NSG 554 Exam 1 | Nurse Practitioners in Primary Care I 120 Questions | Single Best Answer
NSG554 / NSG 554 EXAM 1 (LATEST UPDATE):
NURSE PRACTITIONERS IN PRIMARY CARE I
QUESTIONS AND VERIFIED ANSWERS | 100% CORRECT | GRADE A - WILKES
Wilkes University | Aligned with the NSG 554 Course Syllabus, the AACN Essentials of Master's Education, and the
Family Nurse Practitioner Primary Care Competencies (2026/2027 Edition)
120 Questions | 8 Sections | Single Best Answer (A-D) | Verified Rationales Included
Section 1: Foundations of Primary Care & FNP Role
Q1. Which statement best reflects the definition of primary care advanced by the National Academies
of Medicine (formerly the Institute of Medicine) and emphasized throughout the NSG 554 curriculum?
A. Integrated, accessible health care services delivered by clinicians who are accountable for
addressing the majority of personal health care needs, developing a sustained partnership with
patients, and practicing within the context of family and community [CORRECT]
B. Specialized, episodic care delivered by physician consultants after referral from another
clinician
C. Hospital-based acute care that focuses on stabilization of life-threatening conditions and
discharge planning
D. Disease-focused care limited to the diagnosis and pharmacologic treatment of established
medical conditions
Correct Answer: A
Rationale: The NASEM/IOM definition identifies primary care as integrated, accessible services that address the
majority of personal health care needs, are delivered in sustained partnership, and occur in family and community
context, which is the definition used throughout NSG 554 and the FNP primary care competencies. Option B
describes specialty referral care, Option C describes emergency care, and Option D describes narrow,
disease-oriented management. Only Option A captures the longitudinal, whole-person, community-embedded
nature of primary care expected of the FNP.
Wilkes University | Graduate Nursing & Advanced Practice Education 1
,NSG 554 Exam 1 | Nurse Practitioners in Primary Care I 120 Questions | Single Best Answer
Q2. A Family Nurse Practitioner practices in a state that grants full practice authority. A new patient
presents for evaluation of newly elevated blood pressure readings. Which activity is clearly within the
FNP's independent scope of practice in this practice authority environment?
A. Performing an elective laparoscopic cholecystectomy after completing a brief surgical rotation
B. Evaluating, diagnosing, ordering and interpreting laboratory studies, initiating antihypertensive
therapy, and managing follow-up without physician oversight [CORRECT]
C. Prescribing a Schedule II stimulant outside of any established treatment relationship for weight
loss
D. Delegating nursing diagnosis and medical decision-making to a licensed practical nurse working
at the front desk
Correct Answer: B
Rationale: Full practice authority, as defined by the AANP state practice environment model, permits the NP to
evaluate patients; diagnose; order and interpret diagnostic tests; and initiate and manage treatments, including
prescribing medications, under the exclusive licensure authority of the state board of nursing. Major surgery
(Option A) is outside NP scope, prescribing controlled substances without an established treatment relationship
(Option C) violates DEA and state prescribing requirements, and Option D describes inappropriate delegation of
assessment and diagnosis. Option B is the core, legally protected scope of the FNP role in a full-practice-authority
state.
Q3. A primary care clinic is redesigning its operations to qualify as a patient-centered medical home
(PCMH). Which set of redesign features best aligns with the recognized PCMH model taught in NSG
554?
A. Hospital ownership of the practice, mandatory inpatient admission for all acute complaints, and
centralized scheduling managed by the health plan
B. Physician-centric gatekeeping in which the primary clinician restricts all specialty referrals and
requires written approval for every diagnostic test
C. Team-based comprehensive care, enhanced access including same-day and after-hours options,
care coordination across settings, and continuous quality improvement using patient registries
[CORRECT]
D. Episodic urgent-care visits structured around volume targets, with no responsibility for patients
outside the visit
Correct Answer: C
Rationale: The PCMH model is defined by comprehensive, team-based care; patient-centered engagement;
coordinated care across the health care system; improved access such as same-day and after-hours availability;
and a commitment to quality and safety demonstrated through registries and performance improvement, all core
NSG 554 content. Option C contains exactly these attributes. Options B, D, and D distort the model: PCMH is not
restrictive gatekeeping, not episodic volume-driven urgent care, and not defined by hospital admission
requirements.
