NSG 555 Exam 2 V1 | NSG 555 Nurse Practitioners
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 2 2026)
1. A 55-year-old male with a history of hypertension and diabetes presents for follow-up. His
BP is 148/92 mmHg today. Which class of medication is the most appropriate first-line choice
for this patient?
A. Calcium Channel Blockers
B. Beta-Blockers
C. Loop Diuretics
D. ACE Inhibitors
Correct Answer: D
Explanation: ACE inhibitors are first-line therapy for hypertensive patients with diabetes
because they provide significant renoprotective benefits. According to the JNC 8 and ADA
guidelines, these agents help delay the progression of diabetic nephropathy by reducing
intraglomerular pressure. While other agents like CCBs are effective, ACE inhibitors or
ARBs should be prioritized in this specific patient population.
2. A 68-year-old patient presents with a chronic cough and progressive shortness of breath.
Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.65. What is the most likely
diagnosis?
A. Asthma
,B. Restrictive Lung Disease
C. COPD
D. Congestive Heart Failure
Correct Answer: C
Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the diagnostic
hallmark of chronic obstructive pulmonary disease (COPD). This ratio indicates persistent
airflow limitation that is not fully reversible, distinguishing it from asthma. The patient’s
age and symptoms of chronic cough and dyspnea are consistent with the GOLD criteria for
COPD diagnosis.
3. A patient with mild persistent asthma is currently using an albuterol inhaler as needed.
What is the next step in the stepwise management of their condition according to GINA
guidelines?
A. Add a long-acting beta-agonist (LABA) only
B. Prescribe oral corticosteroids for daily use
C. Switch to a long-acting muscarinic antagonist (LAMA)
D. Start a low-dose inhaled corticosteroid (ICS)
Correct Answer: D
Explanation: For patients with mild persistent asthma, the addition of a low-dose inhaled
corticosteroid (ICS) is recommended to manage underlying airway inflammation. Current
,guidelines emphasize that SABA-only treatment is no longer recommended due to the risk
of severe exacerbations. The ICS acts as a controller medication to reduce the frequency
and severity of asthma symptoms over time.
4. Which physical examination finding is most suggestive of Community-Acquired Pneumonia
(CAP) in an older adult?
A. Hyperresonance on percussion
B. Ego-phony and dullness to percussion
C. Wheezing throughout all lung fields
D. Decreased tactile fremitus
Correct Answer: B
Explanation: Ego-phony, where the patient’s ‘ee’ sound is heard as ‘ay’, and dullness to
percussion are classic signs of pulmonary consolidation associated with pneumonia. These
findings indicate that the lung tissue is filled with fluid or inflammatory exudate rather
than air. In older adults, these physical findings may be more reliable than systemic
symptoms like high fever, which may be absent.
5. A 45-year-old female presents with epigastric pain that improves after eating but recurs 2-3
hours later. Which condition is most likely?
A. Gastric Ulcer
B. Acute Cholecystitis
C. Duodenal Ulcer
, D. Gastroesophageal Reflux Disease
Correct Answer: C
Explanation: Pain from a duodenal ulcer is typically relieved by food or antacids because
the food buffers the stomach acid. The pain usually returns when the stomach is empty,
often a few hours after a meal or during the night. In contrast, gastric ulcer pain is often
exacerbated by food intake, leading to weight loss in some patients.
6. What is the primary diagnostic test for a patient suspected of having obstructive sleep
apnea (OSA)?
A. Chest X-ray
B. Pulmonary Function Tests
C. Polysomnography
D. Echocardiogram
Correct Answer: C
Explanation: Polysomnography, or a sleep study, is the gold standard for diagnosing
obstructive sleep apnea. It monitors various physiological parameters including oxygen
saturation, airflow, and brain activity during sleep. This test allows the clinician to
determine the Apnea-Hypopnea Index (AHI) to grade the severity of the disorder.
7. An 82-year-old patient presents with a history of heart failure and is currently taking
Lisinopril. Which lab value must be monitored closely to prevent complications?
