NR667 CEA FNP Capstone Exit Exam Practice Test
180-Question Comprehensive Review for Chamberlain
University FNP
(Aligned with NR667 Clinical Evaluation Assessment /
Capstone Practicum and Intensive)
This comprehensive 180-question practice test is designed to thoroughly prepare Chamberlain University FNP
students for the NR667 Clinical Evaluation Assessment and Capstone Practicum, covering essential topics in family
nurse practitioner practice. It includes a wide range of clinically relevant scenarios, evidence-based management
strategies, and high-yield questions to enhance critical thinking and readiness for the FNP capstone evaluation.
Question 1
A 68-year-old male with a history of hypertension, type 2 diabetes, and hyperlipidemia
presents to the clinic complaining of exertional chest tightness and shortness of breath
that resolves with rest. He describes the pain as a pressure sensation radiating to his left
jaw, occurring after walking two blocks, and lasting 5–10 minutes. His current
medications include lisinopril, metformin, and atorvastatin. Vital signs show BP 148/88
mmHg, HR 82 bpm, and normal oxygen saturation. On exam, heart sounds are regular
with no murmurs, and lungs are clear. What is the most likely diagnosis, and what is the
next best step in management according to current guidelines?
A) Gastroesophageal reflux disease – start PPI therapy
B) Stable angina – order stress testing and optimize anti-ischemic therapy
C) Costochondritis – prescribe NSAIDs
D) Anxiety disorder – refer for counseling
Correct Answer: B
Rationale: This classic presentation of exertional chest pain relieved by rest in a patient
with multiple cardiac risk factors is highly suggestive of stable angina due to coronary
artery disease. According to the 2023 AHA/ACC Guideline for Chronic Coronary Disease,
,patients with suspected stable angina should undergo risk stratification with non-
invasive stress testing (exercise treadmill, stress echo, or nuclear stress test) to evaluate
for inducible ischemia, while optimizing guideline-directed medical therapy including
antiplatelet agents (if appropriate), beta-blockers or calcium channel blockers for
symptom control, high-intensity statin, ACEI/ARB, and aggressive risk factor
modification (BP <130/80, HbA1c <7%). GERD or musculoskeletal pain are less likely
given the exertional nature and radiation pattern, and anxiety would be a diagnosis of
exclusion after ruling out cardiac etiology. In primary care FNP practice, prompt
recognition and referral for further cardiac evaluation (possibly cardiology consult) is
critical to prevent progression to acute coronary syndrome.
Question 2
A 45-year-old female with obesity (BMI 38) and a family history of type 2 diabetes
presents for her annual wellness visit. She reports increased thirst, frequent urination,
and fatigue over the past 3 months. Random blood glucose is 210 mg/dL, and HbA1c is
8.2%. She denies chest pain, shortness of breath, or neurological symptoms. What is the
most appropriate initial pharmacologic treatment, and what lifestyle interventions
should be emphasized per ADA guidelines?
A) Start insulin glargine immediately
B) Initiate metformin 500 mg twice daily with titration and emphasize diet, exercise, and
weight loss
C) Prescribe glipizide for rapid glycemic control
D) Recommend lifestyle changes only and recheck in 6 months
Correct Answer: B
Rationale: This patient meets diagnostic criteria for type 2 diabetes (HbA1c ≥6.5% and
classic symptoms with random glucose ≥200 mg/dL). The 2024 ADA Standards of Care
recommend metformin as first-line pharmacologic therapy for most patients with type 2
diabetes unless contraindicated (e.g., eGFR <30), combined with intensive lifestyle
modification including medical nutrition therapy, at least 150 minutes/week of moderate
aerobic exercise, resistance training, and weight loss of 5–10% of body weight.
Metformin improves insulin sensitivity, has cardiovascular benefits, is weight-neutral or
promotes modest weight loss, and is cost-effective. Insulin would be reserved for
markedly symptomatic hyperglycemia or very high HbA1c (>10%), while sulfonylureas
like glipizide carry higher hypoglycemia risk and weight gain. Follow-up should include
,monitoring for metformin tolerance (GI side effects) and titration to target HbA1c <7%
(or individualized goal), with screening for complications (retinopathy, nephropathy,
neuropathy).
