NR 667 Final Exam – FNP Capstone Practicum
(Chamberlain)
Family Nurse Practitioner Comprehensive
Examination - 150 Questions
1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. Physical
exam reveals bradycardia and dry skin. Which of the following laboratory findings would the FNP
expect?
A) Increased TSH, decreased T3 and T4
B) Decreased TSH, increased T3 and T4
C) Increased TSH, increased T3 and T4
D) Normal TSH, decreased T3 and T4
Answer: A) Increased TSH, decreased T3 and T4
Rationale: The client's symptoms are consistent with hypothyroidism. In primary hypothyroidism, the
thyroid gland fails to produce adequate T3 and T4, leading to increased TSH due to loss of negative
feedback. Decreased TSH with increased T3/T4 suggests hyperthyroidism. Increased TSH with increased
T3/T4 suggests a pituitary tumor or TSH-secreting tumor.
2. A 55-year-old male with a 30-pack-year smoking history presents with a chronic cough, hemoptysis,
and weight loss. Chest x-ray shows a lung mass. Which of the following is the most appropriate initial
diagnostic test?
A) Sputum cytology
B) CT scan of the chest
C) Bronchoscopy with biopsy
D) PET scan
Answer: B) CT scan of the chest
Rationale: In a patient with suspected lung cancer, a CT scan of the chest is the most appropriate initial
diagnostic test to evaluate the mass and assess for metastasis. Sputum cytology has low sensitivity;
bronchoscopy with biopsy is indicated after imaging confirms a lesion; PET scan is used for staging after
diagnosis.
3. A 30-year-old female presents with palpitations, heat intolerance, weight loss, and tremors.
Physical exam reveals a diffuse, painless goiter and tachycardia. Which of the following is the most
likely diagnosis?
,A) Hashimoto's thyroiditis
B) Graves' disease
C) Toxic multinodular goiter
D) Thyroiditis
Answer: B) Graves' disease
Rationale: The client's symptoms of hyperthyroidism with a diffuse, painless goiter and ophthalmopathy
(if present) are classic for Graves' disease, an autoimmune cause of hyperthyroidism. Hashimoto's
thyroiditis causes hypothyroidism; toxic multinodular goiter typically occurs in older adults and has a
nodular gland; thyroiditis may be painful and transient.
4. A 65-year-old female with a history of hypertension and diabetes presents with acute-onset severe
headache, nausea, and vomiting. Blood pressure is 220/120 mm Hg. Which of the following is the
most appropriate initial management?
A) Oral antihypertensive therapy
B) Intravenous antihypertensive therapy
C) Observation with repeat BP measurement
D) Discharge with follow-up in 24 hours
Answer: B) Intravenous antihypertensive therapy
Rationale: The client is presenting with a hypertensive emergency (severe hypertension with acute end-
organ damage symptoms). Intravenous antihypertensive therapy is indicated for rapid but controlled
blood pressure reduction. Oral therapy is appropriate for hypertensive urgency without end-organ
damage; observation is not appropriate for this presentation.
5. A 50-year-old male presents with epigastric pain that worsens 2-3 hours after meals and is relieved
by food or antacids. Which of the following is the most likely diagnosis?
A) Gastric ulcer
B) Duodenal ulcer
C) Gastroesophageal reflux disease
D) Pancreatitis
Answer: B) Duodenal ulcer
Rationale: Duodenal ulcers typically present with epigastric pain that occurs 2-3 hours after meals and is
relieved by food or antacids (pain-food-relief pattern). Gastric ulcers typically present with pain that
worsens with food. GERD presents with heartburn and regurgitation; pancreatitis presents with severe,
persistent epigastric pain radiating to the back.
6. A 70-year-old male presents with urinary frequency, urgency, nocturia, and a weak urinary stream.
Digital rectal exam reveals an enlarged, smooth prostate. Which of the following is the most likely
diagnosis?
