COMLEX LEVEL 2 CE EXAM ACTUAL 2026/2027 TEST BANK,
COMPREHENSIVE HIGH YIELD PRACTICE QUESTIONS AND STUDY GUIDE
COMPLETE ACCURATE EXAM
1. A 54-year-old man with hypertension, hyperlipidemia, and a 40-pack-year
smoking history presents with 90 minutes of substernal chest pressure
radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads II, III, and aVF with reciprocal depression in leads I and
aVL. He is hypotensive, has clear lungs, and jugular venous distention.
Which intervention is most appropriate immediately after aspirin
administration?
A. Intravenous nitroglycerin
B. Intravenous normal saline bolus
C. Intravenous furosemide
D. Immediate beta-blocker administration
Answer: B
2. A 23-year-old woman presents with acute right lower-quadrant abdominal
pain, nausea, and anorexia. She has a low-grade fever and tenderness at
McBurney point. Pregnancy testing is negative. CT confirms uncomplicated
acute appendicitis. Which organism is most important to cover when
empiric antimicrobial therapy is initiated before surgery?
A. Clostridioides difficile
B. Mycoplasma pneumoniae
C. Neisseria meningitidis
D. Escherichia coli and anaerobic organisms
Answer: D
3. A 67-year-old man with chronic obstructive pulmonary disease presents
with worsening dyspnea, increased sputum production, and purulent
sputum for 3 days. He is using accessory muscles and has diffuse expiratory
wheezing. Oxygen saturation is 84% on room air. Which initial oxygenation
strategy is most appropriate?
A. Controlled supplemental oxygen targeting an oxygen saturation of
pg. 1
, approximately 88%–92%
B. Immediate intubation regardless of response to initial therapy
C. High-flow oxygen targeting an oxygen saturation of 100%
D. No supplemental oxygen because hyperoxia is contraindicated
Answer: A
4. A 31-year-old woman presents with sudden severe unilateral pelvic pain
accompanied by nausea and vomiting. Ultrasound demonstrates an
enlarged ovary with peripheral follicles and reduced venous flow. She has
no fever and pregnancy testing is negative. Which diagnosis best explains
the presentation?
A. Pelvic inflammatory disease
B. Ruptured hemorrhagic cyst
C. Ovarian torsion
D. Endometriosis
Answer: C
5. A 72-year-old man develops sudden right-sided weakness and expressive
aphasia 90 minutes after symptom onset. Noncontrast head CT shows no
hemorrhage. Blood pressure is 174/96 mm Hg, glucose is normal, and there
are no contraindications to thrombolysis. Which treatment should be
considered first?
A. Intravenous alteplase or another appropriate IV thrombolytic agent
within the treatment window
B. Aspirin only because thrombolysis is contraindicated by the blood
pressure
C. Immediate warfarin administration
D. Emergent carotid endarterectomy before reperfusion therapy
Answer: A
6. A 28-year-old pregnant woman at 34 weeks presents with severe headache,
visual disturbances, blood pressure of 172/112 mm Hg, and right upper-
quadrant abdominal pain. Laboratory testing demonstrates
thrombocytopenia and elevated AST and ALT levels. Which medication is
pg. 2
, most appropriate for seizure prophylaxis?
A. Phenytoin
B. Magnesium sulfate
C. Levetiracetam
D. Valproic acid
Answer: B
7. A 45-year-old woman has progressive fatigue, cold intolerance,
constipation, weight gain, and dry skin. Laboratory studies show an elevated
TSH and decreased free T4. She has no cardiac disease and is not pregnant.
Which treatment is most appropriate?
A. Methimazole
B. Propranolol
C. Radioactive iodine
D. Levothyroxine
Answer: D
8. A 60-year-old man with a 50-pack-year smoking history presents with
painless gross hematuria. Urinalysis confirms numerous red blood cells
without evidence of infection. Which diagnosis must be excluded most
urgently?
A. Bladder urothelial carcinoma
B. IgA nephropathy
C. Nephrolithiasis
D. Benign prostatic hyperplasia
Answer: A
9. A 19-year-old college student develops fever, severe headache,
photophobia, neck stiffness, and a petechial rash. Lumbar puncture is
delayed because of concern for increased intracranial pressure. Which
empiric regimen is most appropriate while diagnostic evaluation proceeds?
A. Oral amoxicillin alone
B. Intravenous vancomycin plus an appropriate third-generation
cephalosporin
pg. 3
, C. Intravenous acyclovir alone
D. Oral doxycycline
Answer: B
10. A 36-year-old woman with recurrent episodes of palpitations has a regular
narrow-complex tachycardia at 190/min. She is alert with normal blood
pressure and no chest pain. Vagal maneuvers are unsuccessful. Which
medication is most appropriate for acute termination?
A. Lidocaine
B. Amiodarone
C. Adenosine
D. Digoxin
Answer: C
11. A 64-year-old man with atrial fibrillation has an irregularly irregular rhythm
at 150/min and develops hypotension, altered mental status, and chest
discomfort. Which intervention is most appropriate?
A. Immediate synchronized cardioversion
B. Oral metoprolol and outpatient follow-up
C. Intravenous adenosine
D. Intravenous magnesium only
Answer: A
12. A 48-year-old woman presents with severe epigastric pain radiating to the
back and persistent vomiting. Lipase is markedly elevated, and CT confirms
acute pancreatitis. She is hypotensive and tachycardic. Which initial
management strategy is most appropriate?
