WILKES UNIVERSITY
Passan School of Nursing
NSG555 / NSG 555 EXAM 2
Nurse Practitioners in Primary Care I
Complete Guide with Questions and Verified Answers
LATEST UPDATE | ALL MODULES COVERED
Total Questions 120 Multiple Choice
Cognitive Mix 20% Recall | 50% Application | 30% Analysis
Question Style 75% Scenario-based | 25% Direct Knowledge
Special Inclusions 20 Clinical Reasoning | 15 Pharmacotherapy | 10 Health Promotion
Format Single Best Answer (A-D) with Verified Rationale
Aligned With Wilkes NSG 555 Syllabus | AACN Essentials | FNP Primary Care Competencies
Edition Update — Grade A Verified
EXAMINATION MODULES COVERED
1. Cardiovascular Disorders | 2. Respiratory Disorders | 3. Endocrine & Metabolic
4. Gastrointestinal Disorders | 5. Musculoskeletal & Integumentary
6. Neurological & Psychiatric | 7. Renal & Genitourinary | 8. Hematological & Immunological
NSG555 Exam 2 — Complete Guide | Grade A Verified Answers Page 1
,NSG 555 | Exam 2 — Nurse Practitioners in Primary Care I Wilkes University | 2026/2027 Edition
Examination Overview & How to Use This Guide
This comprehensive examination guide is designed for graduate nursing students enrolled in NSG 555 —
Nurse Practitioners in Primary Care I at Wilkes University. The 120 questions span eight core primary care
modules and are constructed to reflect the cognitive demands of advanced practice nursing: 20% recall of
foundational knowledge, 50% application of clinical guidelines to patient scenarios, and 30% analysis
emphasizing clinical reasoning, differential diagnosis, and management prioritization. The content aligns with
the Wilkes NSG 555 course syllabus, the AACN Essentials of Master's Education in Nursing, and the
2026/2027 Family Nurse Practitioner Primary Care Competencies.
Each question is presented in the format of a single-best-answer multiple choice item with four options (A
through D). The correct answer is marked with *[CORRECT]*, followed by a Correct Answer key line and a
2-4 sentence rationale. The rationale explains why the correct option is best and why the distractors are inferior
or incorrect, anchoring each explanation in current evidence-based guidelines (ACC/AHA, ADA, GINA, GOLD,
IDSA, CDC, USPSTF, AUA, ACR, APA, AAN, AASM, ASH, NHLBI, AASLD, KDIGO, NCEP ATP III, ACG,
ASCRS, AAD, AAO-HNS, AAP, ATA, Endocrine Society, IDSA/ATS, NIH, SAMHSA, ACIP, IMWG, ACOG,
AASM, ACG, AHS, ACP, AAN, EAU/AUA, ASMBS, NOF, NAEPP, IDSA/ATS, AAO-HNS, IDSA, USPSTF, and
CDC).
Question Format Legend
Stem Clinical vignette or direct knowledge prompt, often including patient age, sex, presenting complaint, vital si
Options A-D Four single-best-answer choices. Three distractors represent common primary care errors, prioritization pi
*[CORRECT]* Marker indicating the verified correct answer.
Correct Answer: X Letter key summarizing the correct option for quick reference and answer-key scanning.
Rationale Evidence-based explanation (2-4 sentences) of why the correct answer is best and why each distractor is
Cognitive Level Distribution & Special Inclusions
The question bank was constructed to meet specific cognitive and content targets. Recall questions
(approximately 24 of 120) test foundational knowledge such as guideline thresholds, diagnostic criteria, and
medication mechanisms. Application questions (approximately 60 of 120) require applying evidence-based
guidelines to specific patient presentations. Analysis questions (approximately 36 of 120) require clinical
reasoning, differential diagnosis, and management prioritization. Special inclusions guarantee at least 20
scenario-based clinical reasoning questions, 15 pharmacotherapy and medication management questions, and
10 health promotion and disease prevention questions distributed across the eight sections.
