NUR 612 Exam 5 | (2026) Diagnostic Reasoning
Questions | Health Assessment (PDF)
1. A 58-year-old man presents with substernal chest
pressure that occurs when he walks up two flights of stairs
and subsides within 5 minutes of resting. He has
hypertension and hyperlipidemia. What is the most likely
diagnosis?
A) Acute pericarditis
B) Unstable angina
C) Stable angina
D) Gastroesophageal reflux disease
1
,Answer: C) Stable angina
Rationale: Stable angina is provoked by exertion and
relieved by rest. Pericarditis is typically positional;
unstable angina occurs at rest or with minimal exertion;
GERD is postprandial or recumbent.
2. A 32-year-old female reports episodic palpitations,
severe headaches, and diaphoresis lasting 10–20 minutes.
During an episode, her blood pressure is 200/110 mmHg.
Between episodes she is asymptomatic. Which diagnostic
test is most appropriate first?
A) Serum thyroid-stimulating hormone
B) 24-hour urine metanephrines
2
,C) Electrocardiogram
D) Serum electrolytes
Answer: B) 24-hour urine metanephrines
Rationale: Paroxysmal hypertension with palpitations,
headache, and diaphoresis suggests pheochromocytoma.
Metanephrines (urine or plasma) are first-line. TSH
screens for thyrotoxicosis but is less specific here. ECG
may show tachycardia but not diagnostic.
3. A 45-year-old man reports black, tarry stools for three
days. He denies abdominal pain. He takes ibuprofen
daily for knee pain. What is the most likely source of
bleeding?
A) Hemorrhoids
3
, B) Upper gastrointestinal tractj6 j6
C) Right colon j6
D) Small bowel arteriovenous malformation
j6 j6 j6
Answer: B) Upper gastrointestinal tract
j 6 j 6 j 6 j 6
Rationale: Melena (black, tarry stool) typically indicates
j6 j6 j6 j6 j6 j6
j6 bleeding proximal to the ligament of Treitz. NSAID use
j6 j6 j6 j6 j6 j6 j6 j6
j6 increases risk of gastric or duodenal ulcer. Hemorrhoids
j6 j6 j6 j6 j6 j6 j6
j6 cause bright red blood. Right colon bleeding causes
j6 j6 j6 j6 j6 j6 j6
j6 maroon or dark red stool.
j6 j6 j6 j6
4. A 68-year-old woman with osteoporosis reports progressive
j6 j6 j6 j6 j6 j6 j6
difficulty swallowing solids, then liquids, over
j6 j6 j6 j6 j6 j6
4
Questions | Health Assessment (PDF)
1. A 58-year-old man presents with substernal chest
pressure that occurs when he walks up two flights of stairs
and subsides within 5 minutes of resting. He has
hypertension and hyperlipidemia. What is the most likely
diagnosis?
A) Acute pericarditis
B) Unstable angina
C) Stable angina
D) Gastroesophageal reflux disease
1
,Answer: C) Stable angina
Rationale: Stable angina is provoked by exertion and
relieved by rest. Pericarditis is typically positional;
unstable angina occurs at rest or with minimal exertion;
GERD is postprandial or recumbent.
2. A 32-year-old female reports episodic palpitations,
severe headaches, and diaphoresis lasting 10–20 minutes.
During an episode, her blood pressure is 200/110 mmHg.
Between episodes she is asymptomatic. Which diagnostic
test is most appropriate first?
A) Serum thyroid-stimulating hormone
B) 24-hour urine metanephrines
2
,C) Electrocardiogram
D) Serum electrolytes
Answer: B) 24-hour urine metanephrines
Rationale: Paroxysmal hypertension with palpitations,
headache, and diaphoresis suggests pheochromocytoma.
Metanephrines (urine or plasma) are first-line. TSH
screens for thyrotoxicosis but is less specific here. ECG
may show tachycardia but not diagnostic.
3. A 45-year-old man reports black, tarry stools for three
days. He denies abdominal pain. He takes ibuprofen
daily for knee pain. What is the most likely source of
bleeding?
A) Hemorrhoids
3
, B) Upper gastrointestinal tractj6 j6
C) Right colon j6
D) Small bowel arteriovenous malformation
j6 j6 j6
Answer: B) Upper gastrointestinal tract
j 6 j 6 j 6 j 6
Rationale: Melena (black, tarry stool) typically indicates
j6 j6 j6 j6 j6 j6
j6 bleeding proximal to the ligament of Treitz. NSAID use
j6 j6 j6 j6 j6 j6 j6 j6
j6 increases risk of gastric or duodenal ulcer. Hemorrhoids
j6 j6 j6 j6 j6 j6 j6
j6 cause bright red blood. Right colon bleeding causes
j6 j6 j6 j6 j6 j6 j6
j6 maroon or dark red stool.
j6 j6 j6 j6
4. A 68-year-old woman with osteoporosis reports progressive
j6 j6 j6 j6 j6 j6 j6
difficulty swallowing solids, then liquids, over
j6 j6 j6 j6 j6 j6
4
