Nurse Practitioners in Primary
Care II
Wilkes University
NSG555/NSG 555 Exam 4
Questions & Answers Plus
Detailed Rationales
Latest 2026 | PDF
THIS EXAM CONTAINS:
✓100% Pass
✓Multiple Choice ( A-D)
✓Detailed Rationales For Each Question
✓Correct Answers For Each Question
✓100 Qs & Answers
,SECTION 1: Hypertension Management (Questions 1-10)
Question 1
A 55-year-old Black patient has a blood pressure of 148/92
mmHg on two separate visits. The patient has no comorbidities.
What is the initial drug of choice?
A. Lisinopril
B. Amlodipine
C. Hydrochlorothiazide
D. Metoprolol
Answer: B. Amlodipine
Rationale: A calcium channel blocker (amlodipine) or thiazide
diuretic is recommended as first-line therapy in Black patients
without CKD or heart failure. ACE inhibitors (lisinopril) are less
effective as monotherapy in this population due to lower renin
levels. JNC 8 guidelines support this recommendation. Metoprolol
(beta-blocker) is not recommended as initial therapy for
hypertension without other indications.
Question 2
According to JNC 8 guidelines, what is the recommended blood
pressure goal for a diabetic patient under 60 years old?
A. < 130/80 mmHg
B. < 140/90 mmHg
,C. < 150/90 mmHg
D. < 125/75 mmHg
Answer: B. < 140/90 mmHg
Rationale: JNC 8 recommends a target BP of < 140/90 mmHg for
diabetic patients under 60 years old. The ACC/AHA 2017
guidelines recommend < 130/80 mmHg, but NSG 555 follows JNC
8 guidelines. For patients aged 60 and older without CKD or
diabetes, the target is < 150/90 mmHg.
Question 3
Which antihypertensive medication is contraindicated in
pregnancy?
A. Methyldopa
B. Labetalol
C. Lisinopril
D. Nifedipine
Answer: C. Lisinopril
Rationale: ACE inhibitors (lisinopril) and ARBs are
contraindicated in pregnancy due to the risk of fetal renal
damage, oligohydramnios, and fetal death. Methyldopa, labetalol,
and nifedipine are considered safe for use in pregnancy.
Methyldopa is a first-line agent for chronic hypertension in
pregnancy. Beta-blockers (labetalol) and calcium channel
blockers (nifedipine) are also used.
, Question 4
A 68-year-old patient with hypertension and CKD stage 3 has a
blood pressure of 152/90 mmHg on lisinopril 20 mg daily. What
is the most appropriate next step?
A. Increase lisinopril to 40 mg daily
B. Add amlodipine 5 mg daily
C. Add hydrochlorothiazide 12.5 mg daily
D. Add metoprolol 25 mg daily
Answer: B. Add amlodipine 5 mg daily
Rationale: This patient has CKD with hypertension and is
already on an ACE inhibitor (lisinopril). The blood pressure
remains above the target of < 130/80 mmHg for patients with
CKD. The most appropriate next step is to add a calcium channel
blocker (amlodipine), which is effective and well-tolerated in
patients with CKD. Thiazide diuretics are less effective at this
level of renal function (eGFR 30-59 mL/min). Metoprolol is not
the preferred add-on therapy.
Question 5
A 62-year-old patient with hypertension and heart failure with
reduced ejection fraction (HFrEF) is started on
sacubitril/valsartan (Entresto). Which of the following is a
contraindication to this medication?
A. History of angioedema with ACE inhibitors
B. Serum potassium of 4.8 mEq/L
C. Mild renal impairment (eGFR 55 mL/min)
D. History of diabetes
Care II
Wilkes University
NSG555/NSG 555 Exam 4
Questions & Answers Plus
Detailed Rationales
Latest 2026 | PDF
THIS EXAM CONTAINS:
✓100% Pass
✓Multiple Choice ( A-D)
✓Detailed Rationales For Each Question
✓Correct Answers For Each Question
✓100 Qs & Answers
,SECTION 1: Hypertension Management (Questions 1-10)
Question 1
A 55-year-old Black patient has a blood pressure of 148/92
mmHg on two separate visits. The patient has no comorbidities.
What is the initial drug of choice?
A. Lisinopril
B. Amlodipine
C. Hydrochlorothiazide
D. Metoprolol
Answer: B. Amlodipine
Rationale: A calcium channel blocker (amlodipine) or thiazide
diuretic is recommended as first-line therapy in Black patients
without CKD or heart failure. ACE inhibitors (lisinopril) are less
effective as monotherapy in this population due to lower renin
levels. JNC 8 guidelines support this recommendation. Metoprolol
(beta-blocker) is not recommended as initial therapy for
hypertension without other indications.
Question 2
According to JNC 8 guidelines, what is the recommended blood
pressure goal for a diabetic patient under 60 years old?
A. < 130/80 mmHg
B. < 140/90 mmHg
,C. < 150/90 mmHg
D. < 125/75 mmHg
Answer: B. < 140/90 mmHg
Rationale: JNC 8 recommends a target BP of < 140/90 mmHg for
diabetic patients under 60 years old. The ACC/AHA 2017
guidelines recommend < 130/80 mmHg, but NSG 555 follows JNC
8 guidelines. For patients aged 60 and older without CKD or
diabetes, the target is < 150/90 mmHg.
Question 3
Which antihypertensive medication is contraindicated in
pregnancy?
A. Methyldopa
B. Labetalol
C. Lisinopril
D. Nifedipine
Answer: C. Lisinopril
Rationale: ACE inhibitors (lisinopril) and ARBs are
contraindicated in pregnancy due to the risk of fetal renal
damage, oligohydramnios, and fetal death. Methyldopa, labetalol,
and nifedipine are considered safe for use in pregnancy.
Methyldopa is a first-line agent for chronic hypertension in
pregnancy. Beta-blockers (labetalol) and calcium channel
blockers (nifedipine) are also used.
, Question 4
A 68-year-old patient with hypertension and CKD stage 3 has a
blood pressure of 152/90 mmHg on lisinopril 20 mg daily. What
is the most appropriate next step?
A. Increase lisinopril to 40 mg daily
B. Add amlodipine 5 mg daily
C. Add hydrochlorothiazide 12.5 mg daily
D. Add metoprolol 25 mg daily
Answer: B. Add amlodipine 5 mg daily
Rationale: This patient has CKD with hypertension and is
already on an ACE inhibitor (lisinopril). The blood pressure
remains above the target of < 130/80 mmHg for patients with
CKD. The most appropriate next step is to add a calcium channel
blocker (amlodipine), which is effective and well-tolerated in
patients with CKD. Thiazide diuretics are less effective at this
level of renal function (eGFR 30-59 mL/min). Metoprolol is not
the preferred add-on therapy.
Question 5
A 62-year-old patient with hypertension and heart failure with
reduced ejection fraction (HFrEF) is started on
sacubitril/valsartan (Entresto). Which of the following is a
contraindication to this medication?
A. History of angioedema with ACE inhibitors
B. Serum potassium of 4.8 mEq/L
C. Mild renal impairment (eGFR 55 mL/min)
D. History of diabetes
