NR603 CEA COMPLETE SUCCESS BUNDLE 2026/2027
| Clinical Assessment Exam (CEA) + Midterm + Final
Exam Review + Differential Diagnosis + SOAP Notes
+ 300 Verified Practice Questions & Detailed
Rationales | Most Tested Concepts | Comprehensive
Study Guide
Contents
NR603 CEA MASTER EXAM.................................................................................. 1
NR603 MIDTERM REVIEW .............................................................................. 61
NR603 FINAL EXAM REVIEW ..................................................................... 103
DIFFERENTIAL DIAGNOSIS REVIEW.................................................................. 145
MOST TESTED QUESTIONS ........................................................................... 192
SOAP NOTE MASTER GUIDE ............................................................................ 234
NR603 CEA MASTER EXAM
1. A 28-year-old pregnant client at 24 weeks’ gestation presents for routine prenatal labs.
Her hemoglobin is 9.5 g/dL and hematocrit 30%. She reports fatigue but no shortness of
breath. Which is the most likely diagnosis?
A. Iron-deficiency anemia related to increased maternal iron requirements in pregnancy
B. Beta-thalassemia major
C. Sickle cell crisis
D. Aplastic anemia
Correct answer: A. Iron-deficiency anemia related to increased maternal iron
requirements in pregnancy
Rationale: Pregnancy increases maternal blood volume and iron requirements; mild-to-
moderate microcytic anemia in pregnancy is most often iron-deficiency. Beta-
thalassemia major and sickle cell disease present with different histories and usually
, earlier onset; aplastic anemia involves pancytopenia. The client’s fatigue with Hgb 9.5 in
mid-pregnancy is classic for iron-deficiency and requires iron supplementation and
dietary counseling.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
2. A 65-year-old man with chronic heart failure is prescribed furosemide 40 mg daily.
Which lab result requires immediate follow-up before continuing therapy?
A. Serum potassium 4.6 mEq/L
B. Serum potassium 2.8 mEq/L
C. Serum sodium 139 mEq/L
D. Serum calcium 9.2 mg/dL
Correct answer: B. Serum potassium 2.8 mEq/L
Rationale: Loop diuretics like furosemide cause potassium wasting; hypokalemia (K+ <3.5
mEq/L) increases the risk of life-threatening arrhythmias and potentiates digoxin toxicity.
Immediate correction or adjustment is required. Other values are within normal limits
and not immediate concerns.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
3. A 40-year-old woman presents with fatigue, cold intolerance, constipation, and a slow
heart rate. Which lab result would most likely confirm primary hypothyroidism?
A. Low TSH, high free T4
B. High TSH, low free T4
C. Low TSH, low free T4
D. High TSH, high free T4
Correct answer: B. High TSH, low free T4
Rationale: Primary hypothyroidism (thyroid gland failure) leads to low thyroxine (T4) and
a compensatory rise in TSH from the pituitary. Low TSH with low T4 would indicate
secondary (pituitary) hypothyroidism. High T4 with low TSH indicates hyperthyroidism.
Treatment is levothyroxine replacement.
,DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
4. A client with type 1 diabetes is found confused and diaphoretic. Fingerstick glucose is 38
mg/dL. The client is alert but dizzy and able to swallow. What is the best immediate
action?
A. Give 15–20 g of oral glucose (juice or glucose gel) and recheck in 15 minutes
B. Give 10 units of rapid-acting insulin subcutaneously
C. Call the provider and await orders
D. Recheck glucose in 60 minutes
Correct answer: A. Give 15–20 g of oral glucose (juice or glucose gel) and recheck in 15
minutes
Rationale: Symptomatic hypoglycemia requires immediate glucose per the 15-15 rule.
Insulin would worsen hypoglycemia. Waiting and calling the provider would delay
necessary treatment. If the patient were unable to swallow or unconscious, IV dextrose
or IM glucagon would be indicated.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
5. A client with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L
and peaked T waves on ECG. Which action should the nurse anticipate first?
