NSG 6020 Week 10 Final Exam Prep Document | 2026/2027
Edition | 100 Verified Questions
About This Exam Bank
This comprehensive exam preparation document is meticulously designed for nursing students enrolled in NSG 6020
at South University, targeting the Week 10 Final Exam for the 2026/2027 academic year. It contains 100 verified
questions with revised answers and rationales, ensuring a thorough review of advanced health assessment and
clinical reasoning. The content is aligned with the latest evidence-based practice guidelines and the course
curriculum, providing a reliable resource for achieving a top grade. Each question is accompanied by a detailed
rationale to reinforce understanding and application of key concepts.
Keywords
Advanced Health Assessment, Clinical Reasoning, Differential Diagnosis, Physical Examination, Evidence-Based
Practice, Lifespan Considerations, NCLEX-RN Preparation, South University NSG 6020, Advanced Health
Assessment, Clinical Reasoning, Differential Diagnosis, Physical Examination, Advanced Health Assessment,
Clinical Reasoning, Differential Diagnosis, Physical Examination, Evidence-Based Practice, Lifespan
Considerations
PART 1: EXAM QUESTIONS, ANSWERS AND RATIONALES
1. A patient presents with acute-onset unilateral vision loss and eye pain. On exam, the conjunctiva is injected,
corneal sensation is decreased, and a fixed mid-dilated pupil is noted. Which diagnostic finding would most
definitively confirm the suspected diagnosis?
A) Intraocular pressure of 22 mmHg
B) Fluorescein staining showing a dendritic ulcer
C) Slit-lamp exam revealing cells and flare in the anterior chamber
D) Fundoscopic exam showing a pale optic disc with hemorrhage
' Correct Answer: C
Rationale: The presentation suggests acute anterior uveitis (iritis), which is confirmed by cells and flare in the
anterior chamber on slit-lamp. Elevated IOP is more consistent with angle-closure glaucoma, dendritic ulcer
indicates herpes keratitis, and pale optic disc with hemorrhage is seen in ischemic optic neuropathy.
Why the other answers are wrong:
A) Elevated intraocular pressure is a feature of acute angle-closure glaucoma, not uveitis, and would not confirm
the diagnosis.
B) A dendritic ulcer is characteristic of herpes simplex keratitis, which presents with a branching corneal lesion,
not primarily with anterior chamber inflammation.
D) A pale optic disc with hemorrhage suggests anterior ischemic optic neuropathy, which is painless and does
not cause conjunctival injection.
Reference: Bickley, L. S. (2026). Bates' Guide to Physical Examination and History Taking, 13th ed., Ch. 11
2. A 30-year-old woman presents with fatigue, weight gain, and cold intolerance. Labs show TSH of 8.5 mIU/L
(normal 0.5-4.5), free T4 of 0.4 ng/dL (normal 0.8-1.8), and positive thyroid peroxidase antibodies. Which
additional finding would most support the diagnosis of Hashimoto thyroiditis?
A) Elevated thyroglobulin antibodies
B) Diffuse goiter on ultrasound
C) Low radioiodine uptake on scintigraphy
Page 1
, D) Elevated erythrocyte sedimentation rate
' Correct Answer: A
Rationale: Positive thyroglobulin antibodies, along with TPO antibodies, are strongly associated with autoimmune
thyroiditis (Hashimoto). While a diffuse goiter is common, it is not specific. Low radioiodine uptake is seen in
painless thyroiditis, and elevated ESR is characteristic of subacute granulomatous thyroiditis.
Why the other answers are wrong:
B) A diffuse goiter is a nonspecific finding that can occur in various thyroid conditions, including iodine
deficiency and Graves' disease.
C) Low radioiodine uptake is typical of thyroiditis but is not specific to Hashimoto and more characteristic of
subacute or painless thyroiditis.
D) Elevated ESR is a feature of subacute thyroiditis (de Quervain's), not Hashimoto's, which is not typically
associated with inflammatory markers.
Reference: Jameson, J. L., et al. (2026). Harrison's Principles of Internal Medicine, 21st ed., Ch. 375
3. A patient with a history of chronic obstructive pulmonary disease (COPD) presents with increased dyspnea and
purulent sputum. Chest X-ray shows no infiltrate. Which management step is most appropriate according to the
GOLD 2026 guidelines?
