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NSG 555 Exam 2 Study Guide — Wilkes University
Nurse Practitioners in Primary Care II | 2026/2027
Curriculum | Complete Solutions
Welcome to your comprehensive exam preparation resource. This guide synthesizes high-yield
content across ten clinical domains, formatted for active learning and exam success. Let's
work through each section together.
PART A: ACUTE EMERGENCY CONDITIONS DRILL (Questions 1–15)
Question 1
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?
A. Obtain a chest X-ray
B. Administer oxygen and notify the provider immediately
C. Draw a D-dimer
D. Prepare the patient for a V/Q scan
Correct Answer: B
Rationale: Pulmonary embolism can cause rapid hypoxemia and hemodynamic collapse. The
priority is always to address life-threatening hypoxemia first. Oxygen administration improves
tissue perfusion while the provider is notified for definitive diagnosis and anticoagulation. A
chest X-ray, D-dimer, and V/Q scan are important diagnostic steps, but they do not take
precedence over stabilizing oxygenation.
High-Yield Pearl: In any suspected PE, remember the mantra: "Oxygen first, then investigate."
Hypoxemia kills faster than the time it takes to obtain imaging.
Question 2
A patient is diagnosed with a massive PE and is hemodynamically unstable. Which
intervention is most appropriate?
A. Start thrombolytics immediately
B. Administer IV fluids aggressively
, 2
C. Provide immediate anticoagulation and hemodynamic support
D. Place an inferior vena cava filter
Correct Answer: C
Rationale: Massive PE causes obstructive shock due to right ventricular failure. Immediate
anticoagulation (heparin) prevents further clot propagation, while hemodynamic support
(fluids cautiously, vasopressors if needed) maintains perfusion. Thrombolytics are reserved
for massive PE with hemodynamic instability and no contraindications, but anticoagulation
remains the foundation. Aggressive IV fluids can worsen right heart strain.
High-Yield Pearl: Massive PE = obstructive shock. The right ventricle fails, so fluid
administration must be cautious—too much fluid worsens RV dilation and left ventricular
compression.
Question 3
A 72-year-old male complains of crushing substernal chest pain radiating to his left arm. His
vital signs are stable. What is the first priority intervention?
A. Administer aspirin and oxygen immediately
B. Obtain a 12-lead ECG
C. Draw troponin levels
D. Administer sublingual nitroglycerin
Correct Answer: A
Rationale: In suspected acute MI, chewable aspirin (160–325 mg) and oxygen (if SpO₂ < 90%)
are administered immediately. Aspirin reduces platelet aggregation and mortality. While the
ECG and troponins are critical for diagnosis, they do not take precedence over interventions
that limit myocardial damage. Nitroglycerin is appropriate after aspirin if the patient is
hemodynamically stable and not hypotensive.
High-Yield Pearl: "Aspirin before ECG" in the exam context—unless the question specifies the
ECG has already been obtained. Early aspirin reduces mortality in acute MI.
Question 4
A patient with STEMI is being prepared for emergent reperfusion. Which statement best
describes the treatment goal?
A. Pain control is the primary objective
, 3
B. Time is muscle; rapid restoration of blood flow is critical
C. Anticoagulation alone is sufficient
D. Fibrinolytics are preferred over PCI in all cases
Correct Answer: B
Rationale: In STEMI, the occluded coronary artery must be reopened as quickly as possible to
preserve myocardium. The phrase "time is muscle" reflects the urgency. PCI (percutaneous
coronary intervention) is preferred over fibrinolytics when available within 90 minutes of first
medical contact. Anticoagulation supports but does not replace reperfusion.
High-Yield Pearl: Door-to-balloon time target is ≤90 minutes; door-to-needle time for
fibrinolytics is ≤30 minutes. Know these benchmarks.
Question 5
A patient arrives at the clinic with sudden onset unilateral weakness, facial droop, and slurred
speech. What is the priority action?
A. Obtain a detailed history from the family
B. Assess airway, breathing, and circulation immediately
C. Draw blood for a complete metabolic panel
D. Call for a CT scan appointment
Correct Answer: B
Rationale: The ABCs are the foundation of emergency assessment for any patient with acute
neurological deficits. Stroke patients are at risk for airway compromise due to altered
consciousness or bulbar dysfunction. Stabilization must precede diagnostic workup. Once
stable, emergent brain imaging (non-contrast CT) is obtained to differentiate ischemic from
hemorrhagic stroke.
