NSG 555 Exam 4 V3 | NSG 555 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 4 2026)
1. A 65-year-old male presents with fatigue and exertional dyspnea. Lab results reveal a
hemoglobin of 9.2 g/dL, an MCV of 74 fL, and a low ferritin level. Which of the following is the
most appropriate next step in management?
A. Initiate oral ferrous sulfate therapy.
B. Perform a colonoscopy to rule out occult malignancy.
C. Recommend a diet rich in green leafy vegetables.
D. Refer to hematology for a bone marrow biopsy.
Answer: B
Rationale: In an older male patient, microcytic anemia is iron deficiency anemia until
proven otherwise. Iron deficiency in this demographic is frequently caused by
gastrointestinal blood loss, often from a malignancy. A colonoscopy is essential to identify
the source of blood loss before simply treating the deficiency.
2. Which physical exam finding is most characteristic of a patient presenting with Parkinson’s
disease?
A. Resting ‘pill-rolling’ tremor and bradykinesia.
,B. Symmetrical muscle weakness in the lower extremities.
C. Intention tremor that worsens with movement.
D. Hyperreflexia and positive Babinski sign.
Answer: A
Rationale: Parkinson’s disease is characterized by the classic triad of resting tremor,
bradykinesia, and muscle rigidity. The ‘pill-rolling’ tremor typically occurs at rest and
decreases with purposeful movement. It is a progressive neurodegenerative disorder
caused by the loss of dopaminergic neurons in the substantia nigra.
3. A patient is diagnosed with Vitamin B12 deficiency anemia. Which of the following findings
would help differentiate this from folate deficiency?
A. Elevated mean corpuscular volume (MCV).
B. Presence of hypersegmented neutrophils on peripheral smear.
C. Increased levels of homocysteine.
D. Complaints of paresthesia and loss of vibratory sense.
Answer: D
Rationale: Both B12 and folate deficiencies cause macrocytic anemia and hypersegmented
neutrophils. However, B12 deficiency specifically leads to neurological deficits such as
peripheral neuropathy and posterior column damage. Folate deficiency does not present
with these specific neurological symptoms.
, 4. A 28-year-old female complains of unilateral, throbbing headaches that occur twice a
month and are accompanied by nausea and photophobia. She reports seeing ‘zig-zag lines’
before the pain starts. What is the first-line treatment for acute relief of these symptoms?
A. Propranolol 40 mg daily.
B. Sumatriptan 50 mg at onset.
C. Amitriptyline 25 mg at bedtime.
D. Acetaminophen 500 mg every 4 hours.
Answer: B
Rationale: The patient is describing a migraine with aura. Triptans, such as Sumatriptan,
are considered first-line therapy for the acute management of moderate to severe
migraines. Propranolol and Amitriptyline are used for prophylaxis, not acute relief.
5. Which laboratory finding is most suggestive of Thalassemia trait in a patient with
microcytic anemia?
A. Normal RDW with a very low MCV.
B. Low serum iron and high TIBC.
C. High Red Cell Distribution Width (RDW).
D. Elevated serum ferritin levels.
Answer: A
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 4 2026)
1. A 65-year-old male presents with fatigue and exertional dyspnea. Lab results reveal a
hemoglobin of 9.2 g/dL, an MCV of 74 fL, and a low ferritin level. Which of the following is the
most appropriate next step in management?
A. Initiate oral ferrous sulfate therapy.
B. Perform a colonoscopy to rule out occult malignancy.
C. Recommend a diet rich in green leafy vegetables.
D. Refer to hematology for a bone marrow biopsy.
Answer: B
Rationale: In an older male patient, microcytic anemia is iron deficiency anemia until
proven otherwise. Iron deficiency in this demographic is frequently caused by
gastrointestinal blood loss, often from a malignancy. A colonoscopy is essential to identify
the source of blood loss before simply treating the deficiency.
2. Which physical exam finding is most characteristic of a patient presenting with Parkinson’s
disease?
A. Resting ‘pill-rolling’ tremor and bradykinesia.
,B. Symmetrical muscle weakness in the lower extremities.
C. Intention tremor that worsens with movement.
D. Hyperreflexia and positive Babinski sign.
Answer: A
Rationale: Parkinson’s disease is characterized by the classic triad of resting tremor,
bradykinesia, and muscle rigidity. The ‘pill-rolling’ tremor typically occurs at rest and
decreases with purposeful movement. It is a progressive neurodegenerative disorder
caused by the loss of dopaminergic neurons in the substantia nigra.
3. A patient is diagnosed with Vitamin B12 deficiency anemia. Which of the following findings
would help differentiate this from folate deficiency?
A. Elevated mean corpuscular volume (MCV).
B. Presence of hypersegmented neutrophils on peripheral smear.
C. Increased levels of homocysteine.
D. Complaints of paresthesia and loss of vibratory sense.
Answer: D
Rationale: Both B12 and folate deficiencies cause macrocytic anemia and hypersegmented
neutrophils. However, B12 deficiency specifically leads to neurological deficits such as
peripheral neuropathy and posterior column damage. Folate deficiency does not present
with these specific neurological symptoms.
, 4. A 28-year-old female complains of unilateral, throbbing headaches that occur twice a
month and are accompanied by nausea and photophobia. She reports seeing ‘zig-zag lines’
before the pain starts. What is the first-line treatment for acute relief of these symptoms?
A. Propranolol 40 mg daily.
B. Sumatriptan 50 mg at onset.
C. Amitriptyline 25 mg at bedtime.
D. Acetaminophen 500 mg every 4 hours.
Answer: B
Rationale: The patient is describing a migraine with aura. Triptans, such as Sumatriptan,
are considered first-line therapy for the acute management of moderate to severe
migraines. Propranolol and Amitriptyline are used for prophylaxis, not acute relief.
5. Which laboratory finding is most suggestive of Thalassemia trait in a patient with
microcytic anemia?
A. Normal RDW with a very low MCV.
B. Low serum iron and high TIBC.
C. High Red Cell Distribution Width (RDW).
D. Elevated serum ferritin levels.
Answer: A
