NSG 555 Exam 2 V1 | NSG 555 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 2 2026)
1. A 45-year-old male presents with a blood pressure of 152/94 mmHg on two separate
occasions. According to the ACC/AHA 2017 guidelines, what is the appropriate classification
and initial management for this patient if his 10-year ASCVD risk is 12%?
A. Stage 1 Hypertension; lifestyle modifications only
B. Stage 2 Hypertension; lifestyle modifications and initiate two antihypertensive
medications
C. Stage 2 Hypertension; lifestyle modifications and initiate one antihypertensive
medication
D. Elevated Blood Pressure; reassess in 3-6 months
Answer: C
Rationale: Stage 2 hypertension is defined as a systolic BP of 140 mmHg or higher or a
diastolic BP of 90 mmHg or higher. For patients in Stage 2, the guidelines recommend
lifestyle modifications combined with pharmacological therapy. Since the patient’s blood
pressure is above 140/90 and his ASCVD risk is elevated, initiating at least one medication
is the standard of care to reduce cardiovascular events.
,2. A 32-year-old female smoker presents with a sudden onset of ‘the worst headache of my
life.’ She also reports neck stiffness and photophobia. What is the most likely diagnosis and
priority action?
A. Subarachnoid hemorrhage; refer to the emergency department immediately
B. Tension-type headache; recommend NSAIDs and rest
C. Migraine headache; administer sumatriptan
D. Temporal arteritis; initiate high-dose corticosteroids
Answer: A
Rationale: The ‘thunderclap’ headache described as the worst of one’s life is a classic
presentation of a subarachnoid hemorrhage. Associated symptoms such as meningismus
(neck stiffness) and photophobia further support this life-threatening neurological
emergency. The nurse practitioner must prioritize immediate transfer to an emergency
facility for CT imaging and neurosurgical consultation.
3. When evaluating a patient for Community-Acquired Pneumonia (CAP), the CURB-65 score
is utilized to determine the setting of care. Which of the following components is correctly
identified in the CURB-65 criteria?
A. C-Reactive Protein > 100
B. Blood Pressure < 100/70 mmHg
C. Respiratory Rate > 20 breaths/min
D. Urea (BUN) > 19 mg/dL
,Answer: D
Rationale: The CURB-65 tool stands for Confusion, Urea (BUN > 19 mg/dL or 7 mmol/L),
Respiratory rate (30 or more), Blood pressure (Systolic < 90 or Diastolic 60 or less), and
Age (65 or older). Each positive criterion scores one point, helping the clinician decide
between outpatient treatment, inpatient observation, or ICU admission. An elevated BUN
indicates renal involvement or dehydration, which increases the severity of the pneumonia.
4. A 68-year-old male with a 40 pack-year history of smoking presents with increased dyspnea
and a chronic productive cough. Spirometry reveals an FEV1/FVC ratio of 0.65. How should
the NP classify this condition?
A. Asthma
B. Restrictive Lung Disease
C. Congestive Heart Failure
D. Chronic Obstructive Pulmonary Disease (COPD)
Answer: D
Rationale: COPD is diagnosed based on a post-bronchodilator FEV1/FVC ratio of less than
0.70, which indicates persistent airflow limitation. The patient’s long smoking history and
chronic productive cough are hallmark clinical features of chronic bronchitis, a subset of
COPD. Restrictive lung diseases typically present with a normal or high FEV1/FVC ratio but
reduced lung volumes.
, 5. A patient presents with a ‘strawberry tongue,’ sandpaper-like rash that blanches, and a
sore throat. Which organism is the most likely cause of this presentation?
A. Staphylococcus aureus
B. Mycoplasma pneumoniae
C. Haemophilus influenzae
D. Streptococcus pyogenes (Group A Strep)
Answer: D
Rationale: The combination of pharyngitis, a sandpaper-textured rash (scarlatiniform),
and a strawberry tongue is pathognomonic for Scarlet Fever. Scarlet fever is caused by
erythrogenic toxins produced by Streptococcus pyogenes. Proper treatment with
antibiotics is necessary to prevent complications such as acute rheumatic fever.
6. Which of the following physical exam findings is most suggestive of an Acute Otitis Externa
(AOE) rather than Otitis Media?
