NURS 8026 DIFFERENTIAL DIAGNOSIS TEST 4
EXAM/NUR 8026 TEST 4 ACTUAL EXAM 2026-2027
COMPLETE EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (100% CORRECT VERIFIED
ANSWERS) NEWEST UPDATED VERSION EDITION 2026
GUARANTEED PASS A+ |INSTANT DOWNLOAD PDF
A 72-year-old male with a 40-pack-year smoking history presents with a new-onset cough,
hemoptysis, and weight loss. Chest imaging reveals a hilar mass. Which of the following is
the most appropriate initial diagnostic step to confirm the diagnosis?
A) Positron emission tomography (PET) scan
B) Computed tomography (CT)-guided biopsy
C) Serum tumor markers
D) Bronchoscopy with endobronchial ultrasound (EBUS)
Correct Answer: D) Bronchoscopy with endobronchial ultrasound (EBUS)
Rationale: In a patient with a suspected central hilar mass and a high smoking history,
bronchoscopy with EBUS is the preferred initial diagnostic modality because it allows for
direct visualization and tissue sampling of the lesion and mediastinal lymph nodes. A CT-
guided biopsy is more appropriate for peripheral lesions. PET scans are for staging, not
diagnosis, and serum tumor markers are not diagnostic.
A 45-year-old female presents with acute-onset right upper quadrant pain, fever, and
jaundice. Murphy's sign is positive. Which of the following is the most likely diagnosis?
A) Acute pancreatitis
B) Acute cholecystitis
,C) Choledocholithiasis
D) Hepatic abscess
Correct Answer: B) Acute cholecystitis
Rationale: The classic triad of right upper quadrant pain, fever, and a positive Murphy's sign
is highly suggestive of acute cholecystitis. Choledocholithiasis would more likely present
with elevated bilirubin and dilated bile ducts. Pancreatitis typically presents with epigastric
pain radiating to the back.
A 60-year-old diabetic male presents with a red, swollen, and painful right lower leg. He
reports a fever and chills. On examination, the area is warm, erythematous, and has distinct
borders. There is no crepitus. Which of the following is the most appropriate initial
antibiotic choice?
A) Vancomycin
B) Cefazolin
C) Piperacillin-tazobactam
D) Clindamycin
Correct Answer: B) Cefazolin
Rationale: This presentation is classic for cellulitis, which is most commonly caused by
Streptococcus pyogenes or Staphylococcus aureus. In a non-severe, community-acquired
case without risk factors for MRSA, cefazolin (a first-generation cephalosporin) is
appropriate empiric therapy. Vancomycin is reserved for severe infections or MRSA risk.
A 55-year-old female with a history of hypertension presents with a sudden, severe
"thunderclap" headache and neck stiffness. A non-contrast CT head is negative. Which of
the following is the next best step?
A) MRI of the brain
B) Lumbar puncture
C) CT angiography
D) Discharge with analgesics
Correct Answer: B) Lumbar puncture
,Rationale: In a patient with a thunderclap headache and negative non-contrast CT,
subarachnoid hemorrhage must be ruled out. The next step is a lumbar puncture to check
for xanthochromia and red blood cells. MRI is less sensitive acutely, and CT angiography is
for aneurysms but not the next step after a negative CT.
A 30-year-old male presents with acute-onset testicular pain, nausea, and vomiting. The left
testicle is tender, swollen, and elevated. Cremasteric reflex is absent. Which of the following
is the most likely diagnosis?
A) Testicular torsion
B) Epididymitis
C) Hydrocele
D) Inguinal hernia
Correct Answer: A) Testicular torsion
Rationale: Acute testicular pain with nausea, vomiting, absent cremasteric reflex, and a
high-riding testicle is classic for testicular torsion, a surgical emergency. Epididymitis is
typically more gradual, may have pyuria, and the cremasteric reflex is usually present.
A 70-year-old male with a history of benign prostatic hyperplasia presents with acute
urinary retention. Post-void residual volume is 800 mL. Which of the following is the most
appropriate initial management?
