NR 667 CEA FINAL EXAM – FNP CAPSTONE
PRACTICUM & INTENSIVE COMPREHENSIVE
QUESTIONS & ANSWERS LATEST STUDY GUIDE
(2026) CHAMBERLAIN
1. Which condition is characterized by substernal chest pressure with
exertion that is relieved by rest?
A) Stable angina
B) Unstable angina
C) Myocardial infarction
D) Pericarditis
Correct Answer: A) Stable angina
Rationale: Stable angina causes predictable substernal chest pressure
during exertion and resolves with rest or nitroglycerin. Unstable angina
occurs at rest or with minimal exertion. Myocardial infarction causes
prolonged pain not relieved by rest. Pericarditis causes sharp pain
worsened by inspiration and improved by leaning forward.
2. A 68-year-old client with atrial fibrillation needs rate control.
Which medication is most appropriate?
A) Amiodarone
B) Metoprolol
C) Digoxin only
D) Diltiazem only
Correct Answer: B) Metoprolol
,Rationale: Metoprolol is a beta blocker and first-line for atrial fibrillation rate
control. Amiodarone is generally used for rhythm control and has
significant toxicity. Digoxin is less effective for active patients. Diltiazem is
a calcium channel blocker and may be used, but metoprolol is preferred.
3. Which iron treatment would likely be ineffective in a client
with malabsorption after gastric bypass?
A) Oral ferrous sulfate
B) Intravenous iron sucrose
C) Ferrous gluconate
D) Ferric carboxymaltose
Correct Answer: C) Oral ferrous sulfate
Rationale: Oral ferrous sulfate may be ineffective after gastric bypass because
altered anatomy reduces absorption. Intravenous iron sucrose and ferric
carboxymaltose bypass the gastrointestinal tract and are effective. Ferrous
gluconate is also oral and likely ineffective. Malabsorption requires parenteral
therapy.
4. Which blood lead level requires chelation therapy?
A) Less than 20 mcg/dL
B) 45 mcg/dL
C) 75 mcg/dL
D) Greater than 100 mcg/dL
Correct Answer: D) Greater than 100 mcg/dL
,Rationale: Blood lead levels above 100 mcg/dL require chelation therapy
to prevent severe neurologic and systemic toxicity. Levels below 100
mcg/dL may require source removal and monitoring. Chelation agents
include succimer and edetate calcium disodium. Immediate treatment is
critical.
5. Heart failure with reduced ejection fraction is defined as an ejection
fraction below which percentage?
A) 40 percent
B) 50 percent
C) 55 percent
D) 60 percent
Correct Answer: A) 40 percent
Rationale: Heart failure with reduced ejection fraction is defined as left
ventricular ejection fraction below 40 percent. These patients require
guideline-directed medical therapy including beta blockers, ACE inhibitors
or ARBs, and diuretics. Ejection fraction above 40 percent suggests
preserved or mid-range ejection fraction.
6. Which statement describes the mechanism of action of sacubitril/valsartan?
A) Beta blocker plus alpha blocker
B) Neprilysin inhibitor combined with an ARB
C) Direct renin inhibitor
D) Calcium channel blocker
, Correct Answer: B) Neprilysin inhibitor combined with an ARB
Rationale: Sacubitril/valsartan contains sacubitril, a neprilysin inhibitor, and
valsartan, an angiotensin receptor blocker. It increases natriuretic peptides
while blocking angiotensin II. This improves heart failure outcomes but
may cause hyperkalemia and increased creatinine. It is indicated for heart
failure with reduced ejection fraction.
7. A geriatric client with anemia, back pain, osteoporosis, and
elevated erythrocyte sedimentation rate should be evaluated for
which condition?
A) Cauda equina syndrome
B) Osteoarthritis
C) Multiple myeloma
D) Rheumatoid arthritis
Correct Answer: C) Multiple myeloma
Rationale: Multiple myeloma commonly presents in older adults with
anemia, bone pain, osteoporosis, and elevated inflammatory markers.
Cauda equina syndrome causes saddle anesthesia and bowel or bladder
dysfunction.
Osteoarthritis and rheumatoid arthritis do not explain the full presentation.
Serum protein electrophoresis and imaging are needed.
8. Which medication class is first-line for a client with diabetes and
chronic kidney disease and hypertension?