Important note for learners: The verified answers reflect 2026/2027 guideline recommendations at the time of
writing. Always cross-reference the most current guideline updates, as recommendations evolve. This guide is
a study aid and does not replace clinical judgment, institutional protocols, or supervision by qualified preceptors
and faculty.
NSG555 Exam 2 — Complete Guide | Grade A Verified Answers Page 2
,NSG 555 | Exam 2 — Nurse Practitioners in Primary Care I Wilkes University | 2026/2027 Edition
Section 1: Cardiovascular Disorders in Primary Care
Q1: A 58-year-old African American male with no prior medical history presents for a routine
physical. His BP is 148/96 mmHg on two separate occasions 2 weeks apart. According to current
ACC/AHA hypertension guidelines, what is the correct diagnosis and initial management?
A. Stage 1 hypertension; recommend lifestyle modifications alone and recheck in 6 months
B. Elevated BP; initiate thiazide diuretic therapy
C. Stage 2 hypertension; initiate pharmacologic therapy with two antihypertensive agents from
different classes and lifestyle modifications *[CORRECT]*
D. Hypertensive urgency; refer to emergency department for IV antihypertensive therapy
Correct Answer: C
Rationale: Per the 2017 ACC/AHA guideline, BP ≥140/90 mmHg qualifies as Stage 2 hypertension and warrants
initiation of two antihypertensive agents from different classes plus lifestyle modification, particularly in a high-risk
African American patient in whom thiazide diuretics and CCBs are preferred first-line agents. Option A reflects
outdated JNC 7 thresholds; option B misclassifies the stage; option D is inappropriate because hypertensive
urgency requires SBP ≥180 or DBP ≥120 without end-organ damage and is managed outpatient, not with IV
therapy. This aligns with AACN Essentials competencies in evidence-based primary care management.
Q2: A 62-year-old female with a 10-year history of type 2 diabetes presents for follow-up. Current
medications include metformin and lisinopril. BP today is 138/86 mmHg. She has no albuminuria.
Per ADA and ACC/AHA recommendations, what is the most appropriate BP target for this patient?
A. <140/90 mmHg, as the risks of intensive control outweigh benefits in diabetics without nephropathy
B. <130/80 mmHg, to reduce cardiovascular and renal complications in high-risk diabetic patients
*[CORRECT]*
C. <120/80 mmHg, as recommended for all diabetic patients to maximize risk reduction
D. <150/90 mmHg, since tight control in older diabetics increases mortality
Correct Answer: B
Rationale: The ADA and ACC/AHA recommend a target BP of <130/80 mmHg for adults with diabetes,
particularly those with additional cardiovascular risk factors, because this reduces long-term cardiovascular and
renal complications. Option A is too permissive for a diabetic with elevated CV risk. Option C (<120/80) reflects
SPRINT findings but is not routinely recommended for diabetics due to risks of hypotension and adverse events.
Option D applies only to very elderly or frail patients, not this 62-year-old. NSG 555 curriculum emphasizes
individualized but evidence-based targets.
Q3: A 45-year-old male with newly diagnosed stage 1 hypertension (BP 134/86 mmHg) asks what
lifestyle changes he should make before considering medications. Which lifestyle modification
has the strongest evidence for reducing BP and is endorsed by the DASH-Sodium trial?
A. Reducing dietary sodium to <2,300 mg/day
B. Adopting the DASH diet rich in fruits, vegetables, and low-fat dairy with sodium <1,500 mg/day
*[CORRECT]*
C. Engaging in 30 minutes of brisk walking daily
D. Limiting alcohol to ≤2 drinks/day for men
Correct Answer: B
Rationale: The DASH-Sodium trial demonstrated the greatest BP reduction with a combination of the DASH
eating pattern plus sodium restriction to <1,500 mg/day, achieving reductions of 8-14 mmHg systolic. While
options A, C, and D are all beneficial lifestyle modifications, the combined DASH + low sodium approach yields the
NSG555 Exam 2 — Complete Guide | Grade A Verified Answers Page 3
, NSG 555 | Exam 2 — Nurse Practitioners in Primary Care I Wilkes University | 2026/2027 Edition
most significant impact. NSG 555 emphasizes comprehensive lifestyle counseling as a first-line intervention and
the AACN Essentials promote patient education and health promotion competencies.