Question 3
A 32-year-old G2P2 female presents 6 weeks postpartum with complaints of persistent
heavy vaginal bleeding, fatigue, and dizziness when standing. She had an uncomplicated
vaginal delivery and is breastfeeding. Vital signs show BP 92/58 mmHg, HR 108 bpm,
and she appears pale. Labs reveal hemoglobin 8.2 g/dL and negative urine pregnancy
test. What is the most likely cause, and what is the initial management priority?
A) Postpartum depression – start SSRI
B) Postpartum hemorrhage due to retained products or subinvolution – urgent pelvic
ultrasound and possible D&C or uterotonics
C) Normal lochia – reassure and monitor
D) Iron deficiency from pregnancy – prescribe oral iron only
Correct Answer: B
Rationale: Secondary postpartum hemorrhage (occurring >24 hours after delivery) is
most commonly caused by retained placental tissue, subinvolution of the uterus, or
endometritis. This patient’s hemodynamic instability (tachycardia, hypotension, pallor)
and significant anemia require urgent evaluation with pelvic ultrasound to assess for
retained products of conception. Management per ACOG guidelines includes
stabilization with IV fluids, uterotonic agents (e.g., oxytocin, misoprostol), antibiotics if
infection is suspected, and possible surgical intervention (D&C) if retained tissue is
confirmed. Simple iron supplementation addresses the anemia but does not treat the
underlying bleeding source. Breastfeeding is not a contraindication to most
interventions, but the FNP must ensure timely referral to OB/GYN or ER if unstable. Early
recognition prevents progression to severe hemorrhage or shock.
Question 4
A 58-year-old male with a 40-pack-year smoking history presents with a chronic cough
productive of yellow sputum, progressive dyspnea on exertion, and wheezing.
Spirometry shows FEV1/FVC ratio of 62% with FEV1 55% predicted and minimal
reversibility after bronchodilator. What is the diagnosis, GOLD stage, and first-line
maintenance therapy according to GOLD guidelines?
, A) Asthma – start low-dose inhaled corticosteroid
B) COPD, GOLD Stage 3 – initiate long-acting muscarinic antagonist (LAMA) or
LABA/LAMA combination
C) Community-acquired pneumonia – prescribe antibiotics
D) Congestive heart failure – order BNP and echocardiogram
Correct Answer: B
Rationale: The obstructive spirometry pattern (FEV1/FVC <70%) with poor reversibility in
a long-term smoker confirms COPD. With FEV1 55% predicted, this is GOLD Stage 3
(severe). The 2024 GOLD guidelines recommend initial pharmacologic therapy based on
symptoms and exacerbation history; for most patients with significant dyspnea, a long-
acting bronchodilator (LAMA such as tiotropium or LABA/LAMA combination) is first-
line to improve symptoms and reduce exacerbations. Smoking cessation is the most
important intervention. Inhaled corticosteroids are added for frequent exacerbators or
eosinophilic phenotype, not as monotherapy. The FNP should order chest X-ray to rule
out other pathology, assess for comorbidities (e.g., cardiovascular disease), offer
pulmonary rehabilitation, and provide vaccinations (influenza, pneumococcal, COVID).
Question 5
A 24-year-old female college student presents with dysuria, urinary frequency, and
suprapubic pain for 2 days. She is sexually active with one partner and uses oral
contraceptives. Urinalysis shows positive leukocyte esterase, nitrites, and 20 WBC/hpf.
What is the most appropriate treatment, and what additional counseling is needed?
A) No treatment needed – symptoms are self-limiting
B) Nitrofurantoin 100 mg BID for 5 days and counsel on UTI prevention strategies
C) Ciprofloxacin 500 mg daily for 7 days
D) Refer to urology for cystoscopy
Correct Answer: B
Rationale: This is an uncomplicated lower urinary tract infection (cystitis) in a young
healthy woman. IDSA guidelines recommend nitrofurantoin (Macrobid) 100 mg BID for
5 days as first-line therapy due to low resistance rates in E. coli and favorable safety
profile. Trimethoprim-sulfamethoxazole is an alternative if local resistance is low, while
fluoroquinolones like ciprofloxacin are reserved for complicated cases due to resistance
180-Question Comprehensive Review for Chamberlain
University FNP
(Aligned with NR667 Clinical Evaluation Assessment /
Capstone Practicum and Intensive)
This comprehensive 180-question practice test is designed to thoroughly prepare Chamberlain University FNP
students for the NR667 Clinical Evaluation Assessment and Capstone Practicum, covering essential topics in family
nurse practitioner practice. It includes a wide range of clinically relevant scenarios, evidence-based management
strategies, and high-yield questions to enhance critical thinking and readiness for the FNP capstone evaluation.
