NSG 555 Exam 4 V2 | NSG 555 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 4 2026)
1. A 4-year-old child presents with a barking cough, inspiratory stridor, and a low-grade fever.
Which of the following is the most likely diagnosis?
A. Epiglottitis
B. Laryngotracheobronchitis (Croup)
C. Bacterial Tracheitis
D. Bronchiolitis
Answer: B
Rationale: Croup, or laryngotracheobronchitis, is characterized by the classic ‘seal-like’
barking cough and inspiratory stridor due to subglottic narrowing. It is typically viral in
origin, often caused by parainfluenza virus, and affects children aged 6 months to 3 years
most frequently. Management involves cool mist and potentially corticosteroids like
dexamethasone for symptom relief.
2. When assessing a 12-month-old infant for developmental milestones, which motor skill
should the Nurse Practitioner expect the child to have mastered?
A. Walking with assistance or taking a few steps alone
,B. Running well
C. Jumping with both feet
D. Riding a tricycle
Answer: A
Rationale: At 12 months, infants typically begin to cruise, walk with one hand held, or take
their first independent steps. Failure to stand while holding on by 12 months is considered
a developmental red flag that requires further evaluation. Gross motor skills like jumping
and riding a tricycle are expected at older ages, such as 2 and 3 years respectively.
3. A 15-year-old female presents for a well-visit. According to current guidelines, when should
cervical cancer screening (Pap smear) be initiated in an immunocompetent patient?
A. At the onset of sexual activity
B. At age 18
C. At age 21
D. At age 25
Answer: C
Rationale: Current ASCCP and USPSTF guidelines recommend that cervical cancer
screening begin at age 21, regardless of the age of sexual debut. Screening earlier than age
21 can lead to unnecessary procedures for transient HPV infections that often resolve on
,their own in adolescents. For patients aged 21 to 29, cytology alone every three years is the
standard recommendation.
4. Which of the following physical exam findings is most suggestive of Otitis Media with
Effusion (OME) rather than Acute Otitis Media (AOM)?
A. Erythematous, bulging tympanic membrane
B. Severe otalgia with fever
C. Purulent drainage in the ear canal
D. Fluid behind a non-erythematous, neutral or retracted tympanic membrane
Answer: D
Rationale: Otitis Media with Effusion is characterized by the presence of fluid in the
middle ear without signs or symptoms of acute infection like fever or severe pain. In
contrast, AOM presents with acute onset of symptoms and a bulging, opaque, or
erythematous TM. OME often follows an episode of AOM and usually resolves
spontaneously within a few months.
5. A mother brings her 2-year-old son to the clinic with a history of ‘honey-colored’ crusting
lesions around his nose and mouth. What is the most appropriate first-line treatment?
A. Oral Amoxicillin
B. Oral Acyclovir
C. Topical Hydrocortisone
, D. Topical Mupirocin (Bactroban)
Answer: D
Rationale: Honey-colored crusting is the hallmark sign of non-bullous impetigo, which is
usually caused by Staphylococcus aureus or Streptococcus pyogenes. For localized lesions,
topical mupirocin applied three times daily for 5-7 days is the preferred treatment.
Systemic antibiotics are only indicated if the lesions are widespread or if there are systemic
symptoms like fever.
6. In the management of pediatric asthma, which of the following criteria defines ‘Mild
Persistent’ asthma?
A. Symptoms less than 2 days per week
B. Symptoms throughout the day and frequent nighttime awakenings
C. Daily symptoms and nighttime awakenings > 1 time per week
D. Symptoms more than 2 days per week but not daily
Answer: D
Rationale: Mild persistent asthma is classified by symptoms occurring more than two days
per week but not daily, and nighttime awakenings 3-4 times per month. Patients in this
category require a daily low-dose inhaled corticosteroid (ICS) as a controller medication.
Proper classification is essential for selecting the correct step-up or step-down therapy
according to GINA/NHLBI guidelines.
