NSG 550
EXAM 2
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 550 EXAM 2 - DIAGNOSTIC REASONING
If you require further clarification
or in need of any study resources,
feel free to Message me.
3 EXAM PAGES 3 STUDY PAGES FULL PDF LINKED
,Table of Contents
NSG 550 Exam 2 ................................................................. 2
NSG 550 Exam 2 Study Guide ............................................. 58
NSG 550 Exam 2
Question 1
A 52-year-old male presents to the emergency department with sudden onset of
severe epigastric pain that radiates to his back. He reports nausea and vomiting. The
pain is steady and worsens when he walks or lies supine. He admits to drinking
approximately 12 beers daily and consumed a large fatty meal 4 hours prior to
symptom onset. His vital signs reveal a temperature of 101.2°F, heart rate of 112
bpm, and blood pressure of 148/92 mmHg. Laboratory studies show lipase 980 U/L
(normal: 10–140), amylase 420 U/L (normal: 30–110), ALT 85 U/L, CRP 18 mg/L,
WBC 16,500/μL, and glucose 198 mg/dL.
Which diagnostic imaging study is the first choice to confirm the diagnosis?
A. Abdominal ultrasound
B. CT abdomen with contrast — CORRECT ✓
C. MRI abdomen
D. ERCP
Rationale: The patient presents with classic signs of acute pancreatitis: epigastric
pain radiating to the back, worsened by supine position and walking,
nausea/vomiting, history of alcohol abuse and heavy meal, and laboratory findings
of elevated lipase (>3× upper limit of normal), elevated amylase, elevated ALT, CRP,
WBC, and hyperglycemia. While abdominal ultrasound can visualize the pancreas,
CT abdomen is the first-choice diagnostic imaging for pancreatitis as it provides
detailed visualization of pancreatic inflammation, necrosis, and complications. ERCP
is used to evaluate bile duct patency, not as initial imaging. MRI is not first-line.
,Question 2 (SATA)
A 45-year-old female presents with RUQ pain, nausea, vomiting, and a low-grade
fever. She reports the pain began approximately 6 hours after eating fried chicken.
On physical examination, the nurse practitioner elicits a positive Murphy's sign. Her
WBC is 14,200/μL.
Which of the following diagnostic tests would be appropriate to order? Select
all that apply.
A. RUQ ultrasound — CORRECT ✓
B. HIDA scan — CORRECT ✓
C. CT abdomen
D. ERCP
E. Abdominal x-ray
Rationale: This patient has acute cholecystitis (RUQ pain after fatty meal, positive
Murphy's sign, fever, elevated WBC). The gold standard diagnostic imaging is RUQ
ultrasound (A). If the ultrasound is inconclusive, a HIDA scan (B) would be the
next appropriate test. A CT abdomen (C) is not the preferred initial test for
cholecystitis. ERCP (D) evaluates bile duct patency and is used for bile duct stones,
not gallbladder inflammation. Abdominal x-ray (E) has limited utility for
cholecystitis diagnosis.
Question 3
A 68-year-old male with a history of alcohol abuse presents with epigastric pain,
nausea, and vomiting. Laboratory studies reveal a lipase of 1,250 U/L (3× upper
limit of normal) and an amylase of 380 U/L. The nurse practitioner knows that
lipase is more sensitive and specific than amylase for pancreatitis.
Which statement about these laboratory findings is most accurate?
A. Amylase remains elevated longer than lipase and is therefore more useful for late
diagnosis.
B. Lipase remains elevated longer than amylase and is the preferred diagnostic
marker. — CORRECT ✓
,C. Both enzymes normalize within 24 hours, so serial testing is not useful.
D. ALT elevation is the most specific indicator of pancreatitis.
Rationale: Lipase remains elevated longer than amylase and is more specific for
pancreatitis, making it the preferred diagnostic marker. Amylase can be elevated in
other conditions (salivary gland disorders, intestinal obstruction) and normalizes
more quickly. While ALT may be elevated in pancreatitis (especially gallstone-
related), it is not the most specific indicator. Serial testing is useful because lipase
elevation persists.
