NR511 CEA Exam: 200 Comprehensive Practice Questions
EXAM INSTRUCTIONS
• Total Questions: 200 Multiple Choice & Select All That Apply
• Passing Score: 78% (Chamberlain University requirement)
• Time Allowed: 2.5 Hours
• Topics Covered: Clinical Decision-Making (Differential Diagnosis, PQRST,
OLDCARTS), Primary Care Across the Lifespan (Pediatric, Adult, Geriatric),
Common Acute & Chronic Conditions (HTN, DM, CAD, COPD, Asthma, UTI, URI),
Diagnostic Reasoning (Labs, Imaging, EKGs), Evidence-Based Practice, Health
Promotion & Screening, and Pharmacology
Section 1: Clinical Decision-Making & Differential Diagnosis
(Questions 1–30)
1. A 45-year-old male presents with chest pain that is pressure-like, radiating to
the left arm, associated with diaphoresis and nausea. The pain started 30 minutes
ago while shoveling snow. What is the most appropriate initial action?
• A. Obtain a detailed cardiac history
• B. Administer aspirin 324 mg PO
• C. Activate EMS for immediate transport
• D. Perform an EKG in the office
Rationale: This patient has symptoms concerning for acute coronary syndrome (ACS).
The most appropriate initial action is to activate EMS for immediate transport to an
,emergency department. While aspirin and EKG are important, they should not delay
emergency transport. The "golden hour" for myocardial salvage is critical.
2. A 65-year-old female presents with acute onset of severe, tearing chest pain
radiating to the back. Blood pressure is 160/90 in the right arm and 100/60 in the
left arm. What is the most likely diagnosis?
• A. Acute myocardial infarction
• B. Pulmonary embolism
• C. Aortic dissection
• D. Pericarditis
Rationale: Aortic dissection presents with severe, tearing chest pain that radiates to the
back and can cause discrepancies in blood pressure between arms. This clinical picture is
classic for aortic dissection, which is a medical emergency requiring immediate imaging
and surgical consultation.
3. What is the primary purpose of creating a differential diagnosis list?
• A. To list all possible diseases that could explain a patient's symptoms,
ranked from most to least likely
• B. To provide a definitive diagnosis before any testing is done
• C. To satisfy insurance requirements for reimbursement
• D. To document only the most serious condition regardless of likelihood
Rationale: A differential diagnosis list is a systematic method to identify and rank
potential causes of a patient's presenting symptoms. This process ensures
comprehensive clinical reasoning, prevents premature closure, and guides appropriate
diagnostic testing.
4. A 55-year-old male presents with chest pain. Which finding on history most
increases the probability of acute coronary syndrome (ACS)?
• A. Sharp, positional pain reproducible with palpation
, • B. Substernal pressure radiating to the jaw or left arm, precipitated by
exertion
• C. Pain worse with deep inspiration
• D. Pain relieved by leaning forward
Rationale: Classic anginal chest pain is described as substernal pressure or heaviness
that may radiate to the jaw, shoulder, or left arm. It is typically provoked by exertion or
emotional stress and relieved by rest or nitroglycerin. This pattern has the highest
likelihood of ACS compared to other causes of chest pain.
5. Which of the following is a "Red Flag" symptom in a patient presenting with
acute low back pain that requires immediate imaging or referral?
• A. Pain that radiates down one leg
• B. Numbness in the "saddle area" and new-onset urinary incontinence
• C. Pain that improves with rest
• D. History of a minor lifting injury
Rationale: Saddle anesthesia and new-onset urinary incontinence are symptoms of
cauda equina syndrome, a surgical emergency caused by compression of the cauda
equina nerve roots. Immediate MRI and neurosurgical consultation are required to
prevent permanent neurologic damage.
6. According to the SNAPPS model for clinical education, what does the "S" stand
for?
• A. Summarize the history
• B. Summarize the case
• C. State the differential
• D. Support the diagnosis
Rationale: The SNAPPS model is a learner-centered approach to case presentation that
facilitates clinical reasoning. The acronym stands for: Summarize the case, Narrow the
, differential, Analyze the differential, Probe the preceptor, Plan management, and Select
a case-related issue.
7. Diagnostic test characteristics: Sensitivity is defined as:
• A. The ability of a test to correctly identify those WITHOUT the disease (true
negative rate)
• B. The ability of a test to correctly identify those WITH the disease (true
positive rate)
• C. The proportion of positive tests that are true positives (positive predictive
value)
• D. The proportion of negative tests that are true negatives (negative predictive
value)
Rationale: Sensitivity = True Positives / (True Positives + False Negatives). A highly
sensitive test is useful for ruling OUT disease (SnNout: when a test is Sensitive, a
Negative result rules out the disease). Specificity identifies those without disease. PPV
and NPV are predictive values that depend on disease prevalence.
8. A 32-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is 8.5 mIU/L. What is the most appropriate treatment?
• A. Levothyroxine 25-50 mcg daily
• B. Methimazole 10 mg daily
• C. Radioactive iodine ablation
• D. Observation with repeat TSH in 6 months
Rationale: An elevated TSH with clinical symptoms indicates overt hypothyroidism. The
standard of care is levothyroxine replacement therapy, starting with a low dose (25-50
mcg daily) and titrating based on TSH response. Methimazole and radioactive iodine are
used for hyperthyroidism.
