CEA PREP ACTUAL FINALS EXAMS QUESTIONS AND
ANSWERS SET A+
✔✔A frail elderly patient presents with constipation. Which of the following normal
physiologic changes seen with aging is the most likely cause?
*Increased bile secretion
*Decreased bowel muscle tone
*Increased absorption of calcium
*Decreased pancreatic secretions - ✔✔Decreased bowel muscle tone
Rationale: The frail, elderly patient will typically have their GI track decrease bile
secretion and decrease absorption of calcium. A decrease in pancreas secretions is not
related to presence of constipation, however, decreased bowel muscle tone certainly
does reduce the GI motility and increase the transit time, thereby increasing the drying
of stool in the large intestine which leads to constipation
✔✔Your irate patient on involuntary hold due to risk of harm to themself or others says
they are going to "kill you when you leave work after they get discharged". This
statement is an example of which of the following?
*None of these options
*Verbal battery
*Verbal assault
*Emotional battery - ✔✔Verbal assault
Rationale: Assault refers to the risk of a harm to others, whereas battery refers to the
actual act of that harm.
✔✔The patient you just saw in urgent care is being admitted for strep viridans
endocarditis. Which of the following does the prudent nurse practitioner considered the
most possible source of the illness?
*Perioral abscess seen on maxillofacial bone CT scan this admission
*Recent viral infection diagnosed as a common cold
*Recent infestation of scabies on the webbings of feet
*New IV catheter placed today in the operating room - ✔✔Perioral abscess seen on
maxillofacial bone CT scan this admission
,Rationale: Gumline infections are remarkably easy to introduce pathogens into the
bloodstream to attack valves, cause sepsis, etc. Strep viridans is a very common oral
pathogen. Scabies do not carry a risk of bacterial sepsis, nor does a recent low-grade
common cold virus. Any invasive lines should be considered at risk, but the IV catheter
placement is both unlikely as a source and does not fit the timing after already being
admitted.
✔✔Which of the following bacteria are more commonly associated with pharyngitis?
*Proteus
*Enterococcus
*Group A Streptococcus
*Streptomyces - ✔✔Group A Streptococcus
Rationale: Group A Streptococcus represents the most common bacteria found in
pharyngitis. Enterococcus are found in the intestines. Streptomyces species are
commonly associated with immunocompromised patients and lung abscess. Proteus is
commonly associated with urinary tract infection in men.
✔✔Which of the following is not one of the four Ds of epiglottitis?
*Dysphagia
*Dystonia
*Dysphonia
*Drooling - ✔✔Drooling
✔✔Initial management for a patient with dry eyes should include:
*Cyclosporine ophthalmic emulsion
*Preservative-free lubricative eye drops
*Referring to ophthalmology
*Erythromycin 0.5% ointment - ✔✔Preservative-free lubricative eye drops
Rationale: Preservative-free lubricative eye drops are the lest invasive and most likely to
provide immediate relief. If this is unsuccessful, it would be considered reasonable to
refer the patient to ophthalmology.
✔✔Workup to rule out cardiac source of an embolic stroke should include which of the
following exams?
*12 Lead EKG
*CT chest without contrast
*CT facial bones
*Transthoracic or Transesophageal echocardiogram - ✔✔Transthoracic or
Transesophageal echocardiogram
Rationale: Patients with acute embolic strokes should have a transthoracic
echocardiogram to evaluate for any presence of valvular dysfunction. With presence of
pharyngitis, the risk of bacterial endocarditis must be ruled out, and valvular vegetation
as a cause must be evaluated with an echocardiogram. If any findings are noted, a
transesophageal echocardiogram may be performed to better identify the vegetation.
,✔✔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. Which of the
following indices would indicate a potential iron deficiency anemia?
*MCV 72, MCHC 38
*MCV 112, MCHC 40
*MCV 95, MCHC 34
*MCV 67, MCHC 29 - ✔✔MCV 67, MCHC 29
Rationale: Iron deficiency anemia (IDA) is identified as a microcytic, hypochromic
anemia. Normal MCV is 80-100 and normal MCHC is 33-37 therefore MCV less than 80
and MCHC less than 33 is considered microcytic hypochromic and indicative
✔✔A 49 y.o. M patient, who works in an automotive battery factory, presents to urgent
care with three-day onset of abdominal pain, constipation, anorexia, muscle aches,
headache, and excessive fatigue. Considering the patient's occupation, the provider
should include which of the following labs in his work-up?
