Nurse Practitioners in Primary
Care II
Wilkes University
NSG555/NSG 555 Exam 2
Questions & Answers Plus
Detailed Rationales
Latest 2026 | PDF
THIS EXAM CONTAINS:
✓100% Pass
✓Multiple Choice ( A-D)
✓Detailed Rationales For Each Question
✓Correct Answers For Each Question
✓100 Qs & Answers
,SECTION 1: Cardiovascular Disorders (Questions 1-15)
Question 1
A 68-year-old male patient with a history of hypertension and
type 2 diabetes presents with a blood pressure of 152/94 mmHg
on two separate visits. His laboratory results show a serum
creatinine of 1.6 mg/dL and an estimated GFR of 45
mL/min/1.73m². Which antihypertensive medication should be
prioritized in this patient?
A. Hydrochlorothiazide
B. Amlodipine
C. Lisinopril
D. Metoprolol
Answer: C. Lisinopril
Rationale: This patient has hypertension with chronic kidney
disease (CKD) stage 3 (eGFR 45 mL/min/1.73m²). ACE inhibitors
(lisinopril) or ARBs are the preferred agents for patients with
hypertension and CKD, as they have renoprotective effects and
slow the progression of kidney disease. They are also beneficial in
patients with diabetes. Hydrochlorothiazide is less effective when
GFR is below 30-40 mL/min. Amlodipine and metoprolol are
appropriate but not the priority in this scenario.
Question 2
A 72-year-old female patient with a history of heart failure with
reduced ejection fraction (HFrEF) presents with worsening
,dyspnea, orthopnea, and 3+ pitting edema in her lower
extremities. Her medications include lisinopril, carvedilol, and
furosemide. Which of the following is the most appropriate initial
adjustment to her medication regimen?
A. Increase the lisinopril dose
B. Increase the carvedilol dose
C. Increase the furosemide dose
D. Add digoxin
Answer: C. Increase the furosemide dose
Rationale: This patient is experiencing volume overload with
worsening heart failure symptoms (dyspnea, orthopnea, edema).
The most appropriate initial intervention is to increase the dose
of the loop diuretic (furosemide) to manage fluid overload and
relieve symptoms. ACE inhibitors and beta-blockers are
foundational therapies for HFrEF but should be titrated slowly
and not adjusted during acute decompensation. Digoxin may be
added for symptom control but is not the initial priority.
Question 3
Which of the following is the most common cause of secondary
hypertension in adults?
A. Primary aldosteronism
B. Chronic kidney disease
C. Renal artery stenosis
D. Obstructive sleep apnea
Answer: B. Chronic kidney disease
, Rationale: Chronic kidney disease (CKD) is the most common
cause of secondary hypertension in adults. Other causes include
primary aldosteronism, renal artery stenosis, obstructive sleep
apnea, pheochromocytoma, Cushing's syndrome, and coarctation
of the aorta. Secondary hypertension should be suspected in
patients with resistant hypertension, sudden onset of
hypertension before age 30 or after age 55, or hypertension with
suggestive symptoms or signs.
Question 4
A 65-year-old male patient with a history of atrial fibrillation is
prescribed warfarin for stroke prevention. His INR is 1.8. Which
of the following is the most appropriate management?
A. Increase the warfarin dose and recheck INR in 1 week
B. Continue the current dose and recheck INR in 1 month
C. Hold the warfarin dose and restart at a lower dose
D. Administer vitamin K 5 mg orally
Answer: A. Increase the warfarin dose and recheck INR in 1
week
Rationale: The target INR for atrial fibrillation is typically 2.0-
3.0. An INR of 1.8 is below the therapeutic range. The appropriate
management is to increase the warfarin dose and recheck the INR
in 1 week (typically within 5-7 days after a dose adjustment).
Vitamin K is indicated for INR > 5.0 without bleeding or > 10.0, or
for bleeding at any INR. Holding the dose is not appropriate for a
mildly subtherapeutic INR.
