NSG 554 Final Exam V2 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Final Exam 2026)
1. A 52-year-old male presents for a routine check-up. His blood pressure today is 154/94
mmHg, and it was 152/92 mmHg at his last visit three weeks ago. He has no other medical
history. Which of the following is the most appropriate first-line treatment according to JNC 8
or ACC/AHA guidelines?
A. Start Lisinopril 10mg daily and encourage lifestyle changes.
B. Initiate lifestyle modifications only and recheck in 3 months.
C. Prescribe Atenolol 25mg daily.
D. Begin Hydrochlorothiazide 12.5mg and Lisinopril 10mg simultaneously.
Answer: A
Rationale: This patient meets the criteria for Stage 2 hypertension because his systolic
blood pressure is consistently above 140 mmHg. First-line pharmacologic options for non-
black patients include ACE inhibitors, ARBs, Calcium Channel Blockers, or Thiazide
diuretics. Lifestyle modifications should always accompany medication, but medication is
indicated now due to the sustained elevation.
,2. A 35-year-old female presents with symptoms of polyuria, polydipsia, and unexplained
weight loss. Her random plasma glucose is 215 mg/dL. What is the next step in diagnosing
this patient for Diabetes Mellitus?
A. The patient already meets the diagnostic criteria for diabetes.
B. Perform an A1C test to confirm the diagnosis.
C. Schedule a fasting plasma glucose test for tomorrow.
D. Order a 2-hour Oral Glucose Tolerance Test (OGTT).
Answer: A
Rationale: Diagnostic criteria for Diabetes Mellitus include a random plasma glucose of
200 mg/dL or higher in a patient with classic symptoms of hyperglycemia. In this case, the
symptoms and the glucose level are sufficient for diagnosis without further testing. Other
criteria include A1C ≥ 6.5% or Fasting Plasma Glucose ≥ 126 mg/dL, but these usually
require a second test unless the patient is symptomatic.
3. Which of the following is considered a ‘red flag’ in a patient presenting with acute low back
pain that would necessitate immediate imaging?
A. Pain that increases with coughing or sneezing.
B. History of mild trauma in a young adult.
C. Localized muscle spasms in the lumbar region.
D. New onset of urinary incontinence or saddle anesthesia.
,Answer: D
Rationale: Saddle anesthesia and urinary incontinence are hallmark signs of Cauda Equina
Syndrome, which is a surgical emergency. Immediate MRI is required to prevent
permanent neurological damage. Routine imaging is generally not recommended for non-
specific low back pain within the first 4-6 weeks unless red flags are present.
4. An 18-year-old college student presents with a sore throat, fever, and significant cervical
lymphadenopathy. A rapid strep test is negative. Which physical exam finding is most
suggestive of Infectious Mononucleosis?
A. Anterior cervical lymphadenopathy.
B. Vesicles on the soft palate.
C. Sandpaper-like rash.
D. Splenomegaly.
Answer: D
Rationale: Splenomegaly is a classic finding in Infectious Mononucleosis and necessitates
counseling regarding the avoidance of contact sports. Posterior cervical lymphadenopathy
is also more common in mono than in streptococcal pharyngitis. A negative rapid strep test
in a high-risk demographic should prompt further investigation for Epstein-Barr virus.
5. According to the USPSTF, at what age should routine screening for colorectal cancer begin
for an average-risk adult?
A. 40 years old
, B. 45 years old
C. 50 years old
D. 55 years old
Answer: B
Rationale: The USPSTF updated its guidelines in 2021 to recommend that colorectal
cancer screening begin at age 45 for all average-risk adults. This change was prompted by
the increasing incidence of colorectal cancer in younger populations. Screening can be
performed via stool-based tests or direct visualization methods like colonoscopy.
6. A 65-year-old smoker presents with a chronic cough and progressive dyspnea. Spirometry
reveals an FEV1/FVC ratio of 0.62. This finding is diagnostic for which condition?
A. Asthma
B. Restrictive Lung Disease
C. Congestive Heart Failure
D. Chronic Obstructive Pulmonary Disease (COPD)
Answer: D
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the gold standard for
diagnosing COPD. This indicates persistent airflow limitation that is not fully reversible.
Patients with COPD often have a history of tobacco exposure and present with chronic
respiratory symptoms.
