Page 1 of 193
NSG 550 Exam 2 - Diagnostic Reasoning–
QUESTIONS AND DETAILED SOLUTIONS JUST
RELEASED
NSG 550 Exam 2 - Diagnostic Reasoning
Wilkes University -Questions with Rationales
10 POINT FORM EXAM COVERAGE AREAS (MOSTLY TESTED)
1. Diagnostic Reasoning Frameworks - Dual-process theory (System 1 intuitive vs System 2 analytical),
hypothesis generation, and differential diagnosis development
2. Cognitive Biases and Error Prevention - Anchoring, availability heuristic, confirmation bias, premature
closure, and strategies to minimize diagnostic errors
3. Bayesian Reasoning and Probability - Pretest probability, posttest probability, sensitivity, specificity,
predictive values, and likelihood ratios
4. Pulmonary Diagnostic Testing - Spirometry (FEV1/FVC ratio), CXR interpretation, D-dimer, V/Q scan,
CT scans with/without contrast, ABG interpretation, and sputum studies (C+S, AFB, cytology)
5. Cardiovascular Diagnostic Testing - ECG interpretation (ST elevation patterns, infarction localization),
cardiac biomarkers (troponin, CK-MB, BNP), cardiac stress testing, and vascular studies (Doppler,
ultrasound)
6. GI and Hepatobiliary Testing - Liver function tests, amylase/lipase, H. pylori testing, CT scan, KUB, and
endoscopic procedures
7. Pulmonary Conditions - COPD, asthma, pneumonia, pulmonary embolism, tuberculosis, and alpha-1
antitrypsin deficiency
8. Cardiovascular Conditions - Myocardial infarction, heart failure, valvular disease, pericarditis, and DVT
9. SOAP Documentation and Clinical Communication - OLDCARTS mnemonic, problem prioritization
(Maslow's hierarchy), and accurate clinical documentation
, Page 2 of 193
10. Integrative Clinical Cases - Multisystem presentations requiring synthesis of data from multiple
sources to formulate differential diagnoses across the lifespan
MULTIPLE CHOICE QUESTIONS
1. A 45-year-old male presents with acute-onset chest pain. Which initial step in diagnostic reasoning is
most critical for the nurse practitioner to perform?
A. Order a chest X-ray immediately
B. Generate a differential diagnosis
C. Prescribe nitroglycerin
D. Obtain a detailed social history
Answer: B - Generating a differential diagnosis guides focused history, physical exam, and testing.
Ordering tests without a hypothesis leads to inefficiency and diagnostic error .
, Page 3 of 193
2. A nurse practitioner uses the dual-process model of reasoning. Which of the following best describes
System 1 (intuitive) reasoning?
A. Slow, deliberate, analytical processing
B. Rapid, automatic, pattern-recognition processing
C. Requires significant cognitive effort
D. Based on statistical probability calculations
Answer: B - System 1 reasoning is fast, automatic, and based on pattern recognition and intuition
derived from experience. System 2 is slow, deliberate, and analytical .
---
3. Which of the following best describes System 2 (analytical) reasoning in clinical decision-making?
A. Rapid and automatic processing
B. Pattern recognition based on experience
, Page 4 of 193
C. Slow, deliberate, and hypothesis-driven
D. Highly prone to cognitive biases
Answer: C - System 2 reasoning is slow, deliberate, effortful, and uses analytical processes to test
hypotheses. It is less prone to bias but requires more time and cognitive energy .
---
4. A patient presents with a chief complaint of "cough." Using the OLDCARTS mnemonic for the History
of Present Illness, which question best addresses the "C" component?
A. "When did this cough start?"
B. "Can you describe what the cough feels like—is it dry or wet?"
C. "Where exactly do you feel the discomfort when you cough?"
D. "What makes the cough better or worse?"
NSG 550 Exam 2 - Diagnostic Reasoning–
QUESTIONS AND DETAILED SOLUTIONS JUST
RELEASED
NSG 550 Exam 2 - Diagnostic Reasoning
Wilkes University -Questions with Rationales
10 POINT FORM EXAM COVERAGE AREAS (MOSTLY TESTED)
1. Diagnostic Reasoning Frameworks - Dual-process theory (System 1 intuitive vs System 2 analytical),
hypothesis generation, and differential diagnosis development
2. Cognitive Biases and Error Prevention - Anchoring, availability heuristic, confirmation bias, premature
closure, and strategies to minimize diagnostic errors
3. Bayesian Reasoning and Probability - Pretest probability, posttest probability, sensitivity, specificity,
predictive values, and likelihood ratios
4. Pulmonary Diagnostic Testing - Spirometry (FEV1/FVC ratio), CXR interpretation, D-dimer, V/Q scan,
CT scans with/without contrast, ABG interpretation, and sputum studies (C+S, AFB, cytology)
5. Cardiovascular Diagnostic Testing - ECG interpretation (ST elevation patterns, infarction localization),
cardiac biomarkers (troponin, CK-MB, BNP), cardiac stress testing, and vascular studies (Doppler,
ultrasound)
6. GI and Hepatobiliary Testing - Liver function tests, amylase/lipase, H. pylori testing, CT scan, KUB, and
endoscopic procedures
7. Pulmonary Conditions - COPD, asthma, pneumonia, pulmonary embolism, tuberculosis, and alpha-1
antitrypsin deficiency
8. Cardiovascular Conditions - Myocardial infarction, heart failure, valvular disease, pericarditis, and DVT
9. SOAP Documentation and Clinical Communication - OLDCARTS mnemonic, problem prioritization
(Maslow's hierarchy), and accurate clinical documentation
, Page 2 of 193
10. Integrative Clinical Cases - Multisystem presentations requiring synthesis of data from multiple
sources to formulate differential diagnoses across the lifespan
MULTIPLE CHOICE QUESTIONS
1. A 45-year-old male presents with acute-onset chest pain. Which initial step in diagnostic reasoning is
most critical for the nurse practitioner to perform?
A. Order a chest X-ray immediately
B. Generate a differential diagnosis
C. Prescribe nitroglycerin
D. Obtain a detailed social history
Answer: B - Generating a differential diagnosis guides focused history, physical exam, and testing.
Ordering tests without a hypothesis leads to inefficiency and diagnostic error .
, Page 3 of 193
2. A nurse practitioner uses the dual-process model of reasoning. Which of the following best describes
System 1 (intuitive) reasoning?
A. Slow, deliberate, analytical processing
B. Rapid, automatic, pattern-recognition processing
C. Requires significant cognitive effort
D. Based on statistical probability calculations
Answer: B - System 1 reasoning is fast, automatic, and based on pattern recognition and intuition
derived from experience. System 2 is slow, deliberate, and analytical .
---
3. Which of the following best describes System 2 (analytical) reasoning in clinical decision-making?
A. Rapid and automatic processing
B. Pattern recognition based on experience
, Page 4 of 193
C. Slow, deliberate, and hypothesis-driven
D. Highly prone to cognitive biases
Answer: C - System 2 reasoning is slow, deliberate, effortful, and uses analytical processes to test
hypotheses. It is less prone to bias but requires more time and cognitive energy .
---
4. A patient presents with a chief complaint of "cough." Using the OLDCARTS mnemonic for the History
of Present Illness, which question best addresses the "C" component?
A. "When did this cough start?"
B. "Can you describe what the cough feels like—is it dry or wet?"
C. "Where exactly do you feel the discomfort when you cough?"
D. "What makes the cough better or worse?"