Q4: A 55-year-old male with LDL 165 mg/dL, HDL 38 mg/dL, triglycerides 180 mg/dL, and a 10-year
ASCVD risk of 9% presents for counseling. He has no diabetes, no prior ASCVD events, and is a
non-smoker. Per ACC/AHA cholesterol guidelines, what is the most appropriate management?
A. Initiate moderate-intensity statin therapy; lifestyle modifications are insufficient given ASCVD
risk ≥7.5% *[CORRECT]*
B. Initiate high-intensity statin therapy to achieve ≥50% LDL reduction
C. Continue lifestyle modifications alone; statins are reserved for ASCVD risk ≥20%
D. Initiate niacin and omega-3 fatty acids to address mixed dyslipidemia
Correct Answer: A
Rationale: For patients with a 10-year ASCVD risk of 7.5-19.9% (intermediate risk) without diabetes or prior
ASCVD, a moderate-intensity statin is recommended after clinician-patient risk discussion. Option B
(high-intensity) is reserved for ASCVD risk ≥20%, known ASCVD, or LDL ≥190 mg/dL. Option C is incorrect
because the threshold for statin consideration is ≥7.5%. Option D is inappropriate because niacin is no longer
recommended for cardiovascular risk reduction and omega-3s are adjunctive only. This reflects NSG 555
pharmacotherapy content and AACN evidence-based practice.
Q5: A 68-year-old male with hypertension, hyperlipidemia, and a 40-pack-year smoking history
reports substernal chest pressure radiating to his left arm that occurs with exertion and resolves
with rest, occurring 2-3 times per week for the past month. ECG shows normal sinus rhythm with
no acute changes. What is the most likely diagnosis and appropriate next step?
A. Stable angina; refer for outpatient stress testing and initiate sublingual nitroglycerin PRN with
aspirin 81 mg daily *[CORRECT]*
B. Unstable angina; refer immediately to the emergency department for troponin and admission
C. GERD; trial a PPI for 4 weeks and reassess
D. Musculoskeletal chest pain; recommend NSAIDs and rest
Correct Answer: A
Rationale: The presentation is classic for stable angina: reproducible exertional substernal chest pressure
relieved by rest, occurring predictably for over 2 months. Outpatient stress testing with initiation of aspirin and PRN
nitroglycerin is appropriate. Option B (unstable angina) would present with new-onset, worsening, or rest pain.
Option C ignores cardiac risk factors and classic presentation. Option D is inappropriate given the patient's risk
profile and angina features. NSG 555 emphasizes cardiovascular risk assessment and appropriate triage per
AACN competencies.
Q6: A 72-year-old male was discharged 2 weeks ago following an ST-elevation MI treated with
primary PCI and a drug-eluting stent. Current medications include aspirin, ticagrelor, atorvastatin
80 mg, metoprolol, and lisinopril. He asks if he can stop his medications because he feels '100%
better.' What is the most important counseling point?
