FINAL EXAM | NSG 527 / NSG527 | Latest 2026/2027 | Wilkes University Page 1
FINAL EXAM NSG 527 / NSG527
(Latest ): Already Graded A Questions and Verified Answers - Wilkes
Wilkes University | Master of Science in Nursing (MSN) - Advanced Practice Nursing
Aligned with AACN Essentials of Master's Education (2021) and APN Competencies (2026/2027 Edition)
Total Questions 150 Format Multiple Choice (A-D)
Cognitive Levels 20% Recall | 50% Application | 30% Analysis
Style 75% Scenario-based | 25% Direct
Sections 9 Passing Grade A (Verified)
Time Allotted 180 minutes Total Points 150 (1 point each)
Instructions to the Candidate: This comprehensive final examination consists of 150 multiple-choice questions distributed
across nine (9) sections. Each question has exactly ONE most-correct answer (A, B, C, or D). The correct answer is identified
with the *[CORRECT]* marker and followed by a brief rationale grounded in NSG 527 curriculum content, AACN Essentials,
and current national certification standards (e.g., AHA/ACC, IDSA, USPSTF, ADA, AAP, CDC, NCCN). Select the response
that reflects best-evidence, scope-appropriate advanced practice nursing care.
Section 1: Advanced Health Assessment & Diagnostic Reasoning
Q1: A 58-year-old male presents with new-onset chest pressure radiating to his left arm, diaphoresis,
and dyspnea that began 30 minutes ago. Vital signs: BP 152/94, HR 102, RR 22, SpO2 95% on room air.
Which element of the history is MOST critical to obtain before initiating the ECG and troponin
workup?
A. Family history of coronary disease and lipid profile
B. Time of symptom onset and nitroglycerin contraindications *[CORRECT]*
C. Occupational stressors and caffeine intake
D. Recent dietary intake and exercise habits
Correct Answer: B
Rationale: In suspected acute coronary syndrome (ACS), the time of symptom onset determines candidacy for reperfusion
therapy (fibrinolytics within 12 hours, PCI within 12-24 hours) and phosphodiesterase type-5 inhibitor contraindication must
be ruled out before nitroglycerin. Family history (A), stressors (C), and diet (D) inform risk stratification but do not change
immediate emergency management. The NSG 527 curriculum emphasizes time-sensitive assessment priorities aligned with
AHA/ACC ACS guidelines.
Q2: During a comprehensive head-to-toe assessment, the advanced practice nurse (APN) notes jugular
venous distension (JVD) to the jaw angle at 45 degrees, bilateral crackles in the lung bases, and an S3
heart sound. These findings collectively suggest:
A. Acute pericarditis with effusion
B. Volume overload consistent with heart failure *[CORRECT]*
C. Constrictive pericarditis
D. Mitral valve prolapse
NSG 527 Final Examination | Graded A | Verified Answers | © Wilkes University 150 Questions
,FINAL EXAM | NSG 527 / NSG527 | Latest 2026/2027 | Wilkes University Page 2
Correct Answer: B
Rationale: The triad of JVD, bibasilar crackles, and S3 is the classic bedside constellation of left- and right-sided heart
failure indicating volume overload. Pericarditis (A) typically presents with friction rub and positional chest pain; constrictive
pericarditis (C) shows Kussmaul's sign and pericardial knock; mitral valve prolapse (D) produces a mid-systolic click. This
question reflects NSG 527 diagnostic reasoning competencies in cardiovascular assessment.
Q3: A 47-year-old female presents with fatigue, cold intolerance, and a 6-pound weight gain over 2
months. On examination, the thyroid is palpably enlarged with a firm, nodular texture. Which
laboratory pattern confirms primary hypothyroidism?
A. Low TSH, high free T4
B. High TSH, low free T4 *[CORRECT]*
C. High TSH, high free T4
D. Low TSH, low free T4
Correct Answer: B
Rationale: Primary hypothyroidism is defined by decreased thyroid hormone production leading to loss of negative feedback
on the pituitary, producing elevated TSH with low free T4. Low TSH with high T4 (A) indicates primary hyperthyroidism; high
TSH with high T4 (C) is rare and suggests pituitary resistance; low TSH with low T4 (D) indicates secondary (central)
hypothyroidism. This aligns with AACN Essentials competency in interpreting diagnostic studies.
