NR667 CEA Weeks 1–6 Comprehensive Review Practice
Questions & Verified Answers with Complete Solutions
1. A 68-year-old man with type 2 diabetes and stage 3 chronic kidney disease presents with a
3-day history of dysuria and fever. Temperature 38.9°C, BP 90/60, HR 110. Urinalysis shows
pyuria and gram-negative rods. Serum creatinine has risen from 1.8 to 2.6 mg/dL from baseline.
Blood cultures grow E. coli resistant to ceftriaxone but sensitive to ertapenem and
piperacillin-tazobactam. He has no drug allergies. Which antibiotic regimen is the BEST initial
choice?
A. Start ertapenem 1 g IV once daily
B. Start piperacillin-tazobactam 4.5 g IV every 6 hours
C. Start ciprofloxacin 400 mg IV every 12 hours
D. Start meropenem 1 g IV every 8 hours
Answer: B. Start piperacillin-tazobactam 4.5 g IV every 6 hours
2. A 74-year-old woman on chronic warfarin for atrial fibrillation presents with acute left-sided
weakness and aphasia. Last INR was 1.2 one week ago. CT head shows no hemorrhage. She
had a mechanical mitral valve. Which acute intervention is MOST appropriate if the stroke is
within 3.5 hours?
A. Administer IV alteplase after confirming no contraindications
B. Administer IV heparin infusion without bolus
C. Perform mechanical thrombectomy without tPA
D. Administer factor IX complex concentrate
Answer: A. Administer IV alteplase after confirming no contraindications
3. A 32-year-old female nurse reports needlestick injury from a patient with known HIV (viral
load 500,000). She initiated post-exposure prophylaxis (PEP) within 2 hours. What is the MOST
appropriate follow-up testing schedule for HIV?
A. Test at baseline, 6 weeks, 12 weeks, and 6 months
B. Test at baseline, 4 weeks, 8 weeks, 12 weeks
C. Test at baseline, 3 months, and 6 months
D. Test at baseline, 6 weeks, 12 weeks, 24 weeks, and 6 months
Answer: A. Test at baseline, 6 weeks, 12 weeks, and 6 months
4. A 45-year-old man with cirrhosis (MELD 20) presents with confusion, asterixis, and an
ammonia level of 90 µg/dL. He is on lactulose but has not had a bowel movement for 2 days.
Which is the BEST initial management?
A. Administer lactulose 30 mL every hour until producing stools
B. Give a lactulose enema if oral intake is unsuccessful
C. Start rifaximin 550 mg twice daily
D. Administer polyethylene glycol solution
Answer: A. Administer lactulose 30 mL every hour until producing stools
5. A 56-year-old woman with hypertension and obesity presents with episodic palpitations,
tremors, and headaches lasting minutes, with BP spikes to 200/110. Labs show normal thyroid
function and negative urine metanephrines on a 24-hour collection. Plasma metanephrines are
,3-fold elevated. Which is the MOST appropriate next step?
A. Repeat plasma metanephrines after 30 minutes in supine position
B. Order a CT abdomen without contrast
C. Perform a clonidine suppression test
D. Do a 24-hour urine for fractionated metanephrines again
Answer: C. Perform a clonidine suppression test
6. A 28-year-old male medical resident working night shifts presents with fatigue and difficulty
concentrating. His hemoglobin is 12.0 g/dL, MCV 92, ferritin 150 ng/mL, B12 300 pg/mL, folate
normal. He has no bleeding. Which is the MOST likely cause?
A. Iron deficiency anemia
B. Chronic kidney disease
C. Shift work sleep disorder
D. Thalassemia trait
Answer: C. Shift work sleep disorder
7. A 67-year-old man with COPD is admitted with an exacerbation. He receives prednisone 60
mg IV, azithromycin, and albuterol/ipratropium nebulization. On day 2, he develops new-onset
confusion and asterixis. Labs show sodium 128 mEq/L, glucose 120, BUN 30, creatinine 1.5.
