NSG 555 Exam 2 V2 | NSG 555 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 2 2026)
1. A 52-year-old African American male presents with a blood pressure of 154/96 mmHg on
two separate occasions. He has no history of diabetes or chronic kidney disease. Which of the
following is the most appropriate initial pharmacological treatment according to JNC 8
guidelines?
A. Lisinopril
B. Amlodipine
C. Losartan
D. Metoprolol
Answer: B
Rationale: According to JNC 8 guidelines, initial antihypertensive treatment for the general
African American population should include a thiazide-type diuretic or a calcium channel
blocker. Amlodipine is a calcium channel blocker that has been shown to be more effective
in this demographic for blood pressure reduction. Beta-blockers like Metoprolol are no
longer recommended as first-line therapy for uncomplicated hypertension.
,2. A patient with a history of COPD presents with increased sputum purulence and increased
dyspnea. The FEV1 is 45% of predicted. Which of the following is the most appropriate next
step in management for this acute exacerbation?
A. Initiate a short-acting beta-agonist (SABA) and systemic corticosteroids.
B. Start long-term oxygen therapy at 2L/min.
C. Prescribe a high-dose inhaled corticosteroid (ICS) alone.
D. Order an urgent pulmonary angiography.
Answer: A
Rationale: Acute exacerbations of COPD are primarily managed with bronchodilators such
as SABAs and systemic corticosteroids to reduce airway inflammation. The use of systemic
steroids has been shown to shorten recovery time and improve lung function during the
acute phase. Antibiotics should also be considered if the patient exhibits increased sputum
purulence and volume.
3. An 18-year-old female complains of a sore throat, fatigue, and cervical lymphadenopathy.
Physical exam reveals an enlarged spleen. A monospot test is positive. What is the most
important education to provide regarding her activities?
A. She can return to sports immediately once the fever subsides.
B. She requires immediate surgical consult for splenectomy.
C. She should take amoxicillin for 10 days to prevent secondary infection.
D. She must avoid contact sports for at least 3-4 weeks.
,Answer: D
Rationale: Patients with infectious mononucleosis are at significant risk for splenic
rupture due to splenomegaly. It is standard clinical practice to restrict contact sports and
heavy lifting for at least 3 to 4 weeks after the onset of symptoms. Amoxicillin should be
avoided as it frequently causes a maculopapular rash in patients with EBV infection.
4. A 65-year-old male with a 40 pack-year smoking history presents for an annual physical. He
has no symptoms. According to the USPSTF, which screening test is indicated?
A. Chest X-ray
B. Sputum cytology
C. Pulmonary function tests
D. Low-dose computed tomography (LDCT)
Answer: D
Rationale: The USPSTF recommends annual screening for lung cancer with LDCT in adults
aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have
quit within the past 15 years. Chest X-rays are not recommended for lung cancer screening
as they do not reduce mortality. This patient meets the criteria based on age and significant
smoking history.
5. Which of the following findings is most characteristic of a patient with community-acquired
pneumonia (CAP) on physical examination?
A. Hyperresonance on percussion
, B. Vesicular breath sounds throughout
C. Increased tactile fremitus over the affected area
D. Tracheal deviation to the opposite side
Answer: C
Rationale: Consolidation in the lung tissue, as seen in pneumonia, leads to increased tactile
fremitus and dullness to percussion. In contrast, conditions like pneumothorax or
emphysema would produce hyperresonance. Auscultation in CAP often reveals crackles,
rales, or bronchial breath sounds over the area of consolidation.
6. A patient is diagnosed with Step 2 persistent asthma. Which of the following is the
preferred daily maintenance medication?
A. Low-dose inhaled corticosteroid (ICS)
B. Long-acting beta-agonist (LABA) alone
C. Leukotriene receptor antagonist (LTRA) alone
D. Theophylline
Answer: A
Rationale: For Step 2 asthma management, the GINA and NAEPP guidelines recommend a
low-dose inhaled corticosteroid as the primary maintenance therapy. ICS medications
address the underlying inflammation characteristic of persistent asthma. LABAs should
never be used as monotherapy in asthma due to the risk of severe exacerbations and death.
