NR667 Week 7 Actual Exam Style V2 | NR
667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 65-year-old male presents for a follow-up of hypertension and type 2 diabetes. The
provider performs a medically appropriate history and examination and decides on moderate
complexity medical decision-making. Which E/M code is most appropriate for this established
patient visit?
A. 99212
B. 99214
C. 99213
D. 99215
Answer: B
Rationale: For an established patient, a level 4 visit (99214) is characterized by moderate
complexity medical decision-making. The current 2021 guidelines focus on either time or
medical decision-making (MDM) rather than specific history and exam elements. Moderate
MDM typically involves managing two or more stable chronic illnesses or one worsening
chronic illness.
,2. Which of the following describes the ethical principle of ‘Nonmaleficence’ in the context of
FNP practice?
A. The duty to do good for the patient.
B. The patient’s right to self-determination.
C. The duty to do no harm to the patient.
D. The duty to be fair and equitable to all patients.
Answer: C
Rationale: Nonmaleficence is the core ethical principle that dictates healthcare providers
should avoid causing unnecessary harm. It is often balanced with beneficence, which is the
duty to act in the best interest of the patient. In clinical practice, this means weighing the
risks of a treatment against its potential benefits.
3. A 45-year-old female presents with a TSH level of 12.4 mIU/L and a low Free T4 level. She
reports fatigue and weight gain. What is the most appropriate initial management?
A. Start Levothyroxine 25 mcg daily.
B. Wait 6 weeks and retest the TSH.
C. Start Levothyroxine 1.6 mcg/kg/day.
D. Refer to an endocrinologist immediately.
Answer: C
, Rationale: The patient’s laboratory results and symptoms are consistent with primary
hypothyroidism. The standard replacement dose for healthy adults is approximately 1.6
mcg/kg per day based on ideal body weight. It is important to monitor TSH levels every 4
to 8 weeks after starting therapy until stable.
4. Under Medicare ‘incident-to’ billing rules, what is the required level of supervision for
services provided by an NP in a private practice setting?
A. General supervision (physician available by phone).
B. Personal supervision (physician in the room).
C. Direct supervision (physician in the office suite).
D. No supervision required.
Answer: C
Rationale: Incident-to billing requires direct supervision, meaning the physician must be
present in the office suite and immediately available to provide assistance. The physician
must also have performed the initial visit for the specific problem being treated. This
allows the practice to bill at 100% of the physician fee schedule rather than the 85%
usually paid to NPs.
5. A 12-year-old patient presents with sudden onset of high fever, sore throat, and
‘sandpaper’ rash on the trunk. Which diagnostic test is most appropriate?
A. Rapid Antigen Detection Test (RADT) for Strep.
B. Monospot test.
667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 65-year-old male presents for a follow-up of hypertension and type 2 diabetes. The
provider performs a medically appropriate history and examination and decides on moderate
complexity medical decision-making. Which E/M code is most appropriate for this established
patient visit?
A. 99212
B. 99214
C. 99213
D. 99215
Answer: B
Rationale: For an established patient, a level 4 visit (99214) is characterized by moderate
complexity medical decision-making. The current 2021 guidelines focus on either time or
medical decision-making (MDM) rather than specific history and exam elements. Moderate
MDM typically involves managing two or more stable chronic illnesses or one worsening
chronic illness.
,2. Which of the following describes the ethical principle of ‘Nonmaleficence’ in the context of
FNP practice?
A. The duty to do good for the patient.
B. The patient’s right to self-determination.
C. The duty to do no harm to the patient.
D. The duty to be fair and equitable to all patients.
Answer: C
Rationale: Nonmaleficence is the core ethical principle that dictates healthcare providers
should avoid causing unnecessary harm. It is often balanced with beneficence, which is the
duty to act in the best interest of the patient. In clinical practice, this means weighing the
risks of a treatment against its potential benefits.
3. A 45-year-old female presents with a TSH level of 12.4 mIU/L and a low Free T4 level. She
reports fatigue and weight gain. What is the most appropriate initial management?
A. Start Levothyroxine 25 mcg daily.
B. Wait 6 weeks and retest the TSH.
C. Start Levothyroxine 1.6 mcg/kg/day.
D. Refer to an endocrinologist immediately.
Answer: C
, Rationale: The patient’s laboratory results and symptoms are consistent with primary
hypothyroidism. The standard replacement dose for healthy adults is approximately 1.6
mcg/kg per day based on ideal body weight. It is important to monitor TSH levels every 4
to 8 weeks after starting therapy until stable.
4. Under Medicare ‘incident-to’ billing rules, what is the required level of supervision for
services provided by an NP in a private practice setting?
A. General supervision (physician available by phone).
B. Personal supervision (physician in the room).
C. Direct supervision (physician in the office suite).
D. No supervision required.
Answer: C
Rationale: Incident-to billing requires direct supervision, meaning the physician must be
present in the office suite and immediately available to provide assistance. The physician
must also have performed the initial visit for the specific problem being treated. This
allows the practice to bill at 100% of the physician fee schedule rather than the 85%
usually paid to NPs.
5. A 12-year-old patient presents with sudden onset of high fever, sore throat, and
‘sandpaper’ rash on the trunk. Which diagnostic test is most appropriate?
A. Rapid Antigen Detection Test (RADT) for Strep.
B. Monospot test.
