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NR 667 CEA Practice Exam (2026) |
Chamberlain University Family Nurse
Practitioner Capstone Exam
Assessment
CASE STUDY 1: Cardiovascular
CASE STUDY: A 67-year-old male presents with progressive exertional dyspnea and fatigue over
the past 4 months. He reports occasional chest pressure when walking uphill, relieved with rest.
His medical history includes hypertension (diagnosed 10 years ago), type 2 diabetes (diagnosed
8 years ago), and hyperlipidemia. Current medications: lisinopril 20 mg daily, metformin 1000
mg BID, atorvastatin 40 mg daily. Vitals: BP 138/86, HR 78, RR 18, BMI 31.2. Physical exam
reveals S4 gallop, faint systolic ejection murmur at the right upper sternal border, and 1+
bilateral pedal edema. Labs: HbA1c 7.8%, LDL 112 mg/dL, HDL 38 mg/dL, eGFR 62 mL/min. ECG
shows left ventricular hypertrophy with strain pattern.
Q1: What is the most likely diagnosis for this patient's presentation?
A. Unstable angina
B. Chronic stable angina with underlying aortic stenosis [CORRECT]
C. Heart failure with preserved ejection fraction
D. Pulmonary embolism
Correct Answer: B
Rationale: The patient's history of progressive exertional dyspnea, chest pressure relieved with
rest, along with physical exam findings of S4 gallop and systolic ejection murmur at the right
upper sternal border, are classic for aortic stenosis with coexisting coronary artery disease.
According to ACC/AHA guidelines, the triad of angina, dyspnea on exertion, and syncope
suggests aortic stenosis in older patients with multiple cardiovascular risk factors. The S4 gallop
indicates left ventricular hypertrophy and diastolic dysfunction.
Q2: Which diagnostic test is most appropriate to confirm this patient's diagnosis?
, 2
A. Exercise stress test
B. Cardiac catheterization
C. Transthoracic echocardiogram [CORRECT]
D. Chest X-ray
Correct Answer: C
Rationale: According to ACC/AHA guidelines for valvular heart disease, transthoracic
echocardiography is the test of choice to confirm aortic stenosis, assess valve morphology, and
measure hemodynamic severity. It provides quantitative assessment of peak velocity, mean
gradient, and aortic valve area. Cardiac catheterization may be needed if there is discordance
between clinical and echocardiographic findings.
Q3: What is the most appropriate initial pharmacological management for this patient's
hypertension?
A. Increase lisinopril to 40 mg daily [CORRECT]
B. Add amlodipine 5 mg daily
C. Add hydrochlorothiazide 25 mg daily
D. Change to losartan 50 mg daily
Correct Answer: A
Rationale: According to JNC 8 guidelines, in patients with diabetes and hypertension, the target
blood pressure is <140/90 mmHg. The patient is currently on lisinopril 20 mg and has BP
138/86. The appropriate step is to titrate the ACE inhibitor upward. JNC 8 recommends ACE
inhibitors or ARBs as first-line therapy in patients with diabetes and chronic kidney disease. Up-
titration is preferred over adding a second agent when using a single agent at a submaximal
dose.
Q4: What is the most appropriate management for this patient's hyperlipidemia?
A. Continue current atorvastatin and recheck in 3 months
B. Increase atorvastatin to 80 mg daily [CORRECT]
C. Add ezetimibe 10 mg daily
D. Change to rosuvastatin 40 mg daily
Correct Answer: B
, 3
Rationale: According to ACC/AHA guidelines, patients with diabetes, hypertension, and
established atherosclerotic cardiovascular disease risk should be on high-intensity statin
therapy. This patient has an LDL of 112 mg/dL on atorvastatin 40 mg, which is not at goal (<70
mg/dL for very high-risk patients). Atorvastatin can be increased to 80 mg to achieve ≥50% LDL
reduction. This approach is supported by evidence showing greater cardiovascular risk
reduction with higher statin intensity.
Q5: What echocardiographic finding would indicate severe aortic stenosis requiring surgical
referral?
A. Mean gradient >40 mmHg, valve area <1.0 cm² [CORRECT]
B. Peak velocity >2.5 m/s
C. Valve area >2.0 cm²
D. Mild leaflet calcification
Correct Answer: A
Rationale: According to ACC/AHA valvular heart disease guidelines, severe aortic stenosis is
defined by a mean gradient >40 mmHg, peak velocity >4.0 m/s, and aortic valve area <1.0 cm².
Patients with severe aortic stenosis and symptoms (angina, dyspnea, syncope) should be
referred for surgical or transcatheter aortic valve replacement. The combination of high gradient
and small valve area identifies patients at highest risk who benefit most from intervention.
