NSG6440 / NSG 6440 FINAL EXAM (LATEST 2026/2027):
PRACTICUM IV FAMILY HEALTH - PRIMARY CARE |
SOUTH UNIVERSITY
Practicum IV Family Health - Primary Care | 150 Comprehensive Questions with Rationales
Aligned with AACN Essentials of Master's Education, FNP Primary Care Competencies, USPSTF, ADA, AHA/ACC, GOLD, GINA,
AAFP, ACIP, and CDC Guidance
Examination Format: 150 multiple-choice questions | 8 sections | 4 options (A-D) per question | ONE correct answer per
question. Cognitive Level Distribution: 20% recall, 50% application, 30% analysis. Style: 75% scenario-based, 25% direct
knowledge. Each question includes evidence-based rationale citing NSG 6440 curriculum, AACN Essentials, and current
primary care clinical guidelines.
Section 1: Advanced Health Assessment & Diagnostic Reasoning
Comprehensive history-taking, physical examination, differential diagnosis, clinical reasoning, diagnostic testing, SOAP
documentation, telehealth assessment.
*Q1:* A 52-year-old male presents with new-onset exertional chest pressure radiating to the left arm, diaphoresis, and
dyspnea. Vital signs: BP 156/94, HR 102, RR 22, SpO2 96% on room air. Which element of the history provides the
strongest predictor of acute coronary syndrome (ACS) and should be prioritized in the differential workup?
A. Family history of premature coronary artery disease in a second-degree relative
B. Character of the pain as pressure radiating to the left arm with diaphoresis *[CORRECT]*
C. History of gastroesophageal reflux disease responsive to antacids
D. A recent upper respiratory infection within the past two weeks
Correct Answer: B
Rationale: The pain pattern itself - pressure radiating to the left arm with diaphoresis - is the single strongest historical
predictor of ACS, outweighing family history and GERD in Bayesian terms. NSG 6440 emphasizes symptom
characterization as the foundation of diagnostic reasoning; radiation to the arm and associated autonomic features
substantially raise pretest probability and mandate an immediate ECG and troponin pathway. Family history contributes
to baseline risk but does not recalibrate acute risk in a single encounter.
NSG6440 Final Exam 2026/2027 - South University Page 1
, *Q2:* When performing a comprehensive history and physical on a 68-year-old female with fatigue and weight loss,
which sequence best reflects the AACN-recommended systematic head-to-toe approach while preserving
patient-centeredness?
A. Begin with the chief complaint, then immediately perform the abdominal exam while symptoms are fresh,
then return to the head for completeness
B. Open with the patient's narrative of the chief complaint, gather HPI and ROS, then perform a structured
head-to-toe physical with focused return to problem areas *[CORRECT]*
C. Conduct the physical examination first to identify objective findings, then use the history to confirm or refute
hypotheses
D. Collect family and social history first, then ROS, then physical exam, leaving the chief complaint for last to
avoid leading the patient
Correct Answer: B
Rationale: A patient-centered yet systematic approach - narrative chief complaint, HPI/ROS, then head-to-toe physical
with focused re-examination - aligns with AACN Essentials and NSG 6440 health assessment competencies. This
sequence respects the patient's story while ensuring no body system is omitted. Leading with the physical exam or
deferring the chief complaint disrupts the therapeutic relationship and risks anchoring bias.
*Q3:* A 45-year-old presents with acute-onset severe lower abdominal pain. During the abdominal exam, you note
involuntary guarding and rebound tenderness in the right lower quadrant. Which finding most specifically increases
the likelihood of peritoneal irritation requiring surgical evaluation?
