NSG 550
EXAMS 1-3
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
300 Exam Questions w/ Answers
Expert Rationales included.
Exam 1, 2 & 3 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 550 EXAMS 1-3 - DIAGNOSTIC REASONING
If you require further clarification
or in need of any study resources,
feel free to Message me.
3 PAGES / EXAM NEW NOTO SANS FONT FULL PDF LINKED
,Table of Contents
NSG 550 Exam 1..................................................................................2
NSG 550 Exam 1 Study Guide...........................................................48
NSG 550 Exam 2...............................................................................58
NSG 550 Exam 2 Study Guide.........................................................108
NSG 550 Exam 3.............................................................................119
NSG 550 Exam 3 Study Guide.........................................................165
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.
,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?
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing's syndrome
D) Addison's disease
Correct Answer: B) Hypothyroidism
Rationale: Hypothyroidism is characterized by high TSH (thyroid-stimulating
hormone) and low T3/T4 levels due to the pituitary gland's compensatory response
to insufficient thyroid hormone production. Clinical manifestations include
bradycardia, weight gain, constipation, cold intolerance, and sluggishness. This is
in direct contrast to hyperthyroidism/Graves' disease, which presents with low TSH,
high T3/T4, hypermetabolism, tachycardia, weight loss, and exophthalmos.
5. A patient with type 1 diabetes presents to the emergency department with
fruity breath, Kussmaul respirations, and altered mental status. Laboratory
,results show high ketones, high anion gap, low potassium, and rising
BUN/creatinine. The nurse recognizes these findings as indicative of:
A) Hyperosmolar hyperglycemic state
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemic shock
D) Acute kidney injury
Correct Answer: B) Diabetic ketoacidosis (DKA)
Rationale: Diabetic ketoacidosis (DKA) is a life-threatening complication of
diabetes mellitus characterized by hyperglycemia, ketonemia, and metabolic
acidosis (high anion gap). The rising BUN and creatinine reflect prerenal azotemia
from dehydration. Low potassium occurs due to osmotic diuresis and acidosis-
driven intracellular shifts. Immediate interventions include IV fluid resuscitation,
insulin administration, and electrolyte replacement.
6. A nurse is caring for a patient who underwent a cystoscopy. Which
statement by the patient indicates a need for further teaching?
A) "I may notice some pink-tinged urine after the procedure."
B) "I should drink plenty of fluids to flush my bladder."
C) "I can resume my normal diet immediately after the procedure."
D) "I should report burning with urination that lasts more than 24 hours."
Correct Answer: C) "I can resume my normal diet immediately after the
procedure."
Rationale: Cystoscopy is the visual examination of the urinary bladder using a
cystoscope inserted through the urethra. While patients can typically resume a
normal diet immediately after an uncomplicated cystoscopy, this statement itself is
not incorrect. However, if the patient had sedation, they may need to wait before
eating. More importantly, the nurse should ensure the patient understands that
mild hematuria, burning with urination, and increased urinary frequency are
expected for 24–48 hours. The patient must report fever, chills, or persistent gross
hematuria.
, 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
, NSG 550 Exam 3
Question 1
A 72-year-old female is brought to the clinic by her daughter, who reports that her
mother has had progressive memory loss over the past 3 years. She forgets recent
conversations, misplaces items daily, and recently got lost driving home from the
grocery store. She denies visual hallucinations or movement disorders. Her MRI
shows cortical atrophy and hippocampal volume loss.
What is the most likely diagnosis?
A. Vascular dementia❌
B. Alzheimer's disease ✅ CORRECT
C. Lewy body dementia ❌
D. Parkinsonism ❌
Rationale: Alzheimer's disease (B) is the most common form of dementia,
characterized by progressive memory loss, cognitive decline, and changes in
behavior. The patient's gradual onset over years, prominent memory impairment,
and cortical atrophy on imaging are classic. Vascular dementia (A) typically has a
stepwise decline with focal neurologic deficits. Lewy body dementia (C) presents
with cognitive fluctuations, visual hallucinations, and movement disorders
(Parkinsonism). Parkinsonism (D) is a syndrome of tremors, rigidity, and
bradykinesia, not primarily a dementia diagnosis.
Question 2
A 68-year-old male with a history of hypertension and two prior strokes presents
with abrupt onset of cognitive decline. His family notes that his memory and
executive function worsened stepwise after each cerebrovascular event. He has no
visual hallucinations.
Which type of dementia is most consistent with this presentation?