Wilkes University | Graduate Nursing & Advanced Practice Education 2
,NSG 554 Exam 1 | Nurse Practitioners in Primary Care I 120 Questions | Single Best Answer
Q4. Which description of an accountable care organization (ACO) is accurate?
A. A stand-alone retail clinic that charges flat fees for single-issue visits and assumes no
accountability for total cost of care
B. A federal insurance product purchased by beneficiaries that covers prescription drug benefits
C. A licensed skilled nursing facility that receives bundled payments for post-acute rehabilitation
services
D. A voluntary network of physicians, hospitals, and other providers that accepts joint
accountability for the quality and total cost of care for a defined panel of patients and may share in
savings achieved against spending benchmarks [CORRECT]
Correct Answer: D
Rationale: An ACO is a provider-led organization held accountable for quality measures and total per-capita cost
of care for an attributed population; if spending falls below benchmarks while quality standards are met, the ACO
shares in savings, a model examined in NSG 554 units on value-based delivery. It is not an insurance product
(Option B), not a fee-for-service retail clinic (Option A), and not a post-acute facility (Option C). The ACO
aligns incentives across the care continuum, which distinguishes it from each distractor.
Q5. A primary care practice joins a value-based care contract in which the clinic receives incentive
payments for achieving blood pressure control, depression remission, and colorectal cancer screening
targets. Which action by the FNP best demonstrates practice consistent with value-based primary care?
A. Using a hypertension registry to identify uncontrolled patients, proactively scheduling outreach
visits, and documenting quality measures at every encounter [CORRECT]
B. Ordering duplicate laboratory panels at each visit to increase revenue per patient under
fee-for-service rules
C. Declining to track population metrics because quality data collection is the responsibility of the
payer
D. Increasing visit length by scheduling half of all appointments as follow-up on unresolved
paperwork
Correct Answer: A
Rationale: Value-based care rewards outcomes, quality, and cost-effectiveness rather than volume; the hallmark
FNP behavior is population-level registry management with proactive outreach and consistent documentation of
quality measures, as taught in the NSG 554 quality improvement module. Options D and B reflect
volume-oriented thinking that value-based models are designed to replace, and Option C abandons the practice's
core accountability. Only Option A links individual care to measurable population outcomes.
Wilkes University | Graduate Nursing & Advanced Practice Education 3
, NSG 554 Exam 1 | Nurse Practitioners in Primary Care I 120 Questions | Single Best Answer
Q6. An FNP is caring for a 58-year-old with type 2 diabetes, moderate depression, and difficulty
affording groceries. Which action best exemplifies effective interprofessional collaboration in the
primary care setting?
A. Recommending that the patient self-refer to community agencies and return only when
symptoms worsen
B. Convening or participating in a coordinated care conference with a registered dietitian, an
integrated behavioral health clinician, and a social worker to develop one unified plan that
addresses glycemic control, mood, and food insecurity [CORRECT]
C. Managing all three problems personally during a single 20-minute visit and documenting the
plan for the chart
D. Referring the patient to three separate specialists without communicating the reason for each
referral
Correct Answer: B
Rationale: Interprofessional collaboration, an AACN Essentials domain and FNP competency, requires distinct
disciplines to communicate, coordinate, and integrate their expertise into a single patient-centered plan rather
than fragmenting care. Option C overstates what one clinician can accomplish and ignores the psychosocial
drivers of disease. Option D produces uncoordinated specialty scatter, and Option A abandons the coordination
role. Option B demonstrates shared decision-making, role clarity, and unified goal setting, the defining features of
collaboration in NSG 554.
Q7. A patient repeatedly misses appointments and reports relying on a neighbor for rides, skipping
medications to stretch the monthly supply, and eating mostly shelf-stable foods because the nearest
supermarket is 40 minutes away. In the framework of social determinants of health (SDOH), these
barriers are best classified primarily as problems of:
A. Education access and quality alone
B. Health care access limited strictly to the absence of insurance coverage
C. Economic stability and neighborhood and built environment, including transportation and food
access [CORRECT]
D. Social and community context defined only by social isolation
Correct Answer: C
Rationale: The Healthy People SDOH domains include economic stability and neighborhood and built
environment, which encompass housing, transportation, and food security; the barriers described (transportation
gaps, medication cost strain, and food desert geography) fall squarely in these two domains as presented in NSG
554. Insurance is not the limiting factor here (Option B), and education and social isolation, while important, are
not the dominant domains described (Options A and D). Screening tools such as PRAPARE or the AAFP Social
Needs Screening Tool would capture these risks.
