Edition
2026
WILKES UNIVERSITY · CRNP PROGRAM
NSG 550 — Diagnostic Reasoning
Exam 3
Study Guide
100 Multiple-Choice Questions with Answers & Rationales
This study guide presents 100 graduate-level multiple-choice questions
focused on adult med-surg differential diagnosis. Each question includes a
clinical scenario, four answer options, the correct answer, and a concise
rationale explaining the diagnostic reasoning behind the answer. Use it to test
your clinical reasoning and to identify areas needing additional review before
exam day.
Exam: NSG 550 — Diagnostic Reasoning, Exam 3
Level: Graduate / MSN-NP
Focus: Adult Medical-Surgical Differential Diagnosis
G U A R A N T E E D PA S S · S T U D Y E D I T I O N · 2 0 2 6
,NSG 550 — Diagnostic Reasoning · Exam 3 Study Guide 100 MCQs · 2026 Edition
Exam Instructions & Study Guide Overview
This study guide contains 100 multiple-choice questions written at the graduate/MSN level for the Wilkes
University NSG 550 Diagnostic Reasoning Exam 3. Questions are presented as a single continuous exam
without section dividers. Each item is followed immediately by the correct answer and a concise rationale that
explains the diagnostic reasoning behind the answer and why the alternatives are incorrect.
Topic Coverage
Although presented as one continuous exam, questions cover the full breadth of adult med-surg differential
diagnosis. The approximate topic distribution is summarized below:
Topic Block Question Range Approx. %
Diagnostic foundations & common presentations Q1 – Q25 25%
Cardiopulmonary & vascular diagnostics Q26 – Q50 25%
GI, renal & endocrine diagnostics Q51 – Q75 25%
Neuro, hematology, infectious & multi-system Q76 – Q100 25%
Wilkes University Page 2 Guaranteed Pass Edition
,NSG 550 — Diagnostic Reasoning · Exam 3 Study Guide 100 MCQs · 2026 Edition
Questions 1 – 100
The following 100 multiple-choice questions form a single continuous exam. Each question is followed immediately by the
correct answer and a detailed rationale.
1. A 58-year-old male presents to the clinic with substernal chest pressure
that began 45 minutes ago while shoveling snow. The pain radiates to his
left jaw and is associated with diaphoresis and nausea. Vital signs: BP
148/92, HR 102, RR 20, SpO2 96% on room air. What is the most
appropriate FIRST diagnostic action?
A. Obtain a 12-lead ECG within 10 minutes of arrival
B. Administer aspirin 325 mg chewed and order serial troponins
C. Order a CT angiogram of the chest to rule out pulmonary embolism
D. Perform a focused bedside echocardiogram to assess wall motion
Correct Answer:A A. Obtain a 12-lead ECG within 10 minutes of arrival
Rationale: The presentation is classic for acute coronary syndrome (ACS),
and the first action is to obtain a 12-lead ECG within 10 minutes of arrival to
identify ST-elevation, which would trigger immediate reperfusion
therapy. Aspirin and troponins are essential but follow the ECG in priority
because the ECG immediately stratifies STEMI from NSTEMI/unstable angina.
CT angiogram is reserved for patients in whom PE is more likely and ACS has
been excluded. Bedside echo can support the diagnosis but cannot substitute for
the ECG, which is faster, cheaper, and definitive for STEMI.
2. A67-year-old female with a history of hypertension and hyperlipidemia
presents with tearing chest pain radiating to the back between the scapulae.
BP is 168/98 in the right arm and 142/82 in the left arm. Which finding is
most specific for the suspected diagnosis?
A. Elevated troponin I
B. Widened mediastinum on chest x-ray
C. ST elevations in leads II, III, aVF
D. Pleuritic chest pain worsened by deep inspiration
Correct Answer:B B. Widened mediastinum on chest x-ray
Wilkes University Page 3 Guaranteed Pass Edition
, NSG 550 — Diagnostic Reasoning · Exam 3 Study Guide 100 MCQs · 2026 Edition
Rationale: The clinical picture is classic for acute aortic dissection: tearing pain
radiating to the back, blood pressure differential >20 mmHg between arms. A
widened mediastinum on chest x-ray is the most specific bedside imaging finding
and is present in roughly 60-90% of proximal dissections. Troponin may be
elevated if the dissection compromises coronary ostia but is not specific. ST
elevations in inferior leads suggest RCA occlusion, not dissection. Pleuritic pain
is more characteristic of pleuritis, pericarditis, or pulmonary embolism.
3. A72-year-old male with atrial fibrillation on warfarin presents with acute
onset of severe tearing abdominal pain that is disproportionate to physical
exam findings. Lactate is 4.2 mmol/L. What is the most likely diagnosis?
