FINAL EXAM NSG 527 / NSG527 (2026/2027) - WILKES
WILKES UNIVERSITY | GRADUATE NURSING & ADVANCED PRACTICE EDUCATION | NSG 527
FINAL EXAM NSG 527 / NSG527 (LATEST )
ALREADY GRADED A QUESTIONS AND VERIFIED ANSWERS - WILKES
Course Alignment Wilkes University NSG 527 Course Syllabus | AACN Essentials of Master's Education | Advanced
Practice Nursing Competencies (2026/2027 Edition)
Total Questions 150 multiple-choice questions across 9 sections (Q1 through Q150)
Cognitive Levels 20% Recall | 50% Application | 30% Analysis
Question Style 75% Scenario-Based (clinical cases, decision-making, ethical dilemmas) | 25% Direct Knowledge
Answer Format Four options (A-D), one correct answer, each with a verified rationale mapped to NSG 527
curriculum and national certification standards
Section 1: Advanced Health Assessment & Diagnostic Reasoning
Q1: A 46-year-old patient presents to the clinic with a chief complaint of abdominal pain. To ensure the history
captures all essential elements of symptom analysis, the nurse practitioner documents onset, location, duration,
character, aggravating and relieving factors, radiation, timing, and severity. Which documentation framework has
the nurse practitioner correctly applied?
A. The ABCDE approach to primary survey assessment
B. The CAGE questionnaire for substance use screening
C. The SBAR tool for structured handoff communication
D. The OLDCARTS mnemonic for comprehensive symptom analysis *[CORRECT]*
Correct Answer: D
Rationale: OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating, Radiation, Timing, Severity) is the
standard NSG 527 framework for complete symptom analysis in the health history. SBAR is a communication handoff tool,
CAGE screens for alcohol misuse, and ABCDE is an emergency primary survey, so none of these replaces a
symptom-analysis framework. AACN Essentials Domain 2 emphasizes person-centered care built on a complete and
systematic history.
Q2: A 78-year-old man reports exertional syncope and dyspnea. On cardiac examination, the nurse practitioner
auscultates a harsh crescendo-decrescendo systolic murmur at the right second intercostal space radiating to the
carotids. Which additional physical examination finding would best support severe aortic stenosis?
A. A fixed split S2 that varies with respiration
B. A wide pulse pressure with a soft S1
C. Slow-rising, low-amplitude carotid pulses (pulsus parvus et tardus) *[CORRECT]*
D. Bounding, rapidly rising carotid artery pulses
Correct Answer: C
Rationale: Pulsus parvus et tardus, a weak and delayed carotid upstroke, reflects prolonged LV ejection through a stenotic
valve and is a hallmark of severe aortic stenosis. Bounding pulses, wide pulse pressure, and a variable split S2 are associated
with aortic regurgitation or physiologic splitting rather than stenosis. This integrates physical diagnosis with hemodynamic
reasoning as taught in the NSG 527 advanced assessment module.
NSG 527 - Comprehensive Final Examination | Graduate Nursing & Advanced Practice Education 1
,FINAL EXAM NSG 527 / NSG527 (2026/2027) - WILKES
Q3: A 45-year-old woman presents with sudden pleuritic chest pain, a respiratory rate of 26, and a heart rate of
112 with no hemodynamic instability and no alternative diagnosis apparent. Using a validated Wells score, she is
classified as low probability for pulmonary embolism. What is the most appropriate next diagnostic step?
A. Order a ventilation-perfusion scan as the first-line study for all suspected PE
B. Order CT pulmonary angiography immediately before any laboratory testing
C. Obtain a D-dimer assay, understanding a negative result can safely rule out PE in low-probability patients
*[CORRECT]*
D. Reassure the patient and schedule follow-up in two weeks
Correct Answer: C
Rationale: In a patient with low pretest probability by the Wells criteria, a sensitive D-dimer with a negative result effectively
excludes pulmonary embolism, avoiding unnecessary radiation and contrast exposure. CT pulmonary angiography is reserved
for moderate-to-high probability patients or those with positive D-dimer results. This reflects the NSG 527 principle of
matching test selection to pretest probability to maximize diagnostic efficiency.
