NSG 550 Exam 1 Diagnostic Reasoning
(2026/2027) PDF | Nursing | Wilkes University
1. A 58-year-old male presents with substernal chest
pressure radiating to the jaw, worsened by exertion.
What is the most appropriate initial step?
A. Order a stat echocardiogram
B. Administer sublingual nitroglycerin
C. Obtain a focused history and vital signs
D. Refer to cardiology
Correct Answer: C
Rationale: The initial step is always to stabilize and
gather critical data. History and vitals guide immediate
management; treatment (B) may follow but not before
assessment. Ordering tests (A) or referral (D) delays
initial assessment.
2. Which heuristic is most likely to cause premature
closure in diagnostic reasoning?
1
,A. Availability heuristic
B. Anchoring
C. Representativeness
D. Search satisfaction
Correct Answer: D
Rationale: Search satisfaction (stopping after finding one
plausible diagnosis) is a direct cause of premature closure.
Anchoring (B) is related but refers to sticking to an initial
impression despite new data.
3. A patient presents with fatigue, weight loss, and night
sweats. Which of the following should be in the
differential?
A. Tuberculosis
B. Malignancy (e.g., lymphoma)
C. HIV
D. All of the above
2
,Correct Answer: D
Rationale: All are classic causes of “B symptoms” (fever,
night sweats, weight loss). A broad differential is essential
in diagnostic reasoning to avoid missing serious conditions.
4. The concept of “pretest probability” influences:
A. The need for a complete blood count
B. The interpretation of a diagnostic test result
C. The patient’s insurance coverage
D. The physical exam technique
Correct Answer: B
Rationale: Pretest probability determines how to interpret
a test result (e.g., positive test in low pretest probability
may be a false positive). It does not directly dictate test
ordering (A) or insurance (C).
5. A 72-year-old with sudden-onset aphasia and right
arm weakness. What is the most critical first question?
3
, A. “When did this start?”
B. “Do you have a headache?”
C. “What medications do you take?”
D. “Have you ever had a seizure?”
Correct Answer: A
*Rationale: Time of onset determines eligibility for
thrombolytics in acute ischemic stroke (within 3–4.5 hours).
Other questions are important but not time-critical.*
6. Which type of reasoning uses a systematic, step-by-
step approach from known facts to a conclusion?
A. Inductive reasoning
B. Deductive reasoning
C. Intuitive reasoning
D. Pattern recognition
Correct Answer: B
Rationale: Deductive reasoning moves from general
principles to specific conclusions (e.g., all chest pain with
4
(2026/2027) PDF | Nursing | Wilkes University
1. A 58-year-old male presents with substernal chest
pressure radiating to the jaw, worsened by exertion.
What is the most appropriate initial step?
A. Order a stat echocardiogram
B. Administer sublingual nitroglycerin
C. Obtain a focused history and vital signs
D. Refer to cardiology
Correct Answer: C
Rationale: The initial step is always to stabilize and
gather critical data. History and vitals guide immediate
management; treatment (B) may follow but not before
assessment. Ordering tests (A) or referral (D) delays
initial assessment.
2. Which heuristic is most likely to cause premature
closure in diagnostic reasoning?
1
,A. Availability heuristic
B. Anchoring
C. Representativeness
D. Search satisfaction
Correct Answer: D
Rationale: Search satisfaction (stopping after finding one
plausible diagnosis) is a direct cause of premature closure.
Anchoring (B) is related but refers to sticking to an initial
impression despite new data.
3. A patient presents with fatigue, weight loss, and night
sweats. Which of the following should be in the
differential?
A. Tuberculosis
B. Malignancy (e.g., lymphoma)
C. HIV
D. All of the above
2
,Correct Answer: D
Rationale: All are classic causes of “B symptoms” (fever,
night sweats, weight loss). A broad differential is essential
in diagnostic reasoning to avoid missing serious conditions.
4. The concept of “pretest probability” influences:
A. The need for a complete blood count
B. The interpretation of a diagnostic test result
C. The patient’s insurance coverage
D. The physical exam technique
Correct Answer: B
Rationale: Pretest probability determines how to interpret
a test result (e.g., positive test in low pretest probability
may be a false positive). It does not directly dictate test
ordering (A) or insurance (C).
5. A 72-year-old with sudden-onset aphasia and right
arm weakness. What is the most critical first question?
3
, A. “When did this start?”
B. “Do you have a headache?”
C. “What medications do you take?”
D. “Have you ever had a seizure?”
Correct Answer: A
*Rationale: Time of onset determines eligibility for
thrombolytics in acute ischemic stroke (within 3–4.5 hours).
Other questions are important but not time-critical.*
6. Which type of reasoning uses a systematic, step-by-
step approach from known facts to a conclusion?
A. Inductive reasoning
B. Deductive reasoning
C. Intuitive reasoning
D. Pattern recognition
Correct Answer: B
Rationale: Deductive reasoning moves from general
principles to specific conclusions (e.g., all chest pain with
4
