CEA PREP EXAM
WITH ACTUAL CORRECT QUESTIONS
AND VERIFIED DETAILED
ANSWERS|FREQUENTLY TESTED
QUESTIONS AND
SOLUTIONS|NEWEST|GUARANTEED
PASS 2026/2027
Which of the following is at highest risk for DMII?
An adult woman with a BMI of 27 who just delivered a baby weighing 9 1/2 lbs
Rationale: Of these options, an adult woman with a BMI of 27 who just delivered a baby weighing 9 1/2
lbs is the most likely due to their increased BMI and the large size of the baby. giving birth to a large
baby, also known as a large-for-gestational-age (LGA) baby, can increase the risk of developing type 2
diabetes later in life. Women who give birth to a LGA baby are 10% more likely to develop DMII 10-14
years after pregnancy compared to women who give birth to babies of average gestational age (AGA).
This increased risk is even after adjusting for other risk factors, such as age, obesity, high blood pressure,
and family history of diabetes.
A starting dose for an elderly adult patient with a BMI of 20 needing levothryoxine
25 mcg
Rationale: The widely considered best practice for treatment of hypothyroidism in the elderly is to "go
slow and start low". 25 mcg is the most appropriate low dose to start with of these options. It is possible
that over time the dose will be increased until therapeutic levels are obtained, but the risk of over-
dosing the patient outweighs the desire to quickly achieve this state.
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?
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:
1|Page
,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:
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 their 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:
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?
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?
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
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?
2|Page
,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?
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?
ESR, fecal occult, Stool culture
Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to determine the potential
cause of her symptoms.
An adult female presents with a 1-week history of left lower quadrant abdominal pain. T=101.2 degrees
F. (38.4 degrees C) and an elevated WBC count. This is the patient's first episode of severe abdominal
pain. The nurse practitioner suspects diverticulitis. Which of the following diagnostic tests would
confirm the diagnosis?
CT scan of the abdomen
Rationale: For patients with acute diverticulitis, CT of the abdomen will provide evidence of the
pathophysiology. Evidence of diverticula will be present on a flat plate KUB x-ray, but there is not
enough specificity to show that it is inflamed as with a CT scan.
A 70-year-old patient presents to the clinic with dyspnea, palpitations, and fatigue. The patient reports a
2-week history of blackened stools, which the patient attributes to drinking berry juice. Assessment
reveals vital signs of BP = 110/60, P = 100, R = 24; Hgb = 4.5 g/dL; Hct = 16%. What is the most
appropriate immediate intervention?
Send to the emergency room.
Rationale: This patient is experiencing a GI bleed and is in need of emergency treatment due to their
considerably low hemoglobin.
An older adult has a follow-up fasting lipid panel 6 months after making therapeutic lifestyle changes.
LDL=205mg/dL (Normal=<100mg/dL), HDL=44mg/dL, and triglycerides=180mg/dL (Normal-<150mg/dL).
The patient is placed on statin therapy. Two months later, the patient presents for follow-up and
complains of body aches. In addition to creatine phosphokinase (CPK), which of the following tests
should the nurse practitioner order?
3|Page
, Liver transaminase (AST and ALT) levels
Rationale: Due to the potential liver function test elevation found with statin use, LFTs of AST/ALT
should be checked routinely after initiation of therapy
A 56-year-old male on your service has been diagnosed with colon cancer which is localized. What is the
primary management that you should expect to prepare your patient for?
Surgery
Rationale: Surgery is the only curative modality for localized colon cancers. Patients with
progressive/metastatic disease may require chemotherapy/radiation.
A 28-year-old woman presents with abdominal pain, diarrhea, and weight loss. She also reports
occasional bloody stools. Colonoscopy reveals continuous inflammation from the rectum extending
proximally. What is the most likely diagnosis?
Ulcerative colitis
Rationale: The presence of inflammatory bowel disease which is present in the patient with bloody stool
suggests ulcerative colitis. This patient should be acutely managed with steroids and chronically with
auto-immune therapy such as biologics and/or DMARDs.
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 use of NSAID's or blood thinners. What questions would be
important to ask to further differentiate your diagnosis?
All these questions would help determine if this bleed was associated with a potential diverticular bleed
(typically painless), painful bowel movement associated with IBD (UC/Crohn's), and changes in bowel
habit/colonoscopy risk for malignancy.
Which is best performed to assess the risk for fall in an 88-year old adult?
Get up and go test
Rationale: This question is asking you if you understand the different screening to available for Mobility
and fall risk. The global screening assessment, PHQ-2 questionnaire, and clock drawing test have no
clinical significance to mobility. The "get up and go" test is the only option that is a mobility test of these
four.
A frail elderly patient presents with constipation. Which of the following normal physiologic changes
seen with aging is the most likely cause?
Decreased bowel muscle tone
Rationale: The frail, elderly patient will typically have their GI track decrease bile secretion and decrease
absorption of calcium. A decrease in pancreas secretions is not related to presence of constipation,
however, decreased bowel muscle tone certainly does reduce the GI motility and increase the transit
time, thereby increasing the drying of stool in the large intestine which leads to constipation
An elderly patient diagnosed with end-stage lung cancer has been refusing meals, opting instead for ice
cream only. The family is concerned about the patient not getting enough nutrition. The NP:
explains loss of appetite is common at the end of life
Rationale: Death is an uncomfortable topic, and must be handled tactfully. Factual re-orientation to the
4|Page
WITH ACTUAL CORRECT QUESTIONS
AND VERIFIED DETAILED
ANSWERS|FREQUENTLY TESTED
QUESTIONS AND
SOLUTIONS|NEWEST|GUARANTEED
PASS 2026/2027
Which of the following is at highest risk for DMII?
