NSG 555 Exam 3 V2 | NSG 555 Nurse Practitioners
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 3 2026)
1. A 45-year-old female presents with epigastric pain that radiates to the back and improves
when leaning forward. Which laboratory finding is most specific for this diagnosis?
A. Elevated serum amylase
B. Elevated alkaline phosphatase
C. Decreased serum calcium
D. Elevated serum lipase
Correct Answer: D
Explanation: Serum lipase is more specific than amylase for the diagnosis of acute
pancreatitis. While both levels rise during an attack, lipase remains elevated longer and is
less likely to be elevated by non-pancreatic conditions. Clinical presentation of epigastric
pain radiating to the back is classic for pancreatitis.
2. Which of the following physical examination findings is most indicative of acute
cholecystitis?
A. Psoas sign
B. Rovsing sign
C. Murphy sign
,D. Grey Turner sign
Correct Answer: C
Explanation: Murphy sign is a specific physical exam technique where the patient halts
inspiration during deep palpation of the right upper quadrant. This occurs because the
inflamed gallbladder comes into contact with the examiner’s hand. Psoas and Rovsing signs
are associated with appendicitis, while Grey Turner sign indicates retroperitoneal
hemorrhage.
3. A 22-year-old male presents with sudden onset of severe right-sided scrotal pain and a
missing cremasteric reflex. What is the priority management?
A. Prescribe Doxycycline 100mg BID for 10 days
B. Order a scrotal ultrasound and await results
C. Perform a Prehn’s maneuver to confirm relief
D. Immediate surgical consultation for torsion
Correct Answer: D
Explanation: Testicular torsion is a surgical emergency that requires immediate
intervention to save the testis. A negative cremasteric reflex is highly suggestive of torsion
rather than epididymitis. Delaying surgery for imaging or antibiotics can lead to permanent
testicular ischemia and loss.
, 4. In the management of Gastroesophageal Reflux Disease (GERD), when should a patient be
referred for an endoscopic evaluation?
A. After failing two weeks of H2 receptor antagonists
B. When the patient reports occasional heartburn after meals
C. If the patient experiences dysphagia or unintentional weight loss
D. As a standard screening for all patients over age 40
Correct Answer: C
Explanation: Alarm symptoms such as dysphagia, weight loss, anemia, or persistent
vomiting necessitate urgent referral for endoscopy. These symptoms may indicate
esophageal cancer or severe complications like Barrett’s esophagus. Standard
uncomplicated GERD is typically managed empirically with lifestyle changes and PPIs first.
5. A 65-year-old male presents with hematuria, frequency, and a weak urinary stream. Digital
rectal exam reveals a smooth, firm, nontender enlarged prostate. What is the first-line
medication class?
A. 5-alpha-reductase inhibitors
B. Alpha-adrenergic antagonists
C. Phosphodiesterase-5 inhibitors
D. Anticholinergic agents
Correct Answer: B
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 3 2026)
1. A 45-year-old female presents with epigastric pain that radiates to the back and improves
when leaning forward. Which laboratory finding is most specific for this diagnosis?
A. Elevated serum amylase
B. Elevated alkaline phosphatase
C. Decreased serum calcium
D. Elevated serum lipase
Correct Answer: D
Explanation: Serum lipase is more specific than amylase for the diagnosis of acute
pancreatitis. While both levels rise during an attack, lipase remains elevated longer and is
less likely to be elevated by non-pancreatic conditions. Clinical presentation of epigastric
pain radiating to the back is classic for pancreatitis.
2. Which of the following physical examination findings is most indicative of acute
cholecystitis?
A. Psoas sign
B. Rovsing sign
C. Murphy sign
,D. Grey Turner sign
Correct Answer: C
Explanation: Murphy sign is a specific physical exam technique where the patient halts
inspiration during deep palpation of the right upper quadrant. This occurs because the
inflamed gallbladder comes into contact with the examiner’s hand. Psoas and Rovsing signs
are associated with appendicitis, while Grey Turner sign indicates retroperitoneal
hemorrhage.
3. A 22-year-old male presents with sudden onset of severe right-sided scrotal pain and a
missing cremasteric reflex. What is the priority management?
A. Prescribe Doxycycline 100mg BID for 10 days
B. Order a scrotal ultrasound and await results
C. Perform a Prehn’s maneuver to confirm relief
D. Immediate surgical consultation for torsion
Correct Answer: D
Explanation: Testicular torsion is a surgical emergency that requires immediate
intervention to save the testis. A negative cremasteric reflex is highly suggestive of torsion
rather than epididymitis. Delaying surgery for imaging or antibiotics can lead to permanent
testicular ischemia and loss.
, 4. In the management of Gastroesophageal Reflux Disease (GERD), when should a patient be
referred for an endoscopic evaluation?
A. After failing two weeks of H2 receptor antagonists
B. When the patient reports occasional heartburn after meals
C. If the patient experiences dysphagia or unintentional weight loss
D. As a standard screening for all patients over age 40
Correct Answer: C
Explanation: Alarm symptoms such as dysphagia, weight loss, anemia, or persistent
vomiting necessitate urgent referral for endoscopy. These symptoms may indicate
esophageal cancer or severe complications like Barrett’s esophagus. Standard
uncomplicated GERD is typically managed empirically with lifestyle changes and PPIs first.
5. A 65-year-old male presents with hematuria, frequency, and a weak urinary stream. Digital
rectal exam reveals a smooth, firm, nontender enlarged prostate. What is the first-line
medication class?
A. 5-alpha-reductase inhibitors
B. Alpha-adrenergic antagonists
C. Phosphodiesterase-5 inhibitors
D. Anticholinergic agents
Correct Answer: B
