NR 603 CEA MIDTERM EXAM REVIEW – ORIGINAL
PRACTICE QUESTIONS AND DETAILED
RATIONALES | ADVANCED CLINICAL DIAGNOSIS
AND PRACTICE ACROSS THE LIFESPAN | 100
ORIGINAL STUDY QUESTIONS
Core Domains
• Cardiovascular Disorders and Pharmacologic Management
• Respiratory Disorders and Airway Management
• Endocrine Disorders and Metabolic Emergencies
• Gastrointestinal and Hepatic Disorders
• Renal Disorders and Electrolyte Imbalances
• Hematologic Disorders and Coagulation
• Musculoskeletal and Rheumatologic Disorders
• Neurologic and Psychiatric Disorders
• Infectious Disease and Antimicrobial Stewardship
• Professional Practice, Ethics, and Billing
Introduction
This practice examination assesses advanced practice nursing knowledge across
the lifespan, emphasizing differential diagnosis, clinical decision-making, and
evidence-based management of acute and chronic conditions. The examination
evaluates competency in cardiovascular, respiratory, endocrine, renal,
gastrointestinal, hematologic, musculoskeletal, and neurologic disorders, as well
as professional practice standards. Questions are structured as clinical vignettes
requiring application of diagnostic reasoning and therapeutic principles. Emphasis
is placed on prioritization, patient safety, pharmacologic selection, and the
independent and collaborative decision-making required of the advanced practice
registered nurse in primary and acute care settings.
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male with a history of heart failure with reduced ejection
fraction (HFrEF) presents with worsening dyspnea and lower extremity edema.
His current medications include lisinopril, carvedilol, and furosemide. Which
,additional medication class has the strongest evidence for reducing mortality
in HFrEF?
A. Calcium channel blocker
B. Mineralocorticoid receptor antagonist
C. Loop diuretic
D. Digoxin
B. Mineralocorticoid receptor antagonist
RATIONALE: Mineralocorticoid receptor antagonists (spironolactone,
eplerenone) reduce mortality and hospitalization in HFrEF when added to standard
therapy. Calcium channel blockers are generally avoided, loop diuretics provide
symptomatic relief without mortality benefit, and digoxin reduces hospitalizations
but not mortality.
2. A 55-year-old female presents with fatigue, cold intolerance, weight gain,
and constipation. TSH is elevated and free T4 is low. Which condition is most
likely?
A. Hyperthyroidism
B. Primary hypothyroidism
C. Central hypothyroidism
D. Subclinical hypothyroidism
B. Primary hypothyroidism
RATIONALE: Elevated TSH with low free T4 is diagnostic of primary
hypothyroidism. In central hypothyroidism, TSH would be low or inappropriately
normal. Subclinical hypothyroidism has elevated TSH with normal free T4.
3. A 72-year-old male with COPD presents with increased dyspnea, increased
sputum production, and change in sputum color. Which intervention is most
appropriate initially?
A. Increase maintenance bronchodilator dose only
B. Initiate systemic corticosteroids and antibiotics
C. Start long-term oxygen therapy
D. Begin scheduled nebulized albuterol only
B. Initiate systemic corticosteroids and antibiotics
RATIONALE: This presentation suggests an acute exacerbation of COPD with
possible bacterial infection. Guidelines recommend systemic corticosteroids and
antibiotics when there is increased sputum purulence. Oxygen therapy is indicated
for hypoxemia but not as the primary intervention for exacerbation.
, 4. A 45-year-old female presents with a blood pressure of 158/98 mmHg on
two separate occasions. She has no other cardiovascular risk factors.
According to the 2017 ACC/AHA guidelines, which classification is correct?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 1 hypertension
D. Stage 2 hypertension
D. Stage 2 hypertension
RATIONALE: Stage 2 hypertension is defined as systolic ≥140 mmHg or
diastolic ≥90 mmHg. Stage 1 is 130–139/80–89. Elevated is 120–129/<80.
5. A 60-year-old male with type 2 diabetes has an HbA1c of 9.2% on metformin
monotherapy. Which medication class should be added for its cardiovascular
and renal benefits?