Question 4 (SATA)
A 35-year-old male presents with periumbilical pain that has migrated to the RLQ
over the past 12 hours. He reports nausea, a low-grade fever of 100.8°F, and rebound
tenderness at McBurney's point.
Which diagnostic findings and physical examination signs are consistent with
acute appendicitis? Select all that apply.
A. Rovsing's sign — CORRECT ✓
B. Psoas sign — CORRECT ✓
C. Murphy's sign
D. McBurney's point tenderness — CORRECT ✓
E. Positive obturator sign — CORRECT ✓
Rationale: Rovsing's sign (A) is pain in the RLQ with palpation of the LLQ. Psoas
sign (B) is abdominal pain with passive extension of the thigh with knees extended.
McBurney's point tenderness (D) is rebound tenderness at the RLQ. These are all
classic signs of acute appendicitis. Murphy's sign (C) is associated with
cholecystitis. The obturator sign (E) is also associated with appendicitis (pain with
internal rotation of the flexed right hip), though not explicitly mentioned in the
study guide.
Question 5
,A 28-year-old female presents to the clinic with LLQ pain, constipation alternating
with diarrhea, nausea, vomiting, and a low-grade fever. On examination, a palpable
mass is noted in the LLQ. Her WBC is 12,400/μL.
What is the gold standard diagnostic test for this condition?
A. Abdominal ultrasound
B. CT scan with contrast of the abdomen — CORRECT ✓
C. Colonoscopy
D. Barium enema
Rationale: This patient has diverticulitis (LLQ pain, altered bowel habits, N/V, low-
grade fever, palpable LLQ mass). The gold standard diagnostic test is CT scan
with contrast of the abdomen (B). Colonoscopy is contraindicated during acute
diverticulitis due to perforation risk. Abdominal ultrasound is not the preferred test.
Barium enema is used for colon cancer screening when colonoscopy is unavailable.
Question 6
A 62-year-old female presents with vague abdominal discomfort, fatigue, anorexia,
and weakness. She denies fever. She reports that her symptoms began after a large
family dinner 2 days ago. On physical examination, there is mild RUQ tenderness but
no rebound.
The nurse practitioner recognizes that elderly patients with cholecystitis may
present atypically. Which of the following best describes the typical elderly
presentation of cholecystitis?
A. Severe RUQ pain with fever and leukocytosis
B. Vague symptoms including anorexia, fatigue, no fever, weakness, and N/V —
CORRECT ✓
C. Acute periumbilical pain migrating to the RLQ
D. Epigastric pain radiating to the back with elevated lipase
Rationale: Elderly patients with cholecystitis often present with vague, atypical
symptoms (B): anorexia, fatigue, absence of fever, weakness, and nausea/vomiting.
They may not complain of classic RUQ pain. Option A describes the typical adult
presentation. Option C describes appendicitis. Option D describes pancreatitis.
