NSG 550 EXAM 1 2 3 – DIAGNOSTIC REASONING Wilkes University |
Verified Q&A + Rationales
Master advanced health assessment frameworks and ace your nurse practitioner
milestones with this complete 2026/2027 Wilkes University NSG 550 study package
covering Exams 1, 2, and 3. This comprehensive test bank features high-yield practice
questions paired with 100% verified answers and detailed clinical rationales exploring
differential diagnosis formulation, screening tool interpretation, and laboratory analysis.
It is an indispensable resource for graduate nursing students looking to optimize study
routines, sharpen diagnostic reasoning skills, and confidently secure an A+ grade.
1. A 45-year-old female presents with a 3-month history of progressive fatigue,
dry eyes, and dry mouth. She reports difficulty swallowing dry foods and a
persistent gritty sensation in her eyes. On examination, she has bilateral parotid
enlargement. Which of the following is the MOST appropriate diagnostic test to
confirm the suspected diagnosis?
A) Schirmer's test
B) Serum anti-SSA (Ro) and anti-SSB (La) antibodies
C) Lip biopsy
D) Rheumatoid factor
Correct Answer: B) Serum anti-SSA (Ro) and anti-SSB (La) antibodies
Rationale: The patient's symptoms of dry eyes (xerophthalmia), dry mouth (xerostomia),
and parotid enlargement are classic for Sjögren's syndrome. Anti-SSA (Ro) and anti-SSB
(La) antibodies are the most specific serological markers for Sjögren's syndrome, present in
60-70% of cases. Schirmer's test confirms dry eyes but is not diagnostic. Lip biopsy is
confirmatory but invasive and not first-line .
2. A 55-year-old male with a history of hypertension presents with a sudden onset
of severe, tearing chest pain radiating to the back. His blood pressure is 190/110
mmHg in both arms. He has no history of trauma. Which diagnostic test is MOST
appropriate to confirm the suspected diagnosis?
A) CT angiography of the chest
B) Transesophageal echocardiogram (TEE)
,C) Chest X-ray
D) MRI of the chest
Correct Answer: A) CT angiography of the chest
Rationale: The sudden onset of severe, tearing chest pain radiating to the back with
hypertension is classic for aortic dissection. CT angiography is the preferred initial imaging
modality due to its rapid acquisition, high sensitivity (98-100%), and ability to visualize
the entire aorta. TEE is useful but more invasive and operator-dependent. Chest X-ray may
show a widened mediastinum but is not diagnostic .
3. A 28-year-old female presents with a 6-month history of episodic palpitations,
diaphoresis, and anxiety. She reports that episodes are unpredictable and not
triggered by specific situations. She has no significant medical history. What is the
MOST appropriate initial diagnostic test?
A) 24-hour Holter monitor
B) TSH and free T4
C) Complete blood count
D) Drug screen
Correct Answer: A) 24-hour Holter monitor
Rationale: Episodic palpitations in a young patient should be evaluated for cardiac
arrhythmias, including supraventricular tachycardia or atrial fibrillation. Holter monitoring
is the first-line test to capture arrhythmias. While TSH is also important to rule out
hyperthyroidism, the episodic nature of symptoms makes arrhythmia the most likely
cause, and Holter monitoring is the most appropriate initial step .
4. A 65-year-old female with a history of COPD presents with increasing shortness
of breath and a productive cough with purulent sputum. Her ABG on room air
shows pH 7.30, PaCO₂ 60 mmHg, PaO₂ 55 mmHg, and HCO₃⁻ 26 mEq/L. What is
the MOST appropriate initial intervention?
