NR 667 EXAM 3 COMPREHENSIVE
CAPSTONE PRACTICE QUESTIONS AND
ANSWERS 2026/2027 UPDATE. 100%
VERIFIED
1. A 68-year-old male presents with sudden, severe pain, redness, and swelling in his right
first metatarsophalangeal joint. He reports consuming a large steak and several beers the
previous night. What is the gold standard for diagnosing this condition?
A. Joint aspiration with polarized light microscopy showing negatively birefringent crystals
B. Serum uric acid level greater than 7.0 mg/dL
C. Plain radiograph showing ‘punched-out’ erosions
D. Clinical diagnosis based on the Homan’s sign
Answer: A
Conceptual Explanation: Joint aspiration and finding negatively birefringent needle-
shaped urate crystals is the gold standard for diagnosing gout. Serum uric acid can be
normal during an acute attack.
2. An 8-year-old child presents with a ‘barky’ cough, inspiratory stridor, and low-grade fever.
What is the most likely pathogen responsible for this presentation?
A. Haemophilus influenzae type b
,B. Respiratory syncytial virus (RSV)
C. Parainfluenza virus
D. Group A Streptococcus
Answer: C
Conceptual Explanation: Parainfluenza virus is the most common cause of croup
(laryngotracheobronchitis), characterized by a barky cough and stridor.
3. According to the 2017 ACC/AHA Hypertension guidelines, a patient with a blood pressure
of 135/85 mmHg and a 10-year ASCVD risk of 12% should be classified as:
A. Elevated Blood Pressure
B. Stage 2 Hypertension
C. Stage 1 Hypertension
D. Hypertensive Urgency
Answer: C
Conceptual Explanation: Stage 1 Hypertension is defined as 130-139 mmHg systolic or
80-89 mmHg diastolic. Treatment is recommended if ASCVD risk is >10%.
4. A 24-year-old female presents with a headache described as unilateral, throbbing, and
associated with photophobia and nausea. She reports seeing ‘flashing lights’ before the pain
started. Which medication is first-line for abortive therapy in moderate to severe cases?
A. Sumatriptan
, B. Propranolol
C. Amitriptyline
D. Topiramate
Answer: A
Conceptual Explanation: Triptans like Sumatriptan are first-line abortive treatments for
migraines. Propranolol and Topiramate are used for prophylaxis.
5. When prescribing an SSRI for a 75-year-old patient with depression, which of the following
is a significant concern regarding electrolytes?
A. Hyponatremia
B. Hypercalcemia
C. Hyperkalemia
D. Hypomagnesemia
Answer: A
Conceptual Explanation: SSRIs are associated with the Risk of SIADH, leading to
hyponatremia, particularly in the elderly population.
6. A 45-year-old male with a history of hypertension and DM2 presents with a productive
cough, fever of 102F, and pleuritic chest pain. CXR shows right lower lobe consolidation.
CURB-65 score is 1. What is the appropriate management?
A. Inpatient admission for IV Ceftriaxone
CAPSTONE PRACTICE QUESTIONS AND
ANSWERS 2026/2027 UPDATE. 100%
VERIFIED
1. A 68-year-old male presents with sudden, severe pain, redness, and swelling in his right
first metatarsophalangeal joint. He reports consuming a large steak and several beers the
previous night. What is the gold standard for diagnosing this condition?
A. Joint aspiration with polarized light microscopy showing negatively birefringent crystals
B. Serum uric acid level greater than 7.0 mg/dL
C. Plain radiograph showing ‘punched-out’ erosions
D. Clinical diagnosis based on the Homan’s sign
Answer: A
Conceptual Explanation: Joint aspiration and finding negatively birefringent needle-
shaped urate crystals is the gold standard for diagnosing gout. Serum uric acid can be
normal during an acute attack.
2. An 8-year-old child presents with a ‘barky’ cough, inspiratory stridor, and low-grade fever.
What is the most likely pathogen responsible for this presentation?
A. Haemophilus influenzae type b
,B. Respiratory syncytial virus (RSV)
C. Parainfluenza virus
D. Group A Streptococcus
Answer: C
Conceptual Explanation: Parainfluenza virus is the most common cause of croup
(laryngotracheobronchitis), characterized by a barky cough and stridor.
3. According to the 2017 ACC/AHA Hypertension guidelines, a patient with a blood pressure
of 135/85 mmHg and a 10-year ASCVD risk of 12% should be classified as:
A. Elevated Blood Pressure
B. Stage 2 Hypertension
C. Stage 1 Hypertension
D. Hypertensive Urgency
Answer: C
Conceptual Explanation: Stage 1 Hypertension is defined as 130-139 mmHg systolic or
80-89 mmHg diastolic. Treatment is recommended if ASCVD risk is >10%.
4. A 24-year-old female presents with a headache described as unilateral, throbbing, and
associated with photophobia and nausea. She reports seeing ‘flashing lights’ before the pain
started. Which medication is first-line for abortive therapy in moderate to severe cases?
A. Sumatriptan
, B. Propranolol
C. Amitriptyline
D. Topiramate
Answer: A
Conceptual Explanation: Triptans like Sumatriptan are first-line abortive treatments for
migraines. Propranolol and Topiramate are used for prophylaxis.
5. When prescribing an SSRI for a 75-year-old patient with depression, which of the following
is a significant concern regarding electrolytes?
A. Hyponatremia
B. Hypercalcemia
C. Hyperkalemia
D. Hypomagnesemia
Answer: A
Conceptual Explanation: SSRIs are associated with the Risk of SIADH, leading to
hyponatremia, particularly in the elderly population.
6. A 45-year-old male with a history of hypertension and DM2 presents with a productive
cough, fever of 102F, and pleuritic chest pain. CXR shows right lower lobe consolidation.
CURB-65 score is 1. What is the appropriate management?
A. Inpatient admission for IV Ceftriaxone
