NSG6020 3P EXAM 300 ACTUAL QUESTIONS AND
CORRECT ANSWER WITH RATIONALE LATEST
UPDATE OF THIS YEAR
The NSG6020 3P exam is a comprehensive, high-stakes assessment required
by South University for nurse practitioner students, evaluating competency in
Advanced Pathophysiology, Advanced Pharmacology, and Advanced Physical
Assessment. It tests clinical reasoning, diagnostic skills, and evidence-based
practice across all body systems, including cardiovascular, respiratory,
neurological, musculoskeletal, dermatologic, reproductive, gastrointestinal,
and endocrine. The exam features multiple-choice and case-based questions
that assess differential diagnosis, medication management, and interpretation
of clinical findings. Success requires integration of pathophysiology principles,
pharmacotherapeutic decision-making, and advanced physical examination
techniques. Passing the exam may waive the three individual 3P courses for
re-entry students, demonstrating readiness for clinical practice.
1. A 28-year-old graduate student presents with pain all over that is worse in the
neck, shoulders, hands, low back, and knees. She denies joint swelling, states the
pain is worse in the morning, and has no limitation in range of motion. Physical
examination reveals several tender points on the muscles of the neck, shoulders,
and back. Muscle strength and range of motion are normal. What is the most likely
cause of her pain?
A) Rheumatoid arthritis
B) Fibromyalgia
C) Polymyalgia rheumatica
D) Chronic fatigue syndrome
Answer: B) Fibromyalgia
Rationale: Fibromyalgia is characterized by widespread musculoskeletal pain,
tender points, and normal joint examination findings. The absence of joint
swelling, normal range of motion, and presence of tender points are classic
features. Rheumatoid arthritis would show joint swelling and limitation, while
polymyalgia rheumatica typically occurs in older adults with stiffness in shoulders
and hips .
,2. A patient complains of severe pruritus that is worse at night. Several family
members have the same symptoms. Examination reveals excoriated papules on the
interdigital webs of both hands and on the axillae. This finding is most consistent
with which diagnosis?
A) Atopic dermatitis
B) Scabies
C) Contact dermatitis
D) Psoriasis
Answer: B) Scabies
Rationale: Scabies is a contagious skin infestation caused by the mite Sarcoptes
scabiei. It presents with severe nocturnal pruritus and characteristic lesions in the
interdigital webs, axillae, and other intertriginous areas. Family members are often
affected due to close contact .
3. An obese 55-year-old woman went through menarche at age 16 and menopause
2 years ago. She is concerned because an aunt had severe osteoporosis. Which of
the following is a risk factor for osteoporosis in this patient?
A) Late menopause
B) Delayed menarche
C) Obesity
D) Family history of osteoporosis
Answer: B) Delayed menarche
Rationale: Delayed menarche (after age 16) is a risk factor for osteoporosis
because it results in lower lifetime estrogen exposure. Late menopause and obesity
are actually protective against osteoporosis. While family history is a risk factor,
delayed menarche is the correct option listed .
4. A 68-year-old female presents for a routine follow-up visit. You notice a few
flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of
her forearms but nowhere else. She does not mention them, but they are tender
when you examine them. What should you do next?
A) Document the lesions as normal age-related changes
B) Refer the patient to a dermatologist
C) Ask how she acquired them
D) Perform a skin biopsy
Answer: C) Ask how she acquired them
Rationale: The lesions described are likely ecchymoses (bruises) from trauma,
which are common on the forearms of older adults. The nurse practitioner should
,first inquire about how the patient acquired them to rule out abuse or bleeding
disorders before considering referral or biopsy .
5. A 58-year-old man complains of bilateral back pain that now awakens him at
night and has been steadily increasing for the past 2 months. Which of the
following is the most reassuring finding in this patient?
A) Pain that is bilateral
B) Pain that is worse with activity
C) Pain that is relieved with rest
D) Pain that is associated with fever
Answer: A) Pain that is bilateral
Rationale: Bilateral back pain is often less concerning than unilateral pain,
which may suggest a more serious underlying cause such as infection or
malignancy. Night pain and progressive pain are red flags that require further
investigation. Pain that is bilateral can be reassuring in this context .
6. A 47-year-old man is having difficulties with sexual function. He is recently
separated from his wife of 20 years. He notes that he has early morning erections
but otherwise cannot function. Which of the following is a likely cause for his
problem?
A) Diabetic neuropathy
B) Vascular insufficiency
C) Psychological issues
D) Hypogonadism
Answer: C) Psychological issues
Rationale: Early morning erections (nocturnal penile tumescence) indicate intact
neurologic and vascular function, suggesting the erectile dysfunction is
psychogenic rather than organic. The recent separation and stress are likely
contributing factors .
