NSG 550
EXAM 1
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 1 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 550 - EXAM 1 - Diagnostic Reasoning
If you require further clarification
or in need of any study resources,
feel free to Message me.
EXAM PREVIEW STUDY GUIDE FULL PDF LINKED
,Table of Contents
NSG 550 Exam 1 ................................................................. 2
NSG 550 Exam 1 Study Guide ............................................. 49
NSG 550 Exam 1
1. A 68-year-old male with a history of benign prostatic hyperplasia presents for his
annual physical. His provider orders a PSA level. The nurse understands that an
elevated PSA is most specific for which of the following conditions?
A) Urinary tract infection
B) Prostate cancer
C) Acute kidney injury
D) Bladder obstruction
Correct Answer: B) Prostate cancer
Rationale: PSA (Prostate-Specific Antigen) is a glycoprotein produced by the epithelial cells
of the prostate gland. While PSA can be elevated in benign prostatic hyperplasia, prostatitis,
and urinary retention, it is the primary serum marker used for prostate cancer detection
and monitoring. The nurse must educate the patient that PSA screening, combined with
digital rectal examination, aids in early detection of prostate malignancy.
2. A nurse is reviewing the diagnostic workup for a patient suspected of having
rheumatoid arthritis. Which laboratory tests should the nurse anticipate the
provider will order? Select all that apply.
A) Rheumatoid Factor (RF)
B) Anti-CCP antibody
C) C-reactive Protein (CRP)
D) Erythrocyte Sedimentation Rate (ESR)
E) Complete Blood Count (CBC)
,Correct Answer: A, B, C, D, E
Rationale: The five core diagnostic labs to confirm or support a diagnosis of Rheumatoid
Arthritis include: (1) Rheumatoid Factor (RF) — an autoantibody present in approximately
80% of RA patients; (2) Anti-CCP (Anti-Citrullinated Peptide) antibody — highly specific for
RA and often present before clinical symptoms; (3) CRP — an acute-phase reactant
indicating active inflammation; (4) ESR — measures the rate of erythrocyte sedimentation,
which increases with inflammation; and (5) CBC — to assess for anemia of chronic disease
and thrombocytosis, both common in RA.
3. A patient is scheduled for a bone scan using a radioactive isotope. Which pre-
procedure instruction should the nurse provide?
A) "You will need to fast for 12 hours before the scan."
B) "Remove all metal jewelry and clothing with zippers before the procedure."
C) "You will be radioactive for several weeks and must avoid contact with others."
D) "Drink only clear fluids for 48 hours after the injection."
Correct Answer: B) "Remove all metal jewelry and clothing with zippers before the
procedure."
Rationale: Prior to a nuclear bone scan, patients must remove all metal objects because
metal can interfere with the scanner's ability to capture accurate images. The patient
should hold fluids for 4 hours before the injection, drink 32 oz of water after injection to
promote renal filtering, void 1–3 hours after injection to clear excess isotope from the
bladder, and lie supine during the scan. Radioactive isotopes are excreted in urine and feces
within 48 hours and are not harmful to family or visitors.
4. A 45-year-old female presents with fatigue, weight gain, constipation, and
bradycardia. Laboratory studies reveal elevated TSH and low T3 and T4 levels. The
nurse recognizes these findings are consistent with which condition?
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing's syndrome
D) Addison's disease
Correct Answer: B) Hypothyroidism
Rationale: Hypothyroidism is characterized by high TSH (thyroid-stimulating hormone)
and low T3/T4 levels due to the pituitary gland's compensatory response to insufficient
,thyroid hormone production. Clinical manifestations include bradycardia, weight gain,
constipation, cold intolerance, and sluggishness. This is in direct contrast to
hyperthyroidism/Graves' disease, which presents with low TSH, high T3/T4,
hypermetabolism, tachycardia, weight loss, and exophthalmos.
