CEA Prep Full Practice Exam
The patient is exhibiting a productive cough and a low- Left upper lobe lingula
grade fever. Chest X-ray on PA view shows a left lower Ratonale: Lingular consolidation is described in this question precisely. If the
chest area of consolidation adjacent to the left border of cardiac margin/silhouette is obliterated by the mass, the lesion is either right middle
the heart approximately 2 rib spaces above the lobe or left upper lobe lingula.
costophrenic angle. The lateral x-ray view shows this
lesion absent of the window posterior to the cardiac
silhouette. Which is the most likely location of this area of
focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe
The inability to fully relax the myocardium during relaxation Diastolic dysfunction
is a trademark of which of the following diagnoses? Rationale: The inability for the heart to relax is a trademark of the diagnosis of
diastolic dysfunction and is common in patients with thickened hypertrophic
myocardium.
An otherwise healthy African American adult male has Calcium channel blocker
been diagnosed with hypertension. He has been restricting Rationale: African American patients per JNC8 Hypertension Guidelines should be
his salt intake, eating a DASH (Dietary Approaches to Stop managed with a dihydropyridine calcium channel blocker such as amlodipine
Hypertension) diet, and exercising more, but his blood (Norvasc) as first line management therapy for hypertension not at goal with DASH
pressure is still elevated. Which is the BEST medication to and lifestyle modifications.
prescribe him?
Your patient has been diagnosed with a 4.5cm ascending CT angiography of the chest
aortic aneurysm. Which medical imaging is considered Rationale: CT angiography is considered the standard of care for measuring
standard of care for serial surveillance? vascular luminal dimensions with contrast. CT PE protocol is not timed properly for
the aorta (it's timed for the pulmonary artery). Although a plain film is able to catch
large aneurysms at times, they are not able to provide multi-axis reconstruction
needed to accurately measure the size. Transesophageal echo is not needed to
accurately measure the aorta and requires the patient to undergo sedation which is
unnecessary.
Which of the following medications does not cause beta 1 phenylephrine
stimulation? Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all
have beta receptor activity.
A 50-year-old woman with a history of hypertension Congestive heart failure
presents with dyspnea on exertion and orthopnea. On Rationale: Of the available options, the most accurate response is congestive heart
examination, she has jugular venous distention and failure as it is signifying both a right ventricular back up with jugular venous
bilateral crackles on lung auscultation. What is the most extension and crackles on lung assault, which are suggestive of left ventricular back
likely diagnosis? up. it is possible the patient may have an acute myocardial infarction that
precipitated this, however, a patient has not described that, rather is only describing
dyspnea on exertion and orthopnea, which both speak to a state of fluid overload.
The only appropriate response of these available is congestive heart failure.
Your patient with a history of HFrEF (heart failure with Ordering a transthoracic echocardiogram and order a Lifevest if EF is less than 35%
reduced ejection fraction) with an ejection fraction of 40% Rationale: The patient should have a protective mechanism such as an implantable
who is also not on optimal medical therapy has been automated cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 35%
diagnosed with a myocardial infarction this admission and due to the increased risk of sudden cardiac death with low EF states. Since most
received emergent placement of a drug-eluting stent to the patients are not eligible for 90 days for an AICD in this state, optimizing their
left anterior descending artery. As the medical home who medication regimen and repeating an echo in 2-3 months to re-evaluate for
will manage this patient after discharge, which medication improvement in their EF is required by most insurance companies. A baseline echo
strategy would you expect to be a priority in the patient's is needed at discharge to provide a baseline for improvement vs their repeat echo in
care? 2-3 months.
Dual anti-platelet therapy is required for 12 months minimum post-MI.
A Holter monitor does not provide any conceivable benefit for this patient as
presented.
Which of the following people groups represent the least Caucasians
risk of cardiac disease? Rationale: Statistically African Americans, Native Hawaiians, and American Indians
are at at increased risk of cardiac disease due to higher rates of hypertension,
diabetes, and obesity than Caucasians.
, CEA Prep Full Practice Exam
A 65-year-old woman presents for a follow-up examination. a statin drug.
