Wilkes University NSG 555 Exam 1 (pdf) | 2026/2027 | Nurse
Practitioners in Primary Care II Q&A | Nursing
1. A 62-year-old patient with a history of hypertension and type 2 diabetes
presents for a routine visit. Blood pressure is 148/88 mmHg. The patient is
currently on lisinopril 20 mg daily. Which medication should be added next
according to ACC/AHA guidelines?
A) Hydrochlorothiazide
B) Amlodipine
C) Metoprolol
D) Clonidine
Correct Answer: B) Amlodipine
Rationale: ACC/AHA guidelines recommend adding a calcium channel blocker
(amlodipine) or a thiazide diuretic. In patients with diabetes, CCBs are often
preferred due to metabolic neutrality. The target blood pressure for patients
with diabetes is < 130/80 mmHg. Amlodipine is a first-line add-on agent.
2. A 68-year-old patient with a history of myocardial infarction has an LDL of
145 mg/dL. The patient is currently on atorvastatin 20 mg daily. What is the
next step in management?
A) Increase atorvastatin to 40 mg daily
B) Add ezetimibe
C) Add a PCSK9 inhibitor
D) Continue current therapy and reassess in 6 months
Correct Answer: A) Increase atorvastatin to 40 mg daily
Rationale: For patients with established ASCVD (history of MI), the LDL target
is < 70 mg/dL or a ≥ 50% reduction from baseline. Atorvastatin 20 mg is a
,moderate-intensity statin. Increasing to 40 mg (high-intensity) is the next
step. Ezetimibe and PCSK9 inhibitors are add-on therapies for patients who
do not reach goal on maximally tolerated statin therapy.
3. A 55-year-old patient presents with a blood pressure of 152/94 mmHg on
two separate occasions. The patient has no other comorbidities. What is the
most appropriate initial treatment?
A) Start a thiazide diuretic
B) Recommend lifestyle modifications alone
C) Start an ACE inhibitor
D) Start a calcium channel blocker
Correct Answer: B) Recommend lifestyle modifications alone
Rationale: For patients with Stage 1 hypertension (130-139/80-89) who are at
low risk (no ASCVD, no target organ damage), lifestyle modifications are the
first-line treatment. If blood pressure remains elevated after 3-6 months,
pharmacotherapy should be initiated. This patient has Stage 2 hypertension
(≥ 140/90), so lifestyle modifications alone are insufficient.
4. A 70-year-old patient with heart failure with reduced ejection fraction
(HFrEF) is on carvedilol, lisinopril, and furosemide. The EF is 35% and the
patient remains symptomatic (NYHA class III). Which medication should be
added?
A) Digoxin
B) Spironolactone
C) Hydralazine
D) Isosorbide dinitrate
Correct Answer: B) Spironolactone
,Rationale: Spironolactone (or eplerenone) reduces mortality and
hospitalizations in HFrEF patients with NYHA class II-IV and EF ≤ 35%.
Hydralazine/isosorbide dinitrate is used in African American patients who
remain symptomatic on optimal therapy.
5. A patient with atrial fibrillation is started on warfarin. The INR is 1.2 after 2
weeks of therapy. What is the most likely cause?
A) Non-adherence
B) Drug interaction (e.g., vitamin K intake, rifampin)
C) Liver disease
D) Laboratory error
Correct Answer: B) Drug interaction (e.g., vitamin K intake, rifampin)
Rationale: Subtherapeutic INR (1.2) may be due to increased vitamin K intake
or drugs that induce warfarin metabolism (e.g., rifampin, carbamazepine).
Non-adherence is also possible, but drug interactions are common. The
therapeutic range for warfarin in atrial fibrillation is INR 2.0-3.0.
6. A patient with angina undergoes an exercise stress test. Which finding
suggests a positive test for ischemia?
A) ST elevation during exercise
B) Horizontal or downsloping ST depression ≥ 1 mm
C) T wave inversion
D) Premature ventricular contractions
Correct Answer: B) Horizontal or downsloping ST depression ≥ 1 mm
, Rationale: Horizontal or downsloping ST depression ≥ 1 mm is the most
specific ECG finding for myocardial ischemia during exercise. ST elevation
during exercise may indicate a myocardial infarction. T-wave inversions and
PVCs are non-specific findings.
7. A patient with a bradyarrhythmia (heart rate 38 bpm) and syncope is
found to have complete heart block. What is the treatment?
A) Atropine IV
B) Permanent pacemaker placement
C) Isoproterenol infusion
D) Discontinue rate-controlling medications
Correct Answer: B) Permanent pacemaker placement
Rationale: Complete heart block with symptoms (syncope) requires
permanent pacemaker placement. Atropine is for unstable bradycardia but is
not definitive treatment. Isoproterenol is used for temporary management in
emergency settings.