Wilkes University | Graduate Nursing & Advanced Practice Education 4
NSG554 / NSG 554 EXAM 1 (LATEST UPDATE):
NURSE PRACTITIONERS IN PRIMARY CARE I
QUESTIONS AND VERIFIED ANSWERS | 100% CORRECT | GRADE A - WILKES
Wilkes University | Aligned with the NSG 554 Course Syllabus, the AACN Essentials of Master's Education, and the
Family Nurse Practitioner Primary Care Competencies (2026/2027 Edition)
120 Questions | 8 Sections | Single Best Answer (A-D) | Verified Rationales Included
Section 1: Foundations of Primary Care & FNP Role
Q1. Which statement best reflects the definition of primary care advanced by the National Academies
of Medicine (formerly the Institute of Medicine) and emphasized throughout the NSG 554 curriculum?
A. Integrated, accessible health care services delivered by clinicians who are accountable for
addressing the majority of personal health care needs, developing a sustained partnership with
patients, and practicing within the context of family and community [CORRECT]
B. Specialized, episodic care delivered by physician consultants after referral from another
clinician
C. Hospital-based acute care that focuses on stabilization of life-threatening conditions and
discharge planning
D. Disease-focused care limited to the diagnosis and pharmacologic treatment of established
medical conditions
Correct Answer: A
Rationale: The NASEM/IOM definition identifies primary care as integrated, accessible services that address the
majority of personal health care needs, are delivered in sustained partnership, and occur in family and community
context, which is the definition used throughout NSG 554 and the FNP primary care competencies. Option B
describes specialty referral care, Option C describes emergency care, and Option D describes narrow,
disease-oriented management. Only Option A captures the longitudinal, whole-person, community-embedded
nature of primary care expected of the FNP.
Wilkes University | Graduate Nursing & Advanced Practice Education 1
,NSG 554 Exam 1 | Nurse Practitioners in Primary Care I 120 Questions | Single Best Answer
Q2. A Family Nurse Practitioner practices in a state that grants full practice authority. A new patient
presents for evaluation of newly elevated blood pressure readings. Which activity is clearly within the
FNP's independent scope of practice in this practice authority environment?
A. Performing an elective laparoscopic cholecystectomy after completing a brief surgical rotation
B. Evaluating, diagnosing, ordering and interpreting laboratory studies, initiating antihypertensive
therapy, and managing follow-up without physician oversight [CORRECT]
C. Prescribing a Schedule II stimulant outside of any established treatment relationship for weight
loss
D. Delegating nursing diagnosis and medical decision-making to a licensed practical nurse working
at the front desk
Correct Answer: B
Rationale: Full practice authority, as defined by the AANP state practice environment model, permits the NP to
evaluate patients; diagnose; order and interpret diagnostic tests; and initiate and manage treatments, including
prescribing medications, under the exclusive licensure authority of the state board of nursing. Major surgery
(Option A) is outside NP scope, prescribing controlled substances without an established treatment relationship
(Option C) violates DEA and state prescribing requirements, and Option D describes inappropriate delegation of
assessment and diagnosis. Option B is the core, legally protected scope of the FNP role in a full-practice-authority
state.
Q3. A primary care clinic is redesigning its operations to qualify as a patient-centered medical home
(PCMH). Which set of redesign features best aligns with the recognized PCMH model taught in NSG
554?
A. Hospital ownership of the practice, mandatory inpatient admission for all acute complaints, and
centralized scheduling managed by the health plan
B. Physician-centric gatekeeping in which the primary clinician restricts all specialty referrals and
requires written approval for every diagnostic test
C. Team-based comprehensive care, enhanced access including same-day and after-hours options,
care coordination across settings, and continuous quality improvement using patient registries
[CORRECT]
D. Episodic urgent-care visits structured around volume targets, with no responsibility for patients
outside the visit
Correct Answer: C
Rationale: The PCMH model is defined by comprehensive, team-based care; patient-centered engagement;
coordinated care across the health care system; improved access such as same-day and after-hours availability;
and a commitment to quality and safety demonstrated through registries and performance improvement, all core
NSG 554 content. Option C contains exactly these attributes. Options B, D, and D distort the model: PCMH is not
restrictive gatekeeping, not episodic volume-driven urgent care, and not defined by hospital admission
requirements.
Wilkes University | Graduate Nursing & Advanced Practice Education 2
,NSG 554 Exam 1 | Nurse Practitioners in Primary Care I 120 Questions | Single Best Answer
Q4. Which description of an accountable care organization (ACO) is accurate?