She is a smoker, and her hypertension is now adequately Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be
controlled with medication. Her mother died at age 40 from useful in reducing ASVD risk, but for a patient who is an active smoker with
a heart attack. The fasting lipid profile shows cholesterol = premature coronary disease history (less than age 65 for women), has hypertension
240 mg/dL, HDL = 30, and LDL = 200. In addition to and is far from an LDL goal, this patient is most certainly a candidate for statin
starting therapeutic lifestyle changes, the nurse practitioner therapy, which represents the most aggressive therapy option of these four listed.
should start the patient on:
Which of the following end-organ sequelae is not directly Peripheral neuropathy
caused by uncontrolled hypertension? Ratioanle: Although patients with hypertension frequently have peripheral
neuropathy, it is only directly attributed to patients who are also diabetic and is
commonly found in non-hypertensive diabetic patients. Proteinuria, AV nicking, and
hemorrhagic stroke are all caused by uncontrolled hypertension.
Preventive cardiac care should focus primarily on Genetic predisposition
addressing all the following except? Rationale: Smoking cessation, exercise, and medication compliance all represent
modifiable risk factors and should be the focus of preventive care. Non-modifiable
risk factors such as age, gender, genetic/family history should not be the primary
focus of prevention.
A 33-year-old woman presents with irregular menstrual Oral contraceptives
cycles, hirsutism, and obesity. Laboratory tests reveal Rationale: These are classic symptoms of polycystic ovarian syndrome and the
elevated serum testosterone and LH ratio > 2:1. What is patient should be treated with oral contraceptives to help stabilize their estrogen
the most appropriate initial treatment? and progesterone. Additionally, they may be managed on metformin and/or
spironolactone for their PCOS.
Oral contraceptive pills (OCPs) are often the first pharmacological treatment for
polycystic ovary syndrome (PCOS) because they help manage in several ways:
Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods
lighter and more regular. This is important because irregular ovulation can lead to
endometrial hyperplasia, which is a buildup of uterine tissue that can increase the
risk of uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex
hormone-binding globulin (SHBG), which binds androgens. This can help reduce
symptoms like acne, hirsutism (unwanted body and facial hair), and androgenic
alopecia (male pattern baldness).
Endometrium protection: OCPs can protect the endometrium by ensuring regular
ovulation
A 50-year-old woman with hypertension and diabetes Urine dipstick for protein
comes in for a routine check-up. What screening test Rationale: The most sensitive indicator of diabetic nephropathy would be the
should be regularly performed to monitor for early signs of evidence of small proteins in the urine (proteinuria) as found on urinalysis. The
diabetic nephropathy? other options might describe macro-organ function (such as BUN/Creat from a BMP,
a renal biopsy which is not indicated for routine diabetic nephropathy testing, and a
Abd CT, which is more akin to evaluation of less subtle findings), but at the
functional level of the nephron, namely the glomerulus, evidence of glucose-related
damage is easily identified with proteinuria from a UA.
Which of the following is at highest risk for DMII? An adult woman with a BMI of 27 who just delivered a baby weighing 9 1/2 lbs
Rationale: Of these options, an adult woman with a BMI of 27 who just delivered a
baby weighing 9 1/2 lbs is the most likely due to their increased BMI and the large
size of the baby. giving birth to a large baby, also known as a large-for-gestational-
age (LGA) baby, can increase the risk of developing type 2 diabetes later in life.
Women who give birth to a LGA baby are 10% more likely to develop DMII 10-14
years after pregnancy compared to women who give birth to babies of average
gestational age (AGA). This increased risk is even after adjusting for other risk
factors, such as age, obesity, high blood pressure, and family history of diabetes.
A starting dose for a elderly adult patient with a BMI of 20 25 mcg
needing levothryoxine Rationale: The widely considered best practice for treatment of hypothyroidism in
the elderly is to "go slow and start low". 25 mcg is the most appropriate low dose to
start with of these options. It is possible that over time the dose will be increased
until therapeutic levels are obtained, but the risk of over-dosing the patient
outweighs the desire to quickly achieve this state.
, CEA Prep Full Practice Exam
An adult female who recently returned for a recheck Triiodothyronine (T3) and free thyroxine (FT4)
appointment. The only remarkable laboratory result is for Rationale: Remember that a patient with low TSH is suspicious of hyperthyroidism
thyroid-stimulating hormone (TSH), at 0.3 microunits/mL with a corresponding finding of elevated T3/T4 and clinical symptoms of a goiter,
(normal = 0.4-6 microunits/mL). The patient reports that tremulousness, anxiety, palpitations, weight loss, insomnia, diarrhea, etc. This
her neck hurts; examination reveals thyroid tenderness. patient is describing a sore neck as well, which is suggestive of Graves disease
Which of the following laboratory tests should the nurse (hyperthyroid state).
practitioner order now?
