1
NSG 555 EXAM 1 STUDY GUIDE — WILKES
UNIVERSITY
Nurse Practitioners in Primary Care II | 2026/2027
Update | Complete Solutions
Welcome to your Exam 1 study guide. As your professor, I expect you to do more
than just memorize facts; I expect you to think like a clinician. This guide is
distilled directly from the 2026/2027 curriculum, JNC 8 guidelines, and the FNP
Mastery software you used in NSG 554. Pay close attention to the "High-Yield
Pearls"—these are the exact concepts that separate a passing score from
mastery.
PART A: CHRONIC DISEASE MANAGEMENT DRILL (Questions 1–15)
1. A 58-year-old patient with Type 2 Diabetes has an A1c of 8.5%. They are
currently taking Metformin 1000 mg BID and have no contraindications to
additional therapy. What is the most appropriate next step in management?
A) Increase Metformin to 1500 mg BID
B) Add a Sulfonylurea
C) Add an SGLT-2 inhibitor
D) Start basal insulin
Correct Answer: C) Add an SGLT-2 inhibitor
Rationale: The patient is at goal maximum dose of metformin but has an A1c >7%.
SGLT-2 inhibitors are recommended as a second-line agent due to their proven
cardiovascular and renal benefits, independent of their glucose-lowering effects.
High-Yield Pearl: Always look for CV/renal risk factors in diabetics; SGLT-2
inhibitors are the superior add-on therapy in these cases.
2. A 65-year-old patient with Type 2 Diabetes and an eGFR of 45 mL/min asks if
they can continue taking Metformin. What is your response?
A) Stop it immediately; it is strictly contraindicated.
, 2
B) Continue it, but monitor closely; dose reduction may be needed.
C) Double the dose to compensate for renal clearance.
D) Switch to a sulfonylurea immediately.
Correct Answer: B) Continue it, but monitor closely; dose reduction may be
needed.
Rationale: Metformin is contraindicated when eGFR is <30 mL/min. In Stage 3
CKD (eGFR 30-59), it can be used cautiously, often requiring a dose reduction,
with regular monitoring of renal function.
High-Yield Pearl: eGFR <30 = Stop Metformin. eGFR 30-59 = Use with
caution/reduce dose.
3. According to the JNC 8 guidelines emphasized in NSG 555, what is the blood
pressure target for a 65-year-old patient with no history of diabetes or chronic
kidney disease?
A) <120/80 mmHg
B) <130/80 mmHg
C) <140/90 mmHg
D) <150/90 mmHg
Correct Answer: D) <150/90 mmHg
Rationale: JNC 8 explicitly states that for adults ≥60 years of age without diabetes
or CKD, the treatment target is <150/90 mmHg. (Note: ACC/AHA 2017 says
<130/80, but Wilkes NSG 555 tests strictly on JNC 8).
High-Yield Pearl: Age ≥60 + NO DM/CKD = JNC 8 Target <150/90. Do not over-
treat!
4. What is the JNC 8 blood pressure target for a 45-year-old patient with a history
of Type 2 Diabetes?
A) <130/80 mmHg
B) <140/90 mmHg
C) <150/90 mmHg
, 3
D) <160/100 mmHg
Correct Answer: B) <140/90 mmHg
Rationale: For patients <60 years of age, OR any adult with diabetes or CKD, the
JNC 8 target is <140/90 mmHg.
High-Yield Pearl: <60 years old OR DM/CKD = JNC 8 Target <140/90.
5. A 55-year-old Black female with no history of CKD or heart failure is diagnosed
with hypertension. Which medication class is the most appropriate first-line
monotherapy?
A) Lisinopril (ACE inhibitor)
B) Losartan (ARB)
C) Amlodipine (Calcium Channel Blocker)
D) Metoprolol (Beta-blocker)
Correct Answer: C) Amlodipine (Calcium Channel Blocker)
Rationale: In Black patients without CKD or HF, initial antihypertensive treatment
should include a thiazide diuretic or a CCB. ACE inhibitors are less effective as
monotherapy in this demographic.
High-Yield Pearl: Black patients + HTN + No CKD/HF = CCB or Thiazide.
6. A 42-year-old female with hypertension and CKD (eGFR 40) is being initiated on
antihypertensive therapy. What is the target BP and first-line medication?
