NSG 554 Exam 3 V1 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 3 2026)
1. A 26-year-old primigravida at 28 weeks gestation presents for her routine prenatal visit.
Which of the following laboratory screenings is most appropriate at this stage of pregnancy?
A. Group B Streptococcus (GBS) culture
B. 1-hour Glucose Tolerance Test (GTT)
C. Quad Screen
D. Cystic Fibrosis carrier screening
Answer: B
Rationale: Screening for gestational diabetes using a 1-hour glucose tolerance test is
standard practice between 24 and 28 weeks of gestation. This timing is selected because
placental hormones that cause insulin resistance peak during the late second and early
third trimesters. If the 1-hour screen is elevated, a 3-hour diagnostic test is required to
confirm the diagnosis.
2. According to the Amsel criteria, which of the following findings is diagnostic for Bacterial
Vaginosis (BV)?
A. Positive ‘whiff test’ with 10% KOH
,B. Presence of hyphae on KOH prep
C. Vaginal pH of 4.0
D. Abundant lactobacilli on microscopy
Answer: A
Rationale: The Amsel criteria require three out of four specific findings: thin homogeneous
discharge, pH greater than 4.5, positive whiff test, and the presence of clue cells. A positive
whiff test occurs when 10% potassium hydroxide (KOH) is added to vaginal secretions,
releasing a fishy odor. The absence of lactobacilli and the presence of clue cells are
hallmark microscopic findings for this condition.
3. A 4-month-old infant is brought in for a well-child visit. Which developmental milestone
should the Nurse Practitioner expect the infant to have achieved?
A. Rolling from tummy to back
B. Sitting independently without support
C. Pincer grasp
D. Saying ‘mama’ and ‘dada’ specifically
Answer: A
Rationale: By 4 months of age, infants typically begin to roll from their prone position
(tummy) to their supine position (back). Sitting independently is generally expected closer
to 6 months, while pincer grasp and specific vocalizations occur much later in the first year.
,Monitoring these milestones is essential for assessing neurological and motor development
during primary care visits.
4. A 19-year-old female requests contraception. She has a history of migraines with aura.
Which of the following is the most appropriate contraceptive choice?
A. Copper Intrauterine Device (Paragard)
B. Contraceptive Patch (Ortho Evra)
C. Combined Oral Contraceptive (COC) pill
D. NuvaRing
E. None of the above
Answer: A
Rationale: The use of estrogen-containing contraceptives is contraindicated in women
who experience migraines with aura due to a significantly increased risk of ischemic
stroke. The Copper IUD is a non-hormonal option that provides highly effective long-term
contraception without vascular risks. Progestin-only options would also be considered safe
alternatives in this clinical scenario.
5. Which of the following is the first-line antibiotic treatment for an uncomplicated urinary
tract infection (UTI) in a non-pregnant adult female?
A. Ciprofloxacin 500mg BID for 7 days
B. Nitrofurantoin (Macrobid) 100mg BID for 5 days
, C. Amoxicillin 500mg TID for 10 days
D. Cephalexin 500mg QID for 7 days
Answer: B
Rationale: Nitrofurantoin is considered a first-line agent for uncomplicated cystitis due to
its narrow spectrum and minimal impact on vaginal flora. Trimethoprim-sulfamethoxazole
(Bactrim) is also first-line if local resistance rates are below 20%. Fluoroquinolones like
Ciprofloxacin should be reserved for more complex cases or when other options are not
viable.
6. A 15-year-old male presents with a painful, swollen scrotum. On examination, the NP notes
a negative Prehn’s sign and an absent cremasteric reflex. What is the immediate priority?
A. Prescribe Doxycycline for epididymitis
B. Order an ultrasound to rule out a hydrocele
C. Apply ice packs and follow up in 24 hours
D. Immediate referral to the Emergency Department for suspected testicular torsion
Answer: D
Rationale: Testicular torsion is a surgical emergency that requires intervention within 6
hours to salvage the testicle. The absence of the cremasteric reflex and a negative Prehn’s
sign (lack of pain relief with scrotal elevation) are classic indicators of torsion. Delaying
treatment for imaging in the primary care setting can lead to permanent testicular necrosis.