Which medication is the MOST likely cause?
A. Prednisone
B. Azithromycin
C. Albuterol
D. Ipratropium
Answer: A. Prednisone
8. A 5-year-old boy presents with a 2-day history of fever, sore throat, and vesicular rash on
hands and feet. His mother asks if he needs antibiotics. What is the BEST response?
A. Explain that this is likely hand, foot, and mouth disease, which is viral and does not require antibiotics
B. Prescribe amoxicillin as a precautionary measure
C. Perform a rapid strep test and treat if positive
D. Start acyclovir to shorten the course
Answer: A. Explain that this is likely hand, foot, and mouth disease, which is viral and does not
require antibiotics
9. A 59-year-old woman with asthma is started on montelukast for symptom relief. She returns
2 weeks later reporting mood swings and suicidal thoughts. What is the MOST appropriate
action?
A. Discontinue montelukast immediately and report the adverse event to the FDA via MedWatch
B. Decrease the dose of montelukast and monitor her symptoms closely
C. Add an antidepressant and continue montelukast
D. Taper montelukast over one week and reassess
Answer: A. Discontinue montelukast immediately and report the adverse event to the FDA via
MedWatch
10. A 72-year-old man with metastatic prostate cancer on long-term androgen deprivation
therapy (ADT) presents with acute back pain and leg weakness. MRI shows vertebral
, metastases with epidural spinal cord compression. He has no prior radiotherapy to the area.
Which is the MOST appropriate initial treatment?
A. Start dexamethasone 10 mg IV immediately
B. Consult radiation oncology for urgent radiation therapy
C. Start bisphosphonates for bone pain
D. Prescribe oral opioids for pain control
Answer: A. Start dexamethasone 10 mg IV immediately
11. A 34-year-old woman with systemic lupus erythematosus presents with pleuritic chest pain,
dyspnea, and fatigue. ECG shows diffuse ST elevations. Lab shows positive anti-dsDNA and
low complement C3/C4. Which is the MOST likely diagnosis?
A. Pericarditis due to SLE flare
B. Pulmonary embolism
C. Myocardial infarction
D. Pneumonia
Answer: A. Pericarditis due to SLE flare
12. A 45-year-old man with a history of heroin use disorder is brought to the ED with pinpoint
pupils, respiratory depression, and coma. Naloxone 0.4 mg IV is given with improvement, but
he becomes agitated and combative. What is the BEST next step?
A. Administer an additional dose of naloxone 0.4 mg IV
B. Start a naloxone infusion at 0.25 mg/hr
C. Restrain the patient and use benzodiazepines for agitation
D. Allow patient to be observed in a stretcher without medication
Answer: C. Restrain the patient and use benzodiazepines for agitation
13. A 48-year-old female with a history of obesity and PCOS is diagnosed with nonalcoholic
steatohepatitis (NASH) on liver biopsy with fibrosis stage 2. She has normal renal function.
Which medication has been shown to improve fibrosis in NASH?
A. Pioglitazone
B. Metformin
C. Vitamin E
D. Ursodeoxycholic acid
Answer: A. Pioglitazone
14. A 62-year-old man is started on an ACE inhibitor for hypertension. Two weeks later, he
develops a nonproductive cough. What is the BEST management strategy?
A. Switch to an angiotensin receptor blocker (ARB)
B. Add an antitussive agent
C. Continue the ACE inhibitor and reassure the patient
D. Switch to a beta-blocker like metoprolol
Answer: A. Switch to an angiotensin receptor blocker (ARB)
15. A 23-year-old female with type 1 diabetes is on insulin pump. She presents with vomiting
and abdominal pain. Fingerstick glucose is 250 mg/dL, but serum ketones are 3+ positive.
Which is the MOST appropriate initial fluid?
