NSG 550
EXAM 1
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 1 Comprehensive Study Guide
,Table of Contents
NSG 550 Exam 1 ................................................................. 2
NSG 550 Exam 1 Study Guide ............................................. 49
NSG 550 Exam 1
1. A 68-year-old male with a history of benign prostatic hyperplasia presents for his
annual physical. His provider orders a PSA level. The nurse understands that an
elevated PSA is most specific for which of the following conditions?
A) Urinary tract infection
B) Prostate cancer
C) Acute kidney injury
D) Bladder obstruction
Correct Answer: B) Prostate cancer
Rationale: PSA (Prostate-Specific Antigen) is a glycoprotein produced by the epithelial cells
of the prostate gland. While PSA can be elevated in benign prostatic hyperplasia, prostatitis,
and urinary retention, it is the primary serum marker used for prostate cancer detection
and monitoring. The nurse must educate the patient that PSA screening, combined with
digital rectal examination, aids in early detection of prostate malignancy.
2. A nurse is reviewing the diagnostic workup for a patient suspected of having
rheumatoid arthritis. Which laboratory tests should the nurse anticipate the
provider will order? Select all that apply.
A) Rheumatoid Factor (RF)
B) Anti-CCP antibody
C) C-reactive Protein (CRP)
D) Erythrocyte Sedimentation Rate (ESR)
E) Complete Blood Count (CBC)
,Correct Answer: A, B, C, D, E
Rationale: The five core diagnostic labs to confirm or support a diagnosis of Rheumatoid
Arthritis include: (1) Rheumatoid Factor (RF) — an autoantibody present in approximately
80% of RA patients; (2) Anti-CCP (Anti-Citrullinated Peptide) antibody — highly specific for
RA and often present before clinical symptoms; (3) CRP — an acute-phase reactant
indicating active inflammation; (4) ESR — measures the rate of erythrocyte sedimentation,
which increases with inflammation; and (5) CBC — to assess for anemia of chronic disease
and thrombocytosis, both common in RA.
3. A patient is scheduled for a bone scan using a radioactive isotope. Which pre-
procedure instruction should the nurse provide?
A) "You will need to fast for 12 hours before the scan."
B) "Remove all metal jewelry and clothing with zippers before the procedure."
C) "You will be radioactive for several weeks and must avoid contact with others."
D) "Drink only clear fluids for 48 hours after the injection."
Correct Answer: B) "Remove all metal jewelry and clothing with zippers before the
procedure."
Rationale: Prior to a nuclear bone scan, patients must remove all metal objects because
metal can interfere with the scanner's ability to capture accurate images. The patient
should hold fluids for 4 hours before the injection, drink 32 oz of water after injection to
promote renal filtering, void 1–3 hours after injection to clear excess isotope from the
bladder, and lie supine during the scan. Radioactive isotopes are excreted in urine and feces
within 48 hours and are not harmful to family or visitors.
4. A 45-year-old female presents with fatigue, weight gain, constipation, and
bradycardia. Laboratory studies reveal elevated TSH and low T3 and T4 levels. The
nurse recognizes these findings are consistent with which condition?
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing's syndrome
D) Addison's disease
Correct Answer: B) Hypothyroidism
Rationale: Hypothyroidism is characterized by high TSH (thyroid-stimulating hormone)
and low T3/T4 levels due to the pituitary gland's compensatory response to insufficient
,thyroid hormone production. Clinical manifestations include bradycardia, weight gain,
constipation, cold intolerance, and sluggishness. This is in direct contrast to
hyperthyroidism/Graves' disease, which presents with low TSH, high T3/T4,
hypermetabolism, tachycardia, weight loss, and exophthalmos.
5. A patient with type 1 diabetes presents to the emergency department with fruity
breath, Kussmaul respirations, and altered mental status. Laboratory results show
high ketones, high anion gap, low potassium, and rising BUN/creatinine. The nurse
recognizes these findings as indicative of:
A) Hyperosmolar hyperglycemic state
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemic shock
D) Acute kidney injury
Correct Answer: B) Diabetic ketoacidosis (DKA)
Rationale: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes
mellitus characterized by hyperglycemia, ketonemia, and metabolic acidosis (high anion
gap). The rising BUN and creatinine reflect prerenal azotemia from dehydration. Low
potassium occurs due to osmotic diuresis and acidosis-driven intracellular shifts.
