NR667 FNP Capstone
Practicum and Intensive
Final exam
1.
A 58-year-old female presents with new-onset fatigue, pallor, and occasional
dizziness. She denies GI bleeding but reports long-term NSAID use for osteoarthritis.
Physical exam reveals conjunctival pallor. Which diagnostic test is most appropriate
to order first?
A. Iron studies
B. Colonoscopy
C. CBC with differential
D. Serum B12 and folate
Answer: C – CBC with differential
Rationale: The initial step in evaluating anemia symptoms is a CBC to confirm anemia
and characterize it (microcytic, macrocytic, normocytic). Iron studies or colonoscopy
may follow depending on findings.
2.
,During your FNP clinical practicum, you review a 7-year-old’s asthma action plan. The
child’s peak flow is 60% of personal best and they are coughing frequently at night.
According to NHLBI guidelines, what is the best next step?
A. Continue current therapy, recheck in 1 month
B. Step up therapy by adding inhaled corticosteroid
C. Add oral corticosteroid burst immediately
D. Discontinue all rescue inhaler use
Answer: B – Step up therapy
Rationale: A peak flow of 60% indicates moderate persistent symptoms; guidelines
recommend stepping up therapy (often inhaled corticosteroids) and reassessing
control in 2–6 weeks.
3.
You are precepting in a rural clinic. A 42-year-old farmer presents with a red, swollen
leg after a puncture wound from barbed wire. He is afebrile, and there is no
streaking. Which antibiotic is most appropriate?
A. Amoxicillin
B. Trimethoprim-sulfamethoxazole
C. Cephalexin
D. Azithromycin
Answer: C – Cephalexin
Rationale: For non-purulent cellulitis without systemic signs, first-generation
cephalosporins (e.g., cephalexin) are appropriate to cover streptococci and MSSA.
4.
,A 66-year-old male with diabetes is seen for follow-up. His BP is 148/88 mmHg
despite lifestyle modifications. According to current ADA and ACC/AHA guidelines,
what is the first-line antihypertensive?
A. Beta-blocker
B. ACE inhibitor
C. Calcium channel blocker
D. Alpha-blocker
Answer: B – ACE inhibitor
Rationale: ACE inhibitors (or ARBs) are preferred for patients with diabetes to reduce
progression of nephropathy and cardiovascular risk.
5.
As part of your FNP capstone project, you are implementing an evidence-based
diabetes education program in a community clinic. What is the best method to
evaluate program effectiveness?
A. Staff satisfaction survey
B. Pre- and post-intervention HbA1c measurements
C. Chart review for appointment adherence
D. Literature review of similar programs
Answer: B – HbA1c measurements
Rationale: Objective clinical outcomes (HbA1c) provide the most direct evidence of
program impact on patient health.
6.
During your final practicum evaluation, your preceptor asks about opioid prescribing
laws in your state. Which is the most appropriate initial step before prescribing?
, A. Prescribe lowest effective dose without review
B. Check the state Prescription Drug Monitoring Program (PDMP)
C. Obtain a signed opioid contract after prescription
D. Refer to pain management immediately
Answer: B – Check PDMP
Rationale: Reviewing PDMP is a legal and safety requirement in most states to
prevent misuse and diversion before prescribing controlled substances.
7.
A 29-year-old postpartum woman presents with severe headache, blurred vision,
and BP 170/110 mmHg, 2 weeks after delivery. Urinalysis shows proteinuria. What is
the likely diagnosis?
A. Chronic hypertension
B. Postpartum preeclampsia
C. Migraine
D. Acute stress reaction
Answer: B – Postpartum preeclampsia
Rationale: Preeclampsia can develop up to 6 weeks postpartum; hypertension plus
proteinuria is diagnostic.
8.
A 75-year-old male with COPD presents with increasing dyspnea, purulent sputum,
and wheezing. His oxygen saturation is 89% on room air. What is the next best step?
A. Start oxygen, order chest X-ray, prescribe antibiotics
B. Prescribe oral corticosteroids only
Practicum and Intensive
Final exam
1.
