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NSG 550 EXAM 2 (2026–2027) | DIAGNOSTIC REASONING | VERIFIED
QUESTIONS & ANSWERS 100% CORRECT ALREADY GRADED A+
Q1 — Cardiovascular (chest pain)
A 62-year-old man with HTN and hyperlipidemia presents with 2 hours of central
chest pressure radiating to his left arm, nausea, and diaphoresis. ECG shows 2-mm
ST elevation in leads V2–V4. Troponin I is elevated. He’s within 90 minutes of
PCI-capable hospital arrival. Which is the best next step?
A. Administer fibrinolytic therapy immediately.
B. Begin high-dose IV nitroglycerin and observe.
C. Activate the cath lab for emergent PCI.
D. Arrange urgent coronary CT angiography.
Answer: C. Activate the cath lab for emergent PCI.
Rationale: ST-elevation MI with chest pain and elevated troponin — primary PCI
within 90 minutes is preferred if available. Fibrinolytics are for non-PCI settings or
delays. CT angio is not appropriate acutely.
Q2 — Respiratory (dyspnea, COPD exacerbation)
A 68-year-old COPD patient presents with increased dyspnea, productive cough,
and a respiratory rate of 28. Pulse oximetry on room air is 89%. ABG shows
PaCO₂ 55 mmHg, pH 7.33. Which is the most appropriate immediate
management?
A. High-flow oxygen at 10 L/min via non-rebreather.
B. Controlled supplemental oxygen to target SpO₂ 88–92% and bronchodilators.
C. Start continuous NIV (BiPAP) immediately without oxygen.
D. Emergent endotracheal intubation.
Answer: B. Controlled supplemental oxygen to target SpO₂ 88–92% and
bronchodilators.
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Rationale: COPD exacerbation with hypercapnia needs controlled O₂ (avoid
overoxygenation), inhaled bronchodilators, steroids; consider NIV if worsening.
Non-rebreather may raise PaCO₂.
Q3 — Neurology (acute headache)
A 44-year-old woman has sudden, severe “worst headache of my life,” vomiting,
and photophobia. Neuro exam nonfocal. Best initial diagnostic test?
A. Noncontrast head CT immediately.
B. MRI brain with contrast.
C. Lumbar puncture first.
D. Carotid Doppler.
Answer: A. Noncontrast head CT immediately.
Rationale: Sudden severe thunderclap headache → rule out subarachnoid
hemorrhage; noncontrast CT is first test. If CT negative but suspicion remains,
perform lumbar puncture.
Q4 — Gastrointestinal (abdominal pain)
A 29-year-old woman with RLQ pain for 18 hours, fever, leukocytosis, and
anorexia. Pregnancy test negative. Best next diagnostic step?
A. Immediate CT abdomen/pelvis with IV contrast.
B. Pelvic ultrasound.
C. APPENDICECTOMY without imaging.
D. Focused abdominal ultrasound (graded compression) or CT depending on
availability.
Answer: D. Focused abdominal ultrasound (graded compression) or CT
depending on availability.
Rationale: For suspected appendicitis in adults, ultrasound is often first in young
women (avoid radiation); CT is more sensitive/specific if US equivocal. Immediate
surgery without imaging is reserved for clear clinical diagnosis.
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Q5 — Endocrine (thyroid)
A 36-year-old woman has weight loss, heat intolerance, palpitations, and fine
tremor. TSH low, free T4 elevated. She is pregnant (8 weeks). Which antithyroid
therapy is preferred in the first trimester?
A. Methimazole.
B. Propylthiouracil (PTU).
C. Radioactive iodine.
D. Levothyroxine.
Answer: B. Propylthiouracil (PTU).
Rationale: In first trimester, PTU is preferred due to lower teratogenic risk versus
methimazole. Radioactive iodine is contraindicated in pregnancy; levothyroxine
treats hypothyroidism.
Q6 — Diagnostic testing (interpretation of troponin)
A patient with chest pain has a baseline troponin slightly elevated at 0.06 ng/mL
(upper reference 0.04). Repeat troponin 3 hours later is 0.59 ng/mL. What does this
pattern imply?
