NSG 555 Exam 4 V1 | NSG 555 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 4 2026)
1. A 38-year-old female patient who smokes one pack of cigarettes per day requests a
prescription for contraception. Which of the following options is absolutely contraindicated
for this patient?
A. Combined Oral Contraceptive (COC)
B. Copper Intrauterine Device (Paragard)
C. Progestin-only pill (Mini-pill)
D. Medroxyprogesterone acetate (Depo-Provera)
Answer: A
Rationale: According to the US Medical Eligibility Criteria for Contraceptive Use, combined
oral contraceptives are a Category 4 (unacceptable health risk) for women aged 35 or older
who smoke 15 or more cigarettes per day. This is due to the significantly increased risk of
myocardial infarction, stroke, and thromboembolic events. For this patient, progestin-only
methods or non-hormonal options like the copper IUD would be safer alternatives.
,2. A patient presents with a thin, grayish-white vaginal discharge and a ‘fishy’ odor that is
more noticeable after intercourse. Microscopy reveals clue cells. What is the first-line
treatment for this condition?
A. Fluconazole 150 mg PO once
B. Metronidazole 500 mg PO BID for 7 days
C. Ceftriaxone 500 mg IM once
D. Azithromycin 1g PO once
Answer: B
Rationale: The clinical presentation describes Bacterial Vaginosis (BV), which is diagnosed
using Amsel’s criteria including clue cells and a positive whiff test. Metronidazole 500 mg
orally twice daily for seven days remains the gold standard treatment recommended by the
CDC. It is important to advise the patient to avoid alcohol consumption during treatment
and for 24 hours after to prevent a disulfiram-like reaction.
3. During a routine physical, a 62-year-old male reports increased urinary frequency, urgency,
and a weakened stream. A Digital Rectal Exam (DRE) reveals a smooth, firm, and
symmetrically enlarged prostate without nodules. What is the most likely diagnosis?
A. Prostate Cancer
B. Benign Prostatic Hyperplasia (BPH)
C. Chronic Prostatitis
D. Acute Bacterial Prostatitis
,Answer: B
Rationale: Benign Prostatic Hyperplasia (BPH) characteristically presents with lower
urinary tract symptoms (LUTS) and a symmetrically enlarged, non-tender prostate. In
contrast, prostate cancer usually presents with asymmetrical enlargement or hard nodules
on the prostate surface. Acute prostatitis would typically present with a boggy, extremely
tender prostate and systemic symptoms like fever.
4. A 24-year-old female is diagnosed with uncomplicated Chlamydia trachomatis. According
to the most recent CDC guidelines, what is the preferred treatment?
A. Azithromycin 1g PO in a single dose
B. Ciprofloxacin 500 mg PO BID for 3 days
C. Doxycycline 100 mg PO BID for 7 days
D. Amoxicillin 500 mg PO TID for 10 days
Answer: C
Rationale: Current CDC guidelines have shifted to recommend Doxycycline 100 mg twice
daily for 7 days as the first-line treatment for chlamydial infections in non-pregnant
adolescents and adults. Azithromycin is now considered an alternative therapy due to
concerns regarding lower efficacy in rectal infections and increasing resistance. Providers
must also emphasize the importance of treating all sexual partners from the previous 60
days.
, 5. A 52-year-old female presents with hot flashes, night sweats, and vaginal dryness. She has
an intact uterus. Which hormone replacement therapy (HRT) regimen is appropriate?
A. Estrogen-only therapy
B. Progesterone-only therapy
C. Testosterone-only therapy
D. Estrogen and Progesterone therapy
Answer: D
Rationale: In women with an intact uterus, systemic estrogen therapy must always be
paired with a progestogen to prevent endometrial hyperplasia and the subsequent risk of
endometrial cancer. Estrogen-only therapy is reserved exclusively for women who have
undergone a hysterectomy. The clinician should prescribe the lowest effective dose for the
shortest duration necessary to manage vasomotor symptoms.
6. A patient presents with a painful, erythematous, and ‘honey-colored’ crusted lesion on the
upper lip. What is the most likely diagnosis?
