NSG 554 Exam 3 V3 | NSG 554 Nurse Practitioners in Primary Care |
Wilkes University | 2026 Q&A with Rationale (Wilkes NSG554 Exam 3
2026)
Question 1
A 69-year-old male presents to the primary care clinic complaining of progressive urinary
hesitancy, weak urinary stream, nocturia four times per night, urgency, and a sensation of
incomplete bladder emptying over the past year. He denies dysuria, fever, hematuria, or flank
pain. His medical history is significant for hypertension and hyperlipidemia. On digital rectal
examination, the prostate is enlarged, smooth, rubbery, and non-tender. PSA is within the
expected range for his age.
Which medication is considered the best initial pharmacologic treatment to rapidly improve
his lower urinary tract symptoms?
A. Finasteride (Proscar)
B. Tamsulosin (Flomax)
C. Dutasteride (Avodart)
D. Oxybutynin (Ditropan)
Correct Answer: B. Tamsulosin (Flomax)
Rationale
Tamsulosin is an alpha-1 adrenergic receptor blocker that relaxes smooth muscle in the
prostate and bladder neck, improving urine flow within days. It is considered first-line therapy
for symptomatic benign prostatic hyperplasia (BPH), particularly when rapid symptom relief is
desired.
• A. Finasteride: Incorrect. Shrinks the prostate over several months but does not provide
rapid relief.
• C. Dutasteride: Incorrect. Similar to finasteride; used for long-term prostate reduction.
• D. Oxybutynin: Incorrect. Used for overactive bladder and may worsen urinary retention
in BPH.
Question 2
A 72-year-old male with moderate BPH has a prostate volume of 55 grams on ultrasound. He
reports persistent urinary symptoms despite taking tamsulosin for six months.
,NSG 554 Exam 3 V3 | NSG 554 Nurse Practitioners in Primary Care |
Wilkes University | 2026 Q&A with Rationale (Wilkes NSG554 Exam 3
2026)
Which medication should be added to reduce prostate size and decrease the likelihood of future
urinary retention?
A. Sildenafil
B. Finasteride
C. Tolterodine
D. Phenazopyridine
Correct Answer: B. Finasteride
Rationale
Finasteride inhibits 5-alpha-reductase, preventing conversion of testosterone to
dihydrotestosterone (DHT). It gradually reduces prostate volume and lowers the risk of acute
urinary retention and future surgery.
Question 3
A 24-year-old obese woman presents with irregular menstrual periods occurring every two to
four months. She reports increased facial hair growth, acne, and gradual weight gain over the last
three years. Pregnancy test is negative.
Which diagnosis is most likely?
A. Premature ovarian insufficiency
B. Polycystic ovary syndrome (PCOS)
C. Endometriosis
D. Hyperthyroidism
Correct Answer: B. Polycystic Ovary Syndrome
Rationale
PCOS commonly presents with:
,NSG 554 Exam 3 V3 | NSG 554 Nurse Practitioners in Primary Care |
Wilkes University | 2026 Q&A with Rationale (Wilkes NSG554 Exam 3
2026)
• Oligomenorrhea or amenorrhea
• Clinical or biochemical hyperandrogenism
• Polycystic ovaries on ultrasound
• Obesity and insulin resistance
According to the Rotterdam Criteria, diagnosis requires two of three:
• Hyperandrogenism
• Ovulatory dysfunction
• Polycystic ovaries
Question 4
A woman is being evaluated for possible PCOS.
According to the Rotterdam diagnostic criteria, which statement is correct?
A. Elevated insulin level is required.
B. Two of three diagnostic criteria establish the diagnosis.
C. Elevated prolactin confirms PCOS.
D. Elevated cortisol is diagnostic.
Correct Answer: B
Rationale
The Rotterdam Criteria require any two of the following:
• Hyperandrogenism
• Ovulatory dysfunction
• Polycystic ovaries
Other endocrine disorders such as thyroid disease, hyperprolactinemia, and Cushing syndrome
should first be excluded.
, NSG 554 Exam 3 V3 | NSG 554 Nurse Practitioners in Primary Care |
Wilkes University | 2026 Q&A with Rationale (Wilkes NSG554 Exam 3
2026)
Question 5
A 29-year-old woman with PCOS would like to become pregnant. She has irregular ovulation
and no other infertility factors.
Which medication is currently considered first-line for ovulation induction?
A. Metformin
B. Letrozole
C. Combined oral contraceptive
D. Spironolactone
Correct Answer: B. Letrozole
Rationale
Current guidelines recommend Letrozole as the preferred first-line treatment for ovulation
induction in women with PCOS because it produces higher live birth rates than clomiphene
citrate.
Question 6
A 70-year-old man complains of worsening fatigue and shortness of breath during routine
activities. CBC demonstrates:
• Hemoglobin: 9.6 g/dL
• MCV: 71 fL
Which laboratory study is the most sensitive indicator of iron deficiency?
