NSG 555 Exam 2 V3 | NSG 555 Nurse Practitioners
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 2 2026)
1. A 45-year-old patient presents with a blood pressure of 152/96 mmHg on two separate
clinical visits. According to JNC 8 guidelines, what is the most appropriate first-line
pharmacological intervention for this non-African American patient with no comorbidities?
A. Any of the above (ACEI, ARB, CCB, or Thiazide)
B. Amlodipine (Calcium Channel Blocker)
C. Hydrochlorothiazide (Thiazide Diuretic)
D. Lisinopril (ACE Inhibitor)
Correct Answer: A
Explanation: According to JNC 8 guidelines, initial treatment for Stage 2 hypertension in
non-African American patients can include an ACE inhibitor, ARB, Calcium Channel Blocker,
or Thiazide diuretic. These classes have shown significant efficacy in reducing
cardiovascular mortality and morbidity in primary care populations. The selection should
be based on patient-specific factors, cost, and potential side effect profiles.
2. A 24-year-old female presents with symptoms of asthma occurring 3 times per week, with
nighttime awakenings 3 times per month. Her FEV1 is 85% of predicted. How should this
patient’s asthma be classified and managed according to GINA/NAEPP guidelines?
A. Mild persistent asthma; initiate low-dose ICS plus SABA PRN
,B. Intermittent asthma; initiate SABA PRN
C. Moderate persistent asthma; initiate low-dose ICS-LABA
D. Severe persistent asthma; initiate high-dose ICS-LABA
Correct Answer: A
Explanation: This patient meets the criteria for mild persistent asthma because symptoms
occur more than twice a week but not daily, and nighttime symptoms occur 3-4 times a
month. The standard of care for mild persistent asthma is the introduction of a daily
controller medication, typically a low-dose inhaled corticosteroid (ICS). Using only a SABA
for patients with persistent symptoms increases the risk of exacerbations and airway
remodeling.
3. A 62-year-old male smoker presents with a chronic cough and productive sputum for at
least 3 months in two consecutive years. His post-bronchodilator FEV1/FVC ratio is 0.65.
What is the most likely diagnosis?
A. Asthma
B. Congestive Heart Failure
C. Bronchiectasis
D. Chronic Obstructive Pulmonary Disease (COPD)
Correct Answer: D
,Explanation: The post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the
diagnosis of persistent airflow limitation, which is the hallmark of COPD. The patient’s
clinical history of a chronic productive cough for three months over two years is the classic
definition of chronic bronchitis. Management should focus on smoking cessation,
pulmonary rehabilitation, and appropriate inhaler therapy based on the GOLD assessment.
4. A 68-year-old patient presents with community-acquired pneumonia (CAP). The patient is
confused, has a respiratory rate of 32, a blood pressure of 88/58, and a BUN of 22 mg/dL.
Based on the CURB-65 score, what is the recommended setting for treatment?
A. Inpatient management with consideration for ICU admission
B. Inpatient management on a medical-surgical floor
C. Urgent care follow-up in 24 hours
D. Outpatient management
Correct Answer: A
Explanation: The CURB-65 score for this patient is 4 (Confusion=1, Respiratory rate=1,
BP=1, BUN=1). A score of 3 or higher indicates a high risk of mortality and requires
hospitalization, with scores of 4 or 5 specifically suggesting the need for intensive care.
Aggressive antibiotic therapy and stabilization of hemodynamic status are critical in this
high-risk population.
, 5. During a physical exam, the nurse practitioner notes a mid-systolic click followed by a late
systolic murmur at the apex. This finding is most characteristic of:
A. Mitral Stenosis
B. Mitral Valve Prolapse
C. Aortic Regurgitation
D. Ventricular Septal Defect
Correct Answer: B
Explanation: Mitral Valve Prolapse (MVP) typically presents as a mid-systolic click caused
by the sudden tensing of the chordae tendineae as the valve leaflets prolapse into the left
atrium. If mitral regurgitation is present, the click is followed by a late systolic murmur.
MVP is often asymptomatic but requires monitoring for progression to significant
regurgitation.
6. A patient presents with a circular, erythematous rash with central clearing on the forearm.
The patient recently spent time hiking. What is the first-line treatment for this condition?