Question 1
A 68-year-old male with a history of hypertension, type 2 diabetes, and hyperlipidemia
presents to the clinic complaining of exertional chest tightness and shortness of breath
that resolves with rest. He describes the pain as a pressure sensation radiating to his left
jaw, occurring after walking two blocks, and lasting 5–10 minutes. His current
medications include lisinopril, metformin, and atorvastatin. Vital signs show BP 148/88
mmHg, HR 82 bpm, and normal oxygen saturation. On exam, heart sounds are regular
with no murmurs, and lungs are clear. What is the most likely diagnosis, and what is the
next best step in management according to current guidelines?
A) Gastroesophageal reflux disease – start PPI therapy
B) Stable angina – order stress testing and optimize anti-ischemic therapy
C) Costochondritis – prescribe NSAIDs
D) Anxiety disorder – refer for counseling
Correct Answer: B
Rationale: This classic presentation of exertional chest pain relieved by rest in a patient
with multiple cardiac risk factors is highly suggestive of stable angina due to coronary
artery disease. According to the 2023 AHA/ACC Guideline for Chronic Coronary Disease,
,patients with suspected stable angina should undergo risk stratification with non-
invasive stress testing (exercise treadmill, stress echo, or nuclear stress test) to evaluate
for inducible ischemia, while optimizing guideline-directed medical therapy including
antiplatelet agents (if appropriate), beta-blockers or calcium channel blockers for
symptom control, high-intensity statin, ACEI/ARB, and aggressive risk factor
modification (BP <130/80, HbA1c <7%). GERD or musculoskeletal pain are less likely
given the exertional nature and radiation pattern, and anxiety would be a diagnosis of
exclusion after ruling out cardiac etiology. In primary care FNP practice, prompt
recognition and referral for further cardiac evaluation (possibly cardiology consult) is
critical to prevent progression to acute coronary syndrome.
Question 2
A 45-year-old female with obesity (BMI 38) and a family history of type 2 diabetes
presents for her annual wellness visit. She reports increased thirst, frequent urination,
and fatigue over the past 3 months. Random blood glucose is 210 mg/dL, and HbA1c is
8.2%. She denies chest pain, shortness of breath, or neurological symptoms. What is the
most appropriate initial pharmacologic treatment, and what lifestyle interventions
should be emphasized per ADA guidelines?
A) Start insulin glargine immediately
B) Initiate metformin 500 mg twice daily with titration and emphasize diet, exercise, and
weight loss
C) Prescribe glipizide for rapid glycemic control
D) Recommend lifestyle changes only and recheck in 6 months
Correct Answer: B
Rationale: This patient meets diagnostic criteria for type 2 diabetes (HbA1c ≥6.5% and
classic symptoms with random glucose ≥200 mg/dL). The 2024 ADA Standards of Care
recommend metformin as first-line pharmacologic therapy for most patients with type 2
diabetes unless contraindicated (e.g., eGFR <30), combined with intensive lifestyle
modification including medical nutrition therapy, at least 150 minutes/week of moderate
aerobic exercise, resistance training, and weight loss of 5–10% of body weight.
Metformin improves insulin sensitivity, has cardiovascular benefits, is weight-neutral or
promotes modest weight loss, and is cost-effective. Insulin would be reserved for
markedly symptomatic hyperglycemia or very high HbA1c (>10%), while sulfonylureas
like glipizide carry higher hypoglycemia risk and weight gain. Follow-up should include
,monitoring for metformin tolerance (GI side effects) and titration to target HbA1c <7%
(or individualized goal), with screening for complications (retinopathy, nephropathy,
neuropathy).
