CEA FAMILY NURSE PRACTITIONER (FNP) COMPREHENSIVE
ASSESSMENT EXAM with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Health Assessment, Differential Diagnosis, and Diagnostic Reasoning Across the
Lifespan
2. Primary Care Management of Chronic, Acute, and Complex Comorbid Health Conditions
3. Pharmacology, Evidence-Based Therapeutics, Health Promotion, and Disease Prevention
1. A 48-year-old male presents to the primary care clinic reporting progressive fatigue,
unsteadiness when walking, and a "pins and needles" sensation in both feet over the past three
months. He has a history of type 2 diabetes managed with metformin for the past 6 years and
takes no other regular medications. Neurological examination reveals diminished vibratory sense
and proprioception in the lower extremities, along with a positive Romberg sign. Complete blood
count shows a hemoglobin of 11.2 g/dL and a mean corpuscular volume (MCV) of 108 fL. What
is the most appropriate initial diagnostic workup to confirm the suspected etiology?
A. Serum ferritin and total iron-binding capacity
B. Serum vitamin B12 and methylmalonic acid (MMA) levels, along with intrinsic factor
antibodies
C. Hemoglobin electrophoresis and reticulocyte count
D. Glycated hemoglobin (HbA1c) and continuous glucose monitoring
CORRECT ANSWER : B
Rationale: Long-term metformin use is associated with vitamin B12 malabsorption, presenting
as macrocytic anemia accompanied by characteristic posterior column neurological symptoms
(loss of vibratory sense and proprioception). Serum vitamin B12 and methylmalonic acid (MMA)
levels provide the highest sensitivity, while testing for intrinsic factor antibodies assists in
identifying pernicious anemia. Iron studies evaluate microcytic anemia, whereas hemoglobin
electrophoresis assesses hemoglobinopathies.
2. A 62-year-old female with a 15-pack-year smoking history and mild chronic obstructive
pulmonary disease presents for a routine physical examination. A low-dose computed
tomography (LDCT) scan of the chest is ordered as part of lung cancer screening. The scan
, reveals a solid, non-calcified pulmonary nodule measuring 9 mm in the right upper lobe.
According to current Fleischner Society guidelines for the management of incidental pulmonary
nodules, what is the most appropriate next management step?
A. Reassure the patient and order a repeat chest CT in 12 months
B. Perform a PET-CT scan, obtain a tissue biopsy, or schedule a short-interval repeat CT
scan in 3 months to assess growth velocity
C. Refer immediately for video-assisted thoracoscopic surgery (VATS) lobectomy without
further imaging
D. Prescribe a 14-day course of broad-spectrum antibiotics and repeat chest radiography in 2
weeks
CORRECT ANSWER : B
Rationale: For a solid pulmonary nodule measuring greater than 8 mm in a high-risk patient,
Fleischner Society guidelines recommend high-resolution evaluation via PET-CT, biopsy, or a
short-interval follow-up CT scan in 3 months due to the elevated malignancy risk. A 12-month
interval is reserved for smaller low-risk nodules, and immediate surgical resection is premature
without diagnostic workup.
3. A 55-year-old male with a history of essential hypertension, hyperlipidemia, and stable chronic
kidney disease stage 3a (estimated GFR 52 mL/min/1.73m2) presents for a routine medication
review. His current regimen includes lisinopril 20 mg daily, atorvastatin 40 mg daily, and
hydrochlorothiazide 12.5 mg daily. Laboratory results show a serum creatinine of 1.4 mg/dL and
serum potassium of 4.8 mEq/L. Two weeks ago, his serum creatinine was 1.2 mg/dL. What is the
most appropriate clinical action regarding his lisinopril therapy?
A. Immediately discontinue lisinopril permanently due to catastrophic renal failure
B. Recheck basic metabolic panel and repeat serum creatinine in 1 to 2 weeks, permitting
up to a 30% increase in serum creatinine as an acceptable hemodynamic effect of ACE
inhibition, provided hyperkalemia is absent
C. Double the lisinopril dose to 40 mg daily to achieve tighter intraglomerular pressure reduction
D. Add an immediate-release potassium supplement to counteract potential depletion
CORRECT ANSWER : B
Rationale: ACE inhibitors reduce intraglomerular pressure by efferent arteriolar vasodilation,
which can cause an initial benign serum creatinine rise of up to 30%. Routine monitoring
without discontinuation is warranted provided potassium remains safe and the increase does not
exceed 30%. Immediate discontinuation or doubling the dose would be unsafe.
, 4. A 24-year-old female presents to the urgent care clinic complaining of a 3-day history of dysuria,
frequent urination, and suprapubic discomfort. She denies fever, flank pain, or vaginal discharge.