7. A 50-year-old truck driver presents for a work physical. He is a one-pack-per-
day smoker and has a family history of lung cancer. On digital rectal examination,
you palpate a soft, smooth, and nontender pedunculated mass on the posterior wall
of the rectum. What is the most likely diagnosis?
A) Hemorrhoid
B) Rectal polyp
C) Prostatic hypertrophy
D) Rectal carcinoma
Answer: B) Rectal polyp
, Rationale: A soft, smooth, and nontender pedunculated mass in the rectum is
characteristic of a benign rectal polyp. Hemorrhoids are typically vascular and may
be painful or bleed. Prostatic hypertrophy is felt anteriorly through the rectal wall.
Rectal carcinoma is usually firm, irregular, and fixed .
8. A 15-year-old high school football player presents with severe testicular pain
that began acutely at 8:00 AM. He is nauseated and vomiting, and he cannot
urinate due to pain. On examination, the scrotal skin is tense and red, and he is
very uncomfortable. What is the most likely diagnosis?
A) Epididymitis
B) Testicular torsion
C) Orchitis
D) Inguinal hernia
Answer: B) Testicular torsion
Rationale: Testicular torsion is a surgical emergency characterized by the acute
onset of severe testicular pain, nausea, vomiting, and a tense, red scrotum. It most
commonly occurs in adolescents. Epididymitis typically presents with gradual
onset and may have associated urinary symptoms. Orchitis is inflammation of the
testicle and is often associated with mumps .
9. A 12-year-old boy presents with an enlarged and tender left testicle that he
discovered during a testicular self-examination. He has had a sore throat, cough,
and runny nose for the past three days. On examination, his temperature is 100.8°F,
and the scrotum is red and tense on the left side. What is the most likely diagnosis?
A) Testicular torsion
B) Acute orchitis
C) Epididymitis
D) Hydrocele
Answer: B) Acute orchitis
Rationale: Acute orchitis is inflammation of the testicle, often caused by a viral
infection such as mumps. The presence of a sore throat and respiratory symptoms
preceding the testicular pain suggests a viral etiology. The exam findings of an
enlarged, tender testicle with a red, tense scrotum are consistent with orchitis .
10. A patient presents with joint pain that is worse in the morning and improves
with activity. Which of the following is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Gout
D) Septic arthritis
CORRECT ANSWER WITH RATIONALE LATEST
UPDATE OF THIS YEAR
The NSG6020 3P exam is a comprehensive, high-stakes assessment required
by South University for nurse practitioner students, evaluating competency in
Advanced Pathophysiology, Advanced Pharmacology, and Advanced Physical
Assessment. It tests clinical reasoning, diagnostic skills, and evidence-based
practice across all body systems, including cardiovascular, respiratory,
neurological, musculoskeletal, dermatologic, reproductive, gastrointestinal,
and endocrine. The exam features multiple-choice and case-based questions
that assess differential diagnosis, medication management, and interpretation
of clinical findings. Success requires integration of pathophysiology principles,
pharmacotherapeutic decision-making, and advanced physical examination
techniques. Passing the exam may waive the three individual 3P courses for
re-entry students, demonstrating readiness for clinical practice.
1. A 28-year-old graduate student presents with pain all over that is worse in the
neck, shoulders, hands, low back, and knees. She denies joint swelling, states the
pain is worse in the morning, and has no limitation in range of motion. Physical
examination reveals several tender points on the muscles of the neck, shoulders,
and back. Muscle strength and range of motion are normal. What is the most likely
cause of her pain?
A) Rheumatoid arthritis
B) Fibromyalgia
C) Polymyalgia rheumatica
D) Chronic fatigue syndrome
Answer: B) Fibromyalgia
Rationale: Fibromyalgia is characterized by widespread musculoskeletal pain,
tender points, and normal joint examination findings. The absence of joint
swelling, normal range of motion, and presence of tender points are classic
features. Rheumatoid arthritis would show joint swelling and limitation, while
polymyalgia rheumatica typically occurs in older adults with stiffness in shoulders
and hips .
,2. A patient complains of severe pruritus that is worse at night. Several family
members have the same symptoms. Examination reveals excoriated papules on the
interdigital webs of both hands and on the axillae. This finding is most consistent
with which diagnosis?
A) Atopic dermatitis
B) Scabies
C) Contact dermatitis
D) Psoriasis
Answer: B) Scabies
Rationale: Scabies is a contagious skin infestation caused by the mite Sarcoptes
scabiei. It presents with severe nocturnal pruritus and characteristic lesions in the
interdigital webs, axillae, and other intertriginous areas. Family members are often
affected due to close contact .
