NSG 555 Final Exam V3 | NSG 555 Nurse
Practitioners in Primary Care I | Wilkes University
| 2026 Q&A with Rationale (Wilkes NSG555 Final
Exam 2026)
1. A 45-year-old male presents with a new diagnosis of hypertension. According to JNC 8
guidelines, which of the following is an appropriate initial pharmacologic treatment for a non-
Black patient without chronic kidney disease?
A. Spironolactone
B. Metoprolol
C. Lisinopril
D. Clonidine
Correct Answer: C
Explanation: JNC 8 guidelines recommend ACE inhibitors, ARBs, calcium channel blockers,
or thiazide diuretics as first-line therapy for non-Black patients. Lisinopril is an ACE
inhibitor that provides effective blood pressure control and cardiovascular protection.
Beta-blockers like metoprolol are no longer recommended as first-line therapy for
uncomplicated hypertension.
2. A patient presents with a ‘velvety,’ hyperpigmented plaque on the back of the neck. Which
underlying condition should the nurse practitioner investigate first?
A. Hypothyroidism
,B. Systemic Lupus Erythematosus
C. Insulin resistance
D. Iron deficiency anemia
Correct Answer: C
Explanation: This clinical presentation is consistent with Acanthosis Nigricans. It is highly
associated with insulin resistance and is often a cutaneous marker for Type 2 Diabetes or
metabolic syndrome. The nurse practitioner should order a fasting glucose or hemoglobin
A1c to screen for underlying metabolic issues.
3. A 24-year-old female presents with symptoms of dysuria, urgency, and frequency. A
urinalysis shows positive nitrites and leukocyte esterase. What is the most likely causative
organism?
A. Staphylococcus saprophyticus
B. Proteus mirabilis
C. Klebsiella pneumoniae
D. Escherichia coli
Correct Answer: D
Explanation: Escherichia coli is the most common cause of uncomplicated urinary tract
infections in women, accounting for 75-95% of cases. Nitrites in the urine are a specific
, indicator for gram-negative bacteria like E. coli that convert nitrate to nitrite. Initial
empiric therapy should target this organism while awaiting culture results.
4. In the management of a patient with COPD, which of the following is the primary goal of
using a long-acting muscarinic antagonist (LAMA)?
A. Rapid reversal of acute bronchospasm
B. Reduction of airway inflammation
C. Prevention of exacerbations and improvement of lung function
D. Treatment of secondary bacterial infections
Correct Answer: C
Explanation: LAMAs are a cornerstone of maintenance therapy in COPD according to the
GOLD guidelines. They work by providing sustained bronchodilation and reducing the risk
of acute exacerbations. Unlike SABAs, they are not intended for rescue use during acute
respiratory distress.
5. A 60-year-old patient reports sudden onset of severe eye pain, blurred vision, and seeing
‘halos’ around lights. On examination, the pupil is mid-dilated and non-reactive. What is the
most likely diagnosis?
A. Cataracts
B. Acute angle-closure glaucoma
C. Macular degeneration
Practitioners in Primary Care I | Wilkes University
| 2026 Q&A with Rationale (Wilkes NSG555 Final
Exam 2026)
1. A 45-year-old male presents with a new diagnosis of hypertension. According to JNC 8
guidelines, which of the following is an appropriate initial pharmacologic treatment for a non-
Black patient without chronic kidney disease?
A. Spironolactone
B. Metoprolol
C. Lisinopril
D. Clonidine
Correct Answer: C
Explanation: JNC 8 guidelines recommend ACE inhibitors, ARBs, calcium channel blockers,
or thiazide diuretics as first-line therapy for non-Black patients. Lisinopril is an ACE
inhibitor that provides effective blood pressure control and cardiovascular protection.
Beta-blockers like metoprolol are no longer recommended as first-line therapy for
uncomplicated hypertension.
2. A patient presents with a ‘velvety,’ hyperpigmented plaque on the back of the neck. Which
underlying condition should the nurse practitioner investigate first?
A. Hypothyroidism
,B. Systemic Lupus Erythematosus
C. Insulin resistance
D. Iron deficiency anemia
Correct Answer: C
Explanation: This clinical presentation is consistent with Acanthosis Nigricans. It is highly
associated with insulin resistance and is often a cutaneous marker for Type 2 Diabetes or
metabolic syndrome. The nurse practitioner should order a fasting glucose or hemoglobin
A1c to screen for underlying metabolic issues.
3. A 24-year-old female presents with symptoms of dysuria, urgency, and frequency. A
urinalysis shows positive nitrites and leukocyte esterase. What is the most likely causative
organism?
A. Staphylococcus saprophyticus
B. Proteus mirabilis
C. Klebsiella pneumoniae
D. Escherichia coli
Correct Answer: D
Explanation: Escherichia coli is the most common cause of uncomplicated urinary tract
infections in women, accounting for 75-95% of cases. Nitrites in the urine are a specific
, indicator for gram-negative bacteria like E. coli that convert nitrate to nitrite. Initial
empiric therapy should target this organism while awaiting culture results.
4. In the management of a patient with COPD, which of the following is the primary goal of
using a long-acting muscarinic antagonist (LAMA)?
A. Rapid reversal of acute bronchospasm
B. Reduction of airway inflammation
C. Prevention of exacerbations and improvement of lung function
D. Treatment of secondary bacterial infections
Correct Answer: C
Explanation: LAMAs are a cornerstone of maintenance therapy in COPD according to the
GOLD guidelines. They work by providing sustained bronchodilation and reducing the risk
of acute exacerbations. Unlike SABAs, they are not intended for rescue use during acute
respiratory distress.
5. A 60-year-old patient reports sudden onset of severe eye pain, blurred vision, and seeing
‘halos’ around lights. On examination, the pupil is mid-dilated and non-reactive. What is the
most likely diagnosis?
A. Cataracts
B. Acute angle-closure glaucoma
C. Macular degeneration