A) Start broad-spectrum antibiotics and oral corticosteroids
B) Administer a short-acting beta-agonist alone and reassess
C) Initiate long-term oxygen therapy to maintain SpO2 > 90%
D) Add a phosphodiesterase-4 inhibitor for maintenance
' Correct Answer: A
Rationale: This is an acute exacerbation of COPD characterized by increased dyspnea and purulent sputum. GOLD
guidelines recommend short-acting bronchodilators, systemic corticosteroids, and antibiotics when purulent sputum
is present. Long-term oxygen is for chronic hypoxemia, and roflumilast is a maintenance therapy for severe COPD
with chronic bronchitis.
Why the other answers are wrong:
B) A short-acting beta-agonist alone is insufficient; systemic corticosteroids and antibiotics are indicated for
moderate-severe exacerbations with purulent sputum.
C) Long-term oxygen therapy is reserved for chronic respiratory failure with resting SpO2 88%, not for acute
exacerbation management.
D) Phosphodiesterase-4 inhibitors are used for maintenance in severe COPD with chronic bronchitis and
frequent exacerbations, not for acute exacerbation treatment.
Reference: Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2026). Global Strategy for the
Diagnosis, Management, and Prevention of COPD
4. A patient with a history of hypertension and diabetes presents with acute onset of severe headache, nausea, and
blurred vision. Blood pressure is 220/120 mmHg. Which intervention is most appropriate?
A) Administer sublingual nifedipine to rapidly lower blood pressure
B) Start oral labetalol and discharge home with close follow-up
C) Reduce mean arterial pressure by 20-25% within the first hour using IV antihypertensives
D) Initiate a continuous infusion of sodium nitroprusside to achieve a normal blood pressure within 30 minutes
' Correct Answer: C
Rationale: This is hypertensive emergency with end-organ damage (headache, blurred vision). Guidelines
recommend cautious reduction of MAP by 20-25% within the first hour, not to normal levels, to avoid cerebral
hypoperfusion. IV antihypertensives are used in an ICU setting. Sublingual nifedipine is contraindicated due to
unpredictable drops.
Why the other answers are wrong:
A) Sublingual nifedipine is contraindicated in hypertensive emergencies due to rapid, uncontrolled blood
Page 2
, pressure reduction that can cause ischemic events.
B) Oral antihypertensives are not appropriate for hypertensive emergency with acute end-organ damage; IV
therapy is required.
D) Sodium nitroprusside can cause excessive hypotension and cyanide toxicity; rapid normalization is dangerous
and not recommended.
Reference: Whelton, P. K., et al. (2018). 2017 ACC/AHA Hypertension Guideline; 2026 update
5. A patient presents with pleuritic chest pain, dyspnea, and a pericardial friction rub. ECG shows diffuse
ST-segment elevation with PR depression. Which additional finding would most strongly support the diagnosis of
acute pericarditis?
A) Elevated high-sensitivity troponin
B) Positive D-dimer
C) Echocardiogram showing a small pericardial effusion
D) Chest X-ray showing cardiomegaly
' Correct Answer: C
Rationale: A pericardial effusion is a common complication of acute pericarditis and supports the diagnosis.
Elevated troponin may occur in myopericarditis but is not specific. D-dimer suggests pulmonary embolism.
Cardiomegaly on CXR is nonspecific and may indicate pericardial effusion only if the silhouette is enlarged, but it is
not diagnostic.
Why the other answers are wrong:
A) Elevated troponin indicates myocardial injury, which is not typical of isolated pericarditis and more
consistent with myopericarditis or MI.
B) Positive D-dimer is seen in pulmonary embolism and aortic dissection, which can mimic pericarditis but is
not a diagnostic criterion.
D) Cardiomegaly on CXR is a nonspecific finding and does not confirm pericarditis; it may be present in heart
failure.
Reference: Adler, Y., et al. (2015). ESC Guidelines for the Diagnosis and Management of Pericardial Diseases;
2026 update
6. A patient with chronic kidney disease (eGFR 25 mL/min/1.73m²) is prescribed a new medication. Which
pharmacokinetic change would most likely require dose adjustment?
