CEA Week 1 Exam questions &
answers 2025/2026
The suggested International Normalized Ratio (INR) range in a patient being treated for atrial
fibrillation is:
1.0-2.0
4.0-5.0
2.0-3.0
3.0-4.0 - correct answer ✔✔ 2.0-3.0
Rationale
Remember that for international normalized ratio, the patient is their own normalization with
an INR of 1.0 as the standard of untreated blood, so with an INR of 2.0, think of the patient as
twice as thin for their blood as their normal. Protime can also be used to evaluate bleeding time
for warfarin patients, but has in general been replaced many years ago by the INR as the
standard measurement, where PTT (partial thromboplastin time) or Anti-Xa are more useful for
evaluating bleeding times related to Heparin therapy.
Nonpharmacologic therapy for Raynaud's disease include:
Use of hot soaks
Avoidance of cold
Isometric exercise
Ginkgo biloba - correct answer ✔✔ Avoidance of cold
Rationale
,Raynaud's disease is a peripheral vascular syndrome triggered by cold exposure which causes
the patient to have extremely pale/white vasoconstricted digits followed by a over-dilated
vasoplegic response causing purplish painful revascularization. Avoidance of cold is the most
effective non-pharmacologic way to mitigate this event from occurring. Pharmacologic therapy
would include the use of medications such as calcium channel blockers.
At a follow up from a hospitalization, an adult patient presents with ankle edema. Which of the
following medications is the most likely cause of the edema?
Metformin
HCTZ
Norvasc
Nebivolol - correct answer ✔✔ Norvasc
Rationale
The most common side effects of calcium channel blockers include constipation and lower
extremity edema. The other options do not have any relationship specifically with edema, in
fact, hydrochlorothiazide specifically reduces edema via diuresis.
An adult patient must maintain an International Normalized Ratio (INR) between 2.0 and 3.0.
The patient goes to a clinic for INR determination, and the result is 1.4. Which of the following
would likely decrease the effects of warfarin (Coumadin)?
Red meat
Grapefruit
Red Wine
Broccoli - correct answer ✔✔ Broccoli
Rationale
,It's important to remember with warfarin (Coumadin) therapy that it is a vitamin K antagonist,
and therefore it can be counteracted by a patient who is eating a dietary intake of vitamin K.
Leafy green vegetables such as broccoli and spinach are notorious for increasing vitamin K
levels, and therefore inhibiting the anticoagulation effect of warfarin. It's also important to
remember that with the direct oral anticoagulants category, vitamin K is not affected, and
therefore no dietary restrictions are required for this class of medications such as apixaban,
rivaroxaban, and edoxaban, which is a distinct benefit over warfarin as noted above. Also, with
warfarin it is important to remember that the effects are based on the free drug, not the protein
bound drug level, so patients who have considerable protein stores will require more warfarin
than those who are emaciated or have low protein levels chronically.
With respect to this particular question, red wine and grapefruit do not have an effect of
lowering the INR, in fact, they will raise it by their unique mechanisms. Grapefruit specifically
causes warfarin levels to rise through the CYP 450 system, and red wine causes the INR to
increase by thinning the blood and and red meat is not likely to have a considerable impact,
although it might have some impact if the protein stores are otherwise low prior to initiating the
red meat in the diet. Broccoli is the only option that has vitamin K and should be an obvious
choice for this question.
A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and
orthopnea. On examination, she has jugular venous distention and bilateral crackles on lung
auscultation. What is the most likely diagnosis?
Congestive heart failure
Pulmonary embolism
Acute myocardial infarction
Chronic obstructive pulmonary disease - correct answer ✔✔ Congestive Heart Failure
Rationale
Of the available options, the most accurate response is congestive heart failure as it is signifying
both a right ventricular back up with jugular venous extension and crackles on lung assault,
which are suggestive of left ventricular back up. it is possible the patient may have an acute
, myocardial infarction that precipitated this, however, a patient has not described that, rather is
only describing dyspnea on exertion and orthopnea, which both speak to a state of fluid
overload. The only appropriate response of these available is congestive heart failure.
An older adult female presents for her annual examination. She has been on antihypertensive
medications for over 20 years, with good control. Laboratory values are within normal ranges.
The nurse practitioner is concerned about the patient's cardiac health risks, due her to weight
and her waist circumference. According to the AHA guidelines, which of the following goals is
expected for this patient?
Physical activity for 60 minutes daily, for a minimum of 6 days a week
Physical activity for 30 minutes daily, for a minimum of 5 days a week
Physical activity for 60 minutes daily, 7 days a week
Physical activity for 30 minutes daily, 7 days a week - correct answer ✔✔ Physical activity for 30
minutes daily, for a minimum of 5 days a week
A 75-year-old patient has just been discharged to a nursing facility following hospitalization for
an exacerbation of chronic heart failure. The patient's condition is classified as stage C, which
involves known structural heart disease with previous or present symptoms of failure. If the
patient is adherent to current clinical guidelines, the nurse practitioner who is visiting can
expect treatment to include which of the following medications?