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Exam 4 2026)
1. A 4-year-old child presents with a barking cough, inspiratory stridor, and a low-grade fever.
Which of the following is the most likely diagnosis?
A. Epiglottitis
B. Laryngotracheobronchitis (Croup)
C. Bacterial Tracheitis
D. Bronchiolitis
Answer: B
Rationale: Croup, or laryngotracheobronchitis, is characterized by the classic ‘seal-like’
barking cough and inspiratory stridor due to subglottic narrowing. It is typically viral in
origin, often caused by parainfluenza virus, and affects children aged 6 months to 3 years
most frequently. Management involves cool mist and potentially corticosteroids like
dexamethasone for symptom relief.
2. When assessing a 12-month-old infant for developmental milestones, which motor skill
should the Nurse Practitioner expect the child to have mastered?
A. Walking with assistance or taking a few steps alone
,B. Running well
C. Jumping with both feet
D. Riding a tricycle
Answer: A
Rationale: At 12 months, infants typically begin to cruise, walk with one hand held, or take
their first independent steps. Failure to stand while holding on by 12 months is considered
a developmental red flag that requires further evaluation. Gross motor skills like jumping
and riding a tricycle are expected at older ages, such as 2 and 3 years respectively.
3. A 15-year-old female presents for a well-visit. According to current guidelines, when should
cervical cancer screening (Pap smear) be initiated in an immunocompetent patient?
A. At the onset of sexual activity
B. At age 18
C. At age 21
D. At age 25
Answer: C
Rationale: Current ASCCP and USPSTF guidelines recommend that cervical cancer
screening begin at age 21, regardless of the age of sexual debut. Screening earlier than age
21 can lead to unnecessary procedures for transient HPV infections that often resolve on
,their own in adolescents. For patients aged 21 to 29, cytology alone every three years is the
standard recommendation.
4. Which of the following physical exam findings is most suggestive of Otitis Media with
Effusion (OME) rather than Acute Otitis Media (AOM)?
A. Erythematous, bulging tympanic membrane
B. Severe otalgia with fever
C. Purulent drainage in the ear canal
D. Fluid behind a non-erythematous, neutral or retracted tympanic membrane
Answer: D
Rationale: Otitis Media with Effusion is characterized by the presence of fluid in the
middle ear without signs or symptoms of acute infection like fever or severe pain. In
contrast, AOM presents with acute onset of symptoms and a bulging, opaque, or
erythematous TM. OME often follows an episode of AOM and usually resolves
spontaneously within a few months.
5. A mother brings her 2-year-old son to the clinic with a history of ‘honey-colored’ crusting
lesions around his nose and mouth. What is the most appropriate first-line treatment?
A. Oral Amoxicillin
B. Oral Acyclovir
C. Topical Hydrocortisone
, D. Topical Mupirocin (Bactroban)
Answer: D
Rationale: Honey-colored crusting is the hallmark sign of non-bullous impetigo, which is
usually caused by Staphylococcus aureus or Streptococcus pyogenes. For localized lesions,
topical mupirocin applied three times daily for 5-7 days is the preferred treatment.
Systemic antibiotics are only indicated if the lesions are widespread or if there are systemic
symptoms like fever.
6. In the management of pediatric asthma, which of the following criteria defines ‘Mild
Persistent’ asthma?
A. Symptoms less than 2 days per week
B. Symptoms throughout the day and frequent nighttime awakenings
C. Daily symptoms and nighttime awakenings > 1 time per week
D. Symptoms more than 2 days per week but not daily
Answer: D
Rationale: Mild persistent asthma is classified by symptoms occurring more than two days
per week but not daily, and nighttime awakenings 3-4 times per month. Patients in this
category require a daily low-dose inhaled corticosteroid (ICS) as a controller medication.
Proper classification is essential for selecting the correct step-up or step-down therapy
according to GINA/NHLBI guidelines.
