NR667 Week 3 Actual Exam Style V2 | NR
667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 45-year-old male presents with a blood pressure of 152/94 mmHg on two separate
occasions. He has no other comorbidities. According to current guidelines, what is the initial
recommended pharmacological intervention?
A. Furosemide 20 mg daily
B. Metoprolol 25 mg daily
C. Clonidine 0.1 mg twice daily
D. Lisinopril 10 mg daily
Answer: D
Rationale: According to the JNC 8 and ACC/AHA guidelines, ACE inhibitors like Lisinopril
are first-line agents for Stage 2 hypertension. Beta-blockers are no longer considered first-
line unless a compelling indication like heart failure exists. This patient requires
medication because lifestyle modifications alone are insufficient for Stage 2 hypertension.
2. Which of the following physical exam findings is most indicative of iron deficiency anemia?
A. Glossitis
B. Jaundice
C. Paresthesia
,D. Koilonychia
Answer: D
Rationale: Koilonychia, or spoon-shaped nails, is a classic sign of severe, chronic iron
deficiency anemia. Glossitis can occur in both B12 and iron deficiency, making it less
specific. Paresthesia is specifically associated with Vitamin B12 deficiency due to
neurological involvement.
3. A 62-year-old smoker presents with a chronic cough and productive sputum for at least 3
months in the last 2 consecutive years. What is the most likely diagnosis?
A. Emphysema
B. Chronic Bronchitis
C. Asthma
D. Bronchiectasis
Answer: B
Rationale: The clinical definition of chronic bronchitis is a productive cough for 3 months
in 2 consecutive years. While emphysema is also a part of COPD, it is characterized more by
alveolar destruction and dyspnea. Asthma is typically reversible and involves different
pathophysiological mechanisms.
4. An 18-month-old child is brought to the clinic for a well-child visit. Which developmental
milestone should the nurse practitioner expect the child to have achieved?
A. Using a spoon with little spilling
, B. Speaking in 4 to 5-word sentences
C. Climbing stairs while holding a hand
D. Drawing a square
Answer: C
Rationale: At 18 months, children are expected to walk up steps with assistance and walk
well alone. Spoon usage with minimal spilling and 4-5 word sentences are typically
milestones for older children (24-36 months). Drawing a square is a fine motor skill usually
mastered at age 4.
5. A patient with Type 2 Diabetes has an A1C of 8.2% despite taking Metformin 1000 mg BID.
What is the most appropriate next step according to ADA standards?
A. Increase Metformin to 1500 mg BID
B. Start basal insulin
C. Add a second oral agent like a GLP-1 RA or SGLT2 inhibitor
D. Discontinue Metformin and start Glyburide
Answer: C
Rationale: When A1C is above target (usually 7%) on Metformin monotherapy, dual
therapy is recommended. GLP-1 RAs and SGLT2 inhibitors are preferred second-line
agents, especially if cardiovascular or renal benefits are desired. 1000 mg BID is already
the maximum effective dose of Metformin, so increasing it further is not recommended.
667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 45-year-old male presents with a blood pressure of 152/94 mmHg on two separate
occasions. He has no other comorbidities. According to current guidelines, what is the initial
recommended pharmacological intervention?
A. Furosemide 20 mg daily
B. Metoprolol 25 mg daily
C. Clonidine 0.1 mg twice daily
D. Lisinopril 10 mg daily
Answer: D
Rationale: According to the JNC 8 and ACC/AHA guidelines, ACE inhibitors like Lisinopril
are first-line agents for Stage 2 hypertension. Beta-blockers are no longer considered first-
line unless a compelling indication like heart failure exists. This patient requires
medication because lifestyle modifications alone are insufficient for Stage 2 hypertension.
2. Which of the following physical exam findings is most indicative of iron deficiency anemia?
A. Glossitis
B. Jaundice
C. Paresthesia
,D. Koilonychia
Answer: D
Rationale: Koilonychia, or spoon-shaped nails, is a classic sign of severe, chronic iron
deficiency anemia. Glossitis can occur in both B12 and iron deficiency, making it less
specific. Paresthesia is specifically associated with Vitamin B12 deficiency due to
neurological involvement.
3. A 62-year-old smoker presents with a chronic cough and productive sputum for at least 3
months in the last 2 consecutive years. What is the most likely diagnosis?
A. Emphysema
B. Chronic Bronchitis
C. Asthma
D. Bronchiectasis
Answer: B
Rationale: The clinical definition of chronic bronchitis is a productive cough for 3 months
in 2 consecutive years. While emphysema is also a part of COPD, it is characterized more by
alveolar destruction and dyspnea. Asthma is typically reversible and involves different
pathophysiological mechanisms.
4. An 18-month-old child is brought to the clinic for a well-child visit. Which developmental
milestone should the nurse practitioner expect the child to have achieved?
A. Using a spoon with little spilling
, B. Speaking in 4 to 5-word sentences
C. Climbing stairs while holding a hand
D. Drawing a square
Answer: C
Rationale: At 18 months, children are expected to walk up steps with assistance and walk
well alone. Spoon usage with minimal spilling and 4-5 word sentences are typically
milestones for older children (24-36 months). Drawing a square is a fine motor skill usually
mastered at age 4.
5. A patient with Type 2 Diabetes has an A1C of 8.2% despite taking Metformin 1000 mg BID.
What is the most appropriate next step according to ADA standards?
A. Increase Metformin to 1500 mg BID
B. Start basal insulin
C. Add a second oral agent like a GLP-1 RA or SGLT2 inhibitor
D. Discontinue Metformin and start Glyburide
Answer: C
Rationale: When A1C is above target (usually 7%) on Metformin monotherapy, dual
therapy is recommended. GLP-1 RAs and SGLT2 inhibitors are preferred second-line
agents, especially if cardiovascular or renal benefits are desired. 1000 mg BID is already
the maximum effective dose of Metformin, so increasing it further is not recommended.
