CEA PREP CORE REVIEWS QUESTIONS AND
ANSWERS SET A+
✔✔An adult female presents with a chief complaint of fatigue and weight gain. She
states that she doesn't feel like herself. A diagnosis of hypothyroidism is suspected.
Which of the following physical findings would support this diagnosis? - ✔✔Dry skin,
bradycardia, and hypoactive deep tendon reflexes
Rationale: Dry skin, bradycardia, and hypoactive deep tendon reflexes are all fairly
classic signs of hypothyroidism. To further substantiate these concerns, the patient
should have their TSH and T3 and Free T4 checked, and it is likely their TSH would be
elevated, T3/T4 low.
✔✔An older adult patient with new onset GERD, cough, heartburn. Initial tx -
✔✔Antacid and lifestyle modification/weight loss
Rationale: Before initiating a PPI or H2RA, it would always be wise to initiate
diet/exercise and symptom management when present with an antacid. Loss of
weight/dieting is most likely to deal with obesity as the most common underlying cause
of GERD.
✔✔A 59-year-old male presents with symptoms of abdominal pain, jaundice, and weight
loss which he has not been trying to lose weight. What would be a malignancy
associated with these symptoms? - ✔✔Pancreatic cancer
Raionale: Pancreatic cancer, the most typically presentation includes abdominal pain,
jaundice, and weight loss. Although weight loss and abdominal pain may be present
with adenocarcinoma it is unlikely to present with jaundice, and you're unlikely to have
abdominal pain or jaundice with any esophageal malignancy.
✔✔A 63-year-old male presents with a suspected lower GI bleed. He reports passing
frank small amounts of blood several times today. He denies any use of NSAID's or
blood thinners. What must be taken into consideration before performing a colonoscopy
on this patient? - ✔✔All are reasonable options
,Rationale: This patient has had blood loss and should first be hemodynamically stable,
and fluid/blood product resuscitated. In all cases of GI bleed risk factors for an upper GI
bleed must be taken into consideration first, we must always discuss with the patient all
risks and benefits associated with the procedure to provide an informed consent.
✔✔A 39-year-old female is being seen by your service for diarrhea. Patient reports 3-4
loose stools a day. She also reports mild cramping. Which labs would be helpful in
further workup of a diagnosis? - ✔✔ESR, fecal occult, Stool culture
Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to
determine the potential cause of her symptoms.
✔✔An adult female presents with a 1-week history of left lower quadrant abdominal
pain. T=101.2 degrees F. (38.4 degrees C) and an elevated WBC count. This is the
patient's first episode of severe abdominal pain. The nurse practitioner suspects
diverticulitis. Which of the following diagnostic tests would confirm the diagnosis? -
✔✔CT scan of the abdomen
Rationale: For patients with acute diverticulitis, CT of the abdomen will provide evidence
of the pathophysiology. Evidence of diverticula will be present on a flat plate KUB x-ray,
but there is not enough specificity to show that it is inflamed as with a CT scan.
✔✔A 70-year-old patient presents to the clinic with dyspnea, palpitations, and fatigue.
The patient reports a 2-week history of blackened stools, which the patient attributes to
drinking berry juice. Assessment reveals vital signs of BP = 110/60, P = 100, R = 24;
Hgb = 4.5 g/dL; Hct = 16%. What is the most appropriate immediate intervention? -
✔✔Send to the emergency room.
Rationale: This patient is experiencing a GI bleed and is in need of emergency
treatment due to their considerably low hemoglobin.
✔✔An older adult has a follow-up fasting lipid panel 6 months after making therapeutic
lifestyle changes. LDL=205mg/dL (Normal=<100mg/dL), HDL=44mg/dL, and
triglycerides=180mg/dL (Normal-<150mg/dL). The patient is placed on statin therapy.
Two months later, the patient presents for follow-up and complains of body aches. In
addition to creatine phosphokinase (CPK), which of the following tests should the nurse
practitioner order? - ✔✔Liver transaminase (AST and ALT) levels
Rationale: Due to the potential liver function test elevation found with statin use, LFTs of
AST/ALT should be checked routinely after initiation of therapy
✔✔A 56-year-old male on your service has been diagnosed with colon cancer which is
localized. What is the primary management that you should expect to prepare your
patient for? - ✔✔Surgery
Rationale: Surgery is the only curative modality for localized colon cancers. Patients
with progressive/metastatic disease may require chemotherapy/radiation.