A. Discontinue ticagrelor after 6 months since the stent is likely healed
B. Dual antiplatelet therapy (DAPT) must continue for at least 12 months to prevent stent
thrombosis; sudden discontinuation can be life-threatening *[CORRECT]*
C. Stop lisinopril if it causes cough, as ACE inhibitors are not essential post-MI
D. Atorvastatin can be reduced to 20 mg once LDL is normalized
Correct Answer: B
NSG555 Exam 2 — Complete Guide | Grade A Verified Answers Page 4
Passan School of Nursing
NSG555 / NSG 555 EXAM 2
Nurse Practitioners in Primary Care I
Complete Guide with Questions and Verified Answers
LATEST UPDATE | ALL MODULES COVERED
Total Questions 120 Multiple Choice
Cognitive Mix 20% Recall | 50% Application | 30% Analysis
Question Style 75% Scenario-based | 25% Direct Knowledge
Special Inclusions 20 Clinical Reasoning | 15 Pharmacotherapy | 10 Health Promotion
Format Single Best Answer (A-D) with Verified Rationale
Aligned With Wilkes NSG 555 Syllabus | AACN Essentials | FNP Primary Care Competencies
Edition Update — Grade A Verified
EXAMINATION MODULES COVERED
1. Cardiovascular Disorders | 2. Respiratory Disorders | 3. Endocrine & Metabolic
4. Gastrointestinal Disorders | 5. Musculoskeletal & Integumentary
6. Neurological & Psychiatric | 7. Renal & Genitourinary | 8. Hematological & Immunological
NSG555 Exam 2 — Complete Guide | Grade A Verified Answers Page 1
,NSG 555 | Exam 2 — Nurse Practitioners in Primary Care I Wilkes University | 2026/2027 Edition
Examination Overview & How to Use This Guide
This comprehensive examination guide is designed for graduate nursing students enrolled in NSG 555 —
Nurse Practitioners in Primary Care I at Wilkes University. The 120 questions span eight core primary care
modules and are constructed to reflect the cognitive demands of advanced practice nursing: 20% recall of
foundational knowledge, 50% application of clinical guidelines to patient scenarios, and 30% analysis
emphasizing clinical reasoning, differential diagnosis, and management prioritization. The content aligns with
the Wilkes NSG 555 course syllabus, the AACN Essentials of Master's Education in Nursing, and the
2026/2027 Family Nurse Practitioner Primary Care Competencies.
Each question is presented in the format of a single-best-answer multiple choice item with four options (A
through D). The correct answer is marked with *[CORRECT]*, followed by a Correct Answer key line and a
2-4 sentence rationale. The rationale explains why the correct option is best and why the distractors are inferior
or incorrect, anchoring each explanation in current evidence-based guidelines (ACC/AHA, ADA, GINA, GOLD,
IDSA, CDC, USPSTF, AUA, ACR, APA, AAN, AASM, ASH, NHLBI, AASLD, KDIGO, NCEP ATP III, ACG,
ASCRS, AAD, AAO-HNS, AAP, ATA, Endocrine Society, IDSA/ATS, NIH, SAMHSA, ACIP, IMWG, ACOG,
AASM, ACG, AHS, ACP, AAN, EAU/AUA, ASMBS, NOF, NAEPP, IDSA/ATS, AAO-HNS, IDSA, USPSTF, and
CDC).
Question Format Legend
Stem Clinical vignette or direct knowledge prompt, often including patient age, sex, presenting complaint, vital si
Options A-D Four single-best-answer choices. Three distractors represent common primary care errors, prioritization pi
*[CORRECT]* Marker indicating the verified correct answer.
Correct Answer: X Letter key summarizing the correct option for quick reference and answer-key scanning.
Rationale Evidence-based explanation (2-4 sentences) of why the correct answer is best and why each distractor is
Cognitive Level Distribution & Special Inclusions
The question bank was constructed to meet specific cognitive and content targets. Recall questions
(approximately 24 of 120) test foundational knowledge such as guideline thresholds, diagnostic criteria, and
medication mechanisms. Application questions (approximately 60 of 120) require applying evidence-based
guidelines to specific patient presentations. Analysis questions (approximately 36 of 120) require clinical
reasoning, differential diagnosis, and management prioritization. Special inclusions guarantee at least 20
scenario-based clinical reasoning questions, 15 pharmacotherapy and medication management questions, and
10 health promotion and disease prevention questions distributed across the eight sections.
