Pass NSG 550 Exams 1–3 – Wilkes Diagnostic
Reasoning (2026) Actual Questions, Verified
Answers with Study Guide | Take & Pass
QUESTION 1
A 45-year-old male presents with acute chest pain, diaphoresis, and
nausea. ECG shows ST elevation in leads II, III, aVF. What is the most
likely diagnosis?
A) Anterior wall myocardial infarction
B) Inferior wall myocardial infarction
C) Non-ST elevation myocardial infarction
D) Pericarditis
ANSWER: B) Inferior wall myocardial infarction
EXPLANATION: ST elevation in leads II, III, and aVF (the inferior leads)
indicates an inferior wall myocardial infarction, typically caused by
right coronary artery occlusion. ST elevation in other lead
distributions would suggest different wall involvement. Pericarditis
presents with diffuse, concave ST elevation .
QUESTION 2
,A 62-year-old female presents with fatigue, dyspnea, and bilateral
lower extremity edema. JVP is elevated and an S3 gallop is
auscultated. What is the most likely diagnosis?
A) COPD exacerbation
B) Pulmonary embolism
C) Congestive heart failure
D) Pericardial effusion
ANSWER: C) Congestive heart failure
EXPLANATION: The classic signs of volume overload—elevated JVP,
peripheral edema, and an S3 gallop—along with fatigue and dyspnea
indicate reduced cardiac output from congestive heart failure. An
S3 is an early diastolic filling sound that occurs in volume overload
states .
QUESTION 3
A 38-year-old female presents with 3 months of fatigue, weight gain,
and cold intolerance. TSH is 8.5 mIU/L and free T4 is low. What is
the most likely diagnosis?
A) Graves' disease
B) Primary hypothyroidism
C) Subacute thyroiditis
D) Toxic multinodular goiter
,ANSWER: B) Primary hypothyroidism
EXPLANATION: An elevated TSH with low free T4 confirms primary
hypothyroidism—the thyroid gland itself is failing to produce
adequate hormone. Graves' disease and toxic multinodular goiter
cause hyperthyroidism with suppressed TSH .
QUESTION 4
A 55-year-old male smoker presents with chronic cough, wheezing,
and dyspnea. Spirometry shows FEV1/FVC < 70%. What is the most
likely diagnosis?
A) Asthma
B) COPD
C) Bronchiectasis
D) Interstitial lung disease
ANSWER: B) COPD
EXPLANATION: An FEV1/FVC ratio < 70% confirms an obstructive
pattern on spirometry. In a chronic smoker with chronic cough and
wheezing, COPD is the most likely diagnosis. Asthma also causes
obstruction but typically presents with reversibility and variable
symptoms .
QUESTION 5
, A 28-year-old female presents with irregular menses, hirsutism,
and acne. BMI is 32. What is the most likely diagnosis?
A) Cushing's syndrome
B) Polycystic ovary syndrome
C) Congenital adrenal hyperplasia
D) Ovarian tumor
ANSWER: B) Polycystic ovary syndrome
EXPLANATION: The Rotterdam criteria for PCOS require two of
three: oligo-ovulation, hyperandrogenism (hirsutism, acne), and
polycystic ovaries on ultrasound. This patient meets criteria with
irregular menses (oligo-ovulation) and signs of hyperandrogenism .
QUESTION 6
A 70-year-old male presents with acute confusion, urinary
incontinence, and gait instability. He had a recent UTI. What is the
most likely diagnosis?
A) Alzheimer's disease
B) Dementia with Lewy bodies
C) Delirium
D) Parkinson's disease
ANSWER: C) Delirium
Reasoning (2026) Actual Questions, Verified
Answers with Study Guide | Take & Pass
QUESTION 1
A 45-year-old male presents with acute chest pain, diaphoresis, and
nausea. ECG shows ST elevation in leads II, III, aVF. What is the most
likely diagnosis?
A) Anterior wall myocardial infarction
B) Inferior wall myocardial infarction
C) Non-ST elevation myocardial infarction
D) Pericarditis
ANSWER: B) Inferior wall myocardial infarction
EXPLANATION: ST elevation in leads II, III, and aVF (the inferior leads)
indicates an inferior wall myocardial infarction, typically caused by
right coronary artery occlusion. ST elevation in other lead
distributions would suggest different wall involvement. Pericarditis
presents with diffuse, concave ST elevation .
QUESTION 2
,A 62-year-old female presents with fatigue, dyspnea, and bilateral
lower extremity edema. JVP is elevated and an S3 gallop is
auscultated. What is the most likely diagnosis?
A) COPD exacerbation
B) Pulmonary embolism
C) Congestive heart failure
D) Pericardial effusion
ANSWER: C) Congestive heart failure
EXPLANATION: The classic signs of volume overload—elevated JVP,
peripheral edema, and an S3 gallop—along with fatigue and dyspnea
indicate reduced cardiac output from congestive heart failure. An
S3 is an early diastolic filling sound that occurs in volume overload
states .
QUESTION 3
A 38-year-old female presents with 3 months of fatigue, weight gain,
and cold intolerance. TSH is 8.5 mIU/L and free T4 is low. What is
the most likely diagnosis?
A) Graves' disease
B) Primary hypothyroidism
C) Subacute thyroiditis
D) Toxic multinodular goiter
,ANSWER: B) Primary hypothyroidism
EXPLANATION: An elevated TSH with low free T4 confirms primary
hypothyroidism—the thyroid gland itself is failing to produce
adequate hormone. Graves' disease and toxic multinodular goiter
cause hyperthyroidism with suppressed TSH .
QUESTION 4
A 55-year-old male smoker presents with chronic cough, wheezing,
and dyspnea. Spirometry shows FEV1/FVC < 70%. What is the most
likely diagnosis?
A) Asthma
B) COPD
C) Bronchiectasis
D) Interstitial lung disease
ANSWER: B) COPD
EXPLANATION: An FEV1/FVC ratio < 70% confirms an obstructive
pattern on spirometry. In a chronic smoker with chronic cough and
wheezing, COPD is the most likely diagnosis. Asthma also causes
obstruction but typically presents with reversibility and variable
symptoms .
QUESTION 5
, A 28-year-old female presents with irregular menses, hirsutism,
and acne. BMI is 32. What is the most likely diagnosis?
A) Cushing's syndrome
B) Polycystic ovary syndrome
C) Congenital adrenal hyperplasia
D) Ovarian tumor
ANSWER: B) Polycystic ovary syndrome
EXPLANATION: The Rotterdam criteria for PCOS require two of
three: oligo-ovulation, hyperandrogenism (hirsutism, acne), and
polycystic ovaries on ultrasound. This patient meets criteria with
irregular menses (oligo-ovulation) and signs of hyperandrogenism .
QUESTION 6
A 70-year-old male presents with acute confusion, urinary
incontinence, and gait instability. He had a recent UTI. What is the
most likely diagnosis?
A) Alzheimer's disease
B) Dementia with Lewy bodies
C) Delirium
D) Parkinson's disease
ANSWER: C) Delirium