A. Hyperactive bowel sounds in all four quadrants
B. Rovsing's sign (RLQ pain with LLQ palpation) *[CORRECT]*
C. A positive Murphy's sign reproduced at the right upper quadrant
D. Dullness to percussion throughout the suprapubic region
Correct Answer: B
Rationale: Rovsing's sign - referred RLQ pain on LLQ palpation - indicates peritoneal irritation and raises the likelihood
of appendicitis or another surgical abdomen, fitting NSG 6440 diagnostic reasoning around peritonitis. Murphy's sign
localizes to gallbladder pathology, not diffuse peritoneal signs. Hyperactive bowel sounds suggest obstruction or
gastroenteritis, while suprapubic dullness suggests distention or ascites, not peritoneal inflammation.
*Q4:* A 60-year-old male with a 40-pack-year smoking history presents with hoarseness lasting 7 weeks. He denies
fever, sore throat, or recent URI. Which diagnostic reasoning step represents the most appropriate next action under
primary care scope?
A. Reassure and treat empirically with a proton pump inhibitor for 8 weeks, then re-evaluate
B. Prescribe a 10-day course of azithromycin for suspected chronic sinusitis
C. Refer for otolaryngology evaluation and laryngoscopy given persistence beyond 2 weeks in a high-risk
smoker *[CORRECT]*
D. Order a barium swallow study as the first-line diagnostic test
Correct Answer: C
Rationale: Hoarseness persisting beyond 2 weeks in a smoker mandates laryngoscopy to rule out laryngeal cancer - a
high-stakes can't-miss diagnosis emphasized in NSG 6440 ENT assessment. Empiric PPI or antibiotic therapy delays
definitive evaluation. Barium swallow evaluates structural swallowing issues but does not visualize the larynx directly.
Direct visualization by ENT is the gold standard.
NSG6440 Final Exam 2026/2027 - South University Page 2
, *Q5:* You are evaluating a 30-year-old female with palpitations. The ECG in clinic shows an irregularly irregular
rhythm without visible P waves. Which physical exam maneuver best confirms the diagnosis of atrial fibrillation at the
bedside?
A. Carotid sinus massage with rhythm reversion within 30 seconds
B. Auscultation revealing a regularly irregular rhythm with fixed split S2
C. Vagal maneuver producing transient AV nodal block and unmasking underlying flutter waves
*[CORRECT]*
D. Inspiratory and expiratory blood pressures differing by more than 10 mmHg
Correct Answer: C
Rationale: Vagal maneuvers increase AV nodal block and can unmask underlying atrial activity, helping distinguish
atrial fibrillation from atrial flutter with rapid ventricular response - a differentiation emphasized in NSG 6440 cardiac
assessment. Carotid massage is contraindicated in patients with carotid bruits or known atherosclerosis. A fixed split S2
suggests ASD, and pulsus paradoxus suggests tamponade or severe asthma, none of which confirm AFib.
*Q6:* A patient presents with unilateral vision loss described as 'a curtain descending over my eye' that lasted 10
minutes and fully resolved. The patient has a history of hypertension and atrial fibrillation. Which bedside physical
exam maneuver is most diagnostic and guides urgent referral?
A. Direct fundoscopy looking for papilledema and optic disc pallor
B. Carotid artery auscultation for bruits and pulse assessment *[CORRECT]*
C. Confrontation visual field testing for homonymous hemianopia
D. Snellen acuity testing with and without pinhole correction
Correct Answer: B
Rationale: The curtain-descending description is classic amaurosis fugax, often embolic from carotid disease in an
AFib/hypertensive patient. Carotid auscultation for bruits is the highest-yield bedside maneuver in NSG 6440
neurovascular assessment, guiding urgent carotid ultrasound and neurology referral. Fundoscopy may show retinal
emboli but is operator-dependent; confrontation fields and Snellen acuity evaluate different pathology and would not
address the embolic source.
*Q7:* When documenting a SOAP note in the patient's electronic health record, which element belongs in the
Assessment section rather than the Subjective or Objective sections?
