NR667 CEA Week 8 Exit Exam FNP Capstone
Practicum Intensive Official Practice Exam
Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: ADVANCED HEALTH ASSESSMENT & DIFFERENTIAL DIAGNOSIS Q1 –
Q10
══════════════════════════════════════
Question 1 of 50
A 52-year-old man presents with 3 weeks of progressive dyspnea on exertion and a
nonproductive cough. He has a 30 pack-year smoking history. On auscultation, breath sounds
are diminished on the right side with dullness to percussion. Chest X-ray reveals a large
right-sided pleural effusion. Thoracentesis yields straw-colored fluid with a protein level of
4.8 g/dL and LDH of 220 U/L. Serum protein is 6.2 g/dL and serum LDH is 180 U/L.
A. Order a contrast-enhanced CT scan of the chest to evaluate for pulmonary embolism
B. Refer the patient for chest tube placement and pleurodesis given the high likelihood of
malignancy ✓ CORRECT
C. Prescribe a 10-day course of levofloxacin for community-acquired pneumonia
D. Recommend repeat thoracentesis in 4 weeks for re-evaluation
Correct Answer: B
Rationale: The pleural fluid meets Light's criteria for an exudative effusion (pleural fluid
protein/serum protein ratio >0.5 and pleural fluid LDH/serum LDH ratio >0.6), and in a patient
with a significant smoking history and a large unilateral effusion, malignancy is the leading
concern that requires definitive diagnostic and therapeutic intervention. Chest tube
placement allows complete drainage for symptomatic relief and cytologic analysis, while
pleurodesis prevents recurrence. A chest CT is reasonable but does not address the
immediate need for fluid evacuation and diagnosis.
Question 2 of 50
A 45-year-old woman presents with a 3-week history of progressive fatigue, weight loss, and
heat intolerance. She also notes palpitations and tremor. On examination, her pulse is 110
,beats per minute and regular, she has a fine tremor, and her skin is warm and moist.
Laboratory studies reveal a TSH of 0.01 mIU/L and a free T4 of 2.8 ng/dL. A radioactive
iodine uptake scan shows diffusely increased uptake.
A. Begin methimazole 30 mg daily and schedule follow-up in 6 weeks
B. Order thyroid-stimulating immunoglobulin (TSI) and refer for thyroidectomy
C. Start propranolol 20 mg twice daily and recheck TSH in 3 months
D. Begin methimazole 30 mg daily and propranolol 20 mg twice daily for symptom control ✓
CORRECT
Correct Answer: D
Rationale: The clinical picture of hyperthyroidism with diffuse increased radioactive iodine
uptake is diagnostic of Graves disease, and management requires both an antithyroid drug to
block hormone synthesis and a beta-blocker to control adrenergic symptoms such as tremor
and palpitations. Methimazole alone leaves the patient symptomatic from excess
catecholamine activity, while beta-blockade alone does not address the underlying hormone
overproduction. Propranolol also inhibits peripheral T4-to-T3 conversion, providing additional
biochemical benefit.
Question 3 of 50
A 62-year-old man presents with sudden onset of severe headache, described as "the worst
headache of my life," that began 2 hours ago while he was lifting weights. He denies loss of
consciousness but feels nauseated. On examination, he is alert and oriented, with a
temperature of 37.1°C, blood pressure of 168/94 mmHg, and heart rate of 88 beats per
minute. He has nuchal rigidity and photophobia. A non-contrast head CT is performed.
A. The head CT will most likely show blood in the subarachnoid space ✓ CORRECT
B. Lumbar puncture should be performed immediately regardless of the CT findings
C. The patient most likely has a hypertensive emergency requiring IV nicardipine
D. A contrast-enhanced CT angiography is the initial diagnostic study of choice
Correct Answer: A
Rationale: This presentation is classic for aneurysmal subarachnoid hemorrhage, and
non-contrast head CT is highly sensitive for detecting blood within the first 6 hours of
symptom onset, with sensitivity approaching 100 percent in this time window. A lumbar
puncture is reserved for cases where the CT is negative but clinical suspicion remains high,
not as a universal first step. The blood pressure elevation is a reactive response to the
hemorrhage rather than a hypertensive emergency, and CTA is used to identify the aneurysm
after the diagnosis of SAH is established.
Question 4 of 50
, A 38-year-old woman presents with a 6-month history of dry cough, especially at night, and
intermittent wheezing. She reports that symptoms worsen when she exercises outdoors in
cold weather and when exposed to strong perfumes. She has no history of smoking and no
recent respiratory infections. Spirometry is performed and shows an FEV1/FVC ratio of 0.72.
