NSG 554 Exam 4 V2 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 4 2026)
1. A 55-year-old male smoker presents with chronic cough and exertional dyspnea.
Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.62. Which of the following
confirms the diagnosis for this patient?
A. A chest X-ray showing hyperinflation and flattened diaphragm.
B. Total lung capacity (TLC) greater than 120 percent of predicted.
C. A positive response to a methacholine challenge test.
D. An FEV1/FVC ratio less than 0.70 after bronchodilator use.
Answer: D
Rationale: According to the GOLD guidelines, a post-bronchodilator FEV1/FVC ratio of less
than 0.70 is the diagnostic requirement for Chronic Obstructive Pulmonary Disease
(COPD). While chest X-rays can show suggestive findings like hyperinflation, they are not
diagnostic of the airflow limitation itself. Spirometry remains the gold standard tool for
assessing and confirming obstructive lung diseases in the primary care setting.
,2. A 32-year-old female presents with symptoms of asthma occurring 3 days per week and
nighttime awakenings 3 times per month. She currently uses an Albuterol inhaler as needed.
What is the next step in her management?
A. Continue current PRN SABA therapy only.
B. Initiate a long-acting beta-agonist (LABA) as monotherapy.
C. Add a low-dose inhaled corticosteroid (ICS) daily.
D. Start a short course of oral prednisone for 5 days.
Answer: C
Rationale: The patient’s symptoms classify her as having Mild Persistent Asthma based on
frequency of daytime symptoms and nocturnal awakenings. Step 2 management for asthma
involves adding a daily low-dose inhaled corticosteroid (ICS) to address the underlying
airway inflammation. Long-acting beta-agonists (LABAs) should never be used as
monotherapy due to increased risk of asthma-related death, and oral steroids are reserved
for acute exacerbations.
3. A 48-year-old healthy male is diagnosed with community-acquired pneumonia (CAP). He
has no comorbidities and no recent antibiotic use. Which antibiotic is recommended as first-
line treatment by current ATS/IDSA guidelines?
A. Amoxicillin 1 gram three times daily.
B. Levofloxacin 750 mg daily for 5 days.
C. Ciprofloxacin 500 mg twice daily.
,D. Cephalexin 500 mg four times daily.
Answer: A
Rationale: For healthy outpatients with CAP and no risk factors for MRSA or
Pseudomonas, amoxicillin, doxycycline, or a macrolide (if local resistance is <25%) are the
preferred agents. Amoxicillin at high doses effectively targets Streptococcus pneumoniae,
which is the most common causative organism. Respiratory fluoroquinolones like
levofloxacin are typically reserved for patients with significant comorbidities or recent
prior antibiotic exposure.
4. A 22-year-old student presents with a sore throat, fever of 102 F, and tender anterior
cervical lymphadenopathy. She denies cough and rhinorrhea. Which of the following is the
most appropriate diagnostic action?
A. Perform a Rapid Antigen Detection Test (RADT).
B. Empirically treat with Penicillin VK for 10 days.
C. Obtain a Heterophile antibody (Monospot) test only.
D. Order a CT scan of the neck with contrast.
Answer: A
Rationale: The patient has a Centor score of 3 (fever, adenopathy, absence of cough),
indicating a high clinical suspicion for Group A Streptococcus pharyngitis. Current
guidelines recommend confirming the diagnosis with a Rapid Antigen Detection Test
, (RADT) before initiating antibiotic therapy to ensure stewardship. If the RADT is negative
in an adult, further culture is usually not required, unlike in pediatric populations.
5. An adult patient presents with a 4-day history of purulent nasal discharge, facial pain, and
congestion. He is afebrile and reports no worsening of symptoms. What is the recommended
management plan?
A. Symptomatic relief with saline irrigation and intranasal steroids.
B. Prescribe Amoxicillin-clavulanate for 7 days.
C. Immediate referral to an ENT specialist for drainage.
D. Prescribe Azithromycin for a 5-day course.
Answer: A
Rationale: Most cases of acute rhinosinusitis are viral in origin and do not require
antibiotics if symptoms have lasted less than 10 days and are not severe. Symptomatic
management with saline rinses, decongestants, and intranasal corticosteroids is the
standard of care for viral rhinosinusitis. Antibiotics should be considered only if symptoms
persist beyond 10 days, ‘double sickening’ occurs, or high fever and purulent discharge are
present simultaneously.
6. A 60-year-old patient complains of persistent heartburn and regurgitation twice weekly for
the past 6 months. He has no ‘red flag’ symptoms. What is the initial treatment of choice?
