NSG6440 FINAL EXAM SPRING 2026/2027 |
NSG 6440 Questions & Answers | All
Answered Correctly 100/100 | Latest | Pass
Guaranteed - A+ Graded
Course: NSG6440 Advanced Practice Nursing: Primary Care (Graduate Level) | Exam
Type: Comprehensive Final | Format: Board-Style Clinical Vignettes | Alignment:
AANP/ANCC FNP Certification 2026/2027 Blueprint
[Section 1: Advanced Health Assessment & Differential Diagnosis
(Questions 1-20)]
Q1. A 45-year-old male presents with chest pain described as "pressure" radiating to the
left arm, onset 30 minutes ago while at rest. He is diaphoretic and nauseated. Vital
signs: BP 160/95, HR 98, RR 20, O2 sat 94% on room air. Which is the FIRST priority
action for the NP?
A. Obtain a 12-lead EKG within 10 minutes
B. Administer sublingual nitroglycerin 0.4 mg
C. Order troponin I and complete metabolic panel
D. Start aspirin 325 mg chewable
,Correct Answer: A. Obtain a 12-lead EKG within 10 minutes [CORRECT]
Rationale: In suspected acute coronary syndrome (ACS), the 10-minute EKG is the
critical first step to differentiate STEMI (requiring emergent reperfusion) from
NSTEMI/unstable angina. While aspirin and nitroglycerin are important, EKG guides all
subsequent management. The 2026 AHA/ACC guidelines emphasize "door-to-EKG time
<10 minutes" as a quality metric. Troponins are drawn but do not change immediate
disposition.
Q2. A 62-year-old female reports progressive dyspnea on exertion, orthopnea, and
bilateral lower extremity edema for 2 weeks. Physical exam reveals JVD, S3 gallop, and
crackles at lung bases. Which finding on echocardiogram would MOST support a
diagnosis of heart failure with preserved ejection fraction (HFpEF)?
A. Left ventricular ejection fraction 35%
B. Left ventricular ejection fraction 55% with elevated E/e' ratio
C. Left ventricular ejection fraction 25% with dilated left ventricle
D. Left ventricular ejection fraction 60% with reduced left atrial volume
Correct Answer: B. Left ventricular ejection fraction 55% with elevated E/e' ratio
[CORRECT]
Rationale: HFpEF is defined as EF ≥50% with evidence of diastolic dysfunction. The E/e'
ratio (mitral inflow E velocity to mitral annular e' velocity) >14 indicates elevated left
ventricular filling pressures, supporting HFpEF. Option A describes HFrEF; Option C
describes severe HFrEF; Option D lacks diastolic dysfunction evidence. 2026
,ACC/AHA/HFSA guidelines emphasize comprehensive echocardiographic assessment
for HFpEF diagnosis.
Q3. A 28-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. Physical exam reveals dry skin, brittle hair, and delayed deep tendon
reflexes. Laboratory studies show TSH 12.5 mIU/L (normal 0.4-4.0) and free T4 0.6
ng/dL (normal 0.8-1.8). What is the most likely diagnosis?
A. Subclinical hypothyroidism
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Hashimoto's thyroiditis
Correct Answer: B. Primary hypothyroidism [CORRECT]
Rationale: Primary hypothyroidism is characterized by elevated TSH with low free T4,
indicating thyroid gland failure. Subclinical hypothyroidism (Option A) shows elevated
TSH with normal free T4. Secondary hypothyroidism (Option C) shows low TSH with low
free T4 (pituitary/hypothalamic dysfunction). While Hashimoto's thyroiditis (Option D) is
the most common cause of primary hypothyroidism, the question asks for the diagnosis
based on lab pattern, not etiology.
Q4. A 55-year-old male with a 30 pack-year smoking history presents with cough,
hemoptysis, and unintentional weight loss of 15 pounds over 2 months. Chest X-ray
, reveals a 3.5 cm spiculated mass in the left upper lobe. What is the NEXT best step in
management?
A. Start broad-spectrum antibiotics and repeat chest X-ray in 4 weeks
B. Order a PET-CT scan and schedule bronchoscopy with biopsy
C. Refer immediately to oncology for chemotherapy initiation
D. Obtain sputum cytology for three consecutive mornings
Correct Answer: B. Order a PET-CT scan and schedule bronchoscopy with biopsy
[CORRECT]
Rationale: A spiculated mass in a heavy smoker with constitutional symptoms is highly
suspicious for lung cancer. The 2026 NCCN guidelines recommend tissue diagnosis via
bronchoscopy or CT-guided biopsy for centrally located lesions, with PET-CT for staging.
Starting antibiotics (Option A) delays diagnosis. Chemotherapy (Option C) requires
histologic confirmation first. Sputum cytology (Option D) has low sensitivity for
peripheral lesions.
Q5. [Select All That Apply] A 38-year-old female presents with episodic headaches
described as unilateral, throbbing, associated with nausea, photophobia, and
phonophobia, lasting 4-72 hours. Which features support a diagnosis of migraine
without aura according to ICHD-3 criteria?