A 58-year-old female presents with new-onset fatigue, pallor, and occasional
dizziness. She denies GI bleeding but reports long-term NSAID use for osteoarthritis.
Physical exam reveals conjunctival pallor. Which diagnostic test is most appropriate
to order first?
A. Iron studies
B. Colonoscopy
C. CBC with differential
D. Serum B12 and folate
Answer: C – CBC with differential
Rationale: The initial step in evaluating anemia symptoms is a CBC to confirm anemia
and characterize it (microcytic, macrocytic, normocytic). Iron studies or colonoscopy
may follow depending on findings.
2.
,During your FNP clinical practicum, you review a 7-year-old’s asthma action plan. The
child’s peak flow is 60% of personal best and they are coughing frequently at night.
According to NHLBI guidelines, what is the best next step?
A. Continue current therapy, recheck in 1 month
B. Step up therapy by adding inhaled corticosteroid
C. Add oral corticosteroid burst immediately
D. Discontinue all rescue inhaler use
Answer: B – Step up therapy
Rationale: A peak flow of 60% indicates moderate persistent symptoms; guidelines
recommend stepping up therapy (often inhaled corticosteroids) and reassessing
control in 2–6 weeks.
3.
You are precepting in a rural clinic. A 42-year-old farmer presents with a red, swollen
leg after a puncture wound from barbed wire. He is afebrile, and there is no
streaking. Which antibiotic is most appropriate?
A. Amoxicillin
B. Trimethoprim-sulfamethoxazole
C. Cephalexin
D. Azithromycin
Answer: C – Cephalexin
Rationale: For non-purulent cellulitis without systemic signs, first-generation
cephalosporins (e.g., cephalexin) are appropriate to cover streptococci and MSSA.
4.
,A 66-year-old male with diabetes is seen for follow-up. His BP is 148/88 mmHg
despite lifestyle modifications. According to current ADA and ACC/AHA guidelines,
what is the first-line antihypertensive?
A. Beta-blocker
B. ACE inhibitor
C. Calcium channel blocker
D. Alpha-blocker
Answer: B – ACE inhibitor
Rationale: ACE inhibitors (or ARBs) are preferred for patients with diabetes to reduce
progression of nephropathy and cardiovascular risk.
5.
As part of your FNP capstone project, you are implementing an evidence-based
diabetes education program in a community clinic. What is the best method to
evaluate program effectiveness?
A. Staff satisfaction survey
B. Pre- and post-intervention HbA1c measurements
C. Chart review for appointment adherence
D. Literature review of similar programs
Answer: B – HbA1c measurements
Rationale: Objective clinical outcomes (HbA1c) provide the most direct evidence of
program impact on patient health.
6.
During your final practicum evaluation, your preceptor asks about opioid prescribing
laws in your state. Which is the most appropriate initial step before prescribing?
, A. Prescribe lowest effective dose without review
B. Check the state Prescription Drug Monitoring Program (PDMP)
C. Obtain a signed opioid contract after prescription
D. Refer to pain management immediately
Answer: B – Check PDMP
Rationale: Reviewing PDMP is a legal and safety requirement in most states to
prevent misuse and diversion before prescribing controlled substances.
7.
A 29-year-old postpartum woman presents with severe headache, blurred vision,
and BP 170/110 mmHg, 2 weeks after delivery. Urinalysis shows proteinuria. What is
the likely diagnosis?
A. Chronic hypertension
B. Postpartum preeclampsia
C. Migraine
D. Acute stress reaction
Answer: B – Postpartum preeclampsia
Rationale: Preeclampsia can develop up to 6 weeks postpartum; hypertension plus
proteinuria is diagnostic.
8.
A 75-year-old male with COPD presents with increasing dyspnea, purulent sputum,
and wheezing. His oxygen saturation is 89% on room air. What is the next best step?
A. Start oxygen, order chest X-ray, prescribe antibiotics
B. Prescribe oral corticosteroids only
