NSG 555 Final Exam V3 | NSG 555 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Final Exam 2026)
1. A 52-year-old male with a BMI of 31 and blood pressure of 144/92 mmHg on two separate
occasions has no other comorbidities. What is the most appropriate initial management step
according to JNC 8 and ACC/AHA guidelines?
A. Begin immediate therapy with a beta-blocker.
B. Start a combination of an ACE inhibitor and a diuretic.
C. Initiate lifestyle modifications and re-evaluate in 3-6 months.
D. Prescribe a calcium channel blocker and limit sodium intake.
Answer: C
Rationale: For patients with Stage 1 hypertension and a low 10-year ASCVD risk, lifestyle
modification is the recommended first step. This includes weight loss, DASH diet, and
increased physical activity to reduce cardiovascular burden. Follow-up is essential to
determine if pharmacological intervention becomes necessary later.
2. Which lab finding is most diagnostic for primary hypothyroidism in an adult patient
presenting with fatigue and weight gain?
A. High TSH and low Free T4
,B. High TSH and high Free T4
C. Low TSH and high Free T4
D. Low TSH and low Free T4
Answer: A
Rationale: Primary hypothyroidism is characterized by an elevated Thyroid Stimulating
Hormone (TSH) as the pituitary attempts to stimulate a failing thyroid gland. Concurrently,
the Free T4 level will be low because the thyroid cannot produce sufficient hormone. This
biochemical profile confirms the diagnosis and necessitates levothyroxine replacement
therapy.
3. A 65-year-old female presents for her annual physical. According to the USPSTF, what is the
current recommendation for colorectal cancer screening for this age group?
A. Annual fecal occult blood testing only.
B. Screening is not recommended after age 60.
C. Sigmoidoscopy every 2 years.
D. Colonoscopy every 10 years until age 75.
Answer: D
Rationale: The USPSTF recommends colorectal cancer screening for all adults aged 45 to
75 years. A colonoscopy every 10 years is considered the gold standard for detecting and
, removing precancerous polyps. Clinicians should discuss individual risks and preferences
when selecting between various screening modalities.
4. A patient with Type 2 Diabetes has an A1C of 7.8% despite lifestyle changes. What is the
first-line pharmacological treatment recommended by the ADA?
A. Basal Insulin
B. Glipizide
C. Sitagliptin
D. Metformin
Answer: D
Rationale: Metformin remains the preferred initial pharmacologic agent for the treatment
of type 2 diabetes due to its efficacy and safety profile. It works primarily by reducing
hepatic glucose production and improving insulin sensitivity. Unless contraindicated, it
should be started at the time of diagnosis or when lifestyle goals are not met.
5. An 18-year-old female presents with dysuria and urinary frequency. A dipstick is positive
for nitrites and leukocyte esterase. What is the most common causative organism for this
condition?
A. Staphylococcus saprophyticus
B. Proteus mirabilis
C. Escherichia coli
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG555 Final Exam 2026)
1. A 52-year-old male with a BMI of 31 and blood pressure of 144/92 mmHg on two separate
occasions has no other comorbidities. What is the most appropriate initial management step
according to JNC 8 and ACC/AHA guidelines?
A. Begin immediate therapy with a beta-blocker.
B. Start a combination of an ACE inhibitor and a diuretic.
C. Initiate lifestyle modifications and re-evaluate in 3-6 months.
D. Prescribe a calcium channel blocker and limit sodium intake.
Answer: C
Rationale: For patients with Stage 1 hypertension and a low 10-year ASCVD risk, lifestyle
modification is the recommended first step. This includes weight loss, DASH diet, and
increased physical activity to reduce cardiovascular burden. Follow-up is essential to
determine if pharmacological intervention becomes necessary later.
2. Which lab finding is most diagnostic for primary hypothyroidism in an adult patient
presenting with fatigue and weight gain?
A. High TSH and low Free T4
,B. High TSH and high Free T4
C. Low TSH and high Free T4
D. Low TSH and low Free T4
Answer: A
Rationale: Primary hypothyroidism is characterized by an elevated Thyroid Stimulating
Hormone (TSH) as the pituitary attempts to stimulate a failing thyroid gland. Concurrently,
the Free T4 level will be low because the thyroid cannot produce sufficient hormone. This
biochemical profile confirms the diagnosis and necessitates levothyroxine replacement
therapy.
3. A 65-year-old female presents for her annual physical. According to the USPSTF, what is the
current recommendation for colorectal cancer screening for this age group?
A. Annual fecal occult blood testing only.
B. Screening is not recommended after age 60.
C. Sigmoidoscopy every 2 years.
D. Colonoscopy every 10 years until age 75.
Answer: D
Rationale: The USPSTF recommends colorectal cancer screening for all adults aged 45 to
75 years. A colonoscopy every 10 years is considered the gold standard for detecting and
, removing precancerous polyps. Clinicians should discuss individual risks and preferences
when selecting between various screening modalities.
4. A patient with Type 2 Diabetes has an A1C of 7.8% despite lifestyle changes. What is the
first-line pharmacological treatment recommended by the ADA?
A. Basal Insulin
B. Glipizide
C. Sitagliptin
D. Metformin
Answer: D
Rationale: Metformin remains the preferred initial pharmacologic agent for the treatment
of type 2 diabetes due to its efficacy and safety profile. It works primarily by reducing
hepatic glucose production and improving insulin sensitivity. Unless contraindicated, it
should be started at the time of diagnosis or when lifestyle goals are not met.
5. An 18-year-old female presents with dysuria and urinary frequency. A dipstick is positive
for nitrites and leukocyte esterase. What is the most common causative organism for this
condition?
A. Staphylococcus saprophyticus
B. Proteus mirabilis
C. Escherichia coli
