NR667 FNP CAPSTONE WEEK 1 PRACTICE EXAM
2026/2027 | 150 Questions Full Length | Chamberlain
University | 100% Correct Answers | Pass Guaranteed - A+
Graded
Section 1: Advanced Health Assessment & Differential
Diagnosis (Questions 1-25)
Question 1
A 42-year-old male presents with acute chest pain described as "crushing" and
radiating to the left arm. Vital signs: BP 88/52 mmHg, HR 118 bpm, RR 24, SpO2 91%
on room air. The patient is diaphoretic and anxious. Which assessment finding
requires immediate intervention before proceeding with the full physical
examination?
A. Pain rating of 8/10
B. History of hypertension
C. Blood pressure of 88/52 mmHg [CORRECT]
D. Pain radiating to the left arm
Rationale: A systolic BP of 88 mmHg indicates cardiogenic shock, a life-threatening
emergency requiring immediate stabilization (IV access, fluids, vasopressors) before
any further assessment. While crushing chest pain with radiation suggests MI, the
hypotension is the immediate threat to life. Pain rating, history of HTN, and radiation
pattern are important diagnostic clues but do not represent an immediate
hemodynamic emergency.
Correct Answer: C
Question 2
,A 28-year-old female presents with a 3-day history of sore throat, fever to 102°F, and
tender anterior cervical lymphadenopathy. On examination, the tonsils are enlarged
with white exudate. Which physical examination finding best differentiates viral
pharyngitis from Group A Streptococcal pharyngitis?
A. Presence of cough
B. Tender anterior cervical nodes
C. Absence of cough [CORRECT]
D. Bilateral tonsillar enlargement
Rationale: The Centor/McIsaac criteria identify absence of cough as a key
differentiator favoring GAS pharyngitis. While tender anterior cervical nodes, tonsillar
exudate, and fever are present in both viral and bacterial pharyngitis, the absence of
cough strongly suggests bacterial etiology and supports testing/treatment. Bilateral
enlargement is nonspecific.
Correct Answer: C
Question 3
A 65-year-old male with a 40 pack-year smoking history presents with progressive
dyspnea and a new cough. Physical examination reveals diminished breath sounds
and dullness to percussion at the right lung base. Which diagnostic test should be
ordered first?
A. Chest CT with contrast
B. Chest X-ray [CORRECT]
C. Bronchoscopy
D. Thoracentesis
Rationale: Chest X-ray is the appropriate initial imaging study for evaluating new
respiratory symptoms with physical findings suggestive of pleural effusion or
consolidation. It provides rapid, low-cost screening to guide further workup. CT,
bronchoscopy, and thoracentesis are second-line procedures that require initial
imaging guidance.
Correct Answer: B
,Question 4
During a well-child visit, a 9-month-old infant is noted to have head lag when pulled
from supine to sitting position. The mother reports the child sits with support but
cannot sit independently. Which condition should be prioritized in the differential
diagnosis?
A. Normal developmental variant
B. Cerebral palsy [CORRECT]
C. Hypothyroidism
D. Iron deficiency anemia
Rationale: Persistence of head lag beyond 4-6 months is abnormal and suggests
neuromuscular pathology. Cerebral palsy is the most likely serious diagnosis
requiring urgent referral to early intervention. While hypothyroidism can cause
developmental delay, it typically presents with other features (coarse features,
macroglossia, umbilical hernia). Head lag is not associated with iron deficiency.
Correct Answer: B
Question 5
A 55-year-old female presents with fatigue, weight gain, constipation, and dry skin.
Laboratory studies show TSH 12.4 mIU/L (normal 0.4-4.0) and free T4 0.6 ng/dL
(normal 0.8-1.8). Which physical examination finding is most consistent with this
diagnosis?
A. Exophthalmos
B. Fine tremor
C. Delayed deep tendon reflexes [CORRECT]
D. Warm, moist skin
Rationale: Delayed relaxation phase of deep tendon reflexes is characteristic of
hypothyroidism due to decreased metabolic rate affecting muscle
, contraction/relaxation. Exophthalmos, fine tremor, and warm moist skin are all
findings of hyperthyroidism (Graves' disease), the opposite endocrine state.
Correct Answer: C
Question 6
A 38-year-old male presents with acute onset of severe epigastric pain radiating to
the back, nausea, and vomiting. He admits to heavy alcohol consumption. Vital signs
show HR 112, BP 94/60. Which laboratory value is most specific for confirming the
suspected diagnosis?
A. Elevated serum bilirubin
B. Elevated serum lipase [CORRECT]
C. Elevated alkaline phosphatase
D. Elevated blood urea nitrogen
Rationale: Elevated serum lipase (specifically >3 times upper limit of normal) is the
most specific marker for acute pancreatitis. While amylase also rises, lipase remains
elevated longer and is more specific. The clinical presentation (epigastric pain
radiating to back, alcohol use, hemodynamic instability) is classic for acute
pancreatitis. Bilirubin and ALP suggest biliary obstruction; BUN elevation may
indicate hypovolemia but is nonspecific.
Correct Answer: B
Question 7
A 24-year-old female presents with bilateral wrist pain, morning stiffness lasting 2
hours, and swelling of the proximal interphalangeal joints. Which diagnostic test is
most specific for confirming the likely diagnosis?
