NSG 555/ NSG555 Exam 3 – Nurse Practitioners in Primary Care II
Review| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions &
Answers | Grade A EXAM with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Cardiovascular Disorders and Heart Failure Management in Primary Care
2. Pulmonology, Asthma, COPD Exacerbations, and Obstructive Respiratory Pathology
3. Endocrinology, Diabetes Mellitus Complications, Thyroid Disorders, and Metabolic Syndrome
4. Gastroenterology, Inflammatory Bowel Disease, GERD, and Hepatic Evaluation
5. Nephrology, Chronic Kidney Disease Staging, and Electrolyte Imbalances
6. Musculoskeletal Conditions, Rheumatoid Arthritis, Osteoarthritis, and Gout Management
7. Dermatology, Malignant Lesions, Eczematous Eruptions, and Infectious Dermatoses
8. Neurology, Migraine Prophylaxis, Transient Ischemic Attacks, and Neuropathic Pain
9. Mental Health, Major Depressive Disorder, Generalized Anxiety, and Pharmacotherapy
10. Women’s Health, Contraceptive Management, Menopausal Symptoms, and Breast Pathology
1. A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF, EF
30%) presents for routine follow-up. He reports mild dyspnea on exertion but denies orthopnea
or paroxysmal nocturnal dyspnea. His current medications include lisinopril 20 mg daily,
carvedilol 25 mg twice daily, and furosemide 40 mg daily. Blood pressure is 118/74 mmHg and
heart rate is 64 beats per minute. Laboratory studies reveal a serum creatinine of 1.4 mg/dL and
potassium of 4.6 mEq/L. Which of the following is the most appropriate next step in optimizing
his guideline-directed medical therapy (GDMT)?
, A. Increase the furosemide dose to 80 mg daily to prevent fluid overload.
B. Initiate sacubitril/valsartan after a 36-hour washout period from lisinopril.
C. Discontinue carvedilol due to the risk of worsening heart failure symptoms.
D. Add an alpha-blocker to further reduce afterload and blood pressure.
CORRECT ANSWER : B
Rationale: In patients with HFrEF tolerating an ACE inhibitor, guidelines strongly support
switching to an angiotensin receptor-neprilysin inhibitor (ARNI) like sacubitril/valsartan for
superior mortality and morbidity reduction, provided a 36-hour washout from the ACE inhibitor
is observed to prevent angioedema. Option A is unnecessary since the patient is euvolemic,
option C is incorrect as beta-blockers are foundational GDMT, and option D is not indicated.
2. A 54-year-old female presents to the primary care clinic complaining of worsening fatigue,
weight gain of 10 pounds over three months, constipation, and cold intolerance. Physical
examination reveals dry skin and delayed relaxation of deep tendon reflexes. Laboratory
evaluation shows a TSH of 14.2 mIU/L (reference 0.4–4.0) and a free T4 of 0.6 ng/dL (reference
0.8–1.8). Which of the following is the most appropriate initial pharmacological management?
A. Initiate levothyroxine at 25 to 50 mcg orally once daily, adjusting every 6 weeks based
on repeat TSH levels.
B. Initiate liothyronine (T3) monotherapy at 25 mcg daily to rapidly saturate cellular receptors.
C. Initiate desiccated thyroid extract (porcine) to provide a natural combination of T4 and T3.
D. Monitor clinical symptoms without treatment until TSH exceeds 20 mIU/L.
CORRECT ANSWER : A
Rationale: Primary hypothyroidism with an elevated TSH and low free T4 is treated with
levothyroxine monotherapy, initiating at a low dose (25-50 mcg daily) in otherwise healthy
adults or lower in the elderly/cardiac patients, with TSH re-evaluation every 6 weeks until
euthyroid. Option B and C are not recommended as first-line therapy due to unstable hormone
ratios and cardiovascular risks, and option D delays necessary treatment.
3. A 45-year-old male with a 20 pack-year smoking history presents with a 3-month history of a
chronic, productive cough and progressive dyspnea on exertion. Spirometry reveals a post-
bronchodilator FEV1/FVC ratio of 0.62 and an FEV1 of 58% of predicted. According to GOLD
guidelines, which classification and initial pharmacological therapy combination is most
appropriate?
A. GOLD Group A; prescribe a short-acting beta-agonist as needed.
, B. GOLD Group B; prescribe a long-acting muscarinic antagonist (LAMA) or long-acting
beta-agonist (LABA).
