NR603- CEA Exam Revised Questions with
Correct Answers) – Complete A+ Guide
2026/2027 Update| RATED GRADE A+
A 60-year-old woman with a history of hypertension and diabetes presents with progressive
fatigue and anemia. Her laboratory results show microcytic hypochromic anemia. What is the
most likely diagnosis?
Correct Answer: Iron deficiency anemia
Expert Rationale
Microcytic hypochromic anemia is characterized by small red blood cells with decreased
hemoglobin content. The most common cause is iron deficiency anemia, which can result from
chronic blood loss, inadequate dietary intake, or malabsorption. In a postmenopausal woman,
iron deficiency anemia should prompt evaluation for gastrointestinal bleeding. The NP should
order ferritin, serum iron, and TIBC to confirm the diagnosis and initiate iron supplementation.
DIF: Cognitive Level: Apply (Application) TOP: Hematologic Disorders/Iron Deficiency Anemia
MSC: NCLEX: Physiological Integrity
Treatment for symptomatic aplastic anemia includes what?
Correct Answer: Bone marrow transplant, Prophylactic antibiotics, PRBC/Platelet/WBC
transfusions
Expert Rationale
Aplastic anemia is a bone marrow failure syndrome characterized by pancytopenia. Treatment
options include hematopoietic stem cell transplantation (bone marrow transplant) for eligible
,patients, immunosuppressive therapy (e.g., ATG, cyclosporine), and supportive care with blood
product transfusions (PRBCs, platelets) and prophylactic antibiotics to prevent infections. The
NP should refer patients to hematology for comprehensive management.
DIF: Cognitive Level: Apply (Application) TOP: Aplastic Anemia Management MSC: NCLEX:
Physiological Integrity
A patient presents to the urgent care with SOB, fatigue, headache, and chest pain. Cardiac
work up is negative but CBC reveals a hemoglobin of 6.5. What would indicate a potential iron
deficiency anemia?
Correct Answer: MCV 67, MCHC 29
Expert Rationale
Iron deficiency anemia is characterized by microcytic (low MCV, typically <80 fL) and
hypochromic (low MCHC, typically <32 g/dL) red blood cells. An MCV of 67 and MCHC of 29 are
consistent with iron deficiency anemia. The NP should evaluate the cause of iron deficiency,
including gastrointestinal blood loss, and initiate iron supplementation.
DIF: Cognitive Level: Apply (Application) TOP: Iron Deficiency Anemia/Lab Interpretation MSC:
NCLEX: Physiological Integrity
A 78-year-old male patient reports chronic infections, bruising, fatigue, SOB, and fevers. He
has a history of rectal adenocarcinoma and completed concurrent chemo/radiation earlier
this year. His CBC shows Hgb 7.5, Plt 88, WBC 1.2, ANC 0.8, and peripheral smear shows
dysplasia. What additional work up would you anticipate for this patient?
Correct Answer: Bone marrow biopsy and flow cytometry
Expert Rationale
This patient's pancytopenia with peripheral smear dysplasia in the setting of prior
chemotherapy and radiation is concerning for therapy-related myelodysplastic syndrome (MDS)
or acute leukemia. A bone marrow biopsy with flow cytometry and cytogenetics is essential for
diagnosis and risk stratification. The NP should refer urgently to hematology-oncology.
DIF: Cognitive Level: Analyze (Analysis) TOP: Myelodysplastic Syndrome/Bone Marrow Biopsy
MSC: NCLEX: Physiological Integrity
A patient with a known intrinsic factor autoantibody is at risk for developing which of the
following conditions?
Correct Answer: B12 deficiency and pernicious anemia
,Expert Rationale
Intrinsic factor autoantibodies block the binding of vitamin B12 to intrinsic factor, preventing
absorption in the terminal ileum. This leads to B12 deficiency and pernicious anemia, a
megaloblastic anemia. The NP should check B12 levels and treat with parenteral B12
supplementation.
