NSG 555 Exam 3 V1 | NSG 555 Nurse Practitioners
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 3 2026)
1. A 58-year-old male with a history of COPD presents with increased sputum production and
purulence. His baseline FEV1 is 60%. Which antibiotic is most appropriate for this COPD
exacerbation according to GOLD guidelines?
A. Amoxicillin
B. Doxycycline
C. Ciprofloxacin
D. Azithromycin
Correct Answer: D
Explanation: In patients with COPD exacerbations who have increased sputum purulence
and volume, antibiotics are indicated to reduce the risk of treatment failure. Macrolides like
azithromycin or tetracyclines like doxycycline are typically first-line for uncomplicated
exacerbations. The choice depends on local resistance patterns and patient-specific risk
factors for Pseudomonas.
2. A 34-year-old female presents with symptoms of allergic rhinitis that are interfering with
her sleep and daily activities. She has already tried over-the-counter loratadine without
significant relief. What is the next best step in management?
A. Oral corticosteroids for 5 days
,B. Intranasal corticosteroid spray
C. Intranasal decongestant for 10 days
D. Referral for immunotherapy
Correct Answer: B
Explanation: Intranasal corticosteroids are considered the most effective maintenance
therapy for persistent or moderate-to-severe allergic rhinitis. They work by reducing the
inflammatory response in the nasal mucosa across multiple pathways. Patients should be
educated that maximal effect may take several days to weeks of consistent use.
3. When using the CURB-65 criteria to evaluate a patient with community-acquired
pneumonia (CAP), which of the following findings would warrant a score of 1 point for the ‘U’
component?
A. Urine output less than 30 mL/hr
B. Uric acid elevated above normal limits
C. Urea (BUN) greater than 19 mg/dL
D. Urinary tract infection co-morbidity
Correct Answer: C
Explanation: The ‘U’ in CURB-65 stands for Urea, specifically a blood urea nitrogen (BUN)
level greater than 19 mg/dL (or >7 mmol/L). This tool helps clinicians determine the
,severity of pneumonia and whether the patient requires inpatient or intensive care. A total
score of 2 or higher usually indicates a need for hospitalization.
4. A 22-year-old college student presents with a sore throat, fever, and significant fatigue.
Physical exam reveals posterior cervical lymphadenopathy and palatine petechiae. A rapid
strep test is negative. What is the most likely diagnosis?
A. Infectious Mononucleosis
B. Acute viral pharyngitis
C. Diphtheria
D. Gonococcal pharyngitis
Correct Answer: A
Explanation: Posterior cervical lymphadenopathy and significant fatigue are classic
hallmarks of infectious mononucleosis, often caused by the Epstein-Barr virus. Palatine
petechiae can also occur in mononucleosis, though they are also seen in streptococcal
infections. Clinical diagnosis is supported by a positive Monospot test or presence of
atypical lymphocytes on a peripheral smear.
5. According to the GINA guidelines, what is the preferred controller and reliever for a patient
with Step 2 asthma?
A. Low-dose ICS and SABA as needed
B. Low-dose ICS-formoterol as needed
C. Daily low-dose ICS and ICS-formoterol as needed
, D. Medium-dose ICS and SABA as needed
Correct Answer: B
Explanation: Current GINA guidelines emphasize the use of as-needed low-dose ICS-
formoterol as the preferred therapy for Step 2 asthma to reduce the risk of exacerbations.
This approach ensures that the patient receives an anti-inflammatory medication every
time they use a reliever. Using a SABA alone is no longer recommended due to the risk of
severe exacerbations.
6. A patient presents with a ‘curtain-like’ shadow descending over their vision in the left eye,
accompanied by new floaters. This clinical presentation is most consistent with:
A. Retinal Detachment
B. Acute Angle Closure Glaucoma
C. Macular Degeneration
D. Cataracts
Correct Answer: A
Explanation: Retinal detachment is a medical emergency that often presents with the
sudden appearance of floaters, flashes of light (photopsia), and a shadow or curtain over
the visual field. Prompt referral to an ophthalmologist is necessary to prevent permanent
vision loss. Unlike glaucoma, this condition is usually painless.