A. 0.9% sodium chloride bolus 20 mL/kg
Questions & Verified Answers with Complete Solutions
1. A 68-year-old man with type 2 diabetes and stage 3 chronic kidney disease presents with a
3-day history of dysuria and fever. Temperature 38.9°C, BP 90/60, HR 110. Urinalysis shows
pyuria and gram-negative rods. Serum creatinine has risen from 1.8 to 2.6 mg/dL from baseline.
Blood cultures grow E. coli resistant to ceftriaxone but sensitive to ertapenem and
piperacillin-tazobactam. He has no drug allergies. Which antibiotic regimen is the BEST initial
choice?
A. Start ertapenem 1 g IV once daily
B. Start piperacillin-tazobactam 4.5 g IV every 6 hours
C. Start ciprofloxacin 400 mg IV every 12 hours
D. Start meropenem 1 g IV every 8 hours
Answer: B. Start piperacillin-tazobactam 4.5 g IV every 6 hours
2. A 74-year-old woman on chronic warfarin for atrial fibrillation presents with acute left-sided
weakness and aphasia. Last INR was 1.2 one week ago. CT head shows no hemorrhage. She
had a mechanical mitral valve. Which acute intervention is MOST appropriate if the stroke is
within 3.5 hours?
A. Administer IV alteplase after confirming no contraindications
B. Administer IV heparin infusion without bolus
C. Perform mechanical thrombectomy without tPA
D. Administer factor IX complex concentrate
Answer: A. Administer IV alteplase after confirming no contraindications
3. A 32-year-old female nurse reports needlestick injury from a patient with known HIV (viral
load 500,000). She initiated post-exposure prophylaxis (PEP) within 2 hours. What is the MOST
appropriate follow-up testing schedule for HIV?
A. Test at baseline, 6 weeks, 12 weeks, and 6 months
B. Test at baseline, 4 weeks, 8 weeks, 12 weeks
C. Test at baseline, 3 months, and 6 months
D. Test at baseline, 6 weeks, 12 weeks, 24 weeks, and 6 months
Answer: A. Test at baseline, 6 weeks, 12 weeks, and 6 months
4. A 45-year-old man with cirrhosis (MELD 20) presents with confusion, asterixis, and an
ammonia level of 90 µg/dL. He is on lactulose but has not had a bowel movement for 2 days.
Which is the BEST initial management?
A. Administer lactulose 30 mL every hour until producing stools
B. Give a lactulose enema if oral intake is unsuccessful
C. Start rifaximin 550 mg twice daily
D. Administer polyethylene glycol solution
Answer: A. Administer lactulose 30 mL every hour until producing stools
5. A 56-year-old woman with hypertension and obesity presents with episodic palpitations,
tremors, and headaches lasting minutes, with BP spikes to 200/110. Labs show normal thyroid
function and negative urine metanephrines on a 24-hour collection. Plasma metanephrines are
,3-fold elevated. Which is the MOST appropriate next step?
A. Repeat plasma metanephrines after 30 minutes in supine position
B. Order a CT abdomen without contrast
C. Perform a clonidine suppression test
D. Do a 24-hour urine for fractionated metanephrines again
Answer: C. Perform a clonidine suppression test
6. A 28-year-old male medical resident working night shifts presents with fatigue and difficulty
concentrating. His hemoglobin is 12.0 g/dL, MCV 92, ferritin 150 ng/mL, B12 300 pg/mL, folate
normal. He has no bleeding. Which is the MOST likely cause?
A. Iron deficiency anemia
B. Chronic kidney disease
C. Shift work sleep disorder
D. Thalassemia trait
Answer: C. Shift work sleep disorder
7. A 67-year-old man with COPD is admitted with an exacerbation. He receives prednisone 60
mg IV, azithromycin, and albuterol/ipratropium nebulization. On day 2, he develops new-onset
confusion and asterixis. Labs show sodium 128 mEq/L, glucose 120, BUN 30, creatinine 1.5.
