NSG 555 / NSG555 Exam 1 – Nurse Practitioners in
Primary Care II 2026–2027 | Wilkes University
Primary Care II Study Guide & Exam Prep | Adult-
Gerontology Primary Care NP, Chronic Disease
Management, Differential Diagnosis, Diagnostic
Testing, Pharmacologic Management, Health
Promotion, Preventive Care, Clinical Decision-
Making, Patient Assessment & Practice Questions
Question 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.
Increasing metformin beyond 2000 mg daily provides no additional glycemic benefit and
increases adverse effects. Sulfonylureas are associated with hypoglycemia and weight
gain. Basal insulin is typically reserved for patients with severe hyperglycemia or when
oral agents fail.
Question 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
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. Stopping metformin entirely at eGFR 45 is overly
conservative. Doubling the dose is dangerous in renal impairment. Sulfonylureas carry
hypoglycemia risk and are not preferred in CKD.
Question 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. The ACC/AHA 2017 guideline recommends
<130/80 mmHg, but Wilkes NSG 555 tests strictly on JNC 8. This distinction is critical for
exam success.
Question 4: What is the JNC 8 blood pressure target for a 45-year-old patient with a
history of Type 2 Diabetes?
A. <150/90 mmHg
B. <140/90 mmHg
C. <130/80 mmHg
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. The presence of diabetes automatically places the patient in
the tighter control category regardless of age. This is a high-yield distinction from the
≥60 without comorbidities target of <150/90 mmHg.
Question 5: A 55-year-old Black female with no history of CKD or heart failure is
diagnosed with hypertension. According to JNC 8, which medication class is the
most appropriate first-line monotherapy?
A. Lisinopril
B. Amlodipine
C. Hydrochlorothiazide
D. Metoprolol
CORRECT ANSWER: C. Hydrochlorothiazide
Rationale: JNC 8 recommends that for Black patients without CKD, initial
antihypertensive therapy should include a thiazide-type diuretic or a calcium channel
blocker. ACE inhibitors are less effective as monotherapy in Black patients due to lower
renin levels. Beta-blockers are not first-line for uncomplicated hypertension.
Amlodipine is also appropriate, but hydrochlorothiazide is the classic JNC 8-
recommended thiazide for this population.
Question 6: A 72-year-old patient presents with a blood pressure of 158/92 mmHg
on two separate occasions. He has no diabetes or CKD. According to JNC 8, what is
the appropriate management?
,A. Lifestyle modifications only
B. Initiate antihypertensive medication
C. Recheck in 6 months
D. Refer to cardiology
CORRECT ANSWER: B. Initiate antihypertensive medication
Rationale: This patient is ≥60 years old without diabetes or CKD, so the JNC 8 target is
<150/90 mmHg. His blood pressure of 158/92 exceeds this threshold, warranting
pharmacologic therapy. Lifestyle modifications alone are insufficient for Stage 2
hypertension in this age group. Rechecking in 6 months would delay necessary
treatment.
Question 7: Which of the following is the most common symptom of peripheral
artery disease (PAD)?
A. Chest pain
B. Dyspnea on exertion
C. Intermittent claudication
D. Syncope
CORRECT ANSWER: C. Intermittent claudication
Rationale: Intermittent claudication is the most common symptom of PAD,
characterized by pain, cramping, or fatigue in the calf, thigh, or buttock muscles that
occurs with exercise and is relieved by rest. The pain is due to inadequate blood flow to
meet the metabolic demands of exercising muscles. Chest pain and dyspnea are more
associated with coronary artery disease.
Question 8: A 60-year-old male with hypertension is noted to have a serum
potassium of 5.6 mEq/L on routine labs. He is currently taking lisinopril 20 mg daily.
What is the most appropriate next step?
A. Increase lisinopril dose
B. Add a potassium supplement
C. Discontinue lisinopril and consider an ARB
D. No change; this is expected
CORRECT ANSWER: C. Discontinue lisinopril and consider an ARB
Rationale: Hyperkalemia (K+ >5.5 mEq/L) is a concerning adverse effect of ACE
inhibitors. The appropriate action is to discontinue the offending agent. ARBs have a
lower incidence of hyperkalemia and cough compared to ACE inhibitors, making them a
reasonable alternative. Increasing the ACE inhibitor would worsen hyperkalemia.
Adding potassium would be dangerous.