A) Increase oxygen to 4 L/min nasal cannula
B) Initiate non-invasive positive pressure ventilation (NIPPV)
C) Intubate and initiate mechanical ventilation
D) Administer antibiotics
Correct Answer: B) Initiate non-invasive positive pressure ventilation (NIPPV)
Rationale: This ABG shows acute respiratory acidosis (pH 7.30, PaCO₂ 60) with hypoxemia
(PaO₂ 55). NIPPV is indicated for acute hypercapnic respiratory failure in COPD patients
who are awake and able to protect their airway. It improves ventilation, reduces PaCO₂,
,and can prevent intubation. Intubation is indicated if NIPPV fails or if the patient cannot
protect their airway .
5. A 52-year-old male with a 30-pack-year smoking history presents with a chronic
cough, hemoptysis, and weight loss over the past 6 months. Chest X-ray shows a 3
cm solitary pulmonary nodule with spiculated margins in the right upper lobe.
What is the MOST appropriate next step?
A) Repeat chest X-ray in 3 months
B) CT-guided biopsy
C) PET-CT scan
D) Bronchoscopy
Correct Answer: C) PET-CT scan
Rationale: A solitary pulmonary nodule with spiculated margins in a smoker with
symptoms (cough, hemoptysis, weight loss) is highly suspicious for malignancy. A PET-CT
is the most appropriate next step to evaluate the metabolic activity of the nodule and
assess for metastatic disease. If the PET-CT is positive, biopsy would be indicated. CT-
guided biopsy is appropriate for peripheral nodules, while bronchoscopy is better for
central lesions .
6. A 60-year-old female with a history of type 2 diabetes and hypertension
presents with acute-onset left-sided weakness and facial droop. Her symptoms
started 3 hours ago. Her blood pressure is 165/95 mmHg. Which of the following
is a CONTRAINDICATION to thrombolytic therapy (tPA)?
A) Age >80 years
B) Blood glucose 250 mg/dL
C) Head CT showing no hemorrhage
D) INR 1.8
Correct Answer: D) INR 1.8
Rationale: Contraindications to tPA include INR >1.7, use of anticoagulants, head CT
showing hemorrhage, severe hypertension (systolic >185 or diastolic >110), and recent
major surgery. INR 1.8 is above the threshold, making tPA unsafe due to increased
bleeding risk. Age >80 is not an absolute contraindication. Blood glucose >250 requires
correction but is not a contraindication .
7. A 35-year-old female presents with a 2-week history of progressive weakness in
her lower extremities, urinary retention, and numbness in her legs. She reports a
recent viral illness. On examination, she has bilateral lower extremity weakness,
, hyperreflexia, and a sensory level at T8. What is the MOST appropriate diagnostic
test?
A) MRI of the spine with and without contrast
B) Lumbar puncture
C) CT of the spine
D) EMG/nerve conduction studies
Correct Answer: A) MRI of the spine with and without contrast
Rationale: The presentation of progressive lower extremity weakness, sensory level, and
urinary retention in the setting of a recent viral illness suggests transverse myelitis. MRI of
the spine is the imaging modality of choice to evaluate for cord inflammation,
demyelination, or compression. A sensory level is a "red flag" requiring urgent imaging.
Lumbar puncture may follow but is not the initial test .
8. A 48-year-old male with a history of alcohol use disorder presents with acute-
onset confusion, ataxia, and ophthalmoplegia. He reports a recent binge drinking
episode. What is the MOST appropriate immediate treatment?
A) IV thiamine (vitamin B1)
B) IV dextrose
C) IV lorazepam
D) IV naloxone
Correct Answer: A) IV thiamine (vitamin B1)
Rationale: The classic triad of Wernicke encephalopathy is confusion, ataxia, and
ophthalmoplegia in the setting of thiamine deficiency, most commonly seen in chronic
alcoholism. This is a medical emergency requiring immediate IV thiamine replacement.
Dextrose should be given after thiamine to prevent precipitation of Wernicke
encephalopathy .
9. A 70-year-old female with a history of hypertension presents with a sudden,
severe headache, nausea, and vomiting. She reports that the headache is the
"worst of her life." On examination, she has nuchal rigidity. What is the MOST
appropriate initial diagnostic test?