A. Serum Potassium
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 2 2026)
1. A 55-year-old male with a history of hypertension and diabetes presents for follow-up. His
BP is 148/92 mmHg today. Which class of medication is the most appropriate first-line choice
for this patient?
A. Calcium Channel Blockers
B. Beta-Blockers
C. Loop Diuretics
D. ACE Inhibitors
Correct Answer: D
Explanation: ACE inhibitors are first-line therapy for hypertensive patients with diabetes
because they provide significant renoprotective benefits. According to the JNC 8 and ADA
guidelines, these agents help delay the progression of diabetic nephropathy by reducing
intraglomerular pressure. While other agents like CCBs are effective, ACE inhibitors or
ARBs should be prioritized in this specific patient population.
2. A 68-year-old patient presents with a chronic cough and progressive shortness of breath.
Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.65. What is the most likely
diagnosis?
A. Asthma
,B. Restrictive Lung Disease
C. COPD
D. Congestive Heart Failure
Correct Answer: C
Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the diagnostic
hallmark of chronic obstructive pulmonary disease (COPD). This ratio indicates persistent
airflow limitation that is not fully reversible, distinguishing it from asthma. The patient’s
age and symptoms of chronic cough and dyspnea are consistent with the GOLD criteria for
COPD diagnosis.
3. A patient with mild persistent asthma is currently using an albuterol inhaler as needed.
What is the next step in the stepwise management of their condition according to GINA
guidelines?
A. Add a long-acting beta-agonist (LABA) only
B. Prescribe oral corticosteroids for daily use
C. Switch to a long-acting muscarinic antagonist (LAMA)
D. Start a low-dose inhaled corticosteroid (ICS)
Correct Answer: D
Explanation: For patients with mild persistent asthma, the addition of a low-dose inhaled
corticosteroid (ICS) is recommended to manage underlying airway inflammation. Current
,guidelines emphasize that SABA-only treatment is no longer recommended due to the risk
of severe exacerbations. The ICS acts as a controller medication to reduce the frequency
and severity of asthma symptoms over time.
4. Which physical examination finding is most suggestive of Community-Acquired Pneumonia
(CAP) in an older adult?
A. Hyperresonance on percussion
B. Ego-phony and dullness to percussion
C. Wheezing throughout all lung fields
D. Decreased tactile fremitus
Correct Answer: B
Explanation: Ego-phony, where the patient’s ‘ee’ sound is heard as ‘ay’, and dullness to
percussion are classic signs of pulmonary consolidation associated with pneumonia. These
findings indicate that the lung tissue is filled with fluid or inflammatory exudate rather
than air. In older adults, these physical findings may be more reliable than systemic
symptoms like high fever, which may be absent.
5. A 45-year-old female presents with epigastric pain that improves after eating but recurs 2-3
hours later. Which condition is most likely?
A. Gastric Ulcer
B. Acute Cholecystitis
C. Duodenal Ulcer
, D. Gastroesophageal Reflux Disease
Correct Answer: C
Explanation: Pain from a duodenal ulcer is typically relieved by food or antacids because
the food buffers the stomach acid. The pain usually returns when the stomach is empty,
often a few hours after a meal or during the night. In contrast, gastric ulcer pain is often
exacerbated by food intake, leading to weight loss in some patients.
6. What is the primary diagnostic test for a patient suspected of having obstructive sleep
apnea (OSA)?
A. Chest X-ray
B. Pulmonary Function Tests
C. Polysomnography
D. Echocardiogram
Correct Answer: C
Explanation: Polysomnography, or a sleep study, is the gold standard for diagnosing
obstructive sleep apnea. It monitors various physiological parameters including oxygen
saturation, airflow, and brain activity during sleep. This test allows the clinician to
determine the Apnea-Hypopnea Index (AHI) to grade the severity of the disorder.
7. An 82-year-old patient presents with a history of heart failure and is currently taking
Lisinopril. Which lab value must be monitored closely to prevent complications?
A. Serum Potassium
