NSG 554 Exam 2 V3 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 2 2026)
1. A 45-year-old male presents with a persistent cough for 3 weeks following a viral URI. He
has no fever or shortness of breath. Lung sounds are clear. Which is the most appropriate
management for acute bronchitis?
A. Prescribe Azithromycin for 5 days.
B. Initiate symptomatic treatment with antitussives and fluids.
C. Order a chest X-ray to rule out pneumonia.
D. Prescribe Albuterol inhaler for all patients.
Answer: B
Rationale: Acute bronchitis is predominantly viral in origin, making antibiotics like
Azithromycin unnecessary and inappropriate for routine cases. Symptomatic relief
focusing on cough suppression and hydration is the cornerstone of primary care
management. Routine chest X-rays are not indicated unless there are abnormal vital signs
or physical findings suggestive of consolidation.
2. According to the GINA guidelines, what is the preferred rescue medication for a patient
with mild intermittent asthma?
A. SABA (Albuterol) alone as needed.
,B. Low-dose ICS-formoterol as needed.
C. Daily low-dose ICS with SABA as needed.
D. Oral corticosteroids for any exacerbation.
Answer: B
Rationale: The Global Initiative for Asthma (GINA) now recommends low-dose ICS-
formoterol as the preferred reliever across all asthma severities to reduce the risk of severe
exacerbations. Using SABA alone is no longer recommended because it does not address
the underlying inflammation and is associated with increased mortality. This shift
emphasizes early intervention with inhaled corticosteroids during symptoms.
3. A 68-year-old female with a 40 pack-year history of smoking presents with progressive
dyspnea and a productive cough. Spirometry shows an FEV1/FVC ratio of 0.62. What is the
diagnosis?
A. Restrictive Lung Disease
B. Asthma
C. Congestive Heart Failure
D. Chronic Obstructive Pulmonary Disease (COPD)
Answer: D
Rationale: An FEV1/FVC ratio of less than 0.70 post-bronchodilator is the diagnostic
hallmark of COPD according to GOLD guidelines. The patient’s significant smoking history
,and clinical presentation of chronic cough and dyspnea further support this diagnosis. This
obstructive pattern is permanent and usually progressive, unlike the reversible obstruction
seen in asthma.
4. A patient with hypertension and Type 2 Diabetes should have a blood pressure goal of less
than:
A. 140/90 mmHg
B. 130/80 mmHg
C. 150/90 mmHg
D. 120/70 mmHg
Answer: B
Rationale: Current ACC/AHA guidelines recommend a blood pressure target of less than
130/80 mmHg for patients with diabetes to reduce cardiovascular risk. Aggressive
management is necessary because diabetes and hypertension act synergistically to increase
the risk of macrovascular and microvascular complications. Controlling BP is often more
effective at preventing stroke in this population than intensive glucose control alone.
5. Which of the following is considered the first-line antibiotic treatment for a healthy adult
diagnosed with Community-Acquired Pneumonia (CAP) and no recent antibiotic use?
A. Amoxicillin 1g three times daily.
B. Levofloxacin 750mg daily.
C. Ceftriaxone 1g IM once.
, D. Trimethoprim-Sulfamethoxazole DS.
Answer: A
Rationale: Recent updates to the ATS/IDSA guidelines recommend high-dose Amoxicillin
as a first-line monotherapy for CAP in healthy outpatients without comorbidities.
Doxycycline or a macrolide (if local resistance is <25%) are also viable options for this
population. Fluoroquinolones like Levofloxacin should be reserved for patients with
significant comorbidities or recent antibiotic exposure to prevent resistance.
6. A 32-year-old female presents with a 2-day history of sore throat, fever of 101F, and tender
anterior cervical lymphadenopathy. She denies cough. What is the most appropriate next
step?
A. Prescribe Penicillin VK empirically.
B. Perform a Rapid Antigen Detection Test (RADT) for Strep.
C. Recommend supportive care only for viral pharyngitis.
D. Order a monospot test.
Answer: B
Rationale: The patient’s Centor score of 3 (fever, no cough, lymphadenopathy) indicates a
moderate to high probability of Group A Strep and warrants testing. Empiric treatment is
generally discouraged without a positive RADT or culture to support antibiotic
stewardship. If the RADT is negative in an adult, further culture is often not required, but
clinical judgment is essential.
