NR 668 CEA Final 2026/2027 /instant pdf Exam with correct
answers and rationales A+ Graded
Question 1
A 67-year-old man presents with sudden onset chest pressure radiating to his left arm,
diaphoresis, and nausea that began 30 minutes ago. What is the nurse practitioner's priority
action?
A. Prescribe an antacid.
B. Activate emergency evaluation for acute coronary syndrome.
C. Schedule an outpatient stress test.
D. Recommend rest and fluids.
Correct Answer: B. Activate emergency evaluation for acute coronary syndrome.
Rationale: Acute chest pain with classic ischemic symptoms requires immediate emergency
evaluation to reduce myocardial damage and improve outcomes.
Question 2
A patient with type 2 diabetes has an A1C of 9.4% despite adherence to metformin therapy.
What is the most appropriate next step?
A. Stop all diabetes medications.
B. Reassess lifestyle factors and consider adding another evidence-based glucose-lowering
medication.
C. Continue the same regimen indefinitely.
D. Begin antibiotics.
Correct Answer: B. Reassess lifestyle factors and consider adding another evidence-based
glucose-lowering medication.
,Rationale: Persistent hyperglycemia despite therapy typically requires treatment intensification
based on current guidelines and individual patient factors.
Question 3
A patient presents with unilateral facial weakness involving the forehead and inability to close
one eye. Which diagnosis is most likely?
A. Bell palsy
B. Ischemic stroke
C. Migraine
D. Temporal arteritis
Correct Answer: A. Bell palsy.
Rationale: Bell palsy affects the entire ipsilateral face, including the forehead, due to peripheral
facial nerve involvement.
Question 4
A 25-year-old woman reports dysuria, urinary urgency, and urinary frequency without fever or
flank pain. Which diagnosis is most likely?
A. Acute uncomplicated cystitis
B. Acute pyelonephritis
C. Renal calculi
D. Interstitial nephritis
Correct Answer: A. Acute uncomplicated cystitis.
Rationale: Lower urinary tract symptoms without systemic findings are most consistent with
uncomplicated cystitis.
, Question 5
Which laboratory pattern is most consistent with primary hypothyroidism?
A. Elevated TSH and low free T4
B. Low TSH and elevated free T4
C. Low TSH and low T4
D. Elevated TSH and elevated T4
Correct Answer: A. Elevated TSH and low free T4.
Rationale: Reduced thyroid hormone production stimulates increased pituitary TSH secretion.
Question 6
A patient with COPD presents with worsening dyspnea, increased sputum production, and
purulent sputum. What is the most likely diagnosis?
A. Acute COPD exacerbation
B. Stable COPD
C. Allergic rhinitis
D. Pulmonary fibrosis
Correct Answer: A. Acute COPD exacerbation.
Rationale: Increased dyspnea and changes in sputum characterize an acute exacerbation.
Question 7
Which physical examination finding is most consistent with left-sided heart failure?
A. Bibasilar crackles
B. Enlarged liver
answers and rationales A+ Graded
Question 1
A 67-year-old man presents with sudden onset chest pressure radiating to his left arm,
diaphoresis, and nausea that began 30 minutes ago. What is the nurse practitioner's priority
action?
A. Prescribe an antacid.
B. Activate emergency evaluation for acute coronary syndrome.
C. Schedule an outpatient stress test.
D. Recommend rest and fluids.
Correct Answer: B. Activate emergency evaluation for acute coronary syndrome.
Rationale: Acute chest pain with classic ischemic symptoms requires immediate emergency
evaluation to reduce myocardial damage and improve outcomes.
Question 2
A patient with type 2 diabetes has an A1C of 9.4% despite adherence to metformin therapy.
What is the most appropriate next step?
A. Stop all diabetes medications.
B. Reassess lifestyle factors and consider adding another evidence-based glucose-lowering
medication.
C. Continue the same regimen indefinitely.
D. Begin antibiotics.
Correct Answer: B. Reassess lifestyle factors and consider adding another evidence-based
glucose-lowering medication.
,Rationale: Persistent hyperglycemia despite therapy typically requires treatment intensification
based on current guidelines and individual patient factors.
Question 3
A patient presents with unilateral facial weakness involving the forehead and inability to close
one eye. Which diagnosis is most likely?
A. Bell palsy
B. Ischemic stroke
C. Migraine
D. Temporal arteritis
Correct Answer: A. Bell palsy.
Rationale: Bell palsy affects the entire ipsilateral face, including the forehead, due to peripheral
facial nerve involvement.
Question 4
A 25-year-old woman reports dysuria, urinary urgency, and urinary frequency without fever or
flank pain. Which diagnosis is most likely?
A. Acute uncomplicated cystitis
B. Acute pyelonephritis
C. Renal calculi
D. Interstitial nephritis
Correct Answer: A. Acute uncomplicated cystitis.
Rationale: Lower urinary tract symptoms without systemic findings are most consistent with
uncomplicated cystitis.
, Question 5
Which laboratory pattern is most consistent with primary hypothyroidism?
A. Elevated TSH and low free T4
B. Low TSH and elevated free T4
C. Low TSH and low T4
D. Elevated TSH and elevated T4
Correct Answer: A. Elevated TSH and low free T4.
Rationale: Reduced thyroid hormone production stimulates increased pituitary TSH secretion.
Question 6
A patient with COPD presents with worsening dyspnea, increased sputum production, and
purulent sputum. What is the most likely diagnosis?
A. Acute COPD exacerbation
B. Stable COPD
C. Allergic rhinitis
D. Pulmonary fibrosis
Correct Answer: A. Acute COPD exacerbation.
Rationale: Increased dyspnea and changes in sputum characterize an acute exacerbation.
Question 7
Which physical examination finding is most consistent with left-sided heart failure?
A. Bibasilar crackles
B. Enlarged liver
