1
NR 547 CEA EXAM-CHAMBERLAIN
UNIVERSITY COMPREHENSIVE EXAM
ASSESSMENT (CEA) QUESTIONS AND
VERIFIED ANSWERS WITH RATIONALES
Question 1: A 65-year-old male with a history of heart failure with reduced
ejection fraction (HFrEF) is currently taking lisinopril, carvedilol, and
furosemide. Despite optimal dosing, he remains symptomatic with an
ejection fraction of 30%. According to current evidence-based guidelines,
which medication should the advanced practice nurse consider adding to
his regimen to further reduce mortality and hospitalizations?
A. Digoxin
B. Spironolactone
C. Amlodipine
D. Hydralazine
CORRECT ANSWER: B. Spironolactone
Rationale: Mineralocorticoid receptor antagonists like spironolactone are
recommended in patients with HFrEF (EF ≤ 35%) who remain symptomatic
despite optimal therapy with an ACE inhibitor and a beta-blocker, as they
significantly reduce morbidity and mortality.
Question 2: A 58-year-old female with type 2 diabetes mellitus and chronic
kidney disease (CKD) stage 3 presents for a follow-up. Her current A1c is
7.8%, and her eGFR is 45 mL/min/1.73m². She is currently taking
metformin. Which additional medication class is strongly recommended to
reduce her risk of cardiovascular events and progression of CKD?
A. Sulfonylurea
B. Sodium-glucose cotransporter-2 (SGLT2) inhibitor
C. Dipeptidyl peptidase-4 (DPP-4) inhibitor
D. Thiazolidinedione
CORRECT ANSWER: B. Sodium-glucose cotransporter-2 (SGLT2) inhibitor
Rationale: SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) have proven
cardiovascular and renal benefits, significantly reducing the risk of heart
failure hospitalizations and slowing CKD progression in patients with type 2
diabetes and established CKD.
Question 3: A 72-year-old male is admitted to the ICU with severe
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community-acquired pneumonia. His CURB-65 score is 4. He has a history
of methicillin-resistant Staphylococcus aureus (MRSA) colonization. Which
empiric antibiotic regimen is most appropriate?
A. Ceftriaxone and azithromycin
B. Vancomycin, cefepime, and azithromycin
C. Piperacillin-tazobactam alone
D. Levofloxacin and clindamycin
CORRECT ANSWER: B. Vancomycin, cefepime, and azithromycin
Rationale: A CURB-65 score of 4 indicates severe pneumonia requiring ICU
admission. Given his MRSA history, vancomycin is necessary. Broad-spectrum
coverage for Pseudomonas and other gram-negatives is achieved with
cefepime, and atypical coverage with azithromycin.
Question 4: A 45-year-old female presents with a severe migraine
headache. She has a history of coronary artery disease. Which abortive
migraine medication is contraindicated for this patient?
A. Acetaminophen
B. Sumatriptan
C. Metoclopramide
D. Prochlorperazine
CORRECT ANSWER: B. Sumatriptan
Rationale: Triptans are serotonin 1B/1D receptor agonists that cause
vasoconstriction. They are strictly contraindicated in patients with ischemic
heart disease, history of stroke, or uncontrolled hypertension due to the risk
of coronary vasospasm and myocardial infarction.
Question 5: A 30-year-old female is diagnosed with Graves' disease and
started on methimazole. Two weeks later, she presents with a fever and
sore throat. What is the most critical next step in management?
A. Prescribe an antibiotic for strep throat and continue methimazole.
B. Obtain a complete blood count (CBC) with differential immediately.
C. Switch methimazole to propylthiouracil (PTU).
D. Order thyroid function tests to check for euthyroid status.
CORRECT ANSWER: B. Obtain a complete blood count (CBC) with
differential immediately.
Rationale: Methimazole and PTU carry a black box warning for
agranulocytosis. A fever and sore throat in a patient on these medications
are classic signs of severe neutropenia, requiring immediate CBC evaluation
and discontinuation of the drug if confirmed.
Question 6: A 68-year-old male with Parkinson's disease is experiencing
worsening bradykinesia and resting tremor. He is currently taking
carbidopa-levodopa. The provider decides to add entacapone. What is the
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mechanism of action of entacapone?