Q4: An APN is performing a neurological assessment on a 72-year-old patient with sudden onset of
right-sided weakness and slurred speech that began 1 hour ago. The FAST exam is positive. The NEXT
priority action is to:
A. Obtain a non-contrast head CT to rule out hemorrhage *[CORRECT]*
B. Administer aspirin 325 mg immediately
C. Perform a lumbar puncture to evaluate for infection
D. Start antihypertensive infusion for BP >185/110
Correct Answer: A
Rationale: A non-contrast head CT is mandatory before any stroke intervention to differentiate ischemic from hemorrhagic
stroke, as aspirin (B) and tPA are contraindicated in hemorrhage. Lumbar puncture (C) is not indicated without suspected
subarachnoid hemorrhage with negative CT. Antihypertensive treatment (D) is reserved for BP >185/110 only if tPA is being
considered. The NSG 527 curriculum stresses rapid stroke pathway activation per AHA/ASA guidelines.
Q5: A patient presents with acute onset of severe lower-right quadrant abdominal pain, anorexia, and
low-grade fever. McBurney's point tenderness with rebound is elicited. The Rovsing's sign is positive.
The MOST appropriate diagnostic test to confirm the suspicion is:
A. Abdominal ultrasound
B. CT scan of the abdomen and pelvis with contrast *[CORRECT]*
C. Flat plate and upright abdominal X-ray
D. Colonoscopy
Correct Answer: B
Rationale: CT abdomen/pelvis with IV contrast is the gold standard for adult suspected appendicitis due to its sensitivity
(>94%) and specificity, allowing visualization of appendiceal enlargement, periappendiceal fat stranding, and abscess.
Ultrasound (A) is preferred in pediatrics and pregnancy but is operator-dependent; plain X-rays (C) are nonspecific;
NSG 527 Final Examination | Graded A | Verified Answers | © Wilkes University 150 Questions
,FINAL EXAM | NSG 527 / NSG527 | Latest 2026/2027 | Wilkes University Page 3
colonoscopy (D) is contraindicated in acute inflammation. This aligns with NSG 527 diagnostic testing selection competencies.
Q6: During a telehealth visit, an APN evaluates a patient with a 3-day history of cough and fever. The
patient appears well-perfused and conversational. Which finding would require immediate escalation
from virtual to in-person evaluation?
A. Reported oxygen saturation of 92% on room air *[CORRECT]*
B. Temperature of 100.4 degrees Fahrenheit
C. Mild wheezing on auscultation via digital stethoscope
D. Patient reports symptom duration of 4 days
Correct Answer: A
Rationale: SpO2 of 92% or below on room air meets sepsis/SIRS criteria and indicates potential hypoxemic respiratory failure
requiring in-person evaluation, labs, possible imaging, and supplemental oxygen. Low-grade fever (B) and wheezing (C) can
typically be managed virtually with appropriate prescribing; symptom duration of 4 days (D) is not itself an escalation trigger.
NSG 527 telehealth competencies emphasize recognizing red flags requiring in-person care.
Q7: When documenting a SOAP note, which statement represents the MOST appropriate Assessment
entry?
A. Patient reports cough for 3 days with green sputum
B. Lungs with rhonchi in right lower lobe, SpO2 94%
C. Acute bacterial bronchitis vs community-acquired pneumonia, CAP likely *[CORRECT]*
D. Prescribe azithromycin 500 mg day 1 then 250 mg x 4 days
Correct Answer: C
Rationale: The Assessment section synthesizes subjective and objective data into a differential or working diagnosis with
clinical reasoning. Option A is Subjective data, B is Objective data, and D is the Plan. NSG 527 documentation competencies
require APNs to articulate clinical reasoning in the Assessment, including differentials and most likely diagnosis, supporting
interprofessional communication and continuity of care.