5. A patient with type 1 diabetes presents to the emergency department with fruity
breath, Kussmaul respirations, and altered mental status. Laboratory results show
high ketones, high anion gap, low potassium, and rising BUN/creatinine. The nurse
recognizes these findings as indicative of:
A) Hyperosmolar hyperglycemic state
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemic shock
D) Acute kidney injury
Correct Answer: B) Diabetic ketoacidosis (DKA)
Rationale: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes
mellitus characterized by hyperglycemia, ketonemia, and metabolic acidosis (high anion
gap). The rising BUN and creatinine reflect prerenal azotemia from dehydration. Low
potassium occurs due to osmotic diuresis and acidosis-driven intracellular shifts.
Immediate interventions include IV fluid resuscitation, insulin administration, and
electrolyte replacement.
6. A nurse is caring for a patient who underwent a cystoscopy. Which statement by
the patient indicates a need for further teaching?
A) "I may notice some pink-tinged urine after the procedure."
B) "I should drink plenty of fluids to flush my bladder."
C) "I can resume my normal diet immediately after the procedure."
D) "I should report burning with urination that lasts more than 24 hours."
Correct Answer: C) "I can resume my normal diet immediately after the procedure."
Rationale: Cystoscopy is the visual examination of the urinary bladder using a cystoscope
inserted through the urethra. While patients can typically resume a normal diet
immediately after an uncomplicated cystoscopy, this statement itself is not incorrect.
However, if the patient had sedation, they may need to wait before eating. More
importantly, the nurse should ensure the patient understands that mild hematuria, burning
,with urination, and increased urinary frequency are expected for 24–48 hours. The patient
must report fever, chills, or persistent gross hematuria.
7. A patient with suspected renal obstruction is scheduled for a renal scan. The nurse
explains to the patient that this nuclear scan will determine which of the following?
Select all that apply.
A) Size of the kidneys
B) Shape of the kidneys
C) Function of the kidneys
D) Presence of renal stones
E) Blood flow to the kidneys
Correct Answer: A, B, C
Rationale: Renal scanning (nuclear medicine renal scan) uses radioactive isotopes to
evaluate the size, shape, and function of the kidneys. It is used to diagnose renal
obstruction, renovascular hypertension, and differential renal function. While CT without
contrast is the gold standard for kidney stones, renal scans focus on functional assessment
rather than structural stone detection. Blood flow evaluation is better assessed with
Doppler ultrasound or angiography.
8. A patient with diabetes mellitus is being monitored for early signs of diabetic
nephropathy. Which laboratory test is the best marker to detect patients at risk for
developing this complication?
A) Serum creatinine
B) Blood urea nitrogen (BUN)
C) Microalbuminuria test
D) 24-hour urine protein
Correct Answer: C) Microalbuminuria test
Rationale: The microalbuminuria test detects small amounts of albumin in the urine (30–
300 mg/day) that are not detected by standard urine dipstick testing. It is the earliest and
most sensitive marker for diabetic nephropathy, allowing for intervention before significant
renal damage occurs. While serum creatinine and BUN reflect established renal
dysfunction, microalbuminuria identifies risk before GFR declines. Annual microalbumin
screening is recommended for all patients with diabetes.
, NSG 550 Exam 1 Study Guide
1. Clinical Reasoning & Test Ordering
Clinical Reasoning:
You come to the table with your own knowledge base and experience
Use this to help determine best course of action, best testing and diagnosis
Knowledge of disease process + physical exam findings + subjective data will influence what tests
you order based on guidelines
How to Order Tests:
Do NOT use shotgun approach (order variety of tests and then develop diagnosis)
Develop your diagnosis first and then order tests to rule in or rule out diagnosis
Best Info for Differential Diagnosis:
Always listen to what the patient is telling you during the health history
Remain flexible, listen, ability to infer
Keep in mind what tests you want to rule in for the probable diagnosis or rule out for differentials
Patient Safety in Management of Dx Studies:
Ordering provider is responsible for everything on the radiologist report
You need to read the findings AND impression
Impression can have info that is not in findings; YOU are responsible for relaying this info to the
patient
If there's a discrepancy in findings vs. impression → discuss with radiologist; do not allow
discrepancy to remain
When Ordering Tests:
Need to tell radiologist what you're looking for!
