1
. NSG6440 / NSG 6440 FINAL EXAM (LATEST 2026/27):
PRACTICUM IV FAMILY HEALTH - PRIMARY CARE |
SOUTH UNIVERSITY
1.
A 52-year-old woman presents to the primary care clinic for an annual
examination. She has hypertension controlled with lisinopril, a BMI of 31 kg/m²,
and a sedentary lifestyle. She reports that her mother had a myocardial infarction at
age 58. Her blood pressure today is 138/84 mmHg. She does not smoke and drinks
alcohol occasionally. Which intervention should the family nurse practitioner
prioritize as part of cardiovascular risk reduction?
A. Recommend complete avoidance of dietary carbohydrates
B. Encourage regular physical activity, weight reduction, and a heart-healthy
dietary pattern
C. Begin aspirin therapy solely because of her family history
D. Recommend annual cardiac stress testing regardless of symptoms
Answer: B
2.
A 67-year-old man presents for follow-up of hypertension and hyperlipidemia. He
reports increasing difficulty hearing conversations, particularly when several
people are speaking at once. Otoscopic examination reveals no cerumen impaction,
drainage, or acute infection. Which is the most appropriate next step in primary
care?
A. Prescribe oral antibiotics
B. Reassure him that age-related hearing loss does not require evaluation
C. Arrange formal audiologic evaluation
D. Begin high-dose corticosteroid therapy immediately
Answer: C
3.
A 24-year-old woman presents with dysuria, urinary frequency, and suprapubic
discomfort for 2 days. She denies fever, flank pain, vaginal discharge, or pelvic
,2
pain. She is not pregnant and has no history of recurrent urinary tract infections.
Which diagnosis is most consistent with this presentation?
A. Acute uncomplicated cystitis
B. Acute pyelonephritis
C. Pelvic inflammatory disease
D. Nephrolithiasis
Answer: A
4.
A 35-year-old woman presents with fatigue, constipation, cold intolerance, dry
skin, and gradual weight gain. Her thyroid gland is not enlarged, and she has no
neck pain. Laboratory testing demonstrates an elevated TSH with a low free T4.
Which diagnosis best explains these findings?
A. Primary hypothyroidism
B. Primary hyperthyroidism
C. Secondary hyperthyroidism
D. Euthyroid sick syndrome
Answer: A
5.
A 61-year-old patient with type 2 diabetes mellitus returns for chronic disease
management. His A1C has remained above his individualized target despite
adherence to metformin, dietary counseling, and regular physical activity. Renal
function is adequate, and he has established atherosclerotic cardiovascular disease.
Which consideration is most appropriate when intensifying therapy?
A. Add a medication class with demonstrated cardiovascular benefit
B. Discontinue metformin immediately in every patient with cardiovascular
disease
C. Avoid all injectable medications permanently
D. Treat only the fasting glucose and ignore overall glycemic control
Answer: A
6.
,3
A 44-year-old woman reports episodic headaches occurring three to four times per
month. She describes unilateral throbbing pain associated with nausea and
photophobia. Neurologic examination is normal, and there are no red-flag features.
Which diagnosis is most likely?
A. Tension-type headache
B. Migraine without aura
C. Cluster headache
D. Temporal arteritis
Answer: B
7.
A 72-year-old man presents with urinary hesitancy, weak urinary stream,
prolonged voiding, and nocturia. He denies fever, dysuria, hematuria, and acute
urinary retention. Which condition should be highest on the differential diagnosis?
A. Benign prostatic hyperplasia
B. Acute bacterial prostatitis
C. Nephrotic syndrome
D. Acute cystitis
Answer: A
8.
A 29-year-old woman reports a painless breast lump that she first noticed several
weeks ago. She has no fever, erythema, nipple discharge, or recent trauma. On
examination, the mass is firm and mobile. What is the most appropriate approach?
A. Assume the mass is benign because she is young
B. Perform appropriate diagnostic breast imaging based on age and clinical
findings
C. Begin antibiotics without further evaluation
D. Reassure her that breast cancer cannot occur before age 40
Answer: B
9.
, 4
A 76-year-old woman taking warfarin for atrial fibrillation presents with
spontaneous bruising and several episodes of epistaxis. Her medication history
reveals a recently prescribed antibiotic. Which laboratory test is most important to
evaluate initially?
A. Serum amylase
B. INR
C. Troponin
D. Hemoglobin A1C
Answer: B
10.
A 17-year-old adolescent presents for an annual examination accompanied by a
parent. The parent remains in the room and answers most questions concerning the
adolescent's school performance, relationships, mood, and substance use. Which
approach is most appropriate for comprehensive adolescent primary care?
A. Conduct the entire interview with the parent
B. Avoid discussing sexual or substance-use behaviors
C. Provide confidential one-on-one time with the adolescent when appropriate
D. Require the parent to approve every question asked
Answer: C
11.
A 58-year-old man with a 40-pack-year smoking history presents for preventive
care. He currently smokes one pack per day and states that he has tried to quit
several times. Which intervention is most appropriate?
A. Tell him to stop smoking without further counseling
B. Assess readiness to quit and provide evidence-based tobacco cessation support
C. Recommend switching permanently to cigars
D. Recommend smoking only outdoors
Answer: B
12.
