Wilkes University NSG 555 Exam 3 (pdf) | 2026/2027 | Nurse
Practitioners in Primary Care II Q&A | Nursing
1. A 58-year-old male with hypertension reports substernal chest pressure
when walking uphill that resolves with rest. His ECG is normal. What is the
most appropriate next step?
A) Coronary angiography
B) Stress testing (exercise treadmill or nuclear)
C) Prescribe nitroglycerin and discharge
D) Repeat ECG in 1 hour
Correct Answer: B) Stress testing (exercise treadmill or nuclear)
Rationale: Classic stable angina requires risk stratification. A normal resting
ECG does not rule out coronary artery disease (CAD). Stress testing assesses
for inducible ischemia and guides further management. Coronary
angiography is reserved for patients with high-risk features or positive stress
tests.
2. A 72-year-old female has a new murmur, mid-systolic click, and late
systolic murmur at the apex. These findings suggest:
A) Aortic stenosis
B) Mitral valve prolapse
C) Mitral stenosis
D) Tricuspid regurgitation
Correct Answer: B) Mitral valve prolapse
Rationale: A mid-systolic click followed by a late systolic murmur at the apex
is classic for mitral valve prolapse (MVP). MVP is the most common cause of
mitral regurgitation. Aortic stenosis presents with a systolic ejection murmur
,at the right upper sternal border. Mitral stenosis presents with a diastolic
rumble at the apex.
3. 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.
4. A 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 being evaluated for stroke risk. Which
score is used to assess stroke risk in atrial fibrillation?
A) CHA₂DS₂-VASc
B) HAS-BLED
C) CURB-65
D) Wells criteria
Correct Answer: A) CHA₂DS₂-VASc
Rationale: The CHA₂DS₂-VASc score is used to assess stroke risk in patients
with atrial fibrillation. The HAS-BLED score is used to assess bleeding risk.
CURB-65 is used for pneumonia severity, and Wells criteria are used for
pulmonary embolism.
6. A patient with a history of venous thromboembolism is started on warfarin.
The INR is 5.2 without bleeding. What is the appropriate action?
A) Administer vitamin K 10 mg IV
B) Hold warfarin and reduce the maintenance dose
C) Increase warfarin dose
D) Give fresh frozen plasma
Correct Answer: B) Hold warfarin and reduce the maintenance dose
Rationale: An INR of 5.2 is above the therapeutic range (2-3). For INR > 5.0
without bleeding, holding warfarin and reducing the maintenance dose is
, appropriate. Vitamin K is reserved for INR > 5.0 with bleeding risk factors or
active bleeding.
7. A patient with peripheral artery disease has an ankle-brachial index (ABI)
of 0.75. This indicates:
A) Normal arterial circulation
B) Mild peripheral artery disease
C) Moderate peripheral artery disease
D) Severe peripheral artery disease
Correct Answer: C) Moderate peripheral artery disease
Rationale: ABI interpretation: Normal (1.0-1.4), Mild PAD (0.71-0.90),
Moderate PAD (0.41-0.70), Severe PAD (< 0.40). An ABI of 0.75 indicates
moderate PAD and is associated with claudication.
8. A patient with suspected pericarditis presents with chest pain that is worse
when lying flat and improves when sitting up and leaning forward. What is
the most likely diagnosis?
A) Myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Aortic dissection
Correct Answer: B) Pericarditis
Rationale: Pericarditis pain is typically pleuritic, worse when lying flat, and
improves when sitting up and leaning forward. A pericardial friction rub may
be audible on auscultation. The pain is often sharp and may be associated
with fever.
Practitioners in Primary Care II Q&A | Nursing
1. A 58-year-old male with hypertension reports substernal chest pressure
when walking uphill that resolves with rest. His ECG is normal. What is the
most appropriate next step?
A) Coronary angiography
B) Stress testing (exercise treadmill or nuclear)
C) Prescribe nitroglycerin and discharge
D) Repeat ECG in 1 hour
Correct Answer: B) Stress testing (exercise treadmill or nuclear)
Rationale: Classic stable angina requires risk stratification. A normal resting
ECG does not rule out coronary artery disease (CAD). Stress testing assesses
for inducible ischemia and guides further management. Coronary
angiography is reserved for patients with high-risk features or positive stress
tests.
2. A 72-year-old female has a new murmur, mid-systolic click, and late
systolic murmur at the apex. These findings suggest:
A) Aortic stenosis
B) Mitral valve prolapse
C) Mitral stenosis
D) Tricuspid regurgitation
Correct Answer: B) Mitral valve prolapse
Rationale: A mid-systolic click followed by a late systolic murmur at the apex
is classic for mitral valve prolapse (MVP). MVP is the most common cause of
mitral regurgitation. Aortic stenosis presents with a systolic ejection murmur
,at the right upper sternal border. Mitral stenosis presents with a diastolic
rumble at the apex.
3. 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.
4. A 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 being evaluated for stroke risk. Which
score is used to assess stroke risk in atrial fibrillation?
A) CHA₂DS₂-VASc
B) HAS-BLED
C) CURB-65
D) Wells criteria
Correct Answer: A) CHA₂DS₂-VASc
Rationale: The CHA₂DS₂-VASc score is used to assess stroke risk in patients
with atrial fibrillation. The HAS-BLED score is used to assess bleeding risk.
CURB-65 is used for pneumonia severity, and Wells criteria are used for
pulmonary embolism.
6. A patient with a history of venous thromboembolism is started on warfarin.
The INR is 5.2 without bleeding. What is the appropriate action?
A) Administer vitamin K 10 mg IV
B) Hold warfarin and reduce the maintenance dose
C) Increase warfarin dose
D) Give fresh frozen plasma
Correct Answer: B) Hold warfarin and reduce the maintenance dose
Rationale: An INR of 5.2 is above the therapeutic range (2-3). For INR > 5.0
without bleeding, holding warfarin and reducing the maintenance dose is
, appropriate. Vitamin K is reserved for INR > 5.0 with bleeding risk factors or
active bleeding.
7. A patient with peripheral artery disease has an ankle-brachial index (ABI)
of 0.75. This indicates:
A) Normal arterial circulation
B) Mild peripheral artery disease
C) Moderate peripheral artery disease
D) Severe peripheral artery disease
Correct Answer: C) Moderate peripheral artery disease
Rationale: ABI interpretation: Normal (1.0-1.4), Mild PAD (0.71-0.90),
Moderate PAD (0.41-0.70), Severe PAD (< 0.40). An ABI of 0.75 indicates
moderate PAD and is associated with claudication.
8. A patient with suspected pericarditis presents with chest pain that is worse
when lying flat and improves when sitting up and leaning forward. What is
the most likely diagnosis?
A) Myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Aortic dissection
Correct Answer: B) Pericarditis
Rationale: Pericarditis pain is typically pleuritic, worse when lying flat, and
improves when sitting up and leaning forward. A pericardial friction rub may
be audible on auscultation. The pain is often sharp and may be associated
with fever.