A. The patient reports pain severity as 7/10 and describes it as 'burning'
B. BP 148/92, HR 88, normal heart sounds, no edema
C. 62-year-old male with essential hypertension, stage 2, uncontrolled on current regimen; consider medication
adjustment and lifestyle counseling *[CORRECT]*
D. Lisinopril 20 mg daily, prescribed 6 months ago by primary care provider
Correct Answer: C
Rationale: The Assessment section synthesizes subjective and objective data into a diagnostic impression - here,
'uncontrolled stage 2 hypertension requiring regimen adjustment' - exactly what AACN documentation competencies and
NSG 6440 require. Option A is subjective, B is objective exam data, and D is part of the plan/medication list. Mixing
these elements undermines clinical reasoning visibility and interprofessional communication.
NSG6440 Final Exam 2026/2027 - South University Page 3
, *Q8:* A 28-year-old female presents with dysuria, urinary frequency, and suprapubic pain for 2 days without fever or
flank pain. Which diagnostic reasoning step reflects evidence-based primary care management?
A. Order urine culture and sensitivity before any treatment, holding antibiotics for 48 hours
B. Treat empirically for uncomplicated cystitis with appropriate first-line antibiotic without routine culture
*[CORRECT]*
C. Initiate broad-spectrum IV antibiotics and refer to the emergency department for pyelonephritis rule-out
D. Prescribe a 3-day course of fluoroquinolone as first-line per current IDSA guidance
Correct Answer: B
Rationale: Uncomplicated cystitis in a healthy premenopausal woman can be treated empirically with nitrofurantoin or
TMP-SMX without routine culture, per AAFP/IDSA guidance taught in NSG 6440. Urine culture is reserved for
recurrent, atypical, or complicated cases. IV antibiotics and ED referral are unnecessary without systemic signs, and
fluoroquinolones are no longer first-line due to adverse effect profile and stewardship concerns.
*Q9:* During a telehealth visit for follow-up of type 2 diabetes, the patient reports fingerstick glucose averaging 220
mg/dL. Which limitation of telehealth assessment must be explicitly acknowledged and addressed by the FNP?
A. Inability to obtain vital signs, perform a physical exam, or assess for diabetic complications such as foot
ulcers or retinopathy during the visit *[CORRECT]*
B. Difficulty prescribing insulin because federal law prohibits controlled insulin prescribing via telehealth
C. Inability to document the visit in the EHR due to HIPAA restrictions on remote platforms
D. Limitation that telehealth visits cannot be billed to Medicare under any circumstances
Correct Answer: A
Rationale: Telehealth fundamentally limits physical assessment - the FNP cannot auscultate, palpate, perform foot
exams, or fundoscopically screen for retinopathy, which are central to diabetes care per NSG 6440 telehealth
competencies. Insulin is not a controlled substance and can be prescribed via telehealth where state law permits.
HIPAA-compliant platforms support EHR documentation, and Medicare has expanded coverage for telehealth,
particularly post-pandemic.
*Q10:* A 70-year-old Cambodian patient presents with chronic knee pain. The patient nods and smiles throughout
your explanation of treatment options but does not ask questions. When you ask if they understand, they say 'yes.'
Which health-literacy and cultural-competence principle should guide your next step?
A. Assume understanding based on the affirmative response and proceed with the plan
B. Use the teach-back method, framing it as your responsibility to confirm clear explanation, and assess for
cultural preferences regarding decision-making by family *[CORRECT]*
C. Provide a longer written handout in English and ask the patient to read it before the next visit
D. Refer the patient to a specialty pain clinic because nonverbal communication suggests dissatisfaction
Correct Answer: B
Rationale: Head-nodding and smiling in some Southeast Asian cultures may reflect respect rather than comprehension;
teach-back - framing it as 'I want to make sure I explained this clearly' - removes blame and verifies understanding per
NSG 6440 cultural competence and health literacy standards. Involving family in decision-making respects collectivist
cultural norms. A long English handout may worsen literacy barriers, and referral without attempting shared
decision-making is premature.