A) Increased volume of distribution for a lipophilic drug
B) Decreased hepatic metabolism of a prodrug
C) Reduced renal clearance of an active metabolite
D) Increased protein binding of an acidic drug
' Correct Answer: C
Rationale: In CKD, renal clearance of drugs and active metabolites is reduced, necessitating dose adjustments.
Volume of distribution may be altered due to fluid overload, but lipophilic drugs are often less affected. Hepatic
metabolism may be variably affected. Protein binding of acidic drugs is often decreased due to uremia and
hypoalbuminemia.
Why the other answers are wrong:
A) Volume of distribution changes are complex; lipophilic drugs may accumulate in tissues, but this is not the
primary reason for dose adjustment in CKD.
B) Hepatic metabolism is generally preserved in CKD, and prodrugs may have altered activation, but this is not
a universal rule.
D) Protein binding of acidic drugs is typically decreased in CKD due to uremic toxins and hypoalbuminemia,
leading to higher free drug levels, not increased binding.
Reference: Lehne, R. A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 5
Page 3
, 7. A 45-year-old man presents with acute severe headache and vomiting. Non-contrast CT of the head is negative.
Lumbar puncture is performed 4 hours after symptom onset. Which CSF finding would be most consistent with
subarachnoid hemorrhage?
A) Clear CSF with normal opening pressure
B) Elevated opening pressure with xanthochromia
C) WBC count of 500/mm³ with 90% lymphocytes
D) CSF protein of 20 mg/dL and glucose of 80 mg/dL
' Correct Answer: B
Rationale: In subarachnoid hemorrhage, xanthochromia (yellowish supernatant from bilirubin) appears 6-12 hours
after bleeding and is a key finding. Elevated opening pressure is common. Clear CSF with normal pressure rules out
SAH. Lymphocytic pleocytosis suggests meningitis. Normal protein and glucose are not consistent with SAH.
Why the other answers are wrong:
A) Clear CSF with normal opening pressure makes subarachnoid hemorrhage highly unlikely.
C) Lymphocytic pleocytosis is more indicative of viral or tuberculous meningitis, not acute hemorrhage.
D) Normal CSF protein and glucose are not typical of SAH, which usually shows elevated protein and normal
glucose.
Reference: Connolly, E. S., et al. (2012). Guidelines for the Management of Aneurysmal Subarachnoid
Hemorrhage; 2026 update
8. A patient with type 2 diabetes is started on metformin. Which mechanism best explains its glucose-lowering
effect?
A) Stimulates pancreatic beta cells to secrete insulin
B) Inhibits renal glucose reabsorption via SGLT2
C) Activates AMPK, reducing hepatic gluconeogenesis
D) Increases insulin sensitivity at peripheral tissues only
' Correct Answer: C
Rationale: Metformin primarily activates AMPK, leading to reduced hepatic glucose production and increased
insulin sensitivity. It does not stimulate insulin secretion. SGLT2 inhibitors block renal glucose reabsorption. While
metformin improves peripheral insulin sensitivity, its primary action is hepatic.
Why the other answers are wrong:
A) Metformin does not stimulate insulin secretion; sulfonylureas do.
B) SGLT2 inhibition is the mechanism of canagliflozin, not metformin.
D) Peripheral insulin sensitivity is a secondary effect; the primary action is on hepatic gluconeogenesis.
Reference: Lehne, R. A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 56
9. A patient with decompensated cirrhosis presents with tense ascites, jaundice, and confusion. Which treatment is
most appropriate for the ascites?
A) Large-volume paracentesis with albumin replacement
B) Oral furosemide 40 mg daily
C) Transjugular intrahepatic portosystemic shunt (TIPS)
D) Lactulose 30 mL every 6 hours
' Correct Answer: A
Rationale: Large-volume paracentesis with albumin is the first-line treatment for tense ascites, as it provides rapid
relief and prevents post-paracentesis circulatory dysfunction. Diuretics are used for moderate ascites but are slower.
TIPS is reserved for refractory ascites. Lactulose treats hepatic encephalopathy, not ascites.
Why the other answers are wrong:
B) Diuretics are effective but act slowly and are not the immediate choice for tense ascites causing respiratory
compromise.
C) TIPS is reserved for refractory ascites and carries risks; it is not first-line for tense ascites.