8. A patient with suspected heart failure with preserved ejection fraction
(HFpEF) should be managed with:
A) ACE inhibitors and beta-blockers
B) Treatment of hypertension and volume management with diuretics
C) ARNI (sacubitril/valsartan)
D) Digoxin
Correct Answer: B) Treatment of hypertension and volume management with
diuretics
Practitioners in Primary Care II Q&A | Nursing
1. A 62-year-old patient with a history of hypertension and type 2 diabetes
presents for a routine visit. Blood pressure is 148/88 mmHg. The patient is
currently on lisinopril 20 mg daily. Which medication should be added next
according to ACC/AHA guidelines?
A) Hydrochlorothiazide
B) Amlodipine
C) Metoprolol
D) Clonidine
Correct Answer: B) Amlodipine
Rationale: ACC/AHA guidelines recommend adding a calcium channel blocker
(amlodipine) or a thiazide diuretic. In patients with diabetes, CCBs are often
preferred due to metabolic neutrality. The target blood pressure for patients
with diabetes is < 130/80 mmHg. Amlodipine is a first-line add-on agent.
2. A 68-year-old patient with a history of myocardial infarction has an LDL of
145 mg/dL. The patient is currently on atorvastatin 20 mg daily. What is the
next step in management?
A) Increase atorvastatin to 40 mg daily
B) Add ezetimibe
C) Add a PCSK9 inhibitor
D) Continue current therapy and reassess in 6 months
Correct Answer: A) Increase atorvastatin to 40 mg daily
Rationale: For patients with established ASCVD (history of MI), the LDL target
is < 70 mg/dL or a ≥ 50% reduction from baseline. Atorvastatin 20 mg is a
,moderate-intensity statin. Increasing to 40 mg (high-intensity) is the next
step. Ezetimibe and PCSK9 inhibitors are add-on therapies for patients who
do not reach goal on maximally tolerated statin therapy.
3. A 55-year-old patient presents with a blood pressure of 152/94 mmHg on
two separate occasions. The patient has no other comorbidities. What is the
most appropriate initial treatment?
A) Start a thiazide diuretic
B) Recommend lifestyle modifications alone
C) Start an ACE inhibitor
D) Start a calcium channel blocker
Correct Answer: B) Recommend lifestyle modifications alone
Rationale: For patients with Stage 1 hypertension (130-139/80-89) who are at
low risk (no ASCVD, no target organ damage), lifestyle modifications are the
first-line treatment. If blood pressure remains elevated after 3-6 months,
pharmacotherapy should be initiated. This patient has Stage 2 hypertension
(≥ 140/90), so lifestyle modifications alone are insufficient.
4. A 70-year-old patient with heart failure with reduced ejection fraction
(HFrEF) is on carvedilol, lisinopril, and furosemide. The EF is 35% and the
patient remains symptomatic (NYHA class III). Which medication should be
added?
A) Digoxin
B) Spironolactone
C) Hydralazine
D) Isosorbide dinitrate
Correct Answer: B) Spironolactone
,Rationale: Spironolactone (or eplerenone) reduces mortality and
hospitalizations in HFrEF patients with NYHA class II-IV and EF ≤ 35%.
Hydralazine/isosorbide dinitrate is used in African American patients who
remain symptomatic on optimal therapy.
5. A patient with atrial fibrillation is started on warfarin. The INR is 1.2 after 2
weeks of therapy. What is the most likely cause?
A) Non-adherence
B) Drug interaction (e.g., vitamin K intake, rifampin)
C) Liver disease
D) Laboratory error
Correct Answer: B) Drug interaction (e.g., vitamin K intake, rifampin)
Rationale: Subtherapeutic INR (1.2) may be due to increased vitamin K intake
or drugs that induce warfarin metabolism (e.g., rifampin, carbamazepine).
Non-adherence is also possible, but drug interactions are common. The
therapeutic range for warfarin in atrial fibrillation is INR 2.0-3.0.
6. A patient with angina undergoes an exercise stress test. Which finding
suggests a positive test for ischemia?
A) ST elevation during exercise
B) Horizontal or downsloping ST depression ≥ 1 mm
C) T wave inversion
D) Premature ventricular contractions
Correct Answer: B) Horizontal or downsloping ST depression ≥ 1 mm
, Rationale: Horizontal or downsloping ST depression ≥ 1 mm is the most
specific ECG finding for myocardial ischemia during exercise. ST elevation
during exercise may indicate a myocardial infarction. T-wave inversions and
PVCs are non-specific findings.
7. A patient with a bradyarrhythmia (heart rate 38 bpm) and syncope is
found to have complete heart block. What is the treatment?
A) Atropine IV
B) Permanent pacemaker placement
C) Isoproterenol infusion
D) Discontinue rate-controlling medications
Correct Answer: B) Permanent pacemaker placement
Rationale: Complete heart block with symptoms (syncope) requires
permanent pacemaker placement. Atropine is for unstable bradycardia but is
not definitive treatment. Isoproterenol is used for temporary management in
emergency settings.
8. A patient with suspected heart failure with preserved ejection fraction
(HFpEF) should be managed with:
A) ACE inhibitors and beta-blockers
B) Treatment of hypertension and volume management with diuretics
C) ARNI (sacubitril/valsartan)
D) Digoxin
Correct Answer: B) Treatment of hypertension and volume management with
diuretics
