NR 668 CEA Final Exam (2026) |
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With rationales 2026\2027 update
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,───────────────────────────────────────────────────────
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A 55-year-old male presents with sudden onset of severe, tearing
chest pain radiating to his back. His blood pressure is 180/110
mmHg in the right arm and 100/60 mmHg in the left arm. Which of
the following is the most appropriate initial diagnostic test?
A. Electrocardiogram (ECG)
B. Chest X-ray
C. CT Angiography of the chest
D. Transthoracic echocardiogram
Answer: C. CT Angiography of the chest
Rationale: The patient's presentation is classic for an aortic
dissection (tearing pain, blood pressure differential >20 mmHg
between arms). A CT angiography is the gold standard for
diagnosing aortic dissection as it provides rapid, highly sensitive
visualization of the aortic lumen and intimal flap. While an ECG and
CXR are often done first in the ER to rule out other diagnoses, CT
angiography is the definitive diagnostic test for this presentation.
A 30-year-old female presents with a 3-day history of dysuria,
urinary frequency, and suprapubic pain. She is otherwise healthy,
not pregnant, and has no fever or flank pain. Urinalysis shows
positive leukocyte esterase and nitrites. What is the most
appropriate treatment?
A. Ciprofloxacin 500 mg twice daily for 7 days
B. Nitrofurantoin 100 mg twice daily for 5 days
C. Amoxicillin 500 mg three times daily for 10 days
D. Trimethoprim-sulfamethoxazole 1 DS twice daily for 3 days
Answer: B. Nitrofurantoin 100 mg twice daily for 5 days
Rationale: This patient has an uncomplicated cystitis. Current IDSA
guidelines recommend Nitrofurantoin for 5 days or Trimethoprim-
,sulfamethoxazole (TMP-SMX) for 3 days as first-line empiric therapy.
Fluoroquinolones (like Ciprofloxacin) are reserved for complicated
UTIs or pyelonephritis due to severe side effects. Amoxicillin is not
recommended due to high E. coli resistance rates.
Which of the following is the most sensitive indicator for diagnosing
acute rheumatic fever in a patient with a recent history of Group A
Strep pharyngitis?
A. Erythema marginatum
B. Polyarthritis
C. Chorea
D. Subcutaneous nodules
Answer: B. Polyarthritis
Rationale: Acute rheumatic fever is diagnosed using the Jones
criteria. Polyarthritis is the most common and most sensitive major
manifestation, occurring in up to 75% of patients. Chorea and
subcutaneous nodules are highly specific but not sensitive.
Erythema marginatum is rare.
A 65-year-old male with a history of COPD presents with increased
dyspnea, purulent sputum, and wheezing. He is afebrile, HR 92, RR
22, SpO2 89% on room air. Which of the following is the most
appropriate initial management?
A. Prescribe oral corticosteroids and a macrolide antibiotic
B. Admit to the ICU for mechanical ventilation
C. Administer a long-acting beta-agonist (LABA) and discharge
D. Order a CT pulmonary angiogram
Answer: A. Prescribe oral corticosteroids and a macrolide antibiotic
Rationale: This patient is experiencing an acute exacerbation of
COPD (increased dyspnea, purulent sputum). Standard outpatient
, management for a moderate exacerbation includes systemic
corticosteroids (e.g., Prednisone 40mg for 5 days) to reduce
inflammation and an antibiotic (e.g., Azithromycin, Doxycycline)
since purulent sputum suggests bacterial infection. He does not
currently meet criteria for ICU admission/mechanical ventilation. A
LABA is for maintenance, not acute relief.
A 42-year-old female presents with fatigue, weight gain,
constipation, and menorrhagia. Her TSH is 25 mIU/L (normal 0.4-
4.0) and free T4 is low. What is the most appropriate treatment?
A. Liothyronine (T3) 50 mcg daily
B. Levothyroxine (T4) 1.6 mcg/kg daily
C. Methimazole 10 mg daily
D. Radioactive iodine ablation
Answer: B. Levothyroxine (T4) 1.6 mcg/kg daily
Rationale: The patient has overt primary hypothyroidism (elevated
TSH, low T4). Levothyroxine is the standard of care for replacement
therapy. Liothyronine (T3) is not routinely used for maintenance due
to cardiovascular risks and short half-life. Methimazole and
radioactive iodine are treatments for hyperthyroidism.
A 24-year-old sexually active female presents with a firm, painless,
mobile 2 cm mass in the left upper outer quadrant of her breast.
She reports the size fluctuates with her menstrual cycle. What is the
most likely diagnosis?