A urine dipstick test is positive for leukocyte esterase and nitrites. Urine culture is pending. She
has no known drug allergies. According to current Infectious Diseases Society of America
(IDSA) guidelines, what is the preferred first-line empiric antimicrobial therapy?
A. Ciprofloxacin 500 mg orally twice daily for 7 days
B. Nitrofurantoin monohydrate/macrocrystals 100 mg orally twice daily for 5 days
C. Azithromycin 1 g orally as a single dose
D. Amoxicillin-clavulanate 875/125 mg orally twice daily for 10 days
CORRECT ANSWER : B
Rationale: Uncomplicated acute cystitis in non-pregnant females is treated first-line with
nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or fosfomycin as a single
dose. Fluoroquinolones like ciprofloxacin should be reserved for complicated infections due to
collateral damage and black box warnings.
5. A 70-year-old male with a history of permanent atrial fibrillation, type 2 diabetes mellitus, and
previous ischemic stroke presents for medication management. He currently takes apixaban 5 mg
orally twice daily, metformin 1,000 mg twice daily, and atorvastatin 80 mg daily. His
CHA2DS2-VASc score is calculated at 5, and his HAS-BLED score is 3. He reports no bleeding
episodes. What is the most appropriate recommendation regarding his antithrombotic regimen?
A. Discontinue apixaban and replace it with daily aspirin 81 mg
B. Continue apixaban 5 mg orally twice daily as prescribed for long-term stroke prevention
C. Add clopidogrel 75 mg daily to apixaban to achieve dual antithrombotic protection
D. Stop all anticoagulation therapy due to advanced age and elevated HAS-BLED score
CORRECT ANSWER : B
Rationale: Patients with atrial fibrillation and a high CHA2DS2-VASc score (5 in this patient)
require lifelong oral anticoagulation. Apixaban is a direct oral anticoagulant (DOAC) superior
to warfarin and aspirin for stroke prevention. A high HAS-BLED score signals caution and
management of modifiable bleeding risks rather than omission of necessary anticoagulation.
6. A 34-year-old female presents with complaints of persistent fatigue, weight gain of 15 pounds
over six months, constipation, and cold intolerance. Physical examination reveals dry skin,
delayed relaxation phase of deep tendon reflexes, and a firm, non-tender diffuse thyroid gland.
Laboratory evaluation reveals a serum TSH of 9.8 mIU/L (reference: 0.4–4.0 mIU/L) and a free
ASSESSMENT EXAM with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Health Assessment, Differential Diagnosis, and Diagnostic Reasoning Across the
Lifespan
2. Primary Care Management of Chronic, Acute, and Complex Comorbid Health Conditions
3. Pharmacology, Evidence-Based Therapeutics, Health Promotion, and Disease Prevention
1. A 48-year-old male presents to the primary care clinic reporting progressive fatigue,
unsteadiness when walking, and a "pins and needles" sensation in both feet over the past three
months. He has a history of type 2 diabetes managed with metformin for the past 6 years and
takes no other regular medications. Neurological examination reveals diminished vibratory sense
and proprioception in the lower extremities, along with a positive Romberg sign. Complete blood
count shows a hemoglobin of 11.2 g/dL and a mean corpuscular volume (MCV) of 108 fL. What
is the most appropriate initial diagnostic workup to confirm the suspected etiology?
A. Serum ferritin and total iron-binding capacity
B. Serum vitamin B12 and methylmalonic acid (MMA) levels, along with intrinsic factor
antibodies
C. Hemoglobin electrophoresis and reticulocyte count
D. Glycated hemoglobin (HbA1c) and continuous glucose monitoring
CORRECT ANSWER : B
Rationale: Long-term metformin use is associated with vitamin B12 malabsorption, presenting
as macrocytic anemia accompanied by characteristic posterior column neurological symptoms
(loss of vibratory sense and proprioception). Serum vitamin B12 and methylmalonic acid (MMA)
levels provide the highest sensitivity, while testing for intrinsic factor antibodies assists in
identifying pernicious anemia. Iron studies evaluate microcytic anemia, whereas hemoglobin
electrophoresis assesses hemoglobinopathies.
2. A 62-year-old female with a 15-pack-year smoking history and mild chronic obstructive
pulmonary disease presents for a routine physical examination. A low-dose computed
tomography (LDCT) scan of the chest is ordered as part of lung cancer screening. The scan
, reveals a solid, non-calcified pulmonary nodule measuring 9 mm in the right upper lobe.
According to current Fleischner Society guidelines for the management of incidental pulmonary
nodules, what is the most appropriate next management step?