,A) Prostate cancer
B) Benign prostatic hyperplasia
C) Urinary tract infection
D) Prostatitis
Answer: B) Benign prostatic hyperplasia
Rationale: The client's symptoms of lower urinary tract symptoms (frequency, urgency, nocturia, weak
stream) with a smooth, enlarged prostate on DRE are classic for BPH. Prostate cancer typically presents
with a hard, nodular prostate on DRE; UTI would present with dysuria and fever; prostatitis presents with
pain and systemic symptoms.
7. A 25-year-old female presents with dysuria, frequency, and urgency. Urinalysis shows positive
nitrites and leukocyte esterase. Which of the following is the most appropriate initial antibiotic for an
uncomplicated UTI?
A) Ciprofloxacin
B) Trimethoprim-sulfamethoxazole
C) Nitrofurantoin
D) Amoxicillin
Answer: C) Nitrofurantoin
Rationale: Nitrofurantoin is a first-line antibiotic for uncomplicated UTIs due to its high efficacy and low
resistance rates. Trimethoprim-sulfamethoxazole has increasing resistance rates; ciprofloxacin is
reserved for complicated UTIs due to resistance concerns; amoxicillin has high resistance rates.
8. A 60-year-old female presents with acute-onset right upper quadrant pain, nausea, and vomiting.
The pain is exacerbated by fatty meals. Which of the following is the most likely diagnosis?
A) Peptic ulcer disease
B) Acute cholecystitis
C) Acute pancreatitis
D) Renal colic
Answer: B) Acute cholecystitis
Rationale: Right upper quadrant pain exacerbated by fatty meals is classic for acute cholecystitis
(gallbladder inflammation). Peptic ulcer disease presents with epigastric pain; acute pancreatitis
presents with severe epigastric pain radiating to the back; renal colic presents with flank pain radiating
to the groin.
9. A 45-year-old male with a history of alcohol use disorder presents with acute epigastric pain
radiating to the back, nausea, and vomiting. Serum amylase and lipase are markedly elevated. Which
of the following is the most likely diagnosis?
A) Peptic ulcer disease
, B) Acute cholecystitis
C) Acute pancreatitis
D) Myocardial infarction
Answer: C) Acute pancreatitis
Rationale: The client's presentation of epigastric pain radiating to the back with elevated amylase and
lipase is classic for acute pancreatitis, especially in the setting of alcohol use. Peptic ulcer disease does
not typically cause radiating back pain; cholecystitis presents with right upper quadrant pain; MI pain is
typically chest pain.
10. A 55-year-old female presents with fatigue, pallor, and shortness of breath. Laboratory findings
show hemoglobin of 8.5 g/dL, MCV of 110 fL, and low vitamin B12 levels. Which of the following is the
most likely diagnosis?
A) Iron deficiency anemia
B) Pernicious anemia
C) Folic acid deficiency anemia
D) Anemia of chronic disease
Answer: B) Pernicious anemia
Rationale: The client has macrocytic anemia (MCV > 100 fL) with low vitamin B12, consistent with
pernicious anemia (vitamin B12 deficiency due to lack of intrinsic factor). Iron deficiency anemia is
microcytic; folic acid deficiency causes macrocytic anemia but with normal B12; anemia of chronic
disease is normocytic.
11. A 65-year-old male presents with acute chest pain that is sharp, pleuritic, and worsened by lying
flat. The pain is relieved by leaning forward. Which of the following is the most likely diagnosis?
A) Acute myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Aortic dissection
Answer: B) Pericarditis
Rationale: The client's chest pain that is sharp, pleuritic, worsened by lying flat, and relieved by leaning
forward is classic for pericarditis. MI pain is typically crushing and not positional; PE pain is pleuritic but
not relieved by leaning forward; aortic dissection presents with tearing pain radiating to the back.
