NR511 CEA Exam (2025-2026 Update) Questions and
Well-Elaborated Answers with Rationale, Exam for
Nursing
Total Questions: 150
Format: Multiple Choice
Content Areas: Dermatology, HEENT, Pulmonary, Cardiovascular, GI, GU,
Musculoskeletal, Neurology, Endocrine, Psych/Mental Health, and Professional Issues.
Section 1: Dermatology (Questions 1-20)
1. A 25-year-old male presents with a single, erythematous, annular lesion with central
clearing on his right forearm. He reports spending time hiking in Connecticut 2 weeks ago.
What is the most appropriate initial management?
A) Oral doxycycline
B) Topical clotrimazole
C) Oral acyclovir
D) Intralesional corticosteroids
Answer: A) Oral doxycycline
Rationale: The lesion is classic erythema migrans (targetoid/annular with central clearing)
consistent with Lyme disease (early localized). The patient has a high-risk exposure in an
endemic area. The treatment of choice is oral doxycycline (100mg BID) for 10-14 days (or
amoxicillin for children/pregnant). Topical antifungals are for tinea corporis (which is usually
scaly and pruritic).
2. A 72-year-old diabetic patient reports a painful, swollen, erythematous right lower leg
with a well-demarcated, raised border. She has a fever of 101.5°F. What is the most likely
diagnosis?
A) Cellulitis
B) Venous stasis dermatitis
C) Erysipelas
D) Deep vein thrombosis
, Answer: C) Erysipelas
Rationale: Erysipelas is a superficial dermal infection (usually Group A Strep) characterized by
intensely erythematous, edematous plaques with a sharply demarcated, raised border ("peau
d'orange"). It commonly affects the lower extremities in elderly and diabetic patients. Systemic
symptoms (fever, chills) are common. Cellulitis is deeper and has less distinct borders.
3. A 45-year-old female presents with a 3-day history of painful vesicles on an
erythematous base on her left torso, limited to a single dermatome. She had chickenpox as
a child. Which of the following is the most effective treatment to reduce the duration of
symptoms if started within 72 hours?
A) Topical acyclovir cream
B) Oral valacyclovir
C) Oral cephalexin
D) Prednisone
Answer: B) Oral valacyclovir
Rationale: This is Herpes Zoster (Shingles). Antiviral therapy (valacyclovir, famciclovir, or
acyclovir) is most effective when initiated within 72 hours of rash onset. It reduces viral
shedding, new lesion formation, and acute pain. Steroids are used adjunctively in some cases for
pain but not as monotherapy.
4. A patient with a history of psoriasis complains of joint pain and morning stiffness lasting
>30 minutes in his fingers and lower back. What is the most appropriate next step?
A) Reassurance that this is normal for psoriasis
B) Prescribe NSAIDs and refer to rheumatology
C) Order serum uric acid
D) Order ANA and RF
Answer: B) Prescribe NSAIDs and refer to rheumatology
Rationale: Psoriatic arthritis affects up to 30% of psoriasis patients. It is characterized by the
"sausage digit" (dactylitis), enthesitis, and sacroiliitis. Morning stiffness >30 minutes is a key
inflammatory feature. Referral to rheumatology is indicated for disease-modifying antirheumatic
drugs (DMARDs). Uric acid is for gout; ANA/RF are usually negative in psoriatic arthritis.
, 5. A mother brings in her 6-year-old child with a rash described as "slapped cheeks" and a
fine, lace-like reticular rash on the arms. The child had a mild fever a few days ago. What
is the diagnosis?
A) Scarlet fever
B) Measles
C) Fifth disease (Erythema infectiosum)
D) Roseola
Answer: C) Fifth disease (Erythema infectiosum)
Rationale: Parvovirus B19 causes Fifth disease. The classic presentation is the "slapped cheek"
facial rash followed by a reticulated (lace-like) rash on the extremities. It is a mild self-limiting
viral illness. It is important to check if the mother is pregnant (risk of fetal hydrops).
Section 2: HEENT (Questions 21-40)
6. A patient with a history of allergic rhinitis presents with a 4-day history of unilateral
facial pain, purulent nasal discharge, and subjective fever. Transillumination of the sinuses
is dull. What is the best initial treatment?
