NR 603 CEA MIDTERM EXAM –
QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM
UPDATE
CORE DOMAINS
1. Cardiovascular Disorders and Hypertension
2. Respiratory Disorders and Pulmonary Function
3. Endocrine Disorders and Diabetes Management
4. Renal and Genitourinary Disorders
5. Hematology and Oncology
6. Neurological and Musculoskeletal Disorders
7. Gastrointestinal and Hepatic Disorders
8. Pharmacology and Clinical Decision-Making
9. Pediatric and Geriatric Primary Care
10. Legal, Ethical, and Professional Practice
INTRODUCTION
The NR 603 CEA Midterm Exam assesses the knowledge and clinical
reasoning skills required for advanced practice nursing students to diagnose
and manage complex health conditions across the lifespan. The examination
covers cardiovascular, respiratory, endocrine, renal, hematologic,
neurological, gastrointestinal, and musculoskeletal disorders, with emphasis
on evidence-based pharmacologic management and diagnostic decision-
making. The multiple-choice and scenario-based structure emphasizes real-
world application, clinical judgment, and safe prescribing practices. This
assessment prepares candidates for the responsibilities of advanced clinical
diagnosis and comprehensive patient management in primary care settings.
SECTION ONE: QUESTIONS 1–100
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes
,presents for a routine visit. His blood pressure is 142/88 mmHg. His labs
show a serum creatinine of 1.6 mg/dL (eGFR 45 mL/min). What is the BEST
initial antihypertensive agent to add to his current regimen of Metformin and
Aspirin?
A. Hydrochlorothiazide
B. Amlodipine
C. Lisinopril
D. Metoprolol
Correct answer:
C. Lisinopril
RATIONALE:
In patients with chronic kidney disease (eGFR < 60 mL/min) and diabetes,
ACE inhibitors such as Lisinopril are first-line because they are
renoprotective and slow the progression of nephropathy. Thiazides are less
effective with an eGFR < 30, and beta-blockers are not first-line for
uncomplicated hypertension.
Question 2
A 72-year-old female presents with progressive shortness of breath,
orthopnea, and 2+ pitting edema to her knees. An S3 gallop is audible.
Ejection fraction is reported as 35%. Which combination of medications
represents the Guideline-Directed Medical Therapy for this patient's
condition?
A. Furosemide, Digoxin, and Hydralazine
B. Metoprolol succinate, Lisinopril, Spironolactone, and Empagliflozin
C. Carvedilol, Losartan, Amlodipine, and Aspirin
D. Diltiazem, Enalapril, and Isosorbide dinitrate
Correct answer:
B. Metoprolol succinate, Lisinopril, Spironolactone, and Empagliflozin
RATIONALE:
This patient has heart failure with reduced ejection fraction (HFrEF). The
"Core 4" therapy includes a beta-blocker (Metoprolol succinate or
Carvedilol), an ACE inhibitor/ARB/ARNI (Lisinopril), a mineralocorticoid
,receptor antagonist (Spironolactone), and an SGLT2 inhibitor
(Empagliflozin), which is now standard regardless of diabetes status.
Question 3
A 55-year-old male with a history of coronary artery disease and a previous
myocardial infarction is prescribed Atorvastatin 80 mg daily. He asks why the
dose is so high. What is the primary goal of high-intensity statin therapy in
this patient?
A. To reduce LDL cholesterol to less than 100 mg/dL
B. To reduce LDL cholesterol by at least 50% from baseline
C. To increase HDL cholesterol to greater than 60 mg/dL
D. To lower triglycerides to less than 150 mg/dL
Correct answer:
B. To reduce LDL cholesterol by at least 50% from baseline
RATIONALE:
For patients with clinical atherosclerotic cardiovascular disease (secondary
prevention), high-intensity statins (Atorvastatin 40-80 mg or Rosuvastatin
20-40 mg) are indicated to achieve an LDL reduction of at least 50%.
Question 4
A patient presents to the ER with crushing substernal chest pain radiating to
his left jaw. EKG shows ST-segment elevation in leads V1-V4. His BP is
145/90. What is the MOST critical immediate intervention?
A. Administer IV Morphine
B. Administer Nitroglycerin sublingual
C. Activate the cath lab for emergent PCI
D. Administer IV Heparin
Correct answer:
C. Activate the cath lab for emergent PCI
RATIONALE:
ST-elevation myocardial infarction (STEMI) is a medical emergency. The gold
standard treatment is emergent percutaneous coronary intervention (PCI).
Time is muscle—reperfusion must occur as rapidly as possible to minimize
, myocardial damage. Morphine, nitroglycerin, and heparin are adjunctive
therapies but do not replace urgent reperfusion.
Question 5
A 52-year-old male presents for a routine check-up. His blood pressure is
144/92 mmHg today and was 142/90 mmHg at his last visit. According to
ACC/AHA guidelines, how is this classified?
A. Stage 2 Hypertension
B. Stage 1 Hypertension
C. Elevated blood pressure
D. Hypertensive crisis
Correct answer:
A. Stage 2 Hypertension
RATIONALE:
Stage 2 hypertension is defined as a systolic pressure of at least 140 mmHg
or a diastolic pressure of at least 90 mmHg on two or more occasions. This
patient's readings meet both criteria.
Question 6
Which of the following is the preferred initial diagnostic test for a patient
suspected of having Chronic Obstructive Pulmonary Disease (COPD)?
A. Chest X-ray
B. Spirometry
C. Arterial Blood Gas
D. Peak Flow Meter
Correct answer:
B. Spirometry
RATIONALE:
Spirometry is the gold standard for diagnosing COPD, requiring a post-
bronchodilator FEV1/FVC ratio of less than 0.70 to confirm persistent airflow
limitation. Chest X-ray may show hyperinflation but is not diagnostic.
QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM
UPDATE
CORE DOMAINS
1. Cardiovascular Disorders and Hypertension
2. Respiratory Disorders and Pulmonary Function
3. Endocrine Disorders and Diabetes Management
4. Renal and Genitourinary Disorders
5. Hematology and Oncology
6. Neurological and Musculoskeletal Disorders
7. Gastrointestinal and Hepatic Disorders
8. Pharmacology and Clinical Decision-Making
9. Pediatric and Geriatric Primary Care
10. Legal, Ethical, and Professional Practice
INTRODUCTION
The NR 603 CEA Midterm Exam assesses the knowledge and clinical
reasoning skills required for advanced practice nursing students to diagnose
and manage complex health conditions across the lifespan. The examination
covers cardiovascular, respiratory, endocrine, renal, hematologic,
neurological, gastrointestinal, and musculoskeletal disorders, with emphasis
on evidence-based pharmacologic management and diagnostic decision-
making. The multiple-choice and scenario-based structure emphasizes real-
world application, clinical judgment, and safe prescribing practices. This
assessment prepares candidates for the responsibilities of advanced clinical
diagnosis and comprehensive patient management in primary care settings.
SECTION ONE: QUESTIONS 1–100
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes
,presents for a routine visit. His blood pressure is 142/88 mmHg. His labs
show a serum creatinine of 1.6 mg/dL (eGFR 45 mL/min). What is the BEST
initial antihypertensive agent to add to his current regimen of Metformin and
Aspirin?
A. Hydrochlorothiazide
B. Amlodipine
C. Lisinopril
D. Metoprolol
Correct answer:
C. Lisinopril
RATIONALE:
In patients with chronic kidney disease (eGFR < 60 mL/min) and diabetes,
ACE inhibitors such as Lisinopril are first-line because they are
renoprotective and slow the progression of nephropathy. Thiazides are less
effective with an eGFR < 30, and beta-blockers are not first-line for
uncomplicated hypertension.
Question 2
A 72-year-old female presents with progressive shortness of breath,
orthopnea, and 2+ pitting edema to her knees. An S3 gallop is audible.
Ejection fraction is reported as 35%. Which combination of medications
represents the Guideline-Directed Medical Therapy for this patient's
condition?
A. Furosemide, Digoxin, and Hydralazine
B. Metoprolol succinate, Lisinopril, Spironolactone, and Empagliflozin
C. Carvedilol, Losartan, Amlodipine, and Aspirin
D. Diltiazem, Enalapril, and Isosorbide dinitrate
Correct answer:
B. Metoprolol succinate, Lisinopril, Spironolactone, and Empagliflozin
RATIONALE:
This patient has heart failure with reduced ejection fraction (HFrEF). The
"Core 4" therapy includes a beta-blocker (Metoprolol succinate or
Carvedilol), an ACE inhibitor/ARB/ARNI (Lisinopril), a mineralocorticoid
,receptor antagonist (Spironolactone), and an SGLT2 inhibitor
(Empagliflozin), which is now standard regardless of diabetes status.
Question 3
A 55-year-old male with a history of coronary artery disease and a previous
myocardial infarction is prescribed Atorvastatin 80 mg daily. He asks why the
dose is so high. What is the primary goal of high-intensity statin therapy in
this patient?
A. To reduce LDL cholesterol to less than 100 mg/dL
B. To reduce LDL cholesterol by at least 50% from baseline
C. To increase HDL cholesterol to greater than 60 mg/dL
D. To lower triglycerides to less than 150 mg/dL
Correct answer:
B. To reduce LDL cholesterol by at least 50% from baseline
RATIONALE:
For patients with clinical atherosclerotic cardiovascular disease (secondary
prevention), high-intensity statins (Atorvastatin 40-80 mg or Rosuvastatin
20-40 mg) are indicated to achieve an LDL reduction of at least 50%.
Question 4
A patient presents to the ER with crushing substernal chest pain radiating to
his left jaw. EKG shows ST-segment elevation in leads V1-V4. His BP is
145/90. What is the MOST critical immediate intervention?
A. Administer IV Morphine
B. Administer Nitroglycerin sublingual
C. Activate the cath lab for emergent PCI
D. Administer IV Heparin
Correct answer:
C. Activate the cath lab for emergent PCI
RATIONALE:
ST-elevation myocardial infarction (STEMI) is a medical emergency. The gold
standard treatment is emergent percutaneous coronary intervention (PCI).
Time is muscle—reperfusion must occur as rapidly as possible to minimize
, myocardial damage. Morphine, nitroglycerin, and heparin are adjunctive
therapies but do not replace urgent reperfusion.
Question 5
A 52-year-old male presents for a routine check-up. His blood pressure is
144/92 mmHg today and was 142/90 mmHg at his last visit. According to
ACC/AHA guidelines, how is this classified?
A. Stage 2 Hypertension
B. Stage 1 Hypertension
C. Elevated blood pressure
D. Hypertensive crisis
Correct answer:
A. Stage 2 Hypertension
RATIONALE:
Stage 2 hypertension is defined as a systolic pressure of at least 140 mmHg
or a diastolic pressure of at least 90 mmHg on two or more occasions. This
patient's readings meet both criteria.
Question 6
Which of the following is the preferred initial diagnostic test for a patient
suspected of having Chronic Obstructive Pulmonary Disease (COPD)?
A. Chest X-ray
B. Spirometry
C. Arterial Blood Gas
D. Peak Flow Meter
Correct answer:
B. Spirometry
RATIONALE:
Spirometry is the gold standard for diagnosing COPD, requiring a post-
bronchodilator FEV1/FVC ratio of less than 0.70 to confirm persistent airflow
limitation. Chest X-ray may show hyperinflation but is not diagnostic.