A. Immediate exploratory laparotomy
B. Aggressive early intravenous crystalloid resuscitation and supportive care
C. Routine prophylactic antibiotics for all cases
D. Immediate total parenteral nutrition
Answer: B
13. A 7-year-old boy presents with periorbital edema and frothy urine after an
upper respiratory infection. Urinalysis shows heavy proteinuria without
pg. 4
COMPREHENSIVE HIGH YIELD PRACTICE QUESTIONS AND STUDY GUIDE
COMPLETE ACCURATE EXAM
1. A 54-year-old man with hypertension, hyperlipidemia, and a 40-pack-year
smoking history presents with 90 minutes of substernal chest pressure
radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads II, III, and aVF with reciprocal depression in leads I and
aVL. He is hypotensive, has clear lungs, and jugular venous distention.
Which intervention is most appropriate immediately after aspirin
administration?
A. Intravenous nitroglycerin
B. Intravenous normal saline bolus
C. Intravenous furosemide
D. Immediate beta-blocker administration
Answer: B
2. A 23-year-old woman presents with acute right lower-quadrant abdominal
pain, nausea, and anorexia. She has a low-grade fever and tenderness at
McBurney point. Pregnancy testing is negative. CT confirms uncomplicated
acute appendicitis. Which organism is most important to cover when
empiric antimicrobial therapy is initiated before surgery?
A. Clostridioides difficile
B. Mycoplasma pneumoniae
C. Neisseria meningitidis
D. Escherichia coli and anaerobic organisms
Answer: D
3. A 67-year-old man with chronic obstructive pulmonary disease presents
with worsening dyspnea, increased sputum production, and purulent
sputum for 3 days. He is using accessory muscles and has diffuse expiratory
wheezing. Oxygen saturation is 84% on room air. Which initial oxygenation
strategy is most appropriate?
A. Controlled supplemental oxygen targeting an oxygen saturation of
pg. 1
, approximately 88%–92%
B. Immediate intubation regardless of response to initial therapy
C. High-flow oxygen targeting an oxygen saturation of 100%
D. No supplemental oxygen because hyperoxia is contraindicated
Answer: A
4. A 31-year-old woman presents with sudden severe unilateral pelvic pain
accompanied by nausea and vomiting. Ultrasound demonstrates an
enlarged ovary with peripheral follicles and reduced venous flow. She has
no fever and pregnancy testing is negative. Which diagnosis best explains
the presentation?
A. Pelvic inflammatory disease
B. Ruptured hemorrhagic cyst
C. Ovarian torsion
D. Endometriosis
Answer: C
5. A 72-year-old man develops sudden right-sided weakness and expressive
aphasia 90 minutes after symptom onset. Noncontrast head CT shows no
hemorrhage. Blood pressure is 174/96 mm Hg, glucose is normal, and there
are no contraindications to thrombolysis. Which treatment should be
considered first?
A. Intravenous alteplase or another appropriate IV thrombolytic agent
within the treatment window
B. Aspirin only because thrombolysis is contraindicated by the blood
pressure
C. Immediate warfarin administration
D. Emergent carotid endarterectomy before reperfusion therapy
Answer: A
6. A 28-year-old pregnant woman at 34 weeks presents with severe headache,
visual disturbances, blood pressure of 172/112 mm Hg, and right upper-
quadrant abdominal pain. Laboratory testing demonstrates
thrombocytopenia and elevated AST and ALT levels. Which medication is
pg. 2
, most appropriate for seizure prophylaxis?
A. Phenytoin
B. Magnesium sulfate
C. Levetiracetam
D. Valproic acid
Answer: B
7. A 45-year-old woman has progressive fatigue, cold intolerance,
constipation, weight gain, and dry skin. Laboratory studies show an elevated
TSH and decreased free T4. She has no cardiac disease and is not pregnant.
Which treatment is most appropriate?
A. Methimazole
B. Propranolol
C. Radioactive iodine
D. Levothyroxine
Answer: D
8. A 60-year-old man with a 50-pack-year smoking history presents with
painless gross hematuria. Urinalysis confirms numerous red blood cells
without evidence of infection. Which diagnosis must be excluded most
urgently?
A. Bladder urothelial carcinoma
B. IgA nephropathy
C. Nephrolithiasis
D. Benign prostatic hyperplasia
Answer: A
9. A 19-year-old college student develops fever, severe headache,
photophobia, neck stiffness, and a petechial rash. Lumbar puncture is
delayed because of concern for increased intracranial pressure. Which
empiric regimen is most appropriate while diagnostic evaluation proceeds?
A. Oral amoxicillin alone
B. Intravenous vancomycin plus an appropriate third-generation
cephalosporin
pg. 3
, C. Intravenous acyclovir alone
D. Oral doxycycline
Answer: B
10. A 36-year-old woman with recurrent episodes of palpitations has a regular
narrow-complex tachycardia at 190/min. She is alert with normal blood
pressure and no chest pain. Vagal maneuvers are unsuccessful. Which
medication is most appropriate for acute termination?
A. Lidocaine
B. Amiodarone
C. Adenosine
D. Digoxin
Answer: C
11. A 64-year-old man with atrial fibrillation has an irregularly irregular rhythm
at 150/min and develops hypotension, altered mental status, and chest
discomfort. Which intervention is most appropriate?
A. Immediate synchronized cardioversion
B. Oral metoprolol and outpatient follow-up
C. Intravenous adenosine
D. Intravenous magnesium only
Answer: A
12. A 48-year-old woman presents with severe epigastric pain radiating to the
back and persistent vomiting. Lipase is markedly elevated, and CT confirms
acute pancreatitis. She is hypotensive and tachycardic. Which initial
management strategy is most appropriate?
A. Immediate exploratory laparotomy
B. Aggressive early intravenous crystalloid resuscitation and supportive care
C. Routine prophylactic antibiotics for all cases
D. Immediate total parenteral nutrition
Answer: B
13. A 7-year-old boy presents with periorbital edema and frothy urine after an
upper respiratory infection. Urinalysis shows heavy proteinuria without
pg. 4
