ANCC IQ
DOMAIN 3: DIAGNOSIS AND
TREATMENT
FINAL ASSESSMENT REVIEW
2026
Multiple Choice Questions (MCQs)
A 52-year-old patient presents with fatigue, weight loss, and night sweats. Physical
exam reveals cervical lymphadenopathy. Which initial diagnostic test is most
appropriate? A) Chest X-ray B) Lymph node biopsy C) Complete blood count with
differential D) ESR and CRP
Answer: B) Lymph node biopsy
Rationale: Lymphadenopathy with constitutional symptoms raises suspicion for
lymphoma. Definitive diagnosis requires tissue biopsy for histopathological
evaluation.
2. Which of the following clinical findings best differentiates bacterial from viral
meningitis?
A) Presence of rash
B) Elevated CSF protein and decreased glucose
C) Photophobia
D) Fever
Answer: B) Elevated CSF protein and decreased glucose
Rationale: Bacterial meningitis typically presents with elevated protein and
decreased glucose in CSF, while viral meningitis usually has normal glucose.
3. When initiating treatment for type 2 diabetes mellitus in an obese patient, which
medication class is preferred as first line?
A) Sulfonylureas
B) Metformin
C) Insulin
D) DPP-4 inhibitors
1
, Answer: B) Metformin
Rationale: Metformin is the recommended first-line agent due to its efficacy, safety
profile, and cardiovascular benefits.
4. In a patient with chronic lower back pain, which red flag symptom warrants urgent
imaging?
A) Pain worse with activity
B) Pain radiating to the thigh
C) Unexplained weight loss
D) Morning stiffness
Answer: C) Unexplained weight loss
Rationale: Weight loss may indicate malignancy or systemic disease requiring urgent
evaluation.
5. A 65-year-old man presents with confusion and focal neurological deficits after a
fall. The most appropriate imaging modality is:
A) MRI brain without contrast
B) CT head without contrast
C) PET scan
D) Ultrasound of the head
Answer: B) CT head without contrast
Rationale: CT is rapid, readily available, and best for initial evaluation of head
trauma for hemorrhage.
True/False Questions
True or False: Elevated troponin levels always indicate a myocardial infarction.
Answer: False
Rationale: Troponin elevation can occur in other conditions including myocarditis,
renal failure, and pulmonary embolism.
True or False: In acute asthma exacerbation, peak expiratory flow rate (PEFR) is the
most reliable monitoring tool for severity.
Answer: True
Rationale: PEFR measurement provides objective assessment of airway obstruction
and response to therapy.
True or False: Antibiotics are always indicated in acute bronchitis.
Answer: False
Rationale: Acute bronchitis is most often viral; antibiotics are not routinely
recommended unless bacterial infection is suspected.
2
DOMAIN 3: DIAGNOSIS AND
TREATMENT
FINAL ASSESSMENT REVIEW
2026
Multiple Choice Questions (MCQs)
A 52-year-old patient presents with fatigue, weight loss, and night sweats. Physical
exam reveals cervical lymphadenopathy. Which initial diagnostic test is most
appropriate? A) Chest X-ray B) Lymph node biopsy C) Complete blood count with
differential D) ESR and CRP
Answer: B) Lymph node biopsy
Rationale: Lymphadenopathy with constitutional symptoms raises suspicion for
lymphoma. Definitive diagnosis requires tissue biopsy for histopathological
evaluation.
2. Which of the following clinical findings best differentiates bacterial from viral
meningitis?
A) Presence of rash
B) Elevated CSF protein and decreased glucose
C) Photophobia
D) Fever
Answer: B) Elevated CSF protein and decreased glucose
Rationale: Bacterial meningitis typically presents with elevated protein and
decreased glucose in CSF, while viral meningitis usually has normal glucose.
3. When initiating treatment for type 2 diabetes mellitus in an obese patient, which
medication class is preferred as first line?
A) Sulfonylureas
B) Metformin
C) Insulin
D) DPP-4 inhibitors
1
, Answer: B) Metformin
Rationale: Metformin is the recommended first-line agent due to its efficacy, safety
profile, and cardiovascular benefits.
4. In a patient with chronic lower back pain, which red flag symptom warrants urgent
imaging?
A) Pain worse with activity
B) Pain radiating to the thigh
C) Unexplained weight loss
D) Morning stiffness
Answer: C) Unexplained weight loss
Rationale: Weight loss may indicate malignancy or systemic disease requiring urgent
evaluation.
5. A 65-year-old man presents with confusion and focal neurological deficits after a
fall. The most appropriate imaging modality is:
A) MRI brain without contrast
B) CT head without contrast
C) PET scan
D) Ultrasound of the head
Answer: B) CT head without contrast
Rationale: CT is rapid, readily available, and best for initial evaluation of head
trauma for hemorrhage.
True/False Questions
True or False: Elevated troponin levels always indicate a myocardial infarction.
Answer: False
Rationale: Troponin elevation can occur in other conditions including myocarditis,
renal failure, and pulmonary embolism.
True or False: In acute asthma exacerbation, peak expiratory flow rate (PEFR) is the
most reliable monitoring tool for severity.
Answer: True
Rationale: PEFR measurement provides objective assessment of airway obstruction
and response to therapy.
True or False: Antibiotics are always indicated in acute bronchitis.
Answer: False
Rationale: Acute bronchitis is most often viral; antibiotics are not routinely
recommended unless bacterial infection is suspected.
2