Hydrochlorothiazide (HCTZ), lisinopril (Zestril), amlodipine (Norvasc)
Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg)
Furosemide (Lasix), prazosin (Minipress), propranolol (Inderal)
Hydrochlorothiazide (HCTZ), metoprolol (Lopressor), losartan (Cozaar) - correct answer ✔✔
Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg)
Rationale
answers 2025/2026
The suggested International Normalized Ratio (INR) range in a patient being treated for atrial
fibrillation is:
1.0-2.0
4.0-5.0
2.0-3.0
3.0-4.0 - correct answer ✔✔ 2.0-3.0
Rationale
Remember that for international normalized ratio, the patient is their own normalization with
an INR of 1.0 as the standard of untreated blood, so with an INR of 2.0, think of the patient as
twice as thin for their blood as their normal. Protime can also be used to evaluate bleeding time
for warfarin patients, but has in general been replaced many years ago by the INR as the
standard measurement, where PTT (partial thromboplastin time) or Anti-Xa are more useful for
evaluating bleeding times related to Heparin therapy.
Nonpharmacologic therapy for Raynaud's disease include:
Use of hot soaks
Avoidance of cold
Isometric exercise
Ginkgo biloba - correct answer ✔✔ Avoidance of cold
Rationale
,Raynaud's disease is a peripheral vascular syndrome triggered by cold exposure which causes
the patient to have extremely pale/white vasoconstricted digits followed by a over-dilated
vasoplegic response causing purplish painful revascularization. Avoidance of cold is the most
effective non-pharmacologic way to mitigate this event from occurring. Pharmacologic therapy
would include the use of medications such as calcium channel blockers.
At a follow up from a hospitalization, an adult patient presents with ankle edema. Which of the
following medications is the most likely cause of the edema?
Metformin
HCTZ
Norvasc
Nebivolol - correct answer ✔✔ Norvasc
Rationale
The most common side effects of calcium channel blockers include constipation and lower
extremity edema. The other options do not have any relationship specifically with edema, in
fact, hydrochlorothiazide specifically reduces edema via diuresis.
An adult patient must maintain an International Normalized Ratio (INR) between 2.0 and 3.0.
The patient goes to a clinic for INR determination, and the result is 1.4. Which of the following
would likely decrease the effects of warfarin (Coumadin)?
Red meat
Grapefruit
Red Wine
Broccoli - correct answer ✔✔ Broccoli
Rationale
,It's important to remember with warfarin (Coumadin) therapy that it is a vitamin K antagonist,
and therefore it can be counteracted by a patient who is eating a dietary intake of vitamin K.
Leafy green vegetables such as broccoli and spinach are notorious for increasing vitamin K
levels, and therefore inhibiting the anticoagulation effect of warfarin. It's also important to
remember that with the direct oral anticoagulants category, vitamin K is not affected, and
therefore no dietary restrictions are required for this class of medications such as apixaban,
rivaroxaban, and edoxaban, which is a distinct benefit over warfarin as noted above. Also, with
warfarin it is important to remember that the effects are based on the free drug, not the protein
bound drug level, so patients who have considerable protein stores will require more warfarin
than those who are emaciated or have low protein levels chronically.
With respect to this particular question, red wine and grapefruit do not have an effect of
lowering the INR, in fact, they will raise it by their unique mechanisms. Grapefruit specifically
causes warfarin levels to rise through the CYP 450 system, and red wine causes the INR to
increase by thinning the blood and and red meat is not likely to have a considerable impact,
although it might have some impact if the protein stores are otherwise low prior to initiating the
red meat in the diet. Broccoli is the only option that has vitamin K and should be an obvious
choice for this question.
A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and
orthopnea. On examination, she has jugular venous distention and bilateral crackles on lung
auscultation. What is the most likely diagnosis?
Congestive heart failure
Pulmonary embolism
Acute myocardial infarction
Chronic obstructive pulmonary disease - correct answer ✔✔ Congestive Heart Failure
Rationale
Of the available options, the most accurate response is congestive heart failure as it is signifying
both a right ventricular back up with jugular venous extension and crackles on lung assault,
which are suggestive of left ventricular back up. it is possible the patient may have an acute
, myocardial infarction that precipitated this, however, a patient has not described that, rather is
only describing dyspnea on exertion and orthopnea, which both speak to a state of fluid
overload. The only appropriate response of these available is congestive heart failure.
An older adult female presents for her annual examination. She has been on antihypertensive
medications for over 20 years, with good control. Laboratory values are within normal ranges.
The nurse practitioner is concerned about the patient's cardiac health risks, due her to weight
and her waist circumference. According to the AHA guidelines, which of the following goals is
expected for this patient?
Physical activity for 60 minutes daily, for a minimum of 6 days a week
Physical activity for 30 minutes daily, for a minimum of 5 days a week
Physical activity for 60 minutes daily, 7 days a week
Physical activity for 30 minutes daily, 7 days a week - correct answer ✔✔ Physical activity for 30
minutes daily, for a minimum of 5 days a week
A 75-year-old patient has just been discharged to a nursing facility following hospitalization for
an exacerbation of chronic heart failure. The patient's condition is classified as stage C, which
involves known structural heart disease with previous or present symptoms of failure. If the
patient is adherent to current clinical guidelines, the nurse practitioner who is visiting can
expect treatment to include which of the following medications?
Hydrochlorothiazide (HCTZ), lisinopril (Zestril), amlodipine (Norvasc)
Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg)
Furosemide (Lasix), prazosin (Minipress), propranolol (Inderal)
Hydrochlorothiazide (HCTZ), metoprolol (Lopressor), losartan (Cozaar) - correct answer ✔✔
Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg)
Rationale
