NR667 Exit Exam Actual Exam Style V1 |
NR 667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 52-year-old male presents with a blood pressure of 148/92 mmHg on three separate
occasions. His 10-year ASCVD risk is 6%. What is the most appropriate initial management for
this patient according to ACC/AHA guidelines?
A. Initiate lifestyle modifications and re-evaluate in 3-6 months
B. Start Lisinopril 10mg daily
C. Start Hydrochlorothiazide 12.5mg daily
D. Refer to cardiology for a stress test
Answer: A
Rationale: For patients with Stage 1 hypertension and an ASCVD risk of less than 10%,
lifestyle modifications are recommended as the first-line therapy. The patient should be
reassessed in three to six months to determine if goals are being met. This conservative
approach avoids polypharmacy in low-risk individuals while addressing root causes like
diet and exercise.
2. Which of the following physical exam findings is most suggestive of acute cholecystitis?
A. McBurney’s point tenderness
B. Psoas sign
,C. Rovsing’s sign
D. Positive Murphy’s sign
Answer: D
Rationale: A positive Murphy’s sign occurs when there is a cessation of inspiration due to
pain when the gallbladder is palpated during a deep breath. This finding is highly specific
for gallbladder inflammation and acute cholecystitis. In contrast, signs like McBurney’s or
Rovsing’s are more indicative of acute appendicitis.
3. A 24-year-old female presents for a routine Pap smear. Her history reveals she has never
had an abnormal Pap. According to current USPSTF guidelines, when should her next
screening be scheduled?
A. In 1 year
B. In 5 years with co-testing
C. In 3 years with cytology alone
D. In 10 years
Answer: C
Rationale: For women aged 21 to 29, the current recommendation is screening with
cervical cytology alone every 3 years. Co-testing with HPV is not recommended for this
specific age group due to the high prevalence of transient HPV infections. Adhering to these
intervals helps minimize unnecessary procedures while ensuring early detection of cervical
changes.
, 4. A patient with Type 2 Diabetes is currently taking Metformin 1000mg BID. His latest A1C is
8.2%. He has a history of heart failure. Which medication class is the most appropriate
addition to his regimen?
A. Sulfonylurea
B. Thiazolidinedione (TZD)
C. DPP-4 Inhibitor
D. SGLT2 Inhibitor
Answer: D
Rationale: SGLT2 inhibitors have shown significant benefits in reducing hospitalizations
for heart failure and slowing the progression of kidney disease in diabetic patients. TZDs
like Pioglitazone should be avoided as they can exacerbate fluid retention and heart failure.
This choice aligns with the ADA Standards of Care for managing patients with established
cardiovascular comorbidities.
5. A 6-month-old infant is brought in for a well-child checkup. Which milestone is typically
expected at this age?
A. Walking while holding onto furniture
B. Speaking two-word sentences
C. Sitting with support or briefly without support
D. Using a pincer grasp to pick up small objects
NR 667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 52-year-old male presents with a blood pressure of 148/92 mmHg on three separate
occasions. His 10-year ASCVD risk is 6%. What is the most appropriate initial management for
this patient according to ACC/AHA guidelines?
A. Initiate lifestyle modifications and re-evaluate in 3-6 months
B. Start Lisinopril 10mg daily
C. Start Hydrochlorothiazide 12.5mg daily
D. Refer to cardiology for a stress test
Answer: A
Rationale: For patients with Stage 1 hypertension and an ASCVD risk of less than 10%,
lifestyle modifications are recommended as the first-line therapy. The patient should be
reassessed in three to six months to determine if goals are being met. This conservative
approach avoids polypharmacy in low-risk individuals while addressing root causes like
diet and exercise.
2. Which of the following physical exam findings is most suggestive of acute cholecystitis?
A. McBurney’s point tenderness
B. Psoas sign
,C. Rovsing’s sign
D. Positive Murphy’s sign
Answer: D
Rationale: A positive Murphy’s sign occurs when there is a cessation of inspiration due to
pain when the gallbladder is palpated during a deep breath. This finding is highly specific
for gallbladder inflammation and acute cholecystitis. In contrast, signs like McBurney’s or
Rovsing’s are more indicative of acute appendicitis.
3. A 24-year-old female presents for a routine Pap smear. Her history reveals she has never
had an abnormal Pap. According to current USPSTF guidelines, when should her next
screening be scheduled?
A. In 1 year
B. In 5 years with co-testing
C. In 3 years with cytology alone
D. In 10 years
Answer: C
Rationale: For women aged 21 to 29, the current recommendation is screening with
cervical cytology alone every 3 years. Co-testing with HPV is not recommended for this
specific age group due to the high prevalence of transient HPV infections. Adhering to these
intervals helps minimize unnecessary procedures while ensuring early detection of cervical
changes.
, 4. A patient with Type 2 Diabetes is currently taking Metformin 1000mg BID. His latest A1C is
8.2%. He has a history of heart failure. Which medication class is the most appropriate
addition to his regimen?
A. Sulfonylurea
B. Thiazolidinedione (TZD)
C. DPP-4 Inhibitor
D. SGLT2 Inhibitor
Answer: D
Rationale: SGLT2 inhibitors have shown significant benefits in reducing hospitalizations
for heart failure and slowing the progression of kidney disease in diabetic patients. TZDs
like Pioglitazone should be avoided as they can exacerbate fluid retention and heart failure.
This choice aligns with the ADA Standards of Care for managing patients with established
cardiovascular comorbidities.
5. A 6-month-old infant is brought in for a well-child checkup. Which milestone is typically
expected at this age?
A. Walking while holding onto furniture
B. Speaking two-word sentences
C. Sitting with support or briefly without support
D. Using a pincer grasp to pick up small objects
