NSG 555 | Exam 4 Advanced Guide | 2026/2027 UPDATE
NSG 555
NURSE PRACTITIONERS IN PRIMARY CARE II
Exam 4 Advanced Guide
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 4 Advanced Guide | 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. 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, pulmonary, endocrine, GI, MSK, infectious disease, and preventive care guidelines.
Study tip: Attempt each question before reading the answer. Then carefully review the rationale.
Topic Index (Selected High-Yield Areas)
• Heart Failure & ARNI therapy
• SGLT2 inhibitors & cardiorenal protection
• COPD / Asthma & GOLD staging
• Atrial Fibrillation & anticoagulation
• Type 2 Diabetes management
• Thyroid disorders
• Gout & Osteoarthritis
• Community-acquired pneumonia
• Anemia work-up
• Hypertension guidelines
• BPH, CKD, Beers Criteria
• Ophthalmologic & surgical emergencies
• Infectious disease (Lyme, zoster)
Page 2
, NSG 555 | Exam 4 Advanced Guide | 2026/2027 UPDATE
Question 1
A 65-year-old male patient presents with a history of heart failure with reduced ejection fraction (HFrEF). Which of
the following medication classes is now considered a ‘pillar’ of therapy to reduce mortality regardless of the
presence of type 2 diabetes?
A. SGLT2 Inhibitors
B. Calcium Channel Blockers
C. Loop Diuretics
D. Alpha-1 Blockers
Answer: A
Rationale
SGLT2 inhibitors (like dapagliflozin) have been added to the four pillars of HFrEF management because they significantly
reduce the risk of cardiovascular death and heart failure hospitalization.
Question 2
When evaluating a patient for suspected Pheochromocytoma, which of the following is the most sensitive initial
screening test?
A. Plasma free metanephrines
B. 24-hour urinary cortisol
C. Serum aldosterone-to-renin ratio
D. Computed Tomography of the adrenal glands
Answer: A
Rationale
Plasma free metanephrines have high sensitivity for pheochromocytoma, making them the preferred initial screening test. CT
imaging is used for localization after biochemical confirmation.
Question 3
A patient with Type 2 Diabetes is already on metformin and a GLP-1 receptor agonist. Their A1C remains elevated
at 8.2%. The patient has established Atherosclerotic Cardiovascular Disease (ASCVD). What is the next best
addition?
A. SGLT2 Inhibitor
B. DPP-4 Inhibitor
C. Sulfonylurea
D. Basal Insulin
Answer: A
Rationale
In patients with established ASCVD, both GLP-1 RAs and SGLT2 inhibitors are recommended for their cardio-protective
benefits according to ADA standards.
Page 3
NSG 555
NURSE PRACTITIONERS IN PRIMARY CARE II
Exam 4 Advanced Guide
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 4 Advanced Guide | 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. 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, pulmonary, endocrine, GI, MSK, infectious disease, and preventive care guidelines.
Study tip: Attempt each question before reading the answer. Then carefully review the rationale.
Topic Index (Selected High-Yield Areas)
• Heart Failure & ARNI therapy
• SGLT2 inhibitors & cardiorenal protection
• COPD / Asthma & GOLD staging
• Atrial Fibrillation & anticoagulation
• Type 2 Diabetes management
• Thyroid disorders
• Gout & Osteoarthritis
• Community-acquired pneumonia
• Anemia work-up
• Hypertension guidelines
• BPH, CKD, Beers Criteria
• Ophthalmologic & surgical emergencies
• Infectious disease (Lyme, zoster)
Page 2
, NSG 555 | Exam 4 Advanced Guide | 2026/2027 UPDATE
Question 1
A 65-year-old male patient presents with a history of heart failure with reduced ejection fraction (HFrEF). Which of
the following medication classes is now considered a ‘pillar’ of therapy to reduce mortality regardless of the
presence of type 2 diabetes?
A. SGLT2 Inhibitors
B. Calcium Channel Blockers
C. Loop Diuretics
D. Alpha-1 Blockers
Answer: A
Rationale
SGLT2 inhibitors (like dapagliflozin) have been added to the four pillars of HFrEF management because they significantly
reduce the risk of cardiovascular death and heart failure hospitalization.
Question 2
When evaluating a patient for suspected Pheochromocytoma, which of the following is the most sensitive initial
screening test?
A. Plasma free metanephrines
B. 24-hour urinary cortisol
C. Serum aldosterone-to-renin ratio
D. Computed Tomography of the adrenal glands
Answer: A
Rationale
Plasma free metanephrines have high sensitivity for pheochromocytoma, making them the preferred initial screening test. CT
imaging is used for localization after biochemical confirmation.
Question 3
A patient with Type 2 Diabetes is already on metformin and a GLP-1 receptor agonist. Their A1C remains elevated
at 8.2%. The patient has established Atherosclerotic Cardiovascular Disease (ASCVD). What is the next best
addition?
A. SGLT2 Inhibitor
B. DPP-4 Inhibitor
C. Sulfonylurea
D. Basal Insulin
Answer: A
Rationale
In patients with established ASCVD, both GLP-1 RAs and SGLT2 inhibitors are recommended for their cardio-protective
benefits according to ADA standards.
Page 3