12. A 35-year-old female presents with fatigue, joint pain, and a malar rash. Laboratory findings show
positive ANA and anti-dsDNA antibodies. Which of the following is the most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus
(Chamberlain)
Family Nurse Practitioner Comprehensive
Examination - 150 Questions
1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. Physical
exam reveals bradycardia and dry skin. Which of the following laboratory findings would the FNP
expect?
A) Increased TSH, decreased T3 and T4
B) Decreased TSH, increased T3 and T4
C) Increased TSH, increased T3 and T4
D) Normal TSH, decreased T3 and T4
Answer: A) Increased TSH, decreased T3 and T4
Rationale: The client's symptoms are consistent with hypothyroidism. In primary hypothyroidism, the
thyroid gland fails to produce adequate T3 and T4, leading to increased TSH due to loss of negative
feedback. Decreased TSH with increased T3/T4 suggests hyperthyroidism. Increased TSH with increased
T3/T4 suggests a pituitary tumor or TSH-secreting tumor.
2. A 55-year-old male with a 30-pack-year smoking history presents with a chronic cough, hemoptysis,
and weight loss. Chest x-ray shows a lung mass. Which of the following is the most appropriate initial
diagnostic test?
A) Sputum cytology
B) CT scan of the chest
C) Bronchoscopy with biopsy
D) PET scan
Answer: B) CT scan of the chest
Rationale: In a patient with suspected lung cancer, a CT scan of the chest is the most appropriate initial
diagnostic test to evaluate the mass and assess for metastasis. Sputum cytology has low sensitivity;
bronchoscopy with biopsy is indicated after imaging confirms a lesion; PET scan is used for staging after
diagnosis.
3. A 30-year-old female presents with palpitations, heat intolerance, weight loss, and tremors.
Physical exam reveals a diffuse, painless goiter and tachycardia. Which of the following is the most
likely diagnosis?
,A) Hashimoto's thyroiditis
B) Graves' disease
C) Toxic multinodular goiter
D) Thyroiditis
Answer: B) Graves' disease
Rationale: The client's symptoms of hyperthyroidism with a diffuse, painless goiter and ophthalmopathy
(if present) are classic for Graves' disease, an autoimmune cause of hyperthyroidism. Hashimoto's
thyroiditis causes hypothyroidism; toxic multinodular goiter typically occurs in older adults and has a
nodular gland; thyroiditis may be painful and transient.
4. A 65-year-old female with a history of hypertension and diabetes presents with acute-onset severe
headache, nausea, and vomiting. Blood pressure is 220/120 mm Hg. Which of the following is the
most appropriate initial management?
A) Oral antihypertensive therapy
B) Intravenous antihypertensive therapy
C) Observation with repeat BP measurement
D) Discharge with follow-up in 24 hours
Answer: B) Intravenous antihypertensive therapy
Rationale: The client is presenting with a hypertensive emergency (severe hypertension with acute end-
organ damage symptoms). Intravenous antihypertensive therapy is indicated for rapid but controlled
blood pressure reduction. Oral therapy is appropriate for hypertensive urgency without end-organ
damage; observation is not appropriate for this presentation.
5. A 50-year-old male presents with epigastric pain that worsens 2-3 hours after meals and is relieved
by food or antacids. Which of the following is the most likely diagnosis?
A) Gastric ulcer
B) Duodenal ulcer
C) Gastroesophageal reflux disease
D) Pancreatitis
Answer: B) Duodenal ulcer
Rationale: Duodenal ulcers typically present with epigastric pain that occurs 2-3 hours after meals and is
relieved by food or antacids (pain-food-relief pattern). Gastric ulcers typically present with pain that
worsens with food. GERD presents with heartburn and regurgitation; pancreatitis presents with severe,
persistent epigastric pain radiating to the back.
6. A 70-year-old male presents with urinary frequency, urgency, nocturia, and a weak urinary stream.
Digital rectal exam reveals an enlarged, smooth prostate. Which of the following is the most likely
diagnosis?
