CEA EXAM 150 HIGH-YIELD ENERGY
EFFICIENCY, HVAC ANALYSIS, AND AUDITING
METHODOLOGIES SUMMARY 2026
◉ An adult female who recently returned for a recheck appointment.
The only remarkable laboratory result is for thyroid-stimulating
hormone (TSH), at 0.3 microunits/mL (normal = 0.4-6
microunits/mL). The patient reports that her neck hurts;
examination reveals thyroid tenderness. Which of the following
laboratory tests should the nurse practitioner order now?.
Answer: Triiodothyronine (T3) and free thyroxine (FT4)
Rationale: Remember that a patient with low TSH is suspicious of
hyperthyroidism with a corresponding finding of elevated T3/T4
and clinical symptoms of a goiter, tremulousness, anxiety,
palpitations, weight loss, insomnia, diarrhea, etc. This patient is
describing a sore neck as well, which is suggestive of Graves disease
(hyperthyroid state).
◉ All the following are symptoms of hypocalcemia except:.
Answer: Visual field deficits
Rationale: Visual field deficits is a potential symptom of pituitary
adenoma. All other are symptoms related to hypocalcemia.
,◉ An adult patient diagnosed with type 2 diabetes mellitus presents
for a recheck. The patient follows a carbohydrate counting diet and
walks 30 minutes 5 times weekly. Current fasting blood glucose =
116 mg/dL [normal = less than 99 mg/dL] and A1c = 6.3% [normal
= less than 7.0%]. In accordance with the American Diabetes
Association, the nurse practitioner would recommend that the next
follow-up appointment be scheduled for:.
Answer: 6 months.
Rationale: Based off of the ADA recommendation, this patient should
be evaluated in six months. They are actually showing good control
and excellent compliance with diet and exercise management
strategies. If there compliance was worse or they were not
controlled with their A1c, this would likely be a three month follow
up.
◉ Your patient has a diagnosis of Hashimoto's and is on
Levothyroxine 75 mcg daily. Her recent TSH was elevated at 15
uU/mL. Your next best action is to:.
Answer: Increase Levothyroxine to 100 mcg daily
Rationale: When the TSH is elevated the patient needs more thyroid
hormone. Once diagnosed with Hashimoto's there is no clinical
need/benefit to repeating anti bodies.
◉ A patient has a 3 cm pituitary mass noted on CT. What is your next
step in evaluating the patient?.
Answer: Screen for hormone deficiencies
,Rationale: Initial work up includes hormone testing. Cabergoline is
the treatment for prolactinoma. Surgery consult is indicated when
there are VF deficits and/or abutment/compression on optic nerves
or chiasm or if adenoma is hyperfunctioning. Adenomas >1 cm with
no VF deficit or abutment/compression of optic nerves or chiasm
require a follow up MRI at 6 months.
◉ An adult female presents with a chief complaint of fatigue and
weight gain. She states that she doesn't feel like herself. A diagnosis
of hypothyroidism is suspected. Which of the following physical
findings would support this diagnosis?.
Answer: Dry skin, bradycardia, and hypoactive deep tendon reflexes
Rationale: Dry skin, bradycardia, and hypoactive deep tendon
reflexes are all fairly classic signs of hypothyroidism. To further
substantiate these concerns, the patient should have their TSH and
T3 and Free T4 checked, and it is likely their TSH would be elevated,
T3/T4 low.
◉ An older adult patient with new onset GERD, cough, heartburn.
Initial tx.
Answer: Antacid and lifestyle modification/weight loss
Rationale: Before initiating a PPI or H2RA, it would always be wise
to initiate diet/exercise and symptom management when present
with an antacid. Loss of weight/dieting is most likely to deal with
obesity as the most common underlying cause of GERD.
, ◉ A 59-year-old male presents with symptoms of abdominal pain,
jaundice, and weight loss which he has not been trying to lose
weight. What would be a malignancy associated with these
symptoms?.
Answer: Pancreatic cancer
Raionale: Pancreatic cancer, the most typically presentation includes
abdominal pain, jaundice, and weight loss. Although weight loss and
abdominal pain may be present with adenocarcinoma it is unlikely
to present with jaundice, and you're unlikely to have abdominal pain
or jaundice with any esophageal malignancy.
◉ A 63-year-old male presents with a suspected lower GI bleed. He
reports passing frank small amounts of blood several times today. He
denies any use of NSAID's or blood thinners. What must be taken
into consideration before performing a colonoscopy on this patient?.
Answer: All are reasonable options
Rationale: This patient has had blood loss and should first be
hemodynamically stable, and fluid/blood product resuscitated. In all
cases of GI bleed risk factors for an upper GI bleed must be taken
into consideration first, we must always discuss with the patient all
risks and benefits associated with the procedure to provide an
informed consent.
◉ A 39-year-old female is being seen by your service for diarrhea.
Patient reports 3-4 loose stools a day. She also reports mild
cramping. Which labs would be helpful in further workup of a
diagnosis?.
