WILKES UNIVERSITY NUR 508: DIAGNOSTIC
REASONING – FINAL EXAM 4 QUESSTIONS AND
CORRECT ANSWER 2026 UPDATE COMPLETE
SOLUTION
1. A patient presents with fever, cough, and pleuritic chest pain. Which diagnostic test is
most appropriate first?
A. Chest X-ray
B. Sputum culture
C. CT scan of the chest
D. Pulmonary function test
Answer: A. Chest X-ray
More Information: A chest X-ray is the initial diagnostic test for suspected pneumonia to
identify infiltrates and assess the extent of lung involvement.
2. A 60-year-old female presents with confusion and hypotension. Labs show elevated BUN
and creatinine. What is the likely diagnosis?
A. Acute kidney injury
B. Chronic kidney disease
C. Hypothyroidism
D. Hepatic failure
Answer: A. Acute kidney injury
More Information: Sudden changes in kidney function, as indicated by rising BUN and
creatinine, along with hypotension and confusion, suggest acute kidney injury.
3. A patient reports palpitations and shortness of breath. Which initial test is most
appropriate?
A. Electrocardiogram (ECG)
B. Echocardiogram
C. Stress test
D. Holter monitor
Answer: A. Electrocardiogram (ECG)
More Information: An ECG is the fastest and most essential test to identify arrhythmias,
ischemic changes, or conduction abnormalities causing palpitations.
,4. A patient with diabetes presents with burning foot pain and numbness. Which
complication is most likely?
A. Diabetic neuropathy
B. Peripheral vascular disease
C. Osteomyelitis
D. Gout
Answer: A. Diabetic neuropathy
More Information: Chronic hyperglycemia can damage peripheral nerves, leading to
numbness, tingling, and burning sensations, especially in the feet.
5. A patient presents with acute right lower quadrant pain, nausea, and fever. Which
diagnostic test is most appropriate?
A. Abdominal X-ray
B. CT scan of the abdomen and pelvis
C. MRI of the abdomen
D. Colonoscopy
Answer: B. CT scan of the abdomen and pelvis
More Information: CT imaging is highly sensitive and specific for diagnosing appendicitis,
helping confirm the location and severity of inflammation.
6. A patient presents with sudden onset shortness of breath and pleuritic chest pain. Which
test is most appropriate to rule out pulmonary embolism?
A. Ventilation-perfusion (V/Q) scan
B. Chest X-ray
C. Echocardiogram
D. ECG
Answer: A. Ventilation-perfusion (V/Q) scan
More Information: A V/Q scan or CT pulmonary angiography is used to detect pulmonary
emboli when clinical suspicion is high.
7. A patient presents with jaundice, abdominal pain, and dark urine. Which lab test is most
important initially?
A. Liver function tests
B. Serum creatinine
C. CBC
D. Serum amylase
, Answer: A. Liver function tests
More Information: Elevated bilirubin, AST, ALT, and alkaline phosphatase help differentiate
between hepatocellular injury and biliary obstruction.
8. A patient has sudden onset severe headache, vomiting, and neck stiffness. Which test is
most urgent?
A. CT scan without contrast
B. MRI brain with contrast
C. Lumbar puncture
D. Carotid Doppler
Answer: A. CT scan without contrast
More Information: This presentation is suggestive of subarachnoid hemorrhage; a non-
contrast CT quickly identifies bleeding.
9. A patient presents with hypotension, tachycardia, and warm skin after a bee sting.
Which condition is most likely?
A. Anaphylactic shock
B. Cardiogenic shock
C. Septic shock
D. Hypovolemic shock
Answer: A. Anaphylactic shock
More Information: Rapid onset hypotension, tachycardia, and warm, flushed skin after an
allergen exposure indicate anaphylaxis requiring immediate epinephrine.
10. A patient presents with hematuria and flank pain. Which test is first-line to evaluate for
kidney stones?
A. Non-contrast CT of the abdomen and pelvis
B. Ultrasound of the kidneys
C. MRI of the abdomen
D. Intravenous pyelogram
Answer: A. Non-contrast CT of the abdomen and pelvis
More Information: CT without contrast is highly sensitive for detecting renal calculi and their
location.
