Page 1 of 280
NSG 550 EXAMS 1–3 (PDF) - DIAGNOSTIC
REASONING (3 FULL SETS EACH SET
CONTAINING 150 Q& A) *** 450 QUESTIONS AND
VERIFIED ANSWERS | 2026/2027 UPDATE
NSG 550 Diagnostic Reasoning Examination EXAM 1
Section 1: Questions 1–50
A 52-year-old male with a 30-pack-year smoking history
presents with a persistent cough and hemoptysis. Which
finding on a chest CT would be most characteristic of a
primary malignant lung neoplasm versus a benign process?
A. A well-circumscribed, smooth-edged nodule with central
calcification
B. A speculated, irregularly marginated mass with associated
pleural retraction
C. A diffuse, bilateral interstitial infiltrate with a "ground-glass"
appearance
D. A thin-walled, air-filled cavity with a visible air-fluid level
Correct Answer: B
Rationale: A speculated margin and pleural retraction are
classic signs of malignancy, indicating invasion and
,Page 2 of 280
desmoplastic reaction. A smooth, calcified nodule suggests a
granuloma. Interstitial infiltrates are more consistent with
interstitial lung disease. A cavitary lesion with an air-fluid level
is typical of an infection or abscess, not primary malignancy.
2. A 45-year-old female presents with fatigue, weight gain, and
cold intolerance. Her TSH is elevated, and free T4 is low. What
is the most likely underlying etiology of her primary
hypothyroidism?
A. Pituitary adenoma
B. Hypothalamic dysfunction
C. Autoimmune thyroiditis (Hashimoto's)
D. Iatrogenic from thyroidectomy
Correct Answer: C
Rationale: In a developed country, Hashimoto's thyroiditis is the
most common cause of primary hypothyroidism. A pituitary
adenoma would cause secondary hypothyroidism (low TSH).
Hypothalamic dysfunction would cause tertiary hypothyroidism.
3. A 68-year-old man with a history of hypertension and
diabetes presents with sudden, painless vision loss in the right
eye. Fundoscopic exam reveals a pale, swollen optic disc with
scattered flame-shaped hemorrhages. What is the most likely
diagnosis?
A. Retinal vein occlusion
B. Retinal artery occlusion
,Page 3 of 280
C. Acute angle-closure glaucoma
D. Vitreous hemorrhage
Correct Answer: B
Rationale: Central retinal artery occlusion (CRAO) presents with
sudden, painless, unilateral vision loss with a pale, edematous
retina and a "cherry-red spot" at the fovea. The pale disc and
hemorrhages support an ischemic event. Retinal vein occlusion
typically presents with more widespread hemorrhages. Angle-
closure glaucoma is painful.
4. A 30-year-old pregnant woman at 28 weeks gestation
reports new-onset headaches and blurred vision. Her blood
pressure is 155/100 mmHg. Urinalysis shows 3+ protein. What
is the priority nursing intervention?
A. Prescribe oral acetaminophen for headache
B. Advise bed rest and schedule a follow-up in one week
C. Initiate seizure prophylaxis with magnesium sulfate
D. Encourage increased fluid intake
Correct Answer: C
Rationale: The patient is presenting with preeclampsia with
severe features (headache, visual changes, and severe
hypertension). Magnesium sulfate is the standard of care for
seizure prophylaxis to prevent eclampsia. Acetaminophen
addresses a symptom, not the underlying pathology.
, Page 4 of 280
5. A 72-year-old patient is found to have a new, asymptomatic
carotid bruit. What is the most appropriate initial step in
management?
A. Immediate referral for carotid endarterectomy
B. Initiate aspirin and high-intensity statin therapy
C. Order a carotid duplex ultrasound
D. Schedule a stress echocardiogram
Correct Answer: C
Rationale: A carotid bruit warrants a carotid duplex ultrasound
to assess for the degree of stenosis. Medical therapy
(aspirin/statin) may be initiated, but the ultrasound is the first
step to quantify the disease. Endarterectomy is only indicated
for significant stenosis in select patients.
6. A 60-year-old male with a history of GERD complains of
chest pain that is substernal, radiating to his back, and
associated with a tearing sensation. Blood pressure is 100/60
mmHg. What is the most critical diagnostic test to order
immediately?
