Wilkes University NSG 550 Diagnostic Reasoning Exam 1 (pdf) |
2026/2027 | NP Q&A | Nursing
1. A nurse practitioner is formulating a differential diagnosis for a patient
presenting with fatigue and weight loss. Which step should the NP take first
in the diagnostic reasoning process?
A) Order a comprehensive metabolic panel
B) Generate a list of possible diagnoses based on the chief complaint and
history
C) Begin treatment for the most likely diagnosis
D) Refer the patient to a specialist
Correct Answer: Generate a list of possible diagnoses based on the chief
complaint and history
Rationale: The diagnostic reasoning process begins with generating a
differential diagnosis—a list of possible diagnoses based on the patient's
chief complaint, history, and initial findings. This list guides the focused
history, physical examination, and diagnostic testing. Treatment and referral
decisions come after the differential is developed and narrowed.
2. A patient reports acute onset of severe headache, photophobia, and neck
stiffness. Which element of the history of present illness is most critical for
narrowing the differential diagnosis?
A) The patient's age and gender
B) The timing and progression of symptoms
C) The patient's family history
D) The patient's medication list
Correct Answer: The timing and progression of symptoms
,Rationale: The history of present illness (HPI) includes the onset, timing,
progression, and associated factors of symptoms. Understanding the timing
and progression helps distinguish between acute, subacute, and chronic
conditions. Acute onset with photophobia and nuchal rigidity is concerning
for meningitis, whereas a gradual onset might suggest a tension headache or
migraine.
3. A nurse practitioner is documenting a SOAP note. Which component
includes the patient's description of symptoms in their own words?
A) Subjective
B) Objective
C) Assessment
D) Plan
Correct Answer: Subjective
Rationale: The "S" in SOAP stands for Subjective data, which includes the
patient's verbal report of symptoms, concerns, and history in their own
words. The Objective component includes measurable findings from the
physical examination and diagnostic tests. The Assessment includes the
differential diagnosis and clinical reasoning, and the Plan outlines the
treatment and follow-up.
4. A patient with suspected urinary tract infection is asked to provide a urine
sample. Which type of urine specimen is most appropriate for culture and
sensitivity?
A) Random urine
B) Timed urine
C) First morning urine
D) Clean-catch midstream urine
,Correct Answer: Clean-catch midstream urine
Rationale: A clean-catch midstream urine specimen minimizes contamination
from the urethra and perineum, making it the preferred specimen for urine
culture and sensitivity. First morning urine is best for concentration studies
and pregnancy testing, random urine is used for routine dipstick screening,
and timed urine collections are used for quantitative measurements.
5. A nurse practitioner is interpreting laboratory results. Which urine test is
best for detecting protein and nitrates?
A) Random urine
B) Timed urine
C) First morning urine
D) Double-voided urine
Correct Answer: Random urine
Rationale: A random urine sample is most commonly used for dipstick testing
to detect protein, nitrates, leukocyte esterase, and other markers. First
morning urine is preferred for pregnancy testing and urine concentration
studies. Timed urine collections are used for quantitative measurements
(e.g., 24-hour urine protein).
6. What is the correct method for a first morning urine collection?
A) Collect urine after breakfast
B) Collect urine twice in the morning
C) Void before bed, then collect first void upon waking
D) Discard the first morning void and collect the second
Correct Answer: Void before bed, then collect first void upon waking
, Rationale: First morning urine is collected by having the patient void before
going to bed, then collecting the first void upon waking. This specimen is
more concentrated and is optimal for detecting substances that accumulate
overnight, such as hCG in pregnancy testing and protein in orthostatic
proteinuria.
7. A nurse practitioner is evaluating diagnostic test results. A test with high
sensitivity is useful for:
A) Confirming a diagnosis
B) Ruling out a disease when the test is negative
C) Ruling in a disease when the test is positive
D) Monitoring disease progression
Correct Answer: Ruling out a disease when the test is negative
Rationale: High sensitivity (SnNOut) means the test has a low false-negative
rate. A negative result in a highly sensitive test helps rule out the disease.
High specificity (SpPIn) means the test has a low false-positive rate, and a
positive result helps rule in the disease.