A. Chronic stable troponin elevation — not MI.
B. Dynamic rise consistent with acute myocardial injury/MI.
C. Lab error; repeat again in 24 hours only.
D. Troponin levels are not helpful in this scenario.
Answer: B. Dynamic rise consistent with acute myocardial injury/MI.
Rationale: A rising troponin with clinical chest pain indicates acute myocardial
injury; serial changes are required to diagnose MI.
Q7 — Pharmacologic reasoning (anticoagulation)
A 75-year-old woman with non-valvular atrial fibrillation and CrCl 25 mL/min
needs anticoagulation. Which is the best agent?
A. Dabigatran (standard dose).
B. Warfarin with INR monitoring.
C. Rivaroxaban standard dose.
D. Aspirin alone.
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Answer: B. Warfarin with INR monitoring.
Rationale: In severe renal impairment (CrCl <30), warfarin is preferred because
DOAC dosing is limited or contraindicated depending on agent. Aspirin alone is
inadequate for stroke prevention.
Q8 — Pediatrics (fever and rash)
A 3-year-old with 3 days of high fever now developed a blanching maculopapular
rash and mucous membrane redness. Conjunctivitis noted. Which is highest on
your differential?
A. Scarlet fever.
B. Kawasaki disease.
C. Viral roseola.
D. Hand-foot-mouth disease.
Answer: B. Kawasaki disease.
Rationale: Prolonged fever, conjunctivitis, mucosal changes, rash suggest
Kawasaki — urgent because of coronary artery risk. Scarlet fever has strawberry
tongue and scarlatiniform rash but different findings.
Q9 — Geriatric (falls + syncope)
An 82-year-old with recurrent falls and a history of syncope. Orthostatic vitals
show BP drop of 30/15 mmHg on standing with dizziness. Which is the most
appropriate next step?
A. Start midodrine.
B. Review and reduce orthostasis-promoting medications and counsel hydration.
C. Implant pacemaker immediately.
D. Begin fludrocortisone in all cases.
Answer: B. Review and reduce orthostasis-promoting medications and
counsel hydration.
Rationale: First-line for orthostatic hypotension includes medication review
(diuretics, antihypertensives), nonpharmacologic measures. Pharmacotherapy
considered if conservative measures fail.
NSG 550 EXAM 2 (2026–2027) | DIAGNOSTIC REASONING | VERIFIED
QUESTIONS & ANSWERS 100% CORRECT ALREADY GRADED A+
Q1 — Cardiovascular (chest pain)
A 62-year-old man with HTN and hyperlipidemia presents with 2 hours of central
chest pressure radiating to his left arm, nausea, and diaphoresis. ECG shows 2-mm
ST elevation in leads V2–V4. Troponin I is elevated. He’s within 90 minutes of
PCI-capable hospital arrival. Which is the best next step?
A. Administer fibrinolytic therapy immediately.
B. Begin high-dose IV nitroglycerin and observe.
C. Activate the cath lab for emergent PCI.
D. Arrange urgent coronary CT angiography.
Answer: C. Activate the cath lab for emergent PCI.
Rationale: ST-elevation MI with chest pain and elevated troponin — primary PCI
within 90 minutes is preferred if available. Fibrinolytics are for non-PCI settings or
delays. CT angio is not appropriate acutely.
Q2 — Respiratory (dyspnea, COPD exacerbation)
A 68-year-old COPD patient presents with increased dyspnea, productive cough,
and a respiratory rate of 28. Pulse oximetry on room air is 89%. ABG shows
PaCO₂ 55 mmHg, pH 7.33. Which is the most appropriate immediate
management?
A. High-flow oxygen at 10 L/min via non-rebreather.
B. Controlled supplemental oxygen to target SpO₂ 88–92% and bronchodilators.
C. Start continuous NIV (BiPAP) immediately without oxygen.
D. Emergent endotracheal intubation.
Answer: B. Controlled supplemental oxygen to target SpO₂ 88–92% and
bronchodilators.
,2 | Page
Rationale: COPD exacerbation with hypercapnia needs controlled O₂ (avoid
overoxygenation), inhaled bronchodilators, steroids; consider NIV if worsening.
Non-rebreather may raise PaCO₂.
Q3 — Neurology (acute headache)
A 44-year-old woman has sudden, severe “worst headache of my life,” vomiting,
and photophobia. Neuro exam nonfocal. Best initial diagnostic test?