. NSG6440 / NSG 6440 FINAL EXAM (LATEST 2026/27):
PRACTICUM IV FAMILY HEALTH - PRIMARY CARE |
SOUTH UNIVERSITY
1.
A 52-year-old woman presents to the primary care clinic for an annual
examination. She has hypertension controlled with lisinopril, a BMI of 31 kg/m²,
and a sedentary lifestyle. She reports that her mother had a myocardial infarction at
age 58. Her blood pressure today is 138/84 mmHg. She does not smoke and drinks
alcohol occasionally. Which intervention should the family nurse practitioner
prioritize as part of cardiovascular risk reduction?
A. Recommend complete avoidance of dietary carbohydrates
B. Encourage regular physical activity, weight reduction, and a heart-healthy
dietary pattern
C. Begin aspirin therapy solely because of her family history
D. Recommend annual cardiac stress testing regardless of symptoms
Answer: B
2.
A 67-year-old man presents for follow-up of hypertension and hyperlipidemia. He
reports increasing difficulty hearing conversations, particularly when several
people are speaking at once. Otoscopic examination reveals no cerumen impaction,
drainage, or acute infection. Which is the most appropriate next step in primary
care?
A. Prescribe oral antibiotics
B. Reassure him that age-related hearing loss does not require evaluation
C. Arrange formal audiologic evaluation
D. Begin high-dose corticosteroid therapy immediately
Answer: C
3.
A 24-year-old woman presents with dysuria, urinary frequency, and suprapubic
discomfort for 2 days. She denies fever, flank pain, vaginal discharge, or pelvic
,2
pain. She is not pregnant and has no history of recurrent urinary tract infections.
Which diagnosis is most consistent with this presentation?
A. Acute uncomplicated cystitis
B. Acute pyelonephritis
C. Pelvic inflammatory disease
D. Nephrolithiasis
Answer: A
4.
A 35-year-old woman presents with fatigue, constipation, cold intolerance, dry
skin, and gradual weight gain. Her thyroid gland is not enlarged, and she has no
neck pain. Laboratory testing demonstrates an elevated TSH with a low free T4.
Which diagnosis best explains these findings?
A. Primary hypothyroidism
B. Primary hyperthyroidism
C. Secondary hyperthyroidism
D. Euthyroid sick syndrome
Answer: A
5.
A 61-year-old patient with type 2 diabetes mellitus returns for chronic disease
management. His A1C has remained above his individualized target despite
adherence to metformin, dietary counseling, and regular physical activity. Renal
function is adequate, and he has established atherosclerotic cardiovascular disease.
Which consideration is most appropriate when intensifying therapy?
A. Add a medication class with demonstrated cardiovascular benefit
B. Discontinue metformin immediately in every patient with cardiovascular
disease
C. Avoid all injectable medications permanently
D. Treat only the fasting glucose and ignore overall glycemic control
Answer: A
6.
,3
A 44-year-old woman reports episodic headaches occurring three to four times per
month. She describes unilateral throbbing pain associated with nausea and
photophobia. Neurologic examination is normal, and there are no red-flag features.
Which diagnosis is most likely?
A. Tension-type headache
B. Migraine without aura
C. Cluster headache
D. Temporal arteritis
Answer: B
7.
A 72-year-old man presents with urinary hesitancy, weak urinary stream,
prolonged voiding, and nocturia. He denies fever, dysuria, hematuria, and acute
urinary retention. Which condition should be highest on the differential diagnosis?
A. Benign prostatic hyperplasia
B. Acute bacterial prostatitis
C. Nephrotic syndrome
D. Acute cystitis
Answer: A
8.
A 29-year-old woman reports a painless breast lump that she first noticed several
weeks ago. She has no fever, erythema, nipple discharge, or recent trauma. On
examination, the mass is firm and mobile. What is the most appropriate approach?
A. Assume the mass is benign because she is young
B. Perform appropriate diagnostic breast imaging based on age and clinical
findings
C. Begin antibiotics without further evaluation
D. Reassure her that breast cancer cannot occur before age 40
Answer: B
9.
, 4
A 76-year-old woman taking warfarin for atrial fibrillation presents with
spontaneous bruising and several episodes of epistaxis. Her medication history
reveals a recently prescribed antibiotic. Which laboratory test is most important to
evaluate initially?
A. Serum amylase
B. INR
C. Troponin
D. Hemoglobin A1C
Answer: B
10.
A 17-year-old adolescent presents for an annual examination accompanied by a
parent. The parent remains in the room and answers most questions concerning the
adolescent's school performance, relationships, mood, and substance use. Which
approach is most appropriate for comprehensive adolescent primary care?
A. Conduct the entire interview with the parent
B. Avoid discussing sexual or substance-use behaviors
C. Provide confidential one-on-one time with the adolescent when appropriate
D. Require the parent to approve every question asked
Answer: C
11.
A 58-year-old man with a 40-pack-year smoking history presents for preventive
care. He currently smokes one pack per day and states that he has tried to quit
several times. Which intervention is most appropriate?
A. Tell him to stop smoking without further counseling
B. Assess readiness to quit and provide evidence-based tobacco cessation support
C. Recommend switching permanently to cigars
D. Recommend smoking only outdoors
Answer: B
12.