A) CT head without contrast
B) Lumbar puncture
C) MRI brain
D) CT angiography
Verified Q&A + Rationales
Master advanced health assessment frameworks and ace your nurse practitioner
milestones with this complete 2026/2027 Wilkes University NSG 550 study package
covering Exams 1, 2, and 3. This comprehensive test bank features high-yield practice
questions paired with 100% verified answers and detailed clinical rationales exploring
differential diagnosis formulation, screening tool interpretation, and laboratory analysis.
It is an indispensable resource for graduate nursing students looking to optimize study
routines, sharpen diagnostic reasoning skills, and confidently secure an A+ grade.
1. A 45-year-old female presents with a 3-month history of progressive fatigue,
dry eyes, and dry mouth. She reports difficulty swallowing dry foods and a
persistent gritty sensation in her eyes. On examination, she has bilateral parotid
enlargement. Which of the following is the MOST appropriate diagnostic test to
confirm the suspected diagnosis?
A) Schirmer's test
B) Serum anti-SSA (Ro) and anti-SSB (La) antibodies
C) Lip biopsy
D) Rheumatoid factor
Correct Answer: B) Serum anti-SSA (Ro) and anti-SSB (La) antibodies
Rationale: The patient's symptoms of dry eyes (xerophthalmia), dry mouth (xerostomia),
and parotid enlargement are classic for Sjögren's syndrome. Anti-SSA (Ro) and anti-SSB
(La) antibodies are the most specific serological markers for Sjögren's syndrome, present in
60-70% of cases. Schirmer's test confirms dry eyes but is not diagnostic. Lip biopsy is
confirmatory but invasive and not first-line .
2. A 55-year-old male with a history of hypertension presents with a sudden onset
of severe, tearing chest pain radiating to the back. His blood pressure is 190/110
mmHg in both arms. He has no history of trauma. Which diagnostic test is MOST
appropriate to confirm the suspected diagnosis?
A) CT angiography of the chest
B) Transesophageal echocardiogram (TEE)
,C) Chest X-ray
D) MRI of the chest
Correct Answer: A) CT angiography of the chest
Rationale: The sudden onset of severe, tearing chest pain radiating to the back with
hypertension is classic for aortic dissection. CT angiography is the preferred initial imaging
modality due to its rapid acquisition, high sensitivity (98-100%), and ability to visualize
the entire aorta. TEE is useful but more invasive and operator-dependent. Chest X-ray may
show a widened mediastinum but is not diagnostic .
3. A 28-year-old female presents with a 6-month history of episodic palpitations,
diaphoresis, and anxiety. She reports that episodes are unpredictable and not
triggered by specific situations. She has no significant medical history. What is the
MOST appropriate initial diagnostic test?
A) 24-hour Holter monitor
B) TSH and free T4
C) Complete blood count
D) Drug screen
Correct Answer: A) 24-hour Holter monitor
Rationale: Episodic palpitations in a young patient should be evaluated for cardiac
arrhythmias, including supraventricular tachycardia or atrial fibrillation. Holter monitoring
is the first-line test to capture arrhythmias. While TSH is also important to rule out
hyperthyroidism, the episodic nature of symptoms makes arrhythmia the most likely
cause, and Holter monitoring is the most appropriate initial step .
4. A 65-year-old female with a history of COPD presents with increasing shortness
of breath and a productive cough with purulent sputum. Her ABG on room air
shows pH 7.30, PaCO₂ 60 mmHg, PaO₂ 55 mmHg, and HCO₃⁻ 26 mEq/L. What is
the MOST appropriate initial intervention?
A) Increase oxygen to 4 L/min nasal cannula
B) Initiate non-invasive positive pressure ventilation (NIPPV)
C) Intubate and initiate mechanical ventilation
D) Administer antibiotics
Correct Answer: B) Initiate non-invasive positive pressure ventilation (NIPPV)
Rationale: This ABG shows acute respiratory acidosis (pH 7.30, PaCO₂ 60) with hypoxemia
(PaO₂ 55). NIPPV is indicated for acute hypercapnic respiratory failure in COPD patients
who are awake and able to protect their airway. It improves ventilation, reduces PaCO₂,
,and can prevent intubation. Intubation is indicated if NIPPV fails or if the patient cannot
protect their airway .