A. Elevated erythrocyte sedimentation rate (ESR)
B. Positive rheumatoid factor (RF)
2026/2027 | 150 Questions Full Length | Chamberlain
University | 100% Correct Answers | Pass Guaranteed - A+
Graded
Section 1: Advanced Health Assessment & Differential
Diagnosis (Questions 1-25)
Question 1
A 42-year-old male presents with acute chest pain described as "crushing" and
radiating to the left arm. Vital signs: BP 88/52 mmHg, HR 118 bpm, RR 24, SpO2 91%
on room air. The patient is diaphoretic and anxious. Which assessment finding
requires immediate intervention before proceeding with the full physical
examination?
A. Pain rating of 8/10
B. History of hypertension
C. Blood pressure of 88/52 mmHg [CORRECT]
D. Pain radiating to the left arm
Rationale: A systolic BP of 88 mmHg indicates cardiogenic shock, a life-threatening
emergency requiring immediate stabilization (IV access, fluids, vasopressors) before
any further assessment. While crushing chest pain with radiation suggests MI, the
hypotension is the immediate threat to life. Pain rating, history of HTN, and radiation
pattern are important diagnostic clues but do not represent an immediate
hemodynamic emergency.
Correct Answer: C
Question 2
,A 28-year-old female presents with a 3-day history of sore throat, fever to 102°F, and
tender anterior cervical lymphadenopathy. On examination, the tonsils are enlarged
with white exudate. Which physical examination finding best differentiates viral
pharyngitis from Group A Streptococcal pharyngitis?
A. Presence of cough
B. Tender anterior cervical nodes
C. Absence of cough [CORRECT]
D. Bilateral tonsillar enlargement
Rationale: The Centor/McIsaac criteria identify absence of cough as a key
differentiator favoring GAS pharyngitis. While tender anterior cervical nodes, tonsillar
exudate, and fever are present in both viral and bacterial pharyngitis, the absence of
cough strongly suggests bacterial etiology and supports testing/treatment. Bilateral
enlargement is nonspecific.
Correct Answer: C
Question 3
A 65-year-old male with a 40 pack-year smoking history presents with progressive
dyspnea and a new cough. Physical examination reveals diminished breath sounds
and dullness to percussion at the right lung base. Which diagnostic test should be
ordered first?
A. Chest CT with contrast
B. Chest X-ray [CORRECT]
C. Bronchoscopy
D. Thoracentesis
Rationale: Chest X-ray is the appropriate initial imaging study for evaluating new
respiratory symptoms with physical findings suggestive of pleural effusion or
consolidation. It provides rapid, low-cost screening to guide further workup. CT,
bronchoscopy, and thoracentesis are second-line procedures that require initial
imaging guidance.
Correct Answer: B
,Question 4
During a well-child visit, a 9-month-old infant is noted to have head lag when pulled
from supine to sitting position. The mother reports the child sits with support but
cannot sit independently. Which condition should be prioritized in the differential
diagnosis?
A. Normal developmental variant
B. Cerebral palsy [CORRECT]
C. Hypothyroidism
D. Iron deficiency anemia
Rationale: Persistence of head lag beyond 4-6 months is abnormal and suggests
neuromuscular pathology. Cerebral palsy is the most likely serious diagnosis
requiring urgent referral to early intervention. While hypothyroidism can cause
developmental delay, it typically presents with other features (coarse features,
macroglossia, umbilical hernia). Head lag is not associated with iron deficiency.
Correct Answer: B
Question 5
A 55-year-old female presents with fatigue, weight gain, constipation, and dry skin.
Laboratory studies show TSH 12.4 mIU/L (normal 0.4-4.0) and free T4 0.6 ng/dL
(normal 0.8-1.8). Which physical examination finding is most consistent with this
diagnosis?
A. Exophthalmos
B. Fine tremor
C. Delayed deep tendon reflexes [CORRECT]
D. Warm, moist skin
Rationale: Delayed relaxation phase of deep tendon reflexes is characteristic of
hypothyroidism due to decreased metabolic rate affecting muscle
, contraction/relaxation. Exophthalmos, fine tremor, and warm moist skin are all
findings of hyperthyroidism (Graves' disease), the opposite endocrine state.
Correct Answer: C
Question 6
A 38-year-old male presents with acute onset of severe epigastric pain radiating to
the back, nausea, and vomiting. He admits to heavy alcohol consumption. Vital signs
show HR 112, BP 94/60. Which laboratory value is most specific for confirming the
suspected diagnosis?
A. Elevated serum bilirubin
B. Elevated serum lipase [CORRECT]
C. Elevated alkaline phosphatase
D. Elevated blood urea nitrogen
Rationale: Elevated serum lipase (specifically >3 times upper limit of normal) is the
most specific marker for acute pancreatitis. While amylase also rises, lipase remains
elevated longer and is more specific. The clinical presentation (epigastric pain
radiating to back, alcohol use, hemodynamic instability) is classic for acute
pancreatitis. Bilirubin and ALP suggest biliary obstruction; BUN elevation may
indicate hypovolemia but is nonspecific.
Correct Answer: B
Question 7
A 24-year-old female presents with bilateral wrist pain, morning stiffness lasting 2
hours, and swelling of the proximal interphalangeal joints. Which diagnostic test is
most specific for confirming the likely diagnosis?
A. Elevated erythrocyte sedimentation rate (ESR)
B. Positive rheumatoid factor (RF)