A) Alpha-blocker therapy
B) Transurethral resection of the prostate
C) Urethral catheterization
D) Suprapubic catheterization
Correct Answer: C) Urethral catheterization
Rationale: Acute urinary retention with a large post-void residual requires immediate
bladder decompression. Urethral catheterization is the first-line intervention. Alpha-blockers
are used for chronic management, and surgery is reserved for refractory cases. Suprapubic is
used if urethral catheterization fails.
, A 25-year-old female presents with palpitations, heat intolerance, and weight loss despite
increased appetite. On examination, she has a fine tremor and exophthalmos. Which of the
following laboratory findings is most consistent with this presentation?
A) Elevated TSH, low free T4
B) Low TSH, elevated free T4
C) Normal TSH, elevated T3
D) Low TSH, low free T4
Correct Answer: B) Low TSH, elevated free T4
Rationale: The symptoms of hyperthyroidism (palpitations, heat intolerance, weight loss,
tremor) with exophthalmos suggest Graves' disease. In primary hyperthyroidism, TSH is
suppressed and free T4 is elevated. Elevated TSH with low free T4 indicates
hypothyroidism.
A 50-year-old male with a history of alcohol use disorder presents with confusion, ataxia,
and ophthalmoplegia. Which of the following is the most likely diagnosis?
A) Wernicke's encephalopathy
B) Korsakoff syndrome
C) Hepatic encephalopathy
D) Cerebellar degeneration
Correct Answer: A) Wernicke's encephalopathy
Rationale: The classic triad of confusion, ataxia, and ophthalmoplegia in a patient with
alcohol use disorder is Wernicke's encephalopathy, caused by thiamine deficiency.
Korsakoff syndrome is a chronic sequelae with memory impairment.
A 65-year-old female presents with a painful, red eye and blurred vision. On examination,
there is a corneal ulcer with a hypopyon. Which of the following is the most appropriate
next step?
A) Topical antibiotics
B) Corneal scraping and culture
C) Systemic antivirals
EXAM/NUR 8026 TEST 4 ACTUAL EXAM 2026-2027
COMPLETE EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (100% CORRECT VERIFIED
ANSWERS) NEWEST UPDATED VERSION EDITION 2026
GUARANTEED PASS A+ |INSTANT DOWNLOAD PDF
A 72-year-old male with a 40-pack-year smoking history presents with a new-onset cough,
hemoptysis, and weight loss. Chest imaging reveals a hilar mass. Which of the following is
the most appropriate initial diagnostic step to confirm the diagnosis?
A) Positron emission tomography (PET) scan
B) Computed tomography (CT)-guided biopsy
C) Serum tumor markers
D) Bronchoscopy with endobronchial ultrasound (EBUS)
Correct Answer: D) Bronchoscopy with endobronchial ultrasound (EBUS)
Rationale: In a patient with a suspected central hilar mass and a high smoking history,
bronchoscopy with EBUS is the preferred initial diagnostic modality because it allows for
direct visualization and tissue sampling of the lesion and mediastinal lymph nodes. A CT-
guided biopsy is more appropriate for peripheral lesions. PET scans are for staging, not
diagnosis, and serum tumor markers are not diagnostic.
A 45-year-old female presents with acute-onset right upper quadrant pain, fever, and
jaundice. Murphy's sign is positive. Which of the following is the most likely diagnosis?
A) Acute pancreatitis
B) Acute cholecystitis
,C) Choledocholithiasis
D) Hepatic abscess
Correct Answer: B) Acute cholecystitis
Rationale: The classic triad of right upper quadrant pain, fever, and a positive Murphy's sign
is highly suggestive of acute cholecystitis. Choledocholithiasis would more likely present
with elevated bilirubin and dilated bile ducts. Pancreatitis typically presents with epigastric
pain radiating to the back.
A 60-year-old diabetic male presents with a red, swollen, and painful right lower leg. He
reports a fever and chills. On examination, the area is warm, erythematous, and has distinct
borders. There is no crepitus. Which of the following is the most appropriate initial
antibiotic choice?
