NSG 554 Exam 4 V1 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 4 2026)
1. A 10-month-old infant presents with a 2-day history of low-grade fever, rhinorrhea, and a
persistent cough. On physical examination, the NP notes diffuse expiratory wheezing and
mild tachypnea. Which of the following is the most appropriate management for this patient?
A. Oral albuterol syrup every 6 hours
B. Systemic corticosteroids and chest physiotherapy
C. Supportive care including hydration and saline nasal drops
D. Inhaled corticosteroids via metered-dose inhaler
Answer: C
Rationale: The presentation is consistent with bronchiolitis, which is most often caused by
Respiratory Syncytial Virus (RSV) in infants. Clinical guidelines from the AAP state that
bronchodilators and corticosteroids are not recommended for routine use in these cases.
The mainstay of management is supportive care to ensure adequate hydration and
oxygenation while the virus runs its course.
,2. An 8-year-old child presents with a sore throat, fever of 102°F, and tender anterior cervical
lymphadenopathy. The NP observes beefy red tonsils with patchy exudates. What is the most
appropriate next step?
A. Prescribe a 10-day course of Amoxicillin immediately
B. Perform a Rapid Antigen Detection Test (RADT) for Group A Strep
C. Advise the parent to use salt-water gargles and return in 3 days
D. Order a monospot test to rule out Epstein-Barr Virus
Answer: B
Rationale: While the Centor criteria suggest a high probability of Group A Strep (GAS),
clinical diagnosis alone is unreliable in children. A Rapid Antigen Detection Test should be
performed to confirm the diagnosis before initiating antibiotic therapy. If the RADT is
negative in a symptomatic child, a follow-up throat culture is the gold standard to ensure
GAS is not missed.
3. Which of the following physical exam findings is most characteristic of an ‘innocent’ or
functional murmur in a school-aged child?
A. A musical or vibratory systolic murmur that decreases in intensity when the child sits up
B. A Grade III/VI murmur that radiates to the axilla
C. A diastolic murmur heard best at the apex
D. A harsh holosystolic murmur associated with a palpable thrill
,Answer: A
Rationale: Still’s murmur is the most common innocent murmur in children and is
typically musical or vibratory in quality. These murmurs are generally Grade I-II, heard
best at the lower left sternal border, and are position-dependent. Diastolic murmurs, loud
murmurs (Grade III+), and those that radiate are typically considered pathologic and
require further investigation.
4. A 5-year-old boy is brought to the clinic for a well-child visit. According to the CDC
immunization schedule, which of the following vaccine series should be completed at this
visit?
A. Hepatitis A and Rotavirus
B. Hepatitis B, Hib, and PCV13
C. Tdap, HPV, and Meningococcal
D. DTaP, IPV, MMR, and Varicella
Answer: D
Rationale: The age range of 4 to 6 years is the standard time for children to receive their
final boosters for DTaP, IPV, MMR, and Varicella before entering kindergarten. These
boosters ensure long-term immunity against these highly contagious diseases. Routine
administration of these vaccines at the 5-year visit follows the national standards of care
for pediatric primary care.
, 5. A 14-year-old female reports a 3-month history of fatigue and heavy menstrual periods.
Her hemoglobin is 10.2 g/dL and her ferritin level is low. What is the first-line treatment for
this condition?
A. Intravenous iron sucrose twice weekly
B. Vitamin B12 injections monthly
C. Daily oral ferrous sulfate (3-6 mg/kg/day of elemental iron)
D. Increasing dietary intake of spinach and red meat only
Answer: C
Rationale: The laboratory findings indicate Iron Deficiency Anemia (IDA), likely secondary
to menstrual blood loss. Oral iron supplementation remains the first-line treatment for
pediatric and adolescent IDA. While dietary changes are helpful, they are insufficient to
replenish iron stores in the setting of established anemia.
6. During a 2-year-old wellness exam, the NP uses the M-CHAT-R tool. What is the primary
purpose of this screening?