C. GOLD Group D; prescribe a triple therapy of LAMA, LABA, and inhaled corticosteroid.
D. GOLD Group C; prescribe an inhaled corticosteroid monotherapy.
CORRECT ANSWER : B
Rationale: Based on the updated GOLD criteria, an FEV1 of 58% places him in spirometric
grade 2, and combined with moderate symptoms (mMRC 2 or CAT >= 10, assumed for chronic
cough and dyspnea on exertion without frequent exacerbations), he falls into Group B. Initial
treatment for Group B is a single long-acting bronchodilator (LAMA or LABA). Options A, C,
and D misclassify his severity or therapeutic requirements.
4. A 60-year-old female with type 2 diabetes mellitus presents for routine management. Her HbA1c
is 8.2% despite maximal dose metformin. She has a documented history of atherosclerotic
cardiovascular disease (ASCVD) with a prior myocardial infarction. Her estimated glomerular
filtration rate (eGFR) is 52 mL/min/1.73m2, and urine albumin-to-creatinine ratio is normal.
Which class of medication should be added to her regimen to reduce cardiovascular events?
A. A sulfonylurea such as glipizide.
B. A sodium-glucose cotransporter 2 (SGLT2) inhibitor or a GLP-1 receptor agonist with
proven cardiovascular benefit.
C. A dipeptidyl peptidase-4 (DPP-4) inhibitor like sitagliptin.
D. Basal insulin glargine titrated to fasting blood glucose targets.
CORRECT ANSWER : B
Rationale: In patients with type 2 diabetes and established ASCVD, independent of baseline
HbA1c, guidelines recommend adding an SGLT2 inhibitor or GLP-1 receptor agonist with
proven cardiovascular benefit to reduce major adverse cardiac events and renal decline. Option
A increases hypoglycemia risk without CV protection, option C offers neutral CV outcomes, and
option D is premature before optimizing organ-protective agents.
5. A 32-year-old female presents with recurrent, painful epigastric burning that worsens 1 to 3
hours after meals and is occasionally relieved by food or antacids. She reports waking up at night
with similar discomfort. A urea breath test is positive for Helicobacter pylori. What is the
recommended first-line eradication therapy regimen?
A. Amoxicillin 1 g twice daily for 5 days alone.
, B. Standard triple therapy consisting of a proton pump inhibitor (PPI) twice daily,
clarithromycin 500 mg twice daily, and amoxicillin 1 g twice daily for 14 days.
C. Bismuth subsalicylate, metronidazole, and tetracycline for 3 days.
D. High-dose PPI monotherapy for 8 weeks without antibiotics.
CORRECT ANSWER : B
Rationale: First-line eradication of H. pylori involves standard triple therapy containing a PPI,
clarithromycin, and amoxicillin (or metronidazole if penicillin-allergic) for a full duration of 14
days in current clinical practice to maximize eradication rates. Options A and D are inadequate
for infection eradication, and option C uses incorrect dosing durations.
6. A 72-year-old male presents for an annual wellness exam. He reports a mild, dull ache in his
right knee that worsens with activity and improves with rest, accompanied by morning stiffness
lasting less than 15 minutes. Examination reveals bony enlargement at the distal interphalangeal
joints and crepitus in the right knee. Radiographs demonstrate joint space narrowing and
osteophytes. Which of the following is the most appropriate first-line pharmacological treatment
for his knee pain?
A. Oral ibuprofen 600 mg three times daily continuously.
B. Topical NSAIDs such as diclofenac sodium gel applied to the affected joint.
C. Intra-articular hyaluronic acid injections as initial monotherapy.
D. Chronic oral long-acting opioid analgesics.
CORRECT ANSWER : B
Rationale: For localized osteoarthritis such as knee OA, topical NSAIDs are recommended as
first-line pharmacotherapy over oral NSAIDs due to significantly lower systemic exposure and
gastrointestinal/renal risks. Options A carries higher systemic risk, option C is second-line or
adjunctive, and option D is strictly contraindicated for routine OA management.
7. A 28-year-old female presents with acute onset of palpitations, tremors, heat intolerance, and
unintended weight loss of 12 pounds over two months. Examination reveals a diffuse, non-tender
goiter and a fine resting tremor. Laboratory evaluation reveals a suppressed TSH (< 0.01 mIU/L)
and elevated free T4 and T3. Thyroid-stimulating immunoglobulin (TSI) is positive. What is the
primary pathophysiology of her condition?
A. Autoimmune destruction of thyroid follicular cells leading to transient hyperthyroidism.
B. Autoimmune stimulation of the TSH receptor by autoantibodies mimicking TSH,
causing autonomous hormone hypersecretion.