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 2 2026)
1. A 52-year-old African American male presents with a blood pressure of 154/96 mmHg on
two separate occasions. He has no history of diabetes or chronic kidney disease. Which of the
following is the most appropriate initial pharmacological treatment according to JNC 8
guidelines?
A. Lisinopril
B. Amlodipine
C. Losartan
D. Metoprolol
Answer: B
Rationale: According to JNC 8 guidelines, initial antihypertensive treatment for the general
African American population should include a thiazide-type diuretic or a calcium channel
blocker. Amlodipine is a calcium channel blocker that has been shown to be more effective
in this demographic for blood pressure reduction. Beta-blockers like Metoprolol are no
longer recommended as first-line therapy for uncomplicated hypertension.
,2. A patient with a history of COPD presents with increased sputum purulence and increased
dyspnea. The FEV1 is 45% of predicted. Which of the following is the most appropriate next
step in management for this acute exacerbation?
A. Initiate a short-acting beta-agonist (SABA) and systemic corticosteroids.
B. Start long-term oxygen therapy at 2L/min.
C. Prescribe a high-dose inhaled corticosteroid (ICS) alone.
D. Order an urgent pulmonary angiography.
Answer: A
Rationale: Acute exacerbations of COPD are primarily managed with bronchodilators such
as SABAs and systemic corticosteroids to reduce airway inflammation. The use of systemic
steroids has been shown to shorten recovery time and improve lung function during the
acute phase. Antibiotics should also be considered if the patient exhibits increased sputum
purulence and volume.
3. An 18-year-old female complains of a sore throat, fatigue, and cervical lymphadenopathy.
Physical exam reveals an enlarged spleen. A monospot test is positive. What is the most
important education to provide regarding her activities?
A. She can return to sports immediately once the fever subsides.
B. She requires immediate surgical consult for splenectomy.
C. She should take amoxicillin for 10 days to prevent secondary infection.
D. She must avoid contact sports for at least 3-4 weeks.
,Answer: D
Rationale: Patients with infectious mononucleosis are at significant risk for splenic
rupture due to splenomegaly. It is standard clinical practice to restrict contact sports and
heavy lifting for at least 3 to 4 weeks after the onset of symptoms. Amoxicillin should be
avoided as it frequently causes a maculopapular rash in patients with EBV infection.
4. A 65-year-old male with a 40 pack-year smoking history presents for an annual physical. He
has no symptoms. According to the USPSTF, which screening test is indicated?
A. Chest X-ray
B. Sputum cytology
C. Pulmonary function tests
D. Low-dose computed tomography (LDCT)
Answer: D
Rationale: The USPSTF recommends annual screening for lung cancer with LDCT in adults
aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have
quit within the past 15 years. Chest X-rays are not recommended for lung cancer screening
as they do not reduce mortality. This patient meets the criteria based on age and significant
smoking history.
5. Which of the following findings is most characteristic of a patient with community-acquired
pneumonia (CAP) on physical examination?
A. Hyperresonance on percussion
, B. Vesicular breath sounds throughout
C. Increased tactile fremitus over the affected area
D. Tracheal deviation to the opposite side
Answer: C
Rationale: Consolidation in the lung tissue, as seen in pneumonia, leads to increased tactile
fremitus and dullness to percussion. In contrast, conditions like pneumothorax or
emphysema would produce hyperresonance. Auscultation in CAP often reveals crackles,
rales, or bronchial breath sounds over the area of consolidation.
6. A patient is diagnosed with Step 2 persistent asthma. Which of the following is the
preferred daily maintenance medication?
A. Low-dose inhaled corticosteroid (ICS)
B. Long-acting beta-agonist (LABA) alone
C. Leukotriene receptor antagonist (LTRA) alone
D. Theophylline
Answer: A
Rationale: For Step 2 asthma management, the GINA and NAEPP guidelines recommend a
low-dose inhaled corticosteroid as the primary maintenance therapy. ICS medications
address the underlying inflammation characteristic of persistent asthma. LABAs should
never be used as monotherapy in asthma due to the risk of severe exacerbations and death.
