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Section 1: Advanced History Taking & Communication (Questions 1-25)
Q1: A nurse practitioner is interviewing a patient with type 2 diabetes who is struggling with
medication adherence. The practitioner says, "It sounds like you are worried about the side
effects of the new medication, and that's making it hard for you to take it every day." Which
motivational interviewing technique is being utilized?
A. Open-ended questioning
B. Affirmation
C. Reflective listening [CORRECT]
D. Summarizing
Correct Answer: C
Rationale: Reflective listening involves paraphrasing or reflecting back what the patient has said
to demonstrate understanding and validate their feelings, which builds rapport without arguing.
A asks broad questions, B validates strengths, and D synthesizes the entire conversation. NSG
6020 Exam Tip: South University heavily tests the OARS acronym; look for "sounds like" or "I
hear you saying" to identify reflective listening.
Q2: During a comprehensive health history, a patient describes their abdominal pain as "sharp,
burning, and starting right after eating spicy food." Which components of the OLDCARTS
mnemonic are being specifically addressed in this description?
A. Onset and Timing
B. Location and Duration
C. Character and Aggravating factors [CORRECT]
D. Radiation and Severity
Correct Answer: C
Rationale: "Sharp, burning" describes the Character of the pain, while "starting right after eating
spicy food" describes the Aggravating factors. A, B, and D represent other elements of the
mnemonic not explicitly detailed in this specific phrase. NSG 6020 Exam Tip: Differentiating
character (quality) from severity (intensity) is a common trick in NSG 6020 exam questions.
,Q3: A patient presents with a chief complaint of "feeling tired." Which of the following is the most
appropriate open-ended question to further explore this symptom?
A. Are you feeling tired because you aren't sleeping well?
B. Do you have a history of anemia or thyroid disease?
C. Tell me more about what you mean by feeling tired. [CORRECT]
D. Have you tried taking iron supplements or getting more sleep?
Correct Answer: C
Rationale: Open-ended questions allow the patient to elaborate in their own words, providing
richer data and avoiding leading the patient toward a specific diagnosis. A, B, and D are
closed-ended or leading questions. NSG 6020 Exam Tip: "Tell me more" or "Describe" are the
gold standards for starting the exploration of a vague chief complaint.
Q4: When assessing a patient's health literacy, the nurse practitioner asks the patient to read a
standard medication label and then explain how they would take the medication. What is the
primary purpose of this assessment?
A. To evaluate the patient's visual acuity and reading speed
B. To determine the patient's ability to obtain, process, and understand basic health information
[CORRECT]
C. To assess the patient's intelligence quotient and cognitive baseline
D. To identify if the patient is intentionally non-compliant with medical advice
Correct Answer: B
Rationale: Health literacy is defined as the degree to which individuals can obtain, process, and
understand basic health information and services needed to make appropriate health decisions.
A and C are incorrect interpretations of the task, and D assumes malicious intent rather than a
capacity barrier. NSG 6020 Exam Tip: Health literacy questions focus on "understanding and
processing," not intelligence or compliance.
Q5: A patient with chronic lower back pain becomes visibly frustrated, raises their voice, and
states, "None of you doctors ever listen to me, and these exercises are a waste of time!" What is
the most therapeutic initial response by the clinician?
A. I understand you are frustrated, but the exercises are medically necessary for your recovery.
B. Please lower your voice; there are other patients in the waiting room.
C. I can see you are very frustrated, and I want to make sure we address your concerns today.
[CORRECT]
D. If you do not want to follow the treatment plan, there is nothing more I can do for you.
Correct Answer: C
Rationale: Acknowledging the patient's emotion (frustration) and committing to addressing their
concerns de-escalates the situation and builds therapeutic rapport. A dismisses the emotion
,with "but," B focuses on environment rather than the patient, and D is an abandonment of care.
NSG 6020 Exam Tip: Challenging encounter questions almost always reward de-escalation,
validation, and setting boundaries simultaneously.
Q6: During the review of systems (ROS), a patient denies any cardiovascular symptoms but
later mentions occasional "heart racing" when asked specifically about palpitations. How should
this be documented?
A. Document as negative for cardiovascular symptoms since the patient initially denied them
B. Document as positive for palpitations under the cardiovascular ROS [CORRECT]
C. Document as a normal cardiovascular review of systems with a patient discrepancy
D. Document only in the history of present illness to avoid redundancy
Correct Answer: B
Rationale: The ROS must accurately reflect all symptoms elicited during the interview,
regardless of whether they were volunteered initially or discovered through specific questioning.
A and C are inaccurate representations, and D fragments the data. NSG 6020 Exam Tip: The
ROS is a dynamic process; if a positive finding is found during probing, it must be documented
as positive.
Q7: A nurse practitioner is taking a sexual history. Which of the following questions best adheres
to a patient-centered, non-judgmental approach?
A. Are you sexually active with men, women, or both?
B. Do you practice safe sex like normal people do?
C. To help me provide the best care, can you tell me about your sexual orientation and any
sexual activity you are engaging in? [CORRECT]
D. Are you aware that your sexual practices put you at high risk for STDs?
Correct Answer: C
Rationale: This question is open-ended, explains the clinical rationale ("to help me provide the
best care"), uses neutral language, and avoids assumptions or judgments. A assumes a binary,
B uses judgmental language ("normal"), and D is accusatory. NSG 6020 Exam Tip: Always
preface sensitive questions with the clinical rationale to reduce patient anxiety and demonstrate
professionalism.
Q8: A patient presents with a cough. They report it started 3 days ago, is worse at night,
produces clear sputum, and is associated with a runny nose and sore throat. They deny fever or
shortness of breath. Which section of the SOAP note does this information primarily belong in?
A. Objective
, B. Assessment
C. Subjective [CORRECT]
D. Plan
Correct Answer: C
Rationale: The Subjective section contains the chief complaint, history of present illness (HPI),
and review of systems—information reported by the patient. A contains clinician-performed
exam findings, B contains diagnoses, and D contains interventions. NSG 6020 Exam Tip:
Patient-reported symptoms, even if quantifiable (e.g., "3 days ago"), always go in the Subjective
section.
Q9: When constructing a genogram, a square represents a male and a circle represents a
female. A shaded shape indicates:
A. The patient is deceased
B. The patient is affected by the condition being mapped [CORRECT]
C. The patient is a carrier of a genetic mutation
D. The patient is the proband
Correct Answer: B
Rationale: In standard genogram notation, a completely shaded or filled symbol indicates that
the individual is affected by the specific disease or condition being tracked. A deceased
individual is marked with an X or slash, and C is usually indicated by a dot or half-shading
depending on the specific inheritance pattern. NSG 6020 Exam Tip: Know the basic genogram
symbols: square (male), circle (female), shaded (affected), X (deceased).
Q10: A patient with a history of alcohol use disorder presents for a routine physical. They state,
"I only have a couple of beers on the weekends." Which communication barrier is most likely
occurring?
A. Cognitive impairment
B. Minimization [CORRECT]
C. Malingering
D. Somatization
Correct Answer: B
Rationale: Minimization is a defense mechanism where the patient downplays the severity or
frequency of their symptoms or behaviors to avoid confrontation or judgment. A refers to
cognitive deficits, C is intentional faking for secondary gain, and D is the expression of
psychological distress as physical symptoms. NSG 6020 Exam Tip: Recognizing defense