NSG 554 Exam 2 V1 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 2 2026)
1. A 45-year-old patient presents with symptoms suggestive of gastroesophageal reflux
disease (GERD). After lifestyle modifications fail, which is the most appropriate next step in
pharmacological management according to current guidelines?
A. Initiate high-dose Proton Pump Inhibitor (PPI) therapy for 12 weeks.
B. Begin standard-dose PPI therapy once daily for 8 weeks.
C. Start a standard dose of H2-receptor antagonist (H2RA) once daily.
D. Perform an immediate upper endoscopy to rule out Barrett’s esophagus.
Answer: B
Rationale: Standard practice guidelines recommend starting standard-dose PPI therapy
for 8 weeks if lifestyle modifications are insufficient. This duration allows for adequate
healing of any potential esophageal erosions. Diagnostic endoscopy is typically reserved for
patients with warning signs or those who fail empirical therapy.
2. According to the JNC 8 guidelines, what is the blood pressure goal for a 65-year-old patient
without diabetes or chronic kidney disease (CKD)?
A. <130/80 mmHg
,B. <150/90 mmHg
C. <140/90 mmHg
D. <120/70 mmHg
Answer: B
Rationale: JNC 8 guidelines suggest a goal of <150/90 mmHg for individuals aged 65 and
older who do not have diabetes or CKD. This recommendation aims to balance the benefits
of blood pressure reduction with the risks of polypharmacy and hypotension in the elderly.
However, clinical judgment should be applied based on the patient’s overall health and
comorbidities.
3. A patient with stable COPD has a FEV1/FVC ratio of <0.70 and an FEV1 of 65% predicted.
Into which GOLD grade does this patient fall?
A. GOLD 1 (Mild)
B. GOLD 2 (Moderate)
C. GOLD 3 (Severe)
D. GOLD 4 (Very Severe)
Answer: B
Rationale: GOLD 2 (Moderate) is defined by an FEV1 between 50% and 79% of the
predicted value in patients with a post-bronchodilator FEV1/FVC ratio <0.70. This
classification is vital for determining the escalation of therapy, such as adding long-acting
, bronchodilators. Classification helps clinicians predict future exacerbation risk and
mortality.
4. A 32-year-old female presents with a sore throat, fever of 101.5°F, and cervical
lymphadenopathy. She lacks a cough. What is her Centor score, and what is the
recommended next step?
A. Centor score 2; provide symptomatic treatment only.
B. Centor score 3; perform a Rapid Antigen Detection Test (RADT).
C. Centor score 4; initiate empiric antibiotic therapy with Penicillin.
D. Centor score 1; obtain a throat culture.
Answer: B
Rationale: The patient scores 1 point each for fever, cervical lymphadenopathy, and lack of
cough, totaling a Centor score of 3. For a score of 3, guidelines recommend performing a
RADT or throat culture to confirm Group A Streptococcus before starting antibiotics.
Empiric treatment without testing is generally discouraged unless the score is higher or
clinical suspicion is extreme.
5. Which of the following is considered the first-line antibiotic treatment for an
uncomplicated urinary tract infection (UTI) in a non-pregnant woman?
A. Ciprofloxacin 500 mg twice daily for 7 days.
B. Nitrofurantoin (Macrobid) 100 mg twice daily for 5 days.
C. Amoxicillin 500 mg three times daily for 10 days.
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 2 2026)
1. A 45-year-old patient presents with symptoms suggestive of gastroesophageal reflux
disease (GERD). After lifestyle modifications fail, which is the most appropriate next step in
pharmacological management according to current guidelines?
A. Initiate high-dose Proton Pump Inhibitor (PPI) therapy for 12 weeks.
B. Begin standard-dose PPI therapy once daily for 8 weeks.
C. Start a standard dose of H2-receptor antagonist (H2RA) once daily.
D. Perform an immediate upper endoscopy to rule out Barrett’s esophagus.
Answer: B
Rationale: Standard practice guidelines recommend starting standard-dose PPI therapy
for 8 weeks if lifestyle modifications are insufficient. This duration allows for adequate
healing of any potential esophageal erosions. Diagnostic endoscopy is typically reserved for
patients with warning signs or those who fail empirical therapy.
2. According to the JNC 8 guidelines, what is the blood pressure goal for a 65-year-old patient
without diabetes or chronic kidney disease (CKD)?
A. <130/80 mmHg
,B. <150/90 mmHg
C. <140/90 mmHg
D. <120/70 mmHg
Answer: B
Rationale: JNC 8 guidelines suggest a goal of <150/90 mmHg for individuals aged 65 and
older who do not have diabetes or CKD. This recommendation aims to balance the benefits
of blood pressure reduction with the risks of polypharmacy and hypotension in the elderly.
However, clinical judgment should be applied based on the patient’s overall health and
comorbidities.
3. A patient with stable COPD has a FEV1/FVC ratio of <0.70 and an FEV1 of 65% predicted.
Into which GOLD grade does this patient fall?
A. GOLD 1 (Mild)
B. GOLD 2 (Moderate)
C. GOLD 3 (Severe)
D. GOLD 4 (Very Severe)
Answer: B
Rationale: GOLD 2 (Moderate) is defined by an FEV1 between 50% and 79% of the
predicted value in patients with a post-bronchodilator FEV1/FVC ratio <0.70. This
classification is vital for determining the escalation of therapy, such as adding long-acting
, bronchodilators. Classification helps clinicians predict future exacerbation risk and
mortality.
4. A 32-year-old female presents with a sore throat, fever of 101.5°F, and cervical
lymphadenopathy. She lacks a cough. What is her Centor score, and what is the
recommended next step?
A. Centor score 2; provide symptomatic treatment only.
B. Centor score 3; perform a Rapid Antigen Detection Test (RADT).
C. Centor score 4; initiate empiric antibiotic therapy with Penicillin.
D. Centor score 1; obtain a throat culture.
Answer: B
Rationale: The patient scores 1 point each for fever, cervical lymphadenopathy, and lack of
cough, totaling a Centor score of 3. For a score of 3, guidelines recommend performing a
RADT or throat culture to confirm Group A Streptococcus before starting antibiotics.
Empiric treatment without testing is generally discouraged unless the score is higher or
clinical suspicion is extreme.
5. Which of the following is considered the first-line antibiotic treatment for an
uncomplicated urinary tract infection (UTI) in a non-pregnant woman?
A. Ciprofloxacin 500 mg twice daily for 7 days.
B. Nitrofurantoin (Macrobid) 100 mg twice daily for 5 days.
C. Amoxicillin 500 mg three times daily for 10 days.