A. Herpes Simplex Virus
B. Non-bullous Impetigo
C. Contact Dermatitis
D. Cellulitis
Answer: B
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 4 2026)
1. A 38-year-old female patient who smokes one pack of cigarettes per day requests a
prescription for contraception. Which of the following options is absolutely contraindicated
for this patient?
A. Combined Oral Contraceptive (COC)
B. Copper Intrauterine Device (Paragard)
C. Progestin-only pill (Mini-pill)
D. Medroxyprogesterone acetate (Depo-Provera)
Answer: A
Rationale: According to the US Medical Eligibility Criteria for Contraceptive Use, combined
oral contraceptives are a Category 4 (unacceptable health risk) for women aged 35 or older
who smoke 15 or more cigarettes per day. This is due to the significantly increased risk of
myocardial infarction, stroke, and thromboembolic events. For this patient, progestin-only
methods or non-hormonal options like the copper IUD would be safer alternatives.
,2. A patient presents with a thin, grayish-white vaginal discharge and a ‘fishy’ odor that is
more noticeable after intercourse. Microscopy reveals clue cells. What is the first-line
treatment for this condition?
A. Fluconazole 150 mg PO once
B. Metronidazole 500 mg PO BID for 7 days
C. Ceftriaxone 500 mg IM once
D. Azithromycin 1g PO once
Answer: B
Rationale: The clinical presentation describes Bacterial Vaginosis (BV), which is diagnosed
using Amsel’s criteria including clue cells and a positive whiff test. Metronidazole 500 mg
orally twice daily for seven days remains the gold standard treatment recommended by the
CDC. It is important to advise the patient to avoid alcohol consumption during treatment
and for 24 hours after to prevent a disulfiram-like reaction.
3. During a routine physical, a 62-year-old male reports increased urinary frequency, urgency,
and a weakened stream. A Digital Rectal Exam (DRE) reveals a smooth, firm, and
symmetrically enlarged prostate without nodules. What is the most likely diagnosis?
A. Prostate Cancer
B. Benign Prostatic Hyperplasia (BPH)
C. Chronic Prostatitis
D. Acute Bacterial Prostatitis
,Answer: B
Rationale: Benign Prostatic Hyperplasia (BPH) characteristically presents with lower
urinary tract symptoms (LUTS) and a symmetrically enlarged, non-tender prostate. In
contrast, prostate cancer usually presents with asymmetrical enlargement or hard nodules
on the prostate surface. Acute prostatitis would typically present with a boggy, extremely
tender prostate and systemic symptoms like fever.
4. A 24-year-old female is diagnosed with uncomplicated Chlamydia trachomatis. According
to the most recent CDC guidelines, what is the preferred treatment?
A. Azithromycin 1g PO in a single dose
B. Ciprofloxacin 500 mg PO BID for 3 days
C. Doxycycline 100 mg PO BID for 7 days
D. Amoxicillin 500 mg PO TID for 10 days
Answer: C
Rationale: Current CDC guidelines have shifted to recommend Doxycycline 100 mg twice
daily for 7 days as the first-line treatment for chlamydial infections in non-pregnant
adolescents and adults. Azithromycin is now considered an alternative therapy due to
concerns regarding lower efficacy in rectal infections and increasing resistance. Providers
must also emphasize the importance of treating all sexual partners from the previous 60
days.
, 5. A 52-year-old female presents with hot flashes, night sweats, and vaginal dryness. She has
an intact uterus. Which hormone replacement therapy (HRT) regimen is appropriate?
A. Estrogen-only therapy
B. Progesterone-only therapy
C. Testosterone-only therapy
D. Estrogen and Progesterone therapy
Answer: D
Rationale: In women with an intact uterus, systemic estrogen therapy must always be
paired with a progestogen to prevent endometrial hyperplasia and the subsequent risk of
endometrial cancer. Estrogen-only therapy is reserved exclusively for women who have
undergone a hysterectomy. The clinician should prescribe the lowest effective dose for the
shortest duration necessary to manage vasomotor symptoms.
6. A patient presents with a painful, erythematous, and ‘honey-colored’ crusted lesion on the
upper lip. What is the most likely diagnosis?
A. Herpes Simplex Virus
B. Non-bullous Impetigo
C. Contact Dermatitis
D. Cellulitis
Answer: B