, NSG 550 Exam 2 Study Guide
1. Pulmonary Disorders
TB (Tuberculosis):
Gold standard: AFB (acid fast bacilli) sputum culture - mycobacterium tuberculosis
Cons: takes time; send to microbio → grow → sensitivities (4-6 weeks)
PPD: Detects exposure, NOT infection; good screening tool only, not diagnostic
PPD Specificity: 95-100%; Sensitivity: as low as 59%
Can rule OUT, not rule in
If PPD positive → CXR or QuantiFERON
If healthcare worker with increased exposure → limit repeated CXRs → use PPD
Sputum test that is not a culture (presumptive, not definitive): AFB (acid-fast
bacillus)
AFB ran in microbiology laboratories because it requires biosafety
Blood serum tests: interferon, QuantiFERON gold
Can you diagnose TB with just QuantiFERON gold? NO - need culture that confirms
TB
When to order sputum culture: any patient with persistent cough, fever, hemoptysis,
or chest x-ray showing pulmonary infection
Microbiology for Pulmonary:
AFB, COVID, flu, strep
PCRs run in microbio labs
Obtained as: sputum, nasopharyngeal, throat swab, viral panels
COVID and flu: PCR (polymerase chain reaction)
PCR: A laboratory technique for amplifying DNA in vitro by incubating with special
primers, DNA polymerase molecules, and nucleotides
PE (Pulmonary Embolism):
Gold standard: CTA of chest
,If CTA contraindicated (iodine allergy, pregnancy) → V/P scan
(ventilation/perfusion) - nuclear medicine
Lung scan is what kind of scan? Nuclear scan
D-dimer test: protein made when a blood clot starts to dissolve; can rule out a PE;
needs a CTA if positive
Low suspicion of low risk patient having clot → order d-dimer (least invasive, less
$$$)
D-dimer measures clot fibrin degradation (clot is being broken down but doesn't tell
where)
Good test before next interventions: DVT → US; PE → CTA
Risk factors for PE: exogenous estrogen (birth control), immobility, recent surgery,
previous hx of clots, malignancy (any active cancer), fx long bones/hips/pelvis,
COVID
Pleural Effusion:
Thoracentesis → test pleural fluid
CXR prior to ensure pleural fluid is mobile and accessible via needle
Sent to microbio to be cultured
Light's Criteria: A pleural effusion is exudative if ANY of the following are true:
- Pleural fluid protein / serum protein > 0.5
- Pleural fluid LDH / serum LDH > 0.6
- Pleural fluid LDH > 2/3 the upper limit of normal serum LDH
If none met → transudative
Transudative Pleural Effusion:
Gross appearance: clear/sour
Protein < 0.5, LDH low
Causes: hypoalbuminemia (cirrhosis), nephrotic syndrome, CHF, constrictive
pericarditis, hypoproteinemia
Exudative Pleural Effusion:
Gross appearance: cloudy/turbid
Protein > 0.5, LDH high
Causes: infection in parenchyma or lungs, autoimmune, esophageal rupture,
malignancy, pancreatitis, post CABG, PE
COPD:
Gold standard: Spirometry (pulmonary function test)
,Tell pt to forcefully exhale into spirometer
FEV1/FVC ratio < 0.70 (70%) post bronchodilator = COPD
PFT: test lung function → bronchodilator → test again
Irreversible airflow limitation is hallmark
PFT helps differentiate restrictive and obstructive forms of pulmonary disease
Classify severity: airflow limitation using spirometry (FEV1:FVC)
Screen for in COPD patients under 40 and white OR high family history: Alpha-1
Antitrypsin Deficiency
Alpha-1 Antitrypsin (AAT) deficiency: inherited disorder that may cause lung
disease and liver disease; do not make enough of this enzyme; lungs more easily
damaged by smoke, pollution, dust
Alpha-1-antitrypsin: serum protease inhibitor produced in liver; if deficient, may
lead to pulmonary emphysema and liver disease
Alpha-1-antitrypsin deficiency: genetic disorder; increases risk for panacinar
emphysema even without smoking
Cough Classification:
Acute cough: less than 3 weeks
Chronic cough: longer than 8 weeks
Acute bronchitis typically preceded by: upper respiratory infection caused by viral
infection
Consider ordering x-ray when: abnormal VS, abnormal lung sounds, >75 years old
Sleep Apnea (OSA):
Polysomnography (sleep study)
S&S: snoring, tired during day even though got sleep, falling asleep during the day
Day time somnolence, snore, nap often → rule out OSA, order sleep study
Used to diagnose sleep apnea in the outpatient setting
Bronchoscopy:
Looks at lungs; can go through mouth or nose
Get down to bifurcation → go to lungs and not esophagus
Dx or therapeutic
Indications: airway obstruction (mass) and need stent, hemorrhage (alveolar
bleeding), biopsy for cancer, pneumonia w/o response to tx (atypical vs fungal)
→ get sample → bronchial alveolar lavage → microbio
Visual examination of the bronchi using a bronchoscope
, NSG 550
EXAM 2
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
EXAM 2
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 550 EXAM 2 - DIAGNOSTIC REASONING
If you require further clarification
or in need of any study resources,
feel free to Message me.
