NR 667 Final Exam | FNP Capstone Practicum (2026)
Actual Q&A PDF | Chamberlain
1. Which of the following best describes the primary mechanism of action of
sacubitril/valsartan (Entresto) in the management of heart failure with reduced
ejection fraction?
A) It acts as a neprilysin inhibitor combined with an angiotensin II receptor
blocker
B) It selectively blocks beta-1 adrenergic receptors to reduce heart rate
C) It inhibits the sodium-potassium ATPase pump in myocardial cells
D) It functions as a direct renin inhibitor to suppress aldosterone secretion
Correct Answer: It acts as a neprilysin inhibitor combined with an angiotensin II receptor
blocker
Rationale: Sacubitril/valsartan combines a neprilysin inhibitor with an angiotensin II
receptor blocker. Neprilysin inhibition increases natriuretic peptides, which promote
vasodilation and natriuresis, while the ARB component blocks the harmful effects of
angiotensin II. This dual mechanism improves outcomes in HFrEF. Beta-blockers,
digoxin, and aliskiren work through entirely different pathways.
2. A 58-year-old male with a history of type 2 diabetes and chronic kidney disease
presents for a routine visit. His most recent eGFR is 26 mL/min/1.73m². Which
medication should be avoided due to the risk of lactic acidosis?
A) Insulin glargine
B) Metformin
C) Empagliflozin
D) Liraglutide
Correct Answer: Metformin
Rationale: Metformin is contraindicated in patients with significant renal impairment,
generally when eGFR falls below 30 mL/min/1.73m², because reduced clearance
increases the risk of lactic acidosis. Insulin, SGLT-2 inhibitors, and GLP-1 receptor
agonists may require dose adjustments but are not contraindicated solely on this basis.
3. What is the primary function of the Model for End-Stage Liver Disease (MELD)
score in clinical practice?
A) To determine the appropriate antibiotic regimen for spontaneous bacterial
peritonitis
B) To estimate glomerular filtration rate in patients with hepatorenal syndrome
C) To prioritize patients with cirrhosis for liver transplantation
D) To assess the severity of hepatic encephalopathy
,Correct Answer: To prioritize patients with cirrhosis for liver transplantation
Rationale: The MELD score uses bilirubin, INR, creatinine, and sodium to estimate short-
term mortality risk in patients with end-stage liver disease. It is the standard tool used by
the United Network for Organ Sharing to allocate deceased donor livers. It does not
guide antibiotic selection, estimate GFR, or grade encephalopathy severity.
4. A 24-year-old female presents to the urgent care clinic with a swollen exudative
pharynx, profound fatigue, and a tender left upper quadrant abdomen. What is
the most likely diagnosis?
A) Streptococcal pharyngitis
B) Acute pancreatitis
C) Epstein-Barr virus infection
D) Tonsillar abscess
Correct Answer: Epstein-Barr virus infection
Rationale: Epstein-Barr virus causes infectious mononucleosis, classically presenting
with exudative pharyngitis, severe fatigue, and splenomegaly that produces left upper
quadrant tenderness. Streptococcal pharyngitis does not typically cause significant
splenic tenderness. Pancreatitis and tonsillar abscess have different clinical
presentations.
5. Which of the following best characterizes presbycusis in the older adult
population?
A) Unilateral low-frequency sensorineural hearing loss
B) Bilateral high-frequency sensorineural hearing loss
C) Unilateral high-frequency conductive hearing loss
D) Bilateral low-frequency conductive hearing loss
Correct Answer: Bilateral high-frequency sensorineural hearing loss
Rationale: Presbycusis is age-related hearing loss characterized by bilateral,
progressive, high-frequency sensorineural hearing loss. High frequencies are affected
first, making it difficult to hear consonants and understand speech in noisy
environments. The loss is symmetric and sensorineural, not conductive or unilateral.
6. A patient currently undergoing concurrent chemotherapy and radiation for glottic
squamous cell carcinoma is admitted with intractable nausea and dehydration.
Admission labs show WBC 1.3, Hgb 7.5, PLT 45, and ANC 0.8. The FNP
recognizes this as which condition?
