NSG 555/ NSG555 EXAM 4- (NEW 2026/ 2027 UPDATE)
NURSE PRACTITIONERS IN PRIMARY CARE II GUIDE
QUESTIONS AND ANSWERS WILKES
48 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Integrate current national guidelines into diagnostic and therapeutic plans for complex primary care
presentations
2 Evaluate risk-benefit and contraindications when selecting pharmacologic therapy in patients with
multimorbidity
3 Apply evidence-based screening, counseling, and referral criteria across preventive and chronic care
domains
4 NSG 555
5 NSG555 Exam 4
6 NEW 2026
7 2027 Update
8 Nurse Practitioners in Primary Care II Guide Questions and Answers Wilkes
9 Foundations of Primary Care II for Nurse Practitioners
10 Applied Primary Care II for Nurse Practitioners
11 Advanced Primary Care II for Nurse Practitioners
12 Primary Care II for Nurse Practitioners Review
ABSTRACT
Page 1
,This study document brings together 48 carefully worded exam questions drawn from NSG 555/
NSG555 Exam 4- (NEW 2026/ 2027 Update) Nurse Practitioners in Primary Care II Guide
Questions and Answers Wilkes, with the strongest emphasis placed on Integrate current national
guidelines into diagnostic and therapeutic plans for complex primary care presentations, Evaluate
risk-benefit and contraindications when selecting pharmacologic therapy in patients with
multimorbidity, Apply evidence-based screening, counseling and and referral criteria across
preventive and chronic care domains. Every item follows the wording style and level of reasoning
you meet in the real paper, and each one is paired with a clear rationale so the correct choice is
never a guess. Work through the set at your own pace, mark the questions that slow you down,
then come back to them until the reasoning feels automatic. Learners who revise this way walk into
the exam room recognising the pattern behind the questions instead of meeting them for the first
time. Keep going - steady, honest practice is what turns a difficult paper into a comfortable pass.
Q1 INTEGRATE CURRENT NATIONAL GUIDELINES INTO DIAGNOSTIC AND THERAPEUTIC
PLANS FOR COMPLEX PRIMARY CARE PRESENTATIONS
A patient with stage 3 chronic kidney disease and type 2 diabetes is on metformin
and an SGLT2 inhibitor. Which parameter most directly determines whether
metformin must be discontinued?
A. Serum potassium >5.0 mEq/L
B. Estimated glomerular filtration rate <30 mL/min/1.73 m² CORRECT
C. Hemoglobin A1c <7.0%
D. Urine albumin-to-creatinine ratio >300 mg/g
RATIONALE: Metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² due to risk
of lactic acidosis; it is not discontinued for isolated hyperkalemia, glycemic control, or
albuminuria. SGLT2 inhibitors may be continued with renal benefit. The other options do not
mandate metformin cessation.
Page 2
, Q2 INTEGRATE CURRENT NATIONAL GUIDELINES INTO DIAGNOSTIC AND THERAPEUTIC
PLANS FOR COMPLEX PRIMARY CARE PRESENTATIONS
Which finding best supports a diagnosis of heart failure with preserved ejection
fraction (HFpEF) rather than heart failure with reduced ejection fraction (HFrEF) in
a patient with dyspnea?
A. Ejection fraction of 55% with elevated natriuretic peptides and diastolic dysfunction on
echocardiogram CORRECT
B. Ejection fraction of 35% with global hypokinesis
C. S3 gallop and elevated jugular venous pressure
D. Improvement in dyspnea with high-dose furosemide
RATIONALE: HFpEF is defined by ejection fraction 50% plus evidence of diastolic dysfunction
and elevated filling pressures, often reflected by elevated natriuretic peptides. Reduced ejection
fraction (40%) defines HFrEF. S3 gallop and diuretic response are nonspecific and can occur in
both.
Q3 INTEGRATE CURRENT NATIONAL GUIDELINES INTO DIAGNOSTIC AND THERAPEUTIC
PLANS FOR COMPLEX PRIMARY CARE PRESENTATIONS
A patient on warfarin for atrial fibrillation is started on fluconazole for a fungal
infection. Which INR change is most anticipated, and what is the best initial
management?
A. INR decrease; increase warfarin dose
B. INR increase; hold warfarin and monitor closely CORRECT
C. No change; continue current regimen
D. INR increase; add vitamin K prophylaxis
RATIONALE: Fluconazole inhibits CYP2C9, reducing warfarin metabolism and increasing INR
and bleeding risk. The appropriate action is to hold warfarin, monitor INR frequently, and adjust
dose. Vitamin K is reserved for active bleeding or severe INR elevation, and no change or dose
increase would be unsafe.