DIF: Cognitive Level: Understand (Comprehension) TOP: Pernicious Anemia/B12 Deficiency
MSC: NCLEX: Physiological Integrity
A 35-year-old man presents with recurrent episodes of severe pain in his back, chest and
extremities. He has a history of sickle cell disease. What is the most appropriate initial
management during a pain crisis?
Correct Answer: Hospitalization for IV fluids and opioids
Expert Rationale
Sickle cell vaso-occlusive crisis causes severe pain due to ischemia from sickled red blood cells.
Management includes hospitalization, aggressive hydration with IV fluids, and opioid analgesics
for pain control. Additional measures may include oxygen therapy and treating underlying
triggers (e.g., infection). The NP should provide prompt pain management and monitor for
complications.
DIF: Cognitive Level: Apply (Application) TOP: Sickle Cell Disease/Vaso-Occlusive Crisis MSC:
NCLEX: Physiological Integrity
Which of the following medication classes is the foundation of the care of heart failure and
has been shown to reduce mortality?
Correct Answer: Beta blockers
Expert Rationale
Beta-blockers (e.g., carvedilol, metoprolol succinate, bisoprolol) are a cornerstone of heart
failure with reduced ejection fraction (HFrEF) therapy and have been shown to reduce mortality
and hospitalizations. They counteract sympathetic overactivity and improve cardiac function.
The NP should initiate beta-blockers at low doses and titrate to target doses.
DIF: Cognitive Level: Remember (Knowledge) TOP: Heart Failure Pharmacotherapy/Beta
Blockers MSC: NCLEX: Pharmacological and Parenteral Therapies
An adult female with rheumatoid arthritis presents to the office for a follow up. She is
currently taking methotrexate and over the counter ibuprofen. Today she complains of severe
, stomach pain and intense abdominal cramping. After the NP makes appropriate adjustments
to the patient's medication regimen, the patient still complains of abdominal discomfort and
reports dark stools. The practitioner suspects:
Correct Answer: Gastric ulceration
Expert Rationale
NSAIDs (ibuprofen) are a common cause of gastric ulcers due to inhibition of prostaglandin
synthesis. Dark, tarry stools (melena) indicate upper gastrointestinal bleeding. Even after
stopping NSAIDs, a gastric ulcer may persist and cause ongoing symptoms. The NP should
consider proton pump inhibitor therapy and refer for esophagogastroduodenoscopy (EGD).
DIF: Cognitive Level: Apply (Application) TOP: NSAID-Induced Gastric Ulcer MSC: NCLEX:
Physiological Integrity
A 43-year-old male with past medical history significant for GERD, smoking, and obesity
presents to your clinic for worsening GERD symptoms, he has been taking Protonix 40mg daily
with no improvement. He had an EGD done with biopsy. Which findings would diagnose the
patient with Barrett's esophagus?
Correct Answer: Intestinal metaplasia with goblet cells
Expert Rationale
Barrett's esophagus is a precancerous condition where the normal squamous epithelium of the
esophagus is replaced by intestinal metaplasia, characterized by the presence of goblet cells on
biopsy. It is associated with chronic GERD and increases the risk of esophageal adenocarcinoma.
The NP should arrange surveillance endoscopy.
DIF: Cognitive Level: Understand (Comprehension) TOP: Barrett's Esophagus MSC: NCLEX:
Physiological Integrity
Your patient presents with unilateral eye pain after a workplace exposure to a causative
substance. Which of the following techniques is useful to assist in removal of the agent?
Correct Answer: Flushing with Morgan lens
Expert Rationale
A Morgan lens is a specialized ocular irrigation device used to continuously flush the eye with
saline to remove chemical agents, foreign bodies, or other irritants. It is particularly useful for
chemical eye injuries. The NP should initiate immediate irrigation and refer to ophthalmology.