8. Among people with a disease, how often the test is positive is known as:
A) Specificity
B) Sensitivity
C) Positive predictive value
D) Negative predictive value
Correct Answer: Sensitivity
2026/2027 | NP Q&A | Nursing
1. A nurse practitioner is formulating a differential diagnosis for a patient
presenting with fatigue and weight loss. Which step should the NP take first
in the diagnostic reasoning process?
A) Order a comprehensive metabolic panel
B) Generate a list of possible diagnoses based on the chief complaint and
history
C) Begin treatment for the most likely diagnosis
D) Refer the patient to a specialist
Correct Answer: Generate a list of possible diagnoses based on the chief
complaint and history
Rationale: The diagnostic reasoning process begins with generating a
differential diagnosis—a list of possible diagnoses based on the patient's
chief complaint, history, and initial findings. This list guides the focused
history, physical examination, and diagnostic testing. Treatment and referral
decisions come after the differential is developed and narrowed.
2. A patient reports acute onset of severe headache, photophobia, and neck
stiffness. Which element of the history of present illness is most critical for
narrowing the differential diagnosis?
A) The patient's age and gender
B) The timing and progression of symptoms
C) The patient's family history
D) The patient's medication list
Correct Answer: The timing and progression of symptoms
,Rationale: The history of present illness (HPI) includes the onset, timing,
progression, and associated factors of symptoms. Understanding the timing
and progression helps distinguish between acute, subacute, and chronic
conditions. Acute onset with photophobia and nuchal rigidity is concerning
for meningitis, whereas a gradual onset might suggest a tension headache or
migraine.
3. A nurse practitioner is documenting a SOAP note. Which component
includes the patient's description of symptoms in their own words?
A) Subjective
B) Objective
C) Assessment
D) Plan
Correct Answer: Subjective
Rationale: The "S" in SOAP stands for Subjective data, which includes the
patient's verbal report of symptoms, concerns, and history in their own
words. The Objective component includes measurable findings from the
physical examination and diagnostic tests. The Assessment includes the
differential diagnosis and clinical reasoning, and the Plan outlines the
treatment and follow-up.
4. A patient with suspected urinary tract infection is asked to provide a urine
sample. Which type of urine specimen is most appropriate for culture and
sensitivity?
A) Random urine
B) Timed urine
C) First morning urine
D) Clean-catch midstream urine
,Correct Answer: Clean-catch midstream urine
Rationale: A clean-catch midstream urine specimen minimizes contamination
from the urethra and perineum, making it the preferred specimen for urine
culture and sensitivity. First morning urine is best for concentration studies
and pregnancy testing, random urine is used for routine dipstick screening,
and timed urine collections are used for quantitative measurements.
5. A nurse practitioner is interpreting laboratory results. Which urine test is
best for detecting protein and nitrates?
A) Random urine
B) Timed urine
C) First morning urine
D) Double-voided urine
Correct Answer: Random urine
Rationale: A random urine sample is most commonly used for dipstick testing
to detect protein, nitrates, leukocyte esterase, and other markers. First
morning urine is preferred for pregnancy testing and urine concentration
studies. Timed urine collections are used for quantitative measurements
(e.g., 24-hour urine protein).
6. What is the correct method for a first morning urine collection?
A) Collect urine after breakfast
B) Collect urine twice in the morning
C) Void before bed, then collect first void upon waking
D) Discard the first morning void and collect the second
Correct Answer: Void before bed, then collect first void upon waking
, Rationale: First morning urine is collected by having the patient void before
going to bed, then collecting the first void upon waking. This specimen is
more concentrated and is optimal for detecting substances that accumulate
overnight, such as hCG in pregnancy testing and protein in orthostatic
proteinuria.
7. A nurse practitioner is evaluating diagnostic test results. A test with high
sensitivity is useful for:
A) Confirming a diagnosis
B) Ruling out a disease when the test is negative
C) Ruling in a disease when the test is positive
D) Monitoring disease progression
Correct Answer: Ruling out a disease when the test is negative
Rationale: High sensitivity (SnNOut) means the test has a low false-negative
rate. A negative result in a highly sensitive test helps rule out the disease.
High specificity (SpPIn) means the test has a low false-positive rate, and a
positive result helps rule in the disease.
8. Among people with a disease, how often the test is positive is known as:
A) Specificity
B) Sensitivity
C) Positive predictive value
D) Negative predictive value
Correct Answer: Sensitivity