Q4: A 62-year-old man with heart failure presents with progressive dyspnea. Which combination of physical
findings is most consistent with a large pleural effusion on the right?
A. Dullness to percussion, decreased tactile fremitus, and diminished breath sounds *[CORRECT]*
B. Normal percussion, normal fremitus, and inspiratory wheezing
C. Resonant percussion, increased fremitus, and egophony
D. Hyperresonance to percussion, increased tactile fremitus, and bronchial breath sounds
Correct Answer: A
Rationale: Fluid between the pleural layers transmits low-frequency sound poorly, producing dullness to percussion, reduced
tactile fremitus, and diminished breath sounds over the effusion. Hyperresonance with increased fremitus suggests
pneumothorax or consolidation, while egophony and bronchial breath sounds indicate consolidated lung. Accurate
interpretation of clustered examination findings is a core NSG 527 diagnostic reasoning competency.
Q5: A 66-year-old man with intermittent calf pain while walking has an ankle-brachial index of 0.72. How should
the nurse practitioner interpret this result?
A. Consistent with peripheral artery disease of mild to moderate severity *[CORRECT]*
B. Diagnostic of acute arterial occlusion requiring emergent intervention
C. Normal result; claudication is likely musculoskeletal in origin
D. Suggests noncompressible, calcified vessels requiring toe-brachial testing
Correct Answer: A
Rationale: An ankle-brachial index below 0.90 is abnormal, with values from roughly 0.71 to 0.90 indicating mild to
moderate peripheral artery disease, which correlates with classic claudication. An ABI above 1.40 suggests noncompressible
calcified vessels, and acute occlusion produces abrupt severe ischemia rather than exertional symptoms. NSG 527 students
apply vascular assessment evidence to guide appropriate exercise therapy and risk factor management.
NSG 527 - Comprehensive Final Examination | Graduate Nursing & Advanced Practice Education 2
,FINAL EXAM NSG 527 / NSG527 (2026/2027) - WILKES
Q6: A 34-year-old patient has complete paralysis of the entire right side of the face, including the forehead, with
inability to wrinkle the brow or close the eye. What is the most accurate interpretation of this finding?
A. A brainstem stroke involving corticobulbar fibers on the contralateral side
B. A cortical lesion of the middle cerebral artery sparing the forehead
C. A peripheral lower motor neuron lesion of cranial nerve VII, such as Bell palsy *[CORRECT]*
D. An isolated lesion of cranial nerve V affecting motor function
Correct Answer: C
Rationale: Involvement of the forehead occurs because the upper face receives bilateral cortical innervation, so central
lesions spare the brow, while a peripheral cranial nerve VII lesion paralyzes the entire hemiface including the forehead. This
distinguishes Bell palsy from stroke, a critical safety distinction in assessment. Cranial nerve differentiation is a required NSG
527 neurological assessment competency.
Q7: A new laboratory screening test for a serious but treatable disease has a sensitivity of 98 percent and a
specificity of 70 percent. A patient receives a negative result. Which statement best reflects the correct clinical
application of test characteristics?
A. A negative result confirms the absence of disease because specificity is high
B. The test is equally useful for ruling in and ruling out disease
C. The very high sensitivity means a negative result is useful for ruling out disease (SNout) *[CORRECT]*
D. A positive result effectively rules out disease because of the SNout rule
Correct Answer: C
Rationale: The mnemonic SNout teaches that a highly Sensitive test, when negative, helps rule out disease, which makes it
valuable for screening where missing a treatable condition is costly. The incorrect choices misapply the principle by confusing
sensitivity with specificity (the rule-in concept, SPin) or by claiming the test performs equally well for ruling in and ruling out.