DIF: Cognitive Level: Apply (Application) TOP: Ocular Chemical Injury/Emergency MSC: NCLEX:
Safe and Effective Care Environment
Correct Answers) – Complete A+ Guide
2026/2027 Update| RATED GRADE A+
A 60-year-old woman with a history of hypertension and diabetes presents with progressive
fatigue and anemia. Her laboratory results show microcytic hypochromic anemia. What is the
most likely diagnosis?
Correct Answer: Iron deficiency anemia
Expert Rationale
Microcytic hypochromic anemia is characterized by small red blood cells with decreased
hemoglobin content. The most common cause is iron deficiency anemia, which can result from
chronic blood loss, inadequate dietary intake, or malabsorption. In a postmenopausal woman,
iron deficiency anemia should prompt evaluation for gastrointestinal bleeding. The NP should
order ferritin, serum iron, and TIBC to confirm the diagnosis and initiate iron supplementation.
DIF: Cognitive Level: Apply (Application) TOP: Hematologic Disorders/Iron Deficiency Anemia
MSC: NCLEX: Physiological Integrity
Treatment for symptomatic aplastic anemia includes what?
Correct Answer: Bone marrow transplant, Prophylactic antibiotics, PRBC/Platelet/WBC
transfusions
Expert Rationale
Aplastic anemia is a bone marrow failure syndrome characterized by pancytopenia. Treatment
options include hematopoietic stem cell transplantation (bone marrow transplant) for eligible
,patients, immunosuppressive therapy (e.g., ATG, cyclosporine), and supportive care with blood
product transfusions (PRBCs, platelets) and prophylactic antibiotics to prevent infections. The
NP should refer patients to hematology for comprehensive management.
DIF: Cognitive Level: Apply (Application) TOP: Aplastic Anemia Management MSC: NCLEX:
Physiological Integrity
A patient presents to the urgent care with SOB, fatigue, headache, and chest pain. Cardiac
work up is negative but CBC reveals a hemoglobin of 6.5. What would indicate a potential iron
deficiency anemia?
Correct Answer: MCV 67, MCHC 29
Expert Rationale
Iron deficiency anemia is characterized by microcytic (low MCV, typically <80 fL) and
hypochromic (low MCHC, typically <32 g/dL) red blood cells. An MCV of 67 and MCHC of 29 are
consistent with iron deficiency anemia. The NP should evaluate the cause of iron deficiency,
including gastrointestinal blood loss, and initiate iron supplementation.
DIF: Cognitive Level: Apply (Application) TOP: Iron Deficiency Anemia/Lab Interpretation MSC:
NCLEX: Physiological Integrity
A 78-year-old male patient reports chronic infections, bruising, fatigue, SOB, and fevers. He
has a history of rectal adenocarcinoma and completed concurrent chemo/radiation earlier
this year. His CBC shows Hgb 7.5, Plt 88, WBC 1.2, ANC 0.8, and peripheral smear shows
dysplasia. What additional work up would you anticipate for this patient?
Correct Answer: Bone marrow biopsy and flow cytometry
Expert Rationale
This patient's pancytopenia with peripheral smear dysplasia in the setting of prior
chemotherapy and radiation is concerning for therapy-related myelodysplastic syndrome (MDS)
or acute leukemia. A bone marrow biopsy with flow cytometry and cytogenetics is essential for
diagnosis and risk stratification. The NP should refer urgently to hematology-oncology.
DIF: Cognitive Level: Analyze (Analysis) TOP: Myelodysplastic Syndrome/Bone Marrow Biopsy
MSC: NCLEX: Physiological Integrity
A patient with a known intrinsic factor autoantibody is at risk for developing which of the
following conditions?
Correct Answer: B12 deficiency and pernicious anemia
,Expert Rationale
Intrinsic factor autoantibodies block the binding of vitamin B12 to intrinsic factor, preventing
absorption in the terminal ileum. This leads to B12 deficiency and pernicious anemia, a
megaloblastic anemia. The NP should check B12 levels and treat with parenteral B12
supplementation.