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 3 2026)
1. A 26-year-old primigravida at 28 weeks gestation presents for her routine prenatal visit.
Which of the following laboratory screenings is most appropriate at this stage of pregnancy?
A. Group B Streptococcus (GBS) culture
B. 1-hour Glucose Tolerance Test (GTT)
C. Quad Screen
D. Cystic Fibrosis carrier screening
Answer: B
Rationale: Screening for gestational diabetes using a 1-hour glucose tolerance test is
standard practice between 24 and 28 weeks of gestation. This timing is selected because
placental hormones that cause insulin resistance peak during the late second and early
third trimesters. If the 1-hour screen is elevated, a 3-hour diagnostic test is required to
confirm the diagnosis.
2. According to the Amsel criteria, which of the following findings is diagnostic for Bacterial
Vaginosis (BV)?
A. Positive ‘whiff test’ with 10% KOH
,B. Presence of hyphae on KOH prep
C. Vaginal pH of 4.0
D. Abundant lactobacilli on microscopy
Answer: A
Rationale: The Amsel criteria require three out of four specific findings: thin homogeneous
discharge, pH greater than 4.5, positive whiff test, and the presence of clue cells. A positive
whiff test occurs when 10% potassium hydroxide (KOH) is added to vaginal secretions,
releasing a fishy odor. The absence of lactobacilli and the presence of clue cells are
hallmark microscopic findings for this condition.
3. A 4-month-old infant is brought in for a well-child visit. Which developmental milestone
should the Nurse Practitioner expect the infant to have achieved?
A. Rolling from tummy to back
B. Sitting independently without support
C. Pincer grasp
D. Saying ‘mama’ and ‘dada’ specifically
Answer: A
Rationale: By 4 months of age, infants typically begin to roll from their prone position
(tummy) to their supine position (back). Sitting independently is generally expected closer
to 6 months, while pincer grasp and specific vocalizations occur much later in the first year.
,Monitoring these milestones is essential for assessing neurological and motor development
during primary care visits.
4. A 19-year-old female requests contraception. She has a history of migraines with aura.
Which of the following is the most appropriate contraceptive choice?
A. Copper Intrauterine Device (Paragard)
B. Contraceptive Patch (Ortho Evra)
C. Combined Oral Contraceptive (COC) pill
D. NuvaRing
E. None of the above
Answer: A
Rationale: The use of estrogen-containing contraceptives is contraindicated in women
who experience migraines with aura due to a significantly increased risk of ischemic
stroke. The Copper IUD is a non-hormonal option that provides highly effective long-term
contraception without vascular risks. Progestin-only options would also be considered safe
alternatives in this clinical scenario.
5. Which of the following is the first-line antibiotic treatment for an uncomplicated urinary
tract infection (UTI) in a non-pregnant adult female?
A. Ciprofloxacin 500mg BID for 7 days
B. Nitrofurantoin (Macrobid) 100mg BID for 5 days
, C. Amoxicillin 500mg TID for 10 days
D. Cephalexin 500mg QID for 7 days
Answer: B
Rationale: Nitrofurantoin is considered a first-line agent for uncomplicated cystitis due to
its narrow spectrum and minimal impact on vaginal flora. Trimethoprim-sulfamethoxazole
(Bactrim) is also first-line if local resistance rates are below 20%. Fluoroquinolones like
Ciprofloxacin should be reserved for more complex cases or when other options are not
viable.
6. A 15-year-old male presents with a painful, swollen scrotum. On examination, the NP notes
a negative Prehn’s sign and an absent cremasteric reflex. What is the immediate priority?
A. Prescribe Doxycycline for epididymitis
B. Order an ultrasound to rule out a hydrocele
C. Apply ice packs and follow up in 24 hours
D. Immediate referral to the Emergency Department for suspected testicular torsion
Answer: D
Rationale: Testicular torsion is a surgical emergency that requires intervention within 6
hours to salvage the testicle. The absence of the cremasteric reflex and a negative Prehn’s
sign (lack of pain relief with scrotal elevation) are classic indicators of torsion. Delaying
treatment for imaging in the primary care setting can lead to permanent testicular necrosis.
