NSG 554 Exam 4 V3 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 4 2026)
1. A 65-year-old male presents with urinary frequency, nocturia, and a weak urinary stream.
The Nurse Practitioner suspects Benign Prostatic Hyperplasia (BPH). Which of the following is
the first-line medication class for rapid symptom relief?
A. 5-alpha-reductase inhibitors
B. Alpha-1 adrenergic antagonists
C. Phosphodiesterase-5 inhibitors
D. Antimuscarinics
Answer: B
Rationale: Alpha-1 adrenergic antagonists like Tamsulosin provide rapid relief by relaxing
the smooth muscles of the bladder neck and prostate. In contrast, 5-alpha-reductase
inhibitors take several months to reduce prostate volume and are typically used for larger
glands. Clinical practice guidelines recommend alpha-blockers as the initial choice for
patients seeking immediate improvement in obstructive voiding symptoms.
,2. A 24-year-old female presents with irregular menses, acne, and hirsutism. According to the
Rotterdam criteria, which diagnostic finding is required to confirm Polycystic Ovary Syndrome
(PCOS)?
A. Presence of at least two of three specific criteria
B. Elevated serum cortisol levels
C. Documented insulin resistance
D. Isolated hyperprolactinemia
Answer: A
Rationale: The Rotterdam criteria require at least two of the following: oligo- or
anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on
ultrasound. Other conditions such as thyroid dysfunction or hyperprolactinemia must be
excluded first to ensure an accurate diagnosis. This approach allows for the inclusion of
various phenotypes of the syndrome seen in primary care settings.
3. When evaluating a patient for suspected Iron Deficiency Anemia (IDA), which laboratory
result is the most sensitive indicator of depleted iron stores?
A. Low Serum Ferritin
B. High Total Iron Binding Capacity (TIBC)
C. Low Serum Iron
D. Low Hemoglobin
,Answer: A
Rationale: Serum ferritin is the most sensitive and specific test for identifying iron
deficiency as it reflects the total body iron stores. While TIBC increases and serum iron
decreases in IDA, ferritin levels drop before changes in hemoglobin or red cell morphology
occur. Providers should note that ferritin can be an acute-phase reactant, potentially
masking deficiency in inflammatory states.
4. A patient with newly diagnosed primary hypothyroidism is started on Levothyroxine. When
should the Nurse Practitioner schedule the follow-up TSH lab to evaluate the dosage?
A. 1 to 2 weeks
B. 6 to 8 weeks
C. 3 to 4 months
D. Immediately after starting therapy
Answer: B
Rationale: It takes approximately 6 to 8 weeks for the Serum TSH level to stabilize after a
change in Levothyroxine dosage due to the drug’s long half-life. Testing earlier may lead to
premature dose adjustments and potential over-replacement or under-replacement.
Monitoring every 6-8 weeks until a stable euthyroid state is achieved is the standard of
care in primary practice.
, 5. Which of the following is considered a ‘red flag’ symptom in a patient presenting with
symptoms of Gastroesophageal Reflux Disease (GERD) that warrants immediate referral for
endoscopy?
A. Heartburn after large meals
B. Unintentional weight loss
C. Regurgitation of sour fluid
D. Belching and bloating
Answer: B
Rationale: Unintentional weight loss is an alarm symptom that may suggest malignancy or
significant esophageal pathology. Other red flags include dysphagia, odynophagia, and
evidence of gastrointestinal bleeding or anemia. The presence of these symptoms
necessitates a prompt referral for upper endoscopy to rule out serious complications like
Barrett’s esophagus or adenocarcinoma.
6. A 30-year-old female requires contraception and has a history of migraines with aura.
Which contraceptive method is contraindicated for this patient?
A. Progestin-only pill (Mini-pill)
B. Copper Intrauterine Device (IUD)
C. Combined Oral Contraceptives (COC)
D. Medroxyprogesterone acetate injection
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 4 2026)
1. A 65-year-old male presents with urinary frequency, nocturia, and a weak urinary stream.
The Nurse Practitioner suspects Benign Prostatic Hyperplasia (BPH). Which of the following is
the first-line medication class for rapid symptom relief?
A. 5-alpha-reductase inhibitors
B. Alpha-1 adrenergic antagonists
C. Phosphodiesterase-5 inhibitors
D. Antimuscarinics
Answer: B
Rationale: Alpha-1 adrenergic antagonists like Tamsulosin provide rapid relief by relaxing
the smooth muscles of the bladder neck and prostate. In contrast, 5-alpha-reductase
inhibitors take several months to reduce prostate volume and are typically used for larger
glands. Clinical practice guidelines recommend alpha-blockers as the initial choice for
patients seeking immediate improvement in obstructive voiding symptoms.
,2. A 24-year-old female presents with irregular menses, acne, and hirsutism. According to the
Rotterdam criteria, which diagnostic finding is required to confirm Polycystic Ovary Syndrome
(PCOS)?
A. Presence of at least two of three specific criteria
B. Elevated serum cortisol levels
C. Documented insulin resistance
D. Isolated hyperprolactinemia
Answer: A
Rationale: The Rotterdam criteria require at least two of the following: oligo- or
anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on
ultrasound. Other conditions such as thyroid dysfunction or hyperprolactinemia must be
excluded first to ensure an accurate diagnosis. This approach allows for the inclusion of
various phenotypes of the syndrome seen in primary care settings.
3. When evaluating a patient for suspected Iron Deficiency Anemia (IDA), which laboratory
result is the most sensitive indicator of depleted iron stores?
A. Low Serum Ferritin
B. High Total Iron Binding Capacity (TIBC)
C. Low Serum Iron
D. Low Hemoglobin
,Answer: A
Rationale: Serum ferritin is the most sensitive and specific test for identifying iron
deficiency as it reflects the total body iron stores. While TIBC increases and serum iron
decreases in IDA, ferritin levels drop before changes in hemoglobin or red cell morphology
occur. Providers should note that ferritin can be an acute-phase reactant, potentially
masking deficiency in inflammatory states.
4. A patient with newly diagnosed primary hypothyroidism is started on Levothyroxine. When
should the Nurse Practitioner schedule the follow-up TSH lab to evaluate the dosage?
A. 1 to 2 weeks
B. 6 to 8 weeks
C. 3 to 4 months
D. Immediately after starting therapy
Answer: B
Rationale: It takes approximately 6 to 8 weeks for the Serum TSH level to stabilize after a
change in Levothyroxine dosage due to the drug’s long half-life. Testing earlier may lead to
premature dose adjustments and potential over-replacement or under-replacement.
Monitoring every 6-8 weeks until a stable euthyroid state is achieved is the standard of
care in primary practice.
, 5. Which of the following is considered a ‘red flag’ symptom in a patient presenting with
symptoms of Gastroesophageal Reflux Disease (GERD) that warrants immediate referral for
endoscopy?
A. Heartburn after large meals
B. Unintentional weight loss
C. Regurgitation of sour fluid
D. Belching and bloating
Answer: B
Rationale: Unintentional weight loss is an alarm symptom that may suggest malignancy or
significant esophageal pathology. Other red flags include dysphagia, odynophagia, and
evidence of gastrointestinal bleeding or anemia. The presence of these symptoms
necessitates a prompt referral for upper endoscopy to rule out serious complications like
Barrett’s esophagus or adenocarcinoma.
6. A 30-year-old female requires contraception and has a history of migraines with aura.
Which contraceptive method is contraindicated for this patient?
A. Progestin-only pill (Mini-pill)
B. Copper Intrauterine Device (IUD)
C. Combined Oral Contraceptives (COC)
D. Medroxyprogesterone acetate injection