Without reason for test, they can't help you decide which test is best
Example: CT of abd/pelvis with contrast for kidney stones is wrong; they won't know it's not best
practice if they don't know what you're looking for
If You Don't Get the Info You're Looking For:
May need to order another test
Example: Suspect pneumonia but CXR does not reveal findings → may need CT
,2. Sensitivity & Specificity
Sensitivity:
The ability of the test to determine who HAS the disease
Rule IN tests
Want low false negatives
Looking for patients that DO have the disease
Specificity:
The ability of the test to determine who does NOT have the disease
Screening tests to rule OUT
Want low false positives
Looking for patients that do NOT have the disease
Key Points:
Can a test be sensitive and specific? YES
Can a screening test be sensitive but not specific? NO
If you're looking to rule out → want specific test
If it is sensitive, great, gives you more info but really important to know what you're looking for
Precision:
Does the test reproduce the same results when repeated on the same patient or sample
A test can be precise but not necessarily accurate if results differ from reference range
Accuracy:
Does the test measure what it was designed to measure
Proportion of all tests (positive and negative) that are correct
3. Imaging Studies
X-Ray:
Mammography (type of x-ray) - malignancy of breast tissue
Bones, joints
KUB (kidneys, ureters, bladder)
Bone densitometry (type of X-ray)
Radiology - general diagnostic imaging
Ultrasound:
Pregnancy
Sex organs (testicles, scrotum, ovaries, uterus)
Thyroid
Breast (if infection only)
Skin and soft tissue infections (lumps, bumps, masses, abscess)
Blood vessels (DVT r/o lower extremities)
Arterial stenosis + carotids
,Sound waves with frequencies above normal human range of hearing
Best non-blood test for thyroid nodules: Ultrasound
MRI (Magnetic Resonance Imaging):
Brain (masses + need contrast)
Can do CT of brain but can only see a bleed; cannot see an acute infarct → need MRI
Skeletal; tendons and ligaments
Best of the best; most info
Most costly $$$$$
Longest to interpret
Uses magnetic fields and radio waves to produce computer-generated images
Distinguishes among different types of soft tissue; allows us to see structures within the brain
In-depth look at vessels, tendon, ligament, muscle
Contrast - infection/vessel
Noncontrast - bone
CT Scan (Computed Tomography):
A series of x-ray photographs taken from different angles and combined by computer into a
composite representation of a slice through the body
Gold standard for kidney stones: non-contrast CT of abd/pelvis
Need to tell radiologist what you're looking for to determine contrast type (oral vs IV)
Need to weigh risk vs benefits; may be a better test but radiation risk is too high
Especially with pediatric patients and pregnancy
Nuclear Medicine / Nuclear Scanning:
Anytime you hear the word 'scan' → nuclear medicine
Bone scan, thyroid scan
Scanners or camera record images on radiographic film
Uses low dosages of radioactive isotopes which are excreted in urine and feces within 48hrs
Not harmful to others
Used to identify, evaluate, and stage bone cancer before and after treatment
Renal scanning: nuclear scans to determine size, shape, and function of kidney
Used to diagnose renal obstruction or hypertension
Bone Scan Preparation:
Obtain consent
Radioactive isotopes will not affect family or visitors
Hold fluids for 4 hours before
Remove metal
After injection of radioisotope, drink 32oz water (promote renal filtering)
1-3 hours after injection, have client void (clear excess isotope from bladder)
Lie supine, not painful
Monitor injection site for redness and swelling
After: encourage fluid intake
, NSG 550
EXAM 1
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 1 Comprehensive Study Guide
EXAM 1
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 1 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 550 - EXAM 1 - Diagnostic Reasoning
If you require further clarification
or in need of any study resources,
feel free to Message me.