Q8: A 64-year-old male with a 40-pack-year smoking history presents with hoarseness lasting 6 weeks.
He denies recent URI symptoms. The MOST appropriate next step is:
A. Reassure and re-evaluate in 4 weeks after antihistamine trial
B. Refer for laryngoscopy to evaluate for laryngeal pathology *[CORRECT]*
C. Prescribe a proton pump inhibitor for laryngopharyngeal reflux
D. Order a thyroid ultrasound
Correct Answer: B
Rationale: Hoarseness persisting beyond 2 weeks in a smoker is a red flag warranting laryngoscopy to rule out laryngeal
cancer, per AAO-HNS guidelines. Reassurance (A) or empiric reflux treatment (C) without visualization risks missing
malignancy. Thyroid ultrasound (D) evaluates thyroid nodules, not vocal cord pathology. NSG 527 emphasizes identifying
high-risk presentations requiring specialist referral.
Q9: An APN is assessing a 6-year-old child brought by parents for ear pain. The otoscopic exam reveals
a bulging, erythematous tympanic membrane with decreased mobility on pneumatic otoscopy. The
MOST accurate diagnosis is:
NSG 527 Final Examination | Graded A | Verified Answers | © Wilkes University 150 Questions
, FINAL EXAM | NSG 527 / NSG527 | Latest 2026/2027 | Wilkes University Page 4
A. Otitis externa
B. Acute otitis media *[CORRECT]*
C. Otitis media with effusion
D. Eustachian tube dysfunction
Correct Answer: B
Rationale: Acute otitis media (AOM) requires moderate-to-severe bulging of the TM or new-onset otorrhea not due to AOE,
with signs/symptoms of acute infection. Bulging TM with decreased mobility is pathognomonic. Otitis externa (A) involves the
ear canal; otitis media with effusion (C) shows fluid without infection signs; eustachian tube dysfunction (D) is a precursor
without marked inflammation. NSG 527 lifespan assessment competencies cover AAP diagnostic criteria.
Q10: A patient from a non-English-speaking background is being assessed for chest pain. The patient
nods 'yes' to all questions but appears confused. Which is the BEST approach to ensure accurate health
assessment?
A. Proceed with the assessment based on the yes responses
B. Use a trained medical interpreter and teach-back confirmation *[CORRECT]*
C. Call a family member to translate sensitive information
D. Document that the patient is uncooperative
Correct Answer: B
Rationale: National CLAS Standards mandate use of qualified medical interpreters for limited English proficiency patients;
family translation risks errors, breaches confidentiality, and may bias responses. Teach-back confirms understanding.
Proceeding on 'yes' responses (A) risks unsafe care; using family (C) violates privacy; labeling as uncooperative (D) is
discriminatory. NSG 527 cultural competence competencies align with AACN Essentials on culturally congruent practice.
Q11: Which of the following physical examination findings is MOST specific to a diagnosis of ascites?
A. Bowel sounds present in all four quadrants
B. Shifting dullness on percussion *[CORRECT]*
C. Rebound tenderness in the right upper quadrant
D. Hyperactive bowel sounds
Correct Answer: B
Rationale: Shifting dullness is the most sensitive and specific bedside sign of ascites, indicating free fluid that redistributes
with position changes. Rebound tenderness (C) suggests peritonitis. Hyperactive bowel sounds (D) suggest obstruction. The NSG
527 curriculum requires mastery of advanced percussion and palpation techniques for accurate abdominal assessment.
Q12: An APN assesses a patient with suspected deep vein thrombosis (DVT). The patient has calf
tenderness, swelling, and a Wells score of 4. Which diagnostic test is MOST appropriate?
