NSG 550
EXAM 3
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 3 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 550 EXAM 3 - DIAGNOSTIC REASONING
If you require further clarification
or in need of any study resources,
feel free to Message me.
3 EXAM PAGES 3 STUDY PAGES FULL PDF LINKED
,Table of Contents
NSG 550 Exam 3 .................................................. 2
NSG 550 Exam 3 Study Guide ............................. 51
NSG 550 Exam 3
Question 1
A 72-year-old female is brought to the clinic by her daughter, who reports that
her mother has had progressive memory loss over the past 3 years. She
forgets recent conversations, misplaces items daily, and recently got lost
driving home from the grocery store. She denies visual hallucinations or
movement disorders. Her MRI shows cortical atrophy and hippocampal
volume loss.
What is the most likely diagnosis?
• A. Vascular dementia
• B. Alzheimer's disease ✅ CORRECT
• C. Lewy body dementia
• D. Parkinsonism
Rationale: Alzheimer's disease (B) is the most common form of dementia,
characterized by progressive memory loss, cognitive decline, and changes in
behavior. The patient's gradual onset over years, prominent memory impairment,
and cortical atrophy on imaging are classic. Vascular dementia (A) typically has a
stepwise decline with focal neurologic deficits. Lewy body dementia (C) presents
with cognitive fluctuations, visual hallucinations, and movement disorders
(Parkinsonism). Parkinsonism (D) is a syndrome of tremors, rigidity, and
bradykinesia, not primarily a dementia diagnosis.
,Question 2
A 68-year-old male with a history of hypertension and two prior strokes
presents with abrupt onset of cognitive decline. His family notes that his
memory and executive function worsened stepwise after each
cerebrovascular event. He has no visual hallucinations.
Which type of dementia is most consistent with this presentation?
• A. Alzheimer's disease
• B. Lewy body dementia
• C. Vascular dementia ✅ CORRECT
• D. Frontotemporal dementia
Rationale: Vascular dementia (C) is the second most common type of dementia,
caused by reduced blood flow to the brain from cerebrovascular disease. The
stepwise decline correlating with stroke events is pathognomonic. Alzheimer's (A)
has a gradual, continuous decline. Lewy body dementia (B) features visual
hallucinations and fluctuating cognition. Frontotemporal dementia (D) presents
with personality/behavior changes and language impairment rather than stepwise
decline.
Question 3 (SATA)
A 65-year-old male presents with cognitive fluctuations, vivid visual
hallucinations of small animals in his home, and Parkinsonian features
including rigidity and bradykinesia. His symptoms fluctuate dramatically from
hour to hour.
Which of the following are characteristic features of this patient's most likely
diagnosis? Select all that apply.
• A. Abnormal protein deposits (Lewy bodies) in the brain ✅ CORRECT
• B. Cognitive fluctuations ✅ CORRECT
• C. Visual hallucinations ✅ CORRECT
• D. Movement disorders (Parkinsonism) ✅ CORRECT
• E. Stepwise cognitive decline after strokes
Rationale: This patient has Lewy body dementia (A, B, C, D), a progressive dementia
associated with abnormal protein deposits (Lewy bodies) in the brain. Core features
include cognitive fluctuations (B), visual hallucinations (C), and movement
,disorders/Parkinsonism (D). Stepwise decline after strokes (E) describes vascular
dementia, not Lewy body dementia.
Question 4
A 70-year-old female with Lewy body dementia develops worsening tremor,
rigidity, and bradykinesia. Her neurologist explains that these motor
symptoms are part of a broader syndrome.
Which syndrome is characterized by tremors, rigidity, and bradykinesia and
can occur with various types of dementia?
• A. Cerebellar ataxia
• B. Parkinsonism ✅ CORRECT
• C. Myoclonus
• D. Chorea
Rationale: Parkinsonism (B) is a syndrome characterized by tremors, rigidity, and
bradykinesia (slowed movement). It can occur in conjunction with various types of
dementia, particularly Lewy body dementia and Parkinson's disease dementia.
Cerebellar ataxia (A) involves coordination and balance. Myoclonus (C) is sudden
muscle jerking. Chorea (D) involves dance-like involuntary movements.
Question 5 (SATA)
A 45-year-old female presents for her annual well-woman examination. She
has no breast complaints. The nurse practitioner discusses breast cancer
screening options.
Which statements about mammography are correct? Select all that apply.
• A. Mammography uses low-dose x-ray for breast cancer detection. ✅
CORRECT
• B. Mammography can monitor benign breast conditions. ✅ CORRECT
• C. Mammography is used for surveillance after breast cancer treatment. ✅
CORRECT
• D. Mammography uses high-frequency sound waves instead of x-rays.