EFFICIENCY, HVAC ANALYSIS, AND AUDITING
METHODOLOGIES SUMMARY 2026
◉ An adult female who recently returned for a recheck appointment.
The only remarkable laboratory result is for thyroid-stimulating
hormone (TSH), at 0.3 microunits/mL (normal = 0.4-6
microunits/mL). The patient reports that her neck hurts;
examination reveals thyroid tenderness. Which of the following
laboratory tests should the nurse practitioner order now?.
Answer: Triiodothyronine (T3) and free thyroxine (FT4)
Rationale: Remember that a patient with low TSH is suspicious of
hyperthyroidism with a corresponding finding of elevated T3/T4
and clinical symptoms of a goiter, tremulousness, anxiety,
palpitations, weight loss, insomnia, diarrhea, etc. This patient is
describing a sore neck as well, which is suggestive of Graves disease
(hyperthyroid state).
◉ All the following are symptoms of hypocalcemia except:.
Answer: Visual field deficits
Rationale: Visual field deficits is a potential symptom of pituitary
adenoma. All other are symptoms related to hypocalcemia.
,◉ An adult patient diagnosed with type 2 diabetes mellitus presents
for a recheck. The patient follows a carbohydrate counting diet and
walks 30 minutes 5 times weekly. Current fasting blood glucose =
116 mg/dL [normal = less than 99 mg/dL] and A1c = 6.3% [normal
= less than 7.0%]. In accordance with the American Diabetes
Association, the nurse practitioner would recommend that the next
follow-up appointment be scheduled for:.
Answer: 6 months.
Rationale: Based off of the ADA recommendation, this patient should
be evaluated in six months. They are actually showing good control
and excellent compliance with diet and exercise management
strategies. If there compliance was worse or they were not
controlled with their A1c, this would likely be a three month follow
up.
◉ Your patient has a diagnosis of Hashimoto's and is on
Levothyroxine 75 mcg daily. Her recent TSH was elevated at 15
uU/mL. Your next best action is to:.
Answer: Increase Levothyroxine to 100 mcg daily
Rationale: When the TSH is elevated the patient needs more thyroid
hormone. Once diagnosed with Hashimoto's there is no clinical
need/benefit to repeating anti bodies.
◉ A patient has a 3 cm pituitary mass noted on CT. What is your next
step in evaluating the patient?.
Answer: Screen for hormone deficiencies
,Rationale: Initial work up includes hormone testing. Cabergoline is
the treatment for prolactinoma. Surgery consult is indicated when
there are VF deficits and/or abutment/compression on optic nerves
or chiasm or if adenoma is hyperfunctioning. Adenomas >1 cm with
no VF deficit or abutment/compression of optic nerves or chiasm
require a follow up MRI at 6 months.
◉ An adult female presents with a chief complaint of fatigue and
weight gain. She states that she doesn't feel like herself. A diagnosis
of hypothyroidism is suspected. Which of the following physical
findings would support this diagnosis?.
Answer: Dry skin, bradycardia, and hypoactive deep tendon reflexes
Rationale: Dry skin, bradycardia, and hypoactive deep tendon
reflexes are all fairly classic signs of hypothyroidism. To further
substantiate these concerns, the patient should have their TSH and
T3 and Free T4 checked, and it is likely their TSH would be elevated,
T3/T4 low.
◉ An older adult patient with new onset GERD, cough, heartburn.
Initial tx.
Answer: Antacid and lifestyle modification/weight loss
Rationale: Before initiating a PPI or H2RA, it would always be wise
to initiate diet/exercise and symptom management when present
with an antacid. Loss of weight/dieting is most likely to deal with
obesity as the most common underlying cause of GERD.
, ◉ A 59-year-old male presents with symptoms of abdominal pain,
jaundice, and weight loss which he has not been trying to lose
weight. What would be a malignancy associated with these
symptoms?.
Answer: Pancreatic cancer
Raionale: Pancreatic cancer, the most typically presentation includes
abdominal pain, jaundice, and weight loss. Although weight loss and
abdominal pain may be present with adenocarcinoma it is unlikely
to present with jaundice, and you're unlikely to have abdominal pain
or jaundice with any esophageal malignancy.
◉ A 63-year-old male presents with a suspected lower GI bleed. He
reports passing frank small amounts of blood several times today. He
denies any use of NSAID's or blood thinners. What must be taken
into consideration before performing a colonoscopy on this patient?.
Answer: All are reasonable options
Rationale: This patient has had blood loss and should first be
hemodynamically stable, and fluid/blood product resuscitated. In all
cases of GI bleed risk factors for an upper GI bleed must be taken
into consideration first, we must always discuss with the patient all
risks and benefits associated with the procedure to provide an
informed consent.
◉ A 39-year-old female is being seen by your service for diarrhea.
Patient reports 3-4 loose stools a day. She also reports mild
cramping. Which labs would be helpful in further workup of a
diagnosis?.