A. Upper endoscopy (EGD) to rule out Barrett’s esophagus.
B. Referral for Nissen fundoplication surgery.
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 4 2026)
1. A 55-year-old male smoker presents with chronic cough and exertional dyspnea.
Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.62. Which of the following
confirms the diagnosis for this patient?
A. A chest X-ray showing hyperinflation and flattened diaphragm.
B. Total lung capacity (TLC) greater than 120 percent of predicted.
C. A positive response to a methacholine challenge test.
D. An FEV1/FVC ratio less than 0.70 after bronchodilator use.
Answer: D
Rationale: According to the GOLD guidelines, a post-bronchodilator FEV1/FVC ratio of less
than 0.70 is the diagnostic requirement for Chronic Obstructive Pulmonary Disease
(COPD). While chest X-rays can show suggestive findings like hyperinflation, they are not
diagnostic of the airflow limitation itself. Spirometry remains the gold standard tool for
assessing and confirming obstructive lung diseases in the primary care setting.
,2. A 32-year-old female presents with symptoms of asthma occurring 3 days per week and
nighttime awakenings 3 times per month. She currently uses an Albuterol inhaler as needed.
What is the next step in her management?
A. Continue current PRN SABA therapy only.
B. Initiate a long-acting beta-agonist (LABA) as monotherapy.
C. Add a low-dose inhaled corticosteroid (ICS) daily.
D. Start a short course of oral prednisone for 5 days.
Answer: C
Rationale: The patient’s symptoms classify her as having Mild Persistent Asthma based on
frequency of daytime symptoms and nocturnal awakenings. Step 2 management for asthma
involves adding a daily low-dose inhaled corticosteroid (ICS) to address the underlying
airway inflammation. Long-acting beta-agonists (LABAs) should never be used as
monotherapy due to increased risk of asthma-related death, and oral steroids are reserved
for acute exacerbations.
3. A 48-year-old healthy male is diagnosed with community-acquired pneumonia (CAP). He
has no comorbidities and no recent antibiotic use. Which antibiotic is recommended as first-
line treatment by current ATS/IDSA guidelines?
A. Amoxicillin 1 gram three times daily.
B. Levofloxacin 750 mg daily for 5 days.
C. Ciprofloxacin 500 mg twice daily.
,D. Cephalexin 500 mg four times daily.
Answer: A
Rationale: For healthy outpatients with CAP and no risk factors for MRSA or
Pseudomonas, amoxicillin, doxycycline, or a macrolide (if local resistance is <25%) are the
preferred agents. Amoxicillin at high doses effectively targets Streptococcus pneumoniae,
which is the most common causative organism. Respiratory fluoroquinolones like
levofloxacin are typically reserved for patients with significant comorbidities or recent
prior antibiotic exposure.
4. A 22-year-old student presents with a sore throat, fever of 102 F, and tender anterior
cervical lymphadenopathy. She denies cough and rhinorrhea. Which of the following is the
most appropriate diagnostic action?
A. Perform a Rapid Antigen Detection Test (RADT).
B. Empirically treat with Penicillin VK for 10 days.
C. Obtain a Heterophile antibody (Monospot) test only.
D. Order a CT scan of the neck with contrast.
Answer: A
Rationale: The patient has a Centor score of 3 (fever, adenopathy, absence of cough),
indicating a high clinical suspicion for Group A Streptococcus pharyngitis. Current
guidelines recommend confirming the diagnosis with a Rapid Antigen Detection Test
, (RADT) before initiating antibiotic therapy to ensure stewardship. If the RADT is negative
in an adult, further culture is usually not required, unlike in pediatric populations.
5. An adult patient presents with a 4-day history of purulent nasal discharge, facial pain, and
congestion. He is afebrile and reports no worsening of symptoms. What is the recommended
management plan?
A. Symptomatic relief with saline irrigation and intranasal steroids.
B. Prescribe Amoxicillin-clavulanate for 7 days.
C. Immediate referral to an ENT specialist for drainage.
D. Prescribe Azithromycin for a 5-day course.
Answer: A
Rationale: Most cases of acute rhinosinusitis are viral in origin and do not require
antibiotics if symptoms have lasted less than 10 days and are not severe. Symptomatic
management with saline rinses, decongestants, and intranasal corticosteroids is the
standard of care for viral rhinosinusitis. Antibiotics should be considered only if symptoms
persist beyond 10 days, ‘double sickening’ occurs, or high fever and purulent discharge are
present simultaneously.
6. A 60-year-old patient complains of persistent heartburn and regurgitation twice weekly for
the past 6 months. He has no ‘red flag’ symptoms. What is the initial treatment of choice?
A. Upper endoscopy (EGD) to rule out Barrett’s esophagus.
B. Referral for Nissen fundoplication surgery.