Important note for learners: The verified answers reflect 2026/2027 guideline recommendations at the time of
writing. Always cross-reference the most current guideline updates, as recommendations evolve. This guide is
a study aid and does not replace clinical judgment, institutional protocols, or supervision by qualified preceptors
and faculty.
NSG555 Exam 2 — Complete Guide | Grade A Verified Answers Page 2
,NSG 555 | Exam 2 — Nurse Practitioners in Primary Care I Wilkes University | 2026/2027 Edition
Section 1: Cardiovascular Disorders in Primary Care
Q1: A 58-year-old African American male with no prior medical history presents for a routine
physical. His BP is 148/96 mmHg on two separate occasions 2 weeks apart. According to current
ACC/AHA hypertension guidelines, what is the correct diagnosis and initial management?
A. Stage 1 hypertension; recommend lifestyle modifications alone and recheck in 6 months
B. Elevated BP; initiate thiazide diuretic therapy
C. Stage 2 hypertension; initiate pharmacologic therapy with two antihypertensive agents from
different classes and lifestyle modifications *[CORRECT]*
D. Hypertensive urgency; refer to emergency department for IV antihypertensive therapy
Correct Answer: C
Rationale: Per the 2017 ACC/AHA guideline, BP ≥140/90 mmHg qualifies as Stage 2 hypertension and warrants
initiation of two antihypertensive agents from different classes plus lifestyle modification, particularly in a high-risk
African American patient in whom thiazide diuretics and CCBs are preferred first-line agents. Option A reflects
outdated JNC 7 thresholds; option B misclassifies the stage; option D is inappropriate because hypertensive
urgency requires SBP ≥180 or DBP ≥120 without end-organ damage and is managed outpatient, not with IV
therapy. This aligns with AACN Essentials competencies in evidence-based primary care management.
Q2: A 62-year-old female with a 10-year history of type 2 diabetes presents for follow-up. Current
medications include metformin and lisinopril. BP today is 138/86 mmHg. She has no albuminuria.
Per ADA and ACC/AHA recommendations, what is the most appropriate BP target for this patient?
A. <140/90 mmHg, as the risks of intensive control outweigh benefits in diabetics without nephropathy
B. <130/80 mmHg, to reduce cardiovascular and renal complications in high-risk diabetic patients
*[CORRECT]*
C. <120/80 mmHg, as recommended for all diabetic patients to maximize risk reduction
D. <150/90 mmHg, since tight control in older diabetics increases mortality
Correct Answer: B
Rationale: The ADA and ACC/AHA recommend a target BP of <130/80 mmHg for adults with diabetes,
particularly those with additional cardiovascular risk factors, because this reduces long-term cardiovascular and
renal complications. Option A is too permissive for a diabetic with elevated CV risk. Option C (<120/80) reflects
SPRINT findings but is not routinely recommended for diabetics due to risks of hypotension and adverse events.
Option D applies only to very elderly or frail patients, not this 62-year-old. NSG 555 curriculum emphasizes
individualized but evidence-based targets.
Q3: A 45-year-old male with newly diagnosed stage 1 hypertension (BP 134/86 mmHg) asks what
lifestyle changes he should make before considering medications. Which lifestyle modification
has the strongest evidence for reducing BP and is endorsed by the DASH-Sodium trial?
A. Reducing dietary sodium to <2,300 mg/day
B. Adopting the DASH diet rich in fruits, vegetables, and low-fat dairy with sodium <1,500 mg/day
*[CORRECT]*
C. Engaging in 30 minutes of brisk walking daily
D. Limiting alcohol to ≤2 drinks/day for men
Correct Answer: B
Rationale: The DASH-Sodium trial demonstrated the greatest BP reduction with a combination of the DASH
eating pattern plus sodium restriction to <1,500 mg/day, achieving reductions of 8-14 mmHg systolic. While
options A, C, and D are all beneficial lifestyle modifications, the combined DASH + low sodium approach yields the
NSG555 Exam 2 — Complete Guide | Grade A Verified Answers Page 3
, NSG 555 | Exam 2 — Nurse Practitioners in Primary Care I Wilkes University | 2026/2027 Edition
most significant impact. NSG 555 emphasizes comprehensive lifestyle counseling as a first-line intervention and
the AACN Essentials promote patient education and health promotion competencies.