• E. Mammography is the only imaging modality needed for all breast evaluations.
,Rationale: Mammography (A, B, C) is a low-dose x-ray used for breast cancer
detection, monitoring of benign breast conditions, and surveillance after breast
cancer treatment. It does NOT use sound waves (D describes ultrasound). It is not
the only imaging needed (E) — ultrasound and MRI are used adjunctively,
particularly for dense breasts or further evaluation of abnormalities.
Question 6
A 52-year-old female undergoes screening mammography. The radiologist
reports the findings using the BI-RADS classification system.
What is the primary purpose of the Breast Imaging Reporting and Data System
(BI-RADS)?
• A. To provide a definitive diagnosis of breast cancer
• B. To serve as a risk assessment and quality assurance tool that
standardizes reporting of mammography, ultrasound, and MRI findings ✅
CORRECT
• C. To replace the need for biopsy in suspicious lesions
• D. To determine genetic risk for breast cancer
Rationale: BI-RADS (B) is a risk assessment and quality assurance tool developed
by the American College of Radiology that provides a widely accepted, standardized
way to report mammography, ultrasound, and MRI findings. It does not provide
definitive diagnosis (A) — biopsy is needed for tissue diagnosis. It does not replace
biopsy (C). Genetic risk (D) is determined by genetic testing (BRCA), not BI-RADS.
Question 7
A 48-year-old female returns for her screening mammogram results. The
radiologist assigns a BI-RADS Category 2.
Which follow-up is most appropriate?
• A. Immediate biopsy
• B. Short-interval follow-up in 6 months
• C. Routine annual mammogram ✅ CORRECT
• D. Referral to breast surgeon
, NSG 550 Exam 3 Study Guide
1. Neurology & Dementia
Types of Dementia:
• Alzheimer's Disease: The most common form of dementia, characterized by memory
loss, cognitive decline, and changes in behavior
• Vascular Dementia: The second most common type, often caused by reduced blood flow
to the brain, leading to cognitive impairment
• Lewy Body Dementia: Progressive dementia associated with abnormal protein deposits
in the brain, leading to cognitive fluctuations, visual hallucinations, and movement
disorders
• Parkinsonism: Syndrome characterized by tremors, rigidity, and bradykinesia; can
occur with various types of dementia including Lewy Body dementia
Dementia Workup - What to Rule Out:
• Infection, endocrine disorders, B12 deficiency
• Metabolic testing + infectious workup
• Labs: TSH, vitamin B12, CBC with differential, CMP, magnesium, ESR, CRP,
homocysteine
Other Testing for Dementia:
• Cognitive testing, mental status exam
• NOT doing genetic testing in clinic
Seizure Testing:
• EEG (electroencephalogram)
Meningitis Testing:
• LP (lumbar puncture/spinal tap): collect cerebrospinal fluid to look for infection,
inflammation
Toxicology Testing:
• Tox report: drug levels, ETOH
• Common meds to test: seizure meds, digoxin, vanco
• Measures levels of chemicals, drugs, poisons, or toxins in the body; used in overdose,
poisoning, or exposure cases
• Pt with hx of seizures on keppra, presents with breakthrough seizure → test tox report
to check antiepileptic med levels/compliance
MRI of Brain:
,• To visualize cerebellum, brain stem, cerebrum
MRI of Spine:
• To visualize nerves, ligaments, vertebrae, spinal cord, discs, nerve root, foramen (hole
where nerve roots come out)
• Nerve impingement from herniated disc
• Concern for ligamentous injury
MRA (Magnetic Resonance Angiography):
• Blood vessels; anything vascular
• Brain: aneurysm, AV malformation
• Neck: carotid
Carotid Bruit:
• Order carotid duplex or carotid US
Herpes Zoster (Shingles):
• Typical presentation: vesicular rash in dermatomal or linear distribution
2. Breast Imaging & Cancer Screening
Mammogram:
• Low-dose x-ray for breast cancer detection, monitoring of benign breast conditions, and
monitoring of breast cancer
• Only way to detect microcalcifications
• Low-dose x-ray used for breast cancer screening and evaluation of breast conditions
What is Included in Mammography Report:
• Patient info
• Imaging findings
• BIRADS assessment [universal discussion of findings/assessment so all providers can
communicate]
• Density of breast tissue
• Clinical correlation
• Follow-up recommendations
• Summary of findings
BI-RADS (Breast Imaging Reporting and Data System):
• Risk assessment and quality assurance tool developed by American College of Radiology
• Provides widely accepted way to report mammography, ultrasound and MRI findings
• Standardized system for reporting findings; assesses risk and guides follow-up
BI-RADS Categories:
• Category 0: Incomplete/bad study, poor imaging; abnormality noted but need additional
