Newest NR 603 CEA — Original Exam Questions verified with correct answers
2026/2027 version /instant pdf
1. A 52-year-old patient presents with crushing substernal chest pain radiating to
the left arm, diaphoresis, and nausea. What is the priority diagnostic test?
A. 12-lead ECG
B. Chest x-ray
C. Abdominal ultrasound
D. Pulmonary function testing
Correct answer: A. 12-lead ECG
Rationale: A 12-lead ECG should be obtained promptly in suspected acute coronary syndrome
to identify ischemic changes or STEMI.
2. A patient with suspected bacterial meningitis presents with fever, severe
headache, neck stiffness, and altered mental status. Which action should occur
before lumbar puncture if increased intracranial pressure is suspected?
A. Obtain neuroimaging
B. Begin oral antibiotics only
C. Perform a stress test
D. Obtain a screening mammogram
Correct answer: A. Obtain neuroimaging
Rationale: Neuroimaging may be required before lumbar puncture in patients at risk for
increased intracranial pressure or mass effect.
3. A 68-year-old patient reports new unilateral temporal headache, jaw
claudication, and transient visual changes. Which laboratory test is most
appropriate initially?
A. ESR and CRP
B. Serum amylase
C. Troponin only
D. TSH only
Correct answer: A. ESR and CRP
,Rationale: Giant cell arteritis commonly causes elevated inflammatory markers and requires
urgent evaluation because of the risk of permanent vision loss.
4. A patient presents with fatigue, weight gain, constipation, cold intolerance,
and dry skin. Which laboratory pattern is most consistent with primary
hypothyroidism?
A. Elevated TSH and low free T4
B. Low TSH and elevated free T4
C. Elevated TSH and elevated free T4
D. Low TSH and low free T4
Correct answer: A. Elevated TSH and low free T4
Rationale: Primary thyroid gland failure causes decreased thyroid hormone production and
compensatory elevation of TSH.
5. A patient with type 2 diabetes has an A1C of 9.8% despite adherence to
metformin. What is the most appropriate next step?
A. Intensify pharmacologic therapy based on patient-specific factors
B. Stop all diabetes medications
C. Wait one year before reassessing
D. Recommend only increased water intake
Correct answer: A. Intensify pharmacologic therapy based on patient-specific factors
Rationale: Persistent poor glycemic control requires treatment intensification, considering
comorbidities, cardiovascular risk, kidney function, cost, and patient preferences.
6. A patient presents with polyuria, polydipsia, abdominal pain, nausea, and
deep rapid respirations. Laboratory studies show hyperglycemia, metabolic
acidosis, and elevated anion gap. Which condition is most likely?
A. Diabetic ketoacidosis
B. Hyperthyroidism
C. SIADH
D. Respiratory alkalosis
, Correct answer: A. Diabetic ketoacidosis
Rationale: DKA is characterized by hyperglycemia, ketone production, high-anion-gap
metabolic acidosis, and compensatory Kussmaul respirations.
7. A patient has severe hyperglycemia, profound dehydration, altered mental
status, and minimal ketone production. Which condition is most likely?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Addisonian crisis
D. Acute pancreatitis
Correct answer: A. Hyperosmolar hyperglycemic state
Rationale: HHS causes extreme hyperglycemia and hyperosmolality with severe dehydration
and usually minimal ketoacidosis.
8. A patient reports fatigue and has pallor. Laboratory studies show low
hemoglobin, low MCV, and low ferritin. Which diagnosis is most likely?
A. Iron-deficiency anemia
B. Vitamin B12 deficiency
C. Folate deficiency
D. Hemolytic anemia
Correct answer: A. Iron-deficiency anemia
Rationale: Microcytosis with depleted iron stores, reflected by low ferritin, is characteristic of
iron-deficiency anemia.
9. A patient has macrocytosis, glossitis, paresthesias, and impaired vibration
sensation. Which deficiency is most likely?