A) Iron deficiency anemia due to chronic blood loss
B) Macrocytic anemia due to B12 deficiency
C) Aplastic anemia due to bone marrow suppression
D) Hemolytic anemia due to immune destruction
,Correct Answer: Aplastic anemia due to bone marrow suppression
Rationale: Concurrent chemotherapy and radiation suppress bone marrow function,
leading to pancytopenia with low white blood cells, hemoglobin, and platelets. The ANC
of 0.8 indicates severe neutropenia. This constellation of findings is classic for aplastic
anemia secondary to myelosuppressive cancer therapy.
7. A 35-year-old woman with moderate-to-severe allergic rhinitis reports persistent
nasal congestion, sneezing, and itchy eyes despite using over-the-counter
antihistamines. What is the most appropriate next step in management?
A) Add an oral decongestant
B) Prescribe a leukotriene receptor antagonist
C) Start an intranasal corticosteroid
D) Refer immediately for allergy immunotherapy
Correct Answer: Start an intranasal corticosteroid
Rationale: Intranasal corticosteroids are first-line therapy for moderate-to-severe
allergic rhinitis, particularly when nasal congestion is the dominant symptom. They
reduce inflammation more effectively than antihistamines alone. Oral decongestants
have limited efficacy and side effects, and immunotherapy is reserved for patients who
fail pharmacologic management.
8. Which term refers to the loss of the right visual field in both eyes due to a post-
chiasmal lesion?
A) Bitemporal hemianopia
B) Right homonymous hemianopia
C) Left homonymous hemianopia
D) Binasal hemianopia
Correct Answer: Right homonymous hemianopia
Rationale: Right homonymous hemianopia is the loss of the right visual field in both
eyes, caused by a lesion posterior to the optic chiasm, typically in the left optic tract,
lateral geniculate nucleus, or visual cortex. Bitemporal hemianopia results from a
chiasmal lesion. Binasal hemianopia is rare and results from bilateral lateral
compression.
9. A 72-year-old male with stable angina undergoes a stress test. Which symptom
during testing requires immediate cardiology referral?
A) Mild fatigue at peak exercise
B) Occasional palpitations that resolve with rest
C) Dizziness with activity
D) Mild shortness of breath at submaximal workload
Correct Answer: Dizziness with activity
, Rationale: Dizziness during stress testing may indicate significant ischemia, arrhythmia,
or hemodynamic compromise and warrants immediate cardiology referral. Mild fatigue
and mild dyspnea at submaximal workloads are common and expected. Occasional
palpitations that resolve with rest are less concerning than exertional dizziness.
10. According to the American College of Cardiology and American Heart
Association guidelines, heart failure with reduced ejection fraction (HFrEF) is
defined as an ejection fraction of less than what percentage?
A) 50%
B) 45%
C) 40%
D) 35%
Correct Answer: 40%
Rationale: HFrEF is defined as an ejection fraction less than 40%. Patients with EF
between 40% and 49% are classified as having heart failure with mildly reduced ejection
fraction (HFmrEF). Those with EF of 50% or greater have heart failure with preserved
ejection fraction (HFpEF).
11. A 25-year-old athlete presents with shoulder pain and difficulty with overhead
activities. Physical examination suggests shoulder impingement syndrome. What
is the most appropriate initial treatment?
A) Corticosteroid injection
B) Surgical decompression
C) NSAIDs and activity modification
D) Immediate physical therapy focusing on rotator cuff strengthening
Correct Answer: NSAIDs and activity modification
Rationale: Initial management of shoulder impingement syndrome includes
nonsteroidal anti-inflammatory drugs, activity modification, and ice. Physical therapy
may be added if symptoms do not improve. Corticosteroid injections are second-line,
and surgery is reserved for refractory cases.
12. What does the forced vital capacity (FVC) represent in pulmonary function
testing?
A) The maximum volume of air that can be inhaled after a normal exhalation
B) The maximum volume of air that can be forcefully exhaled after maximum
inspiration
C) The total volume of air exhaled during the first second of forced expiration
D) The volume of air remaining in the lungs after forced exhalation
Correct Answer: The maximum volume of air that can be forcefully exhaled after
maximum inspiration
Actual Q&A PDF | Chamberlain
1. Which of the following best describes the primary mechanism of action of
sacubitril/valsartan (Entresto) in the management of heart failure with reduced
ejection fraction?
