NSG555 Exam 3 - Nurse Practitioners in Primary Care I | Wilkes University | 2026/2027 Page 1
NSG555 / NSG 555 EXAM 3
(Latest Update)
NURSE PRACTITIONERS IN PRIMARY CARE I
Questions and Verified Answers | 100% Correct | Grade A
Wilkes University
Total Questions 120
Sections 8 (Women's Health, Men's Health, Pediatric, Geriatric, Mental Health, Infectious Diseases, Dermatologica
Question Style 75% scenario-based clinical decision-making, 25% direct knowledge
Cognitive Levels 20% recall, 50% application, 30% analysis
Format Multiple choice (4 options A-D, one correct)
Special Inclusions 20 scenario-based clinical reasoning, 15 health promotion across lifespan, 10 special populations
Aligned Standards AACN Essentials of Master's Education, FNP Primary Care Competencies (2026/2027), USPSTF, CDC/A
Section Topic Q# Count
1 Women's Health in Primary Care Q1-Q18 18
2 Men's Health in Primary Care Q19-Q33 15
3 Pediatric & Adolescent Health in Primary Care Q34-Q51 18
4 Geriatric Health in Primary Care Q52-Q69 18
5 Mental Health in Primary Care Q70-Q84 15
6 Infectious Diseases in Primary Care Q85-Q96 12
7 Dermatological Conditions in Primary Care Q97-Q108 12
8 Health Promotion & Disease Prevention Across the Lifespan Q109-Q120 12
Grade A Verified | Aligned with AACN Essentials & FNP Primary Care Competencies
,NSG555 Exam 3 - Nurse Practitioners in Primary Care I | Wilkes University | 2026/2027 Page 2
Section 1: Women's Health in Primary Care
Q1: A 26-year-old G1P0 woman at 11 weeks gestation presents for her first prenatal visit. She has
no medical history and takes only prenatal vitamins. Which of the following laboratory tests is
recommended as part of routine first-trimester prenatal screening according to ACOG guidelines?
A. Hemoglobin A1c, lipid panel, and thyroid panel only
B. CBC, blood type and Rh, rubella immunity, syphilis (RPR), HIV, hepatitis B surface antigen, and
urine culture [CORRECT]
C. Genetic carrier screening for cystic fibrosis only
D. Quad screen and glucose tolerance test only
Correct Answer: B
Rationale: ACOG-recommended first-trimester prenatal labs include CBC, blood type/Rh with antibody screen,
rubella immunity, syphilis (RPR), HIV, hepatitis B surface antigen, and urine culture to detect asymptomatic
bacteriuria. Genetic carrier screening, quad screen, and glucose tolerance testing are performed at later gestational
ages. The FNP primary care competency emphasizes evidence-based prenatal screening to reduce maternal-fetal
complications.
Q2: A 31-year-old woman presents with a 3-day history of frothy, yellow-green vaginal discharge
with a strong fishy odor and vaginal itching. Saline microscopy reveals motile flagellated
organisms. Wet mount pH is 5.5. What is the most appropriate treatment?
A. Oral fluconazole 150 mg single dose
B. Intravaginal metronidazole gel 0.75% daily for 5 days
C. Oral metronidazole 500 mg twice daily for 7 days (avoid alcohol during treatment and 24 hours
after) [CORRECT]
D. Intravaginal clotrimazole 1% cream for 7 days
Correct Answer: C
Rationale: The presentation (frothy yellow-green discharge, pH >4.5, motile flagellates on wet mount) is classic for
Trichomonas vaginalis. The CDC-recommended treatment is oral metronidazole 500 mg BID for 7 days (or 2 g single
dose). Intravaginal metronidazole treats bacterial vaginosis, not trichomoniasis. Fluconazole and clotrimazole treat
candidiasis. Patients must avoid alcohol due to the disulfiram-like reaction. Sexual partners should also be treated.