3 EXAM PAGES 3 STUDY PAGES FULL PDF LINKED
,Table of Contents
NSG 550 Exam 2 ................................................................. 2
NSG 550 Exam 2 Study Guide ............................................. 58
NSG 550 Exam 2
Question 1
A 52-year-old male presents to the emergency department with sudden onset of
severe epigastric pain that radiates to his back. He reports nausea and vomiting. The
pain is steady and worsens when he walks or lies supine. He admits to drinking
approximately 12 beers daily and consumed a large fatty meal 4 hours prior to
symptom onset. His vital signs reveal a temperature of 101.2°F, heart rate of 112
bpm, and blood pressure of 148/92 mmHg. Laboratory studies show lipase 980 U/L
(normal: 10–140), amylase 420 U/L (normal: 30–110), ALT 85 U/L, CRP 18 mg/L,
WBC 16,500/μL, and glucose 198 mg/dL.
Which diagnostic imaging study is the first choice to confirm the diagnosis?
A. Abdominal ultrasound
B. CT abdomen with contrast — CORRECT ✓
C. MRI abdomen
D. ERCP
Rationale: The patient presents with classic signs of acute pancreatitis: epigastric
pain radiating to the back, worsened by supine position and walking,
nausea/vomiting, history of alcohol abuse and heavy meal, and laboratory findings
of elevated lipase (>3× upper limit of normal), elevated amylase, elevated ALT, CRP,
WBC, and hyperglycemia. While abdominal ultrasound can visualize the pancreas,
CT abdomen is the first-choice diagnostic imaging for pancreatitis as it provides
detailed visualization of pancreatic inflammation, necrosis, and complications. ERCP
is used to evaluate bile duct patency, not as initial imaging. MRI is not first-line.
,Question 2 (SATA)
A 45-year-old female presents with RUQ pain, nausea, vomiting, and a low-grade
fever. She reports the pain began approximately 6 hours after eating fried chicken.
On physical examination, the nurse practitioner elicits a positive Murphy's sign. Her
WBC is 14,200/μL.
Which of the following diagnostic tests would be appropriate to order? Select
all that apply.
A. RUQ ultrasound — CORRECT ✓
B. HIDA scan — CORRECT ✓
C. CT abdomen
D. ERCP
E. Abdominal x-ray
Rationale: This patient has acute cholecystitis (RUQ pain after fatty meal, positive
Murphy's sign, fever, elevated WBC). The gold standard diagnostic imaging is RUQ
ultrasound (A). If the ultrasound is inconclusive, a HIDA scan (B) would be the
next appropriate test. A CT abdomen (C) is not the preferred initial test for
cholecystitis. ERCP (D) evaluates bile duct patency and is used for bile duct stones,
not gallbladder inflammation. Abdominal x-ray (E) has limited utility for
cholecystitis diagnosis.
Question 3
A 68-year-old male with a history of alcohol abuse presents with epigastric pain,
nausea, and vomiting. Laboratory studies reveal a lipase of 1,250 U/L (3× upper
limit of normal) and an amylase of 380 U/L. The nurse practitioner knows that
lipase is more sensitive and specific than amylase for pancreatitis.
Which statement about these laboratory findings is most accurate?
A. Amylase remains elevated longer than lipase and is therefore more useful for late
diagnosis.
B. Lipase remains elevated longer than amylase and is the preferred diagnostic
marker. — CORRECT ✓
,C. Both enzymes normalize within 24 hours, so serial testing is not useful.
D. ALT elevation is the most specific indicator of pancreatitis.
Rationale: Lipase remains elevated longer than amylase and is more specific for
pancreatitis, making it the preferred diagnostic marker. Amylase can be elevated in
other conditions (salivary gland disorders, intestinal obstruction) and normalizes
more quickly. While ALT may be elevated in pancreatitis (especially gallstone-
related), it is not the most specific indicator. Serial testing is useful because lipase
elevation persists.