Immediate interventions include IV fluid resuscitation, insulin administration, and
electrolyte replacement.
6. A nurse is caring for a patient who underwent a cystoscopy. Which statement by
the patient indicates a need for further teaching?
A) "I may notice some pink-tinged urine after the procedure."
B) "I should drink plenty of fluids to flush my bladder."
C) "I can resume my normal diet immediately after the procedure."
D) "I should report burning with urination that lasts more than 24 hours."
Correct Answer: C) "I can resume my normal diet immediately after the procedure."
Rationale: Cystoscopy is the visual examination of the urinary bladder using a cystoscope
inserted through the urethra. While patients can typically resume a normal diet
immediately after an uncomplicated cystoscopy, this statement itself is not incorrect.
However, if the patient had sedation, they may need to wait before eating. More
importantly, the nurse should ensure the patient understands that mild hematuria, burning
,with urination, and increased urinary frequency are expected for 24–48 hours. The patient
must report fever, chills, or persistent gross hematuria.
7. A patient with suspected renal obstruction is scheduled for a renal scan. The nurse
explains to the patient that this nuclear scan will determine which of the following?
Select all that apply.
A) Size of the kidneys
B) Shape of the kidneys
C) Function of the kidneys
D) Presence of renal stones
E) Blood flow to the kidneys
Correct Answer: A, B, C
Rationale: Renal scanning (nuclear medicine renal scan) uses radioactive isotopes to
evaluate the size, shape, and function of the kidneys. It is used to diagnose renal
obstruction, renovascular hypertension, and differential renal function. While CT without
contrast is the gold standard for kidney stones, renal scans focus on functional assessment
rather than structural stone detection. Blood flow evaluation is better assessed with
Doppler ultrasound or angiography.
8. A patient with diabetes mellitus is being monitored for early signs of diabetic
nephropathy. Which laboratory test is the best marker to detect patients at risk for
developing this complication?
A) Serum creatinine
B) Blood urea nitrogen (BUN)
C) Microalbuminuria test
D) 24-hour urine protein
Correct Answer: C) Microalbuminuria test
Rationale: The microalbuminuria test detects small amounts of albumin in the urine (30–
300 mg/day) that are not detected by standard urine dipstick testing. It is the earliest and
most sensitive marker for diabetic nephropathy, allowing for intervention before significant
renal damage occurs. While serum creatinine and BUN reflect established renal
dysfunction, microalbuminuria identifies risk before GFR declines. Annual microalbumin
screening is recommended for all patients with diabetes.
,9. A nurse is preparing a patient for an MRI of the knee to evaluate a suspected
ligament tear. The nurse should include which of the following in the pre-procedure
assessment? Select all that apply.
A) Assess for presence of pacemaker or implanted metal devices
B) Determine if the patient has a history of claustrophobia
C) Verify the patient has removed all jewelry and hairpins
D) Ask about allergies to iodinated contrast media
E) Ensure the patient has fasted for at least 8 hours
Correct Answer: A, B, C
Rationale: MRI uses magnetic fields and radio waves to produce detailed images of soft
tissues including ligaments, tendons, muscles, and vessels. Pre-procedure safety includes
screening for contraindicated metal implants (pacemakers, cochlear implants, aneurysm
clips), assessing for claustrophobia (the enclosed space may require sedation), and
ensuring removal of all ferromagnetic objects. Iodinated contrast is used for CT, not MRI
(which uses gadolinium). Fasting is only required if sedation is planned, not routinely for
non-contrast extremity MRI.
10. A patient with a history of alcohol abuse presents with severe epigastric pain and
coffee-ground emesis. The provider suspects an upper GI bleed and schedules an
endoscopy. Which of the following are additional indications for endoscopy? Select
all that apply.
