NSG 550 EXAM 123 – DIAGNOSTIC REASONING | WILKES UNIVERSITY | QUESTIONS AND ANSWERS
ALREADY GRADED A+| 100% VERIFIED SOLUTIONS………...
Core Domains:
Clinical Assessment and History Taking
Pathophysiology and Disease Presentation
Differential Diagnosis Formulation
Diagnostic Test Selection and Interpretation
Clinical Decision-Making and Critical Thinking
Evidence-Based Practice and Guidelines
Patient Communication and Shared Decision-Making
Legal and Ethical Considerations in Diagnosis
Pharmacologic and Non-Pharmacologic Interventions
Health Promotion and Disease Prevention
Introduction:
This comprehensive diagnostic reasoning examination is designed to assess advanced clinical judgment and
decision-making skills essential for advanced practice nursing. It evaluates the ability to synthesize patient data,
formulate differential diagnoses, select appropriate diagnostic tests, and interpret results within the context of
evidence-based practice. The exam employs multiple-choice and scenario-based questions that challenge students
to apply pathophysiological principles, prioritize clinical findings, and develop safe, patient-centered management
,plans. Emphasis is placed on real-world clinical reasoning, ethical considerations, and the integration of holistic
assessment findings to achieve accurate diagnoses and optimal patient outcomes.
Section One: Questions 1–100
1. A 58-year-old patient presents with a 3-week history of progressive dyspnea on exertion, non-productive
cough, and unintentional weight loss of 10 pounds. The patient has a 40-pack-year smoking history. On
examination, there is decreased breath sounds at the right lung base and dullness to percussion. What is the
most appropriate initial diagnostic test?
A. Chest X-ray.
B. CT scan of the chest.
C. Sputum cytology.
D. Bronchoscopy.
🟢 A. Chest X-ray.
🔴 RATIONALE: A chest X-ray is the initial imaging study for a patient with respiratory symptoms and findings
suggestive of a pulmonary process. It can identify masses, infiltrates, effusions, and other abnormalities. CT
scan, sputum cytology, and bronchoscopy are subsequent steps based on initial findings.
2. A 45-year-old male with a history of hypertension presents with a sudden onset of severe, tearing chest
pain radiating to the back. Blood pressure is 180/110 mmHg in the right arm and 130/80 mmHg in the left
,arm. Which diagnosis is most likely?
A. Myocardial infarction.
B. Pulmonary embolism.
C. Aortic dissection.
D. Pericarditis.
🟢 C. Aortic dissection.
🔴 RATIONALE: The presentation of acute, severe tearing chest pain radiating to the back with a significant
blood pressure differential between arms is classic for aortic dissection. This is a medical emergency requiring
immediate imaging (CT angiography). MI and pulmonary embolism have different presentations. Pericarditis
pain is typically pleuritic and positional.
3. A 32-year-old woman presents with fatigue, joint pain, and a malar rash. She reports intermittent fevers
and hair loss. Laboratory studies reveal anemia, leukopenia, and positive antinuclear antibody (ANA) and
anti-dsDNA antibodies. What is the most likely diagnosis?
A. Rheumatoid arthritis.
B. Systemic lupus erythematosus (SLE).
C. Sjögren's syndrome.
D. Sarcoidosis.
🟢 B. Systemic lupus erythematosus (SLE).
, 🔴 RATIONALE: The constellation of malar rash, arthritis, hematologic abnormalities, and positive ANA and anti-
dsDNA antibodies is characteristic of SLE. Rheumatoid arthritis typically presents with symmetric polyarthritis
and positive rheumatoid factor. Sjögren's syndrome presents with dry eyes and mouth. Sarcoidosis often
involves the lungs and lymph nodes.
4. A 67-year-old patient with a history of diabetes and hypertension presents with a 2-hour history of right-
sided weakness, facial droop, and difficulty speaking. The patient's symptoms began suddenly. Which is the
priority action?
A. Order a stat CT scan of the head without contrast.
B. Administer aspirin 325 mg.
C. Obtain a stat MRI of the brain.
D. Administer intravenous tissue plasminogen activator (tPA).
🟢 A. Order a stat CT scan of the head without contrast.
🔴 RATIONALE: In a patient with acute stroke symptoms, a non-contrast head CT is the initial diagnostic test to
rule out intracranial hemorrhage before considering thrombolytic therapy with tPA. tPA is only indicated if the
CT is negative for hemorrhage and the patient is within the therapeutic window. Aspirin may be given after
hemorrhage is ruled out.