NSG6440 Final Exam 2026/2027 - South University Page 4
PRACTICUM IV FAMILY HEALTH - PRIMARY CARE |
SOUTH UNIVERSITY
Practicum IV Family Health - Primary Care | 150 Comprehensive Questions with Rationales
Aligned with AACN Essentials of Master's Education, FNP Primary Care Competencies, USPSTF, ADA, AHA/ACC, GOLD, GINA,
AAFP, ACIP, and CDC Guidance
Examination Format: 150 multiple-choice questions | 8 sections | 4 options (A-D) per question | ONE correct answer per
question. Cognitive Level Distribution: 20% recall, 50% application, 30% analysis. Style: 75% scenario-based, 25% direct
knowledge. Each question includes evidence-based rationale citing NSG 6440 curriculum, AACN Essentials, and current
primary care clinical guidelines.
Section 1: Advanced Health Assessment & Diagnostic Reasoning
Comprehensive history-taking, physical examination, differential diagnosis, clinical reasoning, diagnostic testing, SOAP
documentation, telehealth assessment.
*Q1:* A 52-year-old male presents with new-onset exertional chest pressure radiating to the left arm, diaphoresis, and
dyspnea. Vital signs: BP 156/94, HR 102, RR 22, SpO2 96% on room air. Which element of the history provides the
strongest predictor of acute coronary syndrome (ACS) and should be prioritized in the differential workup?
A. Family history of premature coronary artery disease in a second-degree relative
B. Character of the pain as pressure radiating to the left arm with diaphoresis *[CORRECT]*
C. History of gastroesophageal reflux disease responsive to antacids
D. A recent upper respiratory infection within the past two weeks
Correct Answer: B
Rationale: The pain pattern itself - pressure radiating to the left arm with diaphoresis - is the single strongest historical
predictor of ACS, outweighing family history and GERD in Bayesian terms. NSG 6440 emphasizes symptom
characterization as the foundation of diagnostic reasoning; radiation to the arm and associated autonomic features
substantially raise pretest probability and mandate an immediate ECG and troponin pathway. Family history contributes
to baseline risk but does not recalibrate acute risk in a single encounter.
NSG6440 Final Exam 2026/2027 - South University Page 1
, *Q2:* When performing a comprehensive history and physical on a 68-year-old female with fatigue and weight loss,
which sequence best reflects the AACN-recommended systematic head-to-toe approach while preserving
patient-centeredness?
A. Begin with the chief complaint, then immediately perform the abdominal exam while symptoms are fresh,
then return to the head for completeness
B. Open with the patient's narrative of the chief complaint, gather HPI and ROS, then perform a structured
head-to-toe physical with focused return to problem areas *[CORRECT]*
C. Conduct the physical examination first to identify objective findings, then use the history to confirm or refute
hypotheses
D. Collect family and social history first, then ROS, then physical exam, leaving the chief complaint for last to
avoid leading the patient
Correct Answer: B
Rationale: A patient-centered yet systematic approach - narrative chief complaint, HPI/ROS, then head-to-toe physical
with focused re-examination - aligns with AACN Essentials and NSG 6440 health assessment competencies. This
sequence respects the patient's story while ensuring no body system is omitted. Leading with the physical exam or
deferring the chief complaint disrupts the therapeutic relationship and risks anchoring bias.
*Q3:* A 45-year-old presents with acute-onset severe lower abdominal pain. During the abdominal exam, you note
involuntary guarding and rebound tenderness in the right lower quadrant. Which finding most specifically increases
the likelihood of peritoneal irritation requiring surgical evaluation?
