NR 603 CEA Midterm Exam (2026) | Chamberlain Advanced Clinical
Diagnosis
1. A 55-year-old male with a history of COPD presents with increased shortness
of breath and productive cough. Spirometry shows an FEV1/FVC ratio of 0.62.
Which of the following classifications of COPD severity does he fall into if his
FEV1 is 65% of predicted?
A. GOLD 1: Mild
B. GOLD 2: Moderate
C. GOLD 3: Severe
D. GOLD 4: Very Severe
Answer: B
Rationale: According to GOLD criteria, an FEV1/FVC < 0.70 confirms airflow limitation. An
FEV1 between 50% and 79% predicted indicates Moderate (GOLD 2) severity.
2. Which of the following is the first-line antihypertensive medication for a non-
African American patient with no chronic kidney disease according to JNC 8
guidelines?
A. Thiazide-type diuretic
B. Loop diuretic
C. Beta-blocker
D. Alpha-blocker
Answer: A
Rationale: For non-African American patients without CKD, first-line options include
Thiazide diuretics, Calcium Channel Blockers, ACE inhibitors, or ARBs.
,3. A patient with Type 2 Diabetes is taking Metformin 1000mg BID. Their recent
labs show an eGFR of 28 mL/min/1.73m². What is the appropriate next step?
A. Continue current dose
B. Reduce dose to 500mg BID
C. Discontinue Metformin
D. Add a Sulfonylurea
Answer: C
Rationale: Metformin is contraindicated when the eGFR falls below 30 mL/min/1.73m²
due to the increased risk of lactic acidosis.
4. Which physical exam finding is most suggestive of Grave’s Disease?
A. Pretibial myxedema
B. Delayed relaxation of deep tendon reflexes
C. Bradycardia
D. Puffy face and periorbital edema
Answer: A
Rationale: Pretibial myxedema and exophthalmos are specific signs of Grave’s Disease
(hyperthyroidism), whereas the others are associated with hypothyroidism.
5. When titrating Levothyroxine for a 70-year-old patient with newly diagnosed
hypothyroidism and a history of CAD, the starting dose should be:
A. 1.6 mcg/kg/day
B. 75 mcg daily
C. 12.5 to 25 mcg daily
D. 100 mcg daily
Answer: C
Rationale: In elderly patients or those with cardiac disease, ‘start low and go slow’ with
12.5-25 mcg to avoid precipitating myocardial ischemia.
, 6. A patient presents with symptoms of asthma occurring 3 times per week,
with nighttime awakenings 3 times per month. How would you classify this
asthma severity?
A. Intermittent
B. Moderate Persistent
C. Mild Persistent
D. Severe Persistent
Answer: C
Rationale: Mild persistent asthma is defined as symptoms >2 days/week but not daily, and
nighttime awakenings 3-4 times/month.
7. Which medication is considered the ‘gold standard’ for the long-term
management of chronic gout by lowering serum urate levels?
A. Allopurinol
B. Indomethacin
C. Colchicine
D. Prednisone
Answer: A
Rationale: Allopurinol is a xanthine oxidase inhibitor used for urate-lowering therapy in
chronic gout management. Colchicine and Indomethacin are for acute flares.
8. In the laboratory evaluation of iron deficiency anemia, which of the following
results is expected?
A. Increased Ferritin
B. Decreased RDW
C. Increased MCV
D. Increased TIBC
Answer: D
Diagnosis
1. A 55-year-old male with a history of COPD presents with increased shortness
of breath and productive cough. Spirometry shows an FEV1/FVC ratio of 0.62.
Which of the following classifications of COPD severity does he fall into if his
FEV1 is 65% of predicted?
A. GOLD 1: Mild
B. GOLD 2: Moderate
C. GOLD 3: Severe
D. GOLD 4: Very Severe
Answer: B
Rationale: According to GOLD criteria, an FEV1/FVC < 0.70 confirms airflow limitation. An
FEV1 between 50% and 79% predicted indicates Moderate (GOLD 2) severity.
2. Which of the following is the first-line antihypertensive medication for a non-
African American patient with no chronic kidney disease according to JNC 8
guidelines?
A. Thiazide-type diuretic
B. Loop diuretic
C. Beta-blocker
D. Alpha-blocker
Answer: A
Rationale: For non-African American patients without CKD, first-line options include
Thiazide diuretics, Calcium Channel Blockers, ACE inhibitors, or ARBs.
,3. A patient with Type 2 Diabetes is taking Metformin 1000mg BID. Their recent
labs show an eGFR of 28 mL/min/1.73m². What is the appropriate next step?
A. Continue current dose
B. Reduce dose to 500mg BID
C. Discontinue Metformin
D. Add a Sulfonylurea
Answer: C
Rationale: Metformin is contraindicated when the eGFR falls below 30 mL/min/1.73m²
due to the increased risk of lactic acidosis.
4. Which physical exam finding is most suggestive of Grave’s Disease?
A. Pretibial myxedema
B. Delayed relaxation of deep tendon reflexes
C. Bradycardia
D. Puffy face and periorbital edema
Answer: A
Rationale: Pretibial myxedema and exophthalmos are specific signs of Grave’s Disease
(hyperthyroidism), whereas the others are associated with hypothyroidism.
5. When titrating Levothyroxine for a 70-year-old patient with newly diagnosed
hypothyroidism and a history of CAD, the starting dose should be:
A. 1.6 mcg/kg/day
B. 75 mcg daily
C. 12.5 to 25 mcg daily
D. 100 mcg daily
Answer: C
Rationale: In elderly patients or those with cardiac disease, ‘start low and go slow’ with
12.5-25 mcg to avoid precipitating myocardial ischemia.
, 6. A patient presents with symptoms of asthma occurring 3 times per week,
with nighttime awakenings 3 times per month. How would you classify this
asthma severity?
A. Intermittent
B. Moderate Persistent
C. Mild Persistent
D. Severe Persistent
Answer: C
Rationale: Mild persistent asthma is defined as symptoms >2 days/week but not daily, and
nighttime awakenings 3-4 times/month.
7. Which medication is considered the ‘gold standard’ for the long-term
management of chronic gout by lowering serum urate levels?
A. Allopurinol
B. Indomethacin
C. Colchicine
D. Prednisone
Answer: A
Rationale: Allopurinol is a xanthine oxidase inhibitor used for urate-lowering therapy in
chronic gout management. Colchicine and Indomethacin are for acute flares.
8. In the laboratory evaluation of iron deficiency anemia, which of the following
results is expected?
A. Increased Ferritin
B. Decreased RDW
C. Increased MCV
D. Increased TIBC
Answer: D