A) Dysphagia
B) Suspected gastric ulcer
C) Follow-up for healing of gastric ulcer
D) Foreign body ingestion
E) Abnormal upper GI series or CT findings
Correct Answer: A, B, C, D, E
Rationale: Indications for upper endoscopy (esophagogastroduodenoscopy/EGD) include
dysphagia or odynophagia (difficulty or painful swallowing), suspected ulcer, follow-up
evaluation for healing of gastric ulcer, upper GI bleeding (to identify and potentially treat
the source), foreign body removal, and abnormal findings on upper GI series or CT scan. For
unexplained anemia, colonoscopy is typically performed first to rule out lower GI bleeding.
,11. A patient presents with acute onset of right lower quadrant pain, fever, and
leukocytosis. The provider suspects appendicitis. Which diagnostic imaging modality
is most appropriate for this patient?
A) X-ray of the abdomen
B) Ultrasound
C) MRI
D) Nuclear medicine scan
Correct Answer: B) Ultrasound
Rationale: Ultrasound is the preferred initial imaging modality for suspected appendicitis,
particularly in children and pregnant patients, due to its lack of ionizing radiation,
availability, and ability to visualize the appendix and surrounding structures. It uses sound
waves with frequencies above the normal human range of hearing. While CT is more
sensitive in adults, ultrasound is the first-line choice to avoid radiation exposure. MRI is
reserved for equivocal cases or when radiation must be avoided.
12. A patient with suspected Cushing's disease undergoes laboratory testing. The
nurse expects which of the following patterns?
A) High ACTH, high cortisol
B) Low ACTH, high cortisol
C) High ACTH, low cortisol
D) Low ACTH, low cortisol
Correct Answer: A) High ACTH, high cortisol
Rationale: Cushing's disease is caused by a pituitary adenoma that secretes excessive
ACTH (adrenocorticotropic hormone), which in turn stimulates the adrenal glands to
produce excessive cortisol. This results in both high ACTH and high cortisol levels. In
contrast, Cushing's syndrome due to an adrenal tumor presents with low ACTH
(suppressed by negative feedback) and high cortisol. Addison's disease shows high ACTH
and low cortisol due to adrenal insufficiency.
13. A nurse is reviewing urinalysis results for a patient with suspected urinary tract
infection (UTI). Which finding is the best indicator of a UTI?
A) Specific gravity of 1.030
B) pH of 8.0
,C) White blood cells greater than 100,000
D) Presence of glucose
Correct Answer: C) White blood cells greater than 100,000
Rationale: Pyuria (white blood cells >100,000/mL or >5 WBCs per high-power field on
microscopy) is the best indicator of urinary tract infection, as it reflects the inflammatory
response to bacterial invasion. While bacteriuria is also diagnostic, significant pyuria with
symptoms confirms UTI. High specific gravity indicates concentrated urine (dehydration),
alkaline pH may suggest Proteus infection but is not diagnostic, and glucosuria indicates
hyperglycemia rather than infection.
14. A patient is scheduled for an arthroscopy of the knee. The nurse explains that this
procedure will allow the provider to:
A) Measure nerve conduction velocities
B) Visually examine the internal structure of the joint
C) Assess bone density
D) Evaluate synovial fluid for crystals
Correct Answer: B) Visually examine the internal structure of the joint
Rationale: Arthroscopy is the visual examination of the internal structure of a joint using a
fiberoptic scope inserted through a small incision. It allows direct visualization of articular
cartilage, menisci, ligaments, and synovium for diagnostic and therapeutic purposes. Nerve
conduction studies assess nerve integrity, bone densitometry measures bone density, and
arthrocentesis with synovial fluid analysis evaluates for infection, gout, or arthritis.
