,NSG 550 Diagnostic Reasoning Exam 2 Wilkes
University Study Guide Clinical Reasoning +
Q&A + Rationales 2026/2027
1. A 58-year-old man presents with intermittent substernal pressure that radiates to the left jaw
and is provoked by climbing two flights of stairs. The discomfort resolves within three minutes
of rest. He denies associated diaphoresis or nausea. Which element of the history most strongly
supports a diagnosis of stable angina rather than an acute coronary syndrome?
A. Substernal location of the pressure
B. Age greater than 55 years
C. Resolution of symptoms with rest within minutes
D. Radiation of pain to the jaw
Correct Answer: C. Resolution of symptoms with rest within minutes
Rationale: Symptoms that are reproducibly provoked by exertion and promptly relieved by rest
are the hallmark of stable angina. Radiation, location, and age increase pretest probability of
coronary disease but do not distinguish stable from unstable presentations. Acute coronary
syndrome is suggested by pain at rest, prolonged duration, or crescendo pattern.
2. A nurse practitioner uses a dual-process model of reasoning. Which scenario best describes
the intuitive (Type 1) process?
A. Systematically comparing differential diagnoses using likelihood ratios
B. Immediately recognizing a pattern of symptoms as a familiar illness
,C. Generating a comprehensive list of possible diagnoses
D. Ordering a broad panel of diagnostic tests to rule out all possibilities
Correct Answer: B. Immediately recognizing a pattern of symptoms as a familiar illness
Rationale: Type 1 (intuitive) reasoning is fast, automatic, and based on pattern recognition and
experience. Type 2 (analytic) reasoning is slow, deliberate, and systematic. The dual-process
model describes how clinicians use both types of reasoning, often alternating between them.
3. A clinician clings to early information and fails to adjust based on new data. This is an
example of:
A. Anchoring bias
B. Confirmation bias
C. Framing effect
D. Search satisficing
Correct Answer: A. Anchoring bias
Rationale: Anchoring bias occurs when a clinician becomes fixed on initial information and does
not adequately adjust the diagnostic hypothesis when new data becomes available. This is one
of the most common cognitive errors in diagnostic reasoning.
4. A test with high sensitivity is best used to:
, A. Rule in disease
B. Rule out disease
C. Confirm disease
D. Establish prevalence
Correct Answer: B. Rule out disease
Rationale: High sensitivity means few false negatives. The mnemonic "SnNout" reminds us that
a highly sensitive test, when negative, helps rule out disease. This is important for screening
tests where missing cases is dangerous.
5. A 72-year-old female with HFrEF (EF 35%), COPD, and T2DM presents with 1 week of
increased fatigue and mild dyspnea on usual exertion. Medications: lisinopril, metoprolol,
furosemide 40 mg daily, metformin, SABA/ICS inhaler. Afebrile, RR 22, SpO₂ 94% on RA, trace
bilateral edema. Lung sounds reveal faint bibasilar crackles. Adherent to meds. Which initial
diagnostic approach is MOST appropriate?
A. Order CT pulmonary angiogram to rule out PE, as she has multiple risk factors.
B. Increase furosemide to 80 mg daily empirically for presumed heart failure exacerbation.
C. Order BNP, BMP, CXR, and schedule follow-up in 48–72 hours to reassess.
D. Refer directly to ED for inpatient management of acute decompensated heart failure.
Correct Answer: C. Order BNP, BMP, CXR, and schedule follow-up in 48–72 hours to reassess.
University Study Guide Clinical Reasoning +
Q&A + Rationales 2026/2027
1. A 58-year-old man presents with intermittent substernal pressure that radiates to the left jaw
and is provoked by climbing two flights of stairs. The discomfort resolves within three minutes
of rest. He denies associated diaphoresis or nausea. Which element of the history most strongly
supports a diagnosis of stable angina rather than an acute coronary syndrome?
A. Substernal location of the pressure
B. Age greater than 55 years
C. Resolution of symptoms with rest within minutes
D. Radiation of pain to the jaw
Correct Answer: C. Resolution of symptoms with rest within minutes
Rationale: Symptoms that are reproducibly provoked by exertion and promptly relieved by rest
are the hallmark of stable angina. Radiation, location, and age increase pretest probability of
coronary disease but do not distinguish stable from unstable presentations. Acute coronary
syndrome is suggested by pain at rest, prolonged duration, or crescendo pattern.
2. A nurse practitioner uses a dual-process model of reasoning. Which scenario best describes
the intuitive (Type 1) process?
A. Systematically comparing differential diagnoses using likelihood ratios
B. Immediately recognizing a pattern of symptoms as a familiar illness
,C. Generating a comprehensive list of possible diagnoses
D. Ordering a broad panel of diagnostic tests to rule out all possibilities
Correct Answer: B. Immediately recognizing a pattern of symptoms as a familiar illness
Rationale: Type 1 (intuitive) reasoning is fast, automatic, and based on pattern recognition and
experience. Type 2 (analytic) reasoning is slow, deliberate, and systematic. The dual-process
model describes how clinicians use both types of reasoning, often alternating between them.
3. A clinician clings to early information and fails to adjust based on new data. This is an
example of:
A. Anchoring bias
B. Confirmation bias
C. Framing effect
D. Search satisficing
Correct Answer: A. Anchoring bias
Rationale: Anchoring bias occurs when a clinician becomes fixed on initial information and does
not adequately adjust the diagnostic hypothesis when new data becomes available. This is one
of the most common cognitive errors in diagnostic reasoning.
4. A test with high sensitivity is best used to:
, A. Rule in disease
B. Rule out disease
C. Confirm disease
D. Establish prevalence
Correct Answer: B. Rule out disease
Rationale: High sensitivity means few false negatives. The mnemonic "SnNout" reminds us that
a highly sensitive test, when negative, helps rule out disease. This is important for screening
tests where missing cases is dangerous.
5. A 72-year-old female with HFrEF (EF 35%), COPD, and T2DM presents with 1 week of
increased fatigue and mild dyspnea on usual exertion. Medications: lisinopril, metoprolol,
furosemide 40 mg daily, metformin, SABA/ICS inhaler. Afebrile, RR 22, SpO₂ 94% on RA, trace
bilateral edema. Lung sounds reveal faint bibasilar crackles. Adherent to meds. Which initial
diagnostic approach is MOST appropriate?
A. Order CT pulmonary angiogram to rule out PE, as she has multiple risk factors.
B. Increase furosemide to 80 mg daily empirically for presumed heart failure exacerbation.
C. Order BNP, BMP, CXR, and schedule follow-up in 48–72 hours to reassess.
D. Refer directly to ED for inpatient management of acute decompensated heart failure.
Correct Answer: C. Order BNP, BMP, CXR, and schedule follow-up in 48–72 hours to reassess.
