Wilkes University NSG 555 Exam 4 (pdf) | 2026/2027 | Nurse
Practitioners in Primary Care II Q&A | Nursing
1. A 55-year-old Black patient has a blood pressure of 148/92 mm Hg on two
separate visits. The patient has no comorbidities. What is the initial drug of
choice according to JNC 8 guidelines?
A) Lisinopril
B) Amlodipine
C) Hydrochlorothiazide
D) Metoprolol
Correct Answer: B) Amlodipine
Rationale: A calcium channel blocker (amlodipine) or thiazide diuretic is
recommended as first-line therapy in Black patients without chronic kidney
disease or heart failure. ACE inhibitors are less effective as monotherapy in
this population. JNC 8 guidelines recommend initial therapy with a thiazide-
type diuretic, CCB, ACE inhibitor, or ARB, but in Black patients, CCBs or
thiazides are preferred.
2. JNC 8 recommends a blood pressure goal for a diabetic patient under 60
years old of:
A) < 130/80 mm Hg
B) < 140/90 mm Hg
C) < 150/90 mm Hg
D) < 125/75 mm Hg
Correct Answer: B) < 140/90 mm Hg
Rationale: JNC 8 recommends a target BP of < 140/90 mm Hg for diabetic
patients under 60 years of age. ACC/AHA 2017 recommends < 130/80 mm
,Hg, but NSG 555 follows JNC 8 guidelines. For patients aged 60 and older, the
target is < 150/90 mm Hg.
3. Which medication is contraindicated in pregnancy?
A) Methyldopa
B) Labetalol
C) ACE inhibitors
D) Nifedipine
Correct Answer: C) ACE inhibitors
Rationale: ACE inhibitors and ARBs are contraindicated in pregnancy due to
the risk of fetal renal dysplasia, oligohydramnios, and fetal death.
Methyldopa, labetalol, and nifedipine are considered safe alternatives for
managing hypertension during pregnancy.
4. A 72-year-old patient with a history of 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. Digoxin may be used for symptom
control but does not provide mortality benefit.
5. 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. Fresh frozen plasma is for life-threatening bleeding.
6. 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.
, 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 unstable angina is admitted to the hospital. Which cardiac
biomarker is most specific for myocardial injury?
A) CK-MB
B) Troponin I
C) Myoglobin
D) BNP
Correct Answer: B) Troponin I
Rationale: Troponin I is the most specific and sensitive cardiac biomarker for
myocardial injury. It rises within 3-4 hours of infarction and remains elevated
for up to 10-14 days. CK-MB is less specific, myoglobin is early but non-
specific, and BNP indicates heart failure.
Practitioners in Primary Care II Q&A | Nursing
1. A 55-year-old Black patient has a blood pressure of 148/92 mm Hg on two
separate visits. The patient has no comorbidities. What is the initial drug of
choice according to JNC 8 guidelines?
A) Lisinopril
B) Amlodipine
C) Hydrochlorothiazide
D) Metoprolol
Correct Answer: B) Amlodipine
Rationale: A calcium channel blocker (amlodipine) or thiazide diuretic is
recommended as first-line therapy in Black patients without chronic kidney
disease or heart failure. ACE inhibitors are less effective as monotherapy in
this population. JNC 8 guidelines recommend initial therapy with a thiazide-
type diuretic, CCB, ACE inhibitor, or ARB, but in Black patients, CCBs or
thiazides are preferred.
2. JNC 8 recommends a blood pressure goal for a diabetic patient under 60
years old of:
A) < 130/80 mm Hg
B) < 140/90 mm Hg
C) < 150/90 mm Hg
D) < 125/75 mm Hg
Correct Answer: B) < 140/90 mm Hg
Rationale: JNC 8 recommends a target BP of < 140/90 mm Hg for diabetic
patients under 60 years of age. ACC/AHA 2017 recommends < 130/80 mm
,Hg, but NSG 555 follows JNC 8 guidelines. For patients aged 60 and older, the
target is < 150/90 mm Hg.
3. Which medication is contraindicated in pregnancy?
A) Methyldopa
B) Labetalol
C) ACE inhibitors
D) Nifedipine
Correct Answer: C) ACE inhibitors
Rationale: ACE inhibitors and ARBs are contraindicated in pregnancy due to
the risk of fetal renal dysplasia, oligohydramnios, and fetal death.
Methyldopa, labetalol, and nifedipine are considered safe alternatives for
managing hypertension during pregnancy.
4. A 72-year-old patient with a history of 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. Digoxin may be used for symptom
control but does not provide mortality benefit.
5. 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. Fresh frozen plasma is for life-threatening bleeding.
6. 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.
, 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 unstable angina is admitted to the hospital. Which cardiac
biomarker is most specific for myocardial injury?
A) CK-MB
B) Troponin I
C) Myoglobin
D) BNP
Correct Answer: B) Troponin I
Rationale: Troponin I is the most specific and sensitive cardiac biomarker for
myocardial injury. It rises within 3-4 hours of infarction and remains elevated
for up to 10-14 days. CK-MB is less specific, myoglobin is early but non-
specific, and BNP indicates heart failure.