High-Yield Pearl: ABCs always come first—even in stroke. You cannot treat what you haven't
stabilized. The CT scan happens after the patient is stable for transport.
Question 6
A patient presents with an ischemic stroke 3 hours after symptom onset. Which treatment
should the nurse anticipate?
A. Immediate anticoagulation with warfarin
, 4
B. Consideration of thrombolytic therapy (alteplase)
C. Administration of aspirin only
D. Observation and serial neurological checks
Correct Answer: B
Rationale: Alteplase (tPA) is indicated for ischemic stroke within 4.5 hours of symptom onset
(up to 3 hours is Class I evidence; 3–4.5 hours with additional criteria). Strict exclusion criteria
must be met (no hemorrhage on CT, no recent surgery, controlled blood pressure). This is the
only FDA-approved thrombolytic for acute ischemic stroke and significantly improves
functional outcomes.
High-Yield Pearl: The 4.5-hour window is your critical number. "Time is brain"—every minute
of delayed treatment costs millions of neurons.
Question 7
A patient with a head injury develops a severe headache, projectile vomiting, and a dilated,
non-reactive pupil. These findings are most consistent with:
A. Concussion
B. Increased intracranial pressure
C. Meningitis
D. Subarachnoid hemorrhage
Correct Answer: B
Rationale: Severe headache, vomiting (often projectile), and pupillary changes (especially
unilateral dilation from CN III compression) are classic signs of increased ICP. The dilated, non-
reactive pupil suggests uncal herniation, a neurosurgical emergency. While subarachnoid
hemorrhage can cause headache and vomiting, the pupillary change specifically localizes to
ICP and herniation.
High-Yield Pearl: "A blown pupil is a herniating brain." Unilateral pupillary dilation in a head-
injured patient = uncal herniation until proven otherwise.
Question 8
Cushing's triad includes which of the following findings?
A. Hypotension, tachycardia, tachypnea
NSG 555 Exam 2 Study Guide — Wilkes University
Nurse Practitioners in Primary Care II | 2026/2027
Curriculum | Complete Solutions
Welcome to your comprehensive exam preparation resource. This guide synthesizes high-yield
content across ten clinical domains, formatted for active learning and exam success. Let's
work through each section together.
PART A: ACUTE EMERGENCY CONDITIONS DRILL (Questions 1–15)
Question 1
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?
A. Obtain a chest X-ray
B. Administer oxygen and notify the provider immediately
C. Draw a D-dimer
D. Prepare the patient for a V/Q scan
Correct Answer: B
Rationale: Pulmonary embolism can cause rapid hypoxemia and hemodynamic collapse. The
priority is always to address life-threatening hypoxemia first. Oxygen administration improves
tissue perfusion while the provider is notified for definitive diagnosis and anticoagulation. A
chest X-ray, D-dimer, and V/Q scan are important diagnostic steps, but they do not take
precedence over stabilizing oxygenation.
High-Yield Pearl: In any suspected PE, remember the mantra: "Oxygen first, then investigate."
Hypoxemia kills faster than the time it takes to obtain imaging.
Question 2
A patient is diagnosed with a massive PE and is hemodynamically unstable. Which
intervention is most appropriate?
A. Start thrombolytics immediately
B. Administer IV fluids aggressively
, 2
C. Provide immediate anticoagulation and hemodynamic support
D. Place an inferior vena cava filter
Correct Answer: C
Rationale: Massive PE causes obstructive shock due to right ventricular failure. Immediate
anticoagulation (heparin) prevents further clot propagation, while hemodynamic support
(fluids cautiously, vasopressors if needed) maintains perfusion. Thrombolytics are reserved
for massive PE with hemodynamic instability and no contraindications, but anticoagulation
remains the foundation. Aggressive IV fluids can worsen right heart strain.
High-Yield Pearl: Massive PE = obstructive shock. The right ventricle fails, so fluid
administration must be cautious—too much fluid worsens RV dilation and left ventricular
compression.
