WILKES UNIVERSITY | GRADUATE NURSING PROGRAM
NSG555 / NSG 555 EXAM 4
(Latest Update)
Nurse Practitioners in Primary Care I - Comprehensive Examination
Questions and Verified Answers | 100% Correct | Grade A - Wilkes
Course NSG 555 - Nurse Practitioners in Primary Care I
Institution Wilkes University, Graduate Nursing Program
Examination Exam 4 - Comprehensive Course Examination (2026/2027 Update)
Wilkes NSG 555 Course Syllabus; AACN Essentials of Master's Education; Family Nurse
Alignment
Practitioner (FNP) Primary Care Competencies (2026/2027 Edition)
Total Questions 100 single-best-answer items (A-D) across Sections 1-8
Time Limit 180 minutes (suggested)
Cognitive Blueprint Recall 20% | Application 50% | Analysis 30%
Item Design 75% scenario-based clinical decision-making; 25% direct knowledge
Answer Key Verified correct answers marked [CORRECT] with detailed rationale after every item
Instructions to the Candidate: Read each item carefully and select the ONE best response. Scenario-based items require
clinical reasoning across assessment, diagnosis, pharmacotherapeutics, and follow-up; direct-knowledge items verify recall
of guideline thresholds and professional standards. Verified answers are marked [CORRECT] immediately below each
option set and are followed by a rationale citing NSG 555 course content, AACN Essentials domains, and current
evidence-based primary care guidelines (ACC/AHA, ADA Standards of Care, GINA, GOLD, USPSTF, ACIP, IDSA,
AGS Beers, CDC). Use the rationales to direct remediation of missed items and to prepare for course examinations and
national FNP certification testing.
Wilkes University - Graduate Nursing Program | NSG 555 Exam 4 Study Guide Page 1
,NSG 555 - Nurse Practitioners in Primary Care I | Exam 4 (Latest Update)
Section 1: Advanced Health Assessment & Diagnostic Reasoning
Questions 1-15 | 15 items
Q1: A 52-year-old premenopausal woman presents with 3 months of progressive fatigue, exertional dyspnea,
and pica. Examination reveals conjunctival pallor and mild tachycardia. CBC shows hemoglobin 9.8 g/dL,
MCV 72 fL, and RDW 16.5%. She reports heavy menstrual bleeding for several years. What is the most
appropriate NEXT diagnostic step?
A. Serum ferritin level [CORRECT]
B. Hemoglobin electrophoresis
C. Immediate oral iron trial without further testing
D. Colonoscopy before any other workup
Correct Answer: A
Rationale: In microcytic anemia with a plausible blood-loss source, serum ferritin is the most sensitive and
specific single test for iron deficiency and is the correct next step in the NSG 555 diagnostic reasoning
sequence. Hemoglobin electrophoresis is reserved for cases where iron studies are normal or elevated,
suggesting thalassemia. An empiric iron trial without confirming the diagnosis violates evidence-based practice
and may mask an underlying GI malignancy; colonoscopy is appropriate later if iron deficiency is confirmed,
particularly at age 50 or older or in men, but menorrhagia is a sufficient explanation to evaluate first.
Q2: When obtaining a symptom history during a comprehensive health assessment, the NP uses the
OLDCARTS mnemonic. Which element of this framework captures what makes the symptom better or
worse?
A. Onset
B. Aggravating and alleviating factors [CORRECT]
C. Radiation
D. Severity
Correct Answer: B
Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating/Alleviating factors,
Radiation, Timing, and Severity, so aggravating and alleviating factors is the correct element. Onset describes
when and how the symptom began, radiation describes migration of the symptom to other body areas, and
severity quantifies intensity, typically with a 0-to-10 scale. Mastery of structured history-taking mnemonics is a
core NSG 555 advanced health assessment competency because it ensures complete, reproducible symptom
characterization that drives accurate differential diagnosis.
Wilkes University - Graduate Nursing Program | NSG 555 Exam 4 Study Guide Page 2
,NSG 555 - Nurse Practitioners in Primary Care I | Exam 4 (Latest Update)
Q3: A 68-year-old man reports 2 weeks of lightheadedness when rising from a chair. His medications include
lisinopril, metoprolol, and zolpidem. He has no syncope, no chest pain, and no focal neurologic deficits on
examination. What is the most appropriate FIRST step in the diagnostic evaluation?