REASONING – FINAL EXAM 4 QUESSTIONS AND
CORRECT ANSWER 2026 UPDATE COMPLETE
SOLUTION
1. A patient presents with fever, cough, and pleuritic chest pain. Which diagnostic test is
most appropriate first?
A. Chest X-ray
B. Sputum culture
C. CT scan of the chest
D. Pulmonary function test
Answer: A. Chest X-ray
More Information: A chest X-ray is the initial diagnostic test for suspected pneumonia to
identify infiltrates and assess the extent of lung involvement.
2. A 60-year-old female presents with confusion and hypotension. Labs show elevated BUN
and creatinine. What is the likely diagnosis?
A. Acute kidney injury
B. Chronic kidney disease
C. Hypothyroidism
D. Hepatic failure
Answer: A. Acute kidney injury
More Information: Sudden changes in kidney function, as indicated by rising BUN and
creatinine, along with hypotension and confusion, suggest acute kidney injury.
3. A patient reports palpitations and shortness of breath. Which initial test is most
appropriate?
A. Electrocardiogram (ECG)
B. Echocardiogram
C. Stress test
D. Holter monitor
Answer: A. Electrocardiogram (ECG)
More Information: An ECG is the fastest and most essential test to identify arrhythmias,
ischemic changes, or conduction abnormalities causing palpitations.
,4. A patient with diabetes presents with burning foot pain and numbness. Which
complication is most likely?
A. Diabetic neuropathy
B. Peripheral vascular disease
C. Osteomyelitis
D. Gout
Answer: A. Diabetic neuropathy
More Information: Chronic hyperglycemia can damage peripheral nerves, leading to
numbness, tingling, and burning sensations, especially in the feet.
5. A patient presents with acute right lower quadrant pain, nausea, and fever. Which
diagnostic test is most appropriate?
A. Abdominal X-ray
B. CT scan of the abdomen and pelvis
C. MRI of the abdomen
D. Colonoscopy
Answer: B. CT scan of the abdomen and pelvis
More Information: CT imaging is highly sensitive and specific for diagnosing appendicitis,
helping confirm the location and severity of inflammation.
6. A patient presents with sudden onset shortness of breath and pleuritic chest pain. Which
test is most appropriate to rule out pulmonary embolism?
A. Ventilation-perfusion (V/Q) scan
B. Chest X-ray
C. Echocardiogram
D. ECG
Answer: A. Ventilation-perfusion (V/Q) scan
More Information: A V/Q scan or CT pulmonary angiography is used to detect pulmonary
emboli when clinical suspicion is high.
7. A patient presents with jaundice, abdominal pain, and dark urine. Which lab test is most
important initially?
A. Liver function tests
B. Serum creatinine
C. CBC
D. Serum amylase
, Answer: A. Liver function tests
More Information: Elevated bilirubin, AST, ALT, and alkaline phosphatase help differentiate
between hepatocellular injury and biliary obstruction.
8. A patient has sudden onset severe headache, vomiting, and neck stiffness. Which test is
most urgent?
A. CT scan without contrast
B. MRI brain with contrast
C. Lumbar puncture
D. Carotid Doppler
Answer: A. CT scan without contrast
More Information: This presentation is suggestive of subarachnoid hemorrhage; a non-
contrast CT quickly identifies bleeding.
9. A patient presents with hypotension, tachycardia, and warm skin after a bee sting.
Which condition is most likely?
A. Anaphylactic shock
B. Cardiogenic shock
C. Septic shock
D. Hypovolemic shock
Answer: A. Anaphylactic shock
More Information: Rapid onset hypotension, tachycardia, and warm, flushed skin after an
allergen exposure indicate anaphylaxis requiring immediate epinephrine.
10. A patient presents with hematuria and flank pain. Which test is first-line to evaluate for
kidney stones?
A. Non-contrast CT of the abdomen and pelvis
B. Ultrasound of the kidneys
C. MRI of the abdomen
D. Intravenous pyelogram
Answer: A. Non-contrast CT of the abdomen and pelvis
More Information: CT without contrast is highly sensitive for detecting renal calculi and their
location.