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Final Exam 2026)
1. A 52-year-old male presents for a routine check-up. His blood pressure today is 154/94
mmHg, and it was 152/92 mmHg at his last visit three weeks ago. He has no other medical
history. Which of the following is the most appropriate first-line treatment according to JNC 8
or ACC/AHA guidelines?
A. Start Lisinopril 10mg daily and encourage lifestyle changes.
B. Initiate lifestyle modifications only and recheck in 3 months.
C. Prescribe Atenolol 25mg daily.
D. Begin Hydrochlorothiazide 12.5mg and Lisinopril 10mg simultaneously.
Answer: A
Rationale: This patient meets the criteria for Stage 2 hypertension because his systolic
blood pressure is consistently above 140 mmHg. First-line pharmacologic options for non-
black patients include ACE inhibitors, ARBs, Calcium Channel Blockers, or Thiazide
diuretics. Lifestyle modifications should always accompany medication, but medication is
indicated now due to the sustained elevation.
,2. A 35-year-old female presents with symptoms of polyuria, polydipsia, and unexplained
weight loss. Her random plasma glucose is 215 mg/dL. What is the next step in diagnosing
this patient for Diabetes Mellitus?
A. The patient already meets the diagnostic criteria for diabetes.
B. Perform an A1C test to confirm the diagnosis.
C. Schedule a fasting plasma glucose test for tomorrow.
D. Order a 2-hour Oral Glucose Tolerance Test (OGTT).
Answer: A
Rationale: Diagnostic criteria for Diabetes Mellitus include a random plasma glucose of
200 mg/dL or higher in a patient with classic symptoms of hyperglycemia. In this case, the
symptoms and the glucose level are sufficient for diagnosis without further testing. Other
criteria include A1C ≥ 6.5% or Fasting Plasma Glucose ≥ 126 mg/dL, but these usually
require a second test unless the patient is symptomatic.
3. Which of the following is considered a ‘red flag’ in a patient presenting with acute low back
pain that would necessitate immediate imaging?
A. Pain that increases with coughing or sneezing.
B. History of mild trauma in a young adult.
C. Localized muscle spasms in the lumbar region.
D. New onset of urinary incontinence or saddle anesthesia.
,Answer: D
Rationale: Saddle anesthesia and urinary incontinence are hallmark signs of Cauda Equina
Syndrome, which is a surgical emergency. Immediate MRI is required to prevent
permanent neurological damage. Routine imaging is generally not recommended for non-
specific low back pain within the first 4-6 weeks unless red flags are present.
4. An 18-year-old college student presents with a sore throat, fever, and significant cervical
lymphadenopathy. A rapid strep test is negative. Which physical exam finding is most
suggestive of Infectious Mononucleosis?
A. Anterior cervical lymphadenopathy.
B. Vesicles on the soft palate.
C. Sandpaper-like rash.
D. Splenomegaly.
Answer: D
Rationale: Splenomegaly is a classic finding in Infectious Mononucleosis and necessitates
counseling regarding the avoidance of contact sports. Posterior cervical lymphadenopathy
is also more common in mono than in streptococcal pharyngitis. A negative rapid strep test
in a high-risk demographic should prompt further investigation for Epstein-Barr virus.
5. According to the USPSTF, at what age should routine screening for colorectal cancer begin
for an average-risk adult?
A. 40 years old
, B. 45 years old
C. 50 years old
D. 55 years old
Answer: B
Rationale: The USPSTF updated its guidelines in 2021 to recommend that colorectal
cancer screening begin at age 45 for all average-risk adults. This change was prompted by
the increasing incidence of colorectal cancer in younger populations. Screening can be
performed via stool-based tests or direct visualization methods like colonoscopy.
6. A 65-year-old smoker presents with a chronic cough and progressive dyspnea. Spirometry
reveals an FEV1/FVC ratio of 0.62. This finding is diagnostic for which condition?
A. Asthma
B. Restrictive Lung Disease
C. Congestive Heart Failure
D. Chronic Obstructive Pulmonary Disease (COPD)
Answer: D
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the gold standard for
diagnosing COPD. This indicates persistent airflow limitation that is not fully reversible.
Patients with COPD often have a history of tobacco exposure and present with chronic
respiratory symptoms.