Understanding sensitivity, specificity, and pretest probability is an NSG 527 and national certification testing objective.
Q8: An 84-year-old woman presents with vague epigastric discomfort, mild confusion, and a blood pressure of
98/60, but her abdomen is soft with only mild tenderness. Which approach best reflects evidence-based
assessment of the older adult with a potentially acute abdomen?
A. Reassure and follow up in 48 hours because a soft abdomen excludes serious pathology
B. Order only basic laboratory studies and defer imaging until symptoms localize
C. Begin a trial of an H2 blocker and antacids before any diagnostic testing
D. Maintain a low threshold for urgent CT imaging and early surgical consultation because older adults present
atypically *[CORRECT]*
Correct Answer: D
Rationale: Older adults frequently present with muted abdominal findings because of decreased pain perception, blunted
febrile response, and comorbidities, so a benign examination does not exclude surgical pathology, and delayed diagnosis
substantially increases mortality. Reassurance or symptomatic trials in this context constitute dangerous management missteps.
NSG 527 emphasizes atypical presentations across the lifespan as an analysis-level competency.
NSG 527 - Comprehensive Final Examination | Graduate Nursing & Advanced Practice Education 3
, FINAL EXAM NSG 527 / NSG527 (2026/2027) - WILKES
Q9: In a SOAP note, the nurse practitioner writes: 'Essential hypertension, inadequately controlled on current
regimen. Start hydrochlorothiazide 25 mg daily, recheck blood pressure in 4 weeks, reinforce low-sodium diet.'
Under which SOAP component does this entry belong?
A. Review of systems
B. Subjective
C. Assessment and Plan *[CORRECT]*
D. Objective
Correct Answer: C
Rationale: The Assessment section contains the diagnostic impression, and the Plan records the therapeutic, educational, and
follow-up actions, which is exactly what this statement combines. Objective data are measurable findings such as vital signs,
while subjective data are patient-reported symptoms. Accurate SOAP note construction is explicitly tested in NSG 527
documentation and billing modules.
Q10: A nurse practitioner is counseling a patient with newly prescribed insulin and wants to verify understanding
using the teach-back method. Which statement best demonstrates this technique?
A. 'I want to be sure I explained things clearly; can you tell me in your own words how you will take your insulin
tonight?' *[CORRECT]*
B. 'Do you understand everything I told you about your insulin?'
C. 'Your daughter was here earlier, so she can explain the insulin instructions to you again.'
D. 'I will give you this printed pamphlet; reading it means you understand the medication.'
Correct Answer: A
Rationale: Teach-back asks the patient to restate instructions in their own words, placing the burden of clear communication
on the clinician and exposing gaps in comprehension. Closed yes-or-no questions, handing out written material alone, and
delegating teaching to family members do not verify patient understanding. Health literacy assessment through teach-back is a
patient safety expectation in NSG 527 and AACN Essentials Domain 2.
Q11: A nurse practitioner who speaks basic Spanish is evaluating a Spanish-speaking patient with chest pain. The
patient's teenage son is present and offers to interpret. What is the most appropriate action?
A. Arrange for a trained professional medical interpreter, in person or by video or phone, for all clinical
discussions *[CORRECT]*
B. Have the son interpret because he knows the patient best and can comfort him
C. Ask the patient to write his symptoms in English instead of speaking
D. Proceed in Spanish since the nurse practitioner has working knowledge of the language
Correct Answer: A
Rationale: Professional medical interpreters are trained in medical vocabulary, neutrality, and confidentiality; family
members, and especially minors, may filter, omit, or distort clinically critical information, and untrained interpreting increases
error rates and liability. Basic clinician fluency is insufficient for safety-critical encounters. This aligns with culturally
competent care standards in NSG 527 and federal language access requirements.
