NSG 555 / NSG555 Exam 2 – Nurse Practitioners in
Primary Care II Review 2026–2027 | Wilkes
University Graduate Nursing Study Guide & Exam
Prep | Primary Care Assessment, Cardiovascular &
Pulmonary Disorders, Spirometry, Hypertension,
Anxiety Disorders, Pharmacologic Management,
Differential Diagnosis, Diagnostic Testing, Chronic
Disease Management, Clinical Decision-Making &
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 the maximum effective 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 .
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 .
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. (Note: ACC/AHA 2017 says <130/80, but
Wilkes NSG 555 tests strictly on JNC 8) .
Question 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
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 .
Question 5: A patient with a murmur has echocardiography showing a calcified
aortic valve with reduced valve area and increased gradient. What is the
diagnosis?
A. Mitral stenosis
B. Aortic stenosis
C. Mitral regurgitation
D. Aortic regurgitation
CORRECT ANSWER: B. Aortic stenosis
Rationale: Aortic stenosis is diagnosed by echocardiography showing a calcified aortic
valve, reduced valve area (<1.0 cm²), and increased transvalvular gradient (>40 mmHg).
The classic triad is syncope, angina, and dyspnea on exertion (SAD) .
Question 6: A patient with peripheral artery disease has an ankle-brachial
index (ABI) of 0.75. This indicates:
A. Normal arterial circulation
B. Mild peripheral artery disease
C. Moderate peripheral artery disease
D. Severe peripheral artery disease
CORRECT ANSWER: B. Mild peripheral artery disease
Rationale: ABI interpretation: Normal (1.0-1.4), Mild PAD (0.71-0.90), Moderate PAD
(0.41-0.70), Severe PAD (<0.40) .
Question 7: A 68-year-old patient presents with sudden onset dyspnea,
tachypnea, and pleuritic chest pain. Oxygen saturation is 89% on room air.
What is the priority nursing action?
Primary Care II Review 2026–2027 | Wilkes
University Graduate Nursing Study Guide & Exam
Prep | Primary Care Assessment, Cardiovascular &
Pulmonary Disorders, Spirometry, Hypertension,
Anxiety Disorders, Pharmacologic Management,
Differential Diagnosis, Diagnostic Testing, Chronic
Disease Management, Clinical Decision-Making &
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 the maximum effective 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 .
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 .
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. (Note: ACC/AHA 2017 says <130/80, but
Wilkes NSG 555 tests strictly on JNC 8) .
Question 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
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 .
Question 5: A patient with a murmur has echocardiography showing a calcified
aortic valve with reduced valve area and increased gradient. What is the
diagnosis?
A. Mitral stenosis
B. Aortic stenosis
C. Mitral regurgitation
D. Aortic regurgitation
CORRECT ANSWER: B. Aortic stenosis
Rationale: Aortic stenosis is diagnosed by echocardiography showing a calcified aortic
valve, reduced valve area (<1.0 cm²), and increased transvalvular gradient (>40 mmHg).
The classic triad is syncope, angina, and dyspnea on exertion (SAD) .
Question 6: A patient with peripheral artery disease has an ankle-brachial
index (ABI) of 0.75. This indicates:
A. Normal arterial circulation
B. Mild peripheral artery disease
C. Moderate peripheral artery disease
D. Severe peripheral artery disease
CORRECT ANSWER: B. Mild peripheral artery disease
Rationale: ABI interpretation: Normal (1.0-1.4), Mild PAD (0.71-0.90), Moderate PAD
(0.41-0.70), Severe PAD (<0.40) .
Question 7: A 68-year-old patient presents with sudden onset dyspnea,
tachypnea, and pleuritic chest pain. Oxygen saturation is 89% on room air.
What is the priority nursing action?