*C. difficile stool culture
*Hemoglobin A1C
*Vitamin B12/Folate
*Blood lead level - ✔✔Blood lead level
Rationale: Factories which produce batteries have a higher risk of workplace exposure
to lead. This patient's symptoms are consistent with an elevated blood lead level and,
potentially, lead poisoning.
✔✔A patient is taking warfarin, 4 mg daily for atrial fibrillation. The patient's current
International Normalized Ratio (INR) is 5.5 mg/dL. The nurse practitioner would:
*Answer hold the warfarin for 1 day and then recheck in two days.
*decrease the warfarin to 3 mg daily.
*increase the warfarin to 5 mg daily.
*hold the warfarin for 4 days and then recheck the INR. - ✔✔Answer hold the warfarin
for 1 day and then recheck in two days.
Rationale: As warfarin has a long half life, it typically takes several days to see
meaningful change in levels of dose change. The INR of 5.5 is supratherapeutic and
must be reduced for the risk of bleeding. Of these options, the only one that offers a
reduction/cessation and and a recheck of the level is to hold the warfarin for one day
and recheck the INR in 2 days.
✔✔Your patient presents with painless lymph node swelling, weight loss, night sweats,
and asks what is wrong with him. Which of the following represents a most appropriate
intervention to confirm a diagnosis of lymphoma?
*Order a CBC and TSH
*Consult pulmonology
*Order a core needle biopsy
*Examine the patient - ✔✔Order a core needle biopsy
Rationale: This question is asking for an intervention. Although examining the patient is
useful, it is an evaluation tool, as is ordering routine lab work. Pulmonology is not an
, appropriate consultation for this patient; rather, hematology or oncology would be best
suited to evaluate and work up this patient. A diagnostic needle biopsy is the most
definitive intervention to gain a diagnosis for a suspected lymphoma.
✔✔Your patient arrives the urgent care complaining of a swollen throat and vocal
changes. Which of the following statements made by the patient brings an index of
suspicion of angioedema?
*This seems to be getting better already getting out of the cold
*I have been taking my lisinopril for the past week as prescribed
*I have never had this happen before
*I do not take any ibuprofen since it gives me an upset stomach - ✔✔I have been taking
my lisinopril for the past week as prescribed
Rationale: Use of ACE Inhibitors and NSAIDS is a common precipitating factor in
angioedema. The rest do not suggest any relationship to angioedema.
✔✔A 35-year-old woman presents with a new, darkly pigmented lesion on her back that
she noticed a few months ago. The lesion is asymmetrical, has irregular borders, and
varies in color. What is the most appropriate next step in management?
*Perform a shave biopsy
*Reassure the patient and advise regular monitoring
*Perform an excisional biopsy
*Perform a punch biopsy - ✔✔Perform an excisional biopsy
Rationale: When a healthcare provider needs to definitively diagnose or rule out a
suspected condition, such as a skin lesion or tumor, an excisional biopsy allows for the
entire lesion or a significant portion of it to be removed and examined under a
microscope by a pathologist.
✔✔An adult daycare worker presents with severe itching on the arms and around the
arms and wrists. The patient's skin is mildly excoriated from scratching. Microscopic
examination of a skin reveals scabies. The treatment of choice for the patient would be?
*triamcinolone
*permethrin
*ketocanozale
*cetirizine - ✔✔permethrin
Rationale: Permethrin is commonly prescribed for the treatment of scabies, a
contagious skin infestation caused by the Sarcoptes scabiei mite. Permethrin is a
synthetic pyrethroid insecticide that works by paralyzing and killing the mites and their
eggs upon contact. It disrupts the nervous system of the mites, leading to their death.
✔✔An adult photography developer presents with two small vesicles on his right middle
finger, proximal to the nail bed. He says he wears gloves when he works with
photography chemicals. He admits to chewing his fingers, and notes that this is his
fourth episode. Previous cultures have been negative. The MOST likely diagnosis is:
*Herpetic whitlow
*Impetigo
ANSWERS SET A+
✔✔A frail elderly patient presents with constipation. Which of the following normal
physiologic changes seen with aging is the most likely cause?