EXAM PREVIEW STUDY GUIDE FULL PDF LINKED
,Table of Contents
NSG 550 Exam 1 ................................................................. 2
NSG 550 Exam 1 Study Guide ............................................. 49
NSG 550 Exam 1
1. A 68-year-old male with a history of benign prostatic hyperplasia presents for his
annual physical. His provider orders a PSA level. The nurse understands that an
elevated PSA is most specific for which of the following conditions?
A) Urinary tract infection
B) Prostate cancer
C) Acute kidney injury
D) Bladder obstruction
Correct Answer: B) Prostate cancer
Rationale: PSA (Prostate-Specific Antigen) is a glycoprotein produced by the epithelial cells
of the prostate gland. While PSA can be elevated in benign prostatic hyperplasia, prostatitis,
and urinary retention, it is the primary serum marker used for prostate cancer detection
and monitoring. The nurse must educate the patient that PSA screening, combined with
digital rectal examination, aids in early detection of prostate malignancy.
2. A nurse is reviewing the diagnostic workup for a patient suspected of having
rheumatoid arthritis. Which laboratory tests should the nurse anticipate the
provider will order? Select all that apply.
A) Rheumatoid Factor (RF)
B) Anti-CCP antibody
C) C-reactive Protein (CRP)
D) Erythrocyte Sedimentation Rate (ESR)
E) Complete Blood Count (CBC)
,Correct Answer: A, B, C, D, E
Rationale: The five core diagnostic labs to confirm or support a diagnosis of Rheumatoid
Arthritis include: (1) Rheumatoid Factor (RF) — an autoantibody present in approximately
80% of RA patients; (2) Anti-CCP (Anti-Citrullinated Peptide) antibody — highly specific for
RA and often present before clinical symptoms; (3) CRP — an acute-phase reactant
indicating active inflammation; (4) ESR — measures the rate of erythrocyte sedimentation,
which increases with inflammation; and (5) CBC — to assess for anemia of chronic disease
and thrombocytosis, both common in RA.
3. A patient is scheduled for a bone scan using a radioactive isotope. Which pre-
procedure instruction should the nurse provide?
A) "You will need to fast for 12 hours before the scan."
B) "Remove all metal jewelry and clothing with zippers before the procedure."
C) "You will be radioactive for several weeks and must avoid contact with others."
D) "Drink only clear fluids for 48 hours after the injection."
Correct Answer: B) "Remove all metal jewelry and clothing with zippers before the
procedure."
Rationale: Prior to a nuclear bone scan, patients must remove all metal objects because
metal can interfere with the scanner's ability to capture accurate images. The patient
should hold fluids for 4 hours before the injection, drink 32 oz of water after injection to
promote renal filtering, void 1–3 hours after injection to clear excess isotope from the
bladder, and lie supine during the scan. Radioactive isotopes are excreted in urine and feces
within 48 hours and are not harmful to family or visitors.
4. A 45-year-old female presents with fatigue, weight gain, constipation, and
bradycardia. Laboratory studies reveal elevated TSH and low T3 and T4 levels. The
nurse recognizes these findings are consistent with which condition?
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing's syndrome
D) Addison's disease
Correct Answer: B) Hypothyroidism
Rationale: Hypothyroidism is characterized by high TSH (thyroid-stimulating hormone)
and low T3/T4 levels due to the pituitary gland's compensatory response to insufficient
,thyroid hormone production. Clinical manifestations include bradycardia, weight gain,
constipation, cold intolerance, and sluggishness. This is in direct contrast to
hyperthyroidism/Graves' disease, which presents with low TSH, high T3/T4,
hypermetabolism, tachycardia, weight loss, and exophthalmos.