An adult woman with a BMI of 27 who just delivered a baby weighing 9 1/2 lbs
Rationale: Of these options, an adult woman with a BMI of 27 who just delivered a baby weighing 9 1/2
lbs is the most likely due to their increased BMI and the large size of the baby. giving birth to a large
baby, also known as a large-for-gestational-age (LGA) baby, can increase the risk of developing type 2
diabetes later in life. Women who give birth to a LGA baby are 10% more likely to develop DMII 10-14
years after pregnancy compared to women who give birth to babies of average gestational age (AGA).
This increased risk is even after adjusting for other risk factors, such as age, obesity, high blood pressure,
and family history of diabetes.
A starting dose for an elderly adult patient with a BMI of 20 needing levothryoxine
25 mcg
Rationale: The widely considered best practice for treatment of hypothyroidism in the elderly is to "go
slow and start low". 25 mcg is the most appropriate low dose to start with of these options. It is possible
that over time the dose will be increased until therapeutic levels are obtained, but the risk of over-
dosing the patient outweighs the desire to quickly achieve this state.
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?
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:
1|Page
,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:
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 their 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:
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?
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?
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
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?
2|Page
,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?
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?
ESR, fecal occult, Stool culture
Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to determine the potential
cause of her symptoms.
An adult female presents with a 1-week history of left lower quadrant abdominal pain. T=101.2 degrees
F. (38.4 degrees C) and an elevated WBC count. This is the patient's first episode of severe abdominal
pain. The nurse practitioner suspects diverticulitis. Which of the following diagnostic tests would
confirm the diagnosis?
CT scan of the abdomen
Rationale: For patients with acute diverticulitis, CT of the abdomen will provide evidence of the
pathophysiology. Evidence of diverticula will be present on a flat plate KUB x-ray, but there is not
enough specificity to show that it is inflamed as with a CT scan.
A 70-year-old patient presents to the clinic with dyspnea, palpitations, and fatigue. The patient reports a
2-week history of blackened stools, which the patient attributes to drinking berry juice. Assessment
reveals vital signs of BP = 110/60, P = 100, R = 24; Hgb = 4.5 g/dL; Hct = 16%. What is the most
appropriate immediate intervention?
Send to the emergency room.
Rationale: This patient is experiencing a GI bleed and is in need of emergency treatment due to their
considerably low hemoglobin.
An older adult has a follow-up fasting lipid panel 6 months after making therapeutic lifestyle changes.
LDL=205mg/dL (Normal=<100mg/dL), HDL=44mg/dL, and triglycerides=180mg/dL (Normal-<150mg/dL).
The patient is placed on statin therapy. Two months later, the patient presents for follow-up and
complains of body aches. In addition to creatine phosphokinase (CPK), which of the following tests
should the nurse practitioner order?
3|Page
, Liver transaminase (AST and ALT) levels
Rationale: Due to the potential liver function test elevation found with statin use, LFTs of AST/ALT
should be checked routinely after initiation of therapy
A 56-year-old male on your service has been diagnosed with colon cancer which is localized. What is the
primary management that you should expect to prepare your patient for?
Surgery
Rationale: Surgery is the only curative modality for localized colon cancers. Patients with
progressive/metastatic disease may require chemotherapy/radiation.
A 28-year-old woman presents with abdominal pain, diarrhea, and weight loss. She also reports
occasional bloody stools. Colonoscopy reveals continuous inflammation from the rectum extending
proximally. What is the most likely diagnosis?
Ulcerative colitis
Rationale: The presence of inflammatory bowel disease which is present in the patient with bloody stool
suggests ulcerative colitis. This patient should be acutely managed with steroids and chronically with
auto-immune therapy such as biologics and/or DMARDs.
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 use of NSAID's or blood thinners. What questions would be
important to ask to further differentiate your diagnosis?
All these questions would help determine if this bleed was associated with a potential diverticular bleed
(typically painless), painful bowel movement associated with IBD (UC/Crohn's), and changes in bowel
habit/colonoscopy risk for malignancy.
Which is best performed to assess the risk for fall in an 88-year old adult?
Get up and go test
Rationale: This question is asking you if you understand the different screening to available for Mobility
and fall risk. The global screening assessment, PHQ-2 questionnaire, and clock drawing test have no
clinical significance to mobility. The "get up and go" test is the only option that is a mobility test of these
four.
A frail elderly patient presents with constipation. Which of the following normal physiologic changes
seen with aging is the most likely cause?
Decreased bowel muscle tone
Rationale: The frail, elderly patient will typically have their GI track decrease bile secretion and decrease
absorption of calcium. A decrease in pancreas secretions is not related to presence of constipation,
however, decreased bowel muscle tone certainly does reduce the GI motility and increase the transit
time, thereby increasing the drying of stool in the large intestine which leads to constipation
An elderly patient diagnosed with end-stage lung cancer has been refusing meals, opting instead for ice
cream only. The family is concerned about the patient not getting enough nutrition. The NP:
explains loss of appetite is common at the end of life
Rationale: Death is an uncomfortable topic, and must be handled tactfully. Factual re-orientation to the
4|Page