Question 9: A 68-year-old male with a history of coronary artery disease and heart
failure is started on sacubitril/valsartan (Entresto). Which of the following is a
contraindication to the use of this medication?
, A. History of angioedema with ACE inhibitors
B. Serum potassium of 4.8 mEq/L
C. eGFR of 55 mL/min
D. Blood pressure of 128/76 mmHg
CORRECT ANSWER: A. History of angioedema with ACE inhibitors
Rationale: Sacubitril/valsartan is contraindicated in patients with a history of
angioedema related to previous ACE inhibitor or ARB therapy due to the risk of life-
threatening angioedema. A potassium of 4.8 is within normal limits. eGFR of 55
represents moderate CKD, which is not an absolute contraindication but requires
monitoring. A blood pressure of 128/76 is acceptable for initiation.
Question 10: A 55-year-old female presents with a blood pressure of 160/100 mmHg
on two separate occasions. She has no other medical problems. According to the
2017 ACC/AHA hypertension guidelines, what is her blood pressure classification?
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension
CORRECT ANSWER: D. Stage 2 hypertension
Rationale: According to the 2017 ACC/AHA guidelines, blood pressure is classified as:
Normal (<120/80 mmHg), Elevated (120-129/<80 mmHg), Stage 1 hypertension (130-
139/80-89 mmHg), and Stage 2 hypertension (≥140/90 mmHg). This patient's blood
pressure of 160/100 mmHg is Stage 2 hypertension.
Question 11: A 48-year-old male presents for a routine wellness exam. According to
current USPSTF guidelines, which screening should the nurse practitioner initiate
for colorectal cancer?
A. Colonoscopy starting at age 50
B. Colonoscopy starting at age 45
C. Fecal occult blood test starting at age 55
D. Annual sigmoidoscopy starting at age 40
CORRECT ANSWER: B. Colonoscopy starting at age 45
Rationale: The USPSTF updated its guidelines to recommend that colorectal cancer
screening begin at age 45 for individuals at average risk. This change reflects the
increasing incidence of colorectal cancer in younger adults. Screening should continue
through age 75 with various modalities available.
Question 12: Which component of the SOAP note includes the patient's description
of their symptoms and the history of the present illness?
A. Plan
B. Objective
Primary Care II 2026–2027 | Wilkes University
Primary Care II Study Guide & Exam Prep | Adult-
Gerontology Primary Care NP, Chronic Disease
Management, Differential Diagnosis, Diagnostic
Testing, Pharmacologic Management, Health
Promotion, Preventive Care, Clinical Decision-
Making, Patient Assessment & Practice Questions
Question 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.
Increasing metformin beyond 2000 mg daily provides no additional glycemic benefit and
increases adverse effects. Sulfonylureas are associated with hypoglycemia and weight
gain. Basal insulin is typically reserved for patients with severe hyperglycemia or when
oral agents fail.
Question 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
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. Stopping metformin entirely at eGFR 45 is overly
conservative. Doubling the dose is dangerous in renal impairment. Sulfonylureas carry
hypoglycemia risk and are not preferred in CKD.
Question 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. The ACC/AHA 2017 guideline recommends
<130/80 mmHg, but Wilkes NSG 555 tests strictly on JNC 8. This distinction is critical for
exam success.
Question 4: What is the JNC 8 blood pressure target for a 45-year-old patient with a
history of Type 2 Diabetes?
A. <150/90 mmHg
B. <140/90 mmHg
C. <130/80 mmHg
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. The presence of diabetes automatically places the patient in
the tighter control category regardless of age. This is a high-yield distinction from the
≥60 without comorbidities target of <150/90 mmHg.
Question 5: A 55-year-old Black female with no history of CKD or heart failure is
diagnosed with hypertension. According to JNC 8, which medication class is the
most appropriate first-line monotherapy?
A. Lisinopril
B. Amlodipine
C. Hydrochlorothiazide
D. Metoprolol
CORRECT ANSWER: C. Hydrochlorothiazide
Rationale: JNC 8 recommends that for Black patients without CKD, initial
antihypertensive therapy should include a thiazide-type diuretic or a calcium channel
blocker. ACE inhibitors are less effective as monotherapy in Black patients due to lower
renin levels. Beta-blockers are not first-line for uncomplicated hypertension.
Amlodipine is also appropriate, but hydrochlorothiazide is the classic JNC 8-
recommended thiazide for this population.