A. D-dimer assay only
B. Venous duplex ultrasound of the lower extremity *[CORRECT]*
C. CT pulmonary angiogram
D. Venography
Correct Answer: B
Rationale: A Wells score >=2 indicates high probability of DVT; the next step is venous duplex ultrasound, the first-line
imaging modality with sensitivity >95% for proximal DVT. D-dimer (A) is reserved for low-probability cases; CTPA (C) is for
NSG 527 Final Examination | Graded A | Verified Answers | © Wilkes University 150 Questions
FINAL EXAM NSG 527 / NSG527
(Latest ): Already Graded A Questions and Verified Answers - Wilkes
Wilkes University | Master of Science in Nursing (MSN) - Advanced Practice Nursing
Aligned with AACN Essentials of Master's Education (2021) and APN Competencies (2026/2027 Edition)
Total Questions 150 Format Multiple Choice (A-D)
Cognitive Levels 20% Recall | 50% Application | 30% Analysis
Style 75% Scenario-based | 25% Direct
Sections 9 Passing Grade A (Verified)
Time Allotted 180 minutes Total Points 150 (1 point each)
Instructions to the Candidate: This comprehensive final examination consists of 150 multiple-choice questions distributed
across nine (9) sections. Each question has exactly ONE most-correct answer (A, B, C, or D). The correct answer is identified
with the *[CORRECT]* marker and followed by a brief rationale grounded in NSG 527 curriculum content, AACN Essentials,
and current national certification standards (e.g., AHA/ACC, IDSA, USPSTF, ADA, AAP, CDC, NCCN). Select the response
that reflects best-evidence, scope-appropriate advanced practice nursing care.
Section 1: Advanced Health Assessment & Diagnostic Reasoning
Q1: A 58-year-old male presents with new-onset chest pressure radiating to his left arm, diaphoresis,
and dyspnea that began 30 minutes ago. Vital signs: BP 152/94, HR 102, RR 22, SpO2 95% on room air.
Which element of the history is MOST critical to obtain before initiating the ECG and troponin
workup?
A. Family history of coronary disease and lipid profile
B. Time of symptom onset and nitroglycerin contraindications *[CORRECT]*
C. Occupational stressors and caffeine intake
D. Recent dietary intake and exercise habits
Correct Answer: B
Rationale: In suspected acute coronary syndrome (ACS), the time of symptom onset determines candidacy for reperfusion
therapy (fibrinolytics within 12 hours, PCI within 12-24 hours) and phosphodiesterase type-5 inhibitor contraindication must
be ruled out before nitroglycerin. Family history (A), stressors (C), and diet (D) inform risk stratification but do not change
immediate emergency management. The NSG 527 curriculum emphasizes time-sensitive assessment priorities aligned with
AHA/ACC ACS guidelines.
Q2: During a comprehensive head-to-toe assessment, the advanced practice nurse (APN) notes jugular
venous distension (JVD) to the jaw angle at 45 degrees, bilateral crackles in the lung bases, and an S3
heart sound. These findings collectively suggest:
A. Acute pericarditis with effusion
B. Volume overload consistent with heart failure *[CORRECT]*
C. Constrictive pericarditis
D. Mitral valve prolapse
NSG 527 Final Examination | Graded A | Verified Answers | © Wilkes University 150 Questions
,FINAL EXAM | NSG 527 / NSG527 | Latest 2026/2027 | Wilkes University Page 2
Correct Answer: B
Rationale: The triad of JVD, bibasilar crackles, and S3 is the classic bedside constellation of left- and right-sided heart
failure indicating volume overload. Pericarditis (A) typically presents with friction rub and positional chest pain; constrictive
pericarditis (C) shows Kussmaul's sign and pericardial knock; mitral valve prolapse (D) produces a mid-systolic click. This
question reflects NSG 527 diagnostic reasoning competencies in cardiovascular assessment.
Q3: A 47-year-old female presents with fatigue, cold intolerance, and a 6-pound weight gain over 2
months. On examination, the thyroid is palpably enlarged with a firm, nodular texture. Which
laboratory pattern confirms primary hypothyroidism?
A. Low TSH, high free T4
B. High TSH, low free T4 *[CORRECT]*
C. High TSH, high free T4
D. Low TSH, low free T4
Correct Answer: B
Rationale: Primary hypothyroidism is defined by decreased thyroid hormone production leading to loss of negative feedback
on the pituitary, producing elevated TSH with low free T4. Low TSH with high T4 (A) indicates primary hyperthyroidism; high
TSH with high T4 (C) is rare and suggests pituitary resistance; low TSH with low T4 (D) indicates secondary (central)
hypothyroidism. This aligns with AACN Essentials competency in interpreting diagnostic studies.
