NSG 554 Final Exam V1 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Final Exam 2026)
1. A 55-year-old African American male presents with a blood pressure of 152/94 mmHg.
According to JNC 8 guidelines, which of the following is the most appropriate initial
pharmacological treatment?
A. Lisinopril (ACE inhibitor)
B. Losartan (ARB)
C. Metoprolol (Beta-blocker)
D. Amlodipine (Calcium channel blocker)
Answer: D
Rationale: According to the JNC 8 guidelines, the initial antihypertensive treatment in the
general African American population should include a thiazide-type diuretic or a calcium
channel blocker (CCB). Amlodipine is a CCB and is highly effective in this demographic. ACE
inhibitors and ARBs are generally less effective as monotherapy for blood pressure
reduction in African American patients unless comorbid conditions like CKD are present.
2. A 45-year-old female presents with a new onset of fatigue and cold intolerance. Her TSH is
8.5 mIU/L and free T4 is low. What is the most likely diagnosis?
A. Subclinical hypothyroidism
,B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Hyperthyroidism
Answer: B
Rationale: Primary hypothyroidism is characterized by an elevated TSH and a low free T4,
indicating the thyroid gland itself is not producing sufficient hormone. Subclinical
hypothyroidism would show an elevated TSH but a normal free T4 level. Secondary
hypothyroidism, which originates in the pituitary, would typically present with a low or
inappropriately normal TSH.
3. Which of the following physical examination findings is most characteristic of
Osteoarthritis (OA) in the hands?
A. Swan-neck deformity
B. Ulnar deviation
C. Bouchard’s nodes
D. Symmetric joint swelling of the MCP joints
Answer: C
Rationale: Bouchard’s nodes are bony enlargements of the proximal interphalangeal (PIP)
joints and are classic signs of osteoarthritis. Heberden’s nodes, affecting the distal
, interphalangeal (DIP) joints, are also characteristic of OA. In contrast, ulnar deviation and
symmetric MCP swelling are more indicative of Rheumatoid Arthritis (RA).
4. A patient with Type 2 Diabetes Mellitus has an A1C of 7.8% despite lifestyle modifications.
What is the recommended first-line pharmacological therapy?
A. Glipizide
B. Pioglitazone
C. Metformin
D. Insulin Glargine
Answer: C
Rationale: Metformin is the preferred initial pharmacological agent for the treatment of
type 2 diabetes mellitus due to its efficacy, safety, and low cost. It works by decreasing
hepatic glucose production and increasing insulin sensitivity. Unless there are
contraindications such as severe renal impairment (eGFR < 30 mL/min/1.73m²), it should
be the first choice.
5. A 22-year-old college student presents with a sore throat, fever, and posterior cervical
lymphadenopathy. A Monospot test is positive. What is the most critical education point
regarding physical activity?
A. Avoid all activity for 1 week
B. No restrictions are necessary once the fever subsides
C. Wear a mask while exercising
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Final Exam 2026)
1. A 55-year-old African American male presents with a blood pressure of 152/94 mmHg.
According to JNC 8 guidelines, which of the following is the most appropriate initial
pharmacological treatment?
A. Lisinopril (ACE inhibitor)
B. Losartan (ARB)
C. Metoprolol (Beta-blocker)
D. Amlodipine (Calcium channel blocker)
Answer: D
Rationale: According to the JNC 8 guidelines, the initial antihypertensive treatment in the
general African American population should include a thiazide-type diuretic or a calcium
channel blocker (CCB). Amlodipine is a CCB and is highly effective in this demographic. ACE
inhibitors and ARBs are generally less effective as monotherapy for blood pressure
reduction in African American patients unless comorbid conditions like CKD are present.
2. A 45-year-old female presents with a new onset of fatigue and cold intolerance. Her TSH is
8.5 mIU/L and free T4 is low. What is the most likely diagnosis?
A. Subclinical hypothyroidism
,B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Hyperthyroidism
Answer: B
Rationale: Primary hypothyroidism is characterized by an elevated TSH and a low free T4,
indicating the thyroid gland itself is not producing sufficient hormone. Subclinical
hypothyroidism would show an elevated TSH but a normal free T4 level. Secondary
hypothyroidism, which originates in the pituitary, would typically present with a low or
inappropriately normal TSH.
3. Which of the following physical examination findings is most characteristic of
Osteoarthritis (OA) in the hands?
A. Swan-neck deformity
B. Ulnar deviation
C. Bouchard’s nodes
D. Symmetric joint swelling of the MCP joints
Answer: C
Rationale: Bouchard’s nodes are bony enlargements of the proximal interphalangeal (PIP)
joints and are classic signs of osteoarthritis. Heberden’s nodes, affecting the distal
, interphalangeal (DIP) joints, are also characteristic of OA. In contrast, ulnar deviation and
symmetric MCP swelling are more indicative of Rheumatoid Arthritis (RA).
4. A patient with Type 2 Diabetes Mellitus has an A1C of 7.8% despite lifestyle modifications.
What is the recommended first-line pharmacological therapy?
A. Glipizide
B. Pioglitazone
C. Metformin
D. Insulin Glargine
Answer: C
Rationale: Metformin is the preferred initial pharmacological agent for the treatment of
type 2 diabetes mellitus due to its efficacy, safety, and low cost. It works by decreasing
hepatic glucose production and increasing insulin sensitivity. Unless there are
contraindications such as severe renal impairment (eGFR < 30 mL/min/1.73m²), it should
be the first choice.
5. A 22-year-old college student presents with a sore throat, fever, and posterior cervical
lymphadenopathy. A Monospot test is positive. What is the most critical education point
regarding physical activity?
A. Avoid all activity for 1 week
B. No restrictions are necessary once the fever subsides
C. Wear a mask while exercising
