NR 667 CEA (Capstone) Practicum and Intensive Final
Assessment
1. Cardiac
A 58-year-old male presents with chest pain radiating to the left arm. Which initial
diagnostic test is most appropriate?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Cardiac MRI
Rationale: ECG is the first-line test for suspected acute coronary syndrome to identify
ischemic changes quickly.
2. Endocrine
A patient with type 2 diabetes has an HbA1c of 9.2%. Which medication is most
appropriate to initiate?
A. Metformin monotherapy
B. Dual therapy with metformin and GLP-1 agonist
B. Lifestyle modification only
C. Insulin pump
Rationale: HbA1c >9% requires combination therapy; GLP-1 agonists improve glycemic
control and promote weight loss.
3. Respiratory
A 35-year-old asthmatic presents with wheezing and shortness of breath. Which
medication provides immediate relief?
A. Inhaled corticosteroid
B. Short-acting beta agonist (albuterol)
B. Leukotriene receptor antagonist
C. Long-acting beta agonist
Rationale: SABAs are rescue medications for acute bronchospasm.
4. Pediatrics
A 2-year-old presents with fever, drooling, and stridor. What is the most likely
diagnosis?
A. Croup
B. Epiglottitis
B. Bronchiolitis
C. Asthma
Rationale: Classic triad of fever, drooling, and stridor in toddlers suggests epiglottitis, a
medical emergency.
5. Geriatrics
Which screening is recommended annually for adults over 65?
A. Colonoscopy
B. Depression screening
,B. Mammogram
C. Pap smear
Rationale: USPSTF recommends annual depression screening in older adults due to
high prevalence and impact.
6. Women’s Health
A 28-year-old woman presents with dysuria and frequency. Urinalysis shows nitrites and
leukocyte esterase. What is the best treatment?
A. Ciprofloxacin for 10 days
B. Nitrofurantoin for 5 days
B. Amoxicillin for 7 days
C. No treatment needed
Rationale: Nitrofurantoin is first-line for uncomplicated UTI in women.
7. Pharmacology
Which antihypertensive is contraindicated in pregnancy?
A. Methyldopa
B. Labetalol
C. ACE inhibitors
C. Nifedipine
Rationale: ACE inhibitors are teratogenic and contraindicated in pregnancy.
8. Neurology
A patient presents with sudden unilateral facial droop, inability to close eye, and
drooling. What is the most likely diagnosis?
A. Stroke
B. Bell’s palsy
B. Myasthenia gravis
C. Guillain-Barré syndrome
Rationale: Isolated facial nerve palsy without other neurological deficits suggests Bell’s
palsy.
9. Infectious Disease
Which vaccine is recommended for adults ≥50 to prevent shingles?
A. Influenza vaccine
B. Pneumococcal vaccine
C. Recombinant zoster vaccine (Shingrix)
C. Hepatitis B vaccine
Rationale: Shingrix is recommended for adults ≥50 to prevent herpes zoster.
10. Psychiatric
A 22-year-old college student presents with excessive worry, restlessness, and difficulty
concentrating for 6 months. What is the most likely diagnosis?
A. Panic disorder
B. Generalized anxiety disorder (GAD)
B. Major depressive disorder
, C. PTSD
Rationale: Persistent worry and anxiety for ≥6 months with functional impairment is
diagnostic of GAD.
11. Gastrointestinal
A 45-year-old presents with epigastric pain relieved by eating. What is the most likely
diagnosis?
A. Gastric ulcer
B. Duodenal ulcer
B. GERD
C. Pancreatitis
Rationale: Duodenal ulcer pain improves with food, unlike gastric ulcers which worsen.
12. Renal
Which lab finding is most consistent with nephrotic syndrome?
A. Hematuria
B. Proteinuria >3.5 g/day
B. Elevated creatinine
C. Hypokalemia
Rationale: Nephrotic syndrome is defined by heavy proteinuria, hypoalbuminemia, and
edema.
13. Musculoskeletal
A 70-year-old woman presents with hip pain after a fall. X-ray shows femoral neck
fracture. What is the best management?
A. Bed rest
B. Surgical fixation
B. Physical therapy only
C. NSAIDs
Rationale: Femoral neck fractures in elderly require surgical intervention to restore
mobility.
14. Dermatology
A child presents with honey-colored crusted lesions around the mouth. What is the
diagnosis?
A. Eczema
B. Impetigo
B. Psoriasis
C. Cellulitis
Rationale: Impetigo is a superficial bacterial infection, classically presenting with honey-
colored crusts.
15. Hematology
Which finding is most consistent with iron deficiency anemia?
