NSG 555 Exam 3 V2 | NSG 555 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 3 2026)
1. A 55-year-old male presents with a blood pressure of 152/94 mmHg on two separate visits.
According to the ACC/AHA guidelines, which is the most appropriate initial pharmacological
treatment for a patient with Stage 2 hypertension and no other comorbidities?
A. Amlodipine 5 mg daily
B. Lisinopril 10 mg daily
C. Metoprolol Succinate 25 mg daily
D. Hydrochlorothiazide 12.5 mg daily
Answer: B
Rationale: For Stage 2 hypertension, initial therapy usually involves a thiazide diuretic,
ACE inhibitor, ARB, or CCB. Lisinopril is an appropriate first-line ACE inhibitor for non-
black patients. Guidelines emphasize starting with one of these four classes unless specific
contraindications exist.
,2. A patient with a history of COPD presents with increased dyspnea and productive cough.
Which finding on a chest X-ray would most likely indicate chronic obstructive pulmonary
disease?
A. Infiltrates in the lower lobes
B. Flattening of the diaphragm
C. Pleural effusion
D. Kerley B lines
Answer: B
Rationale: Flattening of the diaphragm is a classic radiographic sign of hyperinflation
associated with COPD. This occurs due to air trapping within the alveolar sacs. Other signs
include increased retrosternal airspace and a narrowed heart silhouette.
3. When evaluating a patient for Community-Acquired Pneumonia (CAP), the NP uses the
CURB-65 scale. What does the ‘U’ in CURB-65 stand for?
A. Urea (BUN) > 19 mg/dL
B. Urinary tract infection symptoms
C. Uric acid level > 7 mg/dL
D. Underweight status (BMI < 18)
Answer: A
, Rationale: The CURB-65 score is a clinical prediction rule used to determine the severity of
CAP. The ‘U’ specifically stands for Blood Urea Nitrogen (BUN) greater than 19 mg/dL (or
>7 mmol/L). This score helps the practitioner decide between outpatient and inpatient
management.
4. A 24-year-old female presents with a sore throat, fever, and cervical lymphadenopathy.
She has no cough. Which criteria are used to determine the likelihood of Group A Beta-
Hemolytic Streptococcus?
A. Centor Criteria
B. Framingham Criteria
C. Light’s Criteria
D. Duke Criteria
Answer: A
Rationale: The Centor Criteria include fever, tonsillar exudates, tender anterior cervical
lymphadenopathy, and the absence of a cough. A score of 3 or 4 indicates a high probability
of Strep pharyngitis. This assessment tool guides the decision to perform a rapid antigen
test or throat culture.
5. Which of the following is considered the ‘gold standard’ for diagnosing obstructive sleep
apnea?
A. Overnight pulse oximetry
B. Epworth Sleepiness Scale
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 3 2026)
1. A 55-year-old male presents with a blood pressure of 152/94 mmHg on two separate visits.
According to the ACC/AHA guidelines, which is the most appropriate initial pharmacological
treatment for a patient with Stage 2 hypertension and no other comorbidities?
A. Amlodipine 5 mg daily
B. Lisinopril 10 mg daily
C. Metoprolol Succinate 25 mg daily
D. Hydrochlorothiazide 12.5 mg daily
Answer: B
Rationale: For Stage 2 hypertension, initial therapy usually involves a thiazide diuretic,
ACE inhibitor, ARB, or CCB. Lisinopril is an appropriate first-line ACE inhibitor for non-
black patients. Guidelines emphasize starting with one of these four classes unless specific
contraindications exist.
,2. A patient with a history of COPD presents with increased dyspnea and productive cough.
Which finding on a chest X-ray would most likely indicate chronic obstructive pulmonary
disease?
A. Infiltrates in the lower lobes
B. Flattening of the diaphragm
C. Pleural effusion
D. Kerley B lines
Answer: B
Rationale: Flattening of the diaphragm is a classic radiographic sign of hyperinflation
associated with COPD. This occurs due to air trapping within the alveolar sacs. Other signs
include increased retrosternal airspace and a narrowed heart silhouette.
3. When evaluating a patient for Community-Acquired Pneumonia (CAP), the NP uses the
CURB-65 scale. What does the ‘U’ in CURB-65 stand for?
A. Urea (BUN) > 19 mg/dL
B. Urinary tract infection symptoms
C. Uric acid level > 7 mg/dL
D. Underweight status (BMI < 18)
Answer: A
, Rationale: The CURB-65 score is a clinical prediction rule used to determine the severity of
CAP. The ‘U’ specifically stands for Blood Urea Nitrogen (BUN) greater than 19 mg/dL (or
>7 mmol/L). This score helps the practitioner decide between outpatient and inpatient
management.
4. A 24-year-old female presents with a sore throat, fever, and cervical lymphadenopathy.
She has no cough. Which criteria are used to determine the likelihood of Group A Beta-
Hemolytic Streptococcus?
A. Centor Criteria
B. Framingham Criteria
C. Light’s Criteria
D. Duke Criteria
Answer: A
Rationale: The Centor Criteria include fever, tonsillar exudates, tender anterior cervical
lymphadenopathy, and the absence of a cough. A score of 3 or 4 indicates a high probability
of Strep pharyngitis. This assessment tool guides the decision to perform a rapid antigen
test or throat culture.
5. Which of the following is considered the ‘gold standard’ for diagnosing obstructive sleep
apnea?
A. Overnight pulse oximetry
B. Epworth Sleepiness Scale
