NSG 555 Exam 3 V1 | NSG 555 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 3 2026)
1. A 58-year-old male smoker presents with a chronic cough and productive sputum for the
past 3 months. Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.65. Which of the
following is the most appropriate next step in management according to GOLD guidelines?
A. Prescribe a short course of oral corticosteroids
B. Initiate a Long-Acting Muscarinic Antagonist (LAMA)
C. Order a chest CT to rule out malignancy
D. Perform a methacholine challenge test
Answer: B
Rationale: The post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the
diagnosis of COPD. Based on the GOLD guidelines, the initial pharmacological management
for symptomatic patients involves bronchodilators such as LAMAs or LABAs. This patient’s
chronic symptoms suggest the need for maintenance therapy rather than just rescue
medication or acute steroids.
2. Which of the following physical exam findings is most suggestive of an acute exacerbation
of COPD in a primary care setting?
A. Inspiration-to-expiration ratio of 1:1
,B. Vesicular breath sounds in the lung bases
C. Use of accessory muscles and pursed-lip breathing
D. Resonance on percussion over all lung fields
Answer: C
Rationale: The use of accessory muscles and pursed-lip breathing indicates increased
work of breathing and significant airflow obstruction. Patients with COPD often have a
prolonged expiratory phase, typically showing an I:E ratio of 1:3 or 1:4. Hyper-resonance,
rather than simple resonance, is common due to air trapping in these patients.
3. A 24-year-old female with a history of asthma reports using her albuterol inhaler four
times per week. She is currently not on a daily controller. According to GINA guidelines, what
is the preferred next step?
A. Add a leukotriene receptor antagonist (LTRA)
B. Start low-dose ICS-formoterol as needed
C. Continue SABA as needed only
D. Begin high-dose inhaled corticosteroids
Answer: B
Rationale: Current GINA guidelines emphasize the use of low-dose ICS-formoterol as the
preferred reliever and controller therapy to reduce the risk of exacerbations. Using a SABA
alone is no longer recommended because it does not address the underlying airway
,inflammation. This patient falls into Step 1 or 2, where as-needed ICS-formoterol is the gold
standard for safety.
4. A 65-year-old patient presents with a fever of 102°F, productive cough with rust-colored
sputum, and crackles in the right lower lobe. The CURB-65 score is 1. What is the most
appropriate management?
A. Immediate transfer to the Intensive Care Unit
B. Inpatient admission for IV Ceftriaxone
C. Outpatient treatment with Amoxicillin or Doxycycline
D. Observation without antibiotics for 48 hours
Answer: C
Rationale: A CURB-65 score of 1 indicates that the patient is at low risk for mortality and
can typically be managed in the outpatient setting. For a healthy adult with no
comorbidities, first-line treatment for community-acquired pneumonia includes
Amoxicillin or Doxycycline. Close follow-up is necessary to ensure the patient responds to
the initial antibiotic therapy.
5. Which of the following is the gold standard for diagnosing a pulmonary embolism in a
stable patient in the primary care clinic?
A. CT Angiography (CTPA)
B. Ventilation-Perfusion (V/Q) scan
C. D-dimer assay
, D. Chest Radiograph
Answer: A
Rationale: Computed Tomographic Pulmonary Angiography (CTPA) is the preferred
imaging modality for diagnosing pulmonary embolism due to its high sensitivity and
specificity. While a D-dimer can be used to rule out PE in low-probability patients, it cannot
confirm the diagnosis. A V/Q scan is usually reserved for patients who have
contraindications to CT contrast, such as renal failure.
6. A 45-year-old male reports persistent heartburn and regurgitation despite taking an OTC
H2 blocker. He denies weight loss or dysphagia. What is the recommended first-line
treatment?
A. Referral for immediate upper endoscopy
B. Switching to a different H2 blocker at a higher dose
C. An 8-week course of once-daily Proton Pump Inhibitor (PPI)
D. Ordering a 24-hour pH monitoring study
Answer: C
Rationale: For patients with classic symptoms of GERD and no ‘alarm’ symptoms like
weight loss or anemia, an 8-week trial of a PPI is the standard of care. This approach helps
in healing esophageal mucosa and managing symptoms effectively. If the patient fails PPI
therapy, further diagnostic workup like endoscopy would be warranted.