A. Dopamine receptor agonist
B. Catechol-O-methyltransferase (COMT) inhibitor
C. Monoamine oxidase type B (MAO-B) inhibitor
D. Anticholinergic agent
CORRECT ANSWER: B. Catechol-O-methyltransferase (COMT) inhibitor
Rationale: Entacapone is a COMT inhibitor that prevents the peripheral
degradation of levodopa, increasing its half-life and availability to cross the
blood-brain barrier, thereby enhancing the efficacy of carbidopa-levodopa.
Question 7: A 55-year-old female with rheumatoid arthritis is starting
treatment with methotrexate. Which supplemental medication must be
prescribed concurrently to prevent adverse effects such as stomatitis and
hepatotoxicity?
A. Vitamin B12
B. Folic acid
C. Vitamin D
D. Calcium carbonate
CORRECT ANSWER: B. Folic acid
Rationale: Methotrexate is a folate antagonist. Supplementing with folic acid
(or folinic acid) reduces the incidence of gastrointestinal, hepatic, and oral
toxicities without compromising the drug's efficacy in treating rheumatoid
arthritis.
Question 8: A 22-year-old male presents to the emergency department
with acute testicular pain. Ultrasound confirms testicular torsion. He is
scheduled for immediate surgery. Which class of medication should be
administered preoperatively for pain management?
A. Nonsteroidal anti-inflammatory drugs (NSAIDs)
B. Opioid analgesics
C. Muscle relaxants
D. Corticosteroids
CORRECT ANSWER: B. Opioid analgesics
Rationale: Testicular torsion causes severe, acute ischemic pain. Opioid
analgesics are required for adequate pain control while awaiting emergent
surgical detorsion. NSAIDs are insufficient for this level of acute visceral pain.
Question 9: A 60-year-old female with a history of atrial fibrillation is on
warfarin therapy. Her INR is currently 3.8, and she has no signs of active
bleeding. What is the most appropriate management?
A. Administer vitamin K orally.
B. Hold the next dose of warfarin and recheck INR.
C. Administer fresh frozen plasma (FFP).
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D. Increase the warfarin dose.
CORRECT ANSWER: B. Hold the next dose of warfarin and recheck INR.
Rationale: For an INR between 3.0 and 4.5 (or up to 10.0) without active
bleeding, the recommendation is to hold or reduce the warfarin dose and
monitor the INR closely. Vitamin K or FFP is reserved for significantly
elevated INRs with bleeding.
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NR 547 CEA EXAM-CHAMBERLAIN
UNIVERSITY COMPREHENSIVE EXAM
ASSESSMENT (CEA) QUESTIONS AND
VERIFIED ANSWERS WITH RATIONALES
Question 1: A 65-year-old male with a history of heart failure with reduced
ejection fraction (HFrEF) is currently taking lisinopril, carvedilol, and
furosemide. Despite optimal dosing, he remains symptomatic with an
ejection fraction of 30%. According to current evidence-based guidelines,
which medication should the advanced practice nurse consider adding to
his regimen to further reduce mortality and hospitalizations?
A. Digoxin
B. Spironolactone
C. Amlodipine
D. Hydralazine
CORRECT ANSWER: B. Spironolactone
Rationale: Mineralocorticoid receptor antagonists like spironolactone are
recommended in patients with HFrEF (EF ≤ 35%) who remain symptomatic
despite optimal therapy with an ACE inhibitor and a beta-blocker, as they
significantly reduce morbidity and mortality.
Question 2: A 58-year-old female with type 2 diabetes mellitus and chronic
kidney disease (CKD) stage 3 presents for a follow-up. Her current A1c is
7.8%, and her eGFR is 45 mL/min/1.73m². She is currently taking
metformin. Which additional medication class is strongly recommended to
reduce her risk of cardiovascular events and progression of CKD?
A. Sulfonylurea
B. Sodium-glucose cotransporter-2 (SGLT2) inhibitor
C. Dipeptidyl peptidase-4 (DPP-4) inhibitor
D. Thiazolidinedione
CORRECT ANSWER: B. Sodium-glucose cotransporter-2 (SGLT2) inhibitor
Rationale: SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) have proven
cardiovascular and renal benefits, significantly reducing the risk of heart
failure hospitalizations and slowing CKD progression in patients with type 2
diabetes and established CKD.
Question 3: A 72-year-old male is admitted to the ICU with severe
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,2
community-acquired pneumonia. His CURB-65 score is 4. He has a history
of methicillin-resistant Staphylococcus aureus (MRSA) colonization. Which
empiric antibiotic regimen is most appropriate?