A. Vitamin B12 deficiency
B. Iron deficiency
C. Vitamin K deficiency
D. Vitamin C deficiency
2026/2027 version /instant pdf
1. A 52-year-old patient presents with crushing substernal chest pain radiating to
the left arm, diaphoresis, and nausea. What is the priority diagnostic test?
A. 12-lead ECG
B. Chest x-ray
C. Abdominal ultrasound
D. Pulmonary function testing
Correct answer: A. 12-lead ECG
Rationale: A 12-lead ECG should be obtained promptly in suspected acute coronary syndrome
to identify ischemic changes or STEMI.
2. A patient with suspected bacterial meningitis presents with fever, severe
headache, neck stiffness, and altered mental status. Which action should occur
before lumbar puncture if increased intracranial pressure is suspected?
A. Obtain neuroimaging
B. Begin oral antibiotics only
C. Perform a stress test
D. Obtain a screening mammogram
Correct answer: A. Obtain neuroimaging
Rationale: Neuroimaging may be required before lumbar puncture in patients at risk for
increased intracranial pressure or mass effect.
3. A 68-year-old patient reports new unilateral temporal headache, jaw
claudication, and transient visual changes. Which laboratory test is most
appropriate initially?
A. ESR and CRP
B. Serum amylase
C. Troponin only
D. TSH only
Correct answer: A. ESR and CRP
,Rationale: Giant cell arteritis commonly causes elevated inflammatory markers and requires
urgent evaluation because of the risk of permanent vision loss.
4. A patient presents with fatigue, weight gain, constipation, cold intolerance,
and dry skin. Which laboratory pattern is most consistent with primary
hypothyroidism?
A. Elevated TSH and low free T4
B. Low TSH and elevated free T4
C. Elevated TSH and elevated free T4
D. Low TSH and low free T4
Correct answer: A. Elevated TSH and low free T4
Rationale: Primary thyroid gland failure causes decreased thyroid hormone production and
compensatory elevation of TSH.
5. A patient with type 2 diabetes has an A1C of 9.8% despite adherence to
metformin. What is the most appropriate next step?
A. Intensify pharmacologic therapy based on patient-specific factors
B. Stop all diabetes medications
C. Wait one year before reassessing
D. Recommend only increased water intake
Correct answer: A. Intensify pharmacologic therapy based on patient-specific factors
Rationale: Persistent poor glycemic control requires treatment intensification, considering
comorbidities, cardiovascular risk, kidney function, cost, and patient preferences.
6. A patient presents with polyuria, polydipsia, abdominal pain, nausea, and
deep rapid respirations. Laboratory studies show hyperglycemia, metabolic
acidosis, and elevated anion gap. Which condition is most likely?
A. Diabetic ketoacidosis
B. Hyperthyroidism
C. SIADH
D. Respiratory alkalosis
, Correct answer: A. Diabetic ketoacidosis
Rationale: DKA is characterized by hyperglycemia, ketone production, high-anion-gap
metabolic acidosis, and compensatory Kussmaul respirations.
7. A patient has severe hyperglycemia, profound dehydration, altered mental
status, and minimal ketone production. Which condition is most likely?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Addisonian crisis
D. Acute pancreatitis
Correct answer: A. Hyperosmolar hyperglycemic state
Rationale: HHS causes extreme hyperglycemia and hyperosmolality with severe dehydration
and usually minimal ketoacidosis.
8. A patient reports fatigue and has pallor. Laboratory studies show low
hemoglobin, low MCV, and low ferritin. Which diagnosis is most likely?
A. Iron-deficiency anemia
B. Vitamin B12 deficiency
C. Folate deficiency
D. Hemolytic anemia
Correct answer: A. Iron-deficiency anemia
Rationale: Microcytosis with depleted iron stores, reflected by low ferritin, is characteristic of
iron-deficiency anemia.
9. A patient has macrocytosis, glossitis, paresthesias, and impaired vibration
sensation. Which deficiency is most likely?
A. Vitamin B12 deficiency
B. Iron deficiency
C. Vitamin K deficiency
D. Vitamin C deficiency
