NSG 555 Exam 2 V2 | NSG 555 Nurse Practitioners
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 2 2026)
1. A 62-year-old African American male presents for a follow-up of hypertension. According
to JNC 8 guidelines, which of the following is the preferred first-line treatment for this
patient?
A. Lisinopril
B. Valsartan
C. Metoprolol
D. Amlodipine
Correct Answer: D
Explanation: For the general African American population, including those with diabetes,
initial antihypertensive treatment should include a thiazide-type diuretic or a calcium
channel blocker (CCB) such as Amlodipine. This recommendation is based on clinical trials
showing that CCBs and thiazides are more effective in lowering blood pressure and
reducing the risk of stroke in this demographic compared to ACE inhibitors. Clinicians
should initiate therapy and monitor for therapeutic response within one month.
2. A 55-year-old patient presents with a ‘stuck-on’ waxy, brown lesion on the back that is
well-circumscribed. What is the most likely diagnosis?
A. Basal cell carcinoma
,B. Actinic keratosis
C. Seborrheic keratosis
D. Malignant melanoma
Correct Answer: C
Explanation: Seborrheic keratosis is a benign skin tumor common in older adults, often
described as having a ‘stuck-on’ appearance with a waxy or crumbly texture. These lesions
can vary in color from tan to black and are typically found on the trunk, face, or extremities.
While they are benign, they are sometimes biopsied to rule out malignancy if they show
atypical features or rapid growth.
3. Which of the following is considered the ‘gold standard’ for the diagnosis of Chronic
Obstructive Pulmonary Disease (COPD)?
A. Chest X-ray
B. Pulse oximetry
C. Spirometry
D. Arterial blood gas
Correct Answer: C
Explanation: Spirometry is the required diagnostic tool to confirm the presence of
persistent airflow limitation in COPD. A post-bronchodilator FEV1/FVC ratio of less than
0.70 confirms the diagnosis. This objective measurement is essential for determining the
,severity of the disease and guiding pharmacological interventions according to the GOLD
guidelines.
4. A patient presents with acute onset of severe eye pain, blurred vision, and seeing ‘halos’
around lights. The pupil is mid-dilated and non-reactive. What is the immediate priority?
A. Prescribe topical antibiotics
B. Refer to ophthalmology immediately for suspected acute angle-closure glaucoma
C. Administer oral antihistamines
D. Warm compresses and follow up in 48 hours
Correct Answer: B
Explanation: Acute angle-closure glaucoma is a medical emergency characterized by a
rapid increase in intraocular pressure. Symptoms include severe pain, decreased vision,
and physical findings like a cloudy cornea and fixed pupil. Delay in treatment can lead to
permanent vision loss, necessitating urgent intervention by a specialist.
5. A 24-year-old female presents with dysuria and frequency. A urinalysis reveals nitrites and
leukocyte esterase. She is not pregnant. What is the most appropriate first-line treatment?
A. Ciprofloxacin for 7 days
B. Nitrofurantoin 100 mg BID for 5 days
C. Phenazopyridine for 3 days
D. Amoxicillin 500 mg TID for 10 days
, Correct Answer: B
Explanation: Nitrofurantoin (Macrobid) is a first-line agent for uncomplicated cystitis in
non-pregnant women due to its efficacy and minimal impact on vaginal flora. It should be
administered as 100 mg twice daily for five days. Trimethoprim-sulfamethoxazole
(Bactrim) is also a first-line option, provided local resistance rates are below 20%.
6. In the management of Type 2 Diabetes, Metformin is contraindicated in patients with
which of the following conditions?
A. Estimated Glomerular Filtration Rate (eGFR) less than 30 mL/min/1.73m2
B. History of gestational diabetes
C. Body Mass Index (BMI) greater than 35
D. Age over 65 years
Correct Answer: A
Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m2 due to the increased risk of lactic acidosis. For patients with an eGFR
between 30 and 45, the initiation of Metformin is not recommended, and current doses
should be reviewed. Regular monitoring of renal function is mandatory for all patients on
biguanide therapy.
