NR-703 NR703: Advanced Health Assessment and
Diagnostic Reasoning – Comprehensive Evaluation,
Clinical Decision-Making, and Evidence-Based Practice
for Advanced Nursing 2025-2026
1. A 45-year-old female presents with fatigue, weight gain, and
constipation. On exam, her skin is dry, and her reflexes are
slowed. The most likely diagnosis is:
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing’s syndrome
D. Diabetes mellitus
Rationale: Fatigue, weight gain, constipation, dry skin, and
delayed reflexes are classic signs of hypothyroidism.
2. A 6-year-old presents with fever, sore throat, and tonsillar
exudates. Rapid strep test is positive. The first-line treatment is:
A. Azithromycin
B. Penicillin or Amoxicillin
C. Ciprofloxacin
D. Doxycycline
Rationale: Penicillin and amoxicillin are first-line therapy for Group
A Streptococcus in children.
3. A patient presents with acute onset dyspnea, pleuritic chest pain,
and hemoptysis. Which is the most likely diagnosis?
A. Pneumothorax
B. Pulmonary embolism
C. Asthma exacerbation
D. Pneumonia
, Rationale: Acute dyspnea, pleuritic pain, and hemoptysis are
classic for pulmonary embolism.
4. A 60-year-old patient with diabetes presents with a non-healing
foot ulcer. Which is the most important next step?
A. Start topical antifungal
B. Prescribe NSAIDs
C. Assess for peripheral neuropathy and vascular disease
D. Recommend bed rest only
Rationale: Non-healing ulcers in diabetic patients require
assessment for neuropathy and vascular compromise to guide
management.
5. A 25-year-old woman presents with dysuria, frequency, and
urgency. Urinalysis shows positive leukocyte esterase. First-line
treatment is:
A. Nitrofurantoin
B. Ciprofloxacin
C. Amoxicillin
D. Trimethoprim-sulfamethoxazole (TMP-SMX)
Rationale: TMP-SMX is first-line for uncomplicated urinary tract
infection in non-pregnant women.
6. A patient presents with sudden right-sided weakness and slurred
speech. The most appropriate initial imaging is:
A. MRI abdomen
B. Chest X-ray
C. Non-contrast head CT
D. Echocardiogram
Rationale: Non-contrast CT is first-line to differentiate ischemic vs.
hemorrhagic stroke.
, 7. A 32-year-old woman presents with fatigue and pallor. Labs show
microcytic anemia. The most likely cause is:
A. Vitamin B12 deficiency
B. Iron deficiency
C. Folate deficiency
D. Hemolytic anemia
Rationale: Microcytic anemia is most commonly caused by iron
deficiency.
8. A patient presents with chronic cough, night sweats, and weight
loss. Which test is most appropriate first?
A. Chest X-ray
B. Sputum acid-fast bacillus (AFB) test
C. Pulmonary function test
D. CT abdomen
Rationale: Suspected tuberculosis requires sputum testing to
confirm the diagnosis.
9. A patient with COPD exacerbation presents with increased
sputum production and shortness of breath. First-line therapy is:
A. Oral corticosteroids only
B. Short-acting bronchodilator and antibiotics if indicated
C. Long-term oxygen only
D. Inhaled corticosteroid only
Rationale: Acute exacerbations are managed with
bronchodilators, corticosteroids, and antibiotics if bacterial
infection is suspected.
10. A patient presents with jaundice, dark urine, and pale stools.
Labs show elevated AST and ALT. The most likely cause is:
A. Hemolysis
B. Hepatitis
Diagnostic Reasoning – Comprehensive Evaluation,
Clinical Decision-Making, and Evidence-Based Practice
for Advanced Nursing 2025-2026
1. A 45-year-old female presents with fatigue, weight gain, and
constipation. On exam, her skin is dry, and her reflexes are
slowed. The most likely diagnosis is:
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing’s syndrome
D. Diabetes mellitus
Rationale: Fatigue, weight gain, constipation, dry skin, and
delayed reflexes are classic signs of hypothyroidism.
2. A 6-year-old presents with fever, sore throat, and tonsillar
exudates. Rapid strep test is positive. The first-line treatment is:
A. Azithromycin
B. Penicillin or Amoxicillin
C. Ciprofloxacin
D. Doxycycline
Rationale: Penicillin and amoxicillin are first-line therapy for Group
A Streptococcus in children.
3. A patient presents with acute onset dyspnea, pleuritic chest pain,
and hemoptysis. Which is the most likely diagnosis?
A. Pneumothorax
B. Pulmonary embolism
C. Asthma exacerbation
D. Pneumonia
, Rationale: Acute dyspnea, pleuritic pain, and hemoptysis are
classic for pulmonary embolism.
4. A 60-year-old patient with diabetes presents with a non-healing
foot ulcer. Which is the most important next step?
A. Start topical antifungal
B. Prescribe NSAIDs
C. Assess for peripheral neuropathy and vascular disease
D. Recommend bed rest only
Rationale: Non-healing ulcers in diabetic patients require
assessment for neuropathy and vascular compromise to guide
management.
5. A 25-year-old woman presents with dysuria, frequency, and
urgency. Urinalysis shows positive leukocyte esterase. First-line
treatment is:
A. Nitrofurantoin
B. Ciprofloxacin
C. Amoxicillin
D. Trimethoprim-sulfamethoxazole (TMP-SMX)
Rationale: TMP-SMX is first-line for uncomplicated urinary tract
infection in non-pregnant women.
6. A patient presents with sudden right-sided weakness and slurred
speech. The most appropriate initial imaging is:
A. MRI abdomen
B. Chest X-ray
C. Non-contrast head CT
D. Echocardiogram
Rationale: Non-contrast CT is first-line to differentiate ischemic vs.
hemorrhagic stroke.
, 7. A 32-year-old woman presents with fatigue and pallor. Labs show
microcytic anemia. The most likely cause is:
A. Vitamin B12 deficiency
B. Iron deficiency
C. Folate deficiency
D. Hemolytic anemia
Rationale: Microcytic anemia is most commonly caused by iron
deficiency.
8. A patient presents with chronic cough, night sweats, and weight
loss. Which test is most appropriate first?
A. Chest X-ray
B. Sputum acid-fast bacillus (AFB) test
C. Pulmonary function test
D. CT abdomen
Rationale: Suspected tuberculosis requires sputum testing to
confirm the diagnosis.
9. A patient with COPD exacerbation presents with increased
sputum production and shortness of breath. First-line therapy is:
A. Oral corticosteroids only
B. Short-acting bronchodilator and antibiotics if indicated
C. Long-term oxygen only
D. Inhaled corticosteroid only
Rationale: Acute exacerbations are managed with
bronchodilators, corticosteroids, and antibiotics if bacterial
infection is suspected.
10. A patient presents with jaundice, dark urine, and pale stools.
Labs show elevated AST and ALT. The most likely cause is:
A. Hemolysis
B. Hepatitis
