NSG 550 EXAM 3 – DIAGNOSTIC
REASONING (ADVANCED PRACTICE
CLINICAL ASSESSMENT)
1. When evaluating a patient with acute abdominal pain, which clinical sign is most specific
for acute cholecystitis?
A. McBurney’s sign
B. Psoas sign
C. Rovsing’s sign
D. Murphy’s sign
Answer: D
Conceptual Explanation: Murphy’s sign, defined as cessation of inspiration during deep
palpation of the right upper quadrant, is highly specific for acute cholecystitis.
2. A 65-year-old patient presents with sudden onset of ‘the worst headache of my life.’ Which
diagnostic step is the most urgent priority?
A. Lumbar puncture
B. MRI with contrast
,C. Non-contrast CT scan of the head
D. Comprehensive ophthalmological exam
Answer: C
Conceptual Explanation: A non-contrast CT is the initial gold standard for identifying
subarachnoid hemorrhage, which is the primary concern for a ‘thunderclap’ headache.
3. In the diagnostic reasoning process, ‘anchoring bias’ refers to which cognitive error?
A. Favoring recent information over older data
B. Influencing a patient’s story through leading questions
C. Ignoring evidence that contradicts a chosen diagnosis
D. Relying too heavily on the first piece of information offered
Answer: D
Conceptual Explanation: Anchoring bias is the tendency to latch onto the initial
information presented and failing to adjust one’s diagnostic impressions as new data
emerges.
4. Which heart sound is pathognomonic for heart failure in an older adult with dyspnea?
A. S4 gallop
B. S3 gallop
C. Split S2
, D. Ejection click
Answer: B
Conceptual Explanation: An S3 gallop is a sign of ventricular filling into a non-compliant
chamber and is a classic indicator of fluid overload or systolic heart failure.
5. When interpreting a 12-lead EKG, ST-segment elevation in leads II, III, and aVF indicates an
infarction in which territory?
A. Anterior wall
B. Lateral wall
C. Septal wall
D. Inferior wall
Answer: D
Conceptual Explanation: Leads II, III, and aVF look at the inferior aspect of the heart,
typically supplied by the Right Coronary Artery.
6. A patient presents with a ‘curtain dropping’ over their vision in one eye. This symptom is
most characteristic of:
A. Amaurosis fugax
B. Acute angle-closure glaucoma
C. Macular degeneration
D. Cataracts
REASONING (ADVANCED PRACTICE
CLINICAL ASSESSMENT)
1. When evaluating a patient with acute abdominal pain, which clinical sign is most specific
for acute cholecystitis?
A. McBurney’s sign
B. Psoas sign
C. Rovsing’s sign
D. Murphy’s sign
Answer: D
Conceptual Explanation: Murphy’s sign, defined as cessation of inspiration during deep
palpation of the right upper quadrant, is highly specific for acute cholecystitis.
2. A 65-year-old patient presents with sudden onset of ‘the worst headache of my life.’ Which
diagnostic step is the most urgent priority?
A. Lumbar puncture
B. MRI with contrast
,C. Non-contrast CT scan of the head
D. Comprehensive ophthalmological exam
Answer: C
Conceptual Explanation: A non-contrast CT is the initial gold standard for identifying
subarachnoid hemorrhage, which is the primary concern for a ‘thunderclap’ headache.
3. In the diagnostic reasoning process, ‘anchoring bias’ refers to which cognitive error?
A. Favoring recent information over older data
B. Influencing a patient’s story through leading questions
C. Ignoring evidence that contradicts a chosen diagnosis
D. Relying too heavily on the first piece of information offered
Answer: D
Conceptual Explanation: Anchoring bias is the tendency to latch onto the initial
information presented and failing to adjust one’s diagnostic impressions as new data
emerges.
4. Which heart sound is pathognomonic for heart failure in an older adult with dyspnea?
A. S4 gallop
B. S3 gallop
C. Split S2
, D. Ejection click
Answer: B
Conceptual Explanation: An S3 gallop is a sign of ventricular filling into a non-compliant
chamber and is a classic indicator of fluid overload or systolic heart failure.
5. When interpreting a 12-lead EKG, ST-segment elevation in leads II, III, and aVF indicates an
infarction in which territory?
A. Anterior wall
B. Lateral wall
C. Septal wall
D. Inferior wall
Answer: D
Conceptual Explanation: Leads II, III, and aVF look at the inferior aspect of the heart,
typically supplied by the Right Coronary Artery.
6. A patient presents with a ‘curtain dropping’ over their vision in one eye. This symptom is
most characteristic of:
A. Amaurosis fugax
B. Acute angle-closure glaucoma
C. Macular degeneration
D. Cataracts