15. A patient with suspected Addison's disease presents with fatigue, hypotension,
hyperpigmentation, and salt craving. Laboratory studies would most likely reveal:
A) High ACTH, high cortisol
B) Low ACTH, high cortisol
C) High ACTH, low cortisol
D) Low ACTH, low cortisol
Correct Answer: C) High ACTH, low cortisol
Rationale: Addison's disease (primary adrenal insufficiency) results from destruction of
the adrenal cortex, leading to deficient cortisol production. The lack of cortisol removes
negative feedback on the pituitary, causing compensatory elevation of ACTH. High ACTH
also stimulates melanocytes, causing hyperpigmentation of skin and mucous membranes.
, Clinical manifestations include hypotension, fatigue, weight loss, and electrolyte imbalances
(hyponatremia, hyperkalemia).
16. A nurse is caring for a patient who had an arterial blood gas (ABG) drawn from
the radial artery. The nurse knows that arterial puncture is performed to measure
which of the following? Select all that apply.
A) Oxygen levels
B) Carbon dioxide levels
C) pH
D) Hemoglobin
E) Platelet count
Correct Answer: A, B, C
Rationale: Arterial puncture is used to obtain arterial blood gas (ABG) samples to measure
oxygen (PaO2), carbon dioxide (PaCO2), and pH, which assess pulmonary gas exchange and
acid-base status. The brachial and radial arteries are most commonly used; the femoral
artery may be used if necessary. Arterial puncture is more difficult and causes more
discomfort than venipuncture. Hemoglobin and platelet counts are obtained through
venous blood samples (CBC), not ABG.
17. A patient with a suspected joint infection following total knee replacement
undergoes an Alpha Defensin Test on synovial fluid. The nurse understands that this
test detects:
A) Bacterial DNA
B) Immune response proteins associated with infection
C) Crystals indicative of gout
D) Autoimmune antibodies
Correct Answer: B) Immune response proteins associated with infection
Rationale: The Alpha Defensin Test detects alpha defensins, which are antimicrobial
peptides produced by neutrophils as part of the innate immune response. In synovial fluid,
elevated alpha defensin levels are highly specific for periprosthetic joint infection, helping
distinguish infection from aseptic loosening in patients with total joint replacements. This
test has emerged as a valuable diagnostic tool when traditional cultures are negative or
inconclusive.
EXAM 1
Diagnostic Reasoning
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 1 Comprehensive Study Guide
,Table of Contents
NSG 550 Exam 1 ................................................................. 2
NSG 550 Exam 1 Study Guide ............................................. 49
NSG 550 Exam 1
1. A 68-year-old male with a history of benign prostatic hyperplasia presents for his
annual physical. His provider orders a PSA level. The nurse understands that an
elevated PSA is most specific for which of the following conditions?
A) Urinary tract infection
B) Prostate cancer
C) Acute kidney injury
D) Bladder obstruction
Correct Answer: B) Prostate cancer
Rationale: PSA (Prostate-Specific Antigen) is a glycoprotein produced by the epithelial cells
of the prostate gland. While PSA can be elevated in benign prostatic hyperplasia, prostatitis,
and urinary retention, it is the primary serum marker used for prostate cancer detection
and monitoring. The nurse must educate the patient that PSA screening, combined with
digital rectal examination, aids in early detection of prostate malignancy.
2. A nurse is reviewing the diagnostic workup for a patient suspected of having
rheumatoid arthritis. Which laboratory tests should the nurse anticipate the
provider will order? Select all that apply.
A) Rheumatoid Factor (RF)
B) Anti-CCP antibody
C) C-reactive Protein (CRP)
D) Erythrocyte Sedimentation Rate (ESR)
E) Complete Blood Count (CBC)
,Correct Answer: A, B, C, D, E
Rationale: The five core diagnostic labs to confirm or support a diagnosis of Rheumatoid
Arthritis include: (1) Rheumatoid Factor (RF) — an autoantibody present in approximately
80% of RA patients; (2) Anti-CCP (Anti-Citrullinated Peptide) antibody — highly specific for
RA and often present before clinical symptoms; (3) CRP — an acute-phase reactant
indicating active inflammation; (4) ESR — measures the rate of erythrocyte sedimentation,
which increases with inflammation; and (5) CBC — to assess for anemia of chronic disease
and thrombocytosis, both common in RA.