A. A stand-alone retail clinic that charges flat fees for single-issue visits and assumes no
accountability for total cost of care
B. A federal insurance product purchased by beneficiaries that covers prescription drug benefits
C. A licensed skilled nursing facility that receives bundled payments for post-acute rehabilitation
services
D. A voluntary network of physicians, hospitals, and other providers that accepts joint
accountability for the quality and total cost of care for a defined panel of patients and may share in
savings achieved against spending benchmarks [CORRECT]
Correct Answer: D
Rationale: An ACO is a provider-led organization held accountable for quality measures and total per-capita cost
of care for an attributed population; if spending falls below benchmarks while quality standards are met, the ACO
shares in savings, a model examined in NSG 554 units on value-based delivery. It is not an insurance product
(Option B), not a fee-for-service retail clinic (Option A), and not a post-acute facility (Option C). The ACO
aligns incentives across the care continuum, which distinguishes it from each distractor.
Q5. A primary care practice joins a value-based care contract in which the clinic receives incentive
payments for achieving blood pressure control, depression remission, and colorectal cancer screening
targets. Which action by the FNP best demonstrates practice consistent with value-based primary care?
A. Using a hypertension registry to identify uncontrolled patients, proactively scheduling outreach
visits, and documenting quality measures at every encounter [CORRECT]
B. Ordering duplicate laboratory panels at each visit to increase revenue per patient under
fee-for-service rules
C. Declining to track population metrics because quality data collection is the responsibility of the
payer
D. Increasing visit length by scheduling half of all appointments as follow-up on unresolved
paperwork
Correct Answer: A
Rationale: Value-based care rewards outcomes, quality, and cost-effectiveness rather than volume; the hallmark
FNP behavior is population-level registry management with proactive outreach and consistent documentation of
quality measures, as taught in the NSG 554 quality improvement module. Options D and B reflect
volume-oriented thinking that value-based models are designed to replace, and Option C abandons the practice's
core accountability. Only Option A links individual care to measurable population outcomes.
Wilkes University | Graduate Nursing & Advanced Practice Education 3
, NSG 554 Exam 1 | Nurse Practitioners in Primary Care I 120 Questions | Single Best Answer
Q6. An FNP is caring for a 58-year-old with type 2 diabetes, moderate depression, and difficulty
affording groceries. Which action best exemplifies effective interprofessional collaboration in the
primary care setting?
A. Recommending that the patient self-refer to community agencies and return only when
symptoms worsen
B. Convening or participating in a coordinated care conference with a registered dietitian, an
integrated behavioral health clinician, and a social worker to develop one unified plan that
addresses glycemic control, mood, and food insecurity [CORRECT]
C. Managing all three problems personally during a single 20-minute visit and documenting the
plan for the chart
D. Referring the patient to three separate specialists without communicating the reason for each
referral
Correct Answer: B
Rationale: Interprofessional collaboration, an AACN Essentials domain and FNP competency, requires distinct
disciplines to communicate, coordinate, and integrate their expertise into a single patient-centered plan rather
than fragmenting care. Option C overstates what one clinician can accomplish and ignores the psychosocial
drivers of disease. Option D produces uncoordinated specialty scatter, and Option A abandons the coordination
role. Option B demonstrates shared decision-making, role clarity, and unified goal setting, the defining features of
collaboration in NSG 554.
Q7. A patient repeatedly misses appointments and reports relying on a neighbor for rides, skipping
medications to stretch the monthly supply, and eating mostly shelf-stable foods because the nearest
supermarket is 40 minutes away. In the framework of social determinants of health (SDOH), these
barriers are best classified primarily as problems of:
A. Education access and quality alone
B. Health care access limited strictly to the absence of insurance coverage
C. Economic stability and neighborhood and built environment, including transportation and food
access [CORRECT]
D. Social and community context defined only by social isolation
Correct Answer: C
Rationale: The Healthy People SDOH domains include economic stability and neighborhood and built
environment, which encompass housing, transportation, and food security; the barriers described (transportation
gaps, medication cost strain, and food desert geography) fall squarely in these two domains as presented in NSG
554. Insurance is not the limiting factor here (Option B), and education and social isolation, while important, are
not the dominant domains described (Options A and D). Screening tools such as PRAPARE or the AAFP Social
Needs Screening Tool would capture these risks.
Wilkes University | Graduate Nursing & Advanced Practice Education 4