Care II
Wilkes University
NSG555/NSG 555 Exam 2
Questions & Answers Plus
Detailed Rationales
Latest 2026 | PDF
THIS EXAM CONTAINS:
✓100% Pass
✓Multiple Choice ( A-D)
✓Detailed Rationales For Each Question
✓Correct Answers For Each Question
✓100 Qs & Answers
,SECTION 1: Cardiovascular Disorders (Questions 1-15)
Question 1
A 68-year-old male patient with a history of hypertension and
type 2 diabetes presents with a blood pressure of 152/94 mmHg
on two separate visits. His laboratory results show a serum
creatinine of 1.6 mg/dL and an estimated GFR of 45
mL/min/1.73m². Which antihypertensive medication should be
prioritized in this patient?
A. Hydrochlorothiazide
B. Amlodipine
C. Lisinopril
D. Metoprolol
Answer: C. Lisinopril
Rationale: This patient has hypertension with chronic kidney
disease (CKD) stage 3 (eGFR 45 mL/min/1.73m²). ACE inhibitors
(lisinopril) or ARBs are the preferred agents for patients with
hypertension and CKD, as they have renoprotective effects and
slow the progression of kidney disease. They are also beneficial in
patients with diabetes. Hydrochlorothiazide is less effective when
GFR is below 30-40 mL/min. Amlodipine and metoprolol are
appropriate but not the priority in this scenario.
Question 2
A 72-year-old female patient with a history of heart failure with
reduced ejection fraction (HFrEF) presents with worsening
,dyspnea, orthopnea, and 3+ pitting edema in her lower
extremities. Her medications include lisinopril, carvedilol, and
furosemide. Which of the following is the most appropriate initial
adjustment to her medication regimen?
A. Increase the lisinopril dose
B. Increase the carvedilol dose
C. Increase the furosemide dose
D. Add digoxin
Answer: C. Increase the furosemide dose
Rationale: This patient is experiencing volume overload with
worsening heart failure symptoms (dyspnea, orthopnea, edema).
The most appropriate initial intervention is to increase the dose
of the loop diuretic (furosemide) to manage fluid overload and
relieve symptoms. ACE inhibitors and beta-blockers are
foundational therapies for HFrEF but should be titrated slowly
and not adjusted during acute decompensation. Digoxin may be
added for symptom control but is not the initial priority.
Question 3
Which of the following is the most common cause of secondary
hypertension in adults?
A. Primary aldosteronism
B. Chronic kidney disease
C. Renal artery stenosis
D. Obstructive sleep apnea
Answer: B. Chronic kidney disease
, Rationale: Chronic kidney disease (CKD) is the most common
cause of secondary hypertension in adults. Other causes include
primary aldosteronism, renal artery stenosis, obstructive sleep
apnea, pheochromocytoma, Cushing's syndrome, and coarctation
of the aorta. Secondary hypertension should be suspected in
patients with resistant hypertension, sudden onset of
hypertension before age 30 or after age 55, or hypertension with
suggestive symptoms or signs.
Question 4
A 65-year-old male patient with a history of atrial fibrillation is
prescribed warfarin for stroke prevention. His INR is 1.8. Which
of the following is the most appropriate management?
A. Increase the warfarin dose and recheck INR in 1 week
B. Continue the current dose and recheck INR in 1 month
C. Hold the warfarin dose and restart at a lower dose
D. Administer vitamin K 5 mg orally
Answer: A. Increase the warfarin dose and recheck INR in 1
week
Rationale: The target INR for atrial fibrillation is typically 2.0-
3.0. An INR of 1.8 is below the therapeutic range. The appropriate
management is to increase the warfarin dose and recheck the INR
in 1 week (typically within 5-7 days after a dose adjustment).
Vitamin K is indicated for INR > 5.0 without bleeding or > 10.0, or
for bleeding at any INR. Holding the dose is not appropriate for a
mildly subtherapeutic INR.