Q4: An APN is performing a neurological assessment on a 72-year-old patient with sudden onset of
right-sided weakness and slurred speech that began 1 hour ago. The FAST exam is positive. The NEXT
priority action is to:
A. Obtain a non-contrast head CT to rule out hemorrhage *[CORRECT]*
B. Administer aspirin 325 mg immediately
C. Perform a lumbar puncture to evaluate for infection
D. Start antihypertensive infusion for BP >185/110
Correct Answer: A
Rationale: A non-contrast head CT is mandatory before any stroke intervention to differentiate ischemic from hemorrhagic
stroke, as aspirin (B) and tPA are contraindicated in hemorrhage. Lumbar puncture (C) is not indicated without suspected
subarachnoid hemorrhage with negative CT. Antihypertensive treatment (D) is reserved for BP >185/110 only if tPA is being
considered. The NSG 527 curriculum stresses rapid stroke pathway activation per AHA/ASA guidelines.
Q5: A patient presents with acute onset of severe lower-right quadrant abdominal pain, anorexia, and
low-grade fever. McBurney's point tenderness with rebound is elicited. The Rovsing's sign is positive.
The MOST appropriate diagnostic test to confirm the suspicion is:
A. Abdominal ultrasound
B. CT scan of the abdomen and pelvis with contrast *[CORRECT]*
C. Flat plate and upright abdominal X-ray
D. Colonoscopy
Correct Answer: B
Rationale: CT abdomen/pelvis with IV contrast is the gold standard for adult suspected appendicitis due to its sensitivity
(>94%) and specificity, allowing visualization of appendiceal enlargement, periappendiceal fat stranding, and abscess.
Ultrasound (A) is preferred in pediatrics and pregnancy but is operator-dependent; plain X-rays (C) are nonspecific;
NSG 527 Final Examination | Graded A | Verified Answers | © Wilkes University 150 Questions
,FINAL EXAM | NSG 527 / NSG527 | Latest 2026/2027 | Wilkes University Page 3
colonoscopy (D) is contraindicated in acute inflammation. This aligns with NSG 527 diagnostic testing selection competencies.
Q6: During a telehealth visit, an APN evaluates a patient with a 3-day history of cough and fever. The
patient appears well-perfused and conversational. Which finding would require immediate escalation
from virtual to in-person evaluation?
A. Reported oxygen saturation of 92% on room air *[CORRECT]*
B. Temperature of 100.4 degrees Fahrenheit
C. Mild wheezing on auscultation via digital stethoscope
D. Patient reports symptom duration of 4 days
Correct Answer: A
Rationale: SpO2 of 92% or below on room air meets sepsis/SIRS criteria and indicates potential hypoxemic respiratory failure
requiring in-person evaluation, labs, possible imaging, and supplemental oxygen. Low-grade fever (B) and wheezing (C) can
typically be managed virtually with appropriate prescribing; symptom duration of 4 days (D) is not itself an escalation trigger.
NSG 527 telehealth competencies emphasize recognizing red flags requiring in-person care.
Q7: When documenting a SOAP note, which statement represents the MOST appropriate Assessment
entry?
A. Patient reports cough for 3 days with green sputum
B. Lungs with rhonchi in right lower lobe, SpO2 94%
C. Acute bacterial bronchitis vs community-acquired pneumonia, CAP likely *[CORRECT]*
D. Prescribe azithromycin 500 mg day 1 then 250 mg x 4 days
Correct Answer: C
Rationale: The Assessment section synthesizes subjective and objective data into a differential or working diagnosis with
clinical reasoning. Option A is Subjective data, B is Objective data, and D is the Plan. NSG 527 documentation competencies
require APNs to articulate clinical reasoning in the Assessment, including differentials and most likely diagnosis, supporting
interprofessional communication and continuity of care.
Q8: A 64-year-old male with a 40-pack-year smoking history presents with hoarseness lasting 6 weeks.
