NSG 6020 Week 10 Final Exam Prep Document | 2026/2027
Edition | 50 Verified Questions
About This Exam Bank
This comprehensive exam preparation document is meticulously crafted for nursing students enrolled in NSG 6020
at South University, targeting the Week 10 Final Exam for the 2026/2027 academic year. It contains 50 verified
questions that reflect the actual exam blueprint, covering advanced health assessment and diagnostic reasoning
across the lifespan. Each question is paired with a revised answer and a detailed rationale to reinforce critical
thinking and clinical application. This resource ensures students are thoroughly prepared to achieve a top grade, with
content aligned to the latest evidence-based practice guidelines.
Keywords
Advanced Health Assessment, Differential Diagnosis, Physical Examination, Clinical Reasoning, NSG 6020, South
University, Final Exam Prep, Nursing Education, Advanced Health Assessment, Differential Diagnosis, Physical
Examination, Clinical Reasoning, Advanced Health Assessment, Differential Diagnosis, Physical Examination,
Clinical Reasoning, NSG 6020, South University, Advanced Health Assessment, Differential Diagnosis, Physical
Examination, Clinical Reasoning, NSG 6020, South University, Final Exam Prep, Nursing Education, Advanced
Health Assessment
PART 1: EXAM QUESTIONS, ANSWERS AND RATIONALES
1. A patient with type 2 diabetes and chronic kidney disease (eGFR 35 mL/min) presents with a painful, swollen
right knee. Aspiration reveals monosodium urate crystals. Which medication is most appropriate for long-term
urate-lowering therapy?
A) Allopurinol 100 mg daily
B) Probenecid 500 mg twice daily
C) Colchicine 0.6 mg daily
D) Febuxostat 40 mg daily
' Correct Answer: A
Rationale: Allopurinol is the first-line urate-lowering therapy and can be started at a low dose in CKD with gradual
titration. Probenecid is ineffective in renal impairment (eGFR <50). Colchicine is for prophylaxis/acute flares, not
long-term lowering. Febuxostat is a second-line option but has cardiovascular concerns and requires dose
adjustment; allopurinol is preferred.
Why the other answers are wrong:
B) Probenecid is ineffective when eGFR is below 50 mL/min and is not recommended in CKD.
C) Colchicine reduces inflammation, not serum urate levels.
D) Febuxostat is not first-line, especially with cardiovascular risk, and requires dose adjustment.
Reference: Yip, K., & Cohen, R. (2025). Gout management in chronic kidney disease. ACR Guidelines.
2. A patient with a history of recurrent unprovoked deep vein thrombosis and a positive lupus anticoagulant is being
managed for a new pulmonary embolism. Which anticoagulant is most appropriate for long-term therapy?
A) Apixaban 5 mg twice daily
B) Warfarin with target INR 2-3
C) Enoxaparin 1 mg/kg twice daily
D) Rivaroxaban 20 mg daily
' Correct Answer: B
Page 1
,Rationale: In antiphospholipid syndrome with thrombosis, vitamin K antagonists (warfarin) are preferred over
direct oral anticoagulants (DOACs) due to evidence of higher recurrent thrombosis risk with DOACs. Enoxaparin is
for acute management, not long-term. Apixaban and rivaroxaban are DOACs and are not recommended.
Why the other answers are wrong:
A) DOACs are associated with increased recurrent thrombotic events in antiphospholipid syndrome.
C) Enoxaparin is used for initial therapy, not long-term anticoagulation.
D) Rivaroxaban is a DOAC and is not recommended in antiphospholipid syndrome.
Reference: Ortel, T.L., et al. (2020). Antiphospholipid syndrome: ASH guidelines. Blood.
3. Which finding on spirometry is most consistent with a restrictive ventilatory defect?
A) FEV1/FVC ratio <0.70 with reduced FEV1
B) FEV1/FVC ratio >0.70 with reduced total lung capacity
C) FEV1/FVC ratio >0.70 with increased total lung capacity
D) FEV1/FVC ratio <0.70 with normal total lung capacity
' Correct Answer: B
Rationale: Restrictive defects show reduced lung volumes (TLC <80% predicted) with a normal or high
FEV1/FVC ratio. Obstructive defects show reduced ratio (<0.70). Increased TLC is not typical of restriction.
Why the other answers are wrong:
A) This pattern indicates an obstructive defect.
C) Increased TLC is not seen in restriction and would suggest hyperinflation.