A. Reassure the patient and order a repeat chest CT in 12 months
B. Perform a PET-CT scan, obtain a tissue biopsy, or schedule a short-interval repeat CT
scan in 3 months to assess growth velocity
C. Refer immediately for video-assisted thoracoscopic surgery (VATS) lobectomy without
further imaging
D. Prescribe a 14-day course of broad-spectrum antibiotics and repeat chest radiography in 2
weeks
CORRECT ANSWER : B
Rationale: For a solid pulmonary nodule measuring greater than 8 mm in a high-risk patient,
Fleischner Society guidelines recommend high-resolution evaluation via PET-CT, biopsy, or a
short-interval follow-up CT scan in 3 months due to the elevated malignancy risk. A 12-month
interval is reserved for smaller low-risk nodules, and immediate surgical resection is premature
without diagnostic workup.
3. A 55-year-old male with a history of essential hypertension, hyperlipidemia, and stable chronic
kidney disease stage 3a (estimated GFR 52 mL/min/1.73m2) presents for a routine medication
review. His current regimen includes lisinopril 20 mg daily, atorvastatin 40 mg daily, and
hydrochlorothiazide 12.5 mg daily. Laboratory results show a serum creatinine of 1.4 mg/dL and
serum potassium of 4.8 mEq/L. Two weeks ago, his serum creatinine was 1.2 mg/dL. What is the
most appropriate clinical action regarding his lisinopril therapy?
A. Immediately discontinue lisinopril permanently due to catastrophic renal failure
B. Recheck basic metabolic panel and repeat serum creatinine in 1 to 2 weeks, permitting
up to a 30% increase in serum creatinine as an acceptable hemodynamic effect of ACE
inhibition, provided hyperkalemia is absent
C. Double the lisinopril dose to 40 mg daily to achieve tighter intraglomerular pressure reduction
D. Add an immediate-release potassium supplement to counteract potential depletion
CORRECT ANSWER : B
Rationale: ACE inhibitors reduce intraglomerular pressure by efferent arteriolar vasodilation,
which can cause an initial benign serum creatinine rise of up to 30%. Routine monitoring
without discontinuation is warranted provided potassium remains safe and the increase does not
exceed 30%. Immediate discontinuation or doubling the dose would be unsafe.
, 4. A 24-year-old female presents to the urgent care clinic complaining of a 3-day history of dysuria,
frequent urination, and suprapubic discomfort. She denies fever, flank pain, or vaginal discharge.
A urine dipstick test is positive for leukocyte esterase and nitrites. Urine culture is pending. She
has no known drug allergies. According to current Infectious Diseases Society of America
(IDSA) guidelines, what is the preferred first-line empiric antimicrobial therapy?
A. Ciprofloxacin 500 mg orally twice daily for 7 days
B. Nitrofurantoin monohydrate/macrocrystals 100 mg orally twice daily for 5 days
C. Azithromycin 1 g orally as a single dose
D. Amoxicillin-clavulanate 875/125 mg orally twice daily for 10 days
CORRECT ANSWER : B
Rationale: Uncomplicated acute cystitis in non-pregnant females is treated first-line with
nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or fosfomycin as a single
dose. Fluoroquinolones like ciprofloxacin should be reserved for complicated infections due to
collateral damage and black box warnings.
5. A 70-year-old male with a history of permanent atrial fibrillation, type 2 diabetes mellitus, and
previous ischemic stroke presents for medication management. He currently takes apixaban 5 mg
orally twice daily, metformin 1,000 mg twice daily, and atorvastatin 80 mg daily. His
CHA2DS2-VASc score is calculated at 5, and his HAS-BLED score is 3. He reports no bleeding
episodes. What is the most appropriate recommendation regarding his antithrombotic regimen?
A. Discontinue apixaban and replace it with daily aspirin 81 mg
B. Continue apixaban 5 mg orally twice daily as prescribed for long-term stroke prevention
C. Add clopidogrel 75 mg daily to apixaban to achieve dual antithrombotic protection
D. Stop all anticoagulation therapy due to advanced age and elevated HAS-BLED score
CORRECT ANSWER : B
Rationale: Patients with atrial fibrillation and a high CHA2DS2-VASc score (5 in this patient)
require lifelong oral anticoagulation. Apixaban is a direct oral anticoagulant (DOAC) superior
to warfarin and aspirin for stroke prevention. A high HAS-BLED score signals caution and
management of modifiable bleeding risks rather than omission of necessary anticoagulation.
6. A 34-year-old female presents with complaints of persistent fatigue, weight gain of 15 pounds
over six months, constipation, and cold intolerance. Physical examination reveals dry skin,
delayed relaxation phase of deep tendon reflexes, and a firm, non-tender diffuse thyroid gland.
Laboratory evaluation reveals a serum TSH of 9.8 mIU/L (reference: 0.4–4.0 mIU/L) and a free