A. To assess for gross motor developmental delays
B. To screen for Autism Spectrum Disorder (ASD)
C. To evaluate for Attention Deficit Hyperactivity Disorder (ADHD)
D. To determine the child’s readiness for potty training
Answer: B
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 4 2026)
1. A 10-month-old infant presents with a 2-day history of low-grade fever, rhinorrhea, and a
persistent cough. On physical examination, the NP notes diffuse expiratory wheezing and
mild tachypnea. Which of the following is the most appropriate management for this patient?
A. Oral albuterol syrup every 6 hours
B. Systemic corticosteroids and chest physiotherapy
C. Supportive care including hydration and saline nasal drops
D. Inhaled corticosteroids via metered-dose inhaler
Answer: C
Rationale: The presentation is consistent with bronchiolitis, which is most often caused by
Respiratory Syncytial Virus (RSV) in infants. Clinical guidelines from the AAP state that
bronchodilators and corticosteroids are not recommended for routine use in these cases.
The mainstay of management is supportive care to ensure adequate hydration and
oxygenation while the virus runs its course.
,2. An 8-year-old child presents with a sore throat, fever of 102°F, and tender anterior cervical
lymphadenopathy. The NP observes beefy red tonsils with patchy exudates. What is the most
appropriate next step?
A. Prescribe a 10-day course of Amoxicillin immediately
B. Perform a Rapid Antigen Detection Test (RADT) for Group A Strep
C. Advise the parent to use salt-water gargles and return in 3 days
D. Order a monospot test to rule out Epstein-Barr Virus
Answer: B
Rationale: While the Centor criteria suggest a high probability of Group A Strep (GAS),
clinical diagnosis alone is unreliable in children. A Rapid Antigen Detection Test should be
performed to confirm the diagnosis before initiating antibiotic therapy. If the RADT is
negative in a symptomatic child, a follow-up throat culture is the gold standard to ensure
GAS is not missed.
3. Which of the following physical exam findings is most characteristic of an ‘innocent’ or
functional murmur in a school-aged child?
A. A musical or vibratory systolic murmur that decreases in intensity when the child sits up
B. A Grade III/VI murmur that radiates to the axilla
C. A diastolic murmur heard best at the apex
D. A harsh holosystolic murmur associated with a palpable thrill
,Answer: A
Rationale: Still’s murmur is the most common innocent murmur in children and is
typically musical or vibratory in quality. These murmurs are generally Grade I-II, heard
best at the lower left sternal border, and are position-dependent. Diastolic murmurs, loud
murmurs (Grade III+), and those that radiate are typically considered pathologic and
require further investigation.
4. A 5-year-old boy is brought to the clinic for a well-child visit. According to the CDC
immunization schedule, which of the following vaccine series should be completed at this
visit?
A. Hepatitis A and Rotavirus
B. Hepatitis B, Hib, and PCV13
C. Tdap, HPV, and Meningococcal
D. DTaP, IPV, MMR, and Varicella
Answer: D
Rationale: The age range of 4 to 6 years is the standard time for children to receive their
final boosters for DTaP, IPV, MMR, and Varicella before entering kindergarten. These
boosters ensure long-term immunity against these highly contagious diseases. Routine
administration of these vaccines at the 5-year visit follows the national standards of care
for pediatric primary care.
, 5. A 14-year-old female reports a 3-month history of fatigue and heavy menstrual periods.
Her hemoglobin is 10.2 g/dL and her ferritin level is low. What is the first-line treatment for
this condition?
A. Intravenous iron sucrose twice weekly
B. Vitamin B12 injections monthly
C. Daily oral ferrous sulfate (3-6 mg/kg/day of elemental iron)
D. Increasing dietary intake of spinach and red meat only
Answer: C
Rationale: The laboratory findings indicate Iron Deficiency Anemia (IDA), likely secondary
to menstrual blood loss. Oral iron supplementation remains the first-line treatment for
pediatric and adolescent IDA. While dietary changes are helpful, they are insufficient to
replenish iron stores in the setting of established anemia.
6. During a 2-year-old wellness exam, the NP uses the M-CHAT-R tool. What is the primary
purpose of this screening?
A. To assess for gross motor developmental delays
B. To screen for Autism Spectrum Disorder (ASD)
C. To evaluate for Attention Deficit Hyperactivity Disorder (ADHD)
D. To determine the child’s readiness for potty training
Answer: B