CASE STUDY 2: Respiratory
CASE STUDY: A 55-year-old female presents with progressive shortness of breath, chronic cough
productive of clear sputum, and wheezing for the past 2 years. She reports that symptoms are
worse in the morning and with cold air exposure. She has a 35-pack-year smoking history but
quit 2 years ago. Vitals: BP 132/82, HR 84, RR 22, SpO2 91% on room air, temp 98.6°F. Physical
exam reveals diminished breath sounds, prolonged expiration, diffuse expiratory wheezes, and
barrel-shaped chest. Labs: WBC 8,200, Hb 14.2, Hct 42%. Spirometry shows FEV1/FVC ratio
0.62, FEV1 58% predicted, with minimal improvement post-bronchodilator (FEV1 improves 5%).
Q6: What is the most likely diagnosis?
A. Asthma
B. Chronic obstructive pulmonary disease (COPD) [CORRECT]
, 4
C. Bronchiectasis
D. Heart failure
Correct Answer: B
Rationale: According to GOLD guidelines, COPD is diagnosed based on symptoms (dyspnea,
chronic cough, sputum production), risk factors (history of smoking), and spirometry showing
post-bronchodilator FEV1/FVC <0.70. This patient has a 35-pack-year smoking history, chronic
productive cough, and irreversible airflow limitation. The minimal bronchodilator response and
physical exam findings of barrel-shaped chest further support COPD rather than asthma.
Q7: What is the GOLD stage classification for this patient?
A. GOLD 1 (Mild) — FEV1 ≥80% predicted
B. GOLD 2 (Moderate) — FEV1 50-79% predicted [CORRECT]
C. GOLD 3 (Severe) — FEV1 30-49% predicted
D. GOLD 4 (Very Severe) — FEV1 <30% predicted
Correct Answer: B
Rationale: According to GOLD guidelines, the patient's FEV1 of 58% predicted classifies them as
GOLD Stage 2 (moderate COPD). This staging is based on post-bronchodilator spirometry values.
Understanding the GOLD stage is essential for appropriate pharmacological management, which
correlates with severity. Additionally, the patient should be assessed using GOLD ABCD
assessment to determine exacerbation risk and symptom burden.
Q8: What is the most appropriate initial pharmacological management for this patient?
A. Short-acting beta-agonist (SABA) as needed
B. Long-acting muscarinic antagonist (LAMA) monotherapy
C. Long-acting beta-agonist (LABA) plus inhaled corticosteroid (ICS)
D. LAMA plus LABA [CORRECT]
Correct Answer: D
Rationale: According to GOLD 2023 guidelines, this patient has moderate COPD with significant
symptoms. The patient's FEV1 is 58% predicted, placing them in Group B (more symptoms, low
exacerbation risk). GOLD recommends LAMA + LABA for initial therapy in patients with more
symptoms (Group B) or those with high exacerbation risk (Group E). For Group B specifically, a
NR 667 CEA Practice Exam (2026) |
Chamberlain University Family Nurse
Practitioner Capstone Exam
Assessment
CASE STUDY 1: Cardiovascular
CASE STUDY: A 67-year-old male presents with progressive exertional dyspnea and fatigue over
the past 4 months. He reports occasional chest pressure when walking uphill, relieved with rest.
His medical history includes hypertension (diagnosed 10 years ago), type 2 diabetes (diagnosed
8 years ago), and hyperlipidemia. Current medications: lisinopril 20 mg daily, metformin 1000
mg BID, atorvastatin 40 mg daily. Vitals: BP 138/86, HR 78, RR 18, BMI 31.2. Physical exam
reveals S4 gallop, faint systolic ejection murmur at the right upper sternal border, and 1+
bilateral pedal edema. Labs: HbA1c 7.8%, LDL 112 mg/dL, HDL 38 mg/dL, eGFR 62 mL/min. ECG
shows left ventricular hypertrophy with strain pattern.
Q1: What is the most likely diagnosis for this patient's presentation?
A. Unstable angina
B. Chronic stable angina with underlying aortic stenosis [CORRECT]
C. Heart failure with preserved ejection fraction
D. Pulmonary embolism
Correct Answer: B
Rationale: The patient's history of progressive exertional dyspnea, chest pressure relieved with
rest, along with physical exam findings of S4 gallop and systolic ejection murmur at the right
upper sternal border, are classic for aortic stenosis with coexisting coronary artery disease.
According to ACC/AHA guidelines, the triad of angina, dyspnea on exertion, and syncope
suggests aortic stenosis in older patients with multiple cardiovascular risk factors. The S4 gallop
indicates left ventricular hypertrophy and diastolic dysfunction.
Q2: Which diagnostic test is most appropriate to confirm this patient's diagnosis?
, 2
A. Exercise stress test
B. Cardiac catheterization
C. Transthoracic echocardiogram [CORRECT]
D. Chest X-ray
Correct Answer: C
Rationale: According to ACC/AHA guidelines for valvular heart disease, transthoracic
echocardiography is the test of choice to confirm aortic stenosis, assess valve morphology, and
measure hemodynamic severity. It provides quantitative assessment of peak velocity, mean
gradient, and aortic valve area. Cardiac catheterization may be needed if there is discordance
between clinical and echocardiographic findings.
Q3: What is the most appropriate initial pharmacological management for this patient's
hypertension?
