NR667 Week 8 Actual Exam Style V2 | NR
667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 55-year-old male presents for a follow-up of hypertension. His current blood pressure is
155/95 mmHg despite adherence to Lisinopril 20mg daily. He has a history of Type 2
Diabetes. According to JNC 8 guidelines, what should be the next step?
A. Increase Lisinopril to 40mg daily
B. Add a Calcium Channel Blocker or Thiazide diuretic
C. Switch Lisinopril to Losartan
D. Refer to a cardiologist for refractory hypertension
Answer: B
Rationale: For patients with diabetes and hypertension, ACE inhibitors are first-line, but if
the goal is not met, adding a second class is recommended. JNC 8 suggests adding a CCB or
a thiazide-type diuretic to improve blood pressure control. This multi-drug approach
addresses different physiological pathways to achieve the target BP of less than 140/90
mmHg.
,2. A 24-year-old female presents with a chief complaint of a ‘fishy’ vaginal odor that is more
noticeable after intercourse. On examination, you note thin, gray-white discharge. The pH is
5.0 and clue cells are present on microscopy. What is the recommended treatment?
A. Metronidazole 500mg PO BID for 7 days
B. Azithromycin 1g PO x1
C. Fluconazole 150mg PO x1
D. Ceftriaxone 500mg IM x1
Answer: A
Rationale: Bacterial vaginosis is diagnosed using Amsel’s criteria, which includes the
presence of clue cells and a positive whiff test. Metronidazole is the gold standard
treatment to restore the vaginal flora balance. It is important to advise the patient to avoid
alcohol consumption during and for 24 hours after treatment to prevent a disulfiram-like
reaction.
3. An 82-year-old patient is brought in by her daughter due to increasing confusion over the
last 48 hours. The patient has a history of mild cognitive impairment and recently started
taking an antibiotic for a UTI. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Lewy Body Dementia
D. Delirium
, Answer: D
Rationale: Delirium is characterized by an acute onset of cognitive impairment and
fluctuations in consciousness. In elderly patients, infections like UTIs are common triggers
for delirium due to physiological stress. Unlike dementia, delirium is often reversible once
the underlying cause is identified and treated.
4. Which of the following is an example of secondary prevention in a primary care setting?
A. Performing a screening colonoscopy on an asymptomatic 45-year-old
B. Administering the Influenza vaccine
C. Prescribing Metformin for a patient with established Type 2 Diabetes
D. Educating high school students about the dangers of smoking
Answer: A
Rationale: Secondary prevention involves screening for diseases in their early,
asymptomatic stages to improve outcomes. Colonoscopy is a classic example of secondary
prevention because it aims to detect precancerous polyps or early-stage cancer. In contrast,
vaccinations are primary prevention and treating established disease is tertiary
prevention.
5. A 4-year-old child is brought in for a well-child check. The mother is concerned that the
child cannot yet tie their shoes. How should the FNP respond based on developmental
milestones?
A. Refer the child to occupational therapy for fine motor delay
667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 55-year-old male presents for a follow-up of hypertension. His current blood pressure is
155/95 mmHg despite adherence to Lisinopril 20mg daily. He has a history of Type 2
Diabetes. According to JNC 8 guidelines, what should be the next step?
A. Increase Lisinopril to 40mg daily
B. Add a Calcium Channel Blocker or Thiazide diuretic
C. Switch Lisinopril to Losartan
D. Refer to a cardiologist for refractory hypertension
Answer: B
Rationale: For patients with diabetes and hypertension, ACE inhibitors are first-line, but if
the goal is not met, adding a second class is recommended. JNC 8 suggests adding a CCB or
a thiazide-type diuretic to improve blood pressure control. This multi-drug approach
addresses different physiological pathways to achieve the target BP of less than 140/90
mmHg.
,2. A 24-year-old female presents with a chief complaint of a ‘fishy’ vaginal odor that is more
noticeable after intercourse. On examination, you note thin, gray-white discharge. The pH is
5.0 and clue cells are present on microscopy. What is the recommended treatment?
A. Metronidazole 500mg PO BID for 7 days
B. Azithromycin 1g PO x1
C. Fluconazole 150mg PO x1
D. Ceftriaxone 500mg IM x1
Answer: A
Rationale: Bacterial vaginosis is diagnosed using Amsel’s criteria, which includes the
presence of clue cells and a positive whiff test. Metronidazole is the gold standard
treatment to restore the vaginal flora balance. It is important to advise the patient to avoid
alcohol consumption during and for 24 hours after treatment to prevent a disulfiram-like
reaction.
3. An 82-year-old patient is brought in by her daughter due to increasing confusion over the
last 48 hours. The patient has a history of mild cognitive impairment and recently started
taking an antibiotic for a UTI. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Lewy Body Dementia
D. Delirium
, Answer: D
Rationale: Delirium is characterized by an acute onset of cognitive impairment and
fluctuations in consciousness. In elderly patients, infections like UTIs are common triggers
for delirium due to physiological stress. Unlike dementia, delirium is often reversible once
the underlying cause is identified and treated.
4. Which of the following is an example of secondary prevention in a primary care setting?
A. Performing a screening colonoscopy on an asymptomatic 45-year-old
B. Administering the Influenza vaccine
C. Prescribing Metformin for a patient with established Type 2 Diabetes
D. Educating high school students about the dangers of smoking
Answer: A
Rationale: Secondary prevention involves screening for diseases in their early,
asymptomatic stages to improve outcomes. Colonoscopy is a classic example of secondary
prevention because it aims to detect precancerous polyps or early-stage cancer. In contrast,
vaccinations are primary prevention and treating established disease is tertiary
prevention.
5. A 4-year-old child is brought in for a well-child check. The mother is concerned that the
child cannot yet tie their shoes. How should the FNP respond based on developmental
milestones?
A. Refer the child to occupational therapy for fine motor delay