Page 4
Edition | 100 Verified Questions
About This Exam Bank
This comprehensive exam preparation document is meticulously designed for nursing students enrolled in NSG 6020
at South University, targeting the Week 10 Final Exam for the 2026/2027 academic year. It contains 100 verified
questions with revised answers and rationales, ensuring a thorough review of advanced health assessment and
clinical reasoning. The content is aligned with the latest evidence-based practice guidelines and the course
curriculum, providing a reliable resource for achieving a top grade. Each question is accompanied by a detailed
rationale to reinforce understanding and application of key concepts.
Keywords
Advanced Health Assessment, Clinical Reasoning, Differential Diagnosis, Physical Examination, Evidence-Based
Practice, Lifespan Considerations, NCLEX-RN Preparation, South University NSG 6020, Advanced Health
Assessment, Clinical Reasoning, Differential Diagnosis, Physical Examination, Advanced Health Assessment,
Clinical Reasoning, Differential Diagnosis, Physical Examination, Evidence-Based Practice, Lifespan
Considerations
PART 1: EXAM QUESTIONS, ANSWERS AND RATIONALES
1. A patient presents with acute-onset unilateral vision loss and eye pain. On exam, the conjunctiva is injected,
corneal sensation is decreased, and a fixed mid-dilated pupil is noted. Which diagnostic finding would most
definitively confirm the suspected diagnosis?
A) Intraocular pressure of 22 mmHg
B) Fluorescein staining showing a dendritic ulcer
C) Slit-lamp exam revealing cells and flare in the anterior chamber
D) Fundoscopic exam showing a pale optic disc with hemorrhage
' Correct Answer: C
Rationale: The presentation suggests acute anterior uveitis (iritis), which is confirmed by cells and flare in the
anterior chamber on slit-lamp. Elevated IOP is more consistent with angle-closure glaucoma, dendritic ulcer
indicates herpes keratitis, and pale optic disc with hemorrhage is seen in ischemic optic neuropathy.
Why the other answers are wrong:
A) Elevated intraocular pressure is a feature of acute angle-closure glaucoma, not uveitis, and would not confirm
the diagnosis.
B) A dendritic ulcer is characteristic of herpes simplex keratitis, which presents with a branching corneal lesion,
not primarily with anterior chamber inflammation.
D) A pale optic disc with hemorrhage suggests anterior ischemic optic neuropathy, which is painless and does
not cause conjunctival injection.
Reference: Bickley, L. S. (2026). Bates' Guide to Physical Examination and History Taking, 13th ed., Ch. 11
2. A 30-year-old woman presents with fatigue, weight gain, and cold intolerance. Labs show TSH of 8.5 mIU/L
(normal 0.5-4.5), free T4 of 0.4 ng/dL (normal 0.8-1.8), and positive thyroid peroxidase antibodies. Which
additional finding would most support the diagnosis of Hashimoto thyroiditis?
A) Elevated thyroglobulin antibodies
B) Diffuse goiter on ultrasound
C) Low radioiodine uptake on scintigraphy
Page 1
, D) Elevated erythrocyte sedimentation rate
' Correct Answer: A
Rationale: Positive thyroglobulin antibodies, along with TPO antibodies, are strongly associated with autoimmune
thyroiditis (Hashimoto). While a diffuse goiter is common, it is not specific. Low radioiodine uptake is seen in
painless thyroiditis, and elevated ESR is characteristic of subacute granulomatous thyroiditis.
Why the other answers are wrong:
B) A diffuse goiter is a nonspecific finding that can occur in various thyroid conditions, including iodine
deficiency and Graves' disease.
C) Low radioiodine uptake is typical of thyroiditis but is not specific to Hashimoto and more characteristic of
subacute or painless thyroiditis.
D) Elevated ESR is a feature of subacute thyroiditis (de Quervain's), not Hashimoto's, which is not typically
associated with inflammatory markers.
Reference: Jameson, J. L., et al. (2026). Harrison's Principles of Internal Medicine, 21st ed., Ch. 375
3. A patient with a history of chronic obstructive pulmonary disease (COPD) presents with increased dyspnea and
purulent sputum. Chest X-ray shows no infiltrate. Which management step is most appropriate according to the
GOLD 2026 guidelines?