A. Increase lisinopril to 40 mg daily [CORRECT]
B. Add amlodipine 5 mg daily
C. Add hydrochlorothiazide 25 mg daily
D. Change to losartan 50 mg daily
Correct Answer: A
Rationale: According to JNC 8 guidelines, in patients with diabetes and hypertension, the target
blood pressure is <140/90 mmHg. The patient is currently on lisinopril 20 mg and has BP
138/86. The appropriate step is to titrate the ACE inhibitor upward. JNC 8 recommends ACE
inhibitors or ARBs as first-line therapy in patients with diabetes and chronic kidney disease. Up-
titration is preferred over adding a second agent when using a single agent at a submaximal
dose.
Q4: What is the most appropriate management for this patient's hyperlipidemia?
A. Continue current atorvastatin and recheck in 3 months
B. Increase atorvastatin to 80 mg daily [CORRECT]
C. Add ezetimibe 10 mg daily
D. Change to rosuvastatin 40 mg daily
Correct Answer: B
, 3
Rationale: According to ACC/AHA guidelines, patients with diabetes, hypertension, and
established atherosclerotic cardiovascular disease risk should be on high-intensity statin
therapy. This patient has an LDL of 112 mg/dL on atorvastatin 40 mg, which is not at goal (<70
mg/dL for very high-risk patients). Atorvastatin can be increased to 80 mg to achieve ≥50% LDL
reduction. This approach is supported by evidence showing greater cardiovascular risk
reduction with higher statin intensity.
Q5: What echocardiographic finding would indicate severe aortic stenosis requiring surgical
referral?
A. Mean gradient >40 mmHg, valve area <1.0 cm² [CORRECT]
B. Peak velocity >2.5 m/s
C. Valve area >2.0 cm²
D. Mild leaflet calcification
Correct Answer: A
Rationale: According to ACC/AHA valvular heart disease guidelines, severe aortic stenosis is
defined by a mean gradient >40 mmHg, peak velocity >4.0 m/s, and aortic valve area <1.0 cm².
Patients with severe aortic stenosis and symptoms (angina, dyspnea, syncope) should be
referred for surgical or transcatheter aortic valve replacement. The combination of high gradient
and small valve area identifies patients at highest risk who benefit most from intervention.
CASE STUDY 2: Respiratory
CASE STUDY: A 55-year-old female presents with progressive shortness of breath, chronic cough
productive of clear sputum, and wheezing for the past 2 years. She reports that symptoms are
worse in the morning and with cold air exposure. She has a 35-pack-year smoking history but
quit 2 years ago. Vitals: BP 132/82, HR 84, RR 22, SpO2 91% on room air, temp 98.6°F. Physical
exam reveals diminished breath sounds, prolonged expiration, diffuse expiratory wheezes, and
barrel-shaped chest. Labs: WBC 8,200, Hb 14.2, Hct 42%. Spirometry shows FEV1/FVC ratio
0.62, FEV1 58% predicted, with minimal improvement post-bronchodilator (FEV1 improves 5%).
Q6: What is the most likely diagnosis?
A. Asthma
B. Chronic obstructive pulmonary disease (COPD) [CORRECT]
, 4
C. Bronchiectasis
D. Heart failure
Correct Answer: B
Rationale: According to GOLD guidelines, COPD is diagnosed based on symptoms (dyspnea,
chronic cough, sputum production), risk factors (history of smoking), and spirometry showing
post-bronchodilator FEV1/FVC <0.70. This patient has a 35-pack-year smoking history, chronic
productive cough, and irreversible airflow limitation. The minimal bronchodilator response and
physical exam findings of barrel-shaped chest further support COPD rather than asthma.
Q7: What is the GOLD stage classification for this patient?
A. GOLD 1 (Mild) — FEV1 ≥80% predicted
B. GOLD 2 (Moderate) — FEV1 50-79% predicted [CORRECT]
C. GOLD 3 (Severe) — FEV1 30-49% predicted
D. GOLD 4 (Very Severe) — FEV1 <30% predicted
Correct Answer: B
Rationale: According to GOLD guidelines, the patient's FEV1 of 58% predicted classifies them as
GOLD Stage 2 (moderate COPD). This staging is based on post-bronchodilator spirometry values.
Understanding the GOLD stage is essential for appropriate pharmacological management, which
correlates with severity. Additionally, the patient should be assessed using GOLD ABCD
assessment to determine exacerbation risk and symptom burden.
Q8: What is the most appropriate initial pharmacological management for this patient?
A. Short-acting beta-agonist (SABA) as needed
B. Long-acting muscarinic antagonist (LAMA) monotherapy
C. Long-acting beta-agonist (LABA) plus inhaled corticosteroid (ICS)
D. LAMA plus LABA [CORRECT]
Correct Answer: D
Rationale: According to GOLD 2023 guidelines, this patient has moderate COPD with significant
symptoms. The patient's FEV1 is 58% predicted, placing them in Group B (more symptoms, low
exacerbation risk). GOLD recommends LAMA + LABA for initial therapy in patients with more
symptoms (Group B) or those with high exacerbation risk (Group E). For Group B specifically, a