Question 4 (SATA)
A 35-year-old male presents with periumbilical pain that has migrated to the RLQ
over the past 12 hours. He reports nausea, a low-grade fever of 100.8°F, and rebound
tenderness at McBurney's point.
Which diagnostic findings and physical examination signs are consistent with
acute appendicitis? Select all that apply.
A. Rovsing's sign — CORRECT ✓
B. Psoas sign — CORRECT ✓
C. Murphy's sign
D. McBurney's point tenderness — CORRECT ✓
E. Positive obturator sign — CORRECT ✓
Rationale: Rovsing's sign (A) is pain in the RLQ with palpation of the LLQ. Psoas
sign (B) is abdominal pain with passive extension of the thigh with knees extended.
McBurney's point tenderness (D) is rebound tenderness at the RLQ. These are all
classic signs of acute appendicitis. Murphy's sign (C) is associated with
cholecystitis. The obturator sign (E) is also associated with appendicitis (pain with
internal rotation of the flexed right hip), though not explicitly mentioned in the
study guide.
Question 5
,A 28-year-old female presents to the clinic with LLQ pain, constipation alternating
with diarrhea, nausea, vomiting, and a low-grade fever. On examination, a palpable
mass is noted in the LLQ. Her WBC is 12,400/μL.
What is the gold standard diagnostic test for this condition?
A. Abdominal ultrasound
B. CT scan with contrast of the abdomen — CORRECT ✓
C. Colonoscopy
D. Barium enema
Rationale: This patient has diverticulitis (LLQ pain, altered bowel habits, N/V, low-
grade fever, palpable LLQ mass). The gold standard diagnostic test is CT scan
with contrast of the abdomen (B). Colonoscopy is contraindicated during acute
diverticulitis due to perforation risk. Abdominal ultrasound is not the preferred test.
Barium enema is used for colon cancer screening when colonoscopy is unavailable.
Question 6
A 62-year-old female presents with vague abdominal discomfort, fatigue, anorexia,
and weakness. She denies fever. She reports that her symptoms began after a large
family dinner 2 days ago. On physical examination, there is mild RUQ tenderness but
no rebound.
The nurse practitioner recognizes that elderly patients with cholecystitis may
present atypically. Which of the following best describes the typical elderly
presentation of cholecystitis?
A. Severe RUQ pain with fever and leukocytosis
B. Vague symptoms including anorexia, fatigue, no fever, weakness, and N/V —
CORRECT ✓
C. Acute periumbilical pain migrating to the RLQ
D. Epigastric pain radiating to the back with elevated lipase
Rationale: Elderly patients with cholecystitis often present with vague, atypical
symptoms (B): anorexia, fatigue, absence of fever, weakness, and nausea/vomiting.
They may not complain of classic RUQ pain. Option A describes the typical adult
presentation. Option C describes appendicitis. Option D describes pancreatitis.
