NSG 555 | Clinical Management Exam Review | 2026/2027 UPDATE
NSG 555
NURSE PRACTITIONERS IN PRIMARY CARE II
Clinical Management Exam 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 | Clinical Management Exam Review | 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 (Beers Criteria), and preventive
care guidelines (USPSTF, ADA, GOLD, AHA/ACC).
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. These
rationales reinforce the same reasoning process used on the examination and in clinical practice.
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 2019)
• Iron-deficiency anemia & GI malignancy work-up
• Hypertension guidelines (ACC/AHA 2017)
• BPH, CKD medication safety, Beers Criteria
• Acute chest pain differentials (dissection, PE, ACS)
• Ophthalmologic emergencies (CRAO, retinal detachment)
• Lyme disease, herpes zoster, infectious disease
Page 2
, NSG 555 | Clinical Management Exam Review | 2026/2027 UPDATE
Question 1
A 68-year-old patient with HFrEF (LVEF 35%) is currently taking Lisinopril 20mg daily. According to the latest
guidelines, which medication transition provides the greatest reduction in cardiovascular mortality?
A. Switching Lisinopril to Losartan
B. Adding Amlodipine for better blood pressure control
C. Increasing Lisinopril to 40mg daily
D. Switching Lisinopril to Sacubitril/Valsartan (ARNI)
Answer: D
Rationale
Guidelines now prioritize ARNI therapy over ACE inhibitors or ARBs for patients with HFrEF to reduce mortality and
hospitalization risk, provided there is a 36- hour washout period if switching from an ACE inhibitor.
Question 2
When initiating an SGLT2 inhibitor in a patient with Type 2 Diabetes and chronic kidney disease, which clinical
parameter is most expected in the first 2-4 weeks?
A. A significant increase in Serum Potassium
B. An initial modest decline in estimated GFR (eGFR)
C. A rapid increase in Hemoglobin A1c
D. An immediate rise in systolic blood pressure
Answer: B
Rationale
SGLT2 inhibitors typically cause an initial ‘dip’ in eGFR due to hemodynamic changes (afferent arteriole vasoconstriction),
which is usually reversible and followed by long-term renal protection.
Question 3
Which of the following is considered the ‘gold standard’ for diagnosing Heart Failure with Preserved Ejection
Fraction (HFpEF) when clinical symptoms are present but LVEF is >50%?
A. Chest X-ray showing cardiomegaly
B. Exercise stress test without imaging
C. A normal Brain Natriuretic Peptide (BNP) level
D. Echocardiogram showing diastolic dysfunction and elevated filling pressures
Answer: D
Rationale
HFpEF is diagnosed via clinical symptoms, an LVEF of 50% or higher, and evidence of diastolic dysfunction or elevated filling
pressures on echocardiography or invasive testing.
Question 4
A 55-year-old male with a history of HTN and Gout presents with a blood pressure of 152/94. Which
antihypertensive class should be avoided if possible?
A. ACE Inhibitors
B. Calcium Channel Blockers
C. Thiazide Diuretics
D. Angiotensin Receptor Blockers
Answer: C
Rationale
Thiazide diuretics can increase serum uric acid levels, potentially precipitating or worsening gout flares.
Page 3
NSG 555
NURSE PRACTITIONERS IN PRIMARY CARE II
Clinical Management Exam 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 | Clinical Management Exam Review | 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 (Beers Criteria), and preventive
care guidelines (USPSTF, ADA, GOLD, AHA/ACC).
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. These
rationales reinforce the same reasoning process used on the examination and in clinical practice.
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 2019)
• Iron-deficiency anemia & GI malignancy work-up
• Hypertension guidelines (ACC/AHA 2017)
• BPH, CKD medication safety, Beers Criteria
• Acute chest pain differentials (dissection, PE, ACS)
• Ophthalmologic emergencies (CRAO, retinal detachment)
• Lyme disease, herpes zoster, infectious disease
Page 2
, NSG 555 | Clinical Management Exam Review | 2026/2027 UPDATE
Question 1
A 68-year-old patient with HFrEF (LVEF 35%) is currently taking Lisinopril 20mg daily. According to the latest
guidelines, which medication transition provides the greatest reduction in cardiovascular mortality?
A. Switching Lisinopril to Losartan
B. Adding Amlodipine for better blood pressure control
C. Increasing Lisinopril to 40mg daily
D. Switching Lisinopril to Sacubitril/Valsartan (ARNI)
Answer: D
Rationale
Guidelines now prioritize ARNI therapy over ACE inhibitors or ARBs for patients with HFrEF to reduce mortality and
hospitalization risk, provided there is a 36- hour washout period if switching from an ACE inhibitor.
Question 2
When initiating an SGLT2 inhibitor in a patient with Type 2 Diabetes and chronic kidney disease, which clinical
parameter is most expected in the first 2-4 weeks?
A. A significant increase in Serum Potassium
B. An initial modest decline in estimated GFR (eGFR)
C. A rapid increase in Hemoglobin A1c
D. An immediate rise in systolic blood pressure
Answer: B
Rationale
SGLT2 inhibitors typically cause an initial ‘dip’ in eGFR due to hemodynamic changes (afferent arteriole vasoconstriction),
which is usually reversible and followed by long-term renal protection.
Question 3
Which of the following is considered the ‘gold standard’ for diagnosing Heart Failure with Preserved Ejection
Fraction (HFpEF) when clinical symptoms are present but LVEF is >50%?
A. Chest X-ray showing cardiomegaly
B. Exercise stress test without imaging
C. A normal Brain Natriuretic Peptide (BNP) level
D. Echocardiogram showing diastolic dysfunction and elevated filling pressures
Answer: D
Rationale
HFpEF is diagnosed via clinical symptoms, an LVEF of 50% or higher, and evidence of diastolic dysfunction or elevated filling
pressures on echocardiography or invasive testing.
Question 4
A 55-year-old male with a history of HTN and Gout presents with a blood pressure of 152/94. Which
antihypertensive class should be avoided if possible?
A. ACE Inhibitors
B. Calcium Channel Blockers
C. Thiazide Diuretics
D. Angiotensin Receptor Blockers
Answer: C
Rationale
Thiazide diuretics can increase serum uric acid levels, potentially precipitating or worsening gout flares.
Page 3