7. Which physical exam maneuver is most specific for diagnosing acute cholecystitis?
A. McBurney’s sign
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 3 2026)
1. A 58-year-old male with a history of COPD presents with increased sputum production and
purulence. His baseline FEV1 is 60%. Which antibiotic is most appropriate for this COPD
exacerbation according to GOLD guidelines?
A. Amoxicillin
B. Doxycycline
C. Ciprofloxacin
D. Azithromycin
Correct Answer: D
Explanation: In patients with COPD exacerbations who have increased sputum purulence
and volume, antibiotics are indicated to reduce the risk of treatment failure. Macrolides like
azithromycin or tetracyclines like doxycycline are typically first-line for uncomplicated
exacerbations. The choice depends on local resistance patterns and patient-specific risk
factors for Pseudomonas.
2. A 34-year-old female presents with symptoms of allergic rhinitis that are interfering with
her sleep and daily activities. She has already tried over-the-counter loratadine without
significant relief. What is the next best step in management?
A. Oral corticosteroids for 5 days
,B. Intranasal corticosteroid spray
C. Intranasal decongestant for 10 days
D. Referral for immunotherapy
Correct Answer: B
Explanation: Intranasal corticosteroids are considered the most effective maintenance
therapy for persistent or moderate-to-severe allergic rhinitis. They work by reducing the
inflammatory response in the nasal mucosa across multiple pathways. Patients should be
educated that maximal effect may take several days to weeks of consistent use.
3. When using the CURB-65 criteria to evaluate a patient with community-acquired
pneumonia (CAP), which of the following findings would warrant a score of 1 point for the ‘U’
component?
A. Urine output less than 30 mL/hr
B. Uric acid elevated above normal limits
C. Urea (BUN) greater than 19 mg/dL
D. Urinary tract infection co-morbidity
Correct Answer: C
Explanation: The ‘U’ in CURB-65 stands for Urea, specifically a blood urea nitrogen (BUN)
level greater than 19 mg/dL (or >7 mmol/L). This tool helps clinicians determine the
,severity of pneumonia and whether the patient requires inpatient or intensive care. A total
score of 2 or higher usually indicates a need for hospitalization.
4. A 22-year-old college student presents with a sore throat, fever, and significant fatigue.
Physical exam reveals posterior cervical lymphadenopathy and palatine petechiae. A rapid
strep test is negative. What is the most likely diagnosis?
A. Infectious Mononucleosis
B. Acute viral pharyngitis
C. Diphtheria
D. Gonococcal pharyngitis
Correct Answer: A
Explanation: Posterior cervical lymphadenopathy and significant fatigue are classic
hallmarks of infectious mononucleosis, often caused by the Epstein-Barr virus. Palatine
petechiae can also occur in mononucleosis, though they are also seen in streptococcal
infections. Clinical diagnosis is supported by a positive Monospot test or presence of
atypical lymphocytes on a peripheral smear.
5. According to the GINA guidelines, what is the preferred controller and reliever for a patient
with Step 2 asthma?
A. Low-dose ICS and SABA as needed
B. Low-dose ICS-formoterol as needed
C. Daily low-dose ICS and ICS-formoterol as needed
, D. Medium-dose ICS and SABA as needed
Correct Answer: B
Explanation: Current GINA guidelines emphasize the use of as-needed low-dose ICS-
formoterol as the preferred therapy for Step 2 asthma to reduce the risk of exacerbations.
This approach ensures that the patient receives an anti-inflammatory medication every
time they use a reliever. Using a SABA alone is no longer recommended due to the risk of
severe exacerbations.
6. A patient presents with a ‘curtain-like’ shadow descending over their vision in the left eye,
accompanied by new floaters. This clinical presentation is most consistent with:
A. Retinal Detachment
B. Acute Angle Closure Glaucoma
C. Macular Degeneration
D. Cataracts
Correct Answer: A
Explanation: Retinal detachment is a medical emergency that often presents with the
sudden appearance of floaters, flashes of light (photopsia), and a shadow or curtain over
the visual field. Prompt referral to an ophthalmologist is necessary to prevent permanent
vision loss. Unlike glaucoma, this condition is usually painless.
7. Which physical exam maneuver is most specific for diagnosing acute cholecystitis?
A. McBurney’s sign
