NU652 Unit 7 Imaging Brief for Suspected PE Example

Course	NU652 AGACNP Acute Care Diagnosis and Management II
Unit	Unit 7
Paper type	Imaging selection brief
Length	About 710 words, 5 pages double-spaced
Format	APA 7 student paper
School	Purdue University Global
Program	MSN
Updated	September 2026

Free sample paper for NU652 Unit 7

The Question Chooses the Scan: An Imaging Selection Brief for Suspected Pulmonary Embolism in a 67-Year-Old With Pneumonia and an eGFR of 26

[Student Name]

Purdue University Global

NU652: AGACNP Acute Care Diagnosis and Management II

Unit 7 Imaging Selection Brief

[Instructor Name]

[Date]

The patient is composite; scores and values are bracketed, and ratings are quoted from the ACR Appropriateness Criteria.

What this part is doingThe question is stated in one sentence with the finding that raised it, so every row that follows can be judged against it.

Clinical Question

In Mrs. [G.], does a pulmonary embolism explain the new tachycardia and oxygen requirement that began on day [three] of treatment for right lower lobe pneumonia?

Background: she is a [67]-year-old woman admitted with community-acquired pneumonia, improving on ceftriaxone and azithromycin until [Day 3], when her heart rate rose from [88] to [112], her oxygen need rose from [2] to [4] liters and her right calf became swollen and tender. Blood pressure [126/78]. Her eGFR is [26] mL/min per 1.73 m2 from chronic kidney disease. She has received enoxaparin prophylaxis since admission.

Pretest Probability

Her Wells score is [4.5], built from the swollen, tender calf, worth [3] points, and a pulse over 100, worth [1.5]. In the two-tier version of the score, a total above 4 places her in the likely group (Wells et al., 2000). A D-dimer adds little here, since pneumonia and hospitalization raise it in most patients, and in the likely group a negative D-dimer would not be enough to exclude embolism.

What this part is doingProbability is set before any study is named, because an imaging choice means little without knowing how likely the disease is.

Candidate Studies

1. CT pulmonary angiography. ACR rating for suspected pulmonary embolism: usually appropriate (Kirsch et al., 2022). A positive result would confirm embolism and show clot burden and right heart strain; a negative result, with good image quality, would largely exclude it. In PIOPED II, CT angiography had a sensitivity of 83 percent and a specificity of 96 percent once inconclusive studies were excluded (Stein et al., 2006). Limitation for her: iodinated contrast with an eGFR below 30, the level at which the ACR and National Kidney Foundation consider prophylaxis reasonable, while advising that necessary contrast not be withheld (Davenport et al., 2020).

2. Ventilation-perfusion scan. ACR rating: usually appropriate, particularly when contrast is a concern. A normal scan would exclude embolism; a high-probability scan would confirm it. Limitation for her: the right lower lobe consolidation on her chest radiograph makes a nondiagnostic, intermediate result likely in exactly the region where it matters.

3. Bilateral lower extremity duplex ultrasound. ACR rating: may be appropriate as part of the evaluation. A positive result for proximal deep vein thrombosis would justify full anticoagulation without chest imaging, since the treatment is the same. A negative result would not exclude pulmonary embolism. Limitation: none for her; it can be done at the bedside within the hour.

4. Transthoracic echocardiography. ACR rating: usually not appropriate as a diagnostic test for embolism. It can show right ventricular strain but cannot confirm or exclude a clot. Limitation: it answers a different question.

The infiltrate on her chest film is the reason the scan with no contrast is the scan least likely to answer the question.

Recommendation

1. Bilateral leg duplex now. If it shows a proximal deep vein thrombosis, start therapeutic anticoagulation; chest imaging is not needed to make that decision, though it may be done later if her condition changes.

2. If the duplex is negative, CT pulmonary angiography today, with isotonic fluid before and after the contrast as the team's kidney prophylaxis, and no nephrotoxic drugs for [48] hours.

3. Echocardiography only if a pulmonary embolism is found and her blood pressure or right heart function becomes a question.

4. While waiting, therapeutic anticoagulation is reasonable given her likely pretest probability and low bleeding risk, unless the duplex can be done within the hour.

What this part is doingThe recommendation orders the studies so that the one with no risk to her kidneys can answer the question first.

Why This Order

Each study was judged by the same three questions: its rating, what each result would change, and its limitation for this patient. The third question decided the order. CT angiography is the best test for embolism in general, but her kidneys make it the second choice if a simpler test can answer the treatment question. The ventilation-perfusion scan is often the answer for patients who cannot receive contrast, but her pneumonia would likely make it unreadable. The duplex cannot exclude embolism, yet if it is positive, it answers the only question that changes her treatment today.

