes University Passan School of Nursing curriculum standards and diagnostic reasoning
competencies for nurse practitioners
, Table of Contents
Section 1: Neurological Diagnostic Reasoning
Questions 1 - 18
Section 2: Musculoskeletal Diagnostic Reasoning
Questions 19 - 32
Section 3: Dermatologic Diagnostic Reasoning
Questions 33 - 42
Section 4: Psychiatric and Mental Health Diagnostic Reasoning
Questions 43 - 55
Section 5: Infectious Disease and Immunologic Diagnostic Reasoning
Questions 56 - 65
Section 6: Integrated Clinical Scenarios and NGN-Style Prioritization
Questions 66 - 75
Page 2
,NSG 550 Exam 3 | Diagnostic Reasoning for Nurse Practitioners | Wilkes University 2026-2027 75 Questions | Verified Answers
Section 1: Neurological Diagnostic Reasoning
Q1: A 32-year-old female presents to the primary care clinic complaining of a headache that
began 6 hours ago. She describes the pain as unilateral, throbbing, and severe, located behind
her left eye. She reports associated nausea, photophobia, and noted visual scintillations prior
to the onset of the headache. She has a history of similar headaches since her early twenties.
Which of the following is the most likely diagnosis?
A. Tension-type headache
B. Migraine with aura [CORRECT]
C. Cluster headache
D. Sinus headache
Correct Answer: B
Rationale:
This patient presents with classic migraine features: unilateral, throbbing pain with nausea, photophobia, and a
visual aura (scintillations) preceding the headache. Migraines are more common in females and often begin in
early adulthood. Tension-type headaches are typically bilateral and band-like without nausea or photophobia.
Cluster headaches are severe, unilateral, and periorbital with autonomic symptoms (lacrimation, nasal
congestion) but lack aura. Sinus headaches present with facial pressure that worsens with bending forward and
are associated with nasal congestion.
Q2: A 58-year-old male with no prior headache history presents to the emergency department
reporting the sudden onset of the worst headache of his life that peaked in intensity within
seconds. He describes it as an explosive, thunderclap pain. He appears anxious and has mild
nuchal rigidity on examination. Vital signs are BP 168/96 mmHg, HR 88 bpm, RR 20
breaths/min, Temp 37.1 degrees C. Which of the following is the most appropriate initial
diagnostic test?
A. MRI brain with contrast
B. CT head without contrast [CORRECT]
C. Lumbar puncture
D. CT angiography of the head
Correct Answer: B
Rationale:
The sudden onset of a severe thunderclap headache described as the worst headache of life is the hallmark
presentation of a subarachnoid hemorrhage (SAH). The initial diagnostic test of choice is a non-contrast CT
head, which has high sensitivity for detecting acute blood within the first 6 hours. MRI brain is more sensitive for
ischemia and small lesions but is not the first-line test for acute hemorrhage. Lumbar puncture is performed if the
CT is negative but clinical suspicion remains high, looking for xanthochromia. CT angiography may follow to
identify an aneurysm source but is not the initial study.
Q3: A 72-year-old female presents with a new-onset headache over the past 3 weeks. She
describes the pain as a persistent, dull aching over her temples. She also reports jaw pain
when chewing and some visual blurring in her left eye. On examination, the temporal arteries
are tender and thickened on palpation bilaterally. Which of the following laboratory findings
would most strongly support the suspected diagnosis?
A. Elevated white blood cell count
Page 3
, NSG 550 Exam 3 | Diagnostic Reasoning for Nurse Practitioners | Wilkes University 2026-2027 75 Questions | Verified Answers
B. Elevated erythrocyte sedimentation rate (ESR) [CORRECT]
C. Elevated thyroid-stimulating hormone (TSH)
D. Elevated serum creatinine
Correct Answer: B
Rationale:
This patient presents with classic signs of temporal (giant cell) arteritis: new-onset headache in an elderly
patient, jaw claudication, visual changes, and temporal artery tenderness. An elevated ESR is the most
characteristic laboratory finding, often markedly elevated above 50 mm/hr. Temporal arteritis is a medical
emergency because of the risk of irreversible vision loss from anterior ischemic optic neuropathy. Treatment with
high-dose corticosteroids should begin immediately, even before confirmatory temporal artery biopsy. WBC
count may be mildly elevated but is not diagnostic. TSH and creatinine are unrelated to this condition.
Q4: A nurse practitioner is evaluating a 45-year-old patient who reports a headache. Which
of the following findings would be considered a red flag requiring urgent further evaluation?
A. Bilateral band-like pressure without nausea
B. Headache that worsens with physical activity and is accompanied by fever and neck stiffness
[CORRECT]
C. Recurrent headaches triggered by stress with photophobia
D. Unilateral throbbing headache with associated nausea and vomiting
Correct Answer: B
Rationale:
Headache accompanied by fever and neck stiffness (nuchal rigidity) is a red flag for meningitis, which requires
urgent evaluation with lumbar puncture and empiric antibiotics. Red flags for headache include sudden onset
thunderclap pain, worst headache of life, fever with neck stiffness, focal neurological deficits, new onset in elderly
patients, changes in vision, and immunocompromised state. Bilateral band-like pressure is typical of tension-type
headache. Recurrent headaches with photophobia suggest migraine. Unilateral throbbing pain with nausea is
also characteristic of migraine, neither of which requires urgent workup in a stable patient with a known pattern.
Q5: A 65-year-old male presents with acute-onset vertigo, nausea, and vomiting that began 2
hours ago. He reports feeling like the room is spinning. On examination, the nurse
practitioner performs the HINTS (Head Impulse, Nystagmus, Test of Skew) examination.
Findings include a normal head impulse test, direction-changing nystagmus in eccentric gaze,
and a positive skew deviation (one eye appears higher than the other). Which of the following
is the most appropriate next step in management?
A. Perform Dix-Hallpike maneuver
B. Prescribe meclizine and reassure the patient
C. Order urgent MRI brain [CORRECT]
D. Refer for audiometry testing
Correct Answer: C
Rationale:
A positive HINTS examination (normal head impulse, direction-changing nystagmus, and positive skew deviation)
strongly suggests a central cause of vertigo, such as a posterior circulation stroke or TIA, rather than a
peripheral cause like BPPV or vestibular neuritis. Central vertigo requires urgent neuroimaging with MRI brain
to rule out cerebellar or brainstem infarction. The Dix-Hallpike maneuver is used to diagnose BPPV (a
peripheral cause), which would typically show an abnormal head impulse test and unidirectional nystagmus.
Prescribing meclizine without imaging would be inappropriate when central causes have not been excluded.
Audiometry evaluates hearing but does not address the acute risk of stroke.
Page 4