A. Bulging of the tympanic membrane
B. Fluid visualized behind the eardrum
C. Loss of the light reflex on the tympanic membrane
D. Pain with palpation of the tragus or pulling of the pinna
Answer: D
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 2 2026)
1. A 45-year-old male presents with a blood pressure of 152/94 mmHg on two separate
occasions. According to the ACC/AHA 2017 guidelines, what is the appropriate classification
and initial management for this patient if his 10-year ASCVD risk is 12%?
A. Stage 1 Hypertension; lifestyle modifications only
B. Stage 2 Hypertension; lifestyle modifications and initiate two antihypertensive
medications
C. Stage 2 Hypertension; lifestyle modifications and initiate one antihypertensive
medication
D. Elevated Blood Pressure; reassess in 3-6 months
Answer: C
Rationale: Stage 2 hypertension is defined as a systolic BP of 140 mmHg or higher or a
diastolic BP of 90 mmHg or higher. For patients in Stage 2, the guidelines recommend
lifestyle modifications combined with pharmacological therapy. Since the patient’s blood
pressure is above 140/90 and his ASCVD risk is elevated, initiating at least one medication
is the standard of care to reduce cardiovascular events.
,2. A 32-year-old female smoker presents with a sudden onset of ‘the worst headache of my
life.’ She also reports neck stiffness and photophobia. What is the most likely diagnosis and
priority action?
A. Subarachnoid hemorrhage; refer to the emergency department immediately
B. Tension-type headache; recommend NSAIDs and rest
C. Migraine headache; administer sumatriptan
D. Temporal arteritis; initiate high-dose corticosteroids
Answer: A
Rationale: The ‘thunderclap’ headache described as the worst of one’s life is a classic
presentation of a subarachnoid hemorrhage. Associated symptoms such as meningismus
(neck stiffness) and photophobia further support this life-threatening neurological
emergency. The nurse practitioner must prioritize immediate transfer to an emergency
facility for CT imaging and neurosurgical consultation.
3. When evaluating a patient for Community-Acquired Pneumonia (CAP), the CURB-65 score
is utilized to determine the setting of care. Which of the following components is correctly
identified in the CURB-65 criteria?
A. C-Reactive Protein > 100
B. Blood Pressure < 100/70 mmHg
C. Respiratory Rate > 20 breaths/min
D. Urea (BUN) > 19 mg/dL
,Answer: D
Rationale: The CURB-65 tool stands for Confusion, Urea (BUN > 19 mg/dL or 7 mmol/L),
Respiratory rate (30 or more), Blood pressure (Systolic < 90 or Diastolic 60 or less), and
Age (65 or older). Each positive criterion scores one point, helping the clinician decide
between outpatient treatment, inpatient observation, or ICU admission. An elevated BUN
indicates renal involvement or dehydration, which increases the severity of the pneumonia.
4. A 68-year-old male with a 40 pack-year history of smoking presents with increased dyspnea
and a chronic productive cough. Spirometry reveals an FEV1/FVC ratio of 0.65. How should
the NP classify this condition?
A. Asthma
B. Restrictive Lung Disease
C. Congestive Heart Failure
D. Chronic Obstructive Pulmonary Disease (COPD)
Answer: D
Rationale: COPD is diagnosed based on a post-bronchodilator FEV1/FVC ratio of less than
0.70, which indicates persistent airflow limitation. The patient’s long smoking history and
chronic productive cough are hallmark clinical features of chronic bronchitis, a subset of
COPD. Restrictive lung diseases typically present with a normal or high FEV1/FVC ratio but
reduced lung volumes.
, 5. A patient presents with a ‘strawberry tongue,’ sandpaper-like rash that blanches, and a
sore throat. Which organism is the most likely cause of this presentation?
A. Staphylococcus aureus
B. Mycoplasma pneumoniae
C. Haemophilus influenzae
D. Streptococcus pyogenes (Group A Strep)
Answer: D
Rationale: The combination of pharyngitis, a sandpaper-textured rash (scarlatiniform),
and a strawberry tongue is pathognomonic for Scarlet Fever. Scarlet fever is caused by
erythrogenic toxins produced by Streptococcus pyogenes. Proper treatment with
antibiotics is necessary to prevent complications such as acute rheumatic fever.
6. Which of the following physical exam findings is most suggestive of an Acute Otitis Externa
(AOE) rather than Otitis Media?
A. Bulging of the tympanic membrane
B. Fluid visualized behind the eardrum
C. Loss of the light reflex on the tympanic membrane
D. Pain with palpation of the tragus or pulling of the pinna
Answer: D