All the following are symptoms of hypocalcemia except: Visual field deficits
Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All other
are symptoms related to hypocalcemia.
An adult patient diagnosed with type 2 diabetes mellitus 6 months.
presents for a recheck. The patient follows a carbohydrate Rationale: Based off of the ADA recommendation, this patient should be evaluated
counting diet and walks 30 minutes 5 times weekly. in six months. They are actually showing good control and excellent compliance
Current fasting blood glucose = 116 mg/dL [normal = less with diet and exercise management strategies. If there compliance was worse or
than 99 mg/dL] and A1c = 6.3% [normal = less than 7.0%]. they were not controlled with their A1c, this would likely be a three month follow up.
In accordance with the American Diabetes Association, the
nurse practitioner would recommend that the next follow-
up appointment be scheduled for:
Your patient has a diagnosis of Hashimoto's and is on Increase Levothyroxine to 100 mcg daily
Levothyroxine 75 mcg daily. Her recent TSH was elevated Rationale: When the TSH is elevated the patient needs more thyroid hormone.
at 15 uU/mL. Your next best action is to: Once diagnosed with Hashimoto's there is no clinical need/benefit to repeating anti
bodies.
A patient has a 3 cm pituitary mass noted on CT. What is Screen for hormone deficiencies
your next step in evaluating the patient? Rationale: Initial work up includes hormone testing. Cabergoline is the treatment for
prolactinoma. Surgery consult is indicated when there are VF deficits and/or
abutment/compression on optic nerves or chiasm or if adenoma is hyperfunctioning.
Adenomas >1 cm with no VF deficit or abutment/compression of optic nerves or
chiasm require a follow up MRI at 6 months.
An adult female presents with a chief complaint of fatigue Dry skin, bradycardia, and hypoactive deep tendon reflexes
and weight gain. She states that she doesn't feel like Rationale: Dry skin, bradycardia, and hypoactive deep tendon reflexes are all fairly
herself. A diagnosis of hypothyroidism is suspected. Which classic signs of hypothyroidism. To further substantiate these concerns, the patient
of the following physical findings would support this should have their TSH and T3 and Free T4 checked, and it is likely their TSH would
diagnosis? be elevated, T3/T4 low.
An older adult patient with new onset GERD, cough, Antacid and lifestyle modification/weight loss
heartburn. Initial tx 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 Pancreatic cancer
pain, jaundice, and weight loss which he has not been Raionale: Pancreatic cancer, the most typically presentation includes abdominal
trying to lose weight. What would be a malignancy pain, jaundice, and weight loss. Although weight loss and abdominal pain may be
associated with these symptoms? 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 All are reasonable options
bleed. He reports passing frank small amounts of blood Rationale: This patient has had blood loss and should first be hemodynamically
several times today. He denies any use of NSAID's or stable, and fluid/blood product resuscitated. In all cases of GI bleed risk factors for
blood thinners. What must be taken into consideration an upper GI bleed must be taken into consideration first, we must always discuss
before performing a colonoscopy on this patient? 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 ESR, fecal occult, Stool culture
diarrhea. Patient reports 3-4 loose stools a day. She also Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to
reports mild cramping. Which labs would be helpful in determine the potential cause of her symptoms.
further workup of a diagnosis?
, CEA Prep Full Practice Exam
An adult female presents with a 1-week history of left lower CT scan of the abdomen
quadrant abdominal pain. T=101.2 degrees F. (38.4 Rationale: For patients with acute diverticulitis, CT of the abdomen will provide
degrees C) and an elevated WBC count. This is the evidence of the pathophysiology. Evidence of diverticula will be present on a flat
patient's first episode of severe abdominal pain. The nurse plate KUB x-ray, but there is not enough specificity to show that it is inflamed as
practitioner suspects diverticulitis. Which of the following with a CT scan.
diagnostic tests would confirm the diagnosis?
A 70-year-old patient presents to the clinic with dyspnea, Send to the emergency room.
palpitations, and fatigue. The patient reports a 2-week Rationale: This patient is experiencing a GI bleed and is in need of emergency
history of blackened stools, which the patient attributes to treatment due to their considerably low hemoglobin.