A) It acts as a neprilysin inhibitor combined with an angiotensin II receptor
blocker
B) It selectively blocks beta-1 adrenergic receptors to reduce heart rate
C) It inhibits the sodium-potassium ATPase pump in myocardial cells
D) It functions as a direct renin inhibitor to suppress aldosterone secretion
Correct Answer: It acts as a neprilysin inhibitor combined with an angiotensin II receptor
blocker
Rationale: Sacubitril/valsartan combines a neprilysin inhibitor with an angiotensin II
receptor blocker. Neprilysin inhibition increases natriuretic peptides, which promote
vasodilation and natriuresis, while the ARB component blocks the harmful effects of
angiotensin II. This dual mechanism improves outcomes in HFrEF. Beta-blockers,
digoxin, and aliskiren work through entirely different pathways.
2. A 58-year-old male with a history of type 2 diabetes and chronic kidney disease
presents for a routine visit. His most recent eGFR is 26 mL/min/1.73m². Which
medication should be avoided due to the risk of lactic acidosis?
A) Insulin glargine
B) Metformin
C) Empagliflozin
D) Liraglutide
Correct Answer: Metformin
Rationale: Metformin is contraindicated in patients with significant renal impairment,
generally when eGFR falls below 30 mL/min/1.73m², because reduced clearance
increases the risk of lactic acidosis. Insulin, SGLT-2 inhibitors, and GLP-1 receptor
agonists may require dose adjustments but are not contraindicated solely on this basis.
3. What is the primary function of the Model for End-Stage Liver Disease (MELD)
score in clinical practice?
A) To determine the appropriate antibiotic regimen for spontaneous bacterial
peritonitis
B) To estimate glomerular filtration rate in patients with hepatorenal syndrome
C) To prioritize patients with cirrhosis for liver transplantation
D) To assess the severity of hepatic encephalopathy
,Correct Answer: To prioritize patients with cirrhosis for liver transplantation
Rationale: The MELD score uses bilirubin, INR, creatinine, and sodium to estimate short-
term mortality risk in patients with end-stage liver disease. It is the standard tool used by
the United Network for Organ Sharing to allocate deceased donor livers. It does not
guide antibiotic selection, estimate GFR, or grade encephalopathy severity.
4. A 24-year-old female presents to the urgent care clinic with a swollen exudative
pharynx, profound fatigue, and a tender left upper quadrant abdomen. What is
the most likely diagnosis?
A) Streptococcal pharyngitis
B) Acute pancreatitis
C) Epstein-Barr virus infection
D) Tonsillar abscess
Correct Answer: Epstein-Barr virus infection
Rationale: Epstein-Barr virus causes infectious mononucleosis, classically presenting
with exudative pharyngitis, severe fatigue, and splenomegaly that produces left upper
quadrant tenderness. Streptococcal pharyngitis does not typically cause significant
splenic tenderness. Pancreatitis and tonsillar abscess have different clinical
presentations.
5. Which of the following best characterizes presbycusis in the older adult
population?
A) Unilateral low-frequency sensorineural hearing loss
B) Bilateral high-frequency sensorineural hearing loss
C) Unilateral high-frequency conductive hearing loss
D) Bilateral low-frequency conductive hearing loss
Correct Answer: Bilateral high-frequency sensorineural hearing loss
Rationale: Presbycusis is age-related hearing loss characterized by bilateral,
progressive, high-frequency sensorineural hearing loss. High frequencies are affected
first, making it difficult to hear consonants and understand speech in noisy
environments. The loss is symmetric and sensorineural, not conductive or unilateral.
6. A patient currently undergoing concurrent chemotherapy and radiation for glottic
squamous cell carcinoma is admitted with intractable nausea and dehydration.
Admission labs show WBC 1.3, Hgb 7.5, PLT 45, and ANC 0.8. The FNP
recognizes this as which condition?