imaging evaluation
,• Category 1: Negative; symmetrical, no masses, architectural distortion, or suspicious
calcifications; routine annual mammogram
• Category 2: Benign findings noted; 0% probability of malignancy (e.g., fibrocystic); may
not need follow-up other than routine yearly mammogram
• Category 3: Probably benign; <2% probability of malignancy; short interval follow-up
suggested; repeat imaging, no biopsy
• Category 4: Suspicious for malignancy; further evaluation with biopsy should be
considered due to high probability of malignancy
• Category 5: Cancer is highly suspected; highly suggestive of malignancy; >95%
probability; immediate referral required
• Category 6: Known biopsy-proven malignancy; staging; being treated or looking for
disease progression/treatment response
Breast Ultrasound:
• Non-invasive, radiation-free medical imaging technique using high-frequency sound
waves
• Used to determine if palpable lump or lesion found on mammogram is cystic or solid
• Most cysts are benign
• Also used for breast cancer screening in women with dense breasts found on
mammogram
• Evaluates breast masses; distinguishes cystic vs solid lesions
Benign Breast Lesion Ultrasound Appearance:
• Hypoechoic (dark) and well-circumscribed (edges well-defined and easily
distinguishable from normal tissue)
• Posterior acoustic enhancement (brightened area seen behind fluid-filled structure)
Cancer, Hematoma, or Abscess Ultrasound Appearance:
• Hypoechoic but NOT well-circumscribed
• Acoustic shadowing (sound waves blocked by lesion resulting in dark shadow-like area
behind lesion)
Genetic Testing for Cancer:
• Detects increased susceptibility to inherited conditions: breast cancer (BRCA),
medullary thyroid cancer, certain skin and kidney cancers, Lynch syndrome
• Identifies inherited mutations in genes such as BRCA1 and BRCA2
• Allows for personalized screening plan
• Provides crucial information to family members
• Allows healthcare providers to identify individuals who may benefit from additional
screenings
BRCA Screening Recommendations:
• Monthly BSE (breast self-exam) beginning at age 18
• Semiannual clinical breast exams
, NSG 550
EXAM 3
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 3 Comprehensive Study Guide
EXAM 3
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 3 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 550 EXAM 3 - DIAGNOSTIC REASONING
If you require further clarification
or in need of any study resources,
feel free to Message me.
3 EXAM PAGES 3 STUDY PAGES FULL PDF LINKED
,Table of Contents
NSG 550 Exam 3 .................................................. 2
NSG 550 Exam 3 Study Guide ............................. 51
NSG 550 Exam 3
Question 1
A 72-year-old female is brought to the clinic by her daughter, who reports that
her mother has had progressive memory loss over the past 3 years. She
forgets recent conversations, misplaces items daily, and recently got lost
driving home from the grocery store. She denies visual hallucinations or
movement disorders. Her MRI shows cortical atrophy and hippocampal
volume loss.
What is the most likely diagnosis?
• A. Vascular dementia
• B. Alzheimer's disease ✅ CORRECT
• C. Lewy body dementia
• D. Parkinsonism
Rationale: Alzheimer's disease (B) is the most common form of dementia,
characterized by progressive memory loss, cognitive decline, and changes in
behavior. The patient's gradual onset over years, prominent memory impairment,
and cortical atrophy on imaging are classic. Vascular dementia (A) typically has a
stepwise decline with focal neurologic deficits. Lewy body dementia (C) presents
with cognitive fluctuations, visual hallucinations, and movement disorders
(Parkinsonism). Parkinsonism (D) is a syndrome of tremors, rigidity, and
bradykinesia, not primarily a dementia diagnosis.
,Question 2
A 68-year-old male with a history of hypertension and two prior strokes
presents with abrupt onset of cognitive decline. His family notes that his
memory and executive function worsened stepwise after each
cerebrovascular event. He has no visual hallucinations.
Which type of dementia is most consistent with this presentation?
• A. Alzheimer's disease
• B. Lewy body dementia
• C. Vascular dementia ✅ CORRECT
• D. Frontotemporal dementia
Rationale: Vascular dementia (C) is the second most common type of dementia,
caused by reduced blood flow to the brain from cerebrovascular disease. The
stepwise decline correlating with stroke events is pathognomonic. Alzheimer's (A)
has a gradual, continuous decline. Lewy body dementia (B) features visual
hallucinations and fluctuating cognition. Frontotemporal dementia (D) presents
with personality/behavior changes and language impairment rather than stepwise
decline.