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?
An older adult has a follow-up fasting lipid panel 6 months Liver transaminase (AST and ALT) levels
after making therapeutic lifestyle changes. LDL=205mg/dL Rationale: Due to the potential liver function test elevation found with statin use,
(Normal=<100mg/dL), HDL=44mg/dL, and LFTs of AST/ALT should be checked routinely after initiation of therapy
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?
A 56-year-old male on your service has been diagnosed Surgery
with colon cancer which is localized. What is the primary Rationale: Surgery is the only curative modality for localized colon cancers. Patients
management that you should expect to prepare your with progressive/metastatic disease may require chemotherapy/radiation.
patient for?
A 28-year-old woman presents with abdominal pain, Ulcerative colitis
diarrhea, and weight loss. She also reports occasional Rationale: The presence of inflammatory bowel disease which is present in the
bloody stools. Colonoscopy reveals continuous patient with bloody stool suggests ulcerative colitis. This patient should be acutely
inflammation from the rectum extending proximally. What managed with steroids and chronically with auto-immune therapy such as biologics
is the most likely diagnosis? and/or DMARDs.
A 63-year-old male presents with a suspected lower GI All these questions would help determine if this bleed was associated with a
bleed. He reports passing frank small amounts of blood potential diverticular bleed (typically painless), painful bowel movement associated
several times today. He denies use of NSAID's or blood with IBD (UC/Crohn's), and changes in bowel habit/colonoscopy risk for malignancy.
thinners. What questions would be important to ask to
further differentiate your diagnosis?
Which is best performed to assess the risk for fall in an 88- Get up and go test
year old adult? 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 Decreased bowel muscle tone
the following normal physiologic changes seen with aging Rationale: The frail, elderly patient will typically have their GI track decrease bile
is the most likely cause? 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 explains loss of appetite is common at the end of life
has been refusing meals, opting instead for ice cream only. Rationale: Death is an uncomfortable topic, and must be handled tactfully. Factual
The family is concerned about the patient not getting re-orientation to the terminal state of a patient's condition may be appropriate when
enough nutrition. The NP: 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.
The patient is exhibiting a productive cough and a low- Left upper lobe lingula
grade fever. Chest X-ray on PA view shows a left lower Ratonale: Lingular consolidation is described in this question precisely. If the
chest area of consolidation adjacent to the left border of cardiac margin/silhouette is obliterated by the mass, the lesion is either right middle
the heart approximately 2 rib spaces above the lobe or left upper lobe lingula.
costophrenic angle. The lateral x-ray view shows this
lesion absent of the window posterior to the cardiac
silhouette. Which is the most likely location of this area of
focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe
The inability to fully relax the myocardium during relaxation Diastolic dysfunction
is a trademark of which of the following diagnoses? Rationale: The inability for the heart to relax is a trademark of the diagnosis of
diastolic dysfunction and is common in patients with thickened hypertrophic
myocardium.
An otherwise healthy African American adult male has Calcium channel blocker
been diagnosed with hypertension. He has been restricting Rationale: African American patients per JNC8 Hypertension Guidelines should be
his salt intake, eating a DASH (Dietary Approaches to Stop managed with a dihydropyridine calcium channel blocker such as amlodipine
Hypertension) diet, and exercising more, but his blood (Norvasc) as first line management therapy for hypertension not at goal with DASH
pressure is still elevated. Which is the BEST medication to and lifestyle modifications.
prescribe him?
Your patient has been diagnosed with a 4.5cm ascending CT angiography of the chest
aortic aneurysm. Which medical imaging is considered Rationale: CT angiography is considered the standard of care for measuring
standard of care for serial surveillance? vascular luminal dimensions with contrast. CT PE protocol is not timed properly for
the aorta (it's timed for the pulmonary artery). Although a plain film is able to catch
large aneurysms at times, they are not able to provide multi-axis reconstruction
needed to accurately measure the size. Transesophageal echo is not needed to
accurately measure the aorta and requires the patient to undergo sedation which is
unnecessary.
Which of the following medications does not cause beta 1 phenylephrine
stimulation? Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all
have beta receptor activity.