A) Amoxicillin-clavulanate
B) Amoxicillin (if not taken in the last 30 days)
C) Decongestants and nasal saline only
D) Ciprofloxacin
Answer: B) Amoxicillin (if not taken in the last 30 days)
Rationale: The patient meets the criteria for acute bacterial rhinosinusitis (ABRS): symptoms
>10 days, double worsening, or severe symptoms for >3 days with fever and purulence. The
first-line antibiotic is amoxicillin (high dose) or amoxicillin-clavulanate if there is recent
antibiotic use, comorbidities, or severe infection.
7. A 58-year-old smoker presents with hoarseness for 8 weeks. Laryngoscopy reveals a
unilateral vocal cord lesion. What is the most important next step?
A) Voice rest and reflux therapy
B) Biopsy of the lesion
C) CT scan of the neck
D) Speech therapy referral
, Answer: B) Biopsy of the lesion
Rationale: Hoarseness lasting >4 weeks in an adult (especially a smoker) warrants
visualization of the larynx. A unilateral lesion should be biopsied to rule out laryngeal
carcinoma. Benign lesions (polyps/nodules) are usually bilateral.
8. A 30-year-old reports recurrent episodes of vertigo lasting several hours, accompanied
by unilateral tinnitus, a feeling of aural fullness, and fluctuating hearing loss. What is the
most likely diagnosis?
A) Benign Paroxysmal Positional Vertigo (BPPV)
B) Vestibular neuritis
C) Meniere's disease
D) Acoustic neuroma
Answer: C) Meniere's disease
Rationale: Meniere's disease is characterized by episodic vertigo lasting hours, sensorineural
hearing loss (fluctuating), tinnitus, and aural fullness. BPPV lasts seconds to minutes and is
triggered by positional changes. Vestibular neuritis is acute, severe, and lasts days without
hearing loss.
9. A patient complains of chronic "scratchy" throat, globus sensation, and a sour taste in
the mouth upon waking. What is the most appropriate initial treatment?
A) Oral omeprazole
B) Antibiotics
C) Throat lozenges
D) Referral for tonsillectomy
Answer: A) Oral omeprazole
Rationale: These symptoms are classic for Laryngopharyngeal Reflux (LPR) or silent reflux.
The sour taste is a key differentiator from allergies. Treatment is acid suppression with a proton
pump inhibitor (PPI) and lifestyle modifications.
10. A patient presents with sudden, severe, "thunderclap" headache and photophobia. On
exam, there is nuchal rigidity. What is the immediate priority?
Well-Elaborated Answers with Rationale, Exam for
Nursing
Total Questions: 150
Format: Multiple Choice
Content Areas: Dermatology, HEENT, Pulmonary, Cardiovascular, GI, GU,
Musculoskeletal, Neurology, Endocrine, Psych/Mental Health, and Professional Issues.
Section 1: Dermatology (Questions 1-20)
1. A 25-year-old male presents with a single, erythematous, annular lesion with central
clearing on his right forearm. He reports spending time hiking in Connecticut 2 weeks ago.
What is the most appropriate initial management?
A) Oral doxycycline
B) Topical clotrimazole
C) Oral acyclovir
D) Intralesional corticosteroids
Answer: A) Oral doxycycline
Rationale: The lesion is classic erythema migrans (targetoid/annular with central clearing)
consistent with Lyme disease (early localized). The patient has a high-risk exposure in an
endemic area. The treatment of choice is oral doxycycline (100mg BID) for 10-14 days (or
amoxicillin for children/pregnant). Topical antifungals are for tinea corporis (which is usually
scaly and pruritic).
2. A 72-year-old diabetic patient reports a painful, swollen, erythematous right lower leg
with a well-demarcated, raised border. She has a fever of 101.5°F. What is the most likely
diagnosis?
A) Cellulitis
B) Venous stasis dermatitis
C) Erysipelas
D) Deep vein thrombosis
, Answer: C) Erysipelas
Rationale: Erysipelas is a superficial dermal infection (usually Group A Strep) characterized by
intensely erythematous, edematous plaques with a sharply demarcated, raised border ("peau
d'orange"). It commonly affects the lower extremities in elderly and diabetic patients. Systemic
symptoms (fever, chills) are common. Cellulitis is deeper and has less distinct borders.
3. A 45-year-old female presents with a 3-day history of painful vesicles on an
erythematous base on her left torso, limited to a single dermatome. She had chickenpox as
a child. Which of the following is the most effective treatment to reduce the duration of
symptoms if started within 72 hours?
