NR667 Week 9 Actual Exam Style V2 | NR
667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 45-year-old male presents for a routine physical exam. His blood pressure is 152/94
mmHg today and was 150/92 mmHg at his last visit. According to current guidelines, what is
the most appropriate first-line treatment for this patient with no other comorbidities?
A. Lisinopril 10 mg daily
B. Atenolol 25 mg daily
C. Clonidine 0.1 mg twice daily
D. Furosemide 20 mg daily
Answer: A
Rationale: The patient’s blood pressure readings consistently place him in the Stage 2
Hypertension category. According to JNC 8 and ACC/AHA guidelines, ACE inhibitors, ARBs,
CCBs, or thiazide diuretics are recommended as first-line therapy for non-Black patients.
Lisinopril is an ACE inhibitor that provides effective blood pressure control and is an
appropriate starting point.
,2. A 65-year-old female reports a sudden onset of ‘the worst headache of my life.’ She also
mentions some neck stiffness and sensitivity to light. Which of the following is the most likely
diagnosis?
A. Migraine with aura
B. Cluster headache
C. Tension-type headache
D. Subarachnoid hemorrhage
Answer: D
Rationale: A ‘thunderclap’ headache, described as the worst headache of one’s life, is a
classic presentation for a subarachnoid hemorrhage. The accompanying symptoms of
meningismus, such as neck stiffness and photophobia, further support this urgent
diagnosis. Immediate neurosurgical consultation and imaging via CT scan are required to
prevent morbidity and mortality.
3. An 8-month-old infant is brought to the clinic for a well-child checkup. Which of the
following developmental milestones should the nurse practitioner expect the child to have
achieved?
A. Sitting without support
B. Walking independently
C. Speaking 3-5 words clearly
D. Using a spoon to eat
,Answer: A
Rationale: By the age of 8 months, most infants are able to sit without support and may
even begin to pull themselves to a standing position. Walking independently and speaking
multiple words typically occur closer to 12 months of age. Using a spoon effectively is a fine
motor skill that usually develops in the second year of life.
4. A 22-year-old female presents with a sore throat, fever, and fatigue for 5 days. Physical
exam reveals posterior cervical lymphadenopathy and an enlarged spleen. What is the most
appropriate diagnostic test to confirm the suspected diagnosis?
A. Monospot (Heterophile antibody) test
B. Rapid Strep test
C. Complete blood count (CBC)
D. Throat culture
Answer: A
Rationale: The triad of fever, pharyngitis, and lymphadenopathy, especially when
accompanied by splenomegaly, is highly suggestive of Infectious Mononucleosis. The
Monospot test is the primary diagnostic tool used to identify the heterophile antibodies
associated with the Epstein-Barr virus. Providers should also advise the patient to avoid
contact sports to prevent splenic rupture.
, 5. A 55-year-old male with a history of Type 2 Diabetes Mellitus presents for a follow-up. His
A1C is 8.5% despite being on Metformin 1000 mg twice daily. Which of the following is the
next best step in management?
A. Increase Metformin to 3000 mg daily
B. Start basal insulin immediately
C. Switch Metformin to Glipizide
D. Add a second agent such as a GLP-1 agonist or SGLT2 inhibitor
Answer: D
Rationale: When a patient’s A1C remains above the target of 7% on Metformin
monotherapy, the addition of a second oral or injectable agent is indicated. GLP-1 agonists
and SGLT2 inhibitors are often preferred due to their cardiovascular and renal benefits.
Increasing Metformin beyond 2000-2550 mg daily does not provide significant additional
glycemic control and increases side effects.
6. Which of the following is a potential side effect of long-term use of Proton Pump Inhibitors
(PPIs)?
A. Hyperkalemia
B. Hypoglycemia
C. Vitamin B12 deficiency
D. Weight loss
667 FNP Capstone Practicum and
Intensive CEA | Chamberlain
1. A 45-year-old male presents for a routine physical exam. His blood pressure is 152/94
mmHg today and was 150/92 mmHg at his last visit. According to current guidelines, what is
the most appropriate first-line treatment for this patient with no other comorbidities?
A. Lisinopril 10 mg daily
B. Atenolol 25 mg daily
C. Clonidine 0.1 mg twice daily
D. Furosemide 20 mg daily
Answer: A
Rationale: The patient’s blood pressure readings consistently place him in the Stage 2
Hypertension category. According to JNC 8 and ACC/AHA guidelines, ACE inhibitors, ARBs,
CCBs, or thiazide diuretics are recommended as first-line therapy for non-Black patients.
Lisinopril is an ACE inhibitor that provides effective blood pressure control and is an
appropriate starting point.
,2. A 65-year-old female reports a sudden onset of ‘the worst headache of my life.’ She also
mentions some neck stiffness and sensitivity to light. Which of the following is the most likely
diagnosis?
A. Migraine with aura
B. Cluster headache
C. Tension-type headache
D. Subarachnoid hemorrhage
Answer: D
Rationale: A ‘thunderclap’ headache, described as the worst headache of one’s life, is a
classic presentation for a subarachnoid hemorrhage. The accompanying symptoms of
meningismus, such as neck stiffness and photophobia, further support this urgent
diagnosis. Immediate neurosurgical consultation and imaging via CT scan are required to
prevent morbidity and mortality.
3. An 8-month-old infant is brought to the clinic for a well-child checkup. Which of the
following developmental milestones should the nurse practitioner expect the child to have
achieved?
A. Sitting without support
B. Walking independently
C. Speaking 3-5 words clearly
D. Using a spoon to eat
,Answer: A
Rationale: By the age of 8 months, most infants are able to sit without support and may
even begin to pull themselves to a standing position. Walking independently and speaking
multiple words typically occur closer to 12 months of age. Using a spoon effectively is a fine
motor skill that usually develops in the second year of life.
4. A 22-year-old female presents with a sore throat, fever, and fatigue for 5 days. Physical
exam reveals posterior cervical lymphadenopathy and an enlarged spleen. What is the most
appropriate diagnostic test to confirm the suspected diagnosis?
A. Monospot (Heterophile antibody) test
B. Rapid Strep test
C. Complete blood count (CBC)
D. Throat culture
Answer: A
Rationale: The triad of fever, pharyngitis, and lymphadenopathy, especially when
accompanied by splenomegaly, is highly suggestive of Infectious Mononucleosis. The
Monospot test is the primary diagnostic tool used to identify the heterophile antibodies
associated with the Epstein-Barr virus. Providers should also advise the patient to avoid
contact sports to prevent splenic rupture.
, 5. A 55-year-old male with a history of Type 2 Diabetes Mellitus presents for a follow-up. His
A1C is 8.5% despite being on Metformin 1000 mg twice daily. Which of the following is the
next best step in management?
A. Increase Metformin to 3000 mg daily
B. Start basal insulin immediately
C. Switch Metformin to Glipizide
D. Add a second agent such as a GLP-1 agonist or SGLT2 inhibitor
Answer: D
Rationale: When a patient’s A1C remains above the target of 7% on Metformin
monotherapy, the addition of a second oral or injectable agent is indicated. GLP-1 agonists
and SGLT2 inhibitors are often preferred due to their cardiovascular and renal benefits.
Increasing Metformin beyond 2000-2550 mg daily does not provide significant additional
glycemic control and increases side effects.
6. Which of the following is a potential side effect of long-term use of Proton Pump Inhibitors
(PPIs)?
A. Hyperkalemia
B. Hypoglycemia
C. Vitamin B12 deficiency
D. Weight loss