D) Low FEV1/FVC is obstructive, not restrictive.
Reference: Pellegrino, R., et al. (2005). Interpretative strategies for lung function tests. Eur Respir J.
4. A patient presents with fatigue, orthostatic hypotension, and hyperpigmentation of the skin. Laboratory studies
show hyponatremia, hyperkalemia, and low cortisol. Which diagnostic test is most definitive for confirming primary
adrenal insufficiency?
A) Plasma adrenocorticotropic hormone level
B) Cosyntropin stimulation test
C) Serum aldosterone level
D) 24-hour urinary free cortisol
' Correct Answer: B
Rationale: The cosyntropin (ACTH) stimulation test is the gold standard for diagnosing adrenal insufficiency; a
blunted cortisol response confirms the diagnosis. While ACTH helps distinguish primary from secondary, it is not
definitive alone. Aldosterone and urinary cortisol are not diagnostic.
Why the other answers are wrong:
A) ACTH level helps differentiate primary vs. secondary but is not the definitive diagnostic test.
C) Aldosterone is not used to diagnose adrenal insufficiency.
D) Urinary free cortisol is used for Cushing's syndrome, not insufficiency.
Reference: Bornstein, S.R., et al. (2016). Diagnosis and treatment of primary adrenal insufficiency. JCEM.
5. A patient with atrial fibrillation and a CHA2DS2-VASc score of 3 is being started on warfarin. Which factor most
significantly increases the risk of major bleeding?
A) Concomitant use of amiodarone
B) Age 65 years
C) History of gastrointestinal bleeding
D) Female sex
' Correct Answer: C
Rationale: Prior major bleeding, especially GI bleeding, is a strong independent risk factor for
anticoagulant-related bleeding. Amiodarone increases warfarin levels but can be managed with monitoring. Age 65
Page 2
, and female sex are modest risk factors.
Why the other answers are wrong:
A) Amiodarone interacts with warfarin but is not a major bleeding risk factor.
B) Age 65 is a minor factor in bleeding risk scores.
D) Female sex is a minor risk factor.
Reference: Pisters, R., et al. (2010). HAS-BLED bleeding risk score. Chest.
6. Which clinical scenario best illustrates the use of the Ottawa Ankle Rules to determine the need for radiography?
A) A patient with ankle pain and inability to bear weight for four steps immediately after injury
B) A patient with ankle pain and tenderness over the lateral malleolus with no other findings
C) A patient with ankle pain and a history of previous ankle fracture
D) A patient with ankle pain and swelling but no bony tenderness
' Correct Answer: A
Rationale: The Ottawa Ankle Rules require radiography if there is bone tenderness at the posterior edge of either
malleolus or inability to bear weight immediately and for four steps in the ED. Tenderness alone without specific
location or weight-bearing inability does not meet criteria. History and swelling are not indications.
Why the other answers are wrong:
B) Tenderness must be at specific bone sites, not just over the lateral malleolus in general.
C) Previous fracture is not part of the Ottawa rules.
D) Swelling alone is not an indication for radiography.
Reference: Stiell, I.G., et al. (1992). Ottawa Ankle Rules. JAMA.
7. A patient with a history of heart failure with reduced ejection fraction presents with worsening dyspnea and
weight gain. Which medication should be held?
A) Metoprolol succinate
B) Furosemide
C) Lisinopril
D) Spironolactone
' Correct Answer: A
Rationale: In acute decompensated heart failure with evidence of congestion, beta-blockers (metoprolol succinate)
may be temporarily held to avoid worsening hemodynamics, especially if the patient requires inotropic support.
Diuretics and ACE inhibitors are continued. Spironolactone is typically continued unless contraindicated.
Why the other answers are wrong:
B) Furosemide is a key treatment for congestion and should be continued.
C) Lisinopril is generally continued in acute HF.
D) Spironolactone is not typically held in decompensation unless hyperkalemia.
Reference: Yancy, C.W., et al. (2017). ACC/AHA/HFSA Heart Failure Guidelines.
8. Which ECG finding is most characteristic of hyperkalemia?
A) Prolonged PR interval
B) Peaked T waves
C) ST-segment depression
D) Short QT interval
' Correct Answer: B
Rationale: Peaked T waves are the earliest and most characteristic ECG change in hyperkalemia. As potassium
rises, PR prolongation, QRS widening, and loss of P waves occur. ST depression and short QT are not typical.
Why the other answers are wrong:
A) PR prolongation occurs later in hyperkalemia, not as the most characteristic finding.