5. A patient with type 1 diabetes presents to the emergency department with fruity
breath, Kussmaul respirations, and altered mental status. Laboratory results show
high ketones, high anion gap, low potassium, and rising BUN/creatinine. The nurse
recognizes these findings as indicative of:
A) Hyperosmolar hyperglycemic state
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemic shock
D) Acute kidney injury
Correct Answer: B) Diabetic ketoacidosis (DKA)
Rationale: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes
mellitus characterized by hyperglycemia, ketonemia, and metabolic acidosis (high anion
gap). The rising BUN and creatinine reflect prerenal azotemia from dehydration. Low
potassium occurs due to osmotic diuresis and acidosis-driven intracellular shifts.
Immediate interventions include IV fluid resuscitation, insulin administration, and
electrolyte replacement.
6. A nurse is caring for a patient who underwent a cystoscopy. Which statement by
the patient indicates a need for further teaching?
A) "I may notice some pink-tinged urine after the procedure."
B) "I should drink plenty of fluids to flush my bladder."
C) "I can resume my normal diet immediately after the procedure."
D) "I should report burning with urination that lasts more than 24 hours."
Correct Answer: C) "I can resume my normal diet immediately after the procedure."
Rationale: Cystoscopy is the visual examination of the urinary bladder using a cystoscope
inserted through the urethra. While patients can typically resume a normal diet
immediately after an uncomplicated cystoscopy, this statement itself is not incorrect.
However, if the patient had sedation, they may need to wait before eating. More
importantly, the nurse should ensure the patient understands that mild hematuria, burning
,with urination, and increased urinary frequency are expected for 24–48 hours. The patient
must report fever, chills, or persistent gross hematuria.
7. A patient with suspected renal obstruction is scheduled for a renal scan. The nurse
explains to the patient that this nuclear scan will determine which of the following?
Select all that apply.
A) Size of the kidneys
B) Shape of the kidneys
C) Function of the kidneys
D) Presence of renal stones
E) Blood flow to the kidneys
Correct Answer: A, B, C
Rationale: Renal scanning (nuclear medicine renal scan) uses radioactive isotopes to
evaluate the size, shape, and function of the kidneys. It is used to diagnose renal
obstruction, renovascular hypertension, and differential renal function. While CT without
contrast is the gold standard for kidney stones, renal scans focus on functional assessment
rather than structural stone detection. Blood flow evaluation is better assessed with
Doppler ultrasound or angiography.
8. A patient with diabetes mellitus is being monitored for early signs of diabetic
nephropathy. Which laboratory test is the best marker to detect patients at risk for
developing this complication?
A) Serum creatinine
B) Blood urea nitrogen (BUN)
C) Microalbuminuria test
D) 24-hour urine protein
Correct Answer: C) Microalbuminuria test
Rationale: The microalbuminuria test detects small amounts of albumin in the urine (30–
300 mg/day) that are not detected by standard urine dipstick testing. It is the earliest and
most sensitive marker for diabetic nephropathy, allowing for intervention before significant
renal damage occurs. While serum creatinine and BUN reflect established renal
dysfunction, microalbuminuria identifies risk before GFR declines. Annual microalbumin
screening is recommended for all patients with diabetes.
, NSG 550 Exam 1 Study Guide
1. Clinical Reasoning & Test Ordering
Clinical Reasoning:
You come to the table with your own knowledge base and experience
Use this to help determine best course of action, best testing and diagnosis
Knowledge of disease process + physical exam findings + subjective data will influence what tests
you order based on guidelines
How to Order Tests:
Do NOT use shotgun approach (order variety of tests and then develop diagnosis)
Develop your diagnosis first and then order tests to rule in or rule out diagnosis
Best Info for Differential Diagnosis:
Always listen to what the patient is telling you during the health history
Remain flexible, listen, ability to infer
Keep in mind what tests you want to rule in for the probable diagnosis or rule out for differentials
Patient Safety in Management of Dx Studies:
Ordering provider is responsible for everything on the radiologist report
You need to read the findings AND impression
Impression can have info that is not in findings; YOU are responsible for relaying this info to the
patient
If there's a discrepancy in findings vs. impression → discuss with radiologist; do not allow
discrepancy to remain
When Ordering Tests:
Need to tell radiologist what you're looking for!