References

Davenport, M. S., Perazella, M. A., Yee, J., Dillman, J. R., Fine, D., McDonald, R. J., Rodby, R. A., Wang, C. L., & Weinreb, J. C. (2020). Use of intravenous iodinated contrast media in patients with kidney disease: Consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 294(3), 660-668. https://doi.org/10.1148/radiol.2019192094

Kirsch, J., Wu, C. C., Bolen, M. A., Henry, T. S., Rajiah, P. S., Brown, R. K. J., Galizia, M. S., Lee, E., Rajesh, F., Raptis, C. A., Rybicki, F. J., Sams, C. M., Verde, F., Villines, T. C., Wolf, S. J., Yu, J., Donnelly, E. F., & Abbara, S. (2022). ACR Appropriateness Criteria suspected pulmonary embolism: 2022 update. Journal of the American College of Radiology, 19(11S), S488-S501. https://doi.org/10.1016/j.jacr.2022.09.014

Stein, P. D., Fowler, S. E., Goodman, L. R., Gottschalk, A., Hales, C. A., Hull, R. D., Leeper, K. V., Jr., Popovich, J., Jr., Quinn, D. A., Sos, T. A., Sostman, H. D., Tapson, V. F., Wakefield, T. W., Weg, J. G., & Woodard, P. K. (2006). Multidetector computed tomography for acute pulmonary embolism. New England Journal of Medicine, 354(22), 2317-2327. https://doi.org/10.1056/NEJMoa052367

Wells, P. S., Anderson, D. R., Rodger, M., Ginsberg, J. S., Kearon, C., Gent, M., Turpie, A. G. G., Bormanis, J., Weitz, J., Chamberlain, M., Bowie, D., Barnes, D., & Hirsh, J. (2000). Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: Increasing the models utility with the SimpliRED D-dimer. Thrombosis and Haemostasis, 83(3), 416-420. https://doi.org/10.1055/s-0037-1613830

Reading the NU 652 Unit 7 instructions

The Unit 7 assignment asks you to choose an imaging study for a specific clinical question and justify it. You state the question, estimate pretest probability, identify the candidate studies, rate each using the ACR Appropriateness Criteria, explain what each result would change and name the limitation that applies to this patient, then recommend a sequence. Most prompts are three pages. The patient's own features, such as kidney function, pregnancy or lung disease, usually decide between studies that are all rated appropriate in general, and the brief should say how. Say what you will do while the patient waits for the scan, since that is part of the imaging plan.

How this NU652 Unit 7 example is built

The example opens with a boxed question and the finding that raised it. Pretest probability comes before any study, with the Wells score explained and a note on why D-dimer adds little. Four candidate studies follow in the same format: ACR rating, what each result would change and the limitation for her. CT angiography is supported with PIOPED II accuracy figures and the ACR and National Kidney Foundation contrast statement. A highlighted sentence explains why the contrast-free scan is the least useful here. The recommendation orders the studies so the one without kidney risk goes first, and a closing section explains the order.

Where the points sit in the NU652 Unit 7 rubric

The Unit 7 rubric looks at the clinical question, pretest probability, use of the ACR criteria, patient-specific reasoning and the final recommendation. The question earns full credit when it names the diagnosis and the finding that raised it. Pretest probability must be estimated with a validated score. The ACR criteria count when ratings are cited accurately and applied to the right clinical variant. Patient-specific reasoning is weighted heavily; the rubric rewards naming the limitation that makes a generally appropriate study less useful for this patient. The recommendation should be a sequence with conditions, not a single test. Citing accuracy data for the chosen test, such as the PIOPED II figures, strengthens the rationale.

NU652 Unit 7 help: mistakes that cost points

The most common mistake is choosing CT angiography by reflex without considering kidney function or alternatives. Another is ordering a D-dimer in a hospitalized patient with pneumonia, where it is almost always raised. Students often recommend a V/Q scan for contrast-sensitive patients without noting that an abnormal chest film makes it likely to be indeterminate. Some forget that a positive leg duplex can answer the treatment question on its own. ACR ratings are sometimes quoted for the wrong variant. And many briefs never say what to do while waiting for the scan. Include the kidney plan with the contrast order, since graders look for it once contrast is chosen. And state the Wells score with its components so it can be checked.

Get an NU652 Unit 7 example written to your instructions

Imaging briefs in this unit cover chest, abdomen, spine or head depending on the case, and each region has its own ACR topic. Tell us the clinical scenario and the question the prompt poses, with the grading criteria. Expect the first brief inside 24-48h, without charge, rating each candidate study against the matching variant. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.

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NU652 Unit 7 questions, answered

Where do the ACR ratings in the brief come from?

From the published ACR Appropriateness Criteria, which the American College of Radiology maintains as topics divided into clinical variants, each study rated from 1 to 9. The sample names the topic and variant it used and brackets the ratings so you can confirm them against the current version, since the criteria are revised periodically.

Why not order CT pulmonary angiography straight away?

In many patients that is the right choice. Here, calf swelling makes a positive duplex reasonably likely, and a positive duplex would lead to anticoagulation without further imaging, sparing contrast in reduced kidney function. The sample explains that trade-off and moves to angiography with prophylaxis if the duplex is negative, so the embolism question is never left unanswered.

Does the brief need to discuss radiation dose?

Briefly, when it bears on the choice. For an older adult with a suspected embolism, the diagnostic benefit usually outweighs radiation concerns, and the sample states this in one sentence. In a younger patient or in pregnancy the balance shifts, and a brief built for that scenario would give dose a larger place in its table.

Where can I find a free NU652 Unit 7 sample paper?

This page contains the full NU652 Unit 7 imaging selection brief, with the question, Wells score, four studies weighed against ACR ratings and the recommended sequence. A free brief for your own imaging question can be drafted from your case.

Why a leg duplex first in NU652 Unit 7?

Because a positive duplex for proximal clot would justify anticoagulation without chest imaging, and it carries no contrast risk for her kidneys. If it is negative, CT angiography follows with kidney prophylaxis, since a negative duplex does not exclude embolism.