✔✔A 28-year-old woman presents with abdominal pain, diarrhea, and weight loss. She
also reports occasional bloody stools. Colonoscopy reveals continuous inflammation
,from the rectum extending proximally. What is the most likely diagnosis? - ✔✔Ulcerative
colitis
Rationale: The presence of inflammatory bowel disease which is present in the patient
with bloody stool suggests ulcerative colitis. This patient should be acutely managed
with steroids and chronically with auto-immune therapy such as biologics and/or
DMARDs.
✔✔A 63-year-old male presents with a suspected lower GI bleed. He reports passing
frank small amounts of blood several times today. He denies use of NSAID's or blood
thinners. What questions would be important to ask to further differentiate your
diagnosis? - ✔✔All these questions would help determine if this bleed was associated
with a potential diverticular bleed (typically painless), painful bowel movement
associated with IBD (UC/Crohn's), and changes in bowel habit/colonoscopy risk for
malignancy.
✔✔Which is best performed to assess the risk for fall in an 88-year old adult? - ✔✔Get
up and go test
Rationale: This question is asking you if you understand the different screening to
available for Mobility and fall risk. The global screening assessment, PHQ-2
questionnaire, and clock drawing test have no clinical significance to mobility. The "get
up and go" test is the only option that is a mobility test of these four.
✔✔A frail elderly patient presents with constipation. Which of the following normal
physiologic changes seen with aging is the most likely cause? - ✔✔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
✔✔An elderly patient diagnosed with end-stage lung cancer has been refusing meals,
opting instead for ice cream only. The family is concerned about the patient not getting
enough nutrition. The NP: - ✔✔explains loss of appetite is common at the end of life
Rationale: Death is an uncomfortable topic, and must be handled tactfully. Factual re-
orientation to the terminal state of a patient's condition may be appropriate when
unrealistic expectations for their longevity have been voiced. The reasonable choice in
this case is to describe the normalcy of what the patient is experiencing with their loss of
appetite and their terminal state. Testing the patient for depression has really no clinical
bearing on this particular time nor does prescribing methylphenidate. Ordering a UA and
CBC would suggest a concern of a urinary tract infection, and that is not a likely
scenario to describe the patient's existing condition. Support the patient as his advocate
by helping the man enjoy the ice cream he requested.
, ✔✔An elderly patient is being admitted to the skilled nursing facility and is being
screened for the risk of falling. Which of the following information would trigger a
complete falls assessment? - ✔✔A history of two or more falls in the prior year
Rationale: Of these options, the only two that have any clinical bearing on falls are a
patient who has a demonstrated incident of two or more falls in a year and a patient who
has a altered cognition, such as the patient who is living alone and has mild dementia.
Of the two options, the clear winner is the patient who has already demonstrated to fall
in the last year and they should certainly be a valuated more thoroughly with a complete
fall assessment.
✔✔The management of COPD in the elderly is best guided by: - ✔✔symptomatology.
Rationale: Symptomatology is what guides COPD management since the severity and
frequency of symptoms will warrant changes and additions to medications as
exacerbations present.
Although very useful tool for chronic management and baseline status, spirometry does
not typically dictate therapy, rather diagnose the disease state itself. Our blood gases
may be used for clinically correlate severity during an exacerbation, and radiologic
imaging may showcase severity of stable chronic finding such as somatic, lung tissue or
bullae.
✔✔Which of the following is an example of implied consent? - ✔✔The patient collapses
while having a myocardial infarction in the hospital cafeteria. Bystanders witnessed the
patient clutch his chest, say "my chest", then collapse. They start CPR and initiate the
emergency care system to transport the patient for care in the emergency department.
Rationale: Surgical consent is by definition "informed" when the risks and benefits are
discussed as with the patients undergoing surgery and a chest tube, and 2 person
emergency consent is described with the patient with altered mental status. The
collapsed patient reflects a clear inability to care for oneself and care is being performed
under the assumption of what is implied as what any reasonable person would want.
✔✔Which of the following refers to the primary access point of medical care patients are
encouraged to use to aid in providing continuity and reduction of cost per the Affordable
Care Act? - ✔✔The Medical Home
Rationale: The medical home reduces cost by providing continuity of care, reducing
overtesting, duplicate testing, and aids with longitudinal management of the patient. The
other options all increase these cost-burdening elements and should be avoided unless
care through the medical home is not a reasonable or appropriate option.
✔✔A patient states they do not want to have any further medical care and wishes to
leave against medical advice. Unknown to you, the healthcare tech then held their arm
down to get an IV catheter placed against their will. The healthcare tech is at risk of
being charged with which of the following: - ✔✔Battery
Rationale: Assault refers to the risk of a harm to others, whereas battery refers to the
actual act of that harm.