EXAMS 1-3
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
300 Exam Questions w/ Answers
Expert Rationales included.
Exam 1, 2 & 3 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 550 EXAMS 1-3 - DIAGNOSTIC REASONING
If you require further clarification
or in need of any study resources,
feel free to Message me.
3 PAGES / EXAM NEW NOTO SANS FONT FULL PDF LINKED
,Table of Contents
NSG 550 Exam 1..................................................................................2
NSG 550 Exam 1 Study Guide...........................................................48
NSG 550 Exam 2...............................................................................58
NSG 550 Exam 2 Study Guide.........................................................108
NSG 550 Exam 3.............................................................................119
NSG 550 Exam 3 Study Guide.........................................................165
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.
,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?
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing's syndrome
D) Addison's disease
Correct Answer: B) Hypothyroidism
Rationale: Hypothyroidism is characterized by high TSH (thyroid-stimulating
hormone) and low T3/T4 levels due to the pituitary gland's compensatory response
to insufficient thyroid hormone production. Clinical manifestations include
bradycardia, weight gain, constipation, cold intolerance, and sluggishness. This is
in direct contrast to hyperthyroidism/Graves' disease, which presents with low TSH,
high T3/T4, hypermetabolism, tachycardia, weight loss, and exophthalmos.
5. A patient with type 1 diabetes presents to the emergency department with
fruity breath, Kussmaul respirations, and altered mental status. Laboratory
,results show high ketones, high anion gap, low potassium, and rising
BUN/creatinine. The nurse recognizes these findings as indicative of:
A) Hyperosmolar hyperglycemic state
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemic shock
D) Acute kidney injury
Correct Answer: B) Diabetic ketoacidosis (DKA)
Rationale: Diabetic ketoacidosis (DKA) is a life-threatening complication of
diabetes mellitus characterized by hyperglycemia, ketonemia, and metabolic
acidosis (high anion gap). The rising BUN and creatinine reflect prerenal azotemia
from dehydration. Low potassium occurs due to osmotic diuresis and acidosis-
driven intracellular shifts. Immediate interventions include IV fluid resuscitation,
insulin administration, and electrolyte replacement.
6. A nurse is caring for a patient who underwent a cystoscopy. Which
statement by the patient indicates a need for further teaching?
A) "I may notice some pink-tinged urine after the procedure."
B) "I should drink plenty of fluids to flush my bladder."
C) "I can resume my normal diet immediately after the procedure."
D) "I should report burning with urination that lasts more than 24 hours."
Correct Answer: C) "I can resume my normal diet immediately after the
procedure."
Rationale: Cystoscopy is the visual examination of the urinary bladder using a
cystoscope inserted through the urethra. While patients can typically resume a
normal diet immediately after an uncomplicated cystoscopy, this statement itself is
not incorrect. However, if the patient had sedation, they may need to wait before
eating. More importantly, the nurse should ensure the patient understands that
mild hematuria, burning with urination, and increased urinary frequency are
expected for 24–48 hours. The patient must report fever, chills, or persistent gross
hematuria.
, 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
, NSG 550 Exam 3
Question 1
A 72-year-old female is brought to the clinic by her daughter, who reports that her
mother has had progressive memory loss over the past 3 years. She forgets recent
conversations, misplaces items daily, and recently got lost driving home from the
grocery store. She denies visual hallucinations or movement disorders. Her MRI
shows cortical atrophy and hippocampal volume loss.
What is the most likely diagnosis?
A. Vascular dementia❌
B. Alzheimer's disease ✅ CORRECT
C. Lewy body dementia ❌
D. Parkinsonism ❌
Rationale: Alzheimer's disease (B) is the most common form of dementia,
characterized by progressive memory loss, cognitive decline, and changes in
behavior. The patient's gradual onset over years, prominent memory impairment,
and cortical atrophy on imaging are classic. Vascular dementia (A) typically has a
stepwise decline with focal neurologic deficits. Lewy body dementia (C) presents
with cognitive fluctuations, visual hallucinations, and movement disorders
(Parkinsonism). Parkinsonism (D) is a syndrome of tremors, rigidity, and
bradykinesia, not primarily a dementia diagnosis.
Question 2
A 68-year-old male with a history of hypertension and two prior strokes presents
with abrupt onset of cognitive decline. His family notes that his memory and
executive function worsened stepwise after each cerebrovascular event. He has no
visual hallucinations.
Which type of dementia is most consistent with this presentation?