NSG 527 - Comprehensive Final Examination | Graduate Nursing & Advanced Practice Education 4
WILKES UNIVERSITY | GRADUATE NURSING & ADVANCED PRACTICE EDUCATION | NSG 527
FINAL EXAM NSG 527 / NSG527 (LATEST )
ALREADY GRADED A QUESTIONS AND VERIFIED ANSWERS - WILKES
Course Alignment Wilkes University NSG 527 Course Syllabus | AACN Essentials of Master's Education | Advanced
Practice Nursing Competencies (2026/2027 Edition)
Total Questions 150 multiple-choice questions across 9 sections (Q1 through Q150)
Cognitive Levels 20% Recall | 50% Application | 30% Analysis
Question Style 75% Scenario-Based (clinical cases, decision-making, ethical dilemmas) | 25% Direct Knowledge
Answer Format Four options (A-D), one correct answer, each with a verified rationale mapped to NSG 527
curriculum and national certification standards
Section 1: Advanced Health Assessment & Diagnostic Reasoning
Q1: A 46-year-old patient presents to the clinic with a chief complaint of abdominal pain. To ensure the history
captures all essential elements of symptom analysis, the nurse practitioner documents onset, location, duration,
character, aggravating and relieving factors, radiation, timing, and severity. Which documentation framework has
the nurse practitioner correctly applied?
A. The ABCDE approach to primary survey assessment
B. The CAGE questionnaire for substance use screening
C. The SBAR tool for structured handoff communication
D. The OLDCARTS mnemonic for comprehensive symptom analysis *[CORRECT]*
Correct Answer: D
Rationale: OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating, Radiation, Timing, Severity) is the
standard NSG 527 framework for complete symptom analysis in the health history. SBAR is a communication handoff tool,
CAGE screens for alcohol misuse, and ABCDE is an emergency primary survey, so none of these replaces a
symptom-analysis framework. AACN Essentials Domain 2 emphasizes person-centered care built on a complete and
systematic history.
Q2: A 78-year-old man reports exertional syncope and dyspnea. On cardiac examination, the nurse practitioner
auscultates a harsh crescendo-decrescendo systolic murmur at the right second intercostal space radiating to the
carotids. Which additional physical examination finding would best support severe aortic stenosis?
A. A fixed split S2 that varies with respiration
B. A wide pulse pressure with a soft S1
C. Slow-rising, low-amplitude carotid pulses (pulsus parvus et tardus) *[CORRECT]*
D. Bounding, rapidly rising carotid artery pulses
Correct Answer: C
Rationale: Pulsus parvus et tardus, a weak and delayed carotid upstroke, reflects prolonged LV ejection through a stenotic
valve and is a hallmark of severe aortic stenosis. Bounding pulses, wide pulse pressure, and a variable split S2 are associated
with aortic regurgitation or physiologic splitting rather than stenosis. This integrates physical diagnosis with hemodynamic
reasoning as taught in the NSG 527 advanced assessment module.
NSG 527 - Comprehensive Final Examination | Graduate Nursing & Advanced Practice Education 1
,FINAL EXAM NSG 527 / NSG527 (2026/2027) - WILKES
Q3: A 45-year-old woman presents with sudden pleuritic chest pain, a respiratory rate of 26, and a heart rate of
112 with no hemodynamic instability and no alternative diagnosis apparent. Using a validated Wells score, she is
classified as low probability for pulmonary embolism. What is the most appropriate next diagnostic step?
A. Order a ventilation-perfusion scan as the first-line study for all suspected PE
B. Order CT pulmonary angiography immediately before any laboratory testing
C. Obtain a D-dimer assay, understanding a negative result can safely rule out PE in low-probability patients
*[CORRECT]*
D. Reassure the patient and schedule follow-up in two weeks
Correct Answer: C
Rationale: In a patient with low pretest probability by the Wells criteria, a sensitive D-dimer with a negative result effectively
excludes pulmonary embolism, avoiding unnecessary radiation and contrast exposure. CT pulmonary angiography is reserved
for moderate-to-high probability patients or those with positive D-dimer results. This reflects the NSG 527 principle of
matching test selection to pretest probability to maximize diagnostic efficiency.