A. Doxycycline
B. Amoxicillin
C. Cephalexin
D. Hydrocortisone cream
Correct Answer: A
in Primary Care I | Wilkes University | 2026 Q&A
with Rationale (Wilkes NSG555 Exam 2 2026)
1. A 45-year-old patient presents with a blood pressure of 152/96 mmHg on two separate
clinical visits. According to JNC 8 guidelines, what is the most appropriate first-line
pharmacological intervention for this non-African American patient with no comorbidities?
A. Any of the above (ACEI, ARB, CCB, or Thiazide)
B. Amlodipine (Calcium Channel Blocker)
C. Hydrochlorothiazide (Thiazide Diuretic)
D. Lisinopril (ACE Inhibitor)
Correct Answer: A
Explanation: According to JNC 8 guidelines, initial treatment for Stage 2 hypertension in
non-African American patients can include an ACE inhibitor, ARB, Calcium Channel Blocker,
or Thiazide diuretic. These classes have shown significant efficacy in reducing
cardiovascular mortality and morbidity in primary care populations. The selection should
be based on patient-specific factors, cost, and potential side effect profiles.
2. A 24-year-old female presents with symptoms of asthma occurring 3 times per week, with
nighttime awakenings 3 times per month. Her FEV1 is 85% of predicted. How should this
patient’s asthma be classified and managed according to GINA/NAEPP guidelines?
A. Mild persistent asthma; initiate low-dose ICS plus SABA PRN
,B. Intermittent asthma; initiate SABA PRN
C. Moderate persistent asthma; initiate low-dose ICS-LABA
D. Severe persistent asthma; initiate high-dose ICS-LABA
Correct Answer: A
Explanation: This patient meets the criteria for mild persistent asthma because symptoms
occur more than twice a week but not daily, and nighttime symptoms occur 3-4 times a
month. The standard of care for mild persistent asthma is the introduction of a daily
controller medication, typically a low-dose inhaled corticosteroid (ICS). Using only a SABA
for patients with persistent symptoms increases the risk of exacerbations and airway
remodeling.
3. A 62-year-old male smoker presents with a chronic cough and productive sputum for at
least 3 months in two consecutive years. His post-bronchodilator FEV1/FVC ratio is 0.65.
What is the most likely diagnosis?
A. Asthma
B. Congestive Heart Failure
C. Bronchiectasis
D. Chronic Obstructive Pulmonary Disease (COPD)
Correct Answer: D
,Explanation: The post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the
diagnosis of persistent airflow limitation, which is the hallmark of COPD. The patient’s
clinical history of a chronic productive cough for three months over two years is the classic
definition of chronic bronchitis. Management should focus on smoking cessation,
pulmonary rehabilitation, and appropriate inhaler therapy based on the GOLD assessment.
4. A 68-year-old patient presents with community-acquired pneumonia (CAP). The patient is
confused, has a respiratory rate of 32, a blood pressure of 88/58, and a BUN of 22 mg/dL.
Based on the CURB-65 score, what is the recommended setting for treatment?
A. Inpatient management with consideration for ICU admission
B. Inpatient management on a medical-surgical floor
C. Urgent care follow-up in 24 hours
D. Outpatient management
Correct Answer: A
Explanation: The CURB-65 score for this patient is 4 (Confusion=1, Respiratory rate=1,
BP=1, BUN=1). A score of 3 or higher indicates a high risk of mortality and requires
hospitalization, with scores of 4 or 5 specifically suggesting the need for intensive care.
Aggressive antibiotic therapy and stabilization of hemodynamic status are critical in this
high-risk population.
, 5. During a physical exam, the nurse practitioner notes a mid-systolic click followed by a late
systolic murmur at the apex. This finding is most characteristic of:
A. Mitral Stenosis
B. Mitral Valve Prolapse
C. Aortic Regurgitation
D. Ventricular Septal Defect
Correct Answer: B
Explanation: Mitral Valve Prolapse (MVP) typically presents as a mid-systolic click caused
by the sudden tensing of the chordae tendineae as the valve leaflets prolapse into the left
atrium. If mitral regurgitation is present, the click is followed by a late systolic murmur.
MVP is often asymptomatic but requires monitoring for progression to significant
regurgitation.
6. A patient presents with a circular, erythematous rash with central clearing on the forearm.
The patient recently spent time hiking. What is the first-line treatment for this condition?
A. Doxycycline
B. Amoxicillin
C. Cephalexin
D. Hydrocortisone cream
Correct Answer: A