3. A patient is scheduled for a bone scan using a radioactive isotope. Which pre-
procedure instruction should the nurse provide?
A) "You will need to fast for 12 hours before the scan."
B) "Remove all metal jewelry and clothing with zippers before the procedure."
C) "You will be radioactive for several weeks and must avoid contact with others."
D) "Drink only clear fluids for 48 hours after the injection."
Correct Answer: B) "Remove all metal jewelry and clothing with zippers before the
procedure."
Rationale: Prior to a nuclear bone scan, patients must remove all metal objects because
metal can interfere with the scanner's ability to capture accurate images. The patient
should hold fluids for 4 hours before the injection, drink 32 oz of water after injection to
promote renal filtering, void 1–3 hours after injection to clear excess isotope from the
bladder, and lie supine during the scan. Radioactive isotopes are excreted in urine and feces
within 48 hours and are not harmful to family or visitors.
4. A 45-year-old female presents with fatigue, weight gain, constipation, and
bradycardia. Laboratory studies reveal elevated TSH and low T3 and T4 levels. The
nurse recognizes these findings are consistent with which condition?
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing's syndrome
D) Addison's disease
Correct Answer: B) Hypothyroidism
Rationale: Hypothyroidism is characterized by high TSH (thyroid-stimulating hormone)
and low T3/T4 levels due to the pituitary gland's compensatory response to insufficient
,thyroid hormone production. Clinical manifestations include bradycardia, weight gain,
constipation, cold intolerance, and sluggishness. This is in direct contrast to
hyperthyroidism/Graves' disease, which presents with low TSH, high T3/T4,
hypermetabolism, tachycardia, weight loss, and exophthalmos.
5. A patient with type 1 diabetes presents to the emergency department with fruity
breath, Kussmaul respirations, and altered mental status. Laboratory results show
high ketones, high anion gap, low potassium, and rising BUN/creatinine. The nurse
recognizes these findings as indicative of:
A) Hyperosmolar hyperglycemic state
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemic shock
D) Acute kidney injury
Correct Answer: B) Diabetic ketoacidosis (DKA)
Rationale: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes
mellitus characterized by hyperglycemia, ketonemia, and metabolic acidosis (high anion
gap). The rising BUN and creatinine reflect prerenal azotemia from dehydration. Low
potassium occurs due to osmotic diuresis and acidosis-driven intracellular shifts.
Immediate interventions include IV fluid resuscitation, insulin administration, and
electrolyte replacement.
6. A nurse is caring for a patient who underwent a cystoscopy. Which statement by
the patient indicates a need for further teaching?
A) "I may notice some pink-tinged urine after the procedure."
B) "I should drink plenty of fluids to flush my bladder."
C) "I can resume my normal diet immediately after the procedure."
D) "I should report burning with urination that lasts more than 24 hours."
Correct Answer: C) "I can resume my normal diet immediately after the procedure."
Rationale: Cystoscopy is the visual examination of the urinary bladder using a cystoscope
inserted through the urethra. While patients can typically resume a normal diet
immediately after an uncomplicated cystoscopy, this statement itself is not incorrect.
However, if the patient had sedation, they may need to wait before eating. More
importantly, the nurse should ensure the patient understands that mild hematuria, burning
,with urination, and increased urinary frequency are expected for 24–48 hours. The patient
must report fever, chills, or persistent gross hematuria.
7. A patient with suspected renal obstruction is scheduled for a renal scan. The nurse
explains to the patient that this nuclear scan will determine which of the following?
Select all that apply.
A) Size of the kidneys
B) Shape of the kidneys
C) Function of the kidneys
D) Presence of renal stones
E) Blood flow to the kidneys
Correct Answer: A, B, C
Rationale: Renal scanning (nuclear medicine renal scan) uses radioactive isotopes to
evaluate the size, shape, and function of the kidneys. It is used to diagnose renal
obstruction, renovascular hypertension, and differential renal function. While CT without
contrast is the gold standard for kidney stones, renal scans focus on functional assessment
rather than structural stone detection. Blood flow evaluation is better assessed with
Doppler ultrasound or angiography.
