NR667 Exit Exam Actual Exam Style V2 |
NR 667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 65-year-old male presents with a blood pressure of 152/94 mmHg on two separate
occasions. He has no significant past medical history. According to JNC 8 guidelines, what is
the most appropriate initial management?
A. Initiate lifestyle modifications only and recheck in 6 months.
B. Refer to a cardiologist immediately for further evaluation.
C. Prescribe a beta-blocker as first-line therapy.
D. Start a thiazide-type diuretic or ACE inhibitor.
Answer: D
Rationale: JNC 8 guidelines recommend initiating pharmacologic treatment for patients
aged 60 or older with a systolic BP of 150 or higher or diastolic BP of 90 or higher.
Thiazide-type diuretics, CCBs, ACEIs, or ARBs are considered appropriate first-line agents
for the non-black population. Beta-blockers are no longer recommended as first-line
therapy for uncomplicated hypertension.
,2. A 45-year-old female reports a 3-month history of fatigue and cold intolerance. Her TSH is
8.2 mIU/L (normal: 0.4-4.0) and her Free T4 is 0.6 ng/dL (normal: 0.8-1.8). What is the most
likely diagnosis?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Subclinical hypothyroidism
D. Euthyroid sick syndrome
Answer: A
Rationale: Primary hypothyroidism is characterized by an elevated TSH and a low Free T4.
This indicates that the thyroid gland is failing to produce sufficient hormones despite
increased stimulation from the pituitary. Subclinical hypothyroidism would present with
an elevated TSH but a normal Free T4 level.
3. Which of the following is the most appropriate first-line antibiotic for an adult with
uncomplicated Community-Acquired Pneumonia (CAP) and no comorbidities or recent
antibiotic use?
A. Amoxicillin or Doxycycline
B. Ciprofloxacin
C. Vancomycin
D. Trimethoprim-Sulfamethoxazole
,Answer: A
Rationale: For healthy adults without comorbidities, the current guidelines recommend
high-dose amoxicillin or doxycycline as first-line monotherapy. Macrolides are only
recommended if local pneumococcal resistance is less than 25 percent. Fluoroquinolones
like ciprofloxacin are generally reserved for patients with significant risk factors or
comorbidities.
4. A 28-year-old female presents with a malar rash, photosensitivity, and joint pain. Which
laboratory test is the most sensitive screening tool for Systemic Lupus Erythematosus (SLE)?
A. Anti-dsDNA antibody
B. Anti-Smith antibody
C. Rheumatoid Factor (RF)
D. Antinuclear antibody (ANA)
Answer: D
Rationale: The ANA test is highly sensitive for SLE, with over 95 percent of patients testing
positive. While it is sensitive, it is not highly specific, meaning other conditions can also
cause a positive result. Anti-dsDNA and Anti-Smith are more specific for SLE but less
sensitive than the ANA.
5. A 12-month-old infant is brought in for a well-child visit. Which of the following
developmental milestones is most expected at this age?
A. Walking independently and climbing stairs.
, B. Using 50 or more single words.
C. Standing alone and taking a few steps.
D. Drawing a circle and a square.
Answer: C
Rationale: At 12 months, infants are typically expected to stand alone and may take a few
steps. Walking independently is often achieved shortly after the first birthday, but standing
alone is a key milestone for this age. Language skills at this age usually involve saying
‘mama’ or ‘dada’ specifically and potentially one other word.
6. A 50-year-old male with a history of hypertension and a BMI of 32 presents with sudden,
severe pain and swelling in his right great toe. What is the gold standard for diagnosing this
condition?
A. Serum uric acid level
B. X-ray of the foot
C. Joint fluid aspiration and crystal analysis
D. Clinical presentation and response to Colchicine
Answer: C
Rationale: The gold standard for diagnosing gout is the identification of monosodium
urate crystals in synovial fluid under polarized light microscopy. Serum uric acid levels can
NR 667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 65-year-old male presents with a blood pressure of 152/94 mmHg on two separate
occasions. He has no significant past medical history. According to JNC 8 guidelines, what is
the most appropriate initial management?
A. Initiate lifestyle modifications only and recheck in 6 months.
B. Refer to a cardiologist immediately for further evaluation.
C. Prescribe a beta-blocker as first-line therapy.
D. Start a thiazide-type diuretic or ACE inhibitor.
Answer: D
Rationale: JNC 8 guidelines recommend initiating pharmacologic treatment for patients
aged 60 or older with a systolic BP of 150 or higher or diastolic BP of 90 or higher.
Thiazide-type diuretics, CCBs, ACEIs, or ARBs are considered appropriate first-line agents
for the non-black population. Beta-blockers are no longer recommended as first-line
therapy for uncomplicated hypertension.
,2. A 45-year-old female reports a 3-month history of fatigue and cold intolerance. Her TSH is
8.2 mIU/L (normal: 0.4-4.0) and her Free T4 is 0.6 ng/dL (normal: 0.8-1.8). What is the most
likely diagnosis?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Subclinical hypothyroidism
D. Euthyroid sick syndrome
Answer: A
Rationale: Primary hypothyroidism is characterized by an elevated TSH and a low Free T4.
This indicates that the thyroid gland is failing to produce sufficient hormones despite
increased stimulation from the pituitary. Subclinical hypothyroidism would present with
an elevated TSH but a normal Free T4 level.
3. Which of the following is the most appropriate first-line antibiotic for an adult with
uncomplicated Community-Acquired Pneumonia (CAP) and no comorbidities or recent
antibiotic use?
A. Amoxicillin or Doxycycline
B. Ciprofloxacin
C. Vancomycin
D. Trimethoprim-Sulfamethoxazole
,Answer: A
Rationale: For healthy adults without comorbidities, the current guidelines recommend
high-dose amoxicillin or doxycycline as first-line monotherapy. Macrolides are only
recommended if local pneumococcal resistance is less than 25 percent. Fluoroquinolones
like ciprofloxacin are generally reserved for patients with significant risk factors or
comorbidities.
4. A 28-year-old female presents with a malar rash, photosensitivity, and joint pain. Which
laboratory test is the most sensitive screening tool for Systemic Lupus Erythematosus (SLE)?
A. Anti-dsDNA antibody
B. Anti-Smith antibody
C. Rheumatoid Factor (RF)
D. Antinuclear antibody (ANA)
Answer: D
Rationale: The ANA test is highly sensitive for SLE, with over 95 percent of patients testing
positive. While it is sensitive, it is not highly specific, meaning other conditions can also
cause a positive result. Anti-dsDNA and Anti-Smith are more specific for SLE but less
sensitive than the ANA.
5. A 12-month-old infant is brought in for a well-child visit. Which of the following
developmental milestones is most expected at this age?
A. Walking independently and climbing stairs.
, B. Using 50 or more single words.
C. Standing alone and taking a few steps.
D. Drawing a circle and a square.
Answer: C
Rationale: At 12 months, infants are typically expected to stand alone and may take a few
steps. Walking independently is often achieved shortly after the first birthday, but standing
alone is a key milestone for this age. Language skills at this age usually involve saying
‘mama’ or ‘dada’ specifically and potentially one other word.
6. A 50-year-old male with a history of hypertension and a BMI of 32 presents with sudden,
severe pain and swelling in his right great toe. What is the gold standard for diagnosing this
condition?
A. Serum uric acid level
B. X-ray of the foot
C. Joint fluid aspiration and crystal analysis
D. Clinical presentation and response to Colchicine
Answer: C
Rationale: The gold standard for diagnosing gout is the identification of monosodium
urate crystals in synovial fluid under polarized light microscopy. Serum uric acid levels can
