,NSG555/NSG 555 Exam 2 Nurse Practitioners in
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: Administer oxygen and notify the provider immediately
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.
2. A patient is diagnosed with a massive pulmonary embolism and is hemodynamically unstable.
Which intervention is most appropriate?
A) Start thrombolytics immediately
B) Administer IV fluids aggressively
C) Provide immediate anticoagulation and hemodynamic support
D) Place an inferior vena cava filter
Correct Answer: Provide immediate anticoagulation and hemodynamic support
Rationale: Massive PE causes obstructive shock due to right ventricular failure. Immediate
anticoagulation (heparin) prevents further clot propagation, while hemodynamic support maintains
perfusion. Thrombolytics are reserved for massive PE with hemodynamic instability and no
contraindications.
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: Administer aspirin and oxygen immediately
,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 ECG and
troponins are critical for diagnosis, they do not take precedence over interventions that limit
myocardial damage.
4. A patient with ST-elevation myocardial infarction is being prepared for emergent reperfusion.
Which statement best describes the treatment goal?
A) Pain control is the primary objective
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: Time is muscle; rapid restoration of blood flow is critical
Rationale: In STEMI, rapid restoration of blood flow to the ischemic myocardium is the primary goal to
limit infarct size and reduce mortality. Primary PCI is preferred over fibrinolytics when available within
90 minutes.
5. According to the JNC 8 guidelines emphasized in NSG 555, what is the blood pressure target for a
65-year-old patient with no history of diabetes or chronic kidney disease?
A) <120/80 mmHg
B) <130/80 mmHg
C) <140/90 mmHg
D) <150/90 mmHg
Correct Answer: <150/90 mmHg
Rationale: JNC 8 explicitly states that for adults ≥60 years of age without diabetes or CKD, the
treatment target is <150/90 mmHg. (Note: ACC/AHA 2017 recommends <130/80, but Wilkes NSG 555
tests strictly on JNC 8).
6. What is the JNC 8 blood pressure target for a 45-year-old patient with a history of Type 2 Diabetes?
A) <130/80 mmHg
B) <140/90 mmHg
C) <150/90 mmHg
D) <120/80 mmHg
, Correct Answer: <140/90 mmHg
Rationale: JNC 8 recommends a blood pressure target of <140/90 mmHg for patients with diabetes or
chronic kidney disease, regardless of age. This is a key distinction from the ACC/AHA 2017 guidelines,
which recommend <130/80.
7. A 58-year-old patient with Type 2 Diabetes has an A1c of 8.5%. They are currently taking Metformin
1000 mg BID and have no contraindications to additional therapy. What is the most appropriate next
step in management?
A) Increase Metformin to 1500 mg BID
B) Add a Sulfonylurea
C) Add an SGLT-2 inhibitor
D) Start basal insulin
Correct Answer: Add an SGLT-2 inhibitor
Rationale: The patient is at goal maximum dose of metformin but has an A1c >7%. SGLT-2 inhibitors
are recommended as a second-line agent due to their proven cardiovascular and renal benefits,
independent of their glucose-lowering effects.
8. A 65-year-old patient with Type 2 Diabetes and an eGFR of 45 mL/min asks if they can continue
taking Metformin. What is your response?
A) Stop it immediately; it is strictly contraindicated
B) Continue it, but monitor closely; dose reduction may be needed
C) Double the dose to compensate for renal clearance
D) Switch to a sulfonylurea immediately
Correct Answer: Continue it, but monitor closely; dose reduction may be needed
Rationale: Metformin is contraindicated when eGFR is <30 mL/min. In Stage 3 CKD (eGFR 30-59), it can
be used cautiously, often requiring a dose reduction, with regular monitoring of renal function.
9. Which medication class has been shown to reduce major adverse cardiovascular events in patients
with type 2 diabetes and high cardiovascular risk, based on the LEADER trial?