DIF: Cognitive Level: Understand (Comprehension) TOP: Pernicious Anemia/B12 Deficiency
MSC: NCLEX: Physiological Integrity
A 35-year-old man presents with recurrent episodes of severe pain in his back, chest and
extremities. He has a history of sickle cell disease. What is the most appropriate initial
management during a pain crisis?
Correct Answer: Hospitalization for IV fluids and opioids
Expert Rationale
Sickle cell vaso-occlusive crisis causes severe pain due to ischemia from sickled red blood cells.
Management includes hospitalization, aggressive hydration with IV fluids, and opioid analgesics
for pain control. Additional measures may include oxygen therapy and treating underlying
triggers (e.g., infection). The NP should provide prompt pain management and monitor for
complications.
DIF: Cognitive Level: Apply (Application) TOP: Sickle Cell Disease/Vaso-Occlusive Crisis MSC:
NCLEX: Physiological Integrity
Which of the following medication classes is the foundation of the care of heart failure and
has been shown to reduce mortality?
Correct Answer: Beta blockers
Expert Rationale
Beta-blockers (e.g., carvedilol, metoprolol succinate, bisoprolol) are a cornerstone of heart
failure with reduced ejection fraction (HFrEF) therapy and have been shown to reduce mortality
and hospitalizations. They counteract sympathetic overactivity and improve cardiac function.
The NP should initiate beta-blockers at low doses and titrate to target doses.
DIF: Cognitive Level: Remember (Knowledge) TOP: Heart Failure Pharmacotherapy/Beta
Blockers MSC: NCLEX: Pharmacological and Parenteral Therapies
An adult female with rheumatoid arthritis presents to the office for a follow up. She is
currently taking methotrexate and over the counter ibuprofen. Today she complains of severe
, stomach pain and intense abdominal cramping. After the NP makes appropriate adjustments
to the patient's medication regimen, the patient still complains of abdominal discomfort and
reports dark stools. The practitioner suspects:
Correct Answer: Gastric ulceration
Expert Rationale
NSAIDs (ibuprofen) are a common cause of gastric ulcers due to inhibition of prostaglandin
synthesis. Dark, tarry stools (melena) indicate upper gastrointestinal bleeding. Even after
stopping NSAIDs, a gastric ulcer may persist and cause ongoing symptoms. The NP should
consider proton pump inhibitor therapy and refer for esophagogastroduodenoscopy (EGD).
DIF: Cognitive Level: Apply (Application) TOP: NSAID-Induced Gastric Ulcer MSC: NCLEX:
Physiological Integrity
A 43-year-old male with past medical history significant for GERD, smoking, and obesity
presents to your clinic for worsening GERD symptoms, he has been taking Protonix 40mg daily
with no improvement. He had an EGD done with biopsy. Which findings would diagnose the
patient with Barrett's esophagus?
Correct Answer: Intestinal metaplasia with goblet cells
Expert Rationale
Barrett's esophagus is a precancerous condition where the normal squamous epithelium of the
esophagus is replaced by intestinal metaplasia, characterized by the presence of goblet cells on
biopsy. It is associated with chronic GERD and increases the risk of esophageal adenocarcinoma.
The NP should arrange surveillance endoscopy.
DIF: Cognitive Level: Understand (Comprehension) TOP: Barrett's Esophagus MSC: NCLEX:
Physiological Integrity
Your patient presents with unilateral eye pain after a workplace exposure to a causative
substance. Which of the following techniques is useful to assist in removal of the agent?
Correct Answer: Flushing with Morgan lens
Expert Rationale
A Morgan lens is a specialized ocular irrigation device used to continuously flush the eye with
saline to remove chemical agents, foreign bodies, or other irritants. It is particularly useful for
chemical eye injuries. The NP should initiate immediate irrigation and refer to ophthalmology.
DIF: Cognitive Level: Apply (Application) TOP: Ocular Chemical Injury/Emergency MSC: NCLEX:
Safe and Effective Care Environment
