NSG 555 Exam 4 V3 | 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 patient presents with chronic epigastric pain that is relieved by food
but recurs 2 to 3 hours after eating. Which diagnostic test is most appropriate for initial
screening of the suspected condition?
A. Colonoscopy
B. Abdominal Ultrasound
C. Barium swallow
D. Urea breath test
Correct Answer: D
Explanation: The patient’s symptoms are highly suggestive of a duodenal ulcer, often
caused by H. pylori infection. The urea breath test is a highly sensitive and specific non-
invasive test for detecting active H. pylori infection. It is preferred over serology because it
indicates current infection rather than past exposure.
2. A 62-year-old female presents for a routine check-up and has a history of stage 3 chronic
kidney disease (CKD). What is the most appropriate medication for managing her
hypertension while providing renal protection?
A. Amlodipine
B. Furosemide
,C. Hydrochlorothiazide
D. Lisinopril
Correct Answer: D
Explanation: ACE inhibitors like Lisinopril are first-line agents for hypertensive patients
with CKD because they reduce intraglomerular pressure. This mechanism helps to decrease
albuminuria and slow the progression of renal decline. Monitoring of serum potassium and
creatinine levels is required within one to two weeks of starting therapy.
3. A patient presents with a ‘herald patch’ followed by a Christmas tree pattern rash on the
trunk. Which of the following is the most likely diagnosis?
A. Tinea corporis
B. Psoriasis
C. Pityriasis rosea
D. Secondary syphilis
Correct Answer: C
Explanation: Pityriasis rosea typically begins with a single, larger herald patch followed by
smaller lesions along skin cleavage lines. This condition is self-limiting and usually resolves
within 6 to 12 weeks without specific treatment. Management is focused on symptomatic
relief of pruritus using topical steroids or antihistamines.
, 4. A 24-year-old female presents with dysuria, urgency, and frequency but denies fever or
flank pain. What is the most common causative organism for this uncomplicated UTI?
A. Proteus mirabilis
B. Staphylococcus saprophyticus
C. Escherichia coli
D. Klebsiella pneumoniae
Correct Answer: C
Explanation: Escherichia coli is responsible for approximately 75% to 90% of
uncomplicated urinary tract infections in the outpatient setting. Risk factors in young
women include sexual intercourse and the use of spermicides. Empirical treatment with
nitrofurantoin or trimethoprim-sulfamethoxazole is typically initiated based on local
resistance patterns.
5. In patients with type 2 diabetes, which medication class is contraindicated when the
estimated glomerular filtration rate (eGFR) falls below 30 mL/min/1.73m2?
A. GLP-1 receptor agonists
B. Sulfonylureas
C. DPP-4 inhibitors
D. Biguanides (Metformin)
Correct Answer: D
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 4 2026)
1. A 45-year-old male patient presents with chronic epigastric pain that is relieved by food
but recurs 2 to 3 hours after eating. Which diagnostic test is most appropriate for initial
screening of the suspected condition?
A. Colonoscopy
B. Abdominal Ultrasound
C. Barium swallow
D. Urea breath test
Correct Answer: D
Explanation: The patient’s symptoms are highly suggestive of a duodenal ulcer, often
caused by H. pylori infection. The urea breath test is a highly sensitive and specific non-
invasive test for detecting active H. pylori infection. It is preferred over serology because it
indicates current infection rather than past exposure.
2. A 62-year-old female presents for a routine check-up and has a history of stage 3 chronic
kidney disease (CKD). What is the most appropriate medication for managing her
hypertension while providing renal protection?
A. Amlodipine
B. Furosemide
,C. Hydrochlorothiazide
D. Lisinopril
Correct Answer: D
Explanation: ACE inhibitors like Lisinopril are first-line agents for hypertensive patients
with CKD because they reduce intraglomerular pressure. This mechanism helps to decrease
albuminuria and slow the progression of renal decline. Monitoring of serum potassium and
creatinine levels is required within one to two weeks of starting therapy.
3. A patient presents with a ‘herald patch’ followed by a Christmas tree pattern rash on the
trunk. Which of the following is the most likely diagnosis?
A. Tinea corporis
B. Psoriasis
C. Pityriasis rosea
D. Secondary syphilis
Correct Answer: C
Explanation: Pityriasis rosea typically begins with a single, larger herald patch followed by
smaller lesions along skin cleavage lines. This condition is self-limiting and usually resolves
within 6 to 12 weeks without specific treatment. Management is focused on symptomatic
relief of pruritus using topical steroids or antihistamines.
, 4. A 24-year-old female presents with dysuria, urgency, and frequency but denies fever or
flank pain. What is the most common causative organism for this uncomplicated UTI?
A. Proteus mirabilis
B. Staphylococcus saprophyticus
C. Escherichia coli
D. Klebsiella pneumoniae
Correct Answer: C
Explanation: Escherichia coli is responsible for approximately 75% to 90% of
uncomplicated urinary tract infections in the outpatient setting. Risk factors in young
women include sexual intercourse and the use of spermicides. Empirical treatment with
nitrofurantoin or trimethoprim-sulfamethoxazole is typically initiated based on local
resistance patterns.
5. In patients with type 2 diabetes, which medication class is contraindicated when the
estimated glomerular filtration rate (eGFR) falls below 30 mL/min/1.73m2?
A. GLP-1 receptor agonists
B. Sulfonylureas
C. DPP-4 inhibitors
D. Biguanides (Metformin)
Correct Answer: D
