CEA ADVANCED NURSING EOC STUDY GUIDE QUESTIONS
WITH ANSWERS GRADED A+ 2025/2026
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? - 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: - 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 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: - 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? - 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 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? - 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 terminal state of a patient's condition may be appropriate when
unrealistic expectations for their longevity have been voiced. The reasonable choice in
this case is to describe the normalcy of what the patient is experiencing with their loss of
appetite and their terminal state. Testing the patient for depression has really no clinical
bearing on this particular time nor does prescribing methylphenidate. Ordering a UA and
CBC would suggest a concern of a urinary tract infection, and that is not a likely
scenario to describe the patient's existing condition. Support the patient as his advocate
by helping the man enjoy the ice cream he requested.
An elderly patient is being admitted to the skilled nursing facility and is being screened
for the risk of falling. Which of the following information would trigger a complete falls
assessment? - A history of two or more falls in the prior year
Rationale: Of these options, the only two that have any clinical bearing on falls are a
patient who has a demonstrated incident of two or more falls in a year and a patient who
has a altered cognition, such as the patient who is living alone and has mild dementia.
Of the two options, the clear winner is the patient who has already demonstrated to fall
in the last year and they should certainly be a valuated more thoroughly with a complete
fall assessment.
The management of COPD in the elderly is best guided by: - symptomatology.
Rationale: Symptomatology is what guides COPD management since the severity and
frequency of symptoms will warrant changes and additions to medications as
exacerbations present.
Although very useful tool for chronic management and baseline status, spirometry does
not typically dictate therapy, rather diagnose the disease state itself. Our blood gases
may be used for clinically correlate severity during an exacerbation, and radiologic
imaging may showcase severity of stable chronic finding such as somatic, lung tissue or
bullae.
Which of the following is an example of implied consent? - The patient collapses while
having a myocardial infarction in the hospital cafeteria. Bystanders witnessed the
patient clutch his chest, say "my chest", then collapse. They start CPR and initiate the
emergency care system to transport the patient for care in the emergency department.
Rationale: Surgical consent is by definition "informed" when the risks and benefits are
discussed as with the patients undergoing surgery and a chest tube, and 2 person
emergency consent is described with the patient with altered mental status. The
collapsed patient reflects a clear inability to care for oneself and care is being performed
under the assumption of what is implied as what any reasonable person would want.
Which of the following refers to the primary access point of medical care patients are
encouraged to use to aid in providing continuity and reduction of cost per the Affordable
Care Act? - The Medical Home
WITH ANSWERS GRADED A+ 2025/2026
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? - 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: - 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 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: - 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? - 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 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? - 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 terminal state of a patient's condition may be appropriate when
unrealistic expectations for their longevity have been voiced. The reasonable choice in
this case is to describe the normalcy of what the patient is experiencing with their loss of
appetite and their terminal state. Testing the patient for depression has really no clinical
bearing on this particular time nor does prescribing methylphenidate. Ordering a UA and
CBC would suggest a concern of a urinary tract infection, and that is not a likely
scenario to describe the patient's existing condition. Support the patient as his advocate
by helping the man enjoy the ice cream he requested.
An elderly patient is being admitted to the skilled nursing facility and is being screened
for the risk of falling. Which of the following information would trigger a complete falls
assessment? - A history of two or more falls in the prior year
Rationale: Of these options, the only two that have any clinical bearing on falls are a
patient who has a demonstrated incident of two or more falls in a year and a patient who
has a altered cognition, such as the patient who is living alone and has mild dementia.
Of the two options, the clear winner is the patient who has already demonstrated to fall
in the last year and they should certainly be a valuated more thoroughly with a complete
fall assessment.
The management of COPD in the elderly is best guided by: - symptomatology.
Rationale: Symptomatology is what guides COPD management since the severity and
frequency of symptoms will warrant changes and additions to medications as
exacerbations present.
Although very useful tool for chronic management and baseline status, spirometry does
not typically dictate therapy, rather diagnose the disease state itself. Our blood gases
may be used for clinically correlate severity during an exacerbation, and radiologic
imaging may showcase severity of stable chronic finding such as somatic, lung tissue or
bullae.
Which of the following is an example of implied consent? - The patient collapses while
having a myocardial infarction in the hospital cafeteria. Bystanders witnessed the
patient clutch his chest, say "my chest", then collapse. They start CPR and initiate the
emergency care system to transport the patient for care in the emergency department.
Rationale: Surgical consent is by definition "informed" when the risks and benefits are
discussed as with the patients undergoing surgery and a chest tube, and 2 person
emergency consent is described with the patient with altered mental status. The
collapsed patient reflects a clear inability to care for oneself and care is being performed
under the assumption of what is implied as what any reasonable person would want.
Which of the following refers to the primary access point of medical care patients are
encouraged to use to aid in providing continuity and reduction of cost per the Affordable
Care Act? - The Medical Home