A 50-year-old woman with a history of hypertension Congestive heart failure
presents with dyspnea on exertion and orthopnea. On Rationale: Of the available options, the most accurate response is congestive heart
examination, she has jugular venous distention and failure as it is signifying both a right ventricular back up with jugular venous
bilateral crackles on lung auscultation. What is the most extension and crackles on lung assault, which are suggestive of left ventricular back
likely diagnosis? up. it is possible the patient may have an acute myocardial infarction that
precipitated this, however, a patient has not described that, rather is only describing
dyspnea on exertion and orthopnea, which both speak to a state of fluid overload.
The only appropriate response of these available is congestive heart failure.
Your patient with a history of HFrEF (heart failure with Ordering a transthoracic echocardiogram and order a Lifevest if EF is less than 35%
reduced ejection fraction) with an ejection fraction of 40% Rationale: The patient should have a protective mechanism such as an implantable
who is also not on optimal medical therapy has been automated cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 35%
diagnosed with a myocardial infarction this admission and due to the increased risk of sudden cardiac death with low EF states. Since most
received emergent placement of a drug-eluting stent to the patients are not eligible for 90 days for an AICD in this state, optimizing their
left anterior descending artery. As the medical home who medication regimen and repeating an echo in 2-3 months to re-evaluate for
will manage this patient after discharge, which medication improvement in their EF is required by most insurance companies. A baseline echo
strategy would you expect to be a priority in the patient's is needed at discharge to provide a baseline for improvement vs their repeat echo in
care? 2-3 months.
Dual anti-platelet therapy is required for 12 months minimum post-MI.
A Holter monitor does not provide any conceivable benefit for this patient as
presented.
Which of the following people groups represent the least Caucasians
risk of cardiac disease? Rationale: Statistically African Americans, Native Hawaiians, and American Indians
are at at increased risk of cardiac disease due to higher rates of hypertension,
diabetes, and obesity than Caucasians.
, CEA Prep Full Practice Exam
A 65-year-old woman presents for a follow-up examination. a statin drug.
She is a smoker, and her hypertension is now adequately Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be
controlled with medication. Her mother died at age 40 from useful in reducing ASVD risk, but for a patient who is an active smoker with
a heart attack. The fasting lipid profile shows cholesterol = premature coronary disease history (less than age 65 for women), has hypertension
240 mg/dL, HDL = 30, and LDL = 200. In addition to and is far from an LDL goal, this patient is most certainly a candidate for statin
starting therapeutic lifestyle changes, the nurse practitioner therapy, which represents the most aggressive therapy option of these four listed.
should start the patient on:
Which of the following end-organ sequelae is not directly Peripheral neuropathy
caused by uncontrolled hypertension? Ratioanle: Although patients with hypertension frequently have peripheral
neuropathy, it is only directly attributed to patients who are also diabetic and is
commonly found in non-hypertensive diabetic patients. Proteinuria, AV nicking, and
hemorrhagic stroke are all caused by uncontrolled hypertension.
Preventive cardiac care should focus primarily on Genetic predisposition
addressing all the following except? Rationale: Smoking cessation, exercise, and medication compliance all represent
modifiable risk factors and should be the focus of preventive care. Non-modifiable
risk factors such as age, gender, genetic/family history should not be the primary
focus of prevention.
A 33-year-old woman presents with irregular menstrual Oral contraceptives
cycles, hirsutism, and obesity. Laboratory tests reveal Rationale: These are classic symptoms of polycystic ovarian syndrome and the
elevated serum testosterone and LH ratio > 2:1. What is patient should be treated with oral contraceptives to help stabilize their estrogen
the most appropriate initial treatment? and progesterone. Additionally, they may be managed on metformin and/or
spironolactone for their PCOS.
Oral contraceptive pills (OCPs) are often the first pharmacological treatment for
polycystic ovary syndrome (PCOS) because they help manage in several ways:
Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods
lighter and more regular. This is important because irregular ovulation can lead to
endometrial hyperplasia, which is a buildup of uterine tissue that can increase the
risk of uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex
hormone-binding globulin (SHBG), which binds androgens. This can help reduce
symptoms like acne, hirsutism (unwanted body and facial hair), and androgenic
alopecia (male pattern baldness).