After bronchodilator administration, the FEV1 improves by 18%.
A. Start a 14-day course of prednisone 40 mg daily for suspected chronic bronchitis
B. Order a high-resolution CT of the chest to evaluate for bronchiectasis
C. Initiate a low-dose inhaled corticosteroid with scheduled short-acting bronchodilator as
needed ✓ CORRECT
D. Prescribe a proton pump inhibitor for 8 weeks to treat cough-variant GERD
Correct Answer: C
Rationale: The combination of reversible airway obstruction on spirometry, nocturnal
symptoms, and triggers such as cold air and irritants establishes a diagnosis of asthma, for
which inhaled corticosteroids are the cornerstone of anti-inflammatory therapy paired with a
rescue bronchodilator. Chronic bronchitis would not demonstrate significant bronchodilator
reversibility, and bronchiectasis typically presents with purulent sputum production rather
than a dry cough. While GERD can cause chronic cough, the spirometric findings confirm
asthma as the primary diagnosis.
Question 5 of 50
A 55-year-old man with a history of hypertension presents with acute onset of left-sided
pleuritic chest pain and dyspnea that began 30 minutes ago after a 10-hour car ride. He is
diaphoretic and anxious. Vital signs show blood pressure of 96/64 mmHg, heart rate of 118
beats per minute, respiratory rate of 28 breaths per minute, and oxygen saturation of 88% on
room air. Physical examination reveals jugular venous distension and clear lung fields
bilaterally.
A. Order a D-dimer assay and begin low-molecular-weight heparin pending results
B. Activate the massive pulmonary embolism protocol and administer systemic
thrombolytics ✓ CORRECT
C. Obtain a CT pulmonary angiography after stabilizing with supplemental oxygen
D. Insert a central venous catheter and begin IV fluids at 250 mL/hour
Correct Answer: B
Rationale: The presentation of hypotension, tachycardia, hypoxemia, clear lungs, and jugular
venous distension in the setting of recent immobilization defines massive pulmonary
embolism with hemodynamic compromise, for which systemic thrombolysis is indicated to
reduce right ventricular afterload and restore perfusion. D-dimer testing is inappropriate in
high-probability presentations and delays definitive therapy, while CTA may worsen
hemodynamic instability and contrast exposure in a crashing patient. Aggressive fluid
Practicum Intensive Official Practice Exam
Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: ADVANCED HEALTH ASSESSMENT & DIFFERENTIAL DIAGNOSIS Q1 –
Q10
══════════════════════════════════════
Question 1 of 50
A 52-year-old man presents with 3 weeks of progressive dyspnea on exertion and a
nonproductive cough. He has a 30 pack-year smoking history. On auscultation, breath sounds
are diminished on the right side with dullness to percussion. Chest X-ray reveals a large
right-sided pleural effusion. Thoracentesis yields straw-colored fluid with a protein level of
4.8 g/dL and LDH of 220 U/L. Serum protein is 6.2 g/dL and serum LDH is 180 U/L.
A. Order a contrast-enhanced CT scan of the chest to evaluate for pulmonary embolism
B. Refer the patient for chest tube placement and pleurodesis given the high likelihood of
malignancy ✓ CORRECT
C. Prescribe a 10-day course of levofloxacin for community-acquired pneumonia
D. Recommend repeat thoracentesis in 4 weeks for re-evaluation
Correct Answer: B
Rationale: The pleural fluid meets Light's criteria for an exudative effusion (pleural fluid
protein/serum protein ratio >0.5 and pleural fluid LDH/serum LDH ratio >0.6), and in a patient
with a significant smoking history and a large unilateral effusion, malignancy is the leading
concern that requires definitive diagnostic and therapeutic intervention. Chest tube
placement allows complete drainage for symptomatic relief and cytologic analysis, while
pleurodesis prevents recurrence. A chest CT is reasonable but does not address the
immediate need for fluid evacuation and diagnosis.
Question 2 of 50
A 45-year-old woman presents with a 3-week history of progressive fatigue, weight loss, and
heat intolerance. She also notes palpitations and tremor. On examination, her pulse is 110
,beats per minute and regular, she has a fine tremor, and her skin is warm and moist.
Laboratory studies reveal a TSH of 0.01 mIU/L and a free T4 of 2.8 ng/dL. A radioactive
iodine uptake scan shows diffusely increased uptake.