Review| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions &
Answers | Grade A EXAM with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Cardiovascular Disorders and Heart Failure Management in Primary Care
2. Pulmonology, Asthma, COPD Exacerbations, and Obstructive Respiratory Pathology
3. Endocrinology, Diabetes Mellitus Complications, Thyroid Disorders, and Metabolic Syndrome
4. Gastroenterology, Inflammatory Bowel Disease, GERD, and Hepatic Evaluation
5. Nephrology, Chronic Kidney Disease Staging, and Electrolyte Imbalances
6. Musculoskeletal Conditions, Rheumatoid Arthritis, Osteoarthritis, and Gout Management
7. Dermatology, Malignant Lesions, Eczematous Eruptions, and Infectious Dermatoses
8. Neurology, Migraine Prophylaxis, Transient Ischemic Attacks, and Neuropathic Pain
9. Mental Health, Major Depressive Disorder, Generalized Anxiety, and Pharmacotherapy
10. Women’s Health, Contraceptive Management, Menopausal Symptoms, and Breast Pathology
1. A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF, EF
30%) presents for routine follow-up. He reports mild dyspnea on exertion but denies orthopnea
or paroxysmal nocturnal dyspnea. His current medications include lisinopril 20 mg daily,
carvedilol 25 mg twice daily, and furosemide 40 mg daily. Blood pressure is 118/74 mmHg and
heart rate is 64 beats per minute. Laboratory studies reveal a serum creatinine of 1.4 mg/dL and
potassium of 4.6 mEq/L. Which of the following is the most appropriate next step in optimizing
his guideline-directed medical therapy (GDMT)?
, A. Increase the furosemide dose to 80 mg daily to prevent fluid overload.
B. Initiate sacubitril/valsartan after a 36-hour washout period from lisinopril.
C. Discontinue carvedilol due to the risk of worsening heart failure symptoms.
D. Add an alpha-blocker to further reduce afterload and blood pressure.
CORRECT ANSWER : B
Rationale: In patients with HFrEF tolerating an ACE inhibitor, guidelines strongly support
switching to an angiotensin receptor-neprilysin inhibitor (ARNI) like sacubitril/valsartan for
superior mortality and morbidity reduction, provided a 36-hour washout from the ACE inhibitor
is observed to prevent angioedema. Option A is unnecessary since the patient is euvolemic,
option C is incorrect as beta-blockers are foundational GDMT, and option D is not indicated.
2. A 54-year-old female presents to the primary care clinic complaining of worsening fatigue,
weight gain of 10 pounds over three months, constipation, and cold intolerance. Physical
examination reveals dry skin and delayed relaxation of deep tendon reflexes. Laboratory
evaluation shows a TSH of 14.2 mIU/L (reference 0.4–4.0) and a free T4 of 0.6 ng/dL (reference
0.8–1.8). Which of the following is the most appropriate initial pharmacological management?
A. Initiate levothyroxine at 25 to 50 mcg orally once daily, adjusting every 6 weeks based
on repeat TSH levels.
B. Initiate liothyronine (T3) monotherapy at 25 mcg daily to rapidly saturate cellular receptors.
C. Initiate desiccated thyroid extract (porcine) to provide a natural combination of T4 and T3.
D. Monitor clinical symptoms without treatment until TSH exceeds 20 mIU/L.
CORRECT ANSWER : A
Rationale: Primary hypothyroidism with an elevated TSH and low free T4 is treated with
levothyroxine monotherapy, initiating at a low dose (25-50 mcg daily) in otherwise healthy
adults or lower in the elderly/cardiac patients, with TSH re-evaluation every 6 weeks until
euthyroid. Option B and C are not recommended as first-line therapy due to unstable hormone
ratios and cardiovascular risks, and option D delays necessary treatment.
3. A 45-year-old male with a 20 pack-year smoking history presents with a 3-month history of a
chronic, productive cough and progressive dyspnea on exertion. Spirometry reveals a post-
bronchodilator FEV1/FVC ratio of 0.62 and an FEV1 of 58% of predicted. According to GOLD
guidelines, which classification and initial pharmacological therapy combination is most
appropriate?
A. GOLD Group A; prescribe a short-acting beta-agonist as needed.
, B. GOLD Group B; prescribe a long-acting muscarinic antagonist (LAMA) or long-acting
beta-agonist (LABA).