Q3: A 42-year-old woman reports irregular menstrual cycles, hot flashes, night sweats, and vaginal
dryness for the past 4 months. Her FSH level is 35 mIU/mL. She has no contraindications to
hormone therapy. What is the most likely diagnosis and the recommended first-line management if
she has an intact uterus?
A. Premature ovarian failure; combined estrogen-progestin therapy is contraindicated
B. Perimenopause; systemic estrogen plus progestin therapy (e.g., transdermal estradiol with oral
micronized progesterone) is appropriate [CORRECT]
C. Menopause; estrogen-only therapy is preferred even with an intact uterus
D. Polycystic ovary syndrome; combined oral contraceptives are the only option
Correct Answer: B
Rationale: FSH >25 mIU/mL with vasomotor symptoms and irregular cycles in a woman in her 40s indicates
perimenopause. For a woman with an intact uterus, estrogen therapy MUST be paired with a progestin to prevent
endometrial hyperplasia and cancer (unopposed estrogen is contraindicated with intact uterus). Transdermal
estrogen is preferred for lower VTE risk. The FNP role includes shared decision-making around hormone therapy
risks and benefits per the NAMS position statement.
Grade A Verified | Aligned with AACN Essentials & FNP Primary Care Competencies
,NSG555 Exam 3 - Nurse Practitioners in Primary Care I | Wilkes University | 2026/2027 Page 3
Q4: A 24-year-old woman requests contraception. She has a history of migraines with aura,
smokes half a pack of cigarettes daily, and has a BMI of 32. Which contraceptive method is
CONTRAINDICATED for this patient?
A. Copper intrauterine device (ParaGard)
B. Levonorgestrel intrauterine system (Mirena)
C. Combined oral contraceptive pill (estrogen-progestin) [CORRECT]
D. Etonogestrel subdermal implant (Nexplanon)
Correct Answer: C
Rationale: Combined hormonal contraceptives (CHCs) containing estrogen are Category 4 (unacceptable health
risk) per CDC MEC for women with migraines with aura due to elevated stroke risk. Smoking further increases
thrombotic risk in women over 35. Progestin-only methods (IUDs, implant, progestin-only pills) and the copper IUD
are safe and effective alternatives. The FNP must apply CDC MEC categories when counseling on contraceptive
safety.
Q5: A 52-year-old postmenopausal woman presents with new-onset vaginal bleeding 3 years after
her last menstrual period. She has not taken hormone therapy. What is the most appropriate next
step in management?
A. Reassure her that postmenopausal bleeding is normal and follow up in 6 months
B. Initiate oral conjugated equine estrogen to stabilize the endometrium
C. Refer for endometrial biopsy and transvaginal ultrasound to evaluate endometrial thickness
[CORRECT]
D. Prescribe a progestin-only contraceptive to regulate bleeding
Correct Answer: C
Rationale: Any postmenopausal bleeding requires evaluation for endometrial cancer until proven otherwise. The
standard workup includes transvaginal ultrasound to measure endometrial thickness (≤4-5 mm is reassuring in a
postmenopausal woman not on hormone therapy) and endometrial biopsy. Reassurance or hormonal therapy without
evaluation delays cancer diagnosis. The AACN Master's Essentials emphasize timely recognition of red-flag
presentations requiring escalation.
Q6: A 28-year-old woman presents with a 2-week history of bilateral lower abdominal pain,
dyspareunia, abnormal vaginal discharge, and intermittent fever. She is sexually active with
multiple partners and uses condoms inconsistently. Pelvic exam reveals cervical motion
tenderness, uterine tenderness, and adnexal tenderness. What is the most likely diagnosis and the
appropriate outpatient treatment per CDC guidelines?