A) Start broad-spectrum antibiotics and oral corticosteroids
B) Administer a short-acting beta-agonist alone and reassess
C) Initiate long-term oxygen therapy to maintain SpO2 > 90%
D) Add a phosphodiesterase-4 inhibitor for maintenance
' Correct Answer: A
Rationale: This is an acute exacerbation of COPD characterized by increased dyspnea and purulent sputum. GOLD
guidelines recommend short-acting bronchodilators, systemic corticosteroids, and antibiotics when purulent sputum
is present. Long-term oxygen is for chronic hypoxemia, and roflumilast is a maintenance therapy for severe COPD
with chronic bronchitis.
Why the other answers are wrong:
B) A short-acting beta-agonist alone is insufficient; systemic corticosteroids and antibiotics are indicated for
moderate-severe exacerbations with purulent sputum.
C) Long-term oxygen therapy is reserved for chronic respiratory failure with resting SpO2 88%, not for acute
exacerbation management.
D) Phosphodiesterase-4 inhibitors are used for maintenance in severe COPD with chronic bronchitis and
frequent exacerbations, not for acute exacerbation treatment.
Reference: Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2026). Global Strategy for the
Diagnosis, Management, and Prevention of COPD
4. A patient with a history of hypertension and diabetes presents with acute onset of severe headache, nausea, and
blurred vision. Blood pressure is 220/120 mmHg. Which intervention is most appropriate?
A) Administer sublingual nifedipine to rapidly lower blood pressure
B) Start oral labetalol and discharge home with close follow-up
C) Reduce mean arterial pressure by 20-25% within the first hour using IV antihypertensives
D) Initiate a continuous infusion of sodium nitroprusside to achieve a normal blood pressure within 30 minutes
' Correct Answer: C
Rationale: This is hypertensive emergency with end-organ damage (headache, blurred vision). Guidelines
recommend cautious reduction of MAP by 20-25% within the first hour, not to normal levels, to avoid cerebral
hypoperfusion. IV antihypertensives are used in an ICU setting. Sublingual nifedipine is contraindicated due to
unpredictable drops.
Why the other answers are wrong:
A) Sublingual nifedipine is contraindicated in hypertensive emergencies due to rapid, uncontrolled blood
Page 2
, pressure reduction that can cause ischemic events.
B) Oral antihypertensives are not appropriate for hypertensive emergency with acute end-organ damage; IV
therapy is required.
D) Sodium nitroprusside can cause excessive hypotension and cyanide toxicity; rapid normalization is dangerous
and not recommended.
Reference: Whelton, P. K., et al. (2018). 2017 ACC/AHA Hypertension Guideline; 2026 update
5. A patient presents with pleuritic chest pain, dyspnea, and a pericardial friction rub. ECG shows diffuse
ST-segment elevation with PR depression. Which additional finding would most strongly support the diagnosis of
acute pericarditis?
A) Elevated high-sensitivity troponin
B) Positive D-dimer
C) Echocardiogram showing a small pericardial effusion
D) Chest X-ray showing cardiomegaly
' Correct Answer: C
Rationale: A pericardial effusion is a common complication of acute pericarditis and supports the diagnosis.
Elevated troponin may occur in myopericarditis but is not specific. D-dimer suggests pulmonary embolism.
Cardiomegaly on CXR is nonspecific and may indicate pericardial effusion only if the silhouette is enlarged, but it is
not diagnostic.
Why the other answers are wrong:
A) Elevated troponin indicates myocardial injury, which is not typical of isolated pericarditis and more
consistent with myopericarditis or MI.
B) Positive D-dimer is seen in pulmonary embolism and aortic dissection, which can mimic pericarditis but is
not a diagnostic criterion.
D) Cardiomegaly on CXR is a nonspecific finding and does not confirm pericarditis; it may be present in heart
failure.
Reference: Adler, Y., et al. (2015). ESC Guidelines for the Diagnosis and Management of Pericardial Diseases;
2026 update
6. A patient with chronic kidney disease (eGFR 25 mL/min/1.73m²) is prescribed a new medication. Which
pharmacokinetic change would most likely require dose adjustment?
