NSG 554 Exam 2 V2 | NSG 554 Nurse
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 2 2026)
1. A 62-year-old male with a history of hypertension presents with new-onset exertional
chest pain. Which of the following diagnostic tests is the initial gold standard for evaluating
suspected stable angina in the primary care setting?
A. 12-lead Electrocardiogram
B. Exercise Stress Echocardiogram
C. Cardiac Catheterization
D. Cardiac MRI
Answer: A
Rationale: The 12-lead EKG is the essential first step in the evaluation of chest pain to rule
out acute ischemia or previous myocardial infarction. While stress testing provides
functional data, the EKG establishes a baseline and identifies rhythm disturbances or ST-
segment changes. If the resting EKG is abnormal, the clinician may proceed to more
invasive or specialized imaging based on the patient’s risk profile.
2. When managing a patient with newly diagnosed Heart Failure with Reduced Ejection
Fraction (HFrEF), which medication class should be initiated first to improve survival?
A. Loop Diuretics
,B. ACE Inhibitor or ARNI
C. Calcium Channel Blockers
D. Digoxin
Answer: B
Rationale: ACE inhibitors, ARBs, or ARNIs are the cornerstone of HFrEF management
because they provide significant mortality benefits. Loop diuretics are primarily used for
symptom management related to fluid overload but do not improve long-term survival. The
NP must monitor potassium and renal function closely when initiating these
neurohormonal antagonists.
3. A patient presents with a ‘velvety’ systolic murmur heard best at the right upper sternal
border that radiates to the carotids. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Mitral Stenosis
D. Aortic Stenosis
Answer: D
Rationale: Aortic stenosis typically presents as a crescendo-decrescendo systolic murmur
at the right second intercostal space. Radiation to the carotid arteries is a classic finding
, that helps distinguish it from other systolic murmurs. Patients with severe aortic stenosis
may present with the triad of dyspnea, syncope, and angina.
4. According to the JNC 8 guidelines, what is the blood pressure goal for a 65-year-old patient
without diabetes or chronic kidney disease?
A. <130/80 mmHg
B. <150/90 mmHg
C. <140/90 mmHg
D. <120/70 mmHg
Answer: B
Rationale: JNC 8 guidelines recommend a higher threshold for initiating treatment and a
goal of <150/90 mmHg for the general population aged 60 and older. However, many
clinicians still follow the more aggressive ACC/AHA goal of <130/80 mmHg depending on
clinical judgment. In Wilkes University curriculum, it is vital to know both standards,
emphasizing that JNC 8 was specifically designed to reduce polypharmacy in the elderly.
5. Which physical exam finding is most specific for a diagnosis of heart failure in an older
adult?
A. Third Heart Sound (S3)
B. Peripheral Edema
C. Crackles in Lung Bases
Practitioners in Primary Care I | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG554 Exam 2 2026)
1. A 62-year-old male with a history of hypertension presents with new-onset exertional
chest pain. Which of the following diagnostic tests is the initial gold standard for evaluating
suspected stable angina in the primary care setting?
A. 12-lead Electrocardiogram
B. Exercise Stress Echocardiogram
C. Cardiac Catheterization
D. Cardiac MRI
Answer: A
Rationale: The 12-lead EKG is the essential first step in the evaluation of chest pain to rule
out acute ischemia or previous myocardial infarction. While stress testing provides
functional data, the EKG establishes a baseline and identifies rhythm disturbances or ST-
segment changes. If the resting EKG is abnormal, the clinician may proceed to more
invasive or specialized imaging based on the patient’s risk profile.
2. When managing a patient with newly diagnosed Heart Failure with Reduced Ejection
Fraction (HFrEF), which medication class should be initiated first to improve survival?
A. Loop Diuretics
,B. ACE Inhibitor or ARNI
C. Calcium Channel Blockers
D. Digoxin
Answer: B
Rationale: ACE inhibitors, ARBs, or ARNIs are the cornerstone of HFrEF management
because they provide significant mortality benefits. Loop diuretics are primarily used for
symptom management related to fluid overload but do not improve long-term survival. The
NP must monitor potassium and renal function closely when initiating these
neurohormonal antagonists.
3. A patient presents with a ‘velvety’ systolic murmur heard best at the right upper sternal
border that radiates to the carotids. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Mitral Stenosis
D. Aortic Stenosis
Answer: D
Rationale: Aortic stenosis typically presents as a crescendo-decrescendo systolic murmur
at the right second intercostal space. Radiation to the carotid arteries is a classic finding
, that helps distinguish it from other systolic murmurs. Patients with severe aortic stenosis
may present with the triad of dyspnea, syncope, and angina.
4. According to the JNC 8 guidelines, what is the blood pressure goal for a 65-year-old patient
without diabetes or chronic kidney disease?
A. <130/80 mmHg
B. <150/90 mmHg
C. <140/90 mmHg
D. <120/70 mmHg
Answer: B
Rationale: JNC 8 guidelines recommend a higher threshold for initiating treatment and a
goal of <150/90 mmHg for the general population aged 60 and older. However, many
clinicians still follow the more aggressive ACC/AHA goal of <130/80 mmHg depending on
clinical judgment. In Wilkes University curriculum, it is vital to know both standards,
emphasizing that JNC 8 was specifically designed to reduce polypharmacy in the elderly.
5. Which physical exam finding is most specific for a diagnosis of heart failure in an older
adult?
A. Third Heart Sound (S3)
B. Peripheral Edema
C. Crackles in Lung Bases
