NSG 555 Exam 4 V2 | NSG 555 Nurse Practitioners
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 4 2026)
1. A 42-year-old male presents with symptoms of dyspepsia and epigastric pain that improves
after eating. Which diagnostic test is the gold standard for identifying H. pylori infection?
A. Serum H. pylori IgG antibody test
B. Urea Breath Test (UBT)
C. Stool antigen test
D. Endoscopy with gastric biopsy
Correct Answer: D
Explanation: While non-invasive tests like the Urea Breath Test and stool antigen are
commonly used, endoscopy with biopsy remains the gold standard for definitive diagnosis.
This procedure allows for histopathological examination and rapid urease testing (CLOtest)
directly from gastric tissue. It also provides the benefit of direct visualization to rule out
gastric ulcers or malignancy.
2. Which physical examination maneuver is most specific for diagnosing acute cholecystitis in
a primary care setting?
A. Rovsing’s sign
B. Murphy’s sign
,C. Psoas sign
D. Obturator sign
Correct Answer: B
Explanation: Murphy’s sign is elicited by palpating the right upper quadrant while the
patient takes a deep breath, resulting in an inspiratory arrest due to pain. This finding is
highly indicative of gallbladder inflammation or acute cholecystitis. In contrast, Rovsing’s,
Psoas, and Obturator signs are clinical indicators primarily associated with acute
appendicitis.
3. A 28-year-old female presents with a fishy vaginal odor and thin, gray-white discharge.
Microscopy reveals ‘clue cells’. What is the first-line treatment for this condition?
A. Fluconazole 150 mg PO once
B. Azithromycin 1g PO once
C. Ceftriaxone 500 mg IM once
D. Metronidazole 500 mg PO BID for 7 days
Correct Answer: D
Explanation: The clinical presentation and presence of clue cells are pathognomonic for
Bacterial Vaginosis (BV). Metronidazole 500 mg twice daily for seven days is the CDC-
recommended first-line oral therapy. Patients should be advised to avoid alcohol during
treatment and for 24 hours after completion to prevent a disulfiram-like reaction.
,4. In the management of Benign Prostatic Hyperplasia (BPH), which class of medication
provides the most rapid relief of obstructive urinary symptoms?
A. 5-alpha-reductase inhibitors
B. Alpha-1 adrenergic antagonists
C. Anticholinergics
D. Phosphodiesterase-5 inhibitors
Correct Answer: B
Explanation: Alpha-1 adrenergic antagonists, such as Tamsulosin, work by relaxing the
smooth muscles of the prostate and bladder neck. These medications offer symptom relief
within days of starting therapy, making them ideal for acute management. 5-alpha-
reductase inhibitors, on the other hand, require several months to effectively shrink the
prostate gland volume.
5. A patient presents with sudden onset of severe periumbilical pain that later migrates to
the right lower quadrant (RLQ). What is the most likely diagnosis?
A. Acute Diverticulitis
B. Nephrolithiasis
C. Acute Appendicitis
D. Choledocholithiasis
Correct Answer: C
, Explanation: The migration of pain from the periumbilical region to McBurney’s point in
the RLQ is the classic presentation of acute appendicitis. This occurs because the initial
visceral pain is poorly localized, while subsequent parietal peritoneal inflammation
localizes to the RLQ. Prompt surgical consultation is necessary to prevent perforation and
peritonitis.
6. Which of the following is the most common cause of uncomplicated urinary tract infections
(UTIs) in women?
A. Staphylococcus saprophyticus
B. Proteus mirabilis
C. Escherichia coli
D. Klebsiella pneumoniae
Correct Answer: C
Explanation: Escherichia coli is responsible for approximately 75% to 90% of
uncomplicated UTIs in outpatient primary care settings. It is a gram-negative rod that is
part of the normal colonic flora and can easily ascend the female urethra. Management
usually involves antibiotics like Nitrofurantoin or Trimethoprim-sulfamethoxazole,
depending on local resistance patterns.