A. Administer IV calcium gluconate to stabilize cardiac membranes
B. Start oral potassium supplements
C. Restrict fluid intake only
D. Schedule an exercise stress test
Correct answer: A. Administer IV calcium gluconate to stabilize cardiac membranes
Rationale: Hyperkalemia with ECG changes is life-threatening; the immediate priority is
to stabilize the myocardium with IV calcium (gluconate), then shift potassium
intracellularly (insulin + dextrose) and remove potassium (diuretics, exchange resins,
dialysis). Oral potassium is contraindicated.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
, OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
6. A client who underwent total thyroidectomy 4 hours ago reports perioral tingling and
numbness in the fingers. On assessment, Chvostek’s sign is positive. What is the most
appropriate immediate nursing action?
A. Prepare to administer IV calcium gluconate and notify the surgeon
B. Encourage deep breathing exercises only
C. Administer oral levothyroxine now
D. Apply ice packs to the neck incision
Correct answer: A. Prepare to administer IV calcium gluconate and notify the surgeon
Rationale: Perioral tingling and positive Chvostek’s sign after thyroidectomy suggest
hypocalcemia from inadvertent parathyroid damage; IV calcium gluconate may be
required urgently to prevent tetany and laryngospasm. Deep breathing and
levothyroxine are not indicated acutely; ice is unrelated.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
7. A client taking warfarin has an INR of 7.0 but no active bleeding. Which action should
the nurse expect?
A. Hold warfarin and administer oral vitamin K per protocol
B. Increase warfarin dose to raise anticoagulation
C. Give protamine sulfate IV immediately
D. Continue current dose and recheck in 72 hours
Correct answer: A. Hold warfarin and administer oral vitamin K per protocol
Rationale: An INR >6 typically requires reversal with vitamin K if no bleeding. Protamine
sulfate reverses heparin, not warfarin. Increasing or continuing the dose would worsen
over-anticoagulation and bleeding risk.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
8. A postpartum client 3 hours after vaginal delivery has a fundus that is boggy and
displaced to the right; lochia is moderate. What should the nurse do first?
| Clinical Assessment Exam (CEA) + Midterm + Final
Exam Review + Differential Diagnosis + SOAP Notes
+ 300 Verified Practice Questions & Detailed
Rationales | Most Tested Concepts | Comprehensive
Study Guide
Contents
NR603 CEA MASTER EXAM.................................................................................. 1
NR603 MIDTERM REVIEW .............................................................................. 61
NR603 FINAL EXAM REVIEW ..................................................................... 103
DIFFERENTIAL DIAGNOSIS REVIEW.................................................................. 145
MOST TESTED QUESTIONS ........................................................................... 192
SOAP NOTE MASTER GUIDE ............................................................................ 234
NR603 CEA MASTER EXAM
1. A 28-year-old pregnant client at 24 weeks’ gestation presents for routine prenatal labs.
Her hemoglobin is 9.5 g/dL and hematocrit 30%. She reports fatigue but no shortness of
breath. Which is the most likely diagnosis?
A. Iron-deficiency anemia related to increased maternal iron requirements in pregnancy
B. Beta-thalassemia major
C. Sickle cell crisis
D. Aplastic anemia
Correct answer: A. Iron-deficiency anemia related to increased maternal iron
requirements in pregnancy
Rationale: Pregnancy increases maternal blood volume and iron requirements; mild-to-
moderate microcytic anemia in pregnancy is most often iron-deficiency. Beta-
thalassemia major and sickle cell disease present with different histories and usually
, earlier onset; aplastic anemia involves pancytopenia. The client’s fatigue with Hgb 9.5 in
mid-pregnancy is classic for iron-deficiency and requires iron supplementation and
dietary counseling.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
2. A 65-year-old man with chronic heart failure is prescribed furosemide 40 mg daily.
Which lab result requires immediate follow-up before continuing therapy?
A. Serum potassium 4.6 mEq/L
B. Serum potassium 2.8 mEq/L
C. Serum sodium 139 mEq/L
D. Serum calcium 9.2 mg/dL
Correct answer: B. Serum potassium 2.8 mEq/L
Rationale: Loop diuretics like furosemide cause potassium wasting; hypokalemia (K+ <3.5
mEq/L) increases the risk of life-threatening arrhythmias and potentiates digoxin toxicity.
