WILKES UNIVERSITY
Master of Science in Nursing (MSN) — Nurse Practitioner
NSG 550 Diagnostic Reasoning for Nurse Practitioners 2026/2027
Exam 2 Review NCLEX
Question 1
Most accurate method for measuring cardiac output and localizing occlusions
A. Cardiac catheterization
B. Echocardiogram
C. Cardiac MRI
D. CT coronary angiography
Correct Answer: A. Cardiac catheterization
RATIONALE
Cardiac catheterization with coronary angiography is the gold standard for measuring
intracardiac pressures, cardiac output (via thermodilution), and for localizing coronary artery
occlusions.
, Question 2
Serious complication of ethmoid sinus endoscopy
A. Cerebrospinal fluid (CSF) leakage
B. Orbital hematoma
C. Optic nerve injury
D. Carotid artery injury
Correct Answer: A. Cerebrospinal fluid (CSF) leakage
RATIONALE
The ethmoid sinuses are adjacent to the cribriform plate. Endoscopic surgery carries a risk of
inadvertent dural injury leading to CSF leakage, which requires prompt management.
Question 3
Diagnostic implication of a normal BNP in a dyspneic patient
A. Essentially excludes heart failure; suggests pulmonary cause
B. Confirms heart failure
C. Indicates renal failure
D. Requires further cardiac testing
Correct Answer: A. Essentially excludes heart failure; suggests pulmonary cause
RATIONALE
B-type natriuretic peptide (BNP) is elevated in heart failure. A normal BNP (<100 pg/mL) has a
high negative predictive value and essentially excludes heart failure as the cause of dyspnea.
, Question 4
Lab pattern of obstructive (posthepatic) jaundice
A. Elevated total bilirubin with increased direct (conjugated) fraction
B. Elevated indirect (unconjugated) bilirubin only
C. Normal bilirubin with elevated alkaline phosphatase
D. Elevated both direct and indirect equally
Correct Answer:
A. Elevated total bilirubin with increased direct (conjugated) fraction
RATIONALE
Obstructive jaundice leads to conjugated (direct) hyperbilirubinemia because the liver
conjugates bilirubin but the bile cannot flow out. Direct bilirubin is elevated.
Question 5
Diagnostic testing schedule for Legionnaires' disease
A. Legionella pneumophila antibody testing at 1 and 3 weeks
B. Legionella urine antigen testing only
C. Sputum culture and PCR
D. Serum complement fixation test
Correct Answer: A. Legionella pneumophila antibody testing at 1 and 3 weeks
RATIONALE
Seroconversion (fourfold rise in antibody titer) is diagnostic for Legionnaires' disease. Paired
samples are collected at 1 and 3 weeks after symptom onset.
Master of Science in Nursing (MSN) — Nurse Practitioner
NSG 550 Diagnostic Reasoning for Nurse Practitioners 2026/2027
Exam 2 Review NCLEX
Question 1
Most accurate method for measuring cardiac output and localizing occlusions
A. Cardiac catheterization
B. Echocardiogram
C. Cardiac MRI
D. CT coronary angiography
Correct Answer: A. Cardiac catheterization
RATIONALE
Cardiac catheterization with coronary angiography is the gold standard for measuring
intracardiac pressures, cardiac output (via thermodilution), and for localizing coronary artery
occlusions.
, Question 2
Serious complication of ethmoid sinus endoscopy
A. Cerebrospinal fluid (CSF) leakage
B. Orbital hematoma
C. Optic nerve injury
D. Carotid artery injury
Correct Answer: A. Cerebrospinal fluid (CSF) leakage
RATIONALE
The ethmoid sinuses are adjacent to the cribriform plate. Endoscopic surgery carries a risk of
inadvertent dural injury leading to CSF leakage, which requires prompt management.
Question 3
Diagnostic implication of a normal BNP in a dyspneic patient
A. Essentially excludes heart failure; suggests pulmonary cause
B. Confirms heart failure
C. Indicates renal failure
D. Requires further cardiac testing
Correct Answer: A. Essentially excludes heart failure; suggests pulmonary cause
RATIONALE
B-type natriuretic peptide (BNP) is elevated in heart failure. A normal BNP (<100 pg/mL) has a
high negative predictive value and essentially excludes heart failure as the cause of dyspnea.
, Question 4
Lab pattern of obstructive (posthepatic) jaundice
A. Elevated total bilirubin with increased direct (conjugated) fraction
B. Elevated indirect (unconjugated) bilirubin only
C. Normal bilirubin with elevated alkaline phosphatase
D. Elevated both direct and indirect equally
Correct Answer:
A. Elevated total bilirubin with increased direct (conjugated) fraction
RATIONALE
Obstructive jaundice leads to conjugated (direct) hyperbilirubinemia because the liver
conjugates bilirubin but the bile cannot flow out. Direct bilirubin is elevated.
Question 5
Diagnostic testing schedule for Legionnaires' disease
A. Legionella pneumophila antibody testing at 1 and 3 weeks
B. Legionella urine antigen testing only
C. Sputum culture and PCR
D. Serum complement fixation test
Correct Answer: A. Legionella pneumophila antibody testing at 1 and 3 weeks
RATIONALE
Seroconversion (fourfold rise in antibody titer) is diagnostic for Legionnaires' disease. Paired
samples are collected at 1 and 3 weeks after symptom onset.