3. An obese 55-year-old woman went through menarche at age 16 and menopause
2 years ago. She is concerned because an aunt had severe osteoporosis. Which of
the following is a risk factor for osteoporosis in this patient?
A) Late menopause
B) Delayed menarche
C) Obesity
D) Family history of osteoporosis
Answer: B) Delayed menarche
Rationale: Delayed menarche (after age 16) is a risk factor for osteoporosis
because it results in lower lifetime estrogen exposure. Late menopause and obesity
are actually protective against osteoporosis. While family history is a risk factor,
delayed menarche is the correct option listed .
4. A 68-year-old female presents for a routine follow-up visit. You notice a few
flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of
her forearms but nowhere else. She does not mention them, but they are tender
when you examine them. What should you do next?
A) Document the lesions as normal age-related changes
B) Refer the patient to a dermatologist
C) Ask how she acquired them
D) Perform a skin biopsy
Answer: C) Ask how she acquired them
Rationale: The lesions described are likely ecchymoses (bruises) from trauma,
which are common on the forearms of older adults. The nurse practitioner should
,first inquire about how the patient acquired them to rule out abuse or bleeding
disorders before considering referral or biopsy .
5. A 58-year-old man complains of bilateral back pain that now awakens him at
night and has been steadily increasing for the past 2 months. Which of the
following is the most reassuring finding in this patient?
A) Pain that is bilateral
B) Pain that is worse with activity
C) Pain that is relieved with rest
D) Pain that is associated with fever
Answer: A) Pain that is bilateral
Rationale: Bilateral back pain is often less concerning than unilateral pain,
which may suggest a more serious underlying cause such as infection or
malignancy. Night pain and progressive pain are red flags that require further
investigation. Pain that is bilateral can be reassuring in this context .
6. A 47-year-old man is having difficulties with sexual function. He is recently
separated from his wife of 20 years. He notes that he has early morning erections
but otherwise cannot function. Which of the following is a likely cause for his
problem?
A) Diabetic neuropathy
B) Vascular insufficiency
C) Psychological issues
D) Hypogonadism
Answer: C) Psychological issues
Rationale: Early morning erections (nocturnal penile tumescence) indicate intact
neurologic and vascular function, suggesting the erectile dysfunction is
psychogenic rather than organic. The recent separation and stress are likely
contributing factors .
7. A 50-year-old truck driver presents for a work physical. He is a one-pack-per-
day smoker and has a family history of lung cancer. On digital rectal examination,
you palpate a soft, smooth, and nontender pedunculated mass on the posterior wall
of the rectum. What is the most likely diagnosis?
A) Hemorrhoid
B) Rectal polyp
C) Prostatic hypertrophy
D) Rectal carcinoma
Answer: B) Rectal polyp
, Rationale: A soft, smooth, and nontender pedunculated mass in the rectum is
characteristic of a benign rectal polyp. Hemorrhoids are typically vascular and may
be painful or bleed. Prostatic hypertrophy is felt anteriorly through the rectal wall.
Rectal carcinoma is usually firm, irregular, and fixed .
8. A 15-year-old high school football player presents with severe testicular pain
that began acutely at 8:00 AM. He is nauseated and vomiting, and he cannot
urinate due to pain. On examination, the scrotal skin is tense and red, and he is
very uncomfortable. What is the most likely diagnosis?
A) Epididymitis
B) Testicular torsion
C) Orchitis
D) Inguinal hernia
Answer: B) Testicular torsion
Rationale: Testicular torsion is a surgical emergency characterized by the acute
onset of severe testicular pain, nausea, vomiting, and a tense, red scrotum. It most
commonly occurs in adolescents. Epididymitis typically presents with gradual
onset and may have associated urinary symptoms. Orchitis is inflammation of the
testicle and is often associated with mumps .
9. A 12-year-old boy presents with an enlarged and tender left testicle that he
discovered during a testicular self-examination. He has had a sore throat, cough,
and runny nose for the past three days. On examination, his temperature is 100.8°F,
and the scrotum is red and tense on the left side. What is the most likely diagnosis?
A) Testicular torsion
B) Acute orchitis
C) Epididymitis
D) Hydrocele
Answer: B) Acute orchitis
Rationale: Acute orchitis is inflammation of the testicle, often caused by a viral
infection such as mumps. The presence of a sore throat and respiratory symptoms
preceding the testicular pain suggests a viral etiology. The exam findings of an
enlarged, tender testicle with a red, tense scrotum are consistent with orchitis .
10. A patient presents with joint pain that is worse in the morning and improves
with activity. Which of the following is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Gout
D) Septic arthritis
