NSG 554 Exam 3 V3 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 3 2026)
1. A 45-year-old male with a history of hypertension presents for a routine follow-up. His
blood pressure today is 148/92 mmHg despite compliance with Lisinopril 20mg daily.
According to JNC 8 guidelines, what is the next most appropriate step in management?
A. Add Amlodipine 5mg daily
B. Increase Lisinopril to 40mg daily
C. Switch Lisinopril to Losartan
D. Add Metoprolol 25mg daily
Answer: A
Rationale: JNC 8 guidelines suggest adding a second agent from a different class if the goal
blood pressure is not reached within one month of treatment. Adding a Calcium Channel
Blocker (CCB) like Amlodipine provides synergistic effects when combined with an ACE
inhibitor. This approach is often more effective than doubling the dose of the initial
medication, which may increase the risk of side effects like cough or hyperkalemia.
,2. A 32-year-old female presents with persistent coughing and wheezing that occurs
approximately 3 days per week. She reports waking up at night twice a month due to these
symptoms. How should the Nurse Practitioner classify her asthma severity?
A. Intermittent
B. Mild Persistent
C. Moderate Persistent
D. Severe Persistent
Answer: B
Rationale: Mild persistent asthma is characterized by symptoms occurring more than
twice a week but not daily. Nighttime awakenings 3-4 times per month also fit this
classification, though this patient falls slightly below that threshold, the daytime frequency
confirms mild persistent. Proper classification is essential for determining whether to
initiate a daily controller medication like a low-dose inhaled corticosteroid.
3. Which of the following laboratory findings is most diagnostic for primary hypothyroidism?
A. High TSH and Low Free T4
B. High TSH and High Free T4
C. Low TSH and Low Free T4
D. Low TSH and High Free T4
Answer: A
,Rationale: In primary hypothyroidism, the thyroid gland fails to produce sufficient thyroid
hormone, leading to a low Free T4 level. The pituitary gland responds by increasing the
production of Thyroid Stimulating Hormone (TSH) to compensate. This inverse
relationship between TSH and Free T4 is the hallmark of primary thyroid failure,
distinguishing it from secondary causes involving the pituitary.
4. A 68-year-old patient with COPD is categorized into GOLD Group E. Which medication
regimen is currently recommended as the initial treatment for this group?
A. LABA + LAMA combination
B. LAMA monotherapy
C. SABA as needed only
D. ICS + LABA combination
Answer: A
Rationale: GOLD Group E includes patients with high symptom burdens and a history of
frequent exacerbations regardless of their CAT score. Current guidelines recommend
starting these patients on a combination of a Long-Acting Muscarinic Antagonist (LAMA)
and a Long-Acting Beta-Agonist (LABA). This combination therapy has been shown to be
superior to monotherapy in reducing exacerbation rates and improving lung function in
high-risk patients.
, 5. A patient with Type 2 Diabetes is currently taking Metformin 1000mg twice daily. The
recent A1C is 8.2%. The patient has a history of heart failure with reduced ejection fraction
(HFrEF). Which medication class should be added next?
A. Sulfonylurea
B. DPP-4 Inhibitor
C. TZD (Thiazolidinedione)
D. SGLT2 Inhibitor
Answer: D
Rationale: SGLT2 inhibitors are the preferred add-on therapy for patients with Type 2
Diabetes who also have heart failure or chronic kidney disease. These medications provide
cardiovascular benefits beyond glycemic control, specifically reducing hospitalizations for
heart failure. In contrast, TZDs are contraindicated in patients with symptomatic heart
failure due to the risk of fluid retention.
6. What is the first-line antibiotic treatment for an uncomplicated urinary tract infection (UTI)
in a non-pregnant adult female, assuming no local resistance issues?
A. Ciprofloxacin
B. Nitrofurantoin (Macrobid)
C. Amoxicillin
D. Doxycycline
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 3 2026)
1. A 45-year-old male with a history of hypertension presents for a routine follow-up. His
blood pressure today is 148/92 mmHg despite compliance with Lisinopril 20mg daily.
According to JNC 8 guidelines, what is the next most appropriate step in management?
A. Add Amlodipine 5mg daily
B. Increase Lisinopril to 40mg daily
C. Switch Lisinopril to Losartan
D. Add Metoprolol 25mg daily
Answer: A
Rationale: JNC 8 guidelines suggest adding a second agent from a different class if the goal
blood pressure is not reached within one month of treatment. Adding a Calcium Channel
Blocker (CCB) like Amlodipine provides synergistic effects when combined with an ACE
inhibitor. This approach is often more effective than doubling the dose of the initial
medication, which may increase the risk of side effects like cough or hyperkalemia.
,2. A 32-year-old female presents with persistent coughing and wheezing that occurs
approximately 3 days per week. She reports waking up at night twice a month due to these
symptoms. How should the Nurse Practitioner classify her asthma severity?
A. Intermittent
B. Mild Persistent
C. Moderate Persistent
D. Severe Persistent
Answer: B
Rationale: Mild persistent asthma is characterized by symptoms occurring more than
twice a week but not daily. Nighttime awakenings 3-4 times per month also fit this
classification, though this patient falls slightly below that threshold, the daytime frequency
confirms mild persistent. Proper classification is essential for determining whether to
initiate a daily controller medication like a low-dose inhaled corticosteroid.
3. Which of the following laboratory findings is most diagnostic for primary hypothyroidism?
A. High TSH and Low Free T4
B. High TSH and High Free T4
C. Low TSH and Low Free T4
D. Low TSH and High Free T4
Answer: A
,Rationale: In primary hypothyroidism, the thyroid gland fails to produce sufficient thyroid
hormone, leading to a low Free T4 level. The pituitary gland responds by increasing the
production of Thyroid Stimulating Hormone (TSH) to compensate. This inverse
relationship between TSH and Free T4 is the hallmark of primary thyroid failure,
distinguishing it from secondary causes involving the pituitary.
4. A 68-year-old patient with COPD is categorized into GOLD Group E. Which medication
regimen is currently recommended as the initial treatment for this group?
A. LABA + LAMA combination
B. LAMA monotherapy
C. SABA as needed only
D. ICS + LABA combination
Answer: A
Rationale: GOLD Group E includes patients with high symptom burdens and a history of
frequent exacerbations regardless of their CAT score. Current guidelines recommend
starting these patients on a combination of a Long-Acting Muscarinic Antagonist (LAMA)
and a Long-Acting Beta-Agonist (LABA). This combination therapy has been shown to be
superior to monotherapy in reducing exacerbation rates and improving lung function in
high-risk patients.
, 5. A patient with Type 2 Diabetes is currently taking Metformin 1000mg twice daily. The
recent A1C is 8.2%. The patient has a history of heart failure with reduced ejection fraction
(HFrEF). Which medication class should be added next?
A. Sulfonylurea
B. DPP-4 Inhibitor
C. TZD (Thiazolidinedione)
D. SGLT2 Inhibitor
Answer: D
Rationale: SGLT2 inhibitors are the preferred add-on therapy for patients with Type 2
Diabetes who also have heart failure or chronic kidney disease. These medications provide
cardiovascular benefits beyond glycemic control, specifically reducing hospitalizations for
heart failure. In contrast, TZDs are contraindicated in patients with symptomatic heart
failure due to the risk of fluid retention.
6. What is the first-line antibiotic treatment for an uncomplicated urinary tract infection (UTI)
in a non-pregnant adult female, assuming no local resistance issues?
A. Ciprofloxacin
B. Nitrofurantoin (Macrobid)
C. Amoxicillin
D. Doxycycline
