NSG 555 | Exam 1 Comprehensive Practice | 2026/2027 UPDATE
NSG 555
NURSE PRACTITIONERS IN PRIMARY CARE II
Comprehensive Practice – Exam 1 Review
UPDATE
50 Multiple-Choice Questions
Complete Answers with Explained Rationales
Aligned with Current Clinical Guidelines
Wilkes University | Advanced Practice Nursing
Cardiovascular • Pulmonary • Endocrine • GI • MSK • Infectious Disease
For academic study and clinical review • Verify with current institutional protocols
Page 1
,NSG 555 | Exam 1 Comprehensive Practice | 2026/2027 UPDATE
How to Use This Review
This comprehensive exam review contains high-yield multiple-choice questions covering the core clinical
management topics of NSG 555 – Nurse Practitioners in Primary Care II. Each item is followed by the correct
answer and rationales that explain the underlying pathophysiology or guideline recommendation, why the correct
option is preferred, and why the distractors are incorrect.
Topics span cardiovascular disease, pulmonary medicine, endocrinology, gastroenterology, rheumatology,
infectious disease, hematology, nephrology, ophthalmology, urology, geriatrics, and preventive care guidelines
(USPSTF, ADA, GOLD, AHA/ACC, Beers Criteria).
Study tip: Attempt each question before reading the answer. Then carefully review the rationale—paying special
attention to the clinical decision-making points that distinguish the correct choice from plausible alternatives.
Topic Index (Selected High-Yield Areas)
• Heart Failure (HFrEF / HFpEF) & ARNI therapy
• SGLT2 inhibitors – renal & cardiovascular effects
• COPD / Asthma management & GOLD staging
• Atrial Fibrillation, CHA■DS■-VASc & DOAC preference
• Type 2 Diabetes – first-line & cardiorenal agents
• Thyroid disorders & subclinical hypothyroidism
• Gout, Osteoarthritis, and rheumatologic management
• Community-acquired pneumonia (ATS/IDSA)
• Iron-deficiency anemia & GI malignancy work-up
• Hypertension guidelines (ACC/AHA)
• BPH, CKD medication safety, Beers Criteria
• Acute chest pain differentials & ophthalmologic emergencies
• Lyme disease, herpes zoster, infectious disease
Page 2
, NSG 555 | Exam 1 Comprehensive Practice | 2026/2027 UPDATE
Question 1
A 62-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease
(CKD) Stage 3 presents for hypertension management. His current BP is 152/94 mmHg despite taking Lisinopril
and Carvedilol. Which medication is the most appropriate addition based on current guidelines for mortality
reduction?
A. Spironolactone
B. Amlodipine
C. Hydrochlorothiazide
D. Hydralazine
Answer: A
Rationale
Mineralocorticoid receptor antagonists (MRAs) like spironolactone are recommended for patients with HFrEF (NYHA Class
II-IV) to reduce morbidity and mortality, provided renal function and potassium are monitored.
Question 2
Which of the following physical examination findings is most specific for a diagnosis of acute cholecystitis?
A. Rovsing’s sign
B. Murphy’s sign
C. McBurney’s point tenderness
D. Grey Turner’s sign
Answer: B
Rationale
Murphy’s sign is high sensitivity and specificity for acute cholecystitis, characterized by an inspiratory arrest upon deep
palpation of the right upper quadrant.
Question 3
A 45-year-old female presents with a TSH level of 0.1 mIU/L and an elevated Free T4. She has a painful, enlarged
thyroid gland following a recent viral upper respiratory infection. What is the most likely diagnosis?
A. Graves’ disease
B. Subacute thyroiditis (De Quervain’s)
C. Hashimoto’s thyroiditis
D. Toxic multinodular goiter
Answer: B
Rationale
Subacute thyroiditis often follows a viral infection and presents with a painful thyroid, suppressed TSH, and elevated T4 due to
the release of stored hormone.
Question 4
According to the GOLD 2023 guidelines, which medication is indicated as first-line maintenance therapy for a
patient in COPD Group E?
A. SABA as needed only
B. LABA + LAMA combination
C. LABA or LAMA monotherapy
D. Inhaled corticosteroid (ICS) monotherapy
Answer: B
Rationale
For Group E (high exacerbation risk), the recommendation is a combination of LABA + LAMA. ICS is added if eosinophils are
>= 300.