A. 12-lead ECG
B. Serum troponin
C. CT angiography of the chest
D. Chest X-ray
Correct Answer: C
Rationale: The tearing pain radiating to the back, in conjunction
with hypotension, is highly suspicious for an aortic dissection. CT
NSG 550 EXAMS 1–3 (PDF) - DIAGNOSTIC
REASONING (3 FULL SETS EACH SET
CONTAINING 150 Q& A) *** 450 QUESTIONS AND
VERIFIED ANSWERS | 2026/2027 UPDATE
NSG 550 Diagnostic Reasoning Examination EXAM 1
Section 1: Questions 1–50
A 52-year-old male with a 30-pack-year smoking history
presents with a persistent cough and hemoptysis. Which
finding on a chest CT would be most characteristic of a
primary malignant lung neoplasm versus a benign process?
A. A well-circumscribed, smooth-edged nodule with central
calcification
B. A speculated, irregularly marginated mass with associated
pleural retraction
C. A diffuse, bilateral interstitial infiltrate with a "ground-glass"
appearance
D. A thin-walled, air-filled cavity with a visible air-fluid level
Correct Answer: B
Rationale: A speculated margin and pleural retraction are
classic signs of malignancy, indicating invasion and
,Page 2 of 280
desmoplastic reaction. A smooth, calcified nodule suggests a
granuloma. Interstitial infiltrates are more consistent with
interstitial lung disease. A cavitary lesion with an air-fluid level
is typical of an infection or abscess, not primary malignancy.
2. A 45-year-old female presents with fatigue, weight gain, and
cold intolerance. Her TSH is elevated, and free T4 is low. What
is the most likely underlying etiology of her primary
hypothyroidism?
A. Pituitary adenoma
B. Hypothalamic dysfunction
C. Autoimmune thyroiditis (Hashimoto's)
D. Iatrogenic from thyroidectomy
Correct Answer: C
Rationale: In a developed country, Hashimoto's thyroiditis is the
most common cause of primary hypothyroidism. A pituitary
adenoma would cause secondary hypothyroidism (low TSH).
Hypothalamic dysfunction would cause tertiary hypothyroidism.
3. A 68-year-old man with a history of hypertension and
diabetes presents with sudden, painless vision loss in the right
eye. Fundoscopic exam reveals a pale, swollen optic disc with
scattered flame-shaped hemorrhages. What is the most likely
diagnosis?
A. Retinal vein occlusion
B. Retinal artery occlusion
,Page 3 of 280
C. Acute angle-closure glaucoma
D. Vitreous hemorrhage
Correct Answer: B
Rationale: Central retinal artery occlusion (CRAO) presents with
sudden, painless, unilateral vision loss with a pale, edematous
retina and a "cherry-red spot" at the fovea. The pale disc and
hemorrhages support an ischemic event. Retinal vein occlusion
typically presents with more widespread hemorrhages. Angle-
closure glaucoma is painful.
4. A 30-year-old pregnant woman at 28 weeks gestation
reports new-onset headaches and blurred vision. Her blood
pressure is 155/100 mmHg. Urinalysis shows 3+ protein. What
is the priority nursing intervention?
A. Prescribe oral acetaminophen for headache
B. Advise bed rest and schedule a follow-up in one week
C. Initiate seizure prophylaxis with magnesium sulfate
D. Encourage increased fluid intake
Correct Answer: C
Rationale: The patient is presenting with preeclampsia with
severe features (headache, visual changes, and severe
hypertension). Magnesium sulfate is the standard of care for
seizure prophylaxis to prevent eclampsia. Acetaminophen
addresses a symptom, not the underlying pathology.
, Page 4 of 280
5. A 72-year-old patient is found to have a new, asymptomatic
carotid bruit. What is the most appropriate initial step in
management?
A. Immediate referral for carotid endarterectomy
B. Initiate aspirin and high-intensity statin therapy
C. Order a carotid duplex ultrasound
D. Schedule a stress echocardiogram
Correct Answer: C
Rationale: A carotid bruit warrants a carotid duplex ultrasound
to assess for the degree of stenosis. Medical therapy
(aspirin/statin) may be initiated, but the ultrasound is the first
step to quantify the disease. Endarterectomy is only indicated
for significant stenosis in select patients.
6. A 60-year-old male with a history of GERD complains of
chest pain that is substernal, radiating to his back, and
associated with a tearing sensation. Blood pressure is 100/60
mmHg. What is the most critical diagnostic test to order
immediately?
A. 12-lead ECG
B. Serum troponin
C. CT angiography of the chest
D. Chest X-ray
Correct Answer: C
Rationale: The tearing pain radiating to the back, in conjunction
with hypotension, is highly suspicious for an aortic dissection. CT