Immediate correction or adjustment is required. Other values are within normal limits
and not immediate concerns.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
3. A 40-year-old woman presents with fatigue, cold intolerance, constipation, and a slow
heart rate. Which lab result would most likely confirm primary hypothyroidism?
A. Low TSH, high free T4
B. High TSH, low free T4
C. Low TSH, low free T4
D. High TSH, high free T4
Correct answer: B. High TSH, low free T4
Rationale: Primary hypothyroidism (thyroid gland failure) leads to low thyroxine (T4) and
a compensatory rise in TSH from the pituitary. Low TSH with low T4 would indicate
secondary (pituitary) hypothyroidism. High T4 with low TSH indicates hyperthyroidism.
Treatment is levothyroxine replacement.
,DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
4. A client with type 1 diabetes is found confused and diaphoretic. Fingerstick glucose is 38
mg/dL. The client is alert but dizzy and able to swallow. What is the best immediate
action?
A. Give 15–20 g of oral glucose (juice or glucose gel) and recheck in 15 minutes
B. Give 10 units of rapid-acting insulin subcutaneously
C. Call the provider and await orders
D. Recheck glucose in 60 minutes
Correct answer: A. Give 15–20 g of oral glucose (juice or glucose gel) and recheck in 15
minutes
Rationale: Symptomatic hypoglycemia requires immediate glucose per the 15-15 rule.
Insulin would worsen hypoglycemia. Waiting and calling the provider would delay
necessary treatment. If the patient were unable to swallow or unconscious, IV dextrose
or IM glucagon would be indicated.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
5. A client with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L
and peaked T waves on ECG. Which action should the nurse anticipate first?
A. Administer IV calcium gluconate to stabilize cardiac membranes
B. Start oral potassium supplements
C. Restrict fluid intake only
D. Schedule an exercise stress test
Correct answer: A. Administer IV calcium gluconate to stabilize cardiac membranes
Rationale: Hyperkalemia with ECG changes is life-threatening; the immediate priority is
to stabilize the myocardium with IV calcium (gluconate), then shift potassium
intracellularly (insulin + dextrose) and remove potassium (diuretics, exchange resins,
dialysis). Oral potassium is contraindicated.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
, OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
6. A client who underwent total thyroidectomy 4 hours ago reports perioral tingling and
numbness in the fingers. On assessment, Chvostek’s sign is positive. What is the most
appropriate immediate nursing action?
A. Prepare to administer IV calcium gluconate and notify the surgeon
B. Encourage deep breathing exercises only
C. Administer oral levothyroxine now
D. Apply ice packs to the neck incision
Correct answer: A. Prepare to administer IV calcium gluconate and notify the surgeon
Rationale: Perioral tingling and positive Chvostek’s sign after thyroidectomy suggest
hypocalcemia from inadvertent parathyroid damage; IV calcium gluconate may be
required urgently to prevent tetany and laryngospasm. Deep breathing and
levothyroxine are not indicated acutely; ice is unrelated.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
7. A client taking warfarin has an INR of 7.0 but no active bleeding. Which action should
the nurse expect?
A. Hold warfarin and administer oral vitamin K per protocol
B. Increase warfarin dose to raise anticoagulation
C. Give protamine sulfate IV immediately
D. Continue current dose and recheck in 72 hours
Correct answer: A. Hold warfarin and administer oral vitamin K per protocol
Rationale: An INR >6 typically requires reversal with vitamin K if no bleeding. Protamine
sulfate reverses heparin, not warfarin. Increasing or continuing the dose would worsen
over-anticoagulation and bleeding risk.
DIF: Knowledge
REF: Nutrition / Iron Deficiency Risk Groups
OBJ: Identify clients at risk for iron deficiency
TOP: Health Promotion and Maintenance
8. A postpartum client 3 hours after vaginal delivery has a fundus that is boggy and
displaced to the right; lochia is moderate. What should the nurse do first?