A. Bacterial vaginosis; oral metronidazole 500 mg BID for 7 days
B. Pelvic inflammatory disease; ceftriaxone 500 mg IM once plus doxycycline 100 mg BID for 14
days plus metronidazole 500 mg BID for 14 days [CORRECT]
C. Uncomplicated gonorrhea; ceftriaxone 250 mg IM once only
D. Endometriosis; combined oral contraceptives for 3 months
Correct Answer: B
Rationale: Cervical motion tenderness, uterine tenderness, and adnexal tenderness with fever and discharge meet
clinical criteria for pelvic inflammatory disease (PID). CDC-recommended outpatient regimen: ceftriaxone 500 mg IM
(covers gonorrhea) plus doxycycline 100 mg BID x 14 days (covers chlamydia) plus metronidazole 500 mg BID x 14
days (covers anaerobes). BV treatment alone is inadequate. Gonorrhea-only treatment misses polymicrobial
coverage. The FNP must ensure partner treatment and follow-up in 48-72 hours.
Grade A Verified | Aligned with AACN Essentials & FNP Primary Care Competencies
, NSG555 Exam 3 - Nurse Practitioners in Primary Care I | Wilkes University | 2026/2027 Page 4
Q7: A 19-year-old woman presents for her first well-woman visit. She became sexually active 6
months ago and has received the HPV vaccine series. According to current ACS/ASCCP/ACOG
cervical cancer screening guidelines, when should cervical cancer screening begin for this
average-risk patient?
A. Begin Pap testing immediately at age 19 since she is sexually active
B. Begin cervical cytology (Pap) at age 21 regardless of sexual activity [CORRECT]
C. Begin cotesting (Pap + HPV) at age 25
D. Begin HPV testing alone at age 18
Correct Answer: B
Rationale: Current guidelines (ACS, ASCCP, ACOG) recommend beginning cervical cancer screening at age 21
regardless of sexual activity or HPV vaccination status. For ages 21-29, cytology (Pap) alone every 3 years is
recommended if results are normal. HPV cotesting is added at age 30 and above. Vaccination status does not
change screening recommendations because the vaccine does not protect against all HPV types. NSG 555
emphasizes age-appropriate preventive screening aligned with USPSTF/ACOG guidance.
Q8: A 35-year-old woman, G3P3, desires long-term contraception. She reports heavy menstrual
bleeding and dysmenorrhea. She has no history of STIs and is in a mutually monogamous
relationship. Which contraceptive option would best address both her contraceptive needs and
her menstrual concerns?
A. Copper IUD (ParaGard) for 10-year contraception
B. Levonorgestrel IUD (Mirena) for up to 8-year contraception with reduction in menstrual bleeding
[CORRECT]
C. Depot medroxyprogesterone acetate (DMPA) injections every 3 months
D. Combined oral contraceptive pills taken continuously
Correct Answer: B
Rationale: The levonorgestrel-releasing IUD (Mirena) provides highly effective long-acting reversible contraception
AND is FDA-approved to treat heavy menstrual bleeding, with up to 20% of users becoming amenorrheic at 1 year.
The copper IUD often increases menstrual bleeding and cramping, making it a poor choice for this patient. DMPA has
a black box warning for bone mineral density loss with prolonged use. The FNP role includes matching contraceptive
method to patient-specific menstrual and reproductive goals.
Q9: A 22-year-old woman calls the clinic reporting that the condom broke during intercourse last
night. She is not on any contraception and does not desire pregnancy. Her last menstrual period
was 12 days ago. What is the most appropriate recommendation for emergency contraception?
A. Advise her that it is too late and to wait for her next period
B. Recommend ulipristal acetate 30 mg orally as a single dose, taken as soon as possible within
120 hours [CORRECT]
C. Recommend a levonorgestrel IUD placed within 5 days only if she wants long-term contraception
D. Recommend doubling her daily dose of combined oral contraceptives for 5 days
Correct Answer: B
Rationale: Ulipristal acetate (UPA) 30 mg is more effective than levonorgestrel for emergency contraception,
particularly in the 72-120 hour window and for women with higher BMIs, because it delays ovulation even after LH
surge begins. The copper IUD is the most effective EC method and can be placed within 5 days, but only if the patient
desires IUD contraception. Levonorgestrel pills lose efficacy after 72 hours and in higher BMI. Doubling OCP doses is
an outdated approach with more side effects.