Page 3
Edition | 50 Verified Questions
About This Exam Bank
This comprehensive exam preparation document is meticulously crafted for nursing students enrolled in NSG 6020
at South University, targeting the Week 10 Final Exam for the 2026/2027 academic year. It contains 50 verified
questions that reflect the actual exam blueprint, covering advanced health assessment and diagnostic reasoning
across the lifespan. Each question is paired with a revised answer and a detailed rationale to reinforce critical
thinking and clinical application. This resource ensures students are thoroughly prepared to achieve a top grade, with
content aligned to the latest evidence-based practice guidelines.
Keywords
Advanced Health Assessment, Differential Diagnosis, Physical Examination, Clinical Reasoning, NSG 6020, South
University, Final Exam Prep, Nursing Education, Advanced Health Assessment, Differential Diagnosis, Physical
Examination, Clinical Reasoning, Advanced Health Assessment, Differential Diagnosis, Physical Examination,
Clinical Reasoning, NSG 6020, South University, Advanced Health Assessment, Differential Diagnosis, Physical
Examination, Clinical Reasoning, NSG 6020, South University, Final Exam Prep, Nursing Education, Advanced
Health Assessment
PART 1: EXAM QUESTIONS, ANSWERS AND RATIONALES
1. A patient with type 2 diabetes and chronic kidney disease (eGFR 35 mL/min) presents with a painful, swollen
right knee. Aspiration reveals monosodium urate crystals. Which medication is most appropriate for long-term
urate-lowering therapy?
A) Allopurinol 100 mg daily
B) Probenecid 500 mg twice daily
C) Colchicine 0.6 mg daily
D) Febuxostat 40 mg daily
' Correct Answer: A
Rationale: Allopurinol is the first-line urate-lowering therapy and can be started at a low dose in CKD with gradual
titration. Probenecid is ineffective in renal impairment (eGFR <50). Colchicine is for prophylaxis/acute flares, not
long-term lowering. Febuxostat is a second-line option but has cardiovascular concerns and requires dose
adjustment; allopurinol is preferred.
Why the other answers are wrong:
B) Probenecid is ineffective when eGFR is below 50 mL/min and is not recommended in CKD.
C) Colchicine reduces inflammation, not serum urate levels.
D) Febuxostat is not first-line, especially with cardiovascular risk, and requires dose adjustment.
Reference: Yip, K., & Cohen, R. (2025). Gout management in chronic kidney disease. ACR Guidelines.
2. A patient with a history of recurrent unprovoked deep vein thrombosis and a positive lupus anticoagulant is being
managed for a new pulmonary embolism. Which anticoagulant is most appropriate for long-term therapy?
A) Apixaban 5 mg twice daily
B) Warfarin with target INR 2-3
C) Enoxaparin 1 mg/kg twice daily
D) Rivaroxaban 20 mg daily
' Correct Answer: B
Page 1
,Rationale: In antiphospholipid syndrome with thrombosis, vitamin K antagonists (warfarin) are preferred over
direct oral anticoagulants (DOACs) due to evidence of higher recurrent thrombosis risk with DOACs. Enoxaparin is
for acute management, not long-term. Apixaban and rivaroxaban are DOACs and are not recommended.
Why the other answers are wrong:
A) DOACs are associated with increased recurrent thrombotic events in antiphospholipid syndrome.
C) Enoxaparin is used for initial therapy, not long-term anticoagulation.
D) Rivaroxaban is a DOAC and is not recommended in antiphospholipid syndrome.
Reference: Ortel, T.L., et al. (2020). Antiphospholipid syndrome: ASH guidelines. Blood.
3. Which finding on spirometry is most consistent with a restrictive ventilatory defect?
A) FEV1/FVC ratio <0.70 with reduced FEV1
B) FEV1/FVC ratio >0.70 with reduced total lung capacity
C) FEV1/FVC ratio >0.70 with increased total lung capacity
D) FEV1/FVC ratio <0.70 with normal total lung capacity
' Correct Answer: B
Rationale: Restrictive defects show reduced lung volumes (TLC <80% predicted) with a normal or high
FEV1/FVC ratio. Obstructive defects show reduced ratio (<0.70). Increased TLC is not typical of restriction.
Why the other answers are wrong:
A) This pattern indicates an obstructive defect.
C) Increased TLC is not seen in restriction and would suggest hyperinflation.
D) Low FEV1/FVC is obstructive, not restrictive.