A) Target <150/90; Thiazide diuretic
B) Target <130/80; ACE inhibitor
C) Target <140/90; ACE inhibitor
D) Target <140/90; Beta-blocker
Correct Answer: B) Target <130/80; ACE inhibitor
Rationale: For CKD patients, the BP target is <130/80 mmHg to slow progression
and reduce CV risk. ACEi/ARBs provide specific renoprotection and are first-line.
High-Yield Pearl: CKD = Target <130/80. Always pick an ACEi or ARB to protect
the kidneys.
, 4
7. A patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is being
optimized on medical therapy. Which combination of medications is considered
cornerstone therapy?
A) Furosemide and Metolazone
B) Beta-blocker, ACEi/ARB, and Spironolactone
C) Hydralazine and Isosorbide dinitrate for all patients
D) Diltiazem and Enalapril
Correct Answer: B) Beta-blocker, ACEi/ARB, and Spironolactone
Rationale: HFrEF management requires neurohormonal modulation. Beta-
blockers, ACEi/ARBs, and aldosterone antagonists (spironolactone) reduce
mortality. Note: Spironolactone has also been shown to reduce hospitalizations in
HFpEF.
High-Yield Pearl: HFrEF = "ABC" (ACEi/ARB, Beta-blocker, Aldosterone
antagonist like Spironolactone). HFpEF = primarily diuretics for volume +
Spironolactone.
8. A patient with known heart failure calls the clinic reporting a 3-pound weight
gain over the past two days. What is the priority clinical action?
A) Advise the patient to restrict fluid intake to 500 mL/day.
B) Schedule an outpatient echocardiogram in one week.
C) Instruct the patient to take an extra dose of their beta-blocker.
D) Adjust the diuretic dose to manage fluid retention.
Correct Answer: D) Adjust the diuretic dose to manage fluid retention.
Rationale: A daily weight gain of >2 lbs indicates fluid retention in HF patients.
This requires prompt adjustment of diuretic therapy to prevent decompensation
and hospitalization.
High-Yield Pearl: >2 lb daily weight gain in HF = Fluid overload = Adjust diuretic
immediately.
NSG 555 EXAM 1 STUDY GUIDE — WILKES
UNIVERSITY
Nurse Practitioners in Primary Care II | 2026/2027
Update | Complete Solutions
Welcome to your Exam 1 study guide. As your professor, I expect you to do more
than just memorize facts; I expect you to think like a clinician. This guide is
distilled directly from the 2026/2027 curriculum, JNC 8 guidelines, and the FNP
Mastery software you used in NSG 554. Pay close attention to the "High-Yield
Pearls"—these are the exact concepts that separate a passing score from
mastery.
PART A: CHRONIC DISEASE MANAGEMENT DRILL (Questions 1–15)
1. A 58-year-old patient with Type 2 Diabetes has an A1c of 8.5%. They are
currently taking Metformin 1000 mg BID and have no contraindications to
additional therapy. What is the most appropriate next step in management?
A) Increase Metformin to 1500 mg BID
B) Add a Sulfonylurea
C) Add an SGLT-2 inhibitor
D) Start basal insulin
Correct Answer: C) Add an SGLT-2 inhibitor
Rationale: The patient is at goal maximum dose of metformin but has an A1c >7%.
SGLT-2 inhibitors are recommended as a second-line agent due to their proven
cardiovascular and renal benefits, independent of their glucose-lowering effects.
High-Yield Pearl: Always look for CV/renal risk factors in diabetics; SGLT-2
inhibitors are the superior add-on therapy in these cases.
2. A 65-year-old patient with Type 2 Diabetes and an eGFR of 45 mL/min asks if
they can continue taking Metformin. What is your response?
A) Stop it immediately; it is strictly contraindicated.
, 2
B) Continue it, but monitor closely; dose reduction may be needed.
C) Double the dose to compensate for renal clearance.
D) Switch to a sulfonylurea immediately.
Correct Answer: B) Continue it, but monitor closely; dose reduction may be
needed.
Rationale: Metformin is contraindicated when eGFR is <30 mL/min. In Stage 3
CKD (eGFR 30-59), it can be used cautiously, often requiring a dose reduction,
with regular monitoring of renal function.