Question 6: A 72-year-old patient presents with a blood pressure of 158/92 mmHg
on two separate occasions. He has no diabetes or CKD. According to JNC 8, what is
the appropriate management?
,A. Lifestyle modifications only
B. Initiate antihypertensive medication
C. Recheck in 6 months
D. Refer to cardiology
CORRECT ANSWER: B. Initiate antihypertensive medication
Rationale: This patient is ≥60 years old without diabetes or CKD, so the JNC 8 target is
<150/90 mmHg. His blood pressure of 158/92 exceeds this threshold, warranting
pharmacologic therapy. Lifestyle modifications alone are insufficient for Stage 2
hypertension in this age group. Rechecking in 6 months would delay necessary
treatment.
Question 7: Which of the following is the most common symptom of peripheral
artery disease (PAD)?
A. Chest pain
B. Dyspnea on exertion
C. Intermittent claudication
D. Syncope
CORRECT ANSWER: C. Intermittent claudication
Rationale: Intermittent claudication is the most common symptom of PAD,
characterized by pain, cramping, or fatigue in the calf, thigh, or buttock muscles that
occurs with exercise and is relieved by rest. The pain is due to inadequate blood flow to
meet the metabolic demands of exercising muscles. Chest pain and dyspnea are more
associated with coronary artery disease.
Question 8: A 60-year-old male with hypertension is noted to have a serum
potassium of 5.6 mEq/L on routine labs. He is currently taking lisinopril 20 mg daily.
What is the most appropriate next step?
A. Increase lisinopril dose
B. Add a potassium supplement
C. Discontinue lisinopril and consider an ARB
D. No change; this is expected
CORRECT ANSWER: C. Discontinue lisinopril and consider an ARB
Rationale: Hyperkalemia (K+ >5.5 mEq/L) is a concerning adverse effect of ACE
inhibitors. The appropriate action is to discontinue the offending agent. ARBs have a
lower incidence of hyperkalemia and cough compared to ACE inhibitors, making them a
reasonable alternative. Increasing the ACE inhibitor would worsen hyperkalemia.
Adding potassium would be dangerous.
Question 9: A 68-year-old male with a history of coronary artery disease and heart
failure is started on sacubitril/valsartan (Entresto). Which of the following is a
contraindication to the use of this medication?
, A. History of angioedema with ACE inhibitors
B. Serum potassium of 4.8 mEq/L
C. eGFR of 55 mL/min
D. Blood pressure of 128/76 mmHg
CORRECT ANSWER: A. History of angioedema with ACE inhibitors
Rationale: Sacubitril/valsartan is contraindicated in patients with a history of
angioedema related to previous ACE inhibitor or ARB therapy due to the risk of life-
threatening angioedema. A potassium of 4.8 is within normal limits. eGFR of 55
represents moderate CKD, which is not an absolute contraindication but requires
monitoring. A blood pressure of 128/76 is acceptable for initiation.
Question 10: A 55-year-old female presents with a blood pressure of 160/100 mmHg
on two separate occasions. She has no other medical problems. According to the
2017 ACC/AHA hypertension guidelines, what is her blood pressure classification?
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension
CORRECT ANSWER: D. Stage 2 hypertension
Rationale: According to the 2017 ACC/AHA guidelines, blood pressure is classified as:
Normal (<120/80 mmHg), Elevated (120-129/<80 mmHg), Stage 1 hypertension (130-
139/80-89 mmHg), and Stage 2 hypertension (≥140/90 mmHg). This patient's blood
pressure of 160/100 mmHg is Stage 2 hypertension.
Question 11: A 48-year-old male presents for a routine wellness exam. According to
current USPSTF guidelines, which screening should the nurse practitioner initiate
for colorectal cancer?
A. Colonoscopy starting at age 50
B. Colonoscopy starting at age 45
C. Fecal occult blood test starting at age 55
D. Annual sigmoidoscopy starting at age 40
CORRECT ANSWER: B. Colonoscopy starting at age 45
Rationale: The USPSTF updated its guidelines to recommend that colorectal cancer
screening begin at age 45 for individuals at average risk. This change reflects the
increasing incidence of colorectal cancer in younger adults. Screening should continue
through age 75 with various modalities available.
Question 12: Which component of the SOAP note includes the patient's description
of their symptoms and the history of the present illness?
A. Plan
B. Objective