Endometrium protection: OCPs can protect the endometrium by ensuring regular
ovulation
A 50-year-old woman with hypertension and diabetes Urine dipstick for protein
comes in for a routine check-up. What screening test Rationale: The most sensitive indicator of diabetic nephropathy would be the
should be regularly performed to monitor for early signs of evidence of small proteins in the urine (proteinuria) as found on urinalysis. The
diabetic nephropathy? other options might describe macro-organ function (such as BUN/Creat from a BMP,
a renal biopsy which is not indicated for routine diabetic nephropathy testing, and a
Abd CT, which is more akin to evaluation of less subtle findings), but at the
functional level of the nephron, namely the glomerulus, evidence of glucose-related
damage is easily identified with proteinuria from a UA.
Which of the following is at highest risk for DMII? An adult woman with a BMI of 27 who just delivered a baby weighing 9 1/2 lbs
Rationale: Of these options, an adult woman with a BMI of 27 who just delivered a
baby weighing 9 1/2 lbs is the most likely due to their increased BMI and the large
size of the baby. giving birth to a large baby, also known as a large-for-gestational-
age (LGA) baby, can increase the risk of developing type 2 diabetes later in life.
Women who give birth to a LGA baby are 10% more likely to develop DMII 10-14
years after pregnancy compared to women who give birth to babies of average
gestational age (AGA). This increased risk is even after adjusting for other risk
factors, such as age, obesity, high blood pressure, and family history of diabetes.
A starting dose for a elderly adult patient with a BMI of 20 25 mcg
needing levothryoxine Rationale: The widely considered best practice for treatment of hypothyroidism in
the elderly is to "go slow and start low". 25 mcg is the most appropriate low dose to
start with of these options. It is possible that over time the dose will be increased
until therapeutic levels are obtained, but the risk of over-dosing the patient
outweighs the desire to quickly achieve this state.
, CEA Prep Full Practice Exam
An adult female who recently returned for a recheck Triiodothyronine (T3) and free thyroxine (FT4)
appointment. The only remarkable laboratory result is for Rationale: Remember that a patient with low TSH is suspicious of hyperthyroidism
thyroid-stimulating hormone (TSH), at 0.3 microunits/mL with a corresponding finding of elevated T3/T4 and clinical symptoms of a goiter,
(normal = 0.4-6 microunits/mL). The patient reports that tremulousness, anxiety, palpitations, weight loss, insomnia, diarrhea, etc. This
her neck hurts; examination reveals thyroid tenderness. patient is describing a sore neck as well, which is suggestive of Graves disease
Which of the following laboratory tests should the nurse (hyperthyroid state).
practitioner order now?
All the following are symptoms of hypocalcemia except: Visual field deficits
Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All other
are symptoms related to hypocalcemia.
An adult patient diagnosed with type 2 diabetes mellitus 6 months.
presents for a recheck. The patient follows a carbohydrate Rationale: Based off of the ADA recommendation, this patient should be evaluated
counting diet and walks 30 minutes 5 times weekly. in six months. They are actually showing good control and excellent compliance
Current fasting blood glucose = 116 mg/dL [normal = less with diet and exercise management strategies. If there compliance was worse or
than 99 mg/dL] and A1c = 6.3% [normal = less than 7.0%]. they were not controlled with their A1c, this would likely be a three month follow up.
In accordance with the American Diabetes Association, the
nurse practitioner would recommend that the next follow-
up appointment be scheduled for:
Your patient has a diagnosis of Hashimoto's and is on Increase Levothyroxine to 100 mcg daily
Levothyroxine 75 mcg daily. Her recent TSH was elevated Rationale: When the TSH is elevated the patient needs more thyroid hormone.
at 15 uU/mL. Your next best action is to: Once diagnosed with Hashimoto's there is no clinical need/benefit to repeating anti
bodies.
A patient has a 3 cm pituitary mass noted on CT. What is Screen for hormone deficiencies
your next step in evaluating the patient? Rationale: Initial work up includes hormone testing. Cabergoline is the treatment for
prolactinoma. Surgery consult is indicated when there are VF deficits and/or
abutment/compression on optic nerves or chiasm or if adenoma is hyperfunctioning.
Adenomas >1 cm with no VF deficit or abutment/compression of optic nerves or
chiasm require a follow up MRI at 6 months.