A. Carotid duplex ultrasound
B. Noncontrast CT of the head
C. Orthostatic vital signs [CORRECT]
D. Ambulatory cardiac event monitor
Correct Answer: C
Rationale: Orthostatic vital signs are inexpensive, immediately available, and directly test the most likely
explanation: medication-induced orthostatic hypotension, a common adverse effect of ACE inhibitors,
beta-blockers, and sedative-hypnotics in older adults. Advanced imaging such as head CT and carotid duplex
are reserved for patients with red flags such as focal deficits, syncope without prodrome, or vertebrobasilar
symptoms. Choosing low-cost, high-yield testing first exemplifies the diagnostic stewardship and clinical
reasoning emphasized throughout NSG 555 and the AACN Essentials quality and safety domain.
Q4: During a telehealth video visit, a 34-year-old woman describes a sudden 'thunderclap' headache that
began during exercise 3 hours ago. She calls it 'the worst headache of my life.' She is anxious and requests a
prescription for her sister's sumatriptan. What is the BEST action by the NP?
A. Advise hydration and re-evaluation in 1 week
B. Prescribe sumatriptan and schedule a follow-up call
C. Order an outpatient MRI for later this week
D. Direct her to the nearest emergency department for immediate evaluation [CORRECT]
Correct Answer: D
Rationale: Sudden-onset 'worst headache of life' is a classic red flag for subarachnoid hemorrhage until
proven otherwise and mandates emergent in-person evaluation with CT and, if needed, lumbar puncture; this
cannot be excluded via telehealth. Prescribing sumatriptan before excluding a vascular event is contraindicated
because triptans are vasoconstrictors. Delayed outpatient imaging risks catastrophic deterioration. This
scenario tests the telehealth competency of recognizing red flags that require escalation to emergency care, a
critical safety expectation in NSG 555 and AACN Essential IX.
Wilkes University - Graduate Nursing Program | NSG 555 Exam 4 Study Guide Page 3
, NSG 555 - Nurse Practitioners in Primary Care I | Exam 4 (Latest Update)
Q5: A 28-year-old woman presents with 14 hours of right lower quadrant abdominal pain, nausea, and
low-grade fever of 37.8 degrees C. Examination reveals rebound tenderness in the right lower quadrant. Her
last menstrual period was 3 weeks ago. Which diagnostic test BEST differentiates appendicitis from an
ectopic pregnancy?
A. Qualitative beta-hCG with transvaginal pelvic ultrasound [CORRECT]
B. Urinalysis
C. Abdominal plain radiograph
D. ESR and CRP
Correct Answer: A
Rationale: Every reproductive-age woman with abdominal pain requires pregnancy testing first; a qualitative
beta-hCG followed by transvaginal ultrasound is the fastest way to exclude ectopic pregnancy, the most
immediately life-threatening diagnosis in the differential. Graded-compression ultrasound can then assess the
appendix. Urinalysis and inflammatory markers are adjunctive but nonspecific, and plain radiography
contributes nothing to this differential. This question reflects the NSG 555 principle of prioritizing 'rule out the
deadliest' when constructing and sequencing a differential diagnosis.
Q6: Which description BEST characterizes the teach-back method used to address limited health literacy?
A. Providing written instructions at a 12th-grade reading level
B. Asking patients to explain instructions in their own words to confirm understanding [CORRECT]
C. Translating all consent documents into the patient's native language
D. Referring every patient with a new diagnosis to a nurse educator
Correct Answer: B
Rationale: Teach-back asks the patient to restate the plan in their own words, shifting the burden of clear
communication from the patient to the clinician and revealing misunderstandings before they cause harm.
Written materials should be at a 5th-to-6th-grade level, not 12th grade, and translation, while valuable, does not
confirm comprehension. Referral is an adjunct, not a literacy intervention. Teach-back is endorsed by AHRQ's
Health Literacy Universal Precautions Toolkit and is a required patient-education competency in NSG 555 and
the AACN person-centered care domain.
