NSG 554 Final Exam V3 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Final Exam 2026)
1. A 45-year-old male patient presents for a follow-up on his hypertension. He was started on
Lisinopril 10mg daily two weeks ago and has developed a persistent, dry, non-productive
cough. Which of the following is the most appropriate next step in management?
A. Discontinue Lisinopril and start Losartan.
B. Increase the dose of Lisinopril to 20mg.
C. Add Diphenhydramine to manage the cough.
D. Reassure the patient that the cough will resolve in 48 hours.
Answer: A
Rationale: ACE inhibitor-induced cough is caused by the accumulation of bradykinin and
substance P in the respiratory tract. It is a class effect and does not resolve with time while
the medication is continued. Switching to an Angiotensin II Receptor Blocker (ARB) like
Losartan provides similar cardiovascular benefits without the bradykinin-related side
effect.
2. According to the GINA guidelines for asthma management, what is the preferred controller
and reliever for a patient with Step 2 asthma?
A. As-needed low-dose ICS-formoterol.
,B. Daily low-dose ICS plus SABA as needed.
C. SABA (Albuterol) as needed only.
D. Daily medium-dose ICS-LABA.
Answer: A
Rationale: Current GINA guidelines emphasize the use of as-needed low-dose ICS-
formoterol as the preferred therapy in Step 2 to reduce the risk of severe exacerbations.
This strategy ensures that the patient receives anti-inflammatory medication whenever
they treat their symptoms. It has superseded the previous standard of regular daily ICS
with SABA for symptom relief in the primary care setting.
3. A 32-year-old female presents with symptoms of dysuria, frequency, and urgency. A
urinalysis reveals positive nitrites and leukocyte esterase. She is not pregnant and has no
known drug allergies. What is the first-line treatment for this uncomplicated UTI?
A. Ciprofloxacin 500mg BID for 7 days.
B. Nitrofurantoin (Macrobid) 100mg BID for 5 days.
C. Amoxicillin 500mg TID for 10 days.
D. Doxycycline 100mg BID for 7 days.
Answer: B
Rationale: Nitrofurantoin is a first-line agent for uncomplicated cystitis due to its high
efficacy against E. coli and low rates of resistance. Fluoroquinolones like Ciprofloxacin
,should be reserved for more complicated infections or when other options are unavailable
due to side effect concerns. Amoxicillin is generally avoided as a first-line empirical therapy
due to widespread resistance among uropathogens.
4. Which of the following physical exam findings is most suggestive of Community-Acquired
Pneumonia (CAP)?
A. Hyperresonance on percussion.
B. Egophony (E to A change).
C. Decreased tactile fremitus.
D. Wheezing throughout all lung fields.
Answer: B
Rationale: Egophony is a clinical sign where the spoken ‘E’ is heard as ‘A’ over areas of
lung consolidation, which is characteristic of pneumonia. Consolidation increases the
transmission of high-frequency sounds, leading to increased tactile fremitus and dullness
to percussion. Conversely, hyperresonance and decreased fremitus are associated with
conditions like COPD or pneumothorax.
5. A 65-year-old male with a history of heart failure (HFrEF) and an ejection fraction of 35%
presents for management. Which of the following medication classes is NOT considered part
of the GDMT (Guideline-Directed Medical Therapy) for reducing mortality?
A. ACE Inhibitors/ARNI.
B. Beta-Blockers (Carvedilol, Metoprolol Succinate).
, C. Calcium Channel Blockers (Verapamil).
D. SGLT2 Inhibitors.
Answer: C
Rationale: Non-dihydropyridine calcium channel blockers like Verapamil and Diltiazem
are generally contraindicated in HFrEF because they have negative inotropic effects that
can worsen heart failure. The four pillars of GDMT include ARNI/ACEI/ARB, evidence-
based Beta-blockers, Mineralocorticoid receptor antagonists (MRA), and SGLT2 inhibitors.
These classes have been proven in clinical trials to reduce both morbidity and mortality in
patients with reduced ejection fraction.
6. A patient presents with a ‘velvety,’ ‘stuck-on’ appearance lesion on the back that is waxy
and well-demarcated. What is the most likely diagnosis?
A. Malignant Melanoma.
B. Basal Cell Carcinoma.
C. Seborrheic Keratosis.
D. Actinic Keratosis.
Answer: C
Rationale: Seborrheic keratosis is a common benign skin tumor in older adults
characterized by its waxy, ‘pasted on’ appearance. These lesions are typically harmless and
do not require treatment unless they become irritated or the patient desires removal for
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Final Exam 2026)
1. A 45-year-old male patient presents for a follow-up on his hypertension. He was started on
Lisinopril 10mg daily two weeks ago and has developed a persistent, dry, non-productive
cough. Which of the following is the most appropriate next step in management?
A. Discontinue Lisinopril and start Losartan.
B. Increase the dose of Lisinopril to 20mg.
C. Add Diphenhydramine to manage the cough.
D. Reassure the patient that the cough will resolve in 48 hours.
Answer: A
Rationale: ACE inhibitor-induced cough is caused by the accumulation of bradykinin and
substance P in the respiratory tract. It is a class effect and does not resolve with time while
the medication is continued. Switching to an Angiotensin II Receptor Blocker (ARB) like
Losartan provides similar cardiovascular benefits without the bradykinin-related side
effect.
2. According to the GINA guidelines for asthma management, what is the preferred controller
and reliever for a patient with Step 2 asthma?
A. As-needed low-dose ICS-formoterol.
,B. Daily low-dose ICS plus SABA as needed.
C. SABA (Albuterol) as needed only.
D. Daily medium-dose ICS-LABA.
Answer: A
Rationale: Current GINA guidelines emphasize the use of as-needed low-dose ICS-
formoterol as the preferred therapy in Step 2 to reduce the risk of severe exacerbations.
This strategy ensures that the patient receives anti-inflammatory medication whenever
they treat their symptoms. It has superseded the previous standard of regular daily ICS
with SABA for symptom relief in the primary care setting.
3. A 32-year-old female presents with symptoms of dysuria, frequency, and urgency. A
urinalysis reveals positive nitrites and leukocyte esterase. She is not pregnant and has no
known drug allergies. What is the first-line treatment for this uncomplicated UTI?
A. Ciprofloxacin 500mg BID for 7 days.
B. Nitrofurantoin (Macrobid) 100mg BID for 5 days.
C. Amoxicillin 500mg TID for 10 days.
D. Doxycycline 100mg BID for 7 days.
Answer: B
Rationale: Nitrofurantoin is a first-line agent for uncomplicated cystitis due to its high
efficacy against E. coli and low rates of resistance. Fluoroquinolones like Ciprofloxacin
,should be reserved for more complicated infections or when other options are unavailable
due to side effect concerns. Amoxicillin is generally avoided as a first-line empirical therapy
due to widespread resistance among uropathogens.
4. Which of the following physical exam findings is most suggestive of Community-Acquired
Pneumonia (CAP)?
A. Hyperresonance on percussion.
B. Egophony (E to A change).
C. Decreased tactile fremitus.
D. Wheezing throughout all lung fields.
Answer: B
Rationale: Egophony is a clinical sign where the spoken ‘E’ is heard as ‘A’ over areas of
lung consolidation, which is characteristic of pneumonia. Consolidation increases the
transmission of high-frequency sounds, leading to increased tactile fremitus and dullness
to percussion. Conversely, hyperresonance and decreased fremitus are associated with
conditions like COPD or pneumothorax.
5. A 65-year-old male with a history of heart failure (HFrEF) and an ejection fraction of 35%
presents for management. Which of the following medication classes is NOT considered part
of the GDMT (Guideline-Directed Medical Therapy) for reducing mortality?
A. ACE Inhibitors/ARNI.
B. Beta-Blockers (Carvedilol, Metoprolol Succinate).
, C. Calcium Channel Blockers (Verapamil).
D. SGLT2 Inhibitors.
Answer: C
Rationale: Non-dihydropyridine calcium channel blockers like Verapamil and Diltiazem
are generally contraindicated in HFrEF because they have negative inotropic effects that
can worsen heart failure. The four pillars of GDMT include ARNI/ACEI/ARB, evidence-
based Beta-blockers, Mineralocorticoid receptor antagonists (MRA), and SGLT2 inhibitors.
These classes have been proven in clinical trials to reduce both morbidity and mortality in
patients with reduced ejection fraction.
6. A patient presents with a ‘velvety,’ ‘stuck-on’ appearance lesion on the back that is waxy
and well-demarcated. What is the most likely diagnosis?
A. Malignant Melanoma.
B. Basal Cell Carcinoma.
C. Seborrheic Keratosis.
D. Actinic Keratosis.
Answer: C
Rationale: Seborrheic keratosis is a common benign skin tumor in older adults
characterized by its waxy, ‘pasted on’ appearance. These lesions are typically harmless and
do not require treatment unless they become irritated or the patient desires removal for