Question 3
A 32-year-old G2P2 female presents 6 weeks postpartum with complaints of persistent
heavy vaginal bleeding, fatigue, and dizziness when standing. She had an uncomplicated
vaginal delivery and is breastfeeding. Vital signs show BP 92/58 mmHg, HR 108 bpm,
and she appears pale. Labs reveal hemoglobin 8.2 g/dL and negative urine pregnancy
test. What is the most likely cause, and what is the initial management priority?
A) Postpartum depression – start SSRI
B) Postpartum hemorrhage due to retained products or subinvolution – urgent pelvic
ultrasound and possible D&C or uterotonics
C) Normal lochia – reassure and monitor
D) Iron deficiency from pregnancy – prescribe oral iron only
Correct Answer: B
Rationale: Secondary postpartum hemorrhage (occurring >24 hours after delivery) is
most commonly caused by retained placental tissue, subinvolution of the uterus, or
endometritis. This patient’s hemodynamic instability (tachycardia, hypotension, pallor)
and significant anemia require urgent evaluation with pelvic ultrasound to assess for
retained products of conception. Management per ACOG guidelines includes
stabilization with IV fluids, uterotonic agents (e.g., oxytocin, misoprostol), antibiotics if
infection is suspected, and possible surgical intervention (D&C) if retained tissue is
confirmed. Simple iron supplementation addresses the anemia but does not treat the
underlying bleeding source. Breastfeeding is not a contraindication to most
interventions, but the FNP must ensure timely referral to OB/GYN or ER if unstable. Early
recognition prevents progression to severe hemorrhage or shock.
Question 4
A 58-year-old male with a 40-pack-year smoking history presents with a chronic cough
productive of yellow sputum, progressive dyspnea on exertion, and wheezing.
Spirometry shows FEV1/FVC ratio of 62% with FEV1 55% predicted and minimal
reversibility after bronchodilator. What is the diagnosis, GOLD stage, and first-line
maintenance therapy according to GOLD guidelines?
, A) Asthma – start low-dose inhaled corticosteroid
B) COPD, GOLD Stage 3 – initiate long-acting muscarinic antagonist (LAMA) or
LABA/LAMA combination
C) Community-acquired pneumonia – prescribe antibiotics
D) Congestive heart failure – order BNP and echocardiogram
Correct Answer: B
Rationale: The obstructive spirometry pattern (FEV1/FVC <70%) with poor reversibility in
a long-term smoker confirms COPD. With FEV1 55% predicted, this is GOLD Stage 3
(severe). The 2024 GOLD guidelines recommend initial pharmacologic therapy based on
symptoms and exacerbation history; for most patients with significant dyspnea, a long-
acting bronchodilator (LAMA such as tiotropium or LABA/LAMA combination) is first-
line to improve symptoms and reduce exacerbations. Smoking cessation is the most
important intervention. Inhaled corticosteroids are added for frequent exacerbators or
eosinophilic phenotype, not as monotherapy. The FNP should order chest X-ray to rule
out other pathology, assess for comorbidities (e.g., cardiovascular disease), offer
pulmonary rehabilitation, and provide vaccinations (influenza, pneumococcal, COVID).
Question 5
A 24-year-old female college student presents with dysuria, urinary frequency, and
suprapubic pain for 2 days. She is sexually active with one partner and uses oral
contraceptives. Urinalysis shows positive leukocyte esterase, nitrites, and 20 WBC/hpf.
What is the most appropriate treatment, and what additional counseling is needed?
A) No treatment needed – symptoms are self-limiting
B) Nitrofurantoin 100 mg BID for 5 days and counsel on UTI prevention strategies
C) Ciprofloxacin 500 mg daily for 7 days
D) Refer to urology for cystoscopy
Correct Answer: B
Rationale: This is an uncomplicated lower urinary tract infection (cystitis) in a young
healthy woman. IDSA guidelines recommend nitrofurantoin (Macrobid) 100 mg BID for
5 days as first-line therapy due to low resistance rates in E. coli and favorable safety
profile. Trimethoprim-sulfamethoxazole is an alternative if local resistance is low, while
fluoroquinolones like ciprofloxacin are reserved for complicated cases due to resistance
