EXAM 1
Diagnostic Reasoning
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Wilkes University
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,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?