NSG 555 | Exam 4 Comprehensive Review | 2026/2027 UPDATE
NSG 555
NURSE PRACTITIONERS IN PRIMARY CARE II
Exam 4 Comprehensive 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 4 Comprehensive 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. 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 Comprehensive Review | 2026/2027 UPDATE
Question 1
A 65-year-old male with a history of HFrEF (LVEF 30%) remains symptomatic despite being on Lisinopril 20mg
and Carvedilol 25mg BID. Which of the following is the most appropriate next step in evidence-based therapy to
reduce mortality?
A. Increase Carvedilol to 50mg BID
B. Switch Lisinopril to Sacubitril/valsartan (ARNI)
C. Add Furosemide 20mg daily
D. Add Digoxin 0.125mg daily
Answer: B
Rationale
According to current guidelines, switching an ACE inhibitor to an ARNI (Sacubitril/valsartan) is recommended for patients with
symptomatic HFrEF to further reduce morbidity and mortality. ARNI has shown superiority over ACE inhibitors alone.
Question 2
A 58-year-old female presents with persistent epigastric pain. She has completed a 14-day course of triple therapy
for H. pylori. What is the most reliable test to confirm eradication, and when should it be performed?
A. Serum H. pylori IgG antibody test immediately
B. Urea breath test at least 4 weeks after treatment completion
C. Stool antigen test 1 week after treatment completion
D. Repeat endoscopy with biopsy in 2 weeks
Answer: B
Rationale
Eradication testing should be done at least 4 weeks after completing antibiotics and 2 weeks after stopping PPIs. The urea
breath test or stool antigen test are the preferred non-invasive methods. Serum IgG remains positive for years and cannot
confirm eradication.
Question 3
According to the GINA 2023 guidelines, what is the preferred initial ‘Step 1’ therapy for an adult patient with
intermittent asthma symptoms?
A. SABA (albuterol) PRN only
B. Low-dose ICS-formoterol PRN as the sole reliever
C. Low-dose ICS taken whenever SABA is taken
D. Daily low-dose ICS plus SABA PRN
Answer: B
Rationale
GINA guidelines now recommend PRN low-dose ICS-formoterol as the preferred Track 1 reliever and initial therapy to reduce
the risk of severe exacerbations, even in mild asthma, rather than SABA monotherapy.
Page 3
NSG 555
NURSE PRACTITIONERS IN PRIMARY CARE II
Exam 4 Comprehensive 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 4 Comprehensive 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. 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 Comprehensive Review | 2026/2027 UPDATE
Question 1
A 65-year-old male with a history of HFrEF (LVEF 30%) remains symptomatic despite being on Lisinopril 20mg
and Carvedilol 25mg BID. Which of the following is the most appropriate next step in evidence-based therapy to
reduce mortality?
A. Increase Carvedilol to 50mg BID
B. Switch Lisinopril to Sacubitril/valsartan (ARNI)
C. Add Furosemide 20mg daily
D. Add Digoxin 0.125mg daily
Answer: B
Rationale
According to current guidelines, switching an ACE inhibitor to an ARNI (Sacubitril/valsartan) is recommended for patients with
symptomatic HFrEF to further reduce morbidity and mortality. ARNI has shown superiority over ACE inhibitors alone.
Question 2
A 58-year-old female presents with persistent epigastric pain. She has completed a 14-day course of triple therapy
for H. pylori. What is the most reliable test to confirm eradication, and when should it be performed?
A. Serum H. pylori IgG antibody test immediately
B. Urea breath test at least 4 weeks after treatment completion
C. Stool antigen test 1 week after treatment completion
D. Repeat endoscopy with biopsy in 2 weeks
Answer: B
Rationale
Eradication testing should be done at least 4 weeks after completing antibiotics and 2 weeks after stopping PPIs. The urea
breath test or stool antigen test are the preferred non-invasive methods. Serum IgG remains positive for years and cannot
confirm eradication.
Question 3
According to the GINA 2023 guidelines, what is the preferred initial ‘Step 1’ therapy for an adult patient with
intermittent asthma symptoms?
A. SABA (albuterol) PRN only
B. Low-dose ICS-formoterol PRN as the sole reliever
C. Low-dose ICS taken whenever SABA is taken
D. Daily low-dose ICS plus SABA PRN
Answer: B
Rationale
GINA guidelines now recommend PRN low-dose ICS-formoterol as the preferred Track 1 reliever and initial therapy to reduce
the risk of severe exacerbations, even in mild asthma, rather than SABA monotherapy.
Page 3