He denies recent URI symptoms. The MOST appropriate next step is:
A. Reassure and re-evaluate in 4 weeks after antihistamine trial
B. Refer for laryngoscopy to evaluate for laryngeal pathology *[CORRECT]*
C. Prescribe a proton pump inhibitor for laryngopharyngeal reflux
D. Order a thyroid ultrasound
Correct Answer: B
Rationale: Hoarseness persisting beyond 2 weeks in a smoker is a red flag warranting laryngoscopy to rule out laryngeal
cancer, per AAO-HNS guidelines. Reassurance (A) or empiric reflux treatment (C) without visualization risks missing
malignancy. Thyroid ultrasound (D) evaluates thyroid nodules, not vocal cord pathology. NSG 527 emphasizes identifying
high-risk presentations requiring specialist referral.
Q9: An APN is assessing a 6-year-old child brought by parents for ear pain. The otoscopic exam reveals
a bulging, erythematous tympanic membrane with decreased mobility on pneumatic otoscopy. The
MOST accurate diagnosis is:
NSG 527 Final Examination | Graded A | Verified Answers | © Wilkes University 150 Questions
, FINAL EXAM | NSG 527 / NSG527 | Latest 2026/2027 | Wilkes University Page 4
A. Otitis externa
B. Acute otitis media *[CORRECT]*
C. Otitis media with effusion
D. Eustachian tube dysfunction
Correct Answer: B
Rationale: Acute otitis media (AOM) requires moderate-to-severe bulging of the TM or new-onset otorrhea not due to AOE,
with signs/symptoms of acute infection. Bulging TM with decreased mobility is pathognomonic. Otitis externa (A) involves the
ear canal; otitis media with effusion (C) shows fluid without infection signs; eustachian tube dysfunction (D) is a precursor
without marked inflammation. NSG 527 lifespan assessment competencies cover AAP diagnostic criteria.
Q10: A patient from a non-English-speaking background is being assessed for chest pain. The patient
nods 'yes' to all questions but appears confused. Which is the BEST approach to ensure accurate health
assessment?
A. Proceed with the assessment based on the yes responses
B. Use a trained medical interpreter and teach-back confirmation *[CORRECT]*
C. Call a family member to translate sensitive information
D. Document that the patient is uncooperative
Correct Answer: B
Rationale: National CLAS Standards mandate use of qualified medical interpreters for limited English proficiency patients;
family translation risks errors, breaches confidentiality, and may bias responses. Teach-back confirms understanding.
Proceeding on 'yes' responses (A) risks unsafe care; using family (C) violates privacy; labeling as uncooperative (D) is
discriminatory. NSG 527 cultural competence competencies align with AACN Essentials on culturally congruent practice.
Q11: Which of the following physical examination findings is MOST specific to a diagnosis of ascites?
A. Bowel sounds present in all four quadrants
B. Shifting dullness on percussion *[CORRECT]*
C. Rebound tenderness in the right upper quadrant
D. Hyperactive bowel sounds
Correct Answer: B
Rationale: Shifting dullness is the most sensitive and specific bedside sign of ascites, indicating free fluid that redistributes
with position changes. Rebound tenderness (C) suggests peritonitis. Hyperactive bowel sounds (D) suggest obstruction. The NSG
527 curriculum requires mastery of advanced percussion and palpation techniques for accurate abdominal assessment.
Q12: An APN assesses a patient with suspected deep vein thrombosis (DVT). The patient has calf
tenderness, swelling, and a Wells score of 4. Which diagnostic test is MOST appropriate?
A. D-dimer assay only
B. Venous duplex ultrasound of the lower extremity *[CORRECT]*
C. CT pulmonary angiogram
D. Venography
Correct Answer: B
Rationale: A Wells score >=2 indicates high probability of DVT; the next step is venous duplex ultrasound, the first-line
imaging modality with sensitivity >95% for proximal DVT. D-dimer (A) is reserved for low-probability cases; CTPA (C) is for
NSG 527 Final Examination | Graded A | Verified Answers | © Wilkes University 150 Questions