A. Fibroadenoma
B. Breast cancer
C. Intraductal papilloma
D. Fibrocystic breast changes
Answer: A. Fibroadenoma
Chamberlain Questions and Verified
Answers,
With rationales 2026\2027 update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
─
A 55-year-old male presents with sudden onset of severe, tearing
chest pain radiating to his back. His blood pressure is 180/110
mmHg in the right arm and 100/60 mmHg in the left arm. Which of
the following is the most appropriate initial diagnostic test?
A. Electrocardiogram (ECG)
B. Chest X-ray
C. CT Angiography of the chest
D. Transthoracic echocardiogram
Answer: C. CT Angiography of the chest
Rationale: The patient's presentation is classic for an aortic
dissection (tearing pain, blood pressure differential >20 mmHg
between arms). A CT angiography is the gold standard for
diagnosing aortic dissection as it provides rapid, highly sensitive
visualization of the aortic lumen and intimal flap. While an ECG and
CXR are often done first in the ER to rule out other diagnoses, CT
angiography is the definitive diagnostic test for this presentation.
A 30-year-old female presents with a 3-day history of dysuria,
urinary frequency, and suprapubic pain. She is otherwise healthy,
not pregnant, and has no fever or flank pain. Urinalysis shows
positive leukocyte esterase and nitrites. What is the most
appropriate treatment?
A. Ciprofloxacin 500 mg twice daily for 7 days
B. Nitrofurantoin 100 mg twice daily for 5 days
C. Amoxicillin 500 mg three times daily for 10 days
D. Trimethoprim-sulfamethoxazole 1 DS twice daily for 3 days
Answer: B. Nitrofurantoin 100 mg twice daily for 5 days
Rationale: This patient has an uncomplicated cystitis. Current IDSA
guidelines recommend Nitrofurantoin for 5 days or Trimethoprim-
,sulfamethoxazole (TMP-SMX) for 3 days as first-line empiric therapy.
Fluoroquinolones (like Ciprofloxacin) are reserved for complicated
UTIs or pyelonephritis due to severe side effects. Amoxicillin is not
recommended due to high E. coli resistance rates.
Which of the following is the most sensitive indicator for diagnosing
acute rheumatic fever in a patient with a recent history of Group A
Strep pharyngitis?
A. Erythema marginatum
B. Polyarthritis
C. Chorea
D. Subcutaneous nodules
Answer: B. Polyarthritis
Rationale: Acute rheumatic fever is diagnosed using the Jones
criteria. Polyarthritis is the most common and most sensitive major
manifestation, occurring in up to 75% of patients. Chorea and
subcutaneous nodules are highly specific but not sensitive.
Erythema marginatum is rare.
A 65-year-old male with a history of COPD presents with increased
dyspnea, purulent sputum, and wheezing. He is afebrile, HR 92, RR
22, SpO2 89% on room air. Which of the following is the most
appropriate initial management?
A. Prescribe oral corticosteroids and a macrolide antibiotic
B. Admit to the ICU for mechanical ventilation
C. Administer a long-acting beta-agonist (LABA) and discharge
D. Order a CT pulmonary angiogram
Answer: A. Prescribe oral corticosteroids and a macrolide antibiotic
Rationale: This patient is experiencing an acute exacerbation of
COPD (increased dyspnea, purulent sputum). Standard outpatient
, management for a moderate exacerbation includes systemic
corticosteroids (e.g., Prednisone 40mg for 5 days) to reduce
inflammation and an antibiotic (e.g., Azithromycin, Doxycycline)
since purulent sputum suggests bacterial infection. He does not
currently meet criteria for ICU admission/mechanical ventilation. A
LABA is for maintenance, not acute relief.
A 42-year-old female presents with fatigue, weight gain,
constipation, and menorrhagia. Her TSH is 25 mIU/L (normal 0.4-
4.0) and free T4 is low. What is the most appropriate treatment?
A. Liothyronine (T3) 50 mcg daily
B. Levothyroxine (T4) 1.6 mcg/kg daily
C. Methimazole 10 mg daily
D. Radioactive iodine ablation
Answer: B. Levothyroxine (T4) 1.6 mcg/kg daily
Rationale: The patient has overt primary hypothyroidism (elevated
TSH, low T4). Levothyroxine is the standard of care for replacement
therapy. Liothyronine (T3) is not routinely used for maintenance due
to cardiovascular risks and short half-life. Methimazole and
radioactive iodine are treatments for hyperthyroidism.
A 24-year-old sexually active female presents with a firm, painless,
mobile 2 cm mass in the left upper outer quadrant of her breast.
She reports the size fluctuates with her menstrual cycle. What is the
most likely diagnosis?
A. Fibroadenoma
B. Breast cancer
C. Intraductal papilloma
D. Fibrocystic breast changes
Answer: A. Fibroadenoma