Question 3
A 72-year-old male complains of crushing substernal chest pain radiating to his left arm. His
vital signs are stable. What is the first priority intervention?
A. Administer aspirin and oxygen immediately
B. Obtain a 12-lead ECG
C. Draw troponin levels
D. Administer sublingual nitroglycerin
Correct Answer: A
Rationale: In suspected acute MI, chewable aspirin (160–325 mg) and oxygen (if SpO₂ < 90%)
are administered immediately. Aspirin reduces platelet aggregation and mortality. While the
ECG and troponins are critical for diagnosis, they do not take precedence over interventions
that limit myocardial damage. Nitroglycerin is appropriate after aspirin if the patient is
hemodynamically stable and not hypotensive.
High-Yield Pearl: "Aspirin before ECG" in the exam context—unless the question specifies the
ECG has already been obtained. Early aspirin reduces mortality in acute MI.
Question 4
A patient with STEMI is being prepared for emergent reperfusion. Which statement best
describes the treatment goal?
A. Pain control is the primary objective
, 3
B. Time is muscle; rapid restoration of blood flow is critical
C. Anticoagulation alone is sufficient
D. Fibrinolytics are preferred over PCI in all cases
Correct Answer: B
Rationale: In STEMI, the occluded coronary artery must be reopened as quickly as possible to
preserve myocardium. The phrase "time is muscle" reflects the urgency. PCI (percutaneous
coronary intervention) is preferred over fibrinolytics when available within 90 minutes of first
medical contact. Anticoagulation supports but does not replace reperfusion.
High-Yield Pearl: Door-to-balloon time target is ≤90 minutes; door-to-needle time for
fibrinolytics is ≤30 minutes. Know these benchmarks.
Question 5
A patient arrives at the clinic with sudden onset unilateral weakness, facial droop, and slurred
speech. What is the priority action?
A. Obtain a detailed history from the family
B. Assess airway, breathing, and circulation immediately
C. Draw blood for a complete metabolic panel
D. Call for a CT scan appointment
Correct Answer: B
Rationale: The ABCs are the foundation of emergency assessment for any patient with acute
neurological deficits. Stroke patients are at risk for airway compromise due to altered
consciousness or bulbar dysfunction. Stabilization must precede diagnostic workup. Once
stable, emergent brain imaging (non-contrast CT) is obtained to differentiate ischemic from
hemorrhagic stroke.
High-Yield Pearl: ABCs always come first—even in stroke. You cannot treat what you haven't
stabilized. The CT scan happens after the patient is stable for transport.
Question 6
A patient presents with an ischemic stroke 3 hours after symptom onset. Which treatment
should the nurse anticipate?
A. Immediate anticoagulation with warfarin
, 4
B. Consideration of thrombolytic therapy (alteplase)
C. Administration of aspirin only
D. Observation and serial neurological checks
Correct Answer: B
Rationale: Alteplase (tPA) is indicated for ischemic stroke within 4.5 hours of symptom onset
(up to 3 hours is Class I evidence; 3–4.5 hours with additional criteria). Strict exclusion criteria
must be met (no hemorrhage on CT, no recent surgery, controlled blood pressure). This is the
only FDA-approved thrombolytic for acute ischemic stroke and significantly improves
functional outcomes.
High-Yield Pearl: The 4.5-hour window is your critical number. "Time is brain"—every minute
of delayed treatment costs millions of neurons.
Question 7
A patient with a head injury develops a severe headache, projectile vomiting, and a dilated,
non-reactive pupil. These findings are most consistent with:
A. Concussion
B. Increased intracranial pressure
C. Meningitis
D. Subarachnoid hemorrhage
Correct Answer: B
Rationale: Severe headache, vomiting (often projectile), and pupillary changes (especially
unilateral dilation from CN III compression) are classic signs of increased ICP. The dilated, non-
reactive pupil suggests uncal herniation, a neurosurgical emergency. While subarachnoid
hemorrhage can cause headache and vomiting, the pupillary change specifically localizes to
ICP and herniation.
High-Yield Pearl: "A blown pupil is a herniating brain." Unilateral pupillary dilation in a head-
injured patient = uncal herniation until proven otherwise.
Question 8
Cushing's triad includes which of the following findings?
A. Hypotension, tachycardia, tachypnea