Grade A Verified | Aligned with AACN Essentials & FNP Primary Care Competencies
NSG555 / NSG 555 EXAM 3
(Latest Update)
NURSE PRACTITIONERS IN PRIMARY CARE I
Questions and Verified Answers | 100% Correct | Grade A
Wilkes University
Total Questions 120
Sections 8 (Women's Health, Men's Health, Pediatric, Geriatric, Mental Health, Infectious Diseases, Dermatologica
Question Style 75% scenario-based clinical decision-making, 25% direct knowledge
Cognitive Levels 20% recall, 50% application, 30% analysis
Format Multiple choice (4 options A-D, one correct)
Special Inclusions 20 scenario-based clinical reasoning, 15 health promotion across lifespan, 10 special populations
Aligned Standards AACN Essentials of Master's Education, FNP Primary Care Competencies (2026/2027), USPSTF, CDC/A
Section Topic Q# Count
1 Women's Health in Primary Care Q1-Q18 18
2 Men's Health in Primary Care Q19-Q33 15
3 Pediatric & Adolescent Health in Primary Care Q34-Q51 18
4 Geriatric Health in Primary Care Q52-Q69 18
5 Mental Health in Primary Care Q70-Q84 15
6 Infectious Diseases in Primary Care Q85-Q96 12
7 Dermatological Conditions in Primary Care Q97-Q108 12
8 Health Promotion & Disease Prevention Across the Lifespan Q109-Q120 12
Grade A Verified | Aligned with AACN Essentials & FNP Primary Care Competencies
,NSG555 Exam 3 - Nurse Practitioners in Primary Care I | Wilkes University | 2026/2027 Page 2
Section 1: Women's Health in Primary Care
Q1: A 26-year-old G1P0 woman at 11 weeks gestation presents for her first prenatal visit. She has
no medical history and takes only prenatal vitamins. Which of the following laboratory tests is
recommended as part of routine first-trimester prenatal screening according to ACOG guidelines?
A. Hemoglobin A1c, lipid panel, and thyroid panel only
B. CBC, blood type and Rh, rubella immunity, syphilis (RPR), HIV, hepatitis B surface antigen, and
urine culture [CORRECT]
C. Genetic carrier screening for cystic fibrosis only
D. Quad screen and glucose tolerance test only
Correct Answer: B
Rationale: ACOG-recommended first-trimester prenatal labs include CBC, blood type/Rh with antibody screen,
rubella immunity, syphilis (RPR), HIV, hepatitis B surface antigen, and urine culture to detect asymptomatic
bacteriuria. Genetic carrier screening, quad screen, and glucose tolerance testing are performed at later gestational
ages. The FNP primary care competency emphasizes evidence-based prenatal screening to reduce maternal-fetal
complications.
Q2: A 31-year-old woman presents with a 3-day history of frothy, yellow-green vaginal discharge
with a strong fishy odor and vaginal itching. Saline microscopy reveals motile flagellated
organisms. Wet mount pH is 5.5. What is the most appropriate treatment?
A. Oral fluconazole 150 mg single dose
B. Intravaginal metronidazole gel 0.75% daily for 5 days
C. Oral metronidazole 500 mg twice daily for 7 days (avoid alcohol during treatment and 24 hours
after) [CORRECT]
D. Intravaginal clotrimazole 1% cream for 7 days
Correct Answer: C
Rationale: The presentation (frothy yellow-green discharge, pH >4.5, motile flagellates on wet mount) is classic for
Trichomonas vaginalis. The CDC-recommended treatment is oral metronidazole 500 mg BID for 7 days (or 2 g single
dose). Intravaginal metronidazole treats bacterial vaginosis, not trichomoniasis. Fluconazole and clotrimazole treat
candidiasis. Patients must avoid alcohol due to the disulfiram-like reaction. Sexual partners should also be treated.
Q3: A 42-year-old woman reports irregular menstrual cycles, hot flashes, night sweats, and vaginal
dryness for the past 4 months. Her FSH level is 35 mIU/mL. She has no contraindications to
hormone therapy. What is the most likely diagnosis and the recommended first-line management if
she has an intact uterus?