A. Noncontrast head CT immediately.
B. MRI brain with contrast.
C. Lumbar puncture first.
D. Carotid Doppler.
Answer: A. Noncontrast head CT immediately.
Rationale: Sudden severe thunderclap headache → rule out subarachnoid
hemorrhage; noncontrast CT is first test. If CT negative but suspicion remains,
perform lumbar puncture.
Q4 — Gastrointestinal (abdominal pain)
A 29-year-old woman with RLQ pain for 18 hours, fever, leukocytosis, and
anorexia. Pregnancy test negative. Best next diagnostic step?
A. Immediate CT abdomen/pelvis with IV contrast.
B. Pelvic ultrasound.
C. APPENDICECTOMY without imaging.
D. Focused abdominal ultrasound (graded compression) or CT depending on
availability.
Answer: D. Focused abdominal ultrasound (graded compression) or CT
depending on availability.
Rationale: For suspected appendicitis in adults, ultrasound is often first in young
women (avoid radiation); CT is more sensitive/specific if US equivocal. Immediate
surgery without imaging is reserved for clear clinical diagnosis.
,3 | Page
Q5 — Endocrine (thyroid)
A 36-year-old woman has weight loss, heat intolerance, palpitations, and fine
tremor. TSH low, free T4 elevated. She is pregnant (8 weeks). Which antithyroid
therapy is preferred in the first trimester?
A. Methimazole.
B. Propylthiouracil (PTU).
C. Radioactive iodine.
D. Levothyroxine.
Answer: B. Propylthiouracil (PTU).
Rationale: In first trimester, PTU is preferred due to lower teratogenic risk versus
methimazole. Radioactive iodine is contraindicated in pregnancy; levothyroxine
treats hypothyroidism.
Q6 — Diagnostic testing (interpretation of troponin)
A patient with chest pain has a baseline troponin slightly elevated at 0.06 ng/mL
(upper reference 0.04). Repeat troponin 3 hours later is 0.59 ng/mL. What does this
pattern imply?
A. Chronic stable troponin elevation — not MI.
B. Dynamic rise consistent with acute myocardial injury/MI.
C. Lab error; repeat again in 24 hours only.
D. Troponin levels are not helpful in this scenario.
Answer: B. Dynamic rise consistent with acute myocardial injury/MI.
Rationale: A rising troponin with clinical chest pain indicates acute myocardial
injury; serial changes are required to diagnose MI.
Q7 — Pharmacologic reasoning (anticoagulation)
A 75-year-old woman with non-valvular atrial fibrillation and CrCl 25 mL/min
needs anticoagulation. Which is the best agent?
A. Dabigatran (standard dose).
B. Warfarin with INR monitoring.
C. Rivaroxaban standard dose.
D. Aspirin alone.
, 4 | Page
Answer: B. Warfarin with INR monitoring.
Rationale: In severe renal impairment (CrCl <30), warfarin is preferred because
DOAC dosing is limited or contraindicated depending on agent. Aspirin alone is
inadequate for stroke prevention.
Q8 — Pediatrics (fever and rash)
A 3-year-old with 3 days of high fever now developed a blanching maculopapular
rash and mucous membrane redness. Conjunctivitis noted. Which is highest on
your differential?
A. Scarlet fever.
B. Kawasaki disease.
C. Viral roseola.
D. Hand-foot-mouth disease.
Answer: B. Kawasaki disease.
Rationale: Prolonged fever, conjunctivitis, mucosal changes, rash suggest
Kawasaki — urgent because of coronary artery risk. Scarlet fever has strawberry
tongue and scarlatiniform rash but different findings.
Q9 — Geriatric (falls + syncope)
An 82-year-old with recurrent falls and a history of syncope. Orthostatic vitals
show BP drop of 30/15 mmHg on standing with dizziness. Which is the most
appropriate next step?
A. Start midodrine.
B. Review and reduce orthostasis-promoting medications and counsel hydration.
C. Implant pacemaker immediately.
D. Begin fludrocortisone in all cases.
Answer: B. Review and reduce orthostasis-promoting medications and
counsel hydration.
Rationale: First-line for orthostatic hypotension includes medication review
(diuretics, antihypertensives), nonpharmacologic measures. Pharmacotherapy
considered if conservative measures fail.