8. A patient with diabetes mellitus is being monitored for early signs of diabetic
nephropathy. Which laboratory test is the best marker to detect patients at risk for
developing this complication?
A) Serum creatinine
B) Blood urea nitrogen (BUN)
C) Microalbuminuria test
D) 24-hour urine protein
Correct Answer: C) Microalbuminuria test
Rationale: The microalbuminuria test detects small amounts of albumin in the urine (30–
300 mg/day) that are not detected by standard urine dipstick testing. It is the earliest and
most sensitive marker for diabetic nephropathy, allowing for intervention before significant
renal damage occurs. While serum creatinine and BUN reflect established renal
dysfunction, microalbuminuria identifies risk before GFR declines. Annual microalbumin
screening is recommended for all patients with diabetes.
,9. A nurse is preparing a patient for an MRI of the knee to evaluate a suspected
ligament tear. The nurse should include which of the following in the pre-procedure
assessment? Select all that apply.
A) Assess for presence of pacemaker or implanted metal devices
B) Determine if the patient has a history of claustrophobia
C) Verify the patient has removed all jewelry and hairpins
D) Ask about allergies to iodinated contrast media
E) Ensure the patient has fasted for at least 8 hours
Correct Answer: A, B, C
Rationale: MRI uses magnetic fields and radio waves to produce detailed images of soft
tissues including ligaments, tendons, muscles, and vessels. Pre-procedure safety includes
screening for contraindicated metal implants (pacemakers, cochlear implants, aneurysm
clips), assessing for claustrophobia (the enclosed space may require sedation), and
ensuring removal of all ferromagnetic objects. Iodinated contrast is used for CT, not MRI
(which uses gadolinium). Fasting is only required if sedation is planned, not routinely for
non-contrast extremity MRI.
10. A patient with a history of alcohol abuse presents with severe epigastric pain and
coffee-ground emesis. The provider suspects an upper GI bleed and schedules an
endoscopy. Which of the following are additional indications for endoscopy? Select
all that apply.
A) Dysphagia
B) Suspected gastric ulcer
C) Follow-up for healing of gastric ulcer
D) Foreign body ingestion
E) Abnormal upper GI series or CT findings
Correct Answer: A, B, C, D, E
Rationale: Indications for upper endoscopy (esophagogastroduodenoscopy/EGD) include
dysphagia or odynophagia (difficulty or painful swallowing), suspected ulcer, follow-up
evaluation for healing of gastric ulcer, upper GI bleeding (to identify and potentially treat
the source), foreign body removal, and abnormal findings on upper GI series or CT scan. For
unexplained anemia, colonoscopy is typically performed first to rule out lower GI bleeding.
,11. A patient presents with acute onset of right lower quadrant pain, fever, and
leukocytosis. The provider suspects appendicitis. Which diagnostic imaging modality
is most appropriate for this patient?
A) X-ray of the abdomen
B) Ultrasound
C) MRI
D) Nuclear medicine scan
Correct Answer: B) Ultrasound
Rationale: Ultrasound is the preferred initial imaging modality for suspected appendicitis,
particularly in children and pregnant patients, due to its lack of ionizing radiation,
availability, and ability to visualize the appendix and surrounding structures. It uses sound
waves with frequencies above the normal human range of hearing. While CT is more
sensitive in adults, ultrasound is the first-line choice to avoid radiation exposure. MRI is
reserved for equivocal cases or when radiation must be avoided.
12. A patient with suspected Cushing's disease undergoes laboratory testing. The
nurse expects which of the following patterns?
A) High ACTH, high cortisol
B) Low ACTH, high cortisol
C) High ACTH, low cortisol
D) Low ACTH, low cortisol
Correct Answer: A) High ACTH, high cortisol
Rationale: Cushing's disease is caused by a pituitary adenoma that secretes excessive
ACTH (adrenocorticotropic hormone), which in turn stimulates the adrenal glands to
produce excessive cortisol. This results in both high ACTH and high cortisol levels. In
contrast, Cushing's syndrome due to an adrenal tumor presents with low ACTH
(suppressed by negative feedback) and high cortisol. Addison's disease shows high ACTH
and low cortisol due to adrenal insufficiency.