Q4: A 62-year-old man with heart failure presents with progressive dyspnea. Which combination of physical
findings is most consistent with a large pleural effusion on the right?
A. Dullness to percussion, decreased tactile fremitus, and diminished breath sounds *[CORRECT]*
B. Normal percussion, normal fremitus, and inspiratory wheezing
C. Resonant percussion, increased fremitus, and egophony
D. Hyperresonance to percussion, increased tactile fremitus, and bronchial breath sounds
Correct Answer: A
Rationale: Fluid between the pleural layers transmits low-frequency sound poorly, producing dullness to percussion, reduced
tactile fremitus, and diminished breath sounds over the effusion. Hyperresonance with increased fremitus suggests
pneumothorax or consolidation, while egophony and bronchial breath sounds indicate consolidated lung. Accurate
interpretation of clustered examination findings is a core NSG 527 diagnostic reasoning competency.
Q5: A 66-year-old man with intermittent calf pain while walking has an ankle-brachial index of 0.72. How should
the nurse practitioner interpret this result?
A. Consistent with peripheral artery disease of mild to moderate severity *[CORRECT]*
B. Diagnostic of acute arterial occlusion requiring emergent intervention
C. Normal result; claudication is likely musculoskeletal in origin
D. Suggests noncompressible, calcified vessels requiring toe-brachial testing
Correct Answer: A
Rationale: An ankle-brachial index below 0.90 is abnormal, with values from roughly 0.71 to 0.90 indicating mild to
moderate peripheral artery disease, which correlates with classic claudication. An ABI above 1.40 suggests noncompressible
calcified vessels, and acute occlusion produces abrupt severe ischemia rather than exertional symptoms. NSG 527 students
apply vascular assessment evidence to guide appropriate exercise therapy and risk factor management.
NSG 527 - Comprehensive Final Examination | Graduate Nursing & Advanced Practice Education 2
,FINAL EXAM NSG 527 / NSG527 (2026/2027) - WILKES
Q6: A 34-year-old patient has complete paralysis of the entire right side of the face, including the forehead, with
inability to wrinkle the brow or close the eye. What is the most accurate interpretation of this finding?
A. A brainstem stroke involving corticobulbar fibers on the contralateral side
B. A cortical lesion of the middle cerebral artery sparing the forehead
C. A peripheral lower motor neuron lesion of cranial nerve VII, such as Bell palsy *[CORRECT]*
D. An isolated lesion of cranial nerve V affecting motor function
Correct Answer: C
Rationale: Involvement of the forehead occurs because the upper face receives bilateral cortical innervation, so central
lesions spare the brow, while a peripheral cranial nerve VII lesion paralyzes the entire hemiface including the forehead. This
distinguishes Bell palsy from stroke, a critical safety distinction in assessment. Cranial nerve differentiation is a required NSG
527 neurological assessment competency.
Q7: A new laboratory screening test for a serious but treatable disease has a sensitivity of 98 percent and a
specificity of 70 percent. A patient receives a negative result. Which statement best reflects the correct clinical
application of test characteristics?
A. A negative result confirms the absence of disease because specificity is high
B. The test is equally useful for ruling in and ruling out disease
C. The very high sensitivity means a negative result is useful for ruling out disease (SNout) *[CORRECT]*
D. A positive result effectively rules out disease because of the SNout rule
Correct Answer: C
Rationale: The mnemonic SNout teaches that a highly Sensitive test, when negative, helps rule out disease, which makes it
valuable for screening where missing a treatable condition is costly. The incorrect choices misapply the principle by confusing
sensitivity with specificity (the rule-in concept, SPin) or by claiming the test performs equally well for ruling in and ruling out.