A. Serum iron
B. Ferritin
C. Hemoglobin
D. Total iron-binding capacity
Wilkes University | 2026 Q&A with Rationale (Wilkes NSG554 Exam 3
2026)
Question 1
A 69-year-old male presents to the primary care clinic complaining of progressive urinary
hesitancy, weak urinary stream, nocturia four times per night, urgency, and a sensation of
incomplete bladder emptying over the past year. He denies dysuria, fever, hematuria, or flank
pain. His medical history is significant for hypertension and hyperlipidemia. On digital rectal
examination, the prostate is enlarged, smooth, rubbery, and non-tender. PSA is within the
expected range for his age.
Which medication is considered the best initial pharmacologic treatment to rapidly improve
his lower urinary tract symptoms?
A. Finasteride (Proscar)
B. Tamsulosin (Flomax)
C. Dutasteride (Avodart)
D. Oxybutynin (Ditropan)
Correct Answer: B. Tamsulosin (Flomax)
Rationale
Tamsulosin is an alpha-1 adrenergic receptor blocker that relaxes smooth muscle in the
prostate and bladder neck, improving urine flow within days. It is considered first-line therapy
for symptomatic benign prostatic hyperplasia (BPH), particularly when rapid symptom relief is
desired.
• A. Finasteride: Incorrect. Shrinks the prostate over several months but does not provide
rapid relief.
• C. Dutasteride: Incorrect. Similar to finasteride; used for long-term prostate reduction.
• D. Oxybutynin: Incorrect. Used for overactive bladder and may worsen urinary retention
in BPH.
Question 2
A 72-year-old male with moderate BPH has a prostate volume of 55 grams on ultrasound. He
reports persistent urinary symptoms despite taking tamsulosin for six months.
,NSG 554 Exam 3 V3 | NSG 554 Nurse Practitioners in Primary Care |
Wilkes University | 2026 Q&A with Rationale (Wilkes NSG554 Exam 3
2026)
Which medication should be added to reduce prostate size and decrease the likelihood of future
urinary retention?
A. Sildenafil
B. Finasteride
C. Tolterodine
D. Phenazopyridine
Correct Answer: B. Finasteride
Rationale
Finasteride inhibits 5-alpha-reductase, preventing conversion of testosterone to
dihydrotestosterone (DHT). It gradually reduces prostate volume and lowers the risk of acute
urinary retention and future surgery.
Question 3
A 24-year-old obese woman presents with irregular menstrual periods occurring every two to
four months. She reports increased facial hair growth, acne, and gradual weight gain over the last
three years. Pregnancy test is negative.
Which diagnosis is most likely?
A. Premature ovarian insufficiency
B. Polycystic ovary syndrome (PCOS)
C. Endometriosis
D. Hyperthyroidism
Correct Answer: B. Polycystic Ovary Syndrome
Rationale
PCOS commonly presents with:
,NSG 554 Exam 3 V3 | NSG 554 Nurse Practitioners in Primary Care |
Wilkes University | 2026 Q&A with Rationale (Wilkes NSG554 Exam 3
2026)
• Oligomenorrhea or amenorrhea
• Clinical or biochemical hyperandrogenism
• Polycystic ovaries on ultrasound
• Obesity and insulin resistance
According to the Rotterdam Criteria, diagnosis requires two of three:
• Hyperandrogenism
• Ovulatory dysfunction
• Polycystic ovaries
Question 4
A woman is being evaluated for possible PCOS.
According to the Rotterdam diagnostic criteria, which statement is correct?
A. Elevated insulin level is required.
B. Two of three diagnostic criteria establish the diagnosis.
C. Elevated prolactin confirms PCOS.
D. Elevated cortisol is diagnostic.
Correct Answer: B
Rationale
The Rotterdam Criteria require any two of the following:
• Hyperandrogenism
• Ovulatory dysfunction
• Polycystic ovaries
Other endocrine disorders such as thyroid disease, hyperprolactinemia, and Cushing syndrome
should first be excluded.
, NSG 554 Exam 3 V3 | NSG 554 Nurse Practitioners in Primary Care |
Wilkes University | 2026 Q&A with Rationale (Wilkes NSG554 Exam 3
2026)
Question 5
A 29-year-old woman with PCOS would like to become pregnant. She has irregular ovulation
and no other infertility factors.
Which medication is currently considered first-line for ovulation induction?
A. Metformin
B. Letrozole
C. Combined oral contraceptive
D. Spironolactone
Correct Answer: B. Letrozole
Rationale
Current guidelines recommend Letrozole as the preferred first-line treatment for ovulation
induction in women with PCOS because it produces higher live birth rates than clomiphene
citrate.
Question 6
A 70-year-old man complains of worsening fatigue and shortness of breath during routine
activities. CBC demonstrates:
• Hemoglobin: 9.6 g/dL
• MCV: 71 fL
Which laboratory study is the most sensitive indicator of iron deficiency?
A. Serum iron
B. Ferritin
C. Hemoglobin
D. Total iron-binding capacity