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 2 2026)
1. A 62-year-old African American male presents for a follow-up of hypertension. According
to JNC 8 guidelines, which of the following is the preferred first-line treatment for this
patient?
A. Lisinopril
B. Valsartan
C. Metoprolol
D. Amlodipine
Correct Answer: D
Explanation: For the general African American population, including those with diabetes,
initial antihypertensive treatment should include a thiazide-type diuretic or a calcium
channel blocker (CCB) such as Amlodipine. This recommendation is based on clinical trials
showing that CCBs and thiazides are more effective in lowering blood pressure and
reducing the risk of stroke in this demographic compared to ACE inhibitors. Clinicians
should initiate therapy and monitor for therapeutic response within one month.
2. A 55-year-old patient presents with a ‘stuck-on’ waxy, brown lesion on the back that is
well-circumscribed. What is the most likely diagnosis?
A. Basal cell carcinoma
,B. Actinic keratosis
C. Seborrheic keratosis
D. Malignant melanoma
Correct Answer: C
Explanation: Seborrheic keratosis is a benign skin tumor common in older adults, often
described as having a ‘stuck-on’ appearance with a waxy or crumbly texture. These lesions
can vary in color from tan to black and are typically found on the trunk, face, or extremities.
While they are benign, they are sometimes biopsied to rule out malignancy if they show
atypical features or rapid growth.
3. Which of the following is considered the ‘gold standard’ for the diagnosis of Chronic
Obstructive Pulmonary Disease (COPD)?
A. Chest X-ray
B. Pulse oximetry
C. Spirometry
D. Arterial blood gas
Correct Answer: C
Explanation: Spirometry is the required diagnostic tool to confirm the presence of
persistent airflow limitation in COPD. A post-bronchodilator FEV1/FVC ratio of less than
0.70 confirms the diagnosis. This objective measurement is essential for determining the
,severity of the disease and guiding pharmacological interventions according to the GOLD
guidelines.
4. A patient presents with acute onset of severe eye pain, blurred vision, and seeing ‘halos’
around lights. The pupil is mid-dilated and non-reactive. What is the immediate priority?
A. Prescribe topical antibiotics
B. Refer to ophthalmology immediately for suspected acute angle-closure glaucoma
C. Administer oral antihistamines
D. Warm compresses and follow up in 48 hours
Correct Answer: B
Explanation: Acute angle-closure glaucoma is a medical emergency characterized by a
rapid increase in intraocular pressure. Symptoms include severe pain, decreased vision,
and physical findings like a cloudy cornea and fixed pupil. Delay in treatment can lead to
permanent vision loss, necessitating urgent intervention by a specialist.
5. A 24-year-old female presents with dysuria and frequency. A urinalysis reveals nitrites and
leukocyte esterase. She is not pregnant. What is the most appropriate first-line treatment?
A. Ciprofloxacin for 7 days
B. Nitrofurantoin 100 mg BID for 5 days
C. Phenazopyridine for 3 days
D. Amoxicillin 500 mg TID for 10 days
, Correct Answer: B
Explanation: Nitrofurantoin (Macrobid) is a first-line agent for uncomplicated cystitis in
non-pregnant women due to its efficacy and minimal impact on vaginal flora. It should be
administered as 100 mg twice daily for five days. Trimethoprim-sulfamethoxazole
(Bactrim) is also a first-line option, provided local resistance rates are below 20%.
6. In the management of Type 2 Diabetes, Metformin is contraindicated in patients with
which of the following conditions?
A. Estimated Glomerular Filtration Rate (eGFR) less than 30 mL/min/1.73m2
B. History of gestational diabetes
C. Body Mass Index (BMI) greater than 35
D. Age over 65 years
Correct Answer: A
Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m2 due to the increased risk of lactic acidosis. For patients with an eGFR
between 30 and 45, the initiation of Metformin is not recommended, and current doses
should be reviewed. Regular monitoring of renal function is mandatory for all patients on
biguanide therapy.