Wilkes University - Graduate Nursing Program | NSG 555 Exam 4 Study Guide Page 4
NSG555 / NSG 555 EXAM 4
(Latest Update)
Nurse Practitioners in Primary Care I - Comprehensive Examination
Questions and Verified Answers | 100% Correct | Grade A - Wilkes
Course NSG 555 - Nurse Practitioners in Primary Care I
Institution Wilkes University, Graduate Nursing Program
Examination Exam 4 - Comprehensive Course Examination (2026/2027 Update)
Wilkes NSG 555 Course Syllabus; AACN Essentials of Master's Education; Family Nurse
Alignment
Practitioner (FNP) Primary Care Competencies (2026/2027 Edition)
Total Questions 100 single-best-answer items (A-D) across Sections 1-8
Time Limit 180 minutes (suggested)
Cognitive Blueprint Recall 20% | Application 50% | Analysis 30%
Item Design 75% scenario-based clinical decision-making; 25% direct knowledge
Answer Key Verified correct answers marked [CORRECT] with detailed rationale after every item
Instructions to the Candidate: Read each item carefully and select the ONE best response. Scenario-based items require
clinical reasoning across assessment, diagnosis, pharmacotherapeutics, and follow-up; direct-knowledge items verify recall
of guideline thresholds and professional standards. Verified answers are marked [CORRECT] immediately below each
option set and are followed by a rationale citing NSG 555 course content, AACN Essentials domains, and current
evidence-based primary care guidelines (ACC/AHA, ADA Standards of Care, GINA, GOLD, USPSTF, ACIP, IDSA,
AGS Beers, CDC). Use the rationales to direct remediation of missed items and to prepare for course examinations and
national FNP certification testing.
Wilkes University - Graduate Nursing Program | NSG 555 Exam 4 Study Guide Page 1
,NSG 555 - Nurse Practitioners in Primary Care I | Exam 4 (Latest Update)
Section 1: Advanced Health Assessment & Diagnostic Reasoning
Questions 1-15 | 15 items
Q1: A 52-year-old premenopausal woman presents with 3 months of progressive fatigue, exertional dyspnea,
and pica. Examination reveals conjunctival pallor and mild tachycardia. CBC shows hemoglobin 9.8 g/dL,
MCV 72 fL, and RDW 16.5%. She reports heavy menstrual bleeding for several years. What is the most
appropriate NEXT diagnostic step?
A. Serum ferritin level [CORRECT]
B. Hemoglobin electrophoresis
C. Immediate oral iron trial without further testing
D. Colonoscopy before any other workup
Correct Answer: A
Rationale: In microcytic anemia with a plausible blood-loss source, serum ferritin is the most sensitive and
specific single test for iron deficiency and is the correct next step in the NSG 555 diagnostic reasoning
sequence. Hemoglobin electrophoresis is reserved for cases where iron studies are normal or elevated,
suggesting thalassemia. An empiric iron trial without confirming the diagnosis violates evidence-based practice
and may mask an underlying GI malignancy; colonoscopy is appropriate later if iron deficiency is confirmed,
particularly at age 50 or older or in men, but menorrhagia is a sufficient explanation to evaluate first.
Q2: When obtaining a symptom history during a comprehensive health assessment, the NP uses the
OLDCARTS mnemonic. Which element of this framework captures what makes the symptom better or
worse?
A. Onset
B. Aggravating and alleviating factors [CORRECT]
C. Radiation
D. Severity
Correct Answer: B
Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating/Alleviating factors,
Radiation, Timing, and Severity, so aggravating and alleviating factors is the correct element. Onset describes
when and how the symptom began, radiation describes migration of the symptom to other body areas, and
severity quantifies intensity, typically with a 0-to-10 scale. Mastery of structured history-taking mnemonics is a
core NSG 555 advanced health assessment competency because it ensures complete, reproducible symptom
characterization that drives accurate differential diagnosis.
Wilkes University - Graduate Nursing Program | NSG 555 Exam 4 Study Guide Page 2
,NSG 555 - Nurse Practitioners in Primary Care I | Exam 4 (Latest Update)
Q3: A 68-year-old man reports 2 weeks of lightheadedness when rising from a chair. His medications include
lisinopril, metoprolol, and zolpidem. He has no syncope, no chest pain, and no focal neurologic deficits on
examination. What is the most appropriate FIRST step in the diagnostic evaluation?