Question 3 (SATA)
A 65-year-old male presents with cognitive fluctuations, vivid visual
hallucinations of small animals in his home, and Parkinsonian features
including rigidity and bradykinesia. His symptoms fluctuate dramatically from
hour to hour.
Which of the following are characteristic features of this patient's most likely
diagnosis? Select all that apply.
• A. Abnormal protein deposits (Lewy bodies) in the brain ✅ CORRECT
• B. Cognitive fluctuations ✅ CORRECT
• C. Visual hallucinations ✅ CORRECT
• D. Movement disorders (Parkinsonism) ✅ CORRECT
• E. Stepwise cognitive decline after strokes
Rationale: This patient has Lewy body dementia (A, B, C, D), a progressive dementia
associated with abnormal protein deposits (Lewy bodies) in the brain. Core features
include cognitive fluctuations (B), visual hallucinations (C), and movement
,disorders/Parkinsonism (D). Stepwise decline after strokes (E) describes vascular
dementia, not Lewy body dementia.
Question 4
A 70-year-old female with Lewy body dementia develops worsening tremor,
rigidity, and bradykinesia. Her neurologist explains that these motor
symptoms are part of a broader syndrome.
Which syndrome is characterized by tremors, rigidity, and bradykinesia and
can occur with various types of dementia?
• A. Cerebellar ataxia
• B. Parkinsonism ✅ CORRECT
• C. Myoclonus
• D. Chorea
Rationale: Parkinsonism (B) is a syndrome characterized by tremors, rigidity, and
bradykinesia (slowed movement). It can occur in conjunction with various types of
dementia, particularly Lewy body dementia and Parkinson's disease dementia.
Cerebellar ataxia (A) involves coordination and balance. Myoclonus (C) is sudden
muscle jerking. Chorea (D) involves dance-like involuntary movements.
Question 5 (SATA)
A 45-year-old female presents for her annual well-woman examination. She
has no breast complaints. The nurse practitioner discusses breast cancer
screening options.
Which statements about mammography are correct? Select all that apply.
• A. Mammography uses low-dose x-ray for breast cancer detection. ✅
CORRECT
• B. Mammography can monitor benign breast conditions. ✅ CORRECT
• C. Mammography is used for surveillance after breast cancer treatment. ✅
CORRECT
• D. Mammography uses high-frequency sound waves instead of x-rays.
• E. Mammography is the only imaging modality needed for all breast evaluations.
,Rationale: Mammography (A, B, C) is a low-dose x-ray used for breast cancer
detection, monitoring of benign breast conditions, and surveillance after breast
cancer treatment. It does NOT use sound waves (D describes ultrasound). It is not
the only imaging needed (E) — ultrasound and MRI are used adjunctively,
particularly for dense breasts or further evaluation of abnormalities.
Question 6
A 52-year-old female undergoes screening mammography. The radiologist
reports the findings using the BI-RADS classification system.
What is the primary purpose of the Breast Imaging Reporting and Data System
(BI-RADS)?
• A. To provide a definitive diagnosis of breast cancer
• B. To serve as a risk assessment and quality assurance tool that
standardizes reporting of mammography, ultrasound, and MRI findings ✅
CORRECT
• C. To replace the need for biopsy in suspicious lesions
• D. To determine genetic risk for breast cancer
Rationale: BI-RADS (B) is a risk assessment and quality assurance tool developed
by the American College of Radiology that provides a widely accepted, standardized
way to report mammography, ultrasound, and MRI findings. It does not provide
definitive diagnosis (A) — biopsy is needed for tissue diagnosis. It does not replace
biopsy (C). Genetic risk (D) is determined by genetic testing (BRCA), not BI-RADS.
Question 7
A 48-year-old female returns for her screening mammogram results. The
radiologist assigns a BI-RADS Category 2.
Which follow-up is most appropriate?