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 4 2026)
1. A 42-year-old male presents with symptoms of dyspepsia and epigastric pain that improves
after eating. Which diagnostic test is the gold standard for identifying H. pylori infection?
A. Serum H. pylori IgG antibody test
B. Urea Breath Test (UBT)
C. Stool antigen test
D. Endoscopy with gastric biopsy
Correct Answer: D
Explanation: While non-invasive tests like the Urea Breath Test and stool antigen are
commonly used, endoscopy with biopsy remains the gold standard for definitive diagnosis.
This procedure allows for histopathological examination and rapid urease testing (CLOtest)
directly from gastric tissue. It also provides the benefit of direct visualization to rule out
gastric ulcers or malignancy.
2. Which physical examination maneuver is most specific for diagnosing acute cholecystitis in
a primary care setting?
A. Rovsing’s sign
B. Murphy’s sign
,C. Psoas sign
D. Obturator sign
Correct Answer: B
Explanation: Murphy’s sign is elicited by palpating the right upper quadrant while the
patient takes a deep breath, resulting in an inspiratory arrest due to pain. This finding is
highly indicative of gallbladder inflammation or acute cholecystitis. In contrast, Rovsing’s,
Psoas, and Obturator signs are clinical indicators primarily associated with acute
appendicitis.
3. A 28-year-old female presents with a fishy vaginal odor and thin, gray-white discharge.
Microscopy reveals ‘clue cells’. What is the first-line treatment for this condition?
A. Fluconazole 150 mg PO once
B. Azithromycin 1g PO once
C. Ceftriaxone 500 mg IM once
D. Metronidazole 500 mg PO BID for 7 days
Correct Answer: D
Explanation: The clinical presentation and presence of clue cells are pathognomonic for
Bacterial Vaginosis (BV). Metronidazole 500 mg twice daily for seven days is the CDC-
recommended first-line oral therapy. Patients should be advised to avoid alcohol during
treatment and for 24 hours after completion to prevent a disulfiram-like reaction.
,4. In the management of Benign Prostatic Hyperplasia (BPH), which class of medication
provides the most rapid relief of obstructive urinary symptoms?
A. 5-alpha-reductase inhibitors
B. Alpha-1 adrenergic antagonists
C. Anticholinergics
D. Phosphodiesterase-5 inhibitors
Correct Answer: B
Explanation: Alpha-1 adrenergic antagonists, such as Tamsulosin, work by relaxing the
smooth muscles of the prostate and bladder neck. These medications offer symptom relief
within days of starting therapy, making them ideal for acute management. 5-alpha-
reductase inhibitors, on the other hand, require several months to effectively shrink the
prostate gland volume.
5. A patient presents with sudden onset of severe periumbilical pain that later migrates to
the right lower quadrant (RLQ). What is the most likely diagnosis?
A. Acute Diverticulitis
B. Nephrolithiasis
C. Acute Appendicitis
D. Choledocholithiasis
Correct Answer: C
, Explanation: The migration of pain from the periumbilical region to McBurney’s point in
the RLQ is the classic presentation of acute appendicitis. This occurs because the initial
visceral pain is poorly localized, while subsequent parietal peritoneal inflammation
localizes to the RLQ. Prompt surgical consultation is necessary to prevent perforation and
peritonitis.
6. Which of the following is the most common cause of uncomplicated urinary tract infections
(UTIs) in women?
A. Staphylococcus saprophyticus
B. Proteus mirabilis
C. Escherichia coli
D. Klebsiella pneumoniae
Correct Answer: C
Explanation: Escherichia coli is responsible for approximately 75% to 90% of
uncomplicated UTIs in outpatient primary care settings. It is a gram-negative rod that is
part of the normal colonic flora and can easily ascend the female urethra. Management
usually involves antibiotics like Nitrofurantoin or Trimethoprim-sulfamethoxazole,
depending on local resistance patterns.