Reference: Pellegrino, R., et al. (2005). Interpretative strategies for lung function tests. Eur Respir J.
4. A patient presents with fatigue, orthostatic hypotension, and hyperpigmentation of the skin. Laboratory studies
show hyponatremia, hyperkalemia, and low cortisol. Which diagnostic test is most definitive for confirming primary
adrenal insufficiency?
A) Plasma adrenocorticotropic hormone level
B) Cosyntropin stimulation test
C) Serum aldosterone level
D) 24-hour urinary free cortisol
' Correct Answer: B
Rationale: The cosyntropin (ACTH) stimulation test is the gold standard for diagnosing adrenal insufficiency; a
blunted cortisol response confirms the diagnosis. While ACTH helps distinguish primary from secondary, it is not
definitive alone. Aldosterone and urinary cortisol are not diagnostic.
Why the other answers are wrong:
A) ACTH level helps differentiate primary vs. secondary but is not the definitive diagnostic test.
C) Aldosterone is not used to diagnose adrenal insufficiency.
D) Urinary free cortisol is used for Cushing's syndrome, not insufficiency.
Reference: Bornstein, S.R., et al. (2016). Diagnosis and treatment of primary adrenal insufficiency. JCEM.
5. A patient with atrial fibrillation and a CHA2DS2-VASc score of 3 is being started on warfarin. Which factor most
significantly increases the risk of major bleeding?
A) Concomitant use of amiodarone
B) Age 65 years
C) History of gastrointestinal bleeding
D) Female sex
' Correct Answer: C
Rationale: Prior major bleeding, especially GI bleeding, is a strong independent risk factor for
anticoagulant-related bleeding. Amiodarone increases warfarin levels but can be managed with monitoring. Age 65
Page 2
, and female sex are modest risk factors.
Why the other answers are wrong:
A) Amiodarone interacts with warfarin but is not a major bleeding risk factor.
B) Age 65 is a minor factor in bleeding risk scores.
D) Female sex is a minor risk factor.
Reference: Pisters, R., et al. (2010). HAS-BLED bleeding risk score. Chest.
6. Which clinical scenario best illustrates the use of the Ottawa Ankle Rules to determine the need for radiography?
A) A patient with ankle pain and inability to bear weight for four steps immediately after injury
B) A patient with ankle pain and tenderness over the lateral malleolus with no other findings
C) A patient with ankle pain and a history of previous ankle fracture
D) A patient with ankle pain and swelling but no bony tenderness
' Correct Answer: A
Rationale: The Ottawa Ankle Rules require radiography if there is bone tenderness at the posterior edge of either
malleolus or inability to bear weight immediately and for four steps in the ED. Tenderness alone without specific
location or weight-bearing inability does not meet criteria. History and swelling are not indications.
Why the other answers are wrong:
B) Tenderness must be at specific bone sites, not just over the lateral malleolus in general.
C) Previous fracture is not part of the Ottawa rules.
D) Swelling alone is not an indication for radiography.
Reference: Stiell, I.G., et al. (1992). Ottawa Ankle Rules. JAMA.
7. A patient with a history of heart failure with reduced ejection fraction presents with worsening dyspnea and
weight gain. Which medication should be held?
A) Metoprolol succinate
B) Furosemide
C) Lisinopril
D) Spironolactone
' Correct Answer: A
Rationale: In acute decompensated heart failure with evidence of congestion, beta-blockers (metoprolol succinate)
may be temporarily held to avoid worsening hemodynamics, especially if the patient requires inotropic support.
Diuretics and ACE inhibitors are continued. Spironolactone is typically continued unless contraindicated.
Why the other answers are wrong:
B) Furosemide is a key treatment for congestion and should be continued.
C) Lisinopril is generally continued in acute HF.
D) Spironolactone is not typically held in decompensation unless hyperkalemia.
Reference: Yancy, C.W., et al. (2017). ACC/AHA/HFSA Heart Failure Guidelines.
8. Which ECG finding is most characteristic of hyperkalemia?
A) Prolonged PR interval
B) Peaked T waves
C) ST-segment depression
D) Short QT interval
' Correct Answer: B
Rationale: Peaked T waves are the earliest and most characteristic ECG change in hyperkalemia. As potassium
rises, PR prolongation, QRS widening, and loss of P waves occur. ST depression and short QT are not typical.
Why the other answers are wrong:
A) PR prolongation occurs later in hyperkalemia, not as the most characteristic finding.
Page 3