,A) Prostate cancer
B) Benign prostatic hyperplasia
C) Urinary tract infection
D) Prostatitis
Answer: B) Benign prostatic hyperplasia
Rationale: The client's symptoms of lower urinary tract symptoms (frequency, urgency, nocturia, weak
stream) with a smooth, enlarged prostate on DRE are classic for BPH. Prostate cancer typically presents
with a hard, nodular prostate on DRE; UTI would present with dysuria and fever; prostatitis presents with
pain and systemic symptoms.
7. A 25-year-old female presents with dysuria, frequency, and urgency. Urinalysis shows positive
nitrites and leukocyte esterase. Which of the following is the most appropriate initial antibiotic for an
uncomplicated UTI?
A) Ciprofloxacin
B) Trimethoprim-sulfamethoxazole
C) Nitrofurantoin
D) Amoxicillin
Answer: C) Nitrofurantoin
Rationale: Nitrofurantoin is a first-line antibiotic for uncomplicated UTIs due to its high efficacy and low
resistance rates. Trimethoprim-sulfamethoxazole has increasing resistance rates; ciprofloxacin is
reserved for complicated UTIs due to resistance concerns; amoxicillin has high resistance rates.
8. A 60-year-old female presents with acute-onset right upper quadrant pain, nausea, and vomiting.
The pain is exacerbated by fatty meals. Which of the following is the most likely diagnosis?
A) Peptic ulcer disease
B) Acute cholecystitis
C) Acute pancreatitis
D) Renal colic
Answer: B) Acute cholecystitis
Rationale: Right upper quadrant pain exacerbated by fatty meals is classic for acute cholecystitis
(gallbladder inflammation). Peptic ulcer disease presents with epigastric pain; acute pancreatitis
presents with severe epigastric pain radiating to the back; renal colic presents with flank pain radiating
to the groin.
9. A 45-year-old male with a history of alcohol use disorder presents with acute epigastric pain
radiating to the back, nausea, and vomiting. Serum amylase and lipase are markedly elevated. Which
of the following is the most likely diagnosis?
A) Peptic ulcer disease
, B) Acute cholecystitis
C) Acute pancreatitis
D) Myocardial infarction
Answer: C) Acute pancreatitis
Rationale: The client's presentation of epigastric pain radiating to the back with elevated amylase and
lipase is classic for acute pancreatitis, especially in the setting of alcohol use. Peptic ulcer disease does
not typically cause radiating back pain; cholecystitis presents with right upper quadrant pain; MI pain is
typically chest pain.
10. A 55-year-old female presents with fatigue, pallor, and shortness of breath. Laboratory findings
show hemoglobin of 8.5 g/dL, MCV of 110 fL, and low vitamin B12 levels. Which of the following is the
most likely diagnosis?
A) Iron deficiency anemia
B) Pernicious anemia
C) Folic acid deficiency anemia
D) Anemia of chronic disease
Answer: B) Pernicious anemia
Rationale: The client has macrocytic anemia (MCV > 100 fL) with low vitamin B12, consistent with
pernicious anemia (vitamin B12 deficiency due to lack of intrinsic factor). Iron deficiency anemia is
microcytic; folic acid deficiency causes macrocytic anemia but with normal B12; anemia of chronic
disease is normocytic.
11. A 65-year-old male presents with acute chest pain that is sharp, pleuritic, and worsened by lying
flat. The pain is relieved by leaning forward. Which of the following is the most likely diagnosis?
A) Acute myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Aortic dissection
Answer: B) Pericarditis
Rationale: The client's chest pain that is sharp, pleuritic, worsened by lying flat, and relieved by leaning
forward is classic for pericarditis. MI pain is typically crushing and not positional; PE pain is pleuritic but
not relieved by leaning forward; aortic dissection presents with tearing pain radiating to the back.
12. A 35-year-old female presents with fatigue, joint pain, and a malar rash. Laboratory findings show
positive ANA and anti-dsDNA antibodies. Which of the following is the most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus
