NSG 555 Exam 3 V3 | NSG 555 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 3 2026)
1. A 68-year-old male with a history of hypertension and smoking presents with a new onset
of a harsh systolic crescendo-decrescendo murmur heard best at the second intercostal
space, right sternal border. The murmur radiates to the carotid arteries. What is the most
likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: B
Rationale: Aortic stenosis typically presents as a systolic crescendo-decrescendo murmur
at the right upper sternal border. The radiation to the carotids is a classic physical finding
as the blood is ejected through a narrowed valve into the systemic circulation. This
condition is often age-related due to calcification and requires careful monitoring for
symptoms like syncope or angina.
,2. According to the GOLD 2024 guidelines, which of the following is the required spirometry
finding to confirm the diagnosis of COPD?
A. FEV1/FVC ratio < 0.70 post-bronchodilator
B. FEV1 < 80% predicted
C. FEV1/FVC ratio > 0.70 post-bronchodilator
D. FVC < 70% predicted
Answer: A
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the definitive
diagnostic criterion for airflow limitation that is not fully reversible. This measurement
ensures that the obstruction is persistent and characteristic of COPD rather than asthma.
Spirometry is considered the gold standard for diagnosis in patients presenting with
chronic cough, dyspnea, and sputum production.
3. A 45-year-old female patient with a BMI of 32 presents with frequent heartburn and
regurgitation. She has tried OTC antacids with minimal relief. What is the initial
recommended pharmacological step for her suspected GERD?
A. Daily H2 Receptor Antagonist for 2 weeks
B. Metoclopramide 10mg before meals
C. Immediate referral for Upper Endoscopy
D. Daily Proton Pump Inhibitor (PPI) for 8 weeks
,Answer: D
Rationale: The standard of care for initiating therapy in patients with classic symptoms of
GERD and no ‘red flags’ is an 8-week course of PPIs. PPIs are more effective than H2
blockers at healing esophagitis and providing symptomatic relief. If symptoms do not
resolve after the full 8-week course, further investigation such as endoscopy may be
warranted.
4. Which of the following physical exam findings is most suggestive of heart failure with
reduced ejection fraction (HFrEF)?
A. S3 heart sound
B. S4 heart sound
C. Midsystolic click
D. Opening snap
Answer: A
Rationale: An S3 gallop is a sign of ventricular filling into a dilated, non-compliant
chamber and is highly specific for heart failure in older adults. In contrast, an S4 sound is
associated with left ventricular hypertrophy and diastolic stiffness. Recognizing the S3
heart sound is critical for the clinical diagnosis and assessment of volume status in heart
failure patients.
, 5. A patient with a history of asthma reports using their Albuterol inhaler 4 times a week and
waking up 3 times a month with wheezing. How should their asthma be classified according
to GINA/NHLBI guidelines?
A. Intermittent
B. Moderate Persistent
C. Mild Persistent
D. Severe Persistent
Answer: C
Rationale: Mild persistent asthma is defined by symptoms occurring more than twice a
week but not daily, and nighttime awakenings 3 to 4 times a month. This classification
necessitates the addition of a low-dose inhaled corticosteroid (ICS) for maintenance
therapy. Managing asthma based on these severity levels helps reduce the risk of
exacerbations and lung function decline.
6. A 52-year-old male with a history of hypertension presents with sharp, stabbing chest pain
that is worse when lying flat and improved when leaning forward. A friction rub is heard on
auscultation. What is the most appropriate first-line treatment?
A. High-dose Aspirin or NSAIDs plus Colchicine
B. Nitroglycerin sublingual
C. Low-molecular-weight heparin
D. Intravenous Furosemide
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 3 2026)
1. A 68-year-old male with a history of hypertension and smoking presents with a new onset
of a harsh systolic crescendo-decrescendo murmur heard best at the second intercostal
space, right sternal border. The murmur radiates to the carotid arteries. What is the most
likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: B
Rationale: Aortic stenosis typically presents as a systolic crescendo-decrescendo murmur
at the right upper sternal border. The radiation to the carotids is a classic physical finding
as the blood is ejected through a narrowed valve into the systemic circulation. This
condition is often age-related due to calcification and requires careful monitoring for
symptoms like syncope or angina.
,2. According to the GOLD 2024 guidelines, which of the following is the required spirometry
finding to confirm the diagnosis of COPD?
A. FEV1/FVC ratio < 0.70 post-bronchodilator
B. FEV1 < 80% predicted
C. FEV1/FVC ratio > 0.70 post-bronchodilator
D. FVC < 70% predicted
Answer: A
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the definitive
diagnostic criterion for airflow limitation that is not fully reversible. This measurement
ensures that the obstruction is persistent and characteristic of COPD rather than asthma.
Spirometry is considered the gold standard for diagnosis in patients presenting with
chronic cough, dyspnea, and sputum production.
3. A 45-year-old female patient with a BMI of 32 presents with frequent heartburn and
regurgitation. She has tried OTC antacids with minimal relief. What is the initial
recommended pharmacological step for her suspected GERD?
A. Daily H2 Receptor Antagonist for 2 weeks
B. Metoclopramide 10mg before meals
C. Immediate referral for Upper Endoscopy
D. Daily Proton Pump Inhibitor (PPI) for 8 weeks
,Answer: D
Rationale: The standard of care for initiating therapy in patients with classic symptoms of
GERD and no ‘red flags’ is an 8-week course of PPIs. PPIs are more effective than H2
blockers at healing esophagitis and providing symptomatic relief. If symptoms do not
resolve after the full 8-week course, further investigation such as endoscopy may be
warranted.
4. Which of the following physical exam findings is most suggestive of heart failure with
reduced ejection fraction (HFrEF)?
A. S3 heart sound
B. S4 heart sound
C. Midsystolic click
D. Opening snap
Answer: A
Rationale: An S3 gallop is a sign of ventricular filling into a dilated, non-compliant
chamber and is highly specific for heart failure in older adults. In contrast, an S4 sound is
associated with left ventricular hypertrophy and diastolic stiffness. Recognizing the S3
heart sound is critical for the clinical diagnosis and assessment of volume status in heart
failure patients.
, 5. A patient with a history of asthma reports using their Albuterol inhaler 4 times a week and
waking up 3 times a month with wheezing. How should their asthma be classified according
to GINA/NHLBI guidelines?
A. Intermittent
B. Moderate Persistent
C. Mild Persistent
D. Severe Persistent
Answer: C
Rationale: Mild persistent asthma is defined by symptoms occurring more than twice a
week but not daily, and nighttime awakenings 3 to 4 times a month. This classification
necessitates the addition of a low-dose inhaled corticosteroid (ICS) for maintenance
therapy. Managing asthma based on these severity levels helps reduce the risk of
exacerbations and lung function decline.
6. A 52-year-old male with a history of hypertension presents with sharp, stabbing chest pain
that is worse when lying flat and improved when leaning forward. A friction rub is heard on
auscultation. What is the most appropriate first-line treatment?
A. High-dose Aspirin or NSAIDs plus Colchicine
B. Nitroglycerin sublingual
C. Low-molecular-weight heparin
D. Intravenous Furosemide