A. Premature ovarian failure; combined estrogen-progestin therapy is contraindicated
B. Perimenopause; systemic estrogen plus progestin therapy (e.g., transdermal estradiol with oral
micronized progesterone) is appropriate [CORRECT]
C. Menopause; estrogen-only therapy is preferred even with an intact uterus
D. Polycystic ovary syndrome; combined oral contraceptives are the only option
Correct Answer: B
Rationale: FSH >25 mIU/mL with vasomotor symptoms and irregular cycles in a woman in her 40s indicates
perimenopause. For a woman with an intact uterus, estrogen therapy MUST be paired with a progestin to prevent
endometrial hyperplasia and cancer (unopposed estrogen is contraindicated with intact uterus). Transdermal
estrogen is preferred for lower VTE risk. The FNP role includes shared decision-making around hormone therapy
risks and benefits per the NAMS position statement.
Grade A Verified | Aligned with AACN Essentials & FNP Primary Care Competencies
,NSG555 Exam 3 - Nurse Practitioners in Primary Care I | Wilkes University | 2026/2027 Page 3
Q4: A 24-year-old woman requests contraception. She has a history of migraines with aura,
smokes half a pack of cigarettes daily, and has a BMI of 32. Which contraceptive method is
CONTRAINDICATED for this patient?
A. Copper intrauterine device (ParaGard)
B. Levonorgestrel intrauterine system (Mirena)
C. Combined oral contraceptive pill (estrogen-progestin) [CORRECT]
D. Etonogestrel subdermal implant (Nexplanon)
Correct Answer: C
Rationale: Combined hormonal contraceptives (CHCs) containing estrogen are Category 4 (unacceptable health
risk) per CDC MEC for women with migraines with aura due to elevated stroke risk. Smoking further increases
thrombotic risk in women over 35. Progestin-only methods (IUDs, implant, progestin-only pills) and the copper IUD
are safe and effective alternatives. The FNP must apply CDC MEC categories when counseling on contraceptive
safety.
Q5: A 52-year-old postmenopausal woman presents with new-onset vaginal bleeding 3 years after
her last menstrual period. She has not taken hormone therapy. What is the most appropriate next
step in management?
A. Reassure her that postmenopausal bleeding is normal and follow up in 6 months
B. Initiate oral conjugated equine estrogen to stabilize the endometrium
C. Refer for endometrial biopsy and transvaginal ultrasound to evaluate endometrial thickness
[CORRECT]
D. Prescribe a progestin-only contraceptive to regulate bleeding
Correct Answer: C
Rationale: Any postmenopausal bleeding requires evaluation for endometrial cancer until proven otherwise. The
standard workup includes transvaginal ultrasound to measure endometrial thickness (≤4-5 mm is reassuring in a
postmenopausal woman not on hormone therapy) and endometrial biopsy. Reassurance or hormonal therapy without
evaluation delays cancer diagnosis. The AACN Master's Essentials emphasize timely recognition of red-flag
presentations requiring escalation.
Q6: A 28-year-old woman presents with a 2-week history of bilateral lower abdominal pain,
dyspareunia, abnormal vaginal discharge, and intermittent fever. She is sexually active with
multiple partners and uses condoms inconsistently. Pelvic exam reveals cervical motion
tenderness, uterine tenderness, and adnexal tenderness. What is the most likely diagnosis and the
appropriate outpatient treatment per CDC guidelines?