A. Macrocytosis
B. Microcytosis and hypochromia
Assessment
1. Cardiac
A 58-year-old male presents with chest pain radiating to the left arm. Which initial
diagnostic test is most appropriate?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Cardiac MRI
Rationale: ECG is the first-line test for suspected acute coronary syndrome to identify
ischemic changes quickly.
2. Endocrine
A patient with type 2 diabetes has an HbA1c of 9.2%. Which medication is most
appropriate to initiate?
A. Metformin monotherapy
B. Dual therapy with metformin and GLP-1 agonist
B. Lifestyle modification only
C. Insulin pump
Rationale: HbA1c >9% requires combination therapy; GLP-1 agonists improve glycemic
control and promote weight loss.
3. Respiratory
A 35-year-old asthmatic presents with wheezing and shortness of breath. Which
medication provides immediate relief?
A. Inhaled corticosteroid
B. Short-acting beta agonist (albuterol)
B. Leukotriene receptor antagonist
C. Long-acting beta agonist
Rationale: SABAs are rescue medications for acute bronchospasm.
4. Pediatrics
A 2-year-old presents with fever, drooling, and stridor. What is the most likely
diagnosis?
A. Croup
B. Epiglottitis
B. Bronchiolitis
C. Asthma
Rationale: Classic triad of fever, drooling, and stridor in toddlers suggests epiglottitis, a
medical emergency.
5. Geriatrics
Which screening is recommended annually for adults over 65?
A. Colonoscopy
B. Depression screening
,B. Mammogram
C. Pap smear
Rationale: USPSTF recommends annual depression screening in older adults due to
high prevalence and impact.
6. Women’s Health
A 28-year-old woman presents with dysuria and frequency. Urinalysis shows nitrites and
leukocyte esterase. What is the best treatment?
A. Ciprofloxacin for 10 days
B. Nitrofurantoin for 5 days
B. Amoxicillin for 7 days
C. No treatment needed
Rationale: Nitrofurantoin is first-line for uncomplicated UTI in women.
7. Pharmacology
Which antihypertensive is contraindicated in pregnancy?
A. Methyldopa
B. Labetalol
C. ACE inhibitors
C. Nifedipine
Rationale: ACE inhibitors are teratogenic and contraindicated in pregnancy.
8. Neurology
A patient presents with sudden unilateral facial droop, inability to close eye, and
drooling. What is the most likely diagnosis?
A. Stroke
B. Bell’s palsy
B. Myasthenia gravis
C. Guillain-Barré syndrome
Rationale: Isolated facial nerve palsy without other neurological deficits suggests Bell’s
palsy.
9. Infectious Disease
Which vaccine is recommended for adults ≥50 to prevent shingles?
A. Influenza vaccine
B. Pneumococcal vaccine
C. Recombinant zoster vaccine (Shingrix)
C. Hepatitis B vaccine
Rationale: Shingrix is recommended for adults ≥50 to prevent herpes zoster.
10. Psychiatric
A 22-year-old college student presents with excessive worry, restlessness, and difficulty
concentrating for 6 months. What is the most likely diagnosis?
A. Panic disorder
B. Generalized anxiety disorder (GAD)
B. Major depressive disorder
, C. PTSD
Rationale: Persistent worry and anxiety for ≥6 months with functional impairment is
diagnostic of GAD.
11. Gastrointestinal
A 45-year-old presents with epigastric pain relieved by eating. What is the most likely
diagnosis?
A. Gastric ulcer
B. Duodenal ulcer
B. GERD
C. Pancreatitis
Rationale: Duodenal ulcer pain improves with food, unlike gastric ulcers which worsen.
12. Renal
Which lab finding is most consistent with nephrotic syndrome?
A. Hematuria
B. Proteinuria >3.5 g/day
B. Elevated creatinine
C. Hypokalemia
Rationale: Nephrotic syndrome is defined by heavy proteinuria, hypoalbuminemia, and
edema.
13. Musculoskeletal
A 70-year-old woman presents with hip pain after a fall. X-ray shows femoral neck
fracture. What is the best management?
A. Bed rest
B. Surgical fixation
B. Physical therapy only
C. NSAIDs
Rationale: Femoral neck fractures in elderly require surgical intervention to restore
mobility.
14. Dermatology
A child presents with honey-colored crusted lesions around the mouth. What is the
diagnosis?
A. Eczema
B. Impetigo
B. Psoriasis
C. Cellulitis
Rationale: Impetigo is a superficial bacterial infection, classically presenting with honey-
colored crusts.
15. Hematology
Which finding is most consistent with iron deficiency anemia?
A. Macrocytosis
B. Microcytosis and hypochromia