, NSG 550 Exam 2 Study Guide
1. Pulmonary Disorders
TB (Tuberculosis):
Gold standard: AFB (acid fast bacilli) sputum culture - mycobacterium tuberculosis
Cons: takes time; send to microbio → grow → sensitivities (4-6 weeks)
PPD: Detects exposure, NOT infection; good screening tool only, not diagnostic
PPD Specificity: 95-100%; Sensitivity: as low as 59%
Can rule OUT, not rule in
If PPD positive → CXR or QuantiFERON
If healthcare worker with increased exposure → limit repeated CXRs → use PPD
Sputum test that is not a culture (presumptive, not definitive): AFB (acid-fast
bacillus)
AFB ran in microbiology laboratories because it requires biosafety
Blood serum tests: interferon, QuantiFERON gold
Can you diagnose TB with just QuantiFERON gold? NO - need culture that confirms
TB
When to order sputum culture: any patient with persistent cough, fever, hemoptysis,
or chest x-ray showing pulmonary infection
Microbiology for Pulmonary:
AFB, COVID, flu, strep
PCRs run in microbio labs
Obtained as: sputum, nasopharyngeal, throat swab, viral panels
COVID and flu: PCR (polymerase chain reaction)
PCR: A laboratory technique for amplifying DNA in vitro by incubating with special
primers, DNA polymerase molecules, and nucleotides
PE (Pulmonary Embolism):
Gold standard: CTA of chest
,If CTA contraindicated (iodine allergy, pregnancy) → V/P scan
(ventilation/perfusion) - nuclear medicine
Lung scan is what kind of scan? Nuclear scan
D-dimer test: protein made when a blood clot starts to dissolve; can rule out a PE;
needs a CTA if positive
Low suspicion of low risk patient having clot → order d-dimer (least invasive, less
$$$)
D-dimer measures clot fibrin degradation (clot is being broken down but doesn't tell
where)
Good test before next interventions: DVT → US; PE → CTA
Risk factors for PE: exogenous estrogen (birth control), immobility, recent surgery,
previous hx of clots, malignancy (any active cancer), fx long bones/hips/pelvis,
COVID
Pleural Effusion:
Thoracentesis → test pleural fluid
CXR prior to ensure pleural fluid is mobile and accessible via needle
Sent to microbio to be cultured
Light's Criteria: A pleural effusion is exudative if ANY of the following are true:
- Pleural fluid protein / serum protein > 0.5
- Pleural fluid LDH / serum LDH > 0.6
- Pleural fluid LDH > 2/3 the upper limit of normal serum LDH
If none met → transudative
Transudative Pleural Effusion:
Gross appearance: clear/sour
Protein < 0.5, LDH low
Causes: hypoalbuminemia (cirrhosis), nephrotic syndrome, CHF, constrictive
pericarditis, hypoproteinemia
Exudative Pleural Effusion:
Gross appearance: cloudy/turbid
Protein > 0.5, LDH high
Causes: infection in parenchyma or lungs, autoimmune, esophageal rupture,
malignancy, pancreatitis, post CABG, PE
COPD:
Gold standard: Spirometry (pulmonary function test)
,Tell pt to forcefully exhale into spirometer
FEV1/FVC ratio < 0.70 (70%) post bronchodilator = COPD
PFT: test lung function → bronchodilator → test again
Irreversible airflow limitation is hallmark
PFT helps differentiate restrictive and obstructive forms of pulmonary disease
Classify severity: airflow limitation using spirometry (FEV1:FVC)
Screen for in COPD patients under 40 and white OR high family history: Alpha-1
Antitrypsin Deficiency
Alpha-1 Antitrypsin (AAT) deficiency: inherited disorder that may cause lung
disease and liver disease; do not make enough of this enzyme; lungs more easily
damaged by smoke, pollution, dust
Alpha-1-antitrypsin: serum protease inhibitor produced in liver; if deficient, may
lead to pulmonary emphysema and liver disease
Alpha-1-antitrypsin deficiency: genetic disorder; increases risk for panacinar
emphysema even without smoking
Cough Classification:
Acute cough: less than 3 weeks
Chronic cough: longer than 8 weeks
Acute bronchitis typically preceded by: upper respiratory infection caused by viral
infection
Consider ordering x-ray when: abnormal VS, abnormal lung sounds, >75 years old
Sleep Apnea (OSA):
Polysomnography (sleep study)
S&S: snoring, tired during day even though got sleep, falling asleep during the day
Day time somnolence, snore, nap often → rule out OSA, order sleep study
Used to diagnose sleep apnea in the outpatient setting
Bronchoscopy:
Looks at lungs; can go through mouth or nose
Get down to bifurcation → go to lungs and not esophagus
Dx or therapeutic
Indications: airway obstruction (mass) and need stent, hemorrhage (alveolar
bleeding), biopsy for cancer, pneumonia w/o response to tx (atypical vs fungal)
→ get sample → bronchial alveolar lavage → microbio
Visual examination of the bronchi using a bronchoscope
, NSG 550
EXAM 2
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
