NR667 Week 1 Actual Exam Style V1 | NR
667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 55-year-old male patient presents for a follow-up of hypertension. His current
medications include Lisinopril 10mg daily. His blood pressure today is 145/92 mmHg.
According to the JNC 8 guidelines, what is the next appropriate step in management for this
patient?
A. Increase Lisinopril to 20mg daily
B. Add a calcium channel blocker or a thiazide diuretic
C. Continue current dose and reassess in 6 months
D. Refer to a cardiologist for refractory hypertension
Answer: B
Rationale: The patient’s blood pressure is not at the goal of less than 140/90 mmHg for an
adult under 60. JNC 8 guidelines suggest that if the goal is not reached within one month of
treatment, the clinician should increase the dose of the initial drug or add a second drug
from the recommended classes. In this case, adding a different class like a thiazide or CCB is
a standard evidence-based approach to improve control.
,2. A 24-year-old female presents with a primary complaint of a sore throat, fever, and cervical
lymphadenopathy. On examination, you note palatine petechiae and a positive Monospot
test. What is the most appropriate patient education regarding physical activity?
A. She may return to contact sports immediately if she feels better
B. Bed rest is required for at least 14 days to prevent myocarditis
C. She must avoid contact sports for at least 3-4 weeks to prevent splenic rupture
D. Only heavy weightlifting should be avoided for 1 week
Answer: C
Rationale: Infectious mononucleosis often causes splenomegaly, which increases the risk
of splenic rupture during physical contact. Current guidelines recommend avoiding contact
sports and heavy lifting for at least 21 days or until the spleen is no longer palpable. This
precaution is vital because splenic rupture, while rare, is a life-threatening emergency
associated with EBV infection.
3. Which of the following is considered a ‘red flag’ symptom in a patient presenting with low
back pain that would require immediate imaging?
A. Pain that improves with rest
B. Gradual onset of pain over several weeks
C. Pain radiating down the posterior thigh to the knee
D. New onset of urinary incontinence or saddle anesthesia
, Answer: D
Rationale: Urinary incontinence and saddle anesthesia are hallmark signs of Cauda Equina
Syndrome, which is a surgical emergency. Most low back pain is musculoskeletal and does
not require imaging in the first 4-6 weeks unless red flags are present. Other red flags
include unexplained weight loss, history of cancer, or significant trauma.
4. A 68-year-old female with a history of osteoporosis presents for her annual exam. Which
laboratory test is most important to monitor her response to bisphosphonate therapy?
A. Serum Calcium and Vitamin D levels
B. Liver function tests
C. Complete Blood Count (CBC)
D. DEXA scan every 2 years
Answer: D
Rationale: The Dual-Energy X-ray Absorptiometry (DEXA) scan is the gold standard for
monitoring bone mineral density and the effectiveness of osteoporosis treatment.
Monitoring usually occurs every 2 years to allow for detectable changes in bone mass.
While Calcium and Vitamin D are important for overall bone health, they do not directly
measure the therapeutic response of the bone density itself.
5. An FNP is evaluating a 4-year-old child for a routine check-up. Which of the following
immunizations should the child receive at this visit, assuming they are up to date?
A. Hepatitis B, Hib, and PCV13
667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 55-year-old male patient presents for a follow-up of hypertension. His current
medications include Lisinopril 10mg daily. His blood pressure today is 145/92 mmHg.
According to the JNC 8 guidelines, what is the next appropriate step in management for this
patient?
A. Increase Lisinopril to 20mg daily
B. Add a calcium channel blocker or a thiazide diuretic
C. Continue current dose and reassess in 6 months
D. Refer to a cardiologist for refractory hypertension
Answer: B
Rationale: The patient’s blood pressure is not at the goal of less than 140/90 mmHg for an
adult under 60. JNC 8 guidelines suggest that if the goal is not reached within one month of
treatment, the clinician should increase the dose of the initial drug or add a second drug
from the recommended classes. In this case, adding a different class like a thiazide or CCB is
a standard evidence-based approach to improve control.
,2. A 24-year-old female presents with a primary complaint of a sore throat, fever, and cervical
lymphadenopathy. On examination, you note palatine petechiae and a positive Monospot
test. What is the most appropriate patient education regarding physical activity?
A. She may return to contact sports immediately if she feels better
B. Bed rest is required for at least 14 days to prevent myocarditis
C. She must avoid contact sports for at least 3-4 weeks to prevent splenic rupture
D. Only heavy weightlifting should be avoided for 1 week
Answer: C
Rationale: Infectious mononucleosis often causes splenomegaly, which increases the risk
of splenic rupture during physical contact. Current guidelines recommend avoiding contact
sports and heavy lifting for at least 21 days or until the spleen is no longer palpable. This
precaution is vital because splenic rupture, while rare, is a life-threatening emergency
associated with EBV infection.
3. Which of the following is considered a ‘red flag’ symptom in a patient presenting with low
back pain that would require immediate imaging?
A. Pain that improves with rest
B. Gradual onset of pain over several weeks
C. Pain radiating down the posterior thigh to the knee
D. New onset of urinary incontinence or saddle anesthesia
, Answer: D
Rationale: Urinary incontinence and saddle anesthesia are hallmark signs of Cauda Equina
Syndrome, which is a surgical emergency. Most low back pain is musculoskeletal and does
not require imaging in the first 4-6 weeks unless red flags are present. Other red flags
include unexplained weight loss, history of cancer, or significant trauma.
4. A 68-year-old female with a history of osteoporosis presents for her annual exam. Which
laboratory test is most important to monitor her response to bisphosphonate therapy?
A. Serum Calcium and Vitamin D levels
B. Liver function tests
C. Complete Blood Count (CBC)
D. DEXA scan every 2 years
Answer: D
Rationale: The Dual-Energy X-ray Absorptiometry (DEXA) scan is the gold standard for
monitoring bone mineral density and the effectiveness of osteoporosis treatment.
Monitoring usually occurs every 2 years to allow for detectable changes in bone mass.
While Calcium and Vitamin D are important for overall bone health, they do not directly
measure the therapeutic response of the bone density itself.
5. An FNP is evaluating a 4-year-old child for a routine check-up. Which of the following
immunizations should the child receive at this visit, assuming they are up to date?
A. Hepatitis B, Hib, and PCV13