Without reason for test, they can't help you decide which test is best
Example: CT of abd/pelvis with contrast for kidney stones is wrong; they won't know it's not best
practice if they don't know what you're looking for
If You Don't Get the Info You're Looking For:
May need to order another test
Example: Suspect pneumonia but CXR does not reveal findings → may need CT
,2. Sensitivity & Specificity
Sensitivity:
The ability of the test to determine who HAS the disease
Rule IN tests
Want low false negatives
Looking for patients that DO have the disease
Specificity:
The ability of the test to determine who does NOT have the disease
Screening tests to rule OUT
Want low false positives
Looking for patients that do NOT have the disease
Key Points:
Can a test be sensitive and specific? YES
Can a screening test be sensitive but not specific? NO
If you're looking to rule out → want specific test
If it is sensitive, great, gives you more info but really important to know what you're looking for
Precision:
Does the test reproduce the same results when repeated on the same patient or sample
A test can be precise but not necessarily accurate if results differ from reference range
Accuracy:
Does the test measure what it was designed to measure
Proportion of all tests (positive and negative) that are correct
3. Imaging Studies
X-Ray:
Mammography (type of x-ray) - malignancy of breast tissue
Bones, joints
KUB (kidneys, ureters, bladder)
Bone densitometry (type of X-ray)
Radiology - general diagnostic imaging
Ultrasound:
Pregnancy
Sex organs (testicles, scrotum, ovaries, uterus)
Thyroid
Breast (if infection only)
Skin and soft tissue infections (lumps, bumps, masses, abscess)
Blood vessels (DVT r/o lower extremities)
Arterial stenosis + carotids
,Sound waves with frequencies above normal human range of hearing
Best non-blood test for thyroid nodules: Ultrasound
MRI (Magnetic Resonance Imaging):
Brain (masses + need contrast)
Can do CT of brain but can only see a bleed; cannot see an acute infarct → need MRI
Skeletal; tendons and ligaments
Best of the best; most info
Most costly $$$$$
Longest to interpret
Uses magnetic fields and radio waves to produce computer-generated images
Distinguishes among different types of soft tissue; allows us to see structures within the brain
In-depth look at vessels, tendon, ligament, muscle
Contrast - infection/vessel
Noncontrast - bone
CT Scan (Computed Tomography):
A series of x-ray photographs taken from different angles and combined by computer into a
composite representation of a slice through the body
Gold standard for kidney stones: non-contrast CT of abd/pelvis
Need to tell radiologist what you're looking for to determine contrast type (oral vs IV)
Need to weigh risk vs benefits; may be a better test but radiation risk is too high
Especially with pediatric patients and pregnancy
Nuclear Medicine / Nuclear Scanning:
Anytime you hear the word 'scan' → nuclear medicine
Bone scan, thyroid scan
Scanners or camera record images on radiographic film
Uses low dosages of radioactive isotopes which are excreted in urine and feces within 48hrs
Not harmful to others
Used to identify, evaluate, and stage bone cancer before and after treatment
Renal scanning: nuclear scans to determine size, shape, and function of kidney
Used to diagnose renal obstruction or hypertension
Bone Scan Preparation:
Obtain consent
Radioactive isotopes will not affect family or visitors
Hold fluids for 4 hours before
Remove metal
After injection of radioisotope, drink 32oz water (promote renal filtering)
1-3 hours after injection, have client void (clear excess isotope from bladder)
Lie supine, not painful
Monitor injection site for redness and swelling
After: encourage fluid intake
, NSG 550
EXAM 1
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 1 Comprehensive Study Guide