A) DPP-4 inhibitors
B) SGLT-2 inhibitors
C) GLP-1 receptor agonists
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: Administer oxygen and notify the provider immediately
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.
2. A patient is diagnosed with a massive pulmonary embolism and is hemodynamically unstable.
Which intervention is most appropriate?
A) Start thrombolytics immediately
B) Administer IV fluids aggressively
C) Provide immediate anticoagulation and hemodynamic support
D) Place an inferior vena cava filter
Correct Answer: Provide immediate anticoagulation and hemodynamic support
Rationale: Massive PE causes obstructive shock due to right ventricular failure. Immediate
anticoagulation (heparin) prevents further clot propagation, while hemodynamic support maintains
perfusion. Thrombolytics are reserved for massive PE with hemodynamic instability and no
contraindications.
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: Administer aspirin and oxygen immediately
,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 ECG and
troponins are critical for diagnosis, they do not take precedence over interventions that limit
myocardial damage.
4. A patient with ST-elevation myocardial infarction is being prepared for emergent reperfusion.
Which statement best describes the treatment goal?
A) Pain control is the primary objective
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: Time is muscle; rapid restoration of blood flow is critical
Rationale: In STEMI, rapid restoration of blood flow to the ischemic myocardium is the primary goal to
limit infarct size and reduce mortality. Primary PCI is preferred over fibrinolytics when available within
90 minutes.
5. According to the JNC 8 guidelines emphasized in NSG 555, what is the blood pressure target for a
65-year-old patient with no history of diabetes or chronic kidney disease?
A) <120/80 mmHg
B) <130/80 mmHg
C) <140/90 mmHg
D) <150/90 mmHg
Correct Answer: <150/90 mmHg
Rationale: JNC 8 explicitly states that for adults ≥60 years of age without diabetes or CKD, the
treatment target is <150/90 mmHg. (Note: ACC/AHA 2017 recommends <130/80, but Wilkes NSG 555
tests strictly on JNC 8).
6. What is the JNC 8 blood pressure target for a 45-year-old patient with a history of Type 2 Diabetes?
A) <130/80 mmHg
B) <140/90 mmHg
C) <150/90 mmHg
D) <120/80 mmHg
, Correct Answer: <140/90 mmHg
Rationale: JNC 8 recommends a blood pressure target of <140/90 mmHg for patients with diabetes or
chronic kidney disease, regardless of age. This is a key distinction from the ACC/AHA 2017 guidelines,
which recommend <130/80.
7. A 58-year-old patient with Type 2 Diabetes has an A1c of 8.5%. They are currently taking Metformin
1000 mg BID and have no contraindications to additional therapy. What is the most appropriate next
step in management?
A) Increase Metformin to 1500 mg BID
B) Add a Sulfonylurea
C) Add an SGLT-2 inhibitor
D) Start basal insulin
Correct Answer: Add an SGLT-2 inhibitor
Rationale: The patient is at goal maximum dose of metformin but has an A1c >7%. SGLT-2 inhibitors
are recommended as a second-line agent due to their proven cardiovascular and renal benefits,
independent of their glucose-lowering effects.
8. A 65-year-old patient with Type 2 Diabetes and an eGFR of 45 mL/min asks if they can continue
taking Metformin. What is your response?
A) Stop it immediately; it is strictly contraindicated
B) Continue it, but monitor closely; dose reduction may be needed
C) Double the dose to compensate for renal clearance
D) Switch to a sulfonylurea immediately
Correct Answer: Continue it, but monitor closely; dose reduction may be needed
Rationale: Metformin is contraindicated when eGFR is <30 mL/min. In Stage 3 CKD (eGFR 30-59), it can
be used cautiously, often requiring a dose reduction, with regular monitoring of renal function.
9. Which medication class has been shown to reduce major adverse cardiovascular events in patients
with type 2 diabetes and high cardiovascular risk, based on the LEADER trial?
A) DPP-4 inhibitors
B) SGLT-2 inhibitors
C) GLP-1 receptor agonists