A) Increased volume of distribution for a lipophilic drug
B) Decreased hepatic metabolism of a prodrug
C) Reduced renal clearance of an active metabolite
D) Increased protein binding of an acidic drug
' Correct Answer: C
Rationale: In CKD, renal clearance of drugs and active metabolites is reduced, necessitating dose adjustments.
Volume of distribution may be altered due to fluid overload, but lipophilic drugs are often less affected. Hepatic
metabolism may be variably affected. Protein binding of acidic drugs is often decreased due to uremia and
hypoalbuminemia.
Why the other answers are wrong:
A) Volume of distribution changes are complex; lipophilic drugs may accumulate in tissues, but this is not the
primary reason for dose adjustment in CKD.
B) Hepatic metabolism is generally preserved in CKD, and prodrugs may have altered activation, but this is not
a universal rule.
D) Protein binding of acidic drugs is typically decreased in CKD due to uremic toxins and hypoalbuminemia,
leading to higher free drug levels, not increased binding.
Reference: Lehne, R. A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 5
Page 3
, 7. A 45-year-old man presents with acute severe headache and vomiting. Non-contrast CT of the head is negative.
Lumbar puncture is performed 4 hours after symptom onset. Which CSF finding would be most consistent with
subarachnoid hemorrhage?
A) Clear CSF with normal opening pressure
B) Elevated opening pressure with xanthochromia
C) WBC count of 500/mm³ with 90% lymphocytes
D) CSF protein of 20 mg/dL and glucose of 80 mg/dL
' Correct Answer: B
Rationale: In subarachnoid hemorrhage, xanthochromia (yellowish supernatant from bilirubin) appears 6-12 hours
after bleeding and is a key finding. Elevated opening pressure is common. Clear CSF with normal pressure rules out
SAH. Lymphocytic pleocytosis suggests meningitis. Normal protein and glucose are not consistent with SAH.
Why the other answers are wrong:
A) Clear CSF with normal opening pressure makes subarachnoid hemorrhage highly unlikely.
C) Lymphocytic pleocytosis is more indicative of viral or tuberculous meningitis, not acute hemorrhage.
D) Normal CSF protein and glucose are not typical of SAH, which usually shows elevated protein and normal
glucose.
Reference: Connolly, E. S., et al. (2012). Guidelines for the Management of Aneurysmal Subarachnoid
Hemorrhage; 2026 update
8. A patient with type 2 diabetes is started on metformin. Which mechanism best explains its glucose-lowering
effect?
A) Stimulates pancreatic beta cells to secrete insulin
B) Inhibits renal glucose reabsorption via SGLT2
C) Activates AMPK, reducing hepatic gluconeogenesis
D) Increases insulin sensitivity at peripheral tissues only
' Correct Answer: C
Rationale: Metformin primarily activates AMPK, leading to reduced hepatic glucose production and increased
insulin sensitivity. It does not stimulate insulin secretion. SGLT2 inhibitors block renal glucose reabsorption. While
metformin improves peripheral insulin sensitivity, its primary action is hepatic.
Why the other answers are wrong:
A) Metformin does not stimulate insulin secretion; sulfonylureas do.
B) SGLT2 inhibition is the mechanism of canagliflozin, not metformin.
D) Peripheral insulin sensitivity is a secondary effect; the primary action is on hepatic gluconeogenesis.
Reference: Lehne, R. A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 56
9. A patient with decompensated cirrhosis presents with tense ascites, jaundice, and confusion. Which treatment is
most appropriate for the ascites?
A) Large-volume paracentesis with albumin replacement
B) Oral furosemide 40 mg daily
C) Transjugular intrahepatic portosystemic shunt (TIPS)
D) Lactulose 30 mL every 6 hours
' Correct Answer: A
Rationale: Large-volume paracentesis with albumin is the first-line treatment for tense ascites, as it provides rapid
relief and prevents post-paracentesis circulatory dysfunction. Diuretics are used for moderate ascites but are slower.
TIPS is reserved for refractory ascites. Lactulose treats hepatic encephalopathy, not ascites.
Why the other answers are wrong:
B) Diuretics are effective but act slowly and are not the immediate choice for tense ascites causing respiratory
compromise.
C) TIPS is reserved for refractory ascites and carries risks; it is not first-line for tense ascites.
Page 4