• A. Immediate biopsy
• B. Short-interval follow-up in 6 months
• C. Routine annual mammogram ✅ CORRECT
• D. Referral to breast surgeon
, NSG 550 Exam 3 Study Guide
1. Neurology & Dementia
Types of Dementia:
• Alzheimer's Disease: The most common form of dementia, characterized by memory
loss, cognitive decline, and changes in behavior
• Vascular Dementia: The second most common type, often caused by reduced blood flow
to the brain, leading to cognitive impairment
• Lewy Body Dementia: Progressive dementia associated with abnormal protein deposits
in the brain, leading to cognitive fluctuations, visual hallucinations, and movement
disorders
• Parkinsonism: Syndrome characterized by tremors, rigidity, and bradykinesia; can
occur with various types of dementia including Lewy Body dementia
Dementia Workup - What to Rule Out:
• Infection, endocrine disorders, B12 deficiency
• Metabolic testing + infectious workup
• Labs: TSH, vitamin B12, CBC with differential, CMP, magnesium, ESR, CRP,
homocysteine
Other Testing for Dementia:
• Cognitive testing, mental status exam
• NOT doing genetic testing in clinic
Seizure Testing:
• EEG (electroencephalogram)
Meningitis Testing:
• LP (lumbar puncture/spinal tap): collect cerebrospinal fluid to look for infection,
inflammation
Toxicology Testing:
• Tox report: drug levels, ETOH
• Common meds to test: seizure meds, digoxin, vanco
• Measures levels of chemicals, drugs, poisons, or toxins in the body; used in overdose,
poisoning, or exposure cases
• Pt with hx of seizures on keppra, presents with breakthrough seizure → test tox report
to check antiepileptic med levels/compliance
MRI of Brain:
,• To visualize cerebellum, brain stem, cerebrum
MRI of Spine:
• To visualize nerves, ligaments, vertebrae, spinal cord, discs, nerve root, foramen (hole
where nerve roots come out)
• Nerve impingement from herniated disc
• Concern for ligamentous injury
MRA (Magnetic Resonance Angiography):
• Blood vessels; anything vascular
• Brain: aneurysm, AV malformation
• Neck: carotid
Carotid Bruit:
• Order carotid duplex or carotid US
Herpes Zoster (Shingles):
• Typical presentation: vesicular rash in dermatomal or linear distribution
2. Breast Imaging & Cancer Screening
Mammogram:
• Low-dose x-ray for breast cancer detection, monitoring of benign breast conditions, and
monitoring of breast cancer
• Only way to detect microcalcifications
• Low-dose x-ray used for breast cancer screening and evaluation of breast conditions
What is Included in Mammography Report:
• Patient info
• Imaging findings
• BIRADS assessment [universal discussion of findings/assessment so all providers can
communicate]
• Density of breast tissue
• Clinical correlation
• Follow-up recommendations
• Summary of findings
BI-RADS (Breast Imaging Reporting and Data System):
• Risk assessment and quality assurance tool developed by American College of Radiology
• Provides widely accepted way to report mammography, ultrasound and MRI findings
• Standardized system for reporting findings; assesses risk and guides follow-up
BI-RADS Categories:
• Category 0: Incomplete/bad study, poor imaging; abnormality noted but need additional
imaging evaluation
,• Category 1: Negative; symmetrical, no masses, architectural distortion, or suspicious
calcifications; routine annual mammogram
• Category 2: Benign findings noted; 0% probability of malignancy (e.g., fibrocystic); may
not need follow-up other than routine yearly mammogram
• Category 3: Probably benign; <2% probability of malignancy; short interval follow-up
suggested; repeat imaging, no biopsy
• Category 4: Suspicious for malignancy; further evaluation with biopsy should be
considered due to high probability of malignancy
• Category 5: Cancer is highly suspected; highly suggestive of malignancy; >95%
probability; immediate referral required
• Category 6: Known biopsy-proven malignancy; staging; being treated or looking for
disease progression/treatment response
Breast Ultrasound:
• Non-invasive, radiation-free medical imaging technique using high-frequency sound
waves
• Used to determine if palpable lump or lesion found on mammogram is cystic or solid
• Most cysts are benign
• Also used for breast cancer screening in women with dense breasts found on
mammogram
• Evaluates breast masses; distinguishes cystic vs solid lesions
Benign Breast Lesion Ultrasound Appearance:
• Hypoechoic (dark) and well-circumscribed (edges well-defined and easily
distinguishable from normal tissue)
• Posterior acoustic enhancement (brightened area seen behind fluid-filled structure)
Cancer, Hematoma, or Abscess Ultrasound Appearance:
• Hypoechoic but NOT well-circumscribed
• Acoustic shadowing (sound waves blocked by lesion resulting in dark shadow-like area
behind lesion)
Genetic Testing for Cancer:
• Detects increased susceptibility to inherited conditions: breast cancer (BRCA),
medullary thyroid cancer, certain skin and kidney cancers, Lynch syndrome
• Identifies inherited mutations in genes such as BRCA1 and BRCA2
• Allows for personalized screening plan
• Provides crucial information to family members
• Allows healthcare providers to identify individuals who may benefit from additional
screenings
BRCA Screening Recommendations:
• Monthly BSE (breast self-exam) beginning at age 18
• Semiannual clinical breast exams
, NSG 550
EXAM 3
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 3 Comprehensive Study Guide
