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 45-year-old male presents with a pearly, dome-shaped nodule on his nose with visible
telangiectasias. What is the most likely diagnosis for this skin lesion?
A. Squamous cell carcinoma
B. Seborrheic keratosis
C. Malignant melanoma
D. Basal cell carcinoma
Correct Answer: D
Explanation: Basal cell carcinoma (BCC) is the most common form of skin cancer and
typically presents as a pearly, waxy papule with telangiectatic vessels. This presentation is
classic for BCC, which is often found in sun-exposed areas like the face. The diagnosis is
confirmed via biopsy, and while it rarely metastasizes, it can be locally invasive.
2. A patient complains of a ‘burning’ sensation in the epigastric region that occurs primarily at
night and is relieved by antacids. Which of the following is the initial gold standard for
diagnosing H. pylori infection in a primary care setting?
A. Serum antibody testing
B. Urea breath test
,C. Stool antigen test
D. Upper endoscopy with biopsy
Correct Answer: B
Explanation: The urea breath test is a highly sensitive and specific non-invasive test for
detecting active H. pylori infection. While stool antigen testing is also accurate, the urea
breath test is frequently preferred for both initial diagnosis and confirming eradication.
Serum antibody testing is not recommended as it cannot distinguish between past and
active infection.
3. A 22-year-old female presents with acute right lower quadrant pain, nausea, and a positive
Psoas sign. Which diagnostic imaging is the most appropriate next step to confirm suspected
appendicitis?
A. Abdominal ultrasound
B. CT scan of the abdomen and pelvis with contrast
C. Abdominal X-ray (KUB)
D. MRI of the abdomen
Correct Answer: B
Explanation: CT scan of the abdomen and pelvis with contrast is the gold standard for
diagnosing acute appendicitis in adults due to its high sensitivity and specificity.
Ultrasound is often reserved for children or pregnant women to avoid radiation exposure.
, A positive Psoas sign indicates irritation of the psoas muscle, strongly suggesting an
inflamed appendix.
4. A patient presents with a ‘honey-colored’ crusted lesion around the mouth. Which
pathogen is most commonly associated with this presentation of non-bullous impetigo?
A. Streptococcus pyogenes
B. Pseudomonas aeruginosa
C. Staphylococcus aureus
D. Escherichia coli
Correct Answer: C
Explanation: Staphylococcus aureus is currently the most common cause of both bullous
and non-bullous impetigo in developed countries. Streptococcus pyogenes (Group A Strep)
was historically more common but now ranks second. Honey-colored crusting is the
pathognomonic clinical feature of the non-bullous form of this highly contagious bacterial
skin infection.
5. A 50-year-old female presents with RUQ pain that radiates to the right scapula, triggered
by a fatty meal. Murphy’s sign is positive. What is the most likely diagnosis?
A. Acute pancreatitis
B. Peptic ulcer disease
C. Acute cholecystitis
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 4 2026)
1. A 45-year-old male presents with a pearly, dome-shaped nodule on his nose with visible
telangiectasias. What is the most likely diagnosis for this skin lesion?
A. Squamous cell carcinoma
B. Seborrheic keratosis
C. Malignant melanoma
D. Basal cell carcinoma
Correct Answer: D
Explanation: Basal cell carcinoma (BCC) is the most common form of skin cancer and
typically presents as a pearly, waxy papule with telangiectatic vessels. This presentation is
classic for BCC, which is often found in sun-exposed areas like the face. The diagnosis is
confirmed via biopsy, and while it rarely metastasizes, it can be locally invasive.
2. A patient complains of a ‘burning’ sensation in the epigastric region that occurs primarily at
night and is relieved by antacids. Which of the following is the initial gold standard for
diagnosing H. pylori infection in a primary care setting?
A. Serum antibody testing
B. Urea breath test
,C. Stool antigen test
D. Upper endoscopy with biopsy
Correct Answer: B
Explanation: The urea breath test is a highly sensitive and specific non-invasive test for
detecting active H. pylori infection. While stool antigen testing is also accurate, the urea
breath test is frequently preferred for both initial diagnosis and confirming eradication.
Serum antibody testing is not recommended as it cannot distinguish between past and
active infection.
3. A 22-year-old female presents with acute right lower quadrant pain, nausea, and a positive
Psoas sign. Which diagnostic imaging is the most appropriate next step to confirm suspected
appendicitis?
A. Abdominal ultrasound
B. CT scan of the abdomen and pelvis with contrast
C. Abdominal X-ray (KUB)
D. MRI of the abdomen
Correct Answer: B
Explanation: CT scan of the abdomen and pelvis with contrast is the gold standard for
diagnosing acute appendicitis in adults due to its high sensitivity and specificity.
Ultrasound is often reserved for children or pregnant women to avoid radiation exposure.
, A positive Psoas sign indicates irritation of the psoas muscle, strongly suggesting an
inflamed appendix.
4. A patient presents with a ‘honey-colored’ crusted lesion around the mouth. Which
pathogen is most commonly associated with this presentation of non-bullous impetigo?
A. Streptococcus pyogenes
B. Pseudomonas aeruginosa
C. Staphylococcus aureus
D. Escherichia coli
Correct Answer: C
Explanation: Staphylococcus aureus is currently the most common cause of both bullous
and non-bullous impetigo in developed countries. Streptococcus pyogenes (Group A Strep)
was historically more common but now ranks second. Honey-colored crusting is the
pathognomonic clinical feature of the non-bullous form of this highly contagious bacterial
skin infection.
5. A 50-year-old female presents with RUQ pain that radiates to the right scapula, triggered
by a fatty meal. Murphy’s sign is positive. What is the most likely diagnosis?
A. Acute pancreatitis
B. Peptic ulcer disease
C. Acute cholecystitis