C. GOLD Group D; prescribe a triple therapy of LAMA, LABA, and inhaled corticosteroid.
D. GOLD Group C; prescribe an inhaled corticosteroid monotherapy.
CORRECT ANSWER : B
Rationale: Based on the updated GOLD criteria, an FEV1 of 58% places him in spirometric
grade 2, and combined with moderate symptoms (mMRC 2 or CAT >= 10, assumed for chronic
cough and dyspnea on exertion without frequent exacerbations), he falls into Group B. Initial
treatment for Group B is a single long-acting bronchodilator (LAMA or LABA). Options A, C,
and D misclassify his severity or therapeutic requirements.
4. A 60-year-old female with type 2 diabetes mellitus presents for routine management. Her HbA1c
is 8.2% despite maximal dose metformin. She has a documented history of atherosclerotic
cardiovascular disease (ASCVD) with a prior myocardial infarction. Her estimated glomerular
filtration rate (eGFR) is 52 mL/min/1.73m2, and urine albumin-to-creatinine ratio is normal.
Which class of medication should be added to her regimen to reduce cardiovascular events?
A. A sulfonylurea such as glipizide.
B. A sodium-glucose cotransporter 2 (SGLT2) inhibitor or a GLP-1 receptor agonist with
proven cardiovascular benefit.
C. A dipeptidyl peptidase-4 (DPP-4) inhibitor like sitagliptin.
D. Basal insulin glargine titrated to fasting blood glucose targets.
CORRECT ANSWER : B
Rationale: In patients with type 2 diabetes and established ASCVD, independent of baseline
HbA1c, guidelines recommend adding an SGLT2 inhibitor or GLP-1 receptor agonist with
proven cardiovascular benefit to reduce major adverse cardiac events and renal decline. Option
A increases hypoglycemia risk without CV protection, option C offers neutral CV outcomes, and
option D is premature before optimizing organ-protective agents.
5. A 32-year-old female presents with recurrent, painful epigastric burning that worsens 1 to 3
hours after meals and is occasionally relieved by food or antacids. She reports waking up at night
with similar discomfort. A urea breath test is positive for Helicobacter pylori. What is the
recommended first-line eradication therapy regimen?
A. Amoxicillin 1 g twice daily for 5 days alone.
, B. Standard triple therapy consisting of a proton pump inhibitor (PPI) twice daily,
clarithromycin 500 mg twice daily, and amoxicillin 1 g twice daily for 14 days.
C. Bismuth subsalicylate, metronidazole, and tetracycline for 3 days.
D. High-dose PPI monotherapy for 8 weeks without antibiotics.
CORRECT ANSWER : B
Rationale: First-line eradication of H. pylori involves standard triple therapy containing a PPI,
clarithromycin, and amoxicillin (or metronidazole if penicillin-allergic) for a full duration of 14
days in current clinical practice to maximize eradication rates. Options A and D are inadequate
for infection eradication, and option C uses incorrect dosing durations.
6. A 72-year-old male presents for an annual wellness exam. He reports a mild, dull ache in his
right knee that worsens with activity and improves with rest, accompanied by morning stiffness
lasting less than 15 minutes. Examination reveals bony enlargement at the distal interphalangeal
joints and crepitus in the right knee. Radiographs demonstrate joint space narrowing and
osteophytes. Which of the following is the most appropriate first-line pharmacological treatment
for his knee pain?
A. Oral ibuprofen 600 mg three times daily continuously.
B. Topical NSAIDs such as diclofenac sodium gel applied to the affected joint.
C. Intra-articular hyaluronic acid injections as initial monotherapy.
D. Chronic oral long-acting opioid analgesics.
CORRECT ANSWER : B
Rationale: For localized osteoarthritis such as knee OA, topical NSAIDs are recommended as
first-line pharmacotherapy over oral NSAIDs due to significantly lower systemic exposure and
gastrointestinal/renal risks. Options A carries higher systemic risk, option C is second-line or
adjunctive, and option D is strictly contraindicated for routine OA management.
7. A 28-year-old female presents with acute onset of palpitations, tremors, heat intolerance, and
unintended weight loss of 12 pounds over two months. Examination reveals a diffuse, non-tender
goiter and a fine resting tremor. Laboratory evaluation reveals a suppressed TSH (< 0.01 mIU/L)
and elevated free T4 and T3. Thyroid-stimulating immunoglobulin (TSI) is positive. What is the
primary pathophysiology of her condition?
A. Autoimmune destruction of thyroid follicular cells leading to transient hyperthyroidism.
B. Autoimmune stimulation of the TSH receptor by autoantibodies mimicking TSH,
causing autonomous hormone hypersecretion.
