NR667 FNP Capstone Final Exam 2026/2027
- ANCC & AANP Certification Prep
================================================================
TOTAL 85 ITEMS | Breakdown: 55 MC + 15 SATA + 10 Differential
Diagnosis + 8 Evidence-Based Treatment + 7 Professional Practice
DOMAIN A Complex Primary Care Management (30 Q)
1. A 58-year-old Black male (BMI 32, A1C 9.1 %, BP 152/96) on metformin 1 g BID,
lisinopril 10 mg daily, reports 3-day cough, green sputum, T 38.2 °C. Chest X-ray
shows RML infiltrate. Which antibiotic & dosing is evidence-based FIRST-LINE?
A. Amoxicillin-clavulanate 875-125 mg PO q12h × 5 d
B. Levofloxacin 750 mg PO daily × 5 d
C. Doxycycline 100 mg PO BID × 7 d
D. Azithromycin 500 mg day-1 then 250 mg × 4 d
Answer: B – 2026 IDSA CAP outpatient: comorbidities (DM, COPD risk) → respiratory
fluoroquinolone; avoids β-lactam failure.
2. (SATA) A 17-year-old (WT 50 kg) with acute asthma exacerbation (peak flow 45 %
personal best, O2 sat 91 % RA). Which treatments are indicated NOW? (Select
ALL)
A. Albuterol 2.5 mg neb q20 min × 3
B. Ipratropium 0.5 mg neb once
C. Methylprednisolone 40 mg IV now
D. Magnesium sulfate 2 g IV over 20 min
E. Continuous albuterol 10 mg/h
Answer: A, B, C, D – Continuous (E) reserved for severe (<40 %); current 45 % =
moderate.
, 3. Priority: Four patients need STAT review. Whom do you assess FIRST?
4. 4-h post-PCI, sheath still in place, bivalirudin infusing
5. 2-days post-laparotomy, pain 9/10, morphine PCA demand 20, no bolus given
6. New admit, RR 28, SpO₂ 90 % on 2 L, temp 38 °C
7. Day-3 CHF, weight ↑ 2 kg, BP 110/70, JVP 6 cm
Correct order: 3 → 1 → 2 → 4
Answer: Airway/oxygenation (3) > bleeding risk (1) > unrelieved pain (2) > volume
overload stable (4).
[4-30 continue COPD GOLD 2026, resistant HTN, pediatric asthma action plans, geriatric
fall bundle, DM foot infection, polypharmacy taper, transgender hormone monitoring…]
DOMAIN B Advanced Diagnostic Reasoning (25 Q)
31. A 24-year-old female (G2 P1, 10 wks) presents with 3-day RUQ pain, T 38 °C, WBC
15 k, AST 210, ALT 190, bilirubin 2.1. UA shows 15 WBC, no nitrite. US: gallstones,
no duct dilation. MOST likely diagnosis?
A. Acute hepatitis B
B. Cholelithiasis with biliary colic
C. Acute pyelonephritis
D. Cholecystitis
Answer: D – Murphy sign on US, fever, elevated LFTs → cholecystitis; pregnancy
increases risk.
32. (SATA) Which findings support acute pericarditis rather than STEMI? (Select ALL)
A. Diffusely elevated ST with PR depression
B. Troponin I 0.04 ng/mL
C. Chest pain improves when sitting up
D. Q-waves in V1-V3
E. Friction rub on auscultation
Answer: A, C, E – Q-waves (D) suggest infarct; mild troponin can occur in pericarditis.
- ANCC & AANP Certification Prep
================================================================
TOTAL 85 ITEMS | Breakdown: 55 MC + 15 SATA + 10 Differential
Diagnosis + 8 Evidence-Based Treatment + 7 Professional Practice
DOMAIN A Complex Primary Care Management (30 Q)
1. A 58-year-old Black male (BMI 32, A1C 9.1 %, BP 152/96) on metformin 1 g BID,
lisinopril 10 mg daily, reports 3-day cough, green sputum, T 38.2 °C. Chest X-ray
shows RML infiltrate. Which antibiotic & dosing is evidence-based FIRST-LINE?
A. Amoxicillin-clavulanate 875-125 mg PO q12h × 5 d
B. Levofloxacin 750 mg PO daily × 5 d
C. Doxycycline 100 mg PO BID × 7 d
D. Azithromycin 500 mg day-1 then 250 mg × 4 d
Answer: B – 2026 IDSA CAP outpatient: comorbidities (DM, COPD risk) → respiratory
fluoroquinolone; avoids β-lactam failure.
2. (SATA) A 17-year-old (WT 50 kg) with acute asthma exacerbation (peak flow 45 %
personal best, O2 sat 91 % RA). Which treatments are indicated NOW? (Select
ALL)
A. Albuterol 2.5 mg neb q20 min × 3
B. Ipratropium 0.5 mg neb once
C. Methylprednisolone 40 mg IV now
D. Magnesium sulfate 2 g IV over 20 min
E. Continuous albuterol 10 mg/h
Answer: A, B, C, D – Continuous (E) reserved for severe (<40 %); current 45 % =
moderate.
, 3. Priority: Four patients need STAT review. Whom do you assess FIRST?
4. 4-h post-PCI, sheath still in place, bivalirudin infusing
5. 2-days post-laparotomy, pain 9/10, morphine PCA demand 20, no bolus given
6. New admit, RR 28, SpO₂ 90 % on 2 L, temp 38 °C
7. Day-3 CHF, weight ↑ 2 kg, BP 110/70, JVP 6 cm
Correct order: 3 → 1 → 2 → 4
Answer: Airway/oxygenation (3) > bleeding risk (1) > unrelieved pain (2) > volume
overload stable (4).
[4-30 continue COPD GOLD 2026, resistant HTN, pediatric asthma action plans, geriatric
fall bundle, DM foot infection, polypharmacy taper, transgender hormone monitoring…]
DOMAIN B Advanced Diagnostic Reasoning (25 Q)
31. A 24-year-old female (G2 P1, 10 wks) presents with 3-day RUQ pain, T 38 °C, WBC
15 k, AST 210, ALT 190, bilirubin 2.1. UA shows 15 WBC, no nitrite. US: gallstones,
no duct dilation. MOST likely diagnosis?
A. Acute hepatitis B
B. Cholelithiasis with biliary colic
C. Acute pyelonephritis
D. Cholecystitis
Answer: D – Murphy sign on US, fever, elevated LFTs → cholecystitis; pregnancy
increases risk.
32. (SATA) Which findings support acute pericarditis rather than STEMI? (Select ALL)
A. Diffusely elevated ST with PR depression
B. Troponin I 0.04 ng/mL
C. Chest pain improves when sitting up
D. Q-waves in V1-V3
E. Friction rub on auscultation
Answer: A, C, E – Q-waves (D) suggest infarct; mild troponin can occur in pericarditis.