*Increased bile secretion
*Decreased bowel muscle tone
*Increased absorption of calcium
*Decreased pancreatic secretions - ✔✔Decreased bowel muscle tone
Rationale: The frail, elderly patient will typically have their GI track decrease bile
secretion and decrease absorption of calcium. A decrease in pancreas secretions is not
related to presence of constipation, however, decreased bowel muscle tone certainly
does reduce the GI motility and increase the transit time, thereby increasing the drying
of stool in the large intestine which leads to constipation
✔✔Your irate patient on involuntary hold due to risk of harm to themself or others says
they are going to "kill you when you leave work after they get discharged". This
statement is an example of which of the following?
*None of these options
*Verbal battery
*Verbal assault
*Emotional battery - ✔✔Verbal assault
Rationale: Assault refers to the risk of a harm to others, whereas battery refers to the
actual act of that harm.
✔✔The patient you just saw in urgent care is being admitted for strep viridans
endocarditis. Which of the following does the prudent nurse practitioner considered the
most possible source of the illness?
*Perioral abscess seen on maxillofacial bone CT scan this admission
*Recent viral infection diagnosed as a common cold
*Recent infestation of scabies on the webbings of feet
*New IV catheter placed today in the operating room - ✔✔Perioral abscess seen on
maxillofacial bone CT scan this admission
,Rationale: Gumline infections are remarkably easy to introduce pathogens into the
bloodstream to attack valves, cause sepsis, etc. Strep viridans is a very common oral
pathogen. Scabies do not carry a risk of bacterial sepsis, nor does a recent low-grade
common cold virus. Any invasive lines should be considered at risk, but the IV catheter
placement is both unlikely as a source and does not fit the timing after already being
admitted.
✔✔Which of the following bacteria are more commonly associated with pharyngitis?
*Proteus
*Enterococcus
*Group A Streptococcus
*Streptomyces - ✔✔Group A Streptococcus
Rationale: Group A Streptococcus represents the most common bacteria found in
pharyngitis. Enterococcus are found in the intestines. Streptomyces species are
commonly associated with immunocompromised patients and lung abscess. Proteus is
commonly associated with urinary tract infection in men.
✔✔Which of the following is not one of the four Ds of epiglottitis?
*Dysphagia
*Dystonia
*Dysphonia
*Drooling - ✔✔Drooling
✔✔Initial management for a patient with dry eyes should include:
*Cyclosporine ophthalmic emulsion
*Preservative-free lubricative eye drops
*Referring to ophthalmology
*Erythromycin 0.5% ointment - ✔✔Preservative-free lubricative eye drops
Rationale: Preservative-free lubricative eye drops are the lest invasive and most likely to
provide immediate relief. If this is unsuccessful, it would be considered reasonable to
refer the patient to ophthalmology.
✔✔Workup to rule out cardiac source of an embolic stroke should include which of the
following exams?
*12 Lead EKG
*CT chest without contrast
*CT facial bones
*Transthoracic or Transesophageal echocardiogram - ✔✔Transthoracic or
Transesophageal echocardiogram
Rationale: Patients with acute embolic strokes should have a transthoracic
echocardiogram to evaluate for any presence of valvular dysfunction. With presence of
pharyngitis, the risk of bacterial endocarditis must be ruled out, and valvular vegetation
as a cause must be evaluated with an echocardiogram. If any findings are noted, a
transesophageal echocardiogram may be performed to better identify the vegetation.
,✔✔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. Which of the
following indices would indicate a potential iron deficiency anemia?
*MCV 72, MCHC 38
*MCV 112, MCHC 40
*MCV 95, MCHC 34
*MCV 67, MCHC 29 - ✔✔MCV 67, MCHC 29
Rationale: Iron deficiency anemia (IDA) is identified as a microcytic, hypochromic
anemia. Normal MCV is 80-100 and normal MCHC is 33-37 therefore MCV less than 80
and MCHC less than 33 is considered microcytic hypochromic and indicative
✔✔A 49 y.o. M patient, who works in an automotive battery factory, presents to urgent
care with three-day onset of abdominal pain, constipation, anorexia, muscle aches,
headache, and excessive fatigue. Considering the patient's occupation, the provider
should include which of the following labs in his work-up?