Understanding sensitivity, specificity, and pretest probability is an NSG 527 and national certification testing objective.
Q8: An 84-year-old woman presents with vague epigastric discomfort, mild confusion, and a blood pressure of
98/60, but her abdomen is soft with only mild tenderness. Which approach best reflects evidence-based
assessment of the older adult with a potentially acute abdomen?
A. Reassure and follow up in 48 hours because a soft abdomen excludes serious pathology
B. Order only basic laboratory studies and defer imaging until symptoms localize
C. Begin a trial of an H2 blocker and antacids before any diagnostic testing
D. Maintain a low threshold for urgent CT imaging and early surgical consultation because older adults present
atypically *[CORRECT]*
Correct Answer: D
Rationale: Older adults frequently present with muted abdominal findings because of decreased pain perception, blunted
febrile response, and comorbidities, so a benign examination does not exclude surgical pathology, and delayed diagnosis
substantially increases mortality. Reassurance or symptomatic trials in this context constitute dangerous management missteps.
NSG 527 emphasizes atypical presentations across the lifespan as an analysis-level competency.
NSG 527 - Comprehensive Final Examination | Graduate Nursing & Advanced Practice Education 3
, FINAL EXAM NSG 527 / NSG527 (2026/2027) - WILKES
Q9: In a SOAP note, the nurse practitioner writes: 'Essential hypertension, inadequately controlled on current
regimen. Start hydrochlorothiazide 25 mg daily, recheck blood pressure in 4 weeks, reinforce low-sodium diet.'
Under which SOAP component does this entry belong?
A. Review of systems
B. Subjective
C. Assessment and Plan *[CORRECT]*
D. Objective
Correct Answer: C
Rationale: The Assessment section contains the diagnostic impression, and the Plan records the therapeutic, educational, and
follow-up actions, which is exactly what this statement combines. Objective data are measurable findings such as vital signs,
while subjective data are patient-reported symptoms. Accurate SOAP note construction is explicitly tested in NSG 527
documentation and billing modules.
Q10: A nurse practitioner is counseling a patient with newly prescribed insulin and wants to verify understanding
using the teach-back method. Which statement best demonstrates this technique?
A. 'I want to be sure I explained things clearly; can you tell me in your own words how you will take your insulin
tonight?' *[CORRECT]*
B. 'Do you understand everything I told you about your insulin?'
C. 'Your daughter was here earlier, so she can explain the insulin instructions to you again.'
D. 'I will give you this printed pamphlet; reading it means you understand the medication.'
Correct Answer: A
Rationale: Teach-back asks the patient to restate instructions in their own words, placing the burden of clear communication
on the clinician and exposing gaps in comprehension. Closed yes-or-no questions, handing out written material alone, and
delegating teaching to family members do not verify patient understanding. Health literacy assessment through teach-back is a
patient safety expectation in NSG 527 and AACN Essentials Domain 2.
Q11: A nurse practitioner who speaks basic Spanish is evaluating a Spanish-speaking patient with chest pain. The
patient's teenage son is present and offers to interpret. What is the most appropriate action?
A. Arrange for a trained professional medical interpreter, in person or by video or phone, for all clinical
discussions *[CORRECT]*
B. Have the son interpret because he knows the patient best and can comfort him
C. Ask the patient to write his symptoms in English instead of speaking
D. Proceed in Spanish since the nurse practitioner has working knowledge of the language
Correct Answer: A
Rationale: Professional medical interpreters are trained in medical vocabulary, neutrality, and confidentiality; family
members, and especially minors, may filter, omit, or distort clinically critical information, and untrained interpreting increases
error rates and liability. Basic clinician fluency is insufficient for safety-critical encounters. This aligns with culturally
competent care standards in NSG 527 and federal language access requirements.
NSG 527 - Comprehensive Final Examination | Graduate Nursing & Advanced Practice Education 4