A. Acute pancreatitis
B. Acute mesenteric ischemia
C. Perforated peptic ulcer
Wilkes University Page 4 Guaranteed Pass Edition
2026
WILKES UNIVERSITY · CRNP PROGRAM
NSG 550 — Diagnostic Reasoning
Exam 3
Study Guide
100 Multiple-Choice Questions with Answers & Rationales
This study guide presents 100 graduate-level multiple-choice questions
focused on adult med-surg differential diagnosis. Each question includes a
clinical scenario, four answer options, the correct answer, and a concise
rationale explaining the diagnostic reasoning behind the answer. Use it to test
your clinical reasoning and to identify areas needing additional review before
exam day.
Exam: NSG 550 — Diagnostic Reasoning, Exam 3
Level: Graduate / MSN-NP
Focus: Adult Medical-Surgical Differential Diagnosis
G U A R A N T E E D PA S S · S T U D Y E D I T I O N · 2 0 2 6
,NSG 550 — Diagnostic Reasoning · Exam 3 Study Guide 100 MCQs · 2026 Edition
Exam Instructions & Study Guide Overview
This study guide contains 100 multiple-choice questions written at the graduate/MSN level for the Wilkes
University NSG 550 Diagnostic Reasoning Exam 3. Questions are presented as a single continuous exam
without section dividers. Each item is followed immediately by the correct answer and a concise rationale that
explains the diagnostic reasoning behind the answer and why the alternatives are incorrect.
Topic Coverage
Although presented as one continuous exam, questions cover the full breadth of adult med-surg differential
diagnosis. The approximate topic distribution is summarized below:
Topic Block Question Range Approx. %
Diagnostic foundations & common presentations Q1 – Q25 25%
Cardiopulmonary & vascular diagnostics Q26 – Q50 25%
GI, renal & endocrine diagnostics Q51 – Q75 25%
Neuro, hematology, infectious & multi-system Q76 – Q100 25%
Wilkes University Page 2 Guaranteed Pass Edition
,NSG 550 — Diagnostic Reasoning · Exam 3 Study Guide 100 MCQs · 2026 Edition
Questions 1 – 100
The following 100 multiple-choice questions form a single continuous exam. Each question is followed immediately by the
correct answer and a detailed rationale.
1. A 58-year-old male presents to the clinic with substernal chest pressure
that began 45 minutes ago while shoveling snow. The pain radiates to his
left jaw and is associated with diaphoresis and nausea. Vital signs: BP
148/92, HR 102, RR 20, SpO2 96% on room air. What is the most
appropriate FIRST diagnostic action?
A. Obtain a 12-lead ECG within 10 minutes of arrival
B. Administer aspirin 325 mg chewed and order serial troponins
C. Order a CT angiogram of the chest to rule out pulmonary embolism
D. Perform a focused bedside echocardiogram to assess wall motion
Correct Answer:A A. Obtain a 12-lead ECG within 10 minutes of arrival
Rationale: The presentation is classic for acute coronary syndrome (ACS),
and the first action is to obtain a 12-lead ECG within 10 minutes of arrival to
identify ST-elevation, which would trigger immediate reperfusion
therapy. Aspirin and troponins are essential but follow the ECG in priority
because the ECG immediately stratifies STEMI from NSTEMI/unstable angina.
CT angiogram is reserved for patients in whom PE is more likely and ACS has
been excluded. Bedside echo can support the diagnosis but cannot substitute for
the ECG, which is faster, cheaper, and definitive for STEMI.
2. A67-year-old female with a history of hypertension and hyperlipidemia
presents with tearing chest pain radiating to the back between the scapulae.
BP is 168/98 in the right arm and 142/82 in the left arm. Which finding is
most specific for the suspected diagnosis?
A. Elevated troponin I
B. Widened mediastinum on chest x-ray
C. ST elevations in leads II, III, aVF
D. Pleuritic chest pain worsened by deep inspiration
Correct Answer:B B. Widened mediastinum on chest x-ray
Wilkes University Page 3 Guaranteed Pass Edition
, NSG 550 — Diagnostic Reasoning · Exam 3 Study Guide 100 MCQs · 2026 Edition
Rationale: The clinical picture is classic for acute aortic dissection: tearing pain
radiating to the back, blood pressure differential >20 mmHg between arms. A
widened mediastinum on chest x-ray is the most specific bedside imaging finding
and is present in roughly 60-90% of proximal dissections. Troponin may be
elevated if the dissection compromises coronary ostia but is not specific. ST
elevations in inferior leads suggest RCA occlusion, not dissection. Pleuritic pain
is more characteristic of pleuritis, pericarditis, or pulmonary embolism.
3. A72-year-old male with atrial fibrillation on warfarin presents with acute
onset of severe tearing abdominal pain that is disproportionate to physical
exam findings. Lactate is 4.2 mmol/L. What is the most likely diagnosis?
A. Acute pancreatitis
B. Acute mesenteric ischemia
C. Perforated peptic ulcer
Wilkes University Page 4 Guaranteed Pass Edition
