NSG 555 Final Exam V2 | NSG 555 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Final Exam 2026)
1. A 62-year-old African American male presents with a blood pressure of 158/94 mmHg.
According to JNC-8 guidelines, which of the following is the most appropriate initial
pharmacological choice for this patient?
A. Lisinopril
B. Losartan
C. Metoprolol Succinate
D. Amlodipine
Answer: D
Rationale: In the general African American population, including those with diabetes,
initial antihypertensive treatment should include a thiazide-type diuretic or calcium
channel blocker. Amlodipine is a dihydropyridine calcium channel blocker that is effective
in this demographic. This recommendation is based on evidence showing superior
outcomes in preventing stroke and cardiovascular events compared to ACE inhibitors in
this specific population.
,2. A patient is diagnosed with Type 2 Diabetes and has an initial A1C of 7.8%. If the patient
has no contraindications, what is the first-line medication recommended by the American
Diabetes Association (ADA)?
A. Glipizide
B. Metformin
C. Sitagliptin
D. Pioglitazone
Answer: B
Rationale: Metformin is the preferred initial pharmacologic agent for the treatment of type
2 diabetes due to its high efficacy, low cost, and weight-neutral profile. It works by
reducing hepatic glucose production and improving insulin sensitivity. Unless a
contraindication such as advanced renal failure exists, it should be started alongside
lifestyle modifications.
3. Which of the following physical examination findings is most characteristic of Community-
Acquired Pneumonia (CAP)?
A. Increased tactile fremitus
B. Hyperresonance on percussion
C. Decreased breath sounds throughout
D. Wheezing on expiration
, Answer: A
Rationale: Increased tactile fremitus occurs over areas of lung consolidation, which is
typical in bacterial pneumonia. This is because sound waves travel better through dense or
liquid-filled media than through air. Other findings in consolidation include dullness to
percussion and bronchial breath sounds.
4. A 24-year-old female presents with symptoms of asthma that occur 3-4 days per week and
awaken her from sleep 3 times per month. How should her asthma severity be classified?
A. Mild Persistent
B. Intermittent
C. Moderate Persistent
D. Severe Persistent
Answer: A
Rationale: Mild persistent asthma is defined by symptoms occurring more than twice a
week but not daily, and nighttime awakenings 3 to 4 times per month. This patient fits
these criteria because her symptoms are frequent enough to require more than just PRN
rescue therapy. According to GINA and NAEPP guidelines, this classification warrants a
low-dose inhaled corticosteroid.
5. The Nurse Practitioner is evaluating a patient with Chronic Obstructive Pulmonary Disease
(COPD). Which test is considered the gold standard for diagnosing and staging COPD?
A. Chest X-ray
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Final Exam 2026)
1. A 62-year-old African American male presents with a blood pressure of 158/94 mmHg.
According to JNC-8 guidelines, which of the following is the most appropriate initial
pharmacological choice for this patient?
A. Lisinopril
B. Losartan
C. Metoprolol Succinate
D. Amlodipine
Answer: D
Rationale: In the general African American population, including those with diabetes,
initial antihypertensive treatment should include a thiazide-type diuretic or calcium
channel blocker. Amlodipine is a dihydropyridine calcium channel blocker that is effective
in this demographic. This recommendation is based on evidence showing superior
outcomes in preventing stroke and cardiovascular events compared to ACE inhibitors in
this specific population.
,2. A patient is diagnosed with Type 2 Diabetes and has an initial A1C of 7.8%. If the patient
has no contraindications, what is the first-line medication recommended by the American
Diabetes Association (ADA)?
A. Glipizide
B. Metformin
C. Sitagliptin
D. Pioglitazone
Answer: B
Rationale: Metformin is the preferred initial pharmacologic agent for the treatment of type
2 diabetes due to its high efficacy, low cost, and weight-neutral profile. It works by
reducing hepatic glucose production and improving insulin sensitivity. Unless a
contraindication such as advanced renal failure exists, it should be started alongside
lifestyle modifications.
3. Which of the following physical examination findings is most characteristic of Community-
Acquired Pneumonia (CAP)?
A. Increased tactile fremitus
B. Hyperresonance on percussion
C. Decreased breath sounds throughout
D. Wheezing on expiration
, Answer: A
Rationale: Increased tactile fremitus occurs over areas of lung consolidation, which is
typical in bacterial pneumonia. This is because sound waves travel better through dense or
liquid-filled media than through air. Other findings in consolidation include dullness to
percussion and bronchial breath sounds.
4. A 24-year-old female presents with symptoms of asthma that occur 3-4 days per week and
awaken her from sleep 3 times per month. How should her asthma severity be classified?
A. Mild Persistent
B. Intermittent
C. Moderate Persistent
D. Severe Persistent
Answer: A
Rationale: Mild persistent asthma is defined by symptoms occurring more than twice a
week but not daily, and nighttime awakenings 3 to 4 times per month. This patient fits
these criteria because her symptoms are frequent enough to require more than just PRN
rescue therapy. According to GINA and NAEPP guidelines, this classification warrants a
low-dose inhaled corticosteroid.
5. The Nurse Practitioner is evaluating a patient with Chronic Obstructive Pulmonary Disease
(COPD). Which test is considered the gold standard for diagnosing and staging COPD?
A. Chest X-ray
