NSG 550 Final Exam 2026/2027 | Questions and Answers with
Rationales | Wilkes University - Guaranteed Pass
Diagnostic Reasoning & Clinical Decision-Making
1. A 54-year-old patient presents with fatigue, weight loss, and
persistent cough. Which approach best demonstrates diagnostic
reasoning?
A. Choose the most common diagnosis immediately
B. Develop a differential diagnosis based on history, examination, and
risk factors
C. Order every available diagnostic test
D. Treat empirically without further assessment
Answer: B
Rationale: Diagnostic reasoning integrates the history, physical
examination, epidemiology, risk factors, and available diagnostic data
to develop and prioritize a differential diagnosis.
2. Which feature of a patient's history is generally most useful when
evaluating a new symptom?
A. Favorite medication
B. Chronology and onset of the symptom
C. Marital status alone
D. Preferred pharmacy
Answer: B
Rationale: Establishing when and how a symptom began, its
progression, and associated events can substantially narrow the
differential diagnosis.
,3. A clinician initially believes a patient's chest pain is GERD but later
discovers exertional pressure radiating to the jaw. What should the
clinician do?
A. Maintain the original diagnosis
B. Reassess the differential diagnosis
C. Ignore the new information
D. Diagnose anxiety
Answer: B
Rationale: New information should modify diagnostic hypotheses.
Exertional pressure with radiation raises concern for myocardial
ischemia.
4. Which cognitive error occurs when a clinician prematurely accepts
the first plausible diagnosis?
A. Availability bias
B. Anchoring
C. Confirmation bias
D. Framing effect
Answer: B
Rationale: Anchoring occurs when the clinician becomes overly
attached to an initial impression and fails to adequately reconsider
alternatives.
5. A clinician searches only for findings that support an initial diagnosis.
This is:
A. Confirmation bias
B. Representativeness
C. Random error
D. Recall bias
,Answer: A
Rationale: Confirmation bias is the tendency to seek or interpret
information in ways that support an existing belief.
6. Which diagnostic strategy is most appropriate when several
conditions could explain the presentation?
A. Consider only the most common disease
B. Rank the differential according to likelihood and clinical danger
C. Order no tests
D. Select the rarest diagnosis first
Answer: B
Rationale: A useful differential considers both probability and
consequences of missing a serious diagnosis.
7. A diagnosis that must be excluded because failure to identify it could
result in death is often called a:
A. Benign diagnosis
B. Can't-miss diagnosis
C. Historical diagnosis
D. Functional diagnosis
Answer: B
Rationale: “Can't-miss” diagnoses may not be the most likely diagnosis
but carry substantial morbidity or mortality if overlooked.
8. Which question best evaluates symptom chronology?
A. “What does the pain feel like?”
B. “What were you doing when it started?”
C. “Where do you live?”
D. “What medications do you prefer?”
, Answer: B
Rationale: Determining the circumstances surrounding onset helps
identify potential causes and temporal relationships.
9. A patient reports dizziness. Which question is most important
initially?
A. “Do you mean spinning, lightheadedness, or imbalance?”
B. “Do you like coffee?”
C. “What is your occupation?”
D. “Do you exercise?”
Answer: A
Rationale: “Dizziness” is nonspecific. Clarifying the patient's actual
experience helps distinguish vertigo, presyncope, disequilibrium, and
nonspecific lightheadedness.
10. Which diagnosis should generally receive the highest priority in a
differential?
A. The most unusual diagnosis
B. The diagnosis that is both plausible and potentially dangerous
C. The least expensive diagnosis
D. The diagnosis easiest to treat
Answer: B
Rationale: Clinical reasoning requires consideration of both probability
and consequences of delay.
History & Symptom Analysis
11. In OPQRST, the “O” refers to:
A. Origin/onset
B. Objective findings
Rationales | Wilkes University - Guaranteed Pass
Diagnostic Reasoning & Clinical Decision-Making
1. A 54-year-old patient presents with fatigue, weight loss, and
persistent cough. Which approach best demonstrates diagnostic
reasoning?
A. Choose the most common diagnosis immediately
B. Develop a differential diagnosis based on history, examination, and
risk factors
C. Order every available diagnostic test
D. Treat empirically without further assessment
Answer: B
Rationale: Diagnostic reasoning integrates the history, physical
examination, epidemiology, risk factors, and available diagnostic data
to develop and prioritize a differential diagnosis.
2. Which feature of a patient's history is generally most useful when
evaluating a new symptom?
A. Favorite medication
B. Chronology and onset of the symptom
C. Marital status alone
D. Preferred pharmacy
Answer: B
Rationale: Establishing when and how a symptom began, its
progression, and associated events can substantially narrow the
differential diagnosis.
,3. A clinician initially believes a patient's chest pain is GERD but later
discovers exertional pressure radiating to the jaw. What should the
clinician do?
A. Maintain the original diagnosis
B. Reassess the differential diagnosis
C. Ignore the new information
D. Diagnose anxiety
Answer: B
Rationale: New information should modify diagnostic hypotheses.
Exertional pressure with radiation raises concern for myocardial
ischemia.
4. Which cognitive error occurs when a clinician prematurely accepts
the first plausible diagnosis?
A. Availability bias
B. Anchoring
C. Confirmation bias
D. Framing effect
Answer: B
Rationale: Anchoring occurs when the clinician becomes overly
attached to an initial impression and fails to adequately reconsider
alternatives.
5. A clinician searches only for findings that support an initial diagnosis.
This is:
A. Confirmation bias
B. Representativeness
C. Random error
D. Recall bias
,Answer: A
Rationale: Confirmation bias is the tendency to seek or interpret
information in ways that support an existing belief.
6. Which diagnostic strategy is most appropriate when several
conditions could explain the presentation?
A. Consider only the most common disease
B. Rank the differential according to likelihood and clinical danger
C. Order no tests
D. Select the rarest diagnosis first
Answer: B
Rationale: A useful differential considers both probability and
consequences of missing a serious diagnosis.
7. A diagnosis that must be excluded because failure to identify it could
result in death is often called a:
A. Benign diagnosis
B. Can't-miss diagnosis
C. Historical diagnosis
D. Functional diagnosis
Answer: B
Rationale: “Can't-miss” diagnoses may not be the most likely diagnosis
but carry substantial morbidity or mortality if overlooked.
8. Which question best evaluates symptom chronology?
A. “What does the pain feel like?”
B. “What were you doing when it started?”
C. “Where do you live?”
D. “What medications do you prefer?”
, Answer: B
Rationale: Determining the circumstances surrounding onset helps
identify potential causes and temporal relationships.
9. A patient reports dizziness. Which question is most important
initially?
A. “Do you mean spinning, lightheadedness, or imbalance?”
B. “Do you like coffee?”
C. “What is your occupation?”
D. “Do you exercise?”
Answer: A
Rationale: “Dizziness” is nonspecific. Clarifying the patient's actual
experience helps distinguish vertigo, presyncope, disequilibrium, and
nonspecific lightheadedness.
10. Which diagnosis should generally receive the highest priority in a
differential?
A. The most unusual diagnosis
B. The diagnosis that is both plausible and potentially dangerous
C. The least expensive diagnosis
D. The diagnosis easiest to treat
Answer: B
Rationale: Clinical reasoning requires consideration of both probability
and consequences of delay.
History & Symptom Analysis
11. In OPQRST, the “O” refers to:
A. Origin/onset
B. Objective findings
