NSG 554 Exam 1 V2 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 1 2026)
1. According to the USPSTF, at what age should annual screening for lung cancer with low-
dose CT begin for a patient with a 20 pack-year smoking history?
A. 50 years old
B. 45 years old
C. 55 years old
D. 60 years old
Answer: A
Rationale: The USPSTF updated its guidelines to recommend annual screening for lung
cancer with low-dose computed tomography in adults aged 50 to 80 years who have a 20
pack-year smoking history. This recommendation applies to those who currently smoke or
have quit within the past 15 years. Screening should be discontinued once a person has not
smoked for 15 years or develops a health problem that substantially limits life expectancy.
2. Which of the following physical exam findings is most indicative of Acute Otitis Media
(AOM) rather than Otitis Media with Effusion (OME)?
A. Presence of fluid behind the tympanic membrane
,B. Bulging of the tympanic membrane
C. Air-fluid levels
D. Aural fullness
Answer: B
Rationale: Acute Otitis Media is characterized by the rapid onset of signs and symptoms of
inflammation in the middle ear, with bulging of the tympanic membrane being a hallmark
sign. OME involves fluid in the middle ear without signs of acute infection or inflammation.
Differentiating between the two is critical to avoid unnecessary antibiotic use in patients
with OME.
3. A 45-year-old male presents for a wellness exam. His blood pressure today is 138/88
mmHg. According to the 2017 ACC/AHA guidelines, this reading is classified as:
A. Normal
B. Stage 1 Hypertension
C. Elevated
D. Stage 2 Hypertension
Answer: B
Rationale: Stage 1 Hypertension is defined as a systolic pressure between 130-139 mmHg
or a diastolic pressure between 80-89 mmHg. Elevated blood pressure is 120-129 systolic
, and less than 80 diastolic. Accurate classification is necessary to determine the appropriate
timing for follow-up and initiation of lifestyle or pharmacological interventions.
4. A patient presents with a sore throat, fever of 101.5 F, cervical adenopathy, and lack of
cough. Based on the Centor criteria, what is the most appropriate next step?
A. Prescribe Penicillin V immediately
B. Perform a Rapid Antigen Detection Test (RADT)
C. Prescribe Azithromycin for 5 days
D. Reassurance and symptomatic treatment only
Answer: B
Rationale: The patient has a Centor score of 4, which indicates a high probability of Group
A Streptococcus (GAS) pharyngitis. Current guidelines recommend confirming the
diagnosis with a Rapid Antigen Detection Test or throat culture before initiating antibiotics.
Confirmatory testing helps prevent the overuse of antibiotics in viral pharyngitis cases.
5. Which medication is considered first-line for a patient with persistent Mild Allergic
Rhinitis?
A. Oral Diphenhydramine
B. Intranasal Corticosteroid
C. Oral Decongestant
D. Intranasal Saline
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 1 2026)
1. According to the USPSTF, at what age should annual screening for lung cancer with low-
dose CT begin for a patient with a 20 pack-year smoking history?
A. 50 years old
B. 45 years old
C. 55 years old
D. 60 years old
Answer: A
Rationale: The USPSTF updated its guidelines to recommend annual screening for lung
cancer with low-dose computed tomography in adults aged 50 to 80 years who have a 20
pack-year smoking history. This recommendation applies to those who currently smoke or
have quit within the past 15 years. Screening should be discontinued once a person has not
smoked for 15 years or develops a health problem that substantially limits life expectancy.
2. Which of the following physical exam findings is most indicative of Acute Otitis Media
(AOM) rather than Otitis Media with Effusion (OME)?
A. Presence of fluid behind the tympanic membrane
,B. Bulging of the tympanic membrane
C. Air-fluid levels
D. Aural fullness
Answer: B
Rationale: Acute Otitis Media is characterized by the rapid onset of signs and symptoms of
inflammation in the middle ear, with bulging of the tympanic membrane being a hallmark
sign. OME involves fluid in the middle ear without signs of acute infection or inflammation.
Differentiating between the two is critical to avoid unnecessary antibiotic use in patients
with OME.
3. A 45-year-old male presents for a wellness exam. His blood pressure today is 138/88
mmHg. According to the 2017 ACC/AHA guidelines, this reading is classified as:
A. Normal
B. Stage 1 Hypertension
C. Elevated
D. Stage 2 Hypertension
Answer: B
Rationale: Stage 1 Hypertension is defined as a systolic pressure between 130-139 mmHg
or a diastolic pressure between 80-89 mmHg. Elevated blood pressure is 120-129 systolic
, and less than 80 diastolic. Accurate classification is necessary to determine the appropriate
timing for follow-up and initiation of lifestyle or pharmacological interventions.
4. A patient presents with a sore throat, fever of 101.5 F, cervical adenopathy, and lack of
cough. Based on the Centor criteria, what is the most appropriate next step?
A. Prescribe Penicillin V immediately
B. Perform a Rapid Antigen Detection Test (RADT)
C. Prescribe Azithromycin for 5 days
D. Reassurance and symptomatic treatment only
Answer: B
Rationale: The patient has a Centor score of 4, which indicates a high probability of Group
A Streptococcus (GAS) pharyngitis. Current guidelines recommend confirming the
diagnosis with a Rapid Antigen Detection Test or throat culture before initiating antibiotics.
Confirmatory testing helps prevent the overuse of antibiotics in viral pharyngitis cases.
5. Which medication is considered first-line for a patient with persistent Mild Allergic
Rhinitis?
A. Oral Diphenhydramine
B. Intranasal Corticosteroid
C. Oral Decongestant
D. Intranasal Saline