High-Yield Pearl: eGFR <30 = Stop Metformin. eGFR 30-59 = Use with
caution/reduce dose.
3. According to the JNC 8 guidelines emphasized in NSG 555, what is the blood
pressure target for a 65-year-old patient with no history of diabetes or chronic
kidney disease?
A) <120/80 mmHg
B) <130/80 mmHg
C) <140/90 mmHg
D) <150/90 mmHg
Correct Answer: D) <150/90 mmHg
Rationale: JNC 8 explicitly states that for adults ≥60 years of age without diabetes
or CKD, the treatment target is <150/90 mmHg. (Note: ACC/AHA 2017 says
<130/80, but Wilkes NSG 555 tests strictly on JNC 8).
High-Yield Pearl: Age ≥60 + NO DM/CKD = JNC 8 Target <150/90. Do not over-
treat!
4. What is the JNC 8 blood pressure target for a 45-year-old patient with a history
of Type 2 Diabetes?
A) <130/80 mmHg
B) <140/90 mmHg
C) <150/90 mmHg
, 3
D) <160/100 mmHg
Correct Answer: B) <140/90 mmHg
Rationale: For patients <60 years of age, OR any adult with diabetes or CKD, the
JNC 8 target is <140/90 mmHg.
High-Yield Pearl: <60 years old OR DM/CKD = JNC 8 Target <140/90.
5. A 55-year-old Black female with no history of CKD or heart failure is diagnosed
with hypertension. Which medication class is the most appropriate first-line
monotherapy?
A) Lisinopril (ACE inhibitor)
B) Losartan (ARB)
C) Amlodipine (Calcium Channel Blocker)
D) Metoprolol (Beta-blocker)
Correct Answer: C) Amlodipine (Calcium Channel Blocker)
Rationale: In Black patients without CKD or HF, initial antihypertensive treatment
should include a thiazide diuretic or a CCB. ACE inhibitors are less effective as
monotherapy in this demographic.
High-Yield Pearl: Black patients + HTN + No CKD/HF = CCB or Thiazide.
6. A 42-year-old female with hypertension and CKD (eGFR 40) is being initiated on
antihypertensive therapy. What is the target BP and first-line medication?
A) Target <150/90; Thiazide diuretic
B) Target <130/80; ACE inhibitor
C) Target <140/90; ACE inhibitor
D) Target <140/90; Beta-blocker
Correct Answer: B) Target <130/80; ACE inhibitor
Rationale: For CKD patients, the BP target is <130/80 mmHg to slow progression
and reduce CV risk. ACEi/ARBs provide specific renoprotection and are first-line.
High-Yield Pearl: CKD = Target <130/80. Always pick an ACEi or ARB to protect
the kidneys.
, 4
7. A patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is being
optimized on medical therapy. Which combination of medications is considered
cornerstone therapy?
A) Furosemide and Metolazone
B) Beta-blocker, ACEi/ARB, and Spironolactone
C) Hydralazine and Isosorbide dinitrate for all patients
D) Diltiazem and Enalapril
Correct Answer: B) Beta-blocker, ACEi/ARB, and Spironolactone
Rationale: HFrEF management requires neurohormonal modulation. Beta-
blockers, ACEi/ARBs, and aldosterone antagonists (spironolactone) reduce
mortality. Note: Spironolactone has also been shown to reduce hospitalizations in
HFpEF.
High-Yield Pearl: HFrEF = "ABC" (ACEi/ARB, Beta-blocker, Aldosterone
antagonist like Spironolactone). HFpEF = primarily diuretics for volume +
Spironolactone.
8. A patient with known heart failure calls the clinic reporting a 3-pound weight
gain over the past two days. What is the priority clinical action?
A) Advise the patient to restrict fluid intake to 500 mL/day.
B) Schedule an outpatient echocardiogram in one week.
C) Instruct the patient to take an extra dose of their beta-blocker.
D) Adjust the diuretic dose to manage fluid retention.
Correct Answer: D) Adjust the diuretic dose to manage fluid retention.
Rationale: A daily weight gain of >2 lbs indicates fluid retention in HF patients.
This requires prompt adjustment of diuretic therapy to prevent decompensation
and hospitalization.
High-Yield Pearl: >2 lb daily weight gain in HF = Fluid overload = Adjust diuretic
immediately.