Page 3
NSG 555
NURSE PRACTITIONERS IN PRIMARY CARE II
Comprehensive Practice – Exam 1 Review
UPDATE
50 Multiple-Choice Questions
Complete Answers with Explained Rationales
Aligned with Current Clinical Guidelines
Wilkes University | Advanced Practice Nursing
Cardiovascular • Pulmonary • Endocrine • GI • MSK • Infectious Disease
For academic study and clinical review • Verify with current institutional protocols
Page 1
,NSG 555 | Exam 1 Comprehensive Practice | 2026/2027 UPDATE
How to Use This Review
This comprehensive exam review contains high-yield multiple-choice questions covering the core clinical
management topics of NSG 555 – Nurse Practitioners in Primary Care II. Each item is followed by the correct
answer and rationales that explain the underlying pathophysiology or guideline recommendation, why the correct
option is preferred, and why the distractors are incorrect.
Topics span cardiovascular disease, pulmonary medicine, endocrinology, gastroenterology, rheumatology,
infectious disease, hematology, nephrology, ophthalmology, urology, geriatrics, and preventive care guidelines
(USPSTF, ADA, GOLD, AHA/ACC, Beers Criteria).
Study tip: Attempt each question before reading the answer. Then carefully review the rationale—paying special
attention to the clinical decision-making points that distinguish the correct choice from plausible alternatives.
Topic Index (Selected High-Yield Areas)
• Heart Failure (HFrEF / HFpEF) & ARNI therapy
• SGLT2 inhibitors – renal & cardiovascular effects
• COPD / Asthma management & GOLD staging
• Atrial Fibrillation, CHA■DS■-VASc & DOAC preference
• Type 2 Diabetes – first-line & cardiorenal agents
• Thyroid disorders & subclinical hypothyroidism
• Gout, Osteoarthritis, and rheumatologic management
• Community-acquired pneumonia (ATS/IDSA)
• Iron-deficiency anemia & GI malignancy work-up
• Hypertension guidelines (ACC/AHA)
• BPH, CKD medication safety, Beers Criteria
• Acute chest pain differentials & ophthalmologic emergencies
• Lyme disease, herpes zoster, infectious disease
Page 2
, NSG 555 | Exam 1 Comprehensive Practice | 2026/2027 UPDATE
Question 1
A 62-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease
(CKD) Stage 3 presents for hypertension management. His current BP is 152/94 mmHg despite taking Lisinopril
and Carvedilol. Which medication is the most appropriate addition based on current guidelines for mortality
reduction?
A. Spironolactone
B. Amlodipine
C. Hydrochlorothiazide
D. Hydralazine
Answer: A
Rationale
Mineralocorticoid receptor antagonists (MRAs) like spironolactone are recommended for patients with HFrEF (NYHA Class
II-IV) to reduce morbidity and mortality, provided renal function and potassium are monitored.
Question 2
Which of the following physical examination findings is most specific for a diagnosis of acute cholecystitis?
A. Rovsing’s sign
B. Murphy’s sign
C. McBurney’s point tenderness
D. Grey Turner’s sign
Answer: B
Rationale
Murphy’s sign is high sensitivity and specificity for acute cholecystitis, characterized by an inspiratory arrest upon deep
palpation of the right upper quadrant.
Question 3
A 45-year-old female presents with a TSH level of 0.1 mIU/L and an elevated Free T4. She has a painful, enlarged
thyroid gland following a recent viral upper respiratory infection. What is the most likely diagnosis?
A. Graves’ disease
B. Subacute thyroiditis (De Quervain’s)
C. Hashimoto’s thyroiditis
D. Toxic multinodular goiter
Answer: B
Rationale
Subacute thyroiditis often follows a viral infection and presents with a painful thyroid, suppressed TSH, and elevated T4 due to
the release of stored hormone.
Question 4
According to the GOLD 2023 guidelines, which medication is indicated as first-line maintenance therapy for a
patient in COPD Group E?
A. SABA as needed only
B. LABA + LAMA combination
C. LABA or LAMA monotherapy
D. Inhaled corticosteroid (ICS) monotherapy
Answer: B
Rationale
For Group E (high exacerbation risk), the recommendation is a combination of LABA + LAMA. ICS is added if eosinophils are
>= 300.
Page 3