EXAM INSTRUCTIONS
• Total Questions: 200 Multiple Choice & Select All That Apply
• Passing Score: 78% (Chamberlain University requirement)
• Time Allowed: 2.5 Hours
• Topics Covered: Clinical Decision-Making (Differential Diagnosis, PQRST,
OLDCARTS), Primary Care Across the Lifespan (Pediatric, Adult, Geriatric),
Common Acute & Chronic Conditions (HTN, DM, CAD, COPD, Asthma, UTI, URI),
Diagnostic Reasoning (Labs, Imaging, EKGs), Evidence-Based Practice, Health
Promotion & Screening, and Pharmacology
Section 1: Clinical Decision-Making & Differential Diagnosis
(Questions 1–30)
1. A 45-year-old male presents with chest pain that is pressure-like, radiating to
the left arm, associated with diaphoresis and nausea. The pain started 30 minutes
ago while shoveling snow. What is the most appropriate initial action?
• A. Obtain a detailed cardiac history
• B. Administer aspirin 324 mg PO
• C. Activate EMS for immediate transport
• D. Perform an EKG in the office
Rationale: This patient has symptoms concerning for acute coronary syndrome (ACS).
The most appropriate initial action is to activate EMS for immediate transport to an
,emergency department. While aspirin and EKG are important, they should not delay
emergency transport. The "golden hour" for myocardial salvage is critical.
2. A 65-year-old female presents with acute onset of severe, tearing chest pain
radiating to the back. Blood pressure is 160/90 in the right arm and 100/60 in the
left arm. What is the most likely diagnosis?
• A. Acute myocardial infarction
• B. Pulmonary embolism
• C. Aortic dissection
• D. Pericarditis
Rationale: Aortic dissection presents with severe, tearing chest pain that radiates to the
back and can cause discrepancies in blood pressure between arms. This clinical picture is
classic for aortic dissection, which is a medical emergency requiring immediate imaging
and surgical consultation.
3. What is the primary purpose of creating a differential diagnosis list?
• A. To list all possible diseases that could explain a patient's symptoms,
ranked from most to least likely
• B. To provide a definitive diagnosis before any testing is done
• C. To satisfy insurance requirements for reimbursement
• D. To document only the most serious condition regardless of likelihood
Rationale: A differential diagnosis list is a systematic method to identify and rank
potential causes of a patient's presenting symptoms. This process ensures
comprehensive clinical reasoning, prevents premature closure, and guides appropriate
diagnostic testing.
4. A 55-year-old male presents with chest pain. Which finding on history most
increases the probability of acute coronary syndrome (ACS)?
• A. Sharp, positional pain reproducible with palpation
, • B. Substernal pressure radiating to the jaw or left arm, precipitated by
exertion
• C. Pain worse with deep inspiration
• D. Pain relieved by leaning forward
Rationale: Classic anginal chest pain is described as substernal pressure or heaviness
that may radiate to the jaw, shoulder, or left arm. It is typically provoked by exertion or
emotional stress and relieved by rest or nitroglycerin. This pattern has the highest
likelihood of ACS compared to other causes of chest pain.
5. Which of the following is a "Red Flag" symptom in a patient presenting with
acute low back pain that requires immediate imaging or referral?
• A. Pain that radiates down one leg
• B. Numbness in the "saddle area" and new-onset urinary incontinence
• C. Pain that improves with rest
• D. History of a minor lifting injury
Rationale: Saddle anesthesia and new-onset urinary incontinence are symptoms of
cauda equina syndrome, a surgical emergency caused by compression of the cauda
equina nerve roots. Immediate MRI and neurosurgical consultation are required to
prevent permanent neurologic damage.
6. According to the SNAPPS model for clinical education, what does the "S" stand
for?
• A. Summarize the history
• B. Summarize the case
• C. State the differential
• D. Support the diagnosis
Rationale: The SNAPPS model is a learner-centered approach to case presentation that
facilitates clinical reasoning. The acronym stands for: Summarize the case, Narrow the
, differential, Analyze the differential, Probe the preceptor, Plan management, and Select
a case-related issue.
7. Diagnostic test characteristics: Sensitivity is defined as:
• A. The ability of a test to correctly identify those WITHOUT the disease (true
negative rate)
• B. The ability of a test to correctly identify those WITH the disease (true
positive rate)
• C. The proportion of positive tests that are true positives (positive predictive
value)
• D. The proportion of negative tests that are true negatives (negative predictive
value)
Rationale: Sensitivity = True Positives / (True Positives + False Negatives). A highly
sensitive test is useful for ruling OUT disease (SnNout: when a test is Sensitive, a
Negative result rules out the disease). Specificity identifies those without disease. PPV
and NPV are predictive values that depend on disease prevalence.
8. A 32-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is 8.5 mIU/L. What is the most appropriate treatment?
• A. Levothyroxine 25-50 mcg daily
• B. Methimazole 10 mg daily
• C. Radioactive iodine ablation
• D. Observation with repeat TSH in 6 months
Rationale: An elevated TSH with clinical symptoms indicates overt hypothyroidism. The
standard of care is levothyroxine replacement therapy, starting with a low dose (25-50
mcg daily) and titrating based on TSH response. Methimazole and radioactive iodine are
used for hyperthyroidism.