A. Carotid duplex ultrasound
B. Noncontrast CT of the head
C. Orthostatic vital signs [CORRECT]
D. Ambulatory cardiac event monitor
Correct Answer: C
Rationale: Orthostatic vital signs are inexpensive, immediately available, and directly test the most likely
explanation: medication-induced orthostatic hypotension, a common adverse effect of ACE inhibitors,
beta-blockers, and sedative-hypnotics in older adults. Advanced imaging such as head CT and carotid duplex
are reserved for patients with red flags such as focal deficits, syncope without prodrome, or vertebrobasilar
symptoms. Choosing low-cost, high-yield testing first exemplifies the diagnostic stewardship and clinical
reasoning emphasized throughout NSG 555 and the AACN Essentials quality and safety domain.
Q4: During a telehealth video visit, a 34-year-old woman describes a sudden 'thunderclap' headache that
began during exercise 3 hours ago. She calls it 'the worst headache of my life.' She is anxious and requests a
prescription for her sister's sumatriptan. What is the BEST action by the NP?
A. Advise hydration and re-evaluation in 1 week
B. Prescribe sumatriptan and schedule a follow-up call
C. Order an outpatient MRI for later this week
D. Direct her to the nearest emergency department for immediate evaluation [CORRECT]
Correct Answer: D
Rationale: Sudden-onset 'worst headache of life' is a classic red flag for subarachnoid hemorrhage until
proven otherwise and mandates emergent in-person evaluation with CT and, if needed, lumbar puncture; this
cannot be excluded via telehealth. Prescribing sumatriptan before excluding a vascular event is contraindicated
because triptans are vasoconstrictors. Delayed outpatient imaging risks catastrophic deterioration. This
scenario tests the telehealth competency of recognizing red flags that require escalation to emergency care, a
critical safety expectation in NSG 555 and AACN Essential IX.
Wilkes University - Graduate Nursing Program | NSG 555 Exam 4 Study Guide Page 3
, NSG 555 - Nurse Practitioners in Primary Care I | Exam 4 (Latest Update)
Q5: A 28-year-old woman presents with 14 hours of right lower quadrant abdominal pain, nausea, and
low-grade fever of 37.8 degrees C. Examination reveals rebound tenderness in the right lower quadrant. Her
last menstrual period was 3 weeks ago. Which diagnostic test BEST differentiates appendicitis from an
ectopic pregnancy?
A. Qualitative beta-hCG with transvaginal pelvic ultrasound [CORRECT]
B. Urinalysis
C. Abdominal plain radiograph
D. ESR and CRP
Correct Answer: A
Rationale: Every reproductive-age woman with abdominal pain requires pregnancy testing first; a qualitative
beta-hCG followed by transvaginal ultrasound is the fastest way to exclude ectopic pregnancy, the most
immediately life-threatening diagnosis in the differential. Graded-compression ultrasound can then assess the
appendix. Urinalysis and inflammatory markers are adjunctive but nonspecific, and plain radiography
contributes nothing to this differential. This question reflects the NSG 555 principle of prioritizing 'rule out the
deadliest' when constructing and sequencing a differential diagnosis.
Q6: Which description BEST characterizes the teach-back method used to address limited health literacy?
A. Providing written instructions at a 12th-grade reading level
B. Asking patients to explain instructions in their own words to confirm understanding [CORRECT]
C. Translating all consent documents into the patient's native language
D. Referring every patient with a new diagnosis to a nurse educator
Correct Answer: B
Rationale: Teach-back asks the patient to restate the plan in their own words, shifting the burden of clear
communication from the patient to the clinician and revealing misunderstandings before they cause harm.
Written materials should be at a 5th-to-6th-grade level, not 12th grade, and translation, while valuable, does not
confirm comprehension. Referral is an adjunct, not a literacy intervention. Teach-back is endorsed by AHRQ's
Health Literacy Universal Precautions Toolkit and is a required patient-education competency in NSG 555 and
the AACN person-centered care domain.
Wilkes University - Graduate Nursing Program | NSG 555 Exam 4 Study Guide Page 4