Q4: A 55-year-old male with LDL 165 mg/dL, HDL 38 mg/dL, triglycerides 180 mg/dL, and a 10-year
ASCVD risk of 9% presents for counseling. He has no diabetes, no prior ASCVD events, and is a
non-smoker. Per ACC/AHA cholesterol guidelines, what is the most appropriate management?
A. Initiate moderate-intensity statin therapy; lifestyle modifications are insufficient given ASCVD
risk ≥7.5% *[CORRECT]*
B. Initiate high-intensity statin therapy to achieve ≥50% LDL reduction
C. Continue lifestyle modifications alone; statins are reserved for ASCVD risk ≥20%
D. Initiate niacin and omega-3 fatty acids to address mixed dyslipidemia
Correct Answer: A
Rationale: For patients with a 10-year ASCVD risk of 7.5-19.9% (intermediate risk) without diabetes or prior
ASCVD, a moderate-intensity statin is recommended after clinician-patient risk discussion. Option B
(high-intensity) is reserved for ASCVD risk ≥20%, known ASCVD, or LDL ≥190 mg/dL. Option C is incorrect
because the threshold for statin consideration is ≥7.5%. Option D is inappropriate because niacin is no longer
recommended for cardiovascular risk reduction and omega-3s are adjunctive only. This reflects NSG 555
pharmacotherapy content and AACN evidence-based practice.
Q5: A 68-year-old male with hypertension, hyperlipidemia, and a 40-pack-year smoking history
reports substernal chest pressure radiating to his left arm that occurs with exertion and resolves
with rest, occurring 2-3 times per week for the past month. ECG shows normal sinus rhythm with
no acute changes. What is the most likely diagnosis and appropriate next step?
A. Stable angina; refer for outpatient stress testing and initiate sublingual nitroglycerin PRN with
aspirin 81 mg daily *[CORRECT]*
B. Unstable angina; refer immediately to the emergency department for troponin and admission
C. GERD; trial a PPI for 4 weeks and reassess
D. Musculoskeletal chest pain; recommend NSAIDs and rest
Correct Answer: A
Rationale: The presentation is classic for stable angina: reproducible exertional substernal chest pressure
relieved by rest, occurring predictably for over 2 months. Outpatient stress testing with initiation of aspirin and PRN
nitroglycerin is appropriate. Option B (unstable angina) would present with new-onset, worsening, or rest pain.
Option C ignores cardiac risk factors and classic presentation. Option D is inappropriate given the patient's risk
profile and angina features. NSG 555 emphasizes cardiovascular risk assessment and appropriate triage per
AACN competencies.
Q6: A 72-year-old male was discharged 2 weeks ago following an ST-elevation MI treated with
primary PCI and a drug-eluting stent. Current medications include aspirin, ticagrelor, atorvastatin
80 mg, metoprolol, and lisinopril. He asks if he can stop his medications because he feels '100%
better.' What is the most important counseling point?
A. Discontinue ticagrelor after 6 months since the stent is likely healed
B. Dual antiplatelet therapy (DAPT) must continue for at least 12 months to prevent stent
thrombosis; sudden discontinuation can be life-threatening *[CORRECT]*
C. Stop lisinopril if it causes cough, as ACE inhibitors are not essential post-MI
D. Atorvastatin can be reduced to 20 mg once LDL is normalized
Correct Answer: B
NSG555 Exam 2 — Complete Guide | Grade A Verified Answers Page 4