ANSWERS SET A+
✔✔An adult female presents with a chief complaint of fatigue and weight gain. She
states that she doesn't feel like herself. A diagnosis of hypothyroidism is suspected.
Which of the following physical findings would support this diagnosis? - ✔✔Dry skin,
bradycardia, and hypoactive deep tendon reflexes
Rationale: Dry skin, bradycardia, and hypoactive deep tendon reflexes are all fairly
classic signs of hypothyroidism. To further substantiate these concerns, the patient
should have their TSH and T3 and Free T4 checked, and it is likely their TSH would be
elevated, T3/T4 low.
✔✔An older adult patient with new onset GERD, cough, heartburn. Initial tx -
✔✔Antacid and lifestyle modification/weight loss
Rationale: Before initiating a PPI or H2RA, it would always be wise to initiate
diet/exercise and symptom management when present with an antacid. Loss of
weight/dieting is most likely to deal with obesity as the most common underlying cause
of GERD.
✔✔A 59-year-old male presents with symptoms of abdominal pain, jaundice, and weight
loss which he has not been trying to lose weight. What would be a malignancy
associated with these symptoms? - ✔✔Pancreatic cancer
Raionale: Pancreatic cancer, the most typically presentation includes abdominal pain,
jaundice, and weight loss. Although weight loss and abdominal pain may be present
with adenocarcinoma it is unlikely to present with jaundice, and you're unlikely to have
abdominal pain or jaundice with any esophageal malignancy.
✔✔A 63-year-old male presents with a suspected lower GI bleed. He reports passing
frank small amounts of blood several times today. He denies any use of NSAID's or
blood thinners. What must be taken into consideration before performing a colonoscopy
on this patient? - ✔✔All are reasonable options
,Rationale: This patient has had blood loss and should first be hemodynamically stable,
and fluid/blood product resuscitated. In all cases of GI bleed risk factors for an upper GI
bleed must be taken into consideration first, we must always discuss with the patient all
risks and benefits associated with the procedure to provide an informed consent.
✔✔A 39-year-old female is being seen by your service for diarrhea. Patient reports 3-4
loose stools a day. She also reports mild cramping. Which labs would be helpful in
further workup of a diagnosis? - ✔✔ESR, fecal occult, Stool culture
Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to
determine the potential cause of her symptoms.
✔✔An adult female presents with a 1-week history of left lower quadrant abdominal
pain. T=101.2 degrees F. (38.4 degrees C) and an elevated WBC count. This is the
patient's first episode of severe abdominal pain. The nurse practitioner suspects
diverticulitis. Which of the following diagnostic tests would confirm the diagnosis? -
✔✔CT scan of the abdomen
Rationale: For patients with acute diverticulitis, CT of the abdomen will provide evidence
of the pathophysiology. Evidence of diverticula will be present on a flat plate KUB x-ray,
but there is not enough specificity to show that it is inflamed as with a CT scan.
✔✔A 70-year-old patient presents to the clinic with dyspnea, palpitations, and fatigue.
The patient reports a 2-week history of blackened stools, which the patient attributes to
drinking berry juice. Assessment reveals vital signs of BP = 110/60, P = 100, R = 24;
Hgb = 4.5 g/dL; Hct = 16%. What is the most appropriate immediate intervention? -
✔✔Send to the emergency room.
Rationale: This patient is experiencing a GI bleed and is in need of emergency
treatment due to their considerably low hemoglobin.
✔✔An older adult has a follow-up fasting lipid panel 6 months after making therapeutic
lifestyle changes. LDL=205mg/dL (Normal=<100mg/dL), HDL=44mg/dL, and
triglycerides=180mg/dL (Normal-<150mg/dL). The patient is placed on statin therapy.
Two months later, the patient presents for follow-up and complains of body aches. In
addition to creatine phosphokinase (CPK), which of the following tests should the nurse
practitioner order? - ✔✔Liver transaminase (AST and ALT) levels
Rationale: Due to the potential liver function test elevation found with statin use, LFTs of
AST/ALT should be checked routinely after initiation of therapy
✔✔A 56-year-old male on your service has been diagnosed with colon cancer which is
localized. What is the primary management that you should expect to prepare your
patient for? - ✔✔Surgery
Rationale: Surgery is the only curative modality for localized colon cancers. Patients
with progressive/metastatic disease may require chemotherapy/radiation.