ALREADY GRADED A+| 100% VERIFIED SOLUTIONS………...
Core Domains:
Clinical Assessment and History Taking
Pathophysiology and Disease Presentation
Differential Diagnosis Formulation
Diagnostic Test Selection and Interpretation
Clinical Decision-Making and Critical Thinking
Evidence-Based Practice and Guidelines
Patient Communication and Shared Decision-Making
Legal and Ethical Considerations in Diagnosis
Pharmacologic and Non-Pharmacologic Interventions
Health Promotion and Disease Prevention
Introduction:
This comprehensive diagnostic reasoning examination is designed to assess advanced clinical judgment and
decision-making skills essential for advanced practice nursing. It evaluates the ability to synthesize patient data,
formulate differential diagnoses, select appropriate diagnostic tests, and interpret results within the context of
evidence-based practice. The exam employs multiple-choice and scenario-based questions that challenge students
to apply pathophysiological principles, prioritize clinical findings, and develop safe, patient-centered management
,plans. Emphasis is placed on real-world clinical reasoning, ethical considerations, and the integration of holistic
assessment findings to achieve accurate diagnoses and optimal patient outcomes.
Section One: Questions 1–100
1. A 58-year-old patient presents with a 3-week history of progressive dyspnea on exertion, non-productive
cough, and unintentional weight loss of 10 pounds. The patient has a 40-pack-year smoking history. On
examination, there is decreased breath sounds at the right lung base and dullness to percussion. What is the
most appropriate initial diagnostic test?
A. Chest X-ray.
B. CT scan of the chest.
C. Sputum cytology.
D. Bronchoscopy.
🟢 A. Chest X-ray.
🔴 RATIONALE: A chest X-ray is the initial imaging study for a patient with respiratory symptoms and findings
suggestive of a pulmonary process. It can identify masses, infiltrates, effusions, and other abnormalities. CT
scan, sputum cytology, and bronchoscopy are subsequent steps based on initial findings.
2. A 45-year-old male with a history of hypertension presents with a sudden onset of severe, tearing chest
pain radiating to the back. Blood pressure is 180/110 mmHg in the right arm and 130/80 mmHg in the left
,arm. Which diagnosis is most likely?
A. Myocardial infarction.
B. Pulmonary embolism.
C. Aortic dissection.
D. Pericarditis.
🟢 C. Aortic dissection.
🔴 RATIONALE: The presentation of acute, severe tearing chest pain radiating to the back with a significant
blood pressure differential between arms is classic for aortic dissection. This is a medical emergency requiring
immediate imaging (CT angiography). MI and pulmonary embolism have different presentations. Pericarditis
pain is typically pleuritic and positional.
3. A 32-year-old woman presents with fatigue, joint pain, and a malar rash. She reports intermittent fevers
and hair loss. Laboratory studies reveal anemia, leukopenia, and positive antinuclear antibody (ANA) and
anti-dsDNA antibodies. What is the most likely diagnosis?
A. Rheumatoid arthritis.
B. Systemic lupus erythematosus (SLE).
C. Sjögren's syndrome.
D. Sarcoidosis.
🟢 B. Systemic lupus erythematosus (SLE).
, 🔴 RATIONALE: The constellation of malar rash, arthritis, hematologic abnormalities, and positive ANA and anti-
dsDNA antibodies is characteristic of SLE. Rheumatoid arthritis typically presents with symmetric polyarthritis
and positive rheumatoid factor. Sjögren's syndrome presents with dry eyes and mouth. Sarcoidosis often
involves the lungs and lymph nodes.
4. A 67-year-old patient with a history of diabetes and hypertension presents with a 2-hour history of right-
sided weakness, facial droop, and difficulty speaking. The patient's symptoms began suddenly. Which is the
priority action?
A. Order a stat CT scan of the head without contrast.
B. Administer aspirin 325 mg.
C. Obtain a stat MRI of the brain.
D. Administer intravenous tissue plasminogen activator (tPA).
🟢 A. Order a stat CT scan of the head without contrast.
🔴 RATIONALE: In a patient with acute stroke symptoms, a non-contrast head CT is the initial diagnostic test to
rule out intracranial hemorrhage before considering thrombolytic therapy with tPA. tPA is only indicated if the
CT is negative for hemorrhage and the patient is within the therapeutic window. Aspirin may be given after
hemorrhage is ruled out.