*C. difficile stool culture
*Hemoglobin A1C
*Vitamin B12/Folate
*Blood lead level - ✔✔Blood lead level
Rationale: Factories which produce batteries have a higher risk of workplace exposure
to lead. This patient's symptoms are consistent with an elevated blood lead level and,
potentially, lead poisoning.
✔✔A patient is taking warfarin, 4 mg daily for atrial fibrillation. The patient's current
International Normalized Ratio (INR) is 5.5 mg/dL. The nurse practitioner would:
*Answer hold the warfarin for 1 day and then recheck in two days.
*decrease the warfarin to 3 mg daily.
*increase the warfarin to 5 mg daily.
*hold the warfarin for 4 days and then recheck the INR. - ✔✔Answer hold the warfarin
for 1 day and then recheck in two days.
Rationale: As warfarin has a long half life, it typically takes several days to see
meaningful change in levels of dose change. The INR of 5.5 is supratherapeutic and
must be reduced for the risk of bleeding. Of these options, the only one that offers a
reduction/cessation and and a recheck of the level is to hold the warfarin for one day
and recheck the INR in 2 days.
✔✔Your patient presents with painless lymph node swelling, weight loss, night sweats,
and asks what is wrong with him. Which of the following represents a most appropriate
intervention to confirm a diagnosis of lymphoma?
*Order a CBC and TSH
*Consult pulmonology
*Order a core needle biopsy
*Examine the patient - ✔✔Order a core needle biopsy
Rationale: This question is asking for an intervention. Although examining the patient is
useful, it is an evaluation tool, as is ordering routine lab work. Pulmonology is not an
, appropriate consultation for this patient; rather, hematology or oncology would be best
suited to evaluate and work up this patient. A diagnostic needle biopsy is the most
definitive intervention to gain a diagnosis for a suspected lymphoma.
✔✔Your patient arrives the urgent care complaining of a swollen throat and vocal
changes. Which of the following statements made by the patient brings an index of
suspicion of angioedema?
*This seems to be getting better already getting out of the cold
*I have been taking my lisinopril for the past week as prescribed
*I have never had this happen before
*I do not take any ibuprofen since it gives me an upset stomach - ✔✔I have been taking
my lisinopril for the past week as prescribed
Rationale: Use of ACE Inhibitors and NSAIDS is a common precipitating factor in
angioedema. The rest do not suggest any relationship to angioedema.
✔✔A 35-year-old woman presents with a new, darkly pigmented lesion on her back that
she noticed a few months ago. The lesion is asymmetrical, has irregular borders, and
varies in color. What is the most appropriate next step in management?
*Perform a shave biopsy
*Reassure the patient and advise regular monitoring
*Perform an excisional biopsy
*Perform a punch biopsy - ✔✔Perform an excisional biopsy
Rationale: When a healthcare provider needs to definitively diagnose or rule out a
suspected condition, such as a skin lesion or tumor, an excisional biopsy allows for the
entire lesion or a significant portion of it to be removed and examined under a
microscope by a pathologist.
✔✔An adult daycare worker presents with severe itching on the arms and around the
arms and wrists. The patient's skin is mildly excoriated from scratching. Microscopic
examination of a skin reveals scabies. The treatment of choice for the patient would be?
*triamcinolone
*permethrin
*ketocanozale
*cetirizine - ✔✔permethrin
Rationale: Permethrin is commonly prescribed for the treatment of scabies, a
contagious skin infestation caused by the Sarcoptes scabiei mite. Permethrin is a
synthetic pyrethroid insecticide that works by paralyzing and killing the mites and their
eggs upon contact. It disrupts the nervous system of the mites, leading to their death.
✔✔An adult photography developer presents with two small vesicles on his right middle
finger, proximal to the nail bed. He says he wears gloves when he works with
photography chemicals. He admits to chewing his fingers, and notes that this is his
fourth episode. Previous cultures have been negative. The MOST likely diagnosis is:
*Herpetic whitlow
*Impetigo