13. A nurse is reviewing urinalysis results for a patient with suspected urinary tract
infection (UTI). Which finding is the best indicator of a UTI?
A) Specific gravity of 1.030
B) pH of 8.0
,C) White blood cells greater than 100,000
D) Presence of glucose
Correct Answer: C) White blood cells greater than 100,000
Rationale: Pyuria (white blood cells >100,000/mL or >5 WBCs per high-power field on
microscopy) is the best indicator of urinary tract infection, as it reflects the inflammatory
response to bacterial invasion. While bacteriuria is also diagnostic, significant pyuria with
symptoms confirms UTI. High specific gravity indicates concentrated urine (dehydration),
alkaline pH may suggest Proteus infection but is not diagnostic, and glucosuria indicates
hyperglycemia rather than infection.
14. A patient is scheduled for an arthroscopy of the knee. The nurse explains that this
procedure will allow the provider to:
A) Measure nerve conduction velocities
B) Visually examine the internal structure of the joint
C) Assess bone density
D) Evaluate synovial fluid for crystals
Correct Answer: B) Visually examine the internal structure of the joint
Rationale: Arthroscopy is the visual examination of the internal structure of a joint using a
fiberoptic scope inserted through a small incision. It allows direct visualization of articular
cartilage, menisci, ligaments, and synovium for diagnostic and therapeutic purposes. Nerve
conduction studies assess nerve integrity, bone densitometry measures bone density, and
arthrocentesis with synovial fluid analysis evaluates for infection, gout, or arthritis.
15. A patient with suspected Addison's disease presents with fatigue, hypotension,
hyperpigmentation, and salt craving. Laboratory studies would most likely reveal:
A) High ACTH, high cortisol
B) Low ACTH, high cortisol
C) High ACTH, low cortisol
D) Low ACTH, low cortisol
Correct Answer: C) High ACTH, low cortisol
Rationale: Addison's disease (primary adrenal insufficiency) results from destruction of
the adrenal cortex, leading to deficient cortisol production. The lack of cortisol removes
negative feedback on the pituitary, causing compensatory elevation of ACTH. High ACTH
also stimulates melanocytes, causing hyperpigmentation of skin and mucous membranes.
, Clinical manifestations include hypotension, fatigue, weight loss, and electrolyte imbalances
(hyponatremia, hyperkalemia).
16. A nurse is caring for a patient who had an arterial blood gas (ABG) drawn from
the radial artery. The nurse knows that arterial puncture is performed to measure
which of the following? Select all that apply.
A) Oxygen levels
B) Carbon dioxide levels
C) pH
D) Hemoglobin
E) Platelet count
Correct Answer: A, B, C
Rationale: Arterial puncture is used to obtain arterial blood gas (ABG) samples to measure
oxygen (PaO2), carbon dioxide (PaCO2), and pH, which assess pulmonary gas exchange and
acid-base status. The brachial and radial arteries are most commonly used; the femoral
artery may be used if necessary. Arterial puncture is more difficult and causes more
discomfort than venipuncture. Hemoglobin and platelet counts are obtained through
venous blood samples (CBC), not ABG.
17. A patient with a suspected joint infection following total knee replacement
undergoes an Alpha Defensin Test on synovial fluid. The nurse understands that this
test detects:
A) Bacterial DNA
B) Immune response proteins associated with infection
C) Crystals indicative of gout
D) Autoimmune antibodies
Correct Answer: B) Immune response proteins associated with infection
Rationale: The Alpha Defensin Test detects alpha defensins, which are antimicrobial
peptides produced by neutrophils as part of the innate immune response. In synovial fluid,
elevated alpha defensin levels are highly specific for periprosthetic joint infection, helping
distinguish infection from aseptic loosening in patients with total joint replacements. This
test has emerged as a valuable diagnostic tool when traditional cultures are negative or
inconclusive.