A. Ceftriaxone and azithromycin
B. Vancomycin, cefepime, and azithromycin
C. Piperacillin-tazobactam alone
D. Levofloxacin and clindamycin
CORRECT ANSWER: B. Vancomycin, cefepime, and azithromycin
Rationale: A CURB-65 score of 4 indicates severe pneumonia requiring ICU
admission. Given his MRSA history, vancomycin is necessary. Broad-spectrum
coverage for Pseudomonas and other gram-negatives is achieved with
cefepime, and atypical coverage with azithromycin.
Question 4: A 45-year-old female presents with a severe migraine
headache. She has a history of coronary artery disease. Which abortive
migraine medication is contraindicated for this patient?
A. Acetaminophen
B. Sumatriptan
C. Metoclopramide
D. Prochlorperazine
CORRECT ANSWER: B. Sumatriptan
Rationale: Triptans are serotonin 1B/1D receptor agonists that cause
vasoconstriction. They are strictly contraindicated in patients with ischemic
heart disease, history of stroke, or uncontrolled hypertension due to the risk
of coronary vasospasm and myocardial infarction.
Question 5: A 30-year-old female is diagnosed with Graves' disease and
started on methimazole. Two weeks later, she presents with a fever and
sore throat. What is the most critical next step in management?
A. Prescribe an antibiotic for strep throat and continue methimazole.
B. Obtain a complete blood count (CBC) with differential immediately.
C. Switch methimazole to propylthiouracil (PTU).
D. Order thyroid function tests to check for euthyroid status.
CORRECT ANSWER: B. Obtain a complete blood count (CBC) with
differential immediately.
Rationale: Methimazole and PTU carry a black box warning for
agranulocytosis. A fever and sore throat in a patient on these medications
are classic signs of severe neutropenia, requiring immediate CBC evaluation
and discontinuation of the drug if confirmed.
Question 6: A 68-year-old male with Parkinson's disease is experiencing
worsening bradykinesia and resting tremor. He is currently taking
carbidopa-levodopa. The provider decides to add entacapone. What is the
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mechanism of action of entacapone?
A. Dopamine receptor agonist
B. Catechol-O-methyltransferase (COMT) inhibitor
C. Monoamine oxidase type B (MAO-B) inhibitor
D. Anticholinergic agent
CORRECT ANSWER: B. Catechol-O-methyltransferase (COMT) inhibitor
Rationale: Entacapone is a COMT inhibitor that prevents the peripheral
degradation of levodopa, increasing its half-life and availability to cross the
blood-brain barrier, thereby enhancing the efficacy of carbidopa-levodopa.
Question 7: A 55-year-old female with rheumatoid arthritis is starting
treatment with methotrexate. Which supplemental medication must be
prescribed concurrently to prevent adverse effects such as stomatitis and
hepatotoxicity?
A. Vitamin B12
B. Folic acid
C. Vitamin D
D. Calcium carbonate
CORRECT ANSWER: B. Folic acid
Rationale: Methotrexate is a folate antagonist. Supplementing with folic acid
(or folinic acid) reduces the incidence of gastrointestinal, hepatic, and oral
toxicities without compromising the drug's efficacy in treating rheumatoid
arthritis.
Question 8: A 22-year-old male presents to the emergency department
with acute testicular pain. Ultrasound confirms testicular torsion. He is
scheduled for immediate surgery. Which class of medication should be
administered preoperatively for pain management?
A. Nonsteroidal anti-inflammatory drugs (NSAIDs)
B. Opioid analgesics
C. Muscle relaxants
D. Corticosteroids
CORRECT ANSWER: B. Opioid analgesics
Rationale: Testicular torsion causes severe, acute ischemic pain. Opioid
analgesics are required for adequate pain control while awaiting emergent
surgical detorsion. NSAIDs are insufficient for this level of acute visceral pain.
Question 9: A 60-year-old female with a history of atrial fibrillation is on
warfarin therapy. Her INR is currently 3.8, and she has no signs of active
bleeding. What is the most appropriate management?
A. Administer vitamin K orally.
B. Hold the next dose of warfarin and recheck INR.
C. Administer fresh frozen plasma (FFP).
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D. Increase the warfarin dose.
CORRECT ANSWER: B. Hold the next dose of warfarin and recheck INR.
Rationale: For an INR between 3.0 and 4.5 (or up to 10.0) without active
bleeding, the recommendation is to hold or reduce the warfarin dose and
monitor the INR closely. Vitamin K or FFP is reserved for significantly
elevated INRs with bleeding.
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