Page 3
NURSE PRACTITIONERS IN PRIMARY CARE II GUIDE
QUESTIONS AND ANSWERS WILKES
48 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Integrate current national guidelines into diagnostic and therapeutic plans for complex primary care
presentations
2 Evaluate risk-benefit and contraindications when selecting pharmacologic therapy in patients with
multimorbidity
3 Apply evidence-based screening, counseling, and referral criteria across preventive and chronic care
domains
4 NSG 555
5 NSG555 Exam 4
6 NEW 2026
7 2027 Update
8 Nurse Practitioners in Primary Care II Guide Questions and Answers Wilkes
9 Foundations of Primary Care II for Nurse Practitioners
10 Applied Primary Care II for Nurse Practitioners
11 Advanced Primary Care II for Nurse Practitioners
12 Primary Care II for Nurse Practitioners Review
ABSTRACT
Page 1
,This study document brings together 48 carefully worded exam questions drawn from NSG 555/
NSG555 Exam 4- (NEW 2026/ 2027 Update) Nurse Practitioners in Primary Care II Guide
Questions and Answers Wilkes, with the strongest emphasis placed on Integrate current national
guidelines into diagnostic and therapeutic plans for complex primary care presentations, Evaluate
risk-benefit and contraindications when selecting pharmacologic therapy in patients with
multimorbidity, Apply evidence-based screening, counseling and and referral criteria across
preventive and chronic care domains. Every item follows the wording style and level of reasoning
you meet in the real paper, and each one is paired with a clear rationale so the correct choice is
never a guess. Work through the set at your own pace, mark the questions that slow you down,
then come back to them until the reasoning feels automatic. Learners who revise this way walk into
the exam room recognising the pattern behind the questions instead of meeting them for the first
time. Keep going - steady, honest practice is what turns a difficult paper into a comfortable pass.
Q1 INTEGRATE CURRENT NATIONAL GUIDELINES INTO DIAGNOSTIC AND THERAPEUTIC
PLANS FOR COMPLEX PRIMARY CARE PRESENTATIONS
A patient with stage 3 chronic kidney disease and type 2 diabetes is on metformin
and an SGLT2 inhibitor. Which parameter most directly determines whether
metformin must be discontinued?
A. Serum potassium >5.0 mEq/L
B. Estimated glomerular filtration rate <30 mL/min/1.73 m² CORRECT
C. Hemoglobin A1c <7.0%
D. Urine albumin-to-creatinine ratio >300 mg/g
RATIONALE: Metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² due to risk
of lactic acidosis; it is not discontinued for isolated hyperkalemia, glycemic control, or
albuminuria. SGLT2 inhibitors may be continued with renal benefit. The other options do not
mandate metformin cessation.
Page 2
, Q2 INTEGRATE CURRENT NATIONAL GUIDELINES INTO DIAGNOSTIC AND THERAPEUTIC
PLANS FOR COMPLEX PRIMARY CARE PRESENTATIONS
Which finding best supports a diagnosis of heart failure with preserved ejection
fraction (HFpEF) rather than heart failure with reduced ejection fraction (HFrEF) in
a patient with dyspnea?
A. Ejection fraction of 55% with elevated natriuretic peptides and diastolic dysfunction on
echocardiogram CORRECT
B. Ejection fraction of 35% with global hypokinesis
C. S3 gallop and elevated jugular venous pressure
D. Improvement in dyspnea with high-dose furosemide
RATIONALE: HFpEF is defined by ejection fraction 50% plus evidence of diastolic dysfunction
and elevated filling pressures, often reflected by elevated natriuretic peptides. Reduced ejection
fraction (40%) defines HFrEF. S3 gallop and diuretic response are nonspecific and can occur in
both.
Q3 INTEGRATE CURRENT NATIONAL GUIDELINES INTO DIAGNOSTIC AND THERAPEUTIC
PLANS FOR COMPLEX PRIMARY CARE PRESENTATIONS
A patient on warfarin for atrial fibrillation is started on fluconazole for a fungal
infection. Which INR change is most anticipated, and what is the best initial
management?
A. INR decrease; increase warfarin dose
B. INR increase; hold warfarin and monitor closely CORRECT
C. No change; continue current regimen
D. INR increase; add vitamin K prophylaxis
RATIONALE: Fluconazole inhibits CYP2C9, reducing warfarin metabolism and increasing INR
and bleeding risk. The appropriate action is to hold warfarin, monitor INR frequently, and adjust
dose. Vitamin K is reserved for active bleeding or severe INR elevation, and no change or dose
increase would be unsafe.
Page 3