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 3 2026)
1. A 58-year-old male smoker presents with a chronic cough and productive sputum for the
past 3 months. Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.65. Which of the
following is the most appropriate next step in management according to GOLD guidelines?
A. Prescribe a short course of oral corticosteroids
B. Initiate a Long-Acting Muscarinic Antagonist (LAMA)
C. Order a chest CT to rule out malignancy
D. Perform a methacholine challenge test
Answer: B
Rationale: The post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the
diagnosis of COPD. Based on the GOLD guidelines, the initial pharmacological management
for symptomatic patients involves bronchodilators such as LAMAs or LABAs. This patient’s
chronic symptoms suggest the need for maintenance therapy rather than just rescue
medication or acute steroids.
2. Which of the following physical exam findings is most suggestive of an acute exacerbation
of COPD in a primary care setting?
A. Inspiration-to-expiration ratio of 1:1
,B. Vesicular breath sounds in the lung bases
C. Use of accessory muscles and pursed-lip breathing
D. Resonance on percussion over all lung fields
Answer: C
Rationale: The use of accessory muscles and pursed-lip breathing indicates increased
work of breathing and significant airflow obstruction. Patients with COPD often have a
prolonged expiratory phase, typically showing an I:E ratio of 1:3 or 1:4. Hyper-resonance,
rather than simple resonance, is common due to air trapping in these patients.
3. A 24-year-old female with a history of asthma reports using her albuterol inhaler four
times per week. She is currently not on a daily controller. According to GINA guidelines, what
is the preferred next step?
A. Add a leukotriene receptor antagonist (LTRA)
B. Start low-dose ICS-formoterol as needed
C. Continue SABA as needed only
D. Begin high-dose inhaled corticosteroids
Answer: B
Rationale: Current GINA guidelines emphasize the use of low-dose ICS-formoterol as the
preferred reliever and controller therapy to reduce the risk of exacerbations. Using a SABA
alone is no longer recommended because it does not address the underlying airway
,inflammation. This patient falls into Step 1 or 2, where as-needed ICS-formoterol is the gold
standard for safety.
4. A 65-year-old patient presents with a fever of 102°F, productive cough with rust-colored
sputum, and crackles in the right lower lobe. The CURB-65 score is 1. What is the most
appropriate management?
A. Immediate transfer to the Intensive Care Unit
B. Inpatient admission for IV Ceftriaxone
C. Outpatient treatment with Amoxicillin or Doxycycline
D. Observation without antibiotics for 48 hours
Answer: C
Rationale: A CURB-65 score of 1 indicates that the patient is at low risk for mortality and
can typically be managed in the outpatient setting. For a healthy adult with no
comorbidities, first-line treatment for community-acquired pneumonia includes
Amoxicillin or Doxycycline. Close follow-up is necessary to ensure the patient responds to
the initial antibiotic therapy.
5. Which of the following is the gold standard for diagnosing a pulmonary embolism in a
stable patient in the primary care clinic?
A. CT Angiography (CTPA)
B. Ventilation-Perfusion (V/Q) scan
C. D-dimer assay
, D. Chest Radiograph
Answer: A
Rationale: Computed Tomographic Pulmonary Angiography (CTPA) is the preferred
imaging modality for diagnosing pulmonary embolism due to its high sensitivity and
specificity. While a D-dimer can be used to rule out PE in low-probability patients, it cannot
confirm the diagnosis. A V/Q scan is usually reserved for patients who have
contraindications to CT contrast, such as renal failure.
6. A 45-year-old male reports persistent heartburn and regurgitation despite taking an OTC
H2 blocker. He denies weight loss or dysphagia. What is the recommended first-line
treatment?
A. Referral for immediate upper endoscopy
B. Switching to a different H2 blocker at a higher dose
C. An 8-week course of once-daily Proton Pump Inhibitor (PPI)
D. Ordering a 24-hour pH monitoring study
Answer: C
Rationale: For patients with classic symptoms of GERD and no ‘alarm’ symptoms like
weight loss or anemia, an 8-week trial of a PPI is the standard of care. This approach helps
in healing esophageal mucosa and managing symptoms effectively. If the patient fails PPI
therapy, further diagnostic workup like endoscopy would be warranted.