A. Hyperactive bowel sounds in all four quadrants
B. Rovsing's sign (RLQ pain with LLQ palpation) *[CORRECT]*
C. A positive Murphy's sign reproduced at the right upper quadrant
D. Dullness to percussion throughout the suprapubic region
Correct Answer: B
Rationale: Rovsing's sign - referred RLQ pain on LLQ palpation - indicates peritoneal irritation and raises the likelihood
of appendicitis or another surgical abdomen, fitting NSG 6440 diagnostic reasoning around peritonitis. Murphy's sign
localizes to gallbladder pathology, not diffuse peritoneal signs. Hyperactive bowel sounds suggest obstruction or
gastroenteritis, while suprapubic dullness suggests distention or ascites, not peritoneal inflammation.
*Q4:* A 60-year-old male with a 40-pack-year smoking history presents with hoarseness lasting 7 weeks. He denies
fever, sore throat, or recent URI. Which diagnostic reasoning step represents the most appropriate next action under
primary care scope?
A. Reassure and treat empirically with a proton pump inhibitor for 8 weeks, then re-evaluate
B. Prescribe a 10-day course of azithromycin for suspected chronic sinusitis
C. Refer for otolaryngology evaluation and laryngoscopy given persistence beyond 2 weeks in a high-risk
smoker *[CORRECT]*
D. Order a barium swallow study as the first-line diagnostic test
Correct Answer: C
Rationale: Hoarseness persisting beyond 2 weeks in a smoker mandates laryngoscopy to rule out laryngeal cancer - a
high-stakes can't-miss diagnosis emphasized in NSG 6440 ENT assessment. Empiric PPI or antibiotic therapy delays
definitive evaluation. Barium swallow evaluates structural swallowing issues but does not visualize the larynx directly.
Direct visualization by ENT is the gold standard.
NSG6440 Final Exam 2026/2027 - South University Page 2
, *Q5:* You are evaluating a 30-year-old female with palpitations. The ECG in clinic shows an irregularly irregular
rhythm without visible P waves. Which physical exam maneuver best confirms the diagnosis of atrial fibrillation at the
bedside?
A. Carotid sinus massage with rhythm reversion within 30 seconds
B. Auscultation revealing a regularly irregular rhythm with fixed split S2
C. Vagal maneuver producing transient AV nodal block and unmasking underlying flutter waves
*[CORRECT]*
D. Inspiratory and expiratory blood pressures differing by more than 10 mmHg
Correct Answer: C
Rationale: Vagal maneuvers increase AV nodal block and can unmask underlying atrial activity, helping distinguish
atrial fibrillation from atrial flutter with rapid ventricular response - a differentiation emphasized in NSG 6440 cardiac
assessment. Carotid massage is contraindicated in patients with carotid bruits or known atherosclerosis. A fixed split S2
suggests ASD, and pulsus paradoxus suggests tamponade or severe asthma, none of which confirm AFib.
*Q6:* A patient presents with unilateral vision loss described as 'a curtain descending over my eye' that lasted 10
minutes and fully resolved. The patient has a history of hypertension and atrial fibrillation. Which bedside physical
exam maneuver is most diagnostic and guides urgent referral?
A. Direct fundoscopy looking for papilledema and optic disc pallor
B. Carotid artery auscultation for bruits and pulse assessment *[CORRECT]*
C. Confrontation visual field testing for homonymous hemianopia
D. Snellen acuity testing with and without pinhole correction
Correct Answer: B
Rationale: The curtain-descending description is classic amaurosis fugax, often embolic from carotid disease in an
AFib/hypertensive patient. Carotid auscultation for bruits is the highest-yield bedside maneuver in NSG 6440
neurovascular assessment, guiding urgent carotid ultrasound and neurology referral. Fundoscopy may show retinal
emboli but is operator-dependent; confrontation fields and Snellen acuity evaluate different pathology and would not
address the embolic source.
*Q7:* When documenting a SOAP note in the patient's electronic health record, which element belongs in the
Assessment section rather than the Subjective or Objective sections?