A) Topical acyclovir cream
B) Oral valacyclovir
C) Oral cephalexin
D) Prednisone
Answer: B) Oral valacyclovir
Rationale: This is Herpes Zoster (Shingles). Antiviral therapy (valacyclovir, famciclovir, or
acyclovir) is most effective when initiated within 72 hours of rash onset. It reduces viral
shedding, new lesion formation, and acute pain. Steroids are used adjunctively in some cases for
pain but not as monotherapy.
4. A patient with a history of psoriasis complains of joint pain and morning stiffness lasting
>30 minutes in his fingers and lower back. What is the most appropriate next step?
A) Reassurance that this is normal for psoriasis
B) Prescribe NSAIDs and refer to rheumatology
C) Order serum uric acid
D) Order ANA and RF
Answer: B) Prescribe NSAIDs and refer to rheumatology
Rationale: Psoriatic arthritis affects up to 30% of psoriasis patients. It is characterized by the
"sausage digit" (dactylitis), enthesitis, and sacroiliitis. Morning stiffness >30 minutes is a key
inflammatory feature. Referral to rheumatology is indicated for disease-modifying antirheumatic
drugs (DMARDs). Uric acid is for gout; ANA/RF are usually negative in psoriatic arthritis.
, 5. A mother brings in her 6-year-old child with a rash described as "slapped cheeks" and a
fine, lace-like reticular rash on the arms. The child had a mild fever a few days ago. What
is the diagnosis?
A) Scarlet fever
B) Measles
C) Fifth disease (Erythema infectiosum)
D) Roseola
Answer: C) Fifth disease (Erythema infectiosum)
Rationale: Parvovirus B19 causes Fifth disease. The classic presentation is the "slapped cheek"
facial rash followed by a reticulated (lace-like) rash on the extremities. It is a mild self-limiting
viral illness. It is important to check if the mother is pregnant (risk of fetal hydrops).
Section 2: HEENT (Questions 21-40)
6. A patient with a history of allergic rhinitis presents with a 4-day history of unilateral
facial pain, purulent nasal discharge, and subjective fever. Transillumination of the sinuses
is dull. What is the best initial treatment?
A) Amoxicillin-clavulanate
B) Amoxicillin (if not taken in the last 30 days)
C) Decongestants and nasal saline only
D) Ciprofloxacin
Answer: B) Amoxicillin (if not taken in the last 30 days)
Rationale: The patient meets the criteria for acute bacterial rhinosinusitis (ABRS): symptoms
>10 days, double worsening, or severe symptoms for >3 days with fever and purulence. The
first-line antibiotic is amoxicillin (high dose) or amoxicillin-clavulanate if there is recent
antibiotic use, comorbidities, or severe infection.
7. A 58-year-old smoker presents with hoarseness for 8 weeks. Laryngoscopy reveals a
unilateral vocal cord lesion. What is the most important next step?
A) Voice rest and reflux therapy
B) Biopsy of the lesion
C) CT scan of the neck
D) Speech therapy referral
, Answer: B) Biopsy of the lesion
Rationale: Hoarseness lasting >4 weeks in an adult (especially a smoker) warrants
visualization of the larynx. A unilateral lesion should be biopsied to rule out laryngeal
carcinoma. Benign lesions (polyps/nodules) are usually bilateral.
8. A 30-year-old reports recurrent episodes of vertigo lasting several hours, accompanied
by unilateral tinnitus, a feeling of aural fullness, and fluctuating hearing loss. What is the
most likely diagnosis?
A) Benign Paroxysmal Positional Vertigo (BPPV)
B) Vestibular neuritis
C) Meniere's disease
D) Acoustic neuroma
Answer: C) Meniere's disease
Rationale: Meniere's disease is characterized by episodic vertigo lasting hours, sensorineural
hearing loss (fluctuating), tinnitus, and aural fullness. BPPV lasts seconds to minutes and is
triggered by positional changes. Vestibular neuritis is acute, severe, and lasts days without
hearing loss.
9. A patient complains of chronic "scratchy" throat, globus sensation, and a sour taste in
the mouth upon waking. What is the most appropriate initial treatment?
A) Oral omeprazole
B) Antibiotics
C) Throat lozenges
D) Referral for tonsillectomy
Answer: A) Oral omeprazole
Rationale: These symptoms are classic for Laryngopharyngeal Reflux (LPR) or silent reflux.
The sour taste is a key differentiator from allergies. Treatment is acid suppression with a proton
pump inhibitor (PPI) and lifestyle modifications.
10. A patient presents with sudden, severe, "thunderclap" headache and photophobia. On
exam, there is nuchal rigidity. What is the immediate priority?