✔✔A 28-year-old woman presents with abdominal pain, diarrhea, and weight loss. She
also reports occasional bloody stools. Colonoscopy reveals continuous inflammation
,from the rectum extending proximally. What is the most likely diagnosis? - ✔✔Ulcerative
colitis
Rationale: The presence of inflammatory bowel disease which is present in the patient
with bloody stool suggests ulcerative colitis. This patient should be acutely managed
with steroids and chronically with auto-immune therapy such as biologics and/or
DMARDs.
✔✔A 63-year-old male presents with a suspected lower GI bleed. He reports passing
frank small amounts of blood several times today. He denies use of NSAID's or blood
thinners. What questions would be important to ask to further differentiate your
diagnosis? - ✔✔All these questions would help determine if this bleed was associated
with a potential diverticular bleed (typically painless), painful bowel movement
associated with IBD (UC/Crohn's), and changes in bowel habit/colonoscopy risk for
malignancy.
✔✔Which is best performed to assess the risk for fall in an 88-year old adult? - ✔✔Get
up and go test
Rationale: This question is asking you if you understand the different screening to
available for Mobility and fall risk. The global screening assessment, PHQ-2
questionnaire, and clock drawing test have no clinical significance to mobility. The "get
up and go" test is the only option that is a mobility test of these four.
✔✔A frail elderly patient presents with constipation. Which of the following normal
physiologic changes seen with aging is the most likely cause? - ✔✔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
✔✔An elderly patient diagnosed with end-stage lung cancer has been refusing meals,
opting instead for ice cream only. The family is concerned about the patient not getting
enough nutrition. The NP: - ✔✔explains loss of appetite is common at the end of life
Rationale: Death is an uncomfortable topic, and must be handled tactfully. Factual re-
orientation to the terminal state of a patient's condition may be appropriate when
unrealistic expectations for their longevity have been voiced. The reasonable choice in
this case is to describe the normalcy of what the patient is experiencing with their loss of
appetite and their terminal state. Testing the patient for depression has really no clinical
bearing on this particular time nor does prescribing methylphenidate. Ordering a UA and
CBC would suggest a concern of a urinary tract infection, and that is not a likely
scenario to describe the patient's existing condition. Support the patient as his advocate
by helping the man enjoy the ice cream he requested.
, ✔✔An elderly patient is being admitted to the skilled nursing facility and is being
screened for the risk of falling. Which of the following information would trigger a
complete falls assessment? - ✔✔A history of two or more falls in the prior year
Rationale: Of these options, the only two that have any clinical bearing on falls are a
patient who has a demonstrated incident of two or more falls in a year and a patient who
has a altered cognition, such as the patient who is living alone and has mild dementia.
Of the two options, the clear winner is the patient who has already demonstrated to fall
in the last year and they should certainly be a valuated more thoroughly with a complete
fall assessment.
✔✔The management of COPD in the elderly is best guided by: - ✔✔symptomatology.
Rationale: Symptomatology is what guides COPD management since the severity and
frequency of symptoms will warrant changes and additions to medications as
exacerbations present.
Although very useful tool for chronic management and baseline status, spirometry does
not typically dictate therapy, rather diagnose the disease state itself. Our blood gases
may be used for clinically correlate severity during an exacerbation, and radiologic
imaging may showcase severity of stable chronic finding such as somatic, lung tissue or
bullae.
✔✔Which of the following is an example of implied consent? - ✔✔The patient collapses
while having a myocardial infarction in the hospital cafeteria. Bystanders witnessed the
patient clutch his chest, say "my chest", then collapse. They start CPR and initiate the
emergency care system to transport the patient for care in the emergency department.
Rationale: Surgical consent is by definition "informed" when the risks and benefits are
discussed as with the patients undergoing surgery and a chest tube, and 2 person
emergency consent is described with the patient with altered mental status. The
collapsed patient reflects a clear inability to care for oneself and care is being performed
under the assumption of what is implied as what any reasonable person would want.
✔✔Which of the following refers to the primary access point of medical care patients are
encouraged to use to aid in providing continuity and reduction of cost per the Affordable
Care Act? - ✔✔The Medical Home
Rationale: The medical home reduces cost by providing continuity of care, reducing
overtesting, duplicate testing, and aids with longitudinal management of the patient. The
other options all increase these cost-burdening elements and should be avoided unless
care through the medical home is not a reasonable or appropriate option.
✔✔A patient states they do not want to have any further medical care and wishes to
leave against medical advice. Unknown to you, the healthcare tech then held their arm
down to get an IV catheter placed against their will. The healthcare tech is at risk of
being charged with which of the following: - ✔✔Battery
Rationale: Assault refers to the risk of a harm to others, whereas battery refers to the
actual act of that harm.
