CEA Prep: Full Practice Exam Actual
Exam Questions with Verified Answers
2025/2026 PREP
A 33-year-old woman presents with irregular menstrual cycles, hirsutism, and
obesity. Laboratory tests reveal elevated serum testosterone and LH ratio > 2:1.
What is the most appropriate initial treatment? - ANSWER Oral
contraceptives
Rationale: These are classic symptoms of polycystic ovarian syndrome and the
patient should be treated with oral contraceptives to help stabilize their estrogen
and progesterone. Additionally, they may be managed on metformin and/or
spironolactone for their PCOS.
Oral contraceptive pills (OCPs) are often the first pharmacological treatment for
polycystic ovary syndrome (PCOS) because they help manage in several ways:
Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods
lighter and more regular. This is important because irregular ovulation can lead to
endometrial hyperplasia, which is a buildup of uterine tissue that can increase the
risk of uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex
hormone-binding globulin (SHBG), which binds androgens. This can help reduce
symptoms like acne, hirsutism (unwanted body and facial hair), and androgenic
alopecia (male pattern baldness).
Endometrium protection: OCPs can protect the endometrium by ensuring regular
ovulation
A 50-year-old woman with hypertension and diabetes comes in for a routine
check-up. What screening test should be regularly performed to monitor for early
,signs of diabetic nephropathy? - ANSWER Urine dipstick for
protein
Rationale: The most sensitive indicator of diabetic nephropathy would be the
evidence of small proteins in the urine (proteinuria) as found on urinalysis. The
other options might describe macro-organ function (such as BUN/Creat from a
BMP, a renal biopsy which is not indicated for routine diabetic nephropathy
testing, and a Abd CT, which is more akin to evaluation of less subtle findings),
but at the functional level of the nephron, namely the glomerulus, evidence of
glucose-related damage is easily identified with proteinuria from a UA.
Which of the following is at highest risk for DMII? - ANSWER
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 a elderly adult patient with a BMI of 20 needing levothryoxine -
ANSWER 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? - 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.
Exam Questions with Verified Answers
2025/2026 PREP
A 33-year-old woman presents with irregular menstrual cycles, hirsutism, and
obesity. Laboratory tests reveal elevated serum testosterone and LH ratio > 2:1.
What is the most appropriate initial treatment? - ANSWER Oral
contraceptives
Rationale: These are classic symptoms of polycystic ovarian syndrome and the
patient should be treated with oral contraceptives to help stabilize their estrogen
and progesterone. Additionally, they may be managed on metformin and/or
spironolactone for their PCOS.
Oral contraceptive pills (OCPs) are often the first pharmacological treatment for
polycystic ovary syndrome (PCOS) because they help manage in several ways:
Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods
lighter and more regular. This is important because irregular ovulation can lead to
endometrial hyperplasia, which is a buildup of uterine tissue that can increase the
risk of uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex
hormone-binding globulin (SHBG), which binds androgens. This can help reduce
symptoms like acne, hirsutism (unwanted body and facial hair), and androgenic
alopecia (male pattern baldness).
Endometrium protection: OCPs can protect the endometrium by ensuring regular
ovulation
A 50-year-old woman with hypertension and diabetes comes in for a routine
check-up. What screening test should be regularly performed to monitor for early
,signs of diabetic nephropathy? - ANSWER Urine dipstick for
protein
Rationale: The most sensitive indicator of diabetic nephropathy would be the
evidence of small proteins in the urine (proteinuria) as found on urinalysis. The
other options might describe macro-organ function (such as BUN/Creat from a
BMP, a renal biopsy which is not indicated for routine diabetic nephropathy
testing, and a Abd CT, which is more akin to evaluation of less subtle findings),
but at the functional level of the nephron, namely the glomerulus, evidence of
glucose-related damage is easily identified with proteinuria from a UA.
Which of the following is at highest risk for DMII? - ANSWER
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 a elderly adult patient with a BMI of 20 needing levothryoxine -
ANSWER 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? - 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.