A) Iron deficiency anemia due to chronic blood loss
B) Macrocytic anemia due to B12 deficiency
C) Aplastic anemia due to bone marrow suppression
D) Hemolytic anemia due to immune destruction
,Correct Answer: Aplastic anemia due to bone marrow suppression
Rationale: Concurrent chemotherapy and radiation suppress bone marrow function,
leading to pancytopenia with low white blood cells, hemoglobin, and platelets. The ANC
of 0.8 indicates severe neutropenia. This constellation of findings is classic for aplastic
anemia secondary to myelosuppressive cancer therapy.
7. A 35-year-old woman with moderate-to-severe allergic rhinitis reports persistent
nasal congestion, sneezing, and itchy eyes despite using over-the-counter
antihistamines. What is the most appropriate next step in management?
A) Add an oral decongestant
B) Prescribe a leukotriene receptor antagonist
C) Start an intranasal corticosteroid
D) Refer immediately for allergy immunotherapy
Correct Answer: Start an intranasal corticosteroid
Rationale: Intranasal corticosteroids are first-line therapy for moderate-to-severe
allergic rhinitis, particularly when nasal congestion is the dominant symptom. They
reduce inflammation more effectively than antihistamines alone. Oral decongestants
have limited efficacy and side effects, and immunotherapy is reserved for patients who
fail pharmacologic management.
8. Which term refers to the loss of the right visual field in both eyes due to a post-
chiasmal lesion?
A) Bitemporal hemianopia
B) Right homonymous hemianopia
C) Left homonymous hemianopia
D) Binasal hemianopia
Correct Answer: Right homonymous hemianopia
Rationale: Right homonymous hemianopia is the loss of the right visual field in both
eyes, caused by a lesion posterior to the optic chiasm, typically in the left optic tract,
lateral geniculate nucleus, or visual cortex. Bitemporal hemianopia results from a
chiasmal lesion. Binasal hemianopia is rare and results from bilateral lateral
compression.
9. A 72-year-old male with stable angina undergoes a stress test. Which symptom
during testing requires immediate cardiology referral?
A) Mild fatigue at peak exercise
B) Occasional palpitations that resolve with rest
C) Dizziness with activity
D) Mild shortness of breath at submaximal workload
Correct Answer: Dizziness with activity
, Rationale: Dizziness during stress testing may indicate significant ischemia, arrhythmia,
or hemodynamic compromise and warrants immediate cardiology referral. Mild fatigue
and mild dyspnea at submaximal workloads are common and expected. Occasional
palpitations that resolve with rest are less concerning than exertional dizziness.
10. According to the American College of Cardiology and American Heart
Association guidelines, heart failure with reduced ejection fraction (HFrEF) is
defined as an ejection fraction of less than what percentage?
A) 50%
B) 45%
C) 40%
D) 35%
Correct Answer: 40%
Rationale: HFrEF is defined as an ejection fraction less than 40%. Patients with EF
between 40% and 49% are classified as having heart failure with mildly reduced ejection
fraction (HFmrEF). Those with EF of 50% or greater have heart failure with preserved
ejection fraction (HFpEF).
11. A 25-year-old athlete presents with shoulder pain and difficulty with overhead
activities. Physical examination suggests shoulder impingement syndrome. What
is the most appropriate initial treatment?
A) Corticosteroid injection
B) Surgical decompression
C) NSAIDs and activity modification
D) Immediate physical therapy focusing on rotator cuff strengthening
Correct Answer: NSAIDs and activity modification
Rationale: Initial management of shoulder impingement syndrome includes
nonsteroidal anti-inflammatory drugs, activity modification, and ice. Physical therapy
may be added if symptoms do not improve. Corticosteroid injections are second-line,
and surgery is reserved for refractory cases.
12. What does the forced vital capacity (FVC) represent in pulmonary function
testing?
A) The maximum volume of air that can be inhaled after a normal exhalation
B) The maximum volume of air that can be forcefully exhaled after maximum
inspiration
C) The total volume of air exhaled during the first second of forced expiration
D) The volume of air remaining in the lungs after forced exhalation
Correct Answer: The maximum volume of air that can be forcefully exhaled after
maximum inspiration