A. Headache lasting 4-72 hours if untreated
B. Unilateral location
C. Pulsating quality
D. Aggravation by routine physical activity
NSG 6440 Questions & Answers | All
Answered Correctly 100/100 | Latest | Pass
Guaranteed - A+ Graded
Course: NSG6440 Advanced Practice Nursing: Primary Care (Graduate Level) | Exam
Type: Comprehensive Final | Format: Board-Style Clinical Vignettes | Alignment:
AANP/ANCC FNP Certification 2026/2027 Blueprint
[Section 1: Advanced Health Assessment & Differential Diagnosis
(Questions 1-20)]
Q1. A 45-year-old male presents with chest pain described as "pressure" radiating to the
left arm, onset 30 minutes ago while at rest. He is diaphoretic and nauseated. Vital
signs: BP 160/95, HR 98, RR 20, O2 sat 94% on room air. Which is the FIRST priority
action for the NP?
A. Obtain a 12-lead EKG within 10 minutes
B. Administer sublingual nitroglycerin 0.4 mg
C. Order troponin I and complete metabolic panel
D. Start aspirin 325 mg chewable
,Correct Answer: A. Obtain a 12-lead EKG within 10 minutes [CORRECT]
Rationale: In suspected acute coronary syndrome (ACS), the 10-minute EKG is the
critical first step to differentiate STEMI (requiring emergent reperfusion) from
NSTEMI/unstable angina. While aspirin and nitroglycerin are important, EKG guides all
subsequent management. The 2026 AHA/ACC guidelines emphasize "door-to-EKG time
<10 minutes" as a quality metric. Troponins are drawn but do not change immediate
disposition.
Q2. A 62-year-old female reports progressive dyspnea on exertion, orthopnea, and
bilateral lower extremity edema for 2 weeks. Physical exam reveals JVD, S3 gallop, and
crackles at lung bases. Which finding on echocardiogram would MOST support a
diagnosis of heart failure with preserved ejection fraction (HFpEF)?
A. Left ventricular ejection fraction 35%
B. Left ventricular ejection fraction 55% with elevated E/e' ratio
C. Left ventricular ejection fraction 25% with dilated left ventricle
D. Left ventricular ejection fraction 60% with reduced left atrial volume
Correct Answer: B. Left ventricular ejection fraction 55% with elevated E/e' ratio
[CORRECT]
Rationale: HFpEF is defined as EF ≥50% with evidence of diastolic dysfunction. The E/e'
ratio (mitral inflow E velocity to mitral annular e' velocity) >14 indicates elevated left
ventricular filling pressures, supporting HFpEF. Option A describes HFrEF; Option C
describes severe HFrEF; Option D lacks diastolic dysfunction evidence. 2026
,ACC/AHA/HFSA guidelines emphasize comprehensive echocardiographic assessment
for HFpEF diagnosis.
Q3. A 28-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. Physical exam reveals dry skin, brittle hair, and delayed deep tendon
reflexes. Laboratory studies show TSH 12.5 mIU/L (normal 0.4-4.0) and free T4 0.6
ng/dL (normal 0.8-1.8). What is the most likely diagnosis?
A. Subclinical hypothyroidism
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Hashimoto's thyroiditis
Correct Answer: B. Primary hypothyroidism [CORRECT]
Rationale: Primary hypothyroidism is characterized by elevated TSH with low free T4,
indicating thyroid gland failure. Subclinical hypothyroidism (Option A) shows elevated
TSH with normal free T4. Secondary hypothyroidism (Option C) shows low TSH with low
free T4 (pituitary/hypothalamic dysfunction). While Hashimoto's thyroiditis (Option D) is
the most common cause of primary hypothyroidism, the question asks for the diagnosis
based on lab pattern, not etiology.
Q4. A 55-year-old male with a 30 pack-year smoking history presents with cough,
hemoptysis, and unintentional weight loss of 15 pounds over 2 months. Chest X-ray
, reveals a 3.5 cm spiculated mass in the left upper lobe. What is the NEXT best step in
management?
A. Start broad-spectrum antibiotics and repeat chest X-ray in 4 weeks
B. Order a PET-CT scan and schedule bronchoscopy with biopsy
C. Refer immediately to oncology for chemotherapy initiation
D. Obtain sputum cytology for three consecutive mornings
Correct Answer: B. Order a PET-CT scan and schedule bronchoscopy with biopsy
[CORRECT]
Rationale: A spiculated mass in a heavy smoker with constitutional symptoms is highly
suspicious for lung cancer. The 2026 NCCN guidelines recommend tissue diagnosis via
bronchoscopy or CT-guided biopsy for centrally located lesions, with PET-CT for staging.
Starting antibiotics (Option A) delays diagnosis. Chemotherapy (Option C) requires
histologic confirmation first. Sputum cytology (Option D) has low sensitivity for
peripheral lesions.
Q5. [Select All That Apply] A 38-year-old female presents with episodic headaches
described as unilateral, throbbing, associated with nausea, photophobia, and
phonophobia, lasting 4-72 hours. Which features support a diagnosis of migraine
without aura according to ICHD-3 criteria?
A. Headache lasting 4-72 hours if untreated
B. Unilateral location
C. Pulsating quality
D. Aggravation by routine physical activity