An adult female presents with a chief complaint of fatigue Dry skin, bradycardia, and hypoactive deep tendon reflexes
and weight gain. She states that she doesn't feel like Rationale: Dry skin, bradycardia, and hypoactive deep tendon reflexes are all fairly
herself. A diagnosis of hypothyroidism is suspected. Which classic signs of hypothyroidism. To further substantiate these concerns, the patient
of the following physical findings would support this should have their TSH and T3 and Free T4 checked, and it is likely their TSH would
diagnosis? be elevated, T3/T4 low.
An older adult patient with new onset GERD, cough, Antacid and lifestyle modification/weight loss
heartburn. Initial tx 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 Pancreatic cancer
pain, jaundice, and weight loss which he has not been Raionale: Pancreatic cancer, the most typically presentation includes abdominal
trying to lose weight. What would be a malignancy pain, jaundice, and weight loss. Although weight loss and abdominal pain may be
associated with these symptoms? 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 All are reasonable options
bleed. He reports passing frank small amounts of blood Rationale: This patient has had blood loss and should first be hemodynamically
several times today. He denies any use of NSAID's or stable, and fluid/blood product resuscitated. In all cases of GI bleed risk factors for
blood thinners. What must be taken into consideration an upper GI bleed must be taken into consideration first, we must always discuss
before performing a colonoscopy on this patient? 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 ESR, fecal occult, Stool culture
diarrhea. Patient reports 3-4 loose stools a day. She also Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to
reports mild cramping. Which labs would be helpful in determine the potential cause of her symptoms.
further workup of a diagnosis?
, CEA Prep Full Practice Exam
An adult female presents with a 1-week history of left lower CT scan of the abdomen
quadrant abdominal pain. T=101.2 degrees F. (38.4 Rationale: For patients with acute diverticulitis, CT of the abdomen will provide
degrees C) and an elevated WBC count. This is the evidence of the pathophysiology. Evidence of diverticula will be present on a flat
patient's first episode of severe abdominal pain. The nurse plate KUB x-ray, but there is not enough specificity to show that it is inflamed as
practitioner suspects diverticulitis. Which of the following with a CT scan.
diagnostic tests would confirm the diagnosis?
A 70-year-old patient presents to the clinic with dyspnea, Send to the emergency room.
palpitations, and fatigue. The patient reports a 2-week Rationale: This patient is experiencing a GI bleed and is in need of emergency
history of blackened stools, which the patient attributes to treatment due to their considerably low hemoglobin.
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?
An older adult has a follow-up fasting lipid panel 6 months Liver transaminase (AST and ALT) levels
after making therapeutic lifestyle changes. LDL=205mg/dL Rationale: Due to the potential liver function test elevation found with statin use,
(Normal=<100mg/dL), HDL=44mg/dL, and LFTs of AST/ALT should be checked routinely after initiation of therapy
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?
A 56-year-old male on your service has been diagnosed Surgery
with colon cancer which is localized. What is the primary Rationale: Surgery is the only curative modality for localized colon cancers. Patients
management that you should expect to prepare your with progressive/metastatic disease may require chemotherapy/radiation.
patient for?
A 28-year-old woman presents with abdominal pain, Ulcerative colitis
diarrhea, and weight loss. She also reports occasional Rationale: The presence of inflammatory bowel disease which is present in the
bloody stools. Colonoscopy reveals continuous patient with bloody stool suggests ulcerative colitis. This patient should be acutely
inflammation from the rectum extending proximally. What managed with steroids and chronically with auto-immune therapy such as biologics
is the most likely diagnosis? and/or DMARDs.
A 63-year-old male presents with a suspected lower GI All these questions would help determine if this bleed was associated with a
bleed. He reports passing frank small amounts of blood potential diverticular bleed (typically painless), painful bowel movement associated
several times today. He denies use of NSAID's or blood with IBD (UC/Crohn's), and changes in bowel habit/colonoscopy risk for malignancy.
thinners. What questions would be important to ask to
further differentiate your diagnosis?
Which is best performed to assess the risk for fall in an 88- Get up and go test
year old adult? 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 Decreased bowel muscle tone
the following normal physiologic changes seen with aging Rationale: The frail, elderly patient will typically have their GI track decrease bile
is the most likely cause? 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 explains loss of appetite is common at the end of life
has been refusing meals, opting instead for ice cream only. Rationale: Death is an uncomfortable topic, and must be handled tactfully. Factual
The family is concerned about the patient not getting re-orientation to the terminal state of a patient's condition may be appropriate when
enough nutrition. The NP: 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.