A) Beta blocker only
B) Loop diuretic only
PRACTICUM & INTENSIVE COMPREHENSIVE
QUESTIONS & ANSWERS LATEST STUDY GUIDE
(2026) CHAMBERLAIN
1. Which condition is characterized by substernal chest pressure with
exertion that is relieved by rest?
A) Stable angina
B) Unstable angina
C) Myocardial infarction
D) Pericarditis
Correct Answer: A) Stable angina
Rationale: Stable angina causes predictable substernal chest pressure
during exertion and resolves with rest or nitroglycerin. Unstable angina
occurs at rest or with minimal exertion. Myocardial infarction causes
prolonged pain not relieved by rest. Pericarditis causes sharp pain
worsened by inspiration and improved by leaning forward.
2. A 68-year-old client with atrial fibrillation needs rate control.
Which medication is most appropriate?
A) Amiodarone
B) Metoprolol
C) Digoxin only
D) Diltiazem only
Correct Answer: B) Metoprolol
,Rationale: Metoprolol is a beta blocker and first-line for atrial fibrillation rate
control. Amiodarone is generally used for rhythm control and has
significant toxicity. Digoxin is less effective for active patients. Diltiazem is
a calcium channel blocker and may be used, but metoprolol is preferred.
3. Which iron treatment would likely be ineffective in a client
with malabsorption after gastric bypass?
A) Oral ferrous sulfate
B) Intravenous iron sucrose
C) Ferrous gluconate
D) Ferric carboxymaltose
Correct Answer: C) Oral ferrous sulfate
Rationale: Oral ferrous sulfate may be ineffective after gastric bypass because
altered anatomy reduces absorption. Intravenous iron sucrose and ferric
carboxymaltose bypass the gastrointestinal tract and are effective. Ferrous
gluconate is also oral and likely ineffective. Malabsorption requires parenteral
therapy.
4. Which blood lead level requires chelation therapy?
A) Less than 20 mcg/dL
B) 45 mcg/dL
C) 75 mcg/dL
D) Greater than 100 mcg/dL
Correct Answer: D) Greater than 100 mcg/dL
,Rationale: Blood lead levels above 100 mcg/dL require chelation therapy
to prevent severe neurologic and systemic toxicity. Levels below 100
mcg/dL may require source removal and monitoring. Chelation agents
include succimer and edetate calcium disodium. Immediate treatment is
critical.
5. Heart failure with reduced ejection fraction is defined as an ejection
fraction below which percentage?
A) 40 percent
B) 50 percent
C) 55 percent
D) 60 percent
Correct Answer: A) 40 percent
Rationale: Heart failure with reduced ejection fraction is defined as left
ventricular ejection fraction below 40 percent. These patients require
guideline-directed medical therapy including beta blockers, ACE inhibitors
or ARBs, and diuretics. Ejection fraction above 40 percent suggests
preserved or mid-range ejection fraction.
6. Which statement describes the mechanism of action of sacubitril/valsartan?
A) Beta blocker plus alpha blocker
B) Neprilysin inhibitor combined with an ARB
C) Direct renin inhibitor
D) Calcium channel blocker
, Correct Answer: B) Neprilysin inhibitor combined with an ARB
Rationale: Sacubitril/valsartan contains sacubitril, a neprilysin inhibitor, and
valsartan, an angiotensin receptor blocker. It increases natriuretic peptides
while blocking angiotensin II. This improves heart failure outcomes but
may cause hyperkalemia and increased creatinine. It is indicated for heart
failure with reduced ejection fraction.
7. A geriatric client with anemia, back pain, osteoporosis, and
elevated erythrocyte sedimentation rate should be evaluated for
which condition?
A) Cauda equina syndrome
B) Osteoarthritis
C) Multiple myeloma
D) Rheumatoid arthritis
Correct Answer: C) Multiple myeloma
Rationale: Multiple myeloma commonly presents in older adults with
anemia, bone pain, osteoporosis, and elevated inflammatory markers.
Cauda equina syndrome causes saddle anesthesia and bowel or bladder
dysfunction.
Osteoarthritis and rheumatoid arthritis do not explain the full presentation.
Serum protein electrophoresis and imaging are needed.
8. Which medication class is first-line for a client with diabetes and
chronic kidney disease and hypertension?
A) Beta blocker only
B) Loop diuretic only