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 2 2026)
1. A 45-year-old male presents with a persistent cough for 3 weeks following a viral URI. He
has no fever or shortness of breath. Lung sounds are clear. Which is the most appropriate
management for acute bronchitis?
A. Prescribe Azithromycin for 5 days.
B. Initiate symptomatic treatment with antitussives and fluids.
C. Order a chest X-ray to rule out pneumonia.
D. Prescribe Albuterol inhaler for all patients.
Answer: B
Rationale: Acute bronchitis is predominantly viral in origin, making antibiotics like
Azithromycin unnecessary and inappropriate for routine cases. Symptomatic relief
focusing on cough suppression and hydration is the cornerstone of primary care
management. Routine chest X-rays are not indicated unless there are abnormal vital signs
or physical findings suggestive of consolidation.
2. According to the GINA guidelines, what is the preferred rescue medication for a patient
with mild intermittent asthma?
A. SABA (Albuterol) alone as needed.
,B. Low-dose ICS-formoterol as needed.
C. Daily low-dose ICS with SABA as needed.
D. Oral corticosteroids for any exacerbation.
Answer: B
Rationale: The Global Initiative for Asthma (GINA) now recommends low-dose ICS-
formoterol as the preferred reliever across all asthma severities to reduce the risk of severe
exacerbations. Using SABA alone is no longer recommended because it does not address
the underlying inflammation and is associated with increased mortality. This shift
emphasizes early intervention with inhaled corticosteroids during symptoms.
3. A 68-year-old female with a 40 pack-year history of smoking presents with progressive
dyspnea and a productive cough. Spirometry shows an FEV1/FVC ratio of 0.62. What is the
diagnosis?
A. Restrictive Lung Disease
B. Asthma
C. Congestive Heart Failure
D. Chronic Obstructive Pulmonary Disease (COPD)
Answer: D
Rationale: An FEV1/FVC ratio of less than 0.70 post-bronchodilator is the diagnostic
hallmark of COPD according to GOLD guidelines. The patient’s significant smoking history
,and clinical presentation of chronic cough and dyspnea further support this diagnosis. This
obstructive pattern is permanent and usually progressive, unlike the reversible obstruction
seen in asthma.
4. A patient with hypertension and Type 2 Diabetes should have a blood pressure goal of less
than:
A. 140/90 mmHg
B. 130/80 mmHg
C. 150/90 mmHg
D. 120/70 mmHg
Answer: B
Rationale: Current ACC/AHA guidelines recommend a blood pressure target of less than
130/80 mmHg for patients with diabetes to reduce cardiovascular risk. Aggressive
management is necessary because diabetes and hypertension act synergistically to increase
the risk of macrovascular and microvascular complications. Controlling BP is often more
effective at preventing stroke in this population than intensive glucose control alone.
5. Which of the following is considered the first-line antibiotic treatment for a healthy adult
diagnosed with Community-Acquired Pneumonia (CAP) and no recent antibiotic use?
A. Amoxicillin 1g three times daily.
B. Levofloxacin 750mg daily.
C. Ceftriaxone 1g IM once.
, D. Trimethoprim-Sulfamethoxazole DS.
Answer: A
Rationale: Recent updates to the ATS/IDSA guidelines recommend high-dose Amoxicillin
as a first-line monotherapy for CAP in healthy outpatients without comorbidities.
Doxycycline or a macrolide (if local resistance is <25%) are also viable options for this
population. Fluoroquinolones like Levofloxacin should be reserved for patients with
significant comorbidities or recent antibiotic exposure to prevent resistance.
6. A 32-year-old female presents with a 2-day history of sore throat, fever of 101F, and tender
anterior cervical lymphadenopathy. She denies cough. What is the most appropriate next
step?
A. Prescribe Penicillin VK empirically.
B. Perform a Rapid Antigen Detection Test (RADT) for Strep.
C. Recommend supportive care only for viral pharyngitis.
D. Order a monospot test.
Answer: B
Rationale: The patient’s Centor score of 3 (fever, no cough, lymphadenopathy) indicates a
moderate to high probability of Group A Strep and warrants testing. Empiric treatment is
generally discouraged without a positive RADT or culture to support antibiotic
stewardship. If the RADT is negative in an adult, further culture is often not required, but
clinical judgment is essential.