A. Bacterial vaginosis; oral metronidazole 500 mg BID for 7 days
B. Pelvic inflammatory disease; ceftriaxone 500 mg IM once plus doxycycline 100 mg BID for 14
days plus metronidazole 500 mg BID for 14 days [CORRECT]
C. Uncomplicated gonorrhea; ceftriaxone 250 mg IM once only
D. Endometriosis; combined oral contraceptives for 3 months
Correct Answer: B
Rationale: Cervical motion tenderness, uterine tenderness, and adnexal tenderness with fever and discharge meet
clinical criteria for pelvic inflammatory disease (PID). CDC-recommended outpatient regimen: ceftriaxone 500 mg IM
(covers gonorrhea) plus doxycycline 100 mg BID x 14 days (covers chlamydia) plus metronidazole 500 mg BID x 14
days (covers anaerobes). BV treatment alone is inadequate. Gonorrhea-only treatment misses polymicrobial
coverage. The FNP must ensure partner treatment and follow-up in 48-72 hours.
Grade A Verified | Aligned with AACN Essentials & FNP Primary Care Competencies
, NSG555 Exam 3 - Nurse Practitioners in Primary Care I | Wilkes University | 2026/2027 Page 4
Q7: A 19-year-old woman presents for her first well-woman visit. She became sexually active 6
months ago and has received the HPV vaccine series. According to current ACS/ASCCP/ACOG
cervical cancer screening guidelines, when should cervical cancer screening begin for this
average-risk patient?
A. Begin Pap testing immediately at age 19 since she is sexually active
B. Begin cervical cytology (Pap) at age 21 regardless of sexual activity [CORRECT]
C. Begin cotesting (Pap + HPV) at age 25
D. Begin HPV testing alone at age 18
Correct Answer: B
Rationale: Current guidelines (ACS, ASCCP, ACOG) recommend beginning cervical cancer screening at age 21
regardless of sexual activity or HPV vaccination status. For ages 21-29, cytology (Pap) alone every 3 years is
recommended if results are normal. HPV cotesting is added at age 30 and above. Vaccination status does not
change screening recommendations because the vaccine does not protect against all HPV types. NSG 555
emphasizes age-appropriate preventive screening aligned with USPSTF/ACOG guidance.
Q8: A 35-year-old woman, G3P3, desires long-term contraception. She reports heavy menstrual
bleeding and dysmenorrhea. She has no history of STIs and is in a mutually monogamous
relationship. Which contraceptive option would best address both her contraceptive needs and
her menstrual concerns?
A. Copper IUD (ParaGard) for 10-year contraception
B. Levonorgestrel IUD (Mirena) for up to 8-year contraception with reduction in menstrual bleeding
[CORRECT]
C. Depot medroxyprogesterone acetate (DMPA) injections every 3 months
D. Combined oral contraceptive pills taken continuously
Correct Answer: B
Rationale: The levonorgestrel-releasing IUD (Mirena) provides highly effective long-acting reversible contraception
AND is FDA-approved to treat heavy menstrual bleeding, with up to 20% of users becoming amenorrheic at 1 year.
The copper IUD often increases menstrual bleeding and cramping, making it a poor choice for this patient. DMPA has
a black box warning for bone mineral density loss with prolonged use. The FNP role includes matching contraceptive
method to patient-specific menstrual and reproductive goals.
Q9: A 22-year-old woman calls the clinic reporting that the condom broke during intercourse last
night. She is not on any contraception and does not desire pregnancy. Her last menstrual period
was 12 days ago. What is the most appropriate recommendation for emergency contraception?
A. Advise her that it is too late and to wait for her next period
B. Recommend ulipristal acetate 30 mg orally as a single dose, taken as soon as possible within
120 hours [CORRECT]
C. Recommend a levonorgestrel IUD placed within 5 days only if she wants long-term contraception
D. Recommend doubling her daily dose of combined oral contraceptives for 5 days
Correct Answer: B
Rationale: Ulipristal acetate (UPA) 30 mg is more effective than levonorgestrel for emergency contraception,
particularly in the 72-120 hour window and for women with higher BMIs, because it delays ovulation even after LH
surge begins. The copper IUD is the most effective EC method and can be placed within 5 days, but only if the patient
desires IUD contraception. Levonorgestrel pills lose efficacy after 72 hours and in higher BMI. Doubling OCP doses is
an outdated approach with more side effects.
Grade A Verified | Aligned with AACN Essentials & FNP Primary Care Competencies