Which medication is the MOST likely cause?
A. Prednisone
B. Azithromycin
C. Albuterol
D. Ipratropium
Answer: A. Prednisone
8. A 5-year-old boy presents with a 2-day history of fever, sore throat, and vesicular rash on
hands and feet. His mother asks if he needs antibiotics. What is the BEST response?
A. Explain that this is likely hand, foot, and mouth disease, which is viral and does not require antibiotics
B. Prescribe amoxicillin as a precautionary measure
C. Perform a rapid strep test and treat if positive
D. Start acyclovir to shorten the course
Answer: A. Explain that this is likely hand, foot, and mouth disease, which is viral and does not
require antibiotics
9. A 59-year-old woman with asthma is started on montelukast for symptom relief. She returns
2 weeks later reporting mood swings and suicidal thoughts. What is the MOST appropriate
action?
A. Discontinue montelukast immediately and report the adverse event to the FDA via MedWatch
B. Decrease the dose of montelukast and monitor her symptoms closely
C. Add an antidepressant and continue montelukast
D. Taper montelukast over one week and reassess
Answer: A. Discontinue montelukast immediately and report the adverse event to the FDA via
MedWatch
10. A 72-year-old man with metastatic prostate cancer on long-term androgen deprivation
therapy (ADT) presents with acute back pain and leg weakness. MRI shows vertebral
, metastases with epidural spinal cord compression. He has no prior radiotherapy to the area.
Which is the MOST appropriate initial treatment?
A. Start dexamethasone 10 mg IV immediately
B. Consult radiation oncology for urgent radiation therapy
C. Start bisphosphonates for bone pain
D. Prescribe oral opioids for pain control
Answer: A. Start dexamethasone 10 mg IV immediately
11. A 34-year-old woman with systemic lupus erythematosus presents with pleuritic chest pain,
dyspnea, and fatigue. ECG shows diffuse ST elevations. Lab shows positive anti-dsDNA and
low complement C3/C4. Which is the MOST likely diagnosis?
A. Pericarditis due to SLE flare
B. Pulmonary embolism
C. Myocardial infarction
D. Pneumonia
Answer: A. Pericarditis due to SLE flare
12. A 45-year-old man with a history of heroin use disorder is brought to the ED with pinpoint
pupils, respiratory depression, and coma. Naloxone 0.4 mg IV is given with improvement, but
he becomes agitated and combative. What is the BEST next step?
A. Administer an additional dose of naloxone 0.4 mg IV
B. Start a naloxone infusion at 0.25 mg/hr
C. Restrain the patient and use benzodiazepines for agitation
D. Allow patient to be observed in a stretcher without medication
Answer: C. Restrain the patient and use benzodiazepines for agitation
13. A 48-year-old female with a history of obesity and PCOS is diagnosed with nonalcoholic
steatohepatitis (NASH) on liver biopsy with fibrosis stage 2. She has normal renal function.
Which medication has been shown to improve fibrosis in NASH?
A. Pioglitazone
B. Metformin
C. Vitamin E
D. Ursodeoxycholic acid
Answer: A. Pioglitazone
14. A 62-year-old man is started on an ACE inhibitor for hypertension. Two weeks later, he
develops a nonproductive cough. What is the BEST management strategy?
A. Switch to an angiotensin receptor blocker (ARB)
B. Add an antitussive agent
C. Continue the ACE inhibitor and reassure the patient
D. Switch to a beta-blocker like metoprolol
Answer: A. Switch to an angiotensin receptor blocker (ARB)
15. A 23-year-old female with type 1 diabetes is on insulin pump. She presents with vomiting
and abdominal pain. Fingerstick glucose is 250 mg/dL, but serum ketones are 3+ positive.
Which is the MOST appropriate initial fluid?
A. 0.9% sodium chloride bolus 20 mL/kg