A. The patient reports pain severity as 7/10 and describes it as 'burning'
B. BP 148/92, HR 88, normal heart sounds, no edema
C. 62-year-old male with essential hypertension, stage 2, uncontrolled on current regimen; consider medication
adjustment and lifestyle counseling *[CORRECT]*
D. Lisinopril 20 mg daily, prescribed 6 months ago by primary care provider
Correct Answer: C
Rationale: The Assessment section synthesizes subjective and objective data into a diagnostic impression - here,
'uncontrolled stage 2 hypertension requiring regimen adjustment' - exactly what AACN documentation competencies and
NSG 6440 require. Option A is subjective, B is objective exam data, and D is part of the plan/medication list. Mixing
these elements undermines clinical reasoning visibility and interprofessional communication.
NSG6440 Final Exam 2026/2027 - South University Page 3
, *Q8:* A 28-year-old female presents with dysuria, urinary frequency, and suprapubic pain for 2 days without fever or
flank pain. Which diagnostic reasoning step reflects evidence-based primary care management?
A. Order urine culture and sensitivity before any treatment, holding antibiotics for 48 hours
B. Treat empirically for uncomplicated cystitis with appropriate first-line antibiotic without routine culture
*[CORRECT]*
C. Initiate broad-spectrum IV antibiotics and refer to the emergency department for pyelonephritis rule-out
D. Prescribe a 3-day course of fluoroquinolone as first-line per current IDSA guidance
Correct Answer: B
Rationale: Uncomplicated cystitis in a healthy premenopausal woman can be treated empirically with nitrofurantoin or
TMP-SMX without routine culture, per AAFP/IDSA guidance taught in NSG 6440. Urine culture is reserved for
recurrent, atypical, or complicated cases. IV antibiotics and ED referral are unnecessary without systemic signs, and
fluoroquinolones are no longer first-line due to adverse effect profile and stewardship concerns.
*Q9:* During a telehealth visit for follow-up of type 2 diabetes, the patient reports fingerstick glucose averaging 220
mg/dL. Which limitation of telehealth assessment must be explicitly acknowledged and addressed by the FNP?
A. Inability to obtain vital signs, perform a physical exam, or assess for diabetic complications such as foot
ulcers or retinopathy during the visit *[CORRECT]*
B. Difficulty prescribing insulin because federal law prohibits controlled insulin prescribing via telehealth
C. Inability to document the visit in the EHR due to HIPAA restrictions on remote platforms
D. Limitation that telehealth visits cannot be billed to Medicare under any circumstances
Correct Answer: A
Rationale: Telehealth fundamentally limits physical assessment - the FNP cannot auscultate, palpate, perform foot
exams, or fundoscopically screen for retinopathy, which are central to diabetes care per NSG 6440 telehealth
competencies. Insulin is not a controlled substance and can be prescribed via telehealth where state law permits.
HIPAA-compliant platforms support EHR documentation, and Medicare has expanded coverage for telehealth,
particularly post-pandemic.
*Q10:* A 70-year-old Cambodian patient presents with chronic knee pain. The patient nods and smiles throughout
your explanation of treatment options but does not ask questions. When you ask if they understand, they say 'yes.'
Which health-literacy and cultural-competence principle should guide your next step?
A. Assume understanding based on the affirmative response and proceed with the plan
B. Use the teach-back method, framing it as your responsibility to confirm clear explanation, and assess for
cultural preferences regarding decision-making by family *[CORRECT]*
C. Provide a longer written handout in English and ask the patient to read it before the next visit
D. Refer the patient to a specialty pain clinic because nonverbal communication suggests dissatisfaction
Correct Answer: B
Rationale: Head-nodding and smiling in some Southeast Asian cultures may reflect respect rather than comprehension;
teach-back - framing it as 'I want to make sure I explained this clearly' - removes blame and verifies understanding per
NSG 6440 cultural competence and health literacy standards. Involving family in decision-making respects collectivist
cultural norms. A long English handout may worsen literacy barriers, and referral without attempting shared
decision-making is premature.
NSG6440 Final Exam 2026/2027 - South University Page 4