5. A 52-year-old male with a 30-pack-year smoking history presents with a chronic
cough, hemoptysis, and weight loss over the past 6 months. Chest X-ray shows a 3
cm solitary pulmonary nodule with spiculated margins in the right upper lobe.
What is the MOST appropriate next step?
A) Repeat chest X-ray in 3 months
B) CT-guided biopsy
C) PET-CT scan
D) Bronchoscopy
Correct Answer: C) PET-CT scan
Rationale: A solitary pulmonary nodule with spiculated margins in a smoker with
symptoms (cough, hemoptysis, weight loss) is highly suspicious for malignancy. A PET-CT
is the most appropriate next step to evaluate the metabolic activity of the nodule and
assess for metastatic disease. If the PET-CT is positive, biopsy would be indicated. CT-
guided biopsy is appropriate for peripheral nodules, while bronchoscopy is better for
central lesions .
6. A 60-year-old female with a history of type 2 diabetes and hypertension
presents with acute-onset left-sided weakness and facial droop. Her symptoms
started 3 hours ago. Her blood pressure is 165/95 mmHg. Which of the following
is a CONTRAINDICATION to thrombolytic therapy (tPA)?
A) Age >80 years
B) Blood glucose 250 mg/dL
C) Head CT showing no hemorrhage
D) INR 1.8
Correct Answer: D) INR 1.8
Rationale: Contraindications to tPA include INR >1.7, use of anticoagulants, head CT
showing hemorrhage, severe hypertension (systolic >185 or diastolic >110), and recent
major surgery. INR 1.8 is above the threshold, making tPA unsafe due to increased
bleeding risk. Age >80 is not an absolute contraindication. Blood glucose >250 requires
correction but is not a contraindication .
7. A 35-year-old female presents with a 2-week history of progressive weakness in
her lower extremities, urinary retention, and numbness in her legs. She reports a
recent viral illness. On examination, she has bilateral lower extremity weakness,
, hyperreflexia, and a sensory level at T8. What is the MOST appropriate diagnostic
test?
A) MRI of the spine with and without contrast
B) Lumbar puncture
C) CT of the spine
D) EMG/nerve conduction studies
Correct Answer: A) MRI of the spine with and without contrast
Rationale: The presentation of progressive lower extremity weakness, sensory level, and
urinary retention in the setting of a recent viral illness suggests transverse myelitis. MRI of
the spine is the imaging modality of choice to evaluate for cord inflammation,
demyelination, or compression. A sensory level is a "red flag" requiring urgent imaging.
Lumbar puncture may follow but is not the initial test .
8. A 48-year-old male with a history of alcohol use disorder presents with acute-
onset confusion, ataxia, and ophthalmoplegia. He reports a recent binge drinking
episode. What is the MOST appropriate immediate treatment?
A) IV thiamine (vitamin B1)
B) IV dextrose
C) IV lorazepam
D) IV naloxone
Correct Answer: A) IV thiamine (vitamin B1)
Rationale: The classic triad of Wernicke encephalopathy is confusion, ataxia, and
ophthalmoplegia in the setting of thiamine deficiency, most commonly seen in chronic
alcoholism. This is a medical emergency requiring immediate IV thiamine replacement.
Dextrose should be given after thiamine to prevent precipitation of Wernicke
encephalopathy .
9. A 70-year-old female with a history of hypertension presents with a sudden,
severe headache, nausea, and vomiting. She reports that the headache is the
"worst of her life." On examination, she has nuchal rigidity. What is the MOST
appropriate initial diagnostic test?
A) CT head without contrast
B) Lumbar puncture
C) MRI brain
D) CT angiography