A) Vancomycin
B) Cefazolin
C) Piperacillin-tazobactam
D) Clindamycin
Correct Answer: B) Cefazolin
Rationale: This presentation is classic for cellulitis, which is most commonly caused by
Streptococcus pyogenes or Staphylococcus aureus. In a non-severe, community-acquired
case without risk factors for MRSA, cefazolin (a first-generation cephalosporin) is
appropriate empiric therapy. Vancomycin is reserved for severe infections or MRSA risk.
A 55-year-old female with a history of hypertension presents with a sudden, severe
"thunderclap" headache and neck stiffness. A non-contrast CT head is negative. Which of
the following is the next best step?
A) MRI of the brain
B) Lumbar puncture
C) CT angiography
D) Discharge with analgesics
Correct Answer: B) Lumbar puncture
,Rationale: In a patient with a thunderclap headache and negative non-contrast CT,
subarachnoid hemorrhage must be ruled out. The next step is a lumbar puncture to check
for xanthochromia and red blood cells. MRI is less sensitive acutely, and CT angiography is
for aneurysms but not the next step after a negative CT.
A 30-year-old male presents with acute-onset testicular pain, nausea, and vomiting. The left
testicle is tender, swollen, and elevated. Cremasteric reflex is absent. Which of the following
is the most likely diagnosis?
A) Testicular torsion
B) Epididymitis
C) Hydrocele
D) Inguinal hernia
Correct Answer: A) Testicular torsion
Rationale: Acute testicular pain with nausea, vomiting, absent cremasteric reflex, and a
high-riding testicle is classic for testicular torsion, a surgical emergency. Epididymitis is
typically more gradual, may have pyuria, and the cremasteric reflex is usually present.
A 70-year-old male with a history of benign prostatic hyperplasia presents with acute
urinary retention. Post-void residual volume is 800 mL. Which of the following is the most
appropriate initial management?
A) Alpha-blocker therapy
B) Transurethral resection of the prostate
C) Urethral catheterization
D) Suprapubic catheterization
Correct Answer: C) Urethral catheterization
Rationale: Acute urinary retention with a large post-void residual requires immediate
bladder decompression. Urethral catheterization is the first-line intervention. Alpha-blockers
are used for chronic management, and surgery is reserved for refractory cases. Suprapubic is
used if urethral catheterization fails.
, A 25-year-old female presents with palpitations, heat intolerance, and weight loss despite
increased appetite. On examination, she has a fine tremor and exophthalmos. Which of the
following laboratory findings is most consistent with this presentation?
A) Elevated TSH, low free T4
B) Low TSH, elevated free T4
C) Normal TSH, elevated T3
D) Low TSH, low free T4
Correct Answer: B) Low TSH, elevated free T4
Rationale: The symptoms of hyperthyroidism (palpitations, heat intolerance, weight loss,
tremor) with exophthalmos suggest Graves' disease. In primary hyperthyroidism, TSH is
suppressed and free T4 is elevated. Elevated TSH with low free T4 indicates
hypothyroidism.
A 50-year-old male with a history of alcohol use disorder presents with confusion, ataxia,
and ophthalmoplegia. Which of the following is the most likely diagnosis?
A) Wernicke's encephalopathy
B) Korsakoff syndrome
C) Hepatic encephalopathy
D) Cerebellar degeneration
Correct Answer: A) Wernicke's encephalopathy
Rationale: The classic triad of confusion, ataxia, and ophthalmoplegia in a patient with
alcohol use disorder is Wernicke's encephalopathy, caused by thiamine deficiency.
Korsakoff syndrome is a chronic sequelae with memory impairment.
A 65-year-old female presents with a painful, red eye and blurred vision. On examination,
there is a corneal ulcer with a hypopyon. Which of the following is the most appropriate
next step?
A) Topical antibiotics
B) Corneal scraping and culture
C) Systemic antivirals