A. Begin methimazole 30 mg daily and schedule follow-up in 6 weeks
B. Order thyroid-stimulating immunoglobulin (TSI) and refer for thyroidectomy
C. Start propranolol 20 mg twice daily and recheck TSH in 3 months
D. Begin methimazole 30 mg daily and propranolol 20 mg twice daily for symptom control ✓
CORRECT
Correct Answer: D
Rationale: The clinical picture of hyperthyroidism with diffuse increased radioactive iodine
uptake is diagnostic of Graves disease, and management requires both an antithyroid drug to
block hormone synthesis and a beta-blocker to control adrenergic symptoms such as tremor
and palpitations. Methimazole alone leaves the patient symptomatic from excess
catecholamine activity, while beta-blockade alone does not address the underlying hormone
overproduction. Propranolol also inhibits peripheral T4-to-T3 conversion, providing additional
biochemical benefit.
Question 3 of 50
A 62-year-old man presents with sudden onset of severe headache, described as "the worst
headache of my life," that began 2 hours ago while he was lifting weights. He denies loss of
consciousness but feels nauseated. On examination, he is alert and oriented, with a
temperature of 37.1°C, blood pressure of 168/94 mmHg, and heart rate of 88 beats per
minute. He has nuchal rigidity and photophobia. A non-contrast head CT is performed.
A. The head CT will most likely show blood in the subarachnoid space ✓ CORRECT
B. Lumbar puncture should be performed immediately regardless of the CT findings
C. The patient most likely has a hypertensive emergency requiring IV nicardipine
D. A contrast-enhanced CT angiography is the initial diagnostic study of choice
Correct Answer: A
Rationale: This presentation is classic for aneurysmal subarachnoid hemorrhage, and
non-contrast head CT is highly sensitive for detecting blood within the first 6 hours of
symptom onset, with sensitivity approaching 100 percent in this time window. A lumbar
puncture is reserved for cases where the CT is negative but clinical suspicion remains high,
not as a universal first step. The blood pressure elevation is a reactive response to the
hemorrhage rather than a hypertensive emergency, and CTA is used to identify the aneurysm
after the diagnosis of SAH is established.
Question 4 of 50
, A 38-year-old woman presents with a 6-month history of dry cough, especially at night, and
intermittent wheezing. She reports that symptoms worsen when she exercises outdoors in
cold weather and when exposed to strong perfumes. She has no history of smoking and no
recent respiratory infections. Spirometry is performed and shows an FEV1/FVC ratio of 0.72.
After bronchodilator administration, the FEV1 improves by 18%.
A. Start a 14-day course of prednisone 40 mg daily for suspected chronic bronchitis
B. Order a high-resolution CT of the chest to evaluate for bronchiectasis
C. Initiate a low-dose inhaled corticosteroid with scheduled short-acting bronchodilator as
needed ✓ CORRECT
D. Prescribe a proton pump inhibitor for 8 weeks to treat cough-variant GERD
Correct Answer: C
Rationale: The combination of reversible airway obstruction on spirometry, nocturnal
symptoms, and triggers such as cold air and irritants establishes a diagnosis of asthma, for
which inhaled corticosteroids are the cornerstone of anti-inflammatory therapy paired with a
rescue bronchodilator. Chronic bronchitis would not demonstrate significant bronchodilator
reversibility, and bronchiectasis typically presents with purulent sputum production rather
than a dry cough. While GERD can cause chronic cough, the spirometric findings confirm
asthma as the primary diagnosis.
Question 5 of 50
A 55-year-old man with a history of hypertension presents with acute onset of left-sided
pleuritic chest pain and dyspnea that began 30 minutes ago after a 10-hour car ride. He is
diaphoretic and anxious. Vital signs show blood pressure of 96/64 mmHg, heart rate of 118
beats per minute, respiratory rate of 28 breaths per minute, and oxygen saturation of 88% on
room air. Physical examination reveals jugular venous distension and clear lung fields
bilaterally.
A. Order a D-dimer assay and begin low-molecular-weight heparin pending results
B. Activate the massive pulmonary embolism protocol and administer systemic
thrombolytics ✓ CORRECT
C. Obtain a CT pulmonary angiography after stabilizing with supplemental oxygen
D. Insert a central venous catheter and begin IV fluids at 250 mL/hour
Correct Answer: B
Rationale: The presentation of hypotension, tachycardia, hypoxemia, clear lungs, and jugular
venous distension in the setting of recent immobilization defines massive pulmonary
embolism with hemodynamic compromise, for which systemic thrombolysis is indicated to
reduce right ventricular afterload and restore perfusion. D-dimer testing is inappropriate in
high-probability presentations and delays definitive therapy, while CTA may worsen
hemodynamic instability and contrast exposure in a crashing patient. Aggressive fluid