A. Sulfonylurea
B. SGLT2 inhibitor
C. Insulin
D. DPP-4 inhibitor
B. SGLT2 inhibitor
RATIONALE: SGLT2 inhibitors (empagliflozin, dapagliflozin) have demonstrated
cardiovascular and renal protective effects in patients with type 2 diabetes.
Sulfonylureas and DPP-4 inhibitors do not have this benefit.
6. A 28-year-old female presents with palpitations and heat intolerance. TSH is
suppressed and free T4 is elevated. Which medication is first-line for symptom
control?
A. Levothyroxine
B. Methimazole
C. Propranolol
D. Radioactive iodine
C. Propranolol
RATIONALE: Beta-blockers such as propranolol provide rapid symptomatic
relief of adrenergic symptoms (palpitations, tremor, anxiety) in hyperthyroidism.
Methimazole and radioactive iodine address the underlying thyroid dysfunction but
take weeks to work.
PRACTICE QUESTIONS AND DETAILED
RATIONALES | ADVANCED CLINICAL DIAGNOSIS
AND PRACTICE ACROSS THE LIFESPAN | 100
ORIGINAL STUDY QUESTIONS
Core Domains
• Cardiovascular Disorders and Pharmacologic Management
• Respiratory Disorders and Airway Management
• Endocrine Disorders and Metabolic Emergencies
• Gastrointestinal and Hepatic Disorders
• Renal Disorders and Electrolyte Imbalances
• Hematologic Disorders and Coagulation
• Musculoskeletal and Rheumatologic Disorders
• Neurologic and Psychiatric Disorders
• Infectious Disease and Antimicrobial Stewardship
• Professional Practice, Ethics, and Billing
Introduction
This practice examination assesses advanced practice nursing knowledge across
the lifespan, emphasizing differential diagnosis, clinical decision-making, and
evidence-based management of acute and chronic conditions. The examination
evaluates competency in cardiovascular, respiratory, endocrine, renal,
gastrointestinal, hematologic, musculoskeletal, and neurologic disorders, as well
as professional practice standards. Questions are structured as clinical vignettes
requiring application of diagnostic reasoning and therapeutic principles. Emphasis
is placed on prioritization, patient safety, pharmacologic selection, and the
independent and collaborative decision-making required of the advanced practice
registered nurse in primary and acute care settings.
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male with a history of heart failure with reduced ejection
fraction (HFrEF) presents with worsening dyspnea and lower extremity edema.
His current medications include lisinopril, carvedilol, and furosemide. Which
,additional medication class has the strongest evidence for reducing mortality
in HFrEF?
A. Calcium channel blocker
B. Mineralocorticoid receptor antagonist
C. Loop diuretic
D. Digoxin
B. Mineralocorticoid receptor antagonist
RATIONALE: Mineralocorticoid receptor antagonists (spironolactone,
eplerenone) reduce mortality and hospitalization in HFrEF when added to standard
therapy. Calcium channel blockers are generally avoided, loop diuretics provide
symptomatic relief without mortality benefit, and digoxin reduces hospitalizations
but not mortality.
2. A 55-year-old female presents with fatigue, cold intolerance, weight gain,
and constipation. TSH is elevated and free T4 is low. Which condition is most
likely?
A. Hyperthyroidism
B. Primary hypothyroidism
C. Central hypothyroidism
D. Subclinical hypothyroidism
B. Primary hypothyroidism
RATIONALE: Elevated TSH with low free T4 is diagnostic of primary
hypothyroidism. In central hypothyroidism, TSH would be low or inappropriately
normal. Subclinical hypothyroidism has elevated TSH with normal free T4.
3. A 72-year-old male with COPD presents with increased dyspnea, increased
sputum production, and change in sputum color. Which intervention is most
appropriate initially?
A. Increase maintenance bronchodilator dose only
B. Initiate systemic corticosteroids and antibiotics
C. Start long-term oxygen therapy
D. Begin scheduled nebulized albuterol only
B. Initiate systemic corticosteroids and antibiotics
RATIONALE: This presentation suggests an acute exacerbation of COPD with
possible bacterial infection. Guidelines recommend systemic corticosteroids and
antibiotics when there is increased sputum purulence. Oxygen therapy is indicated
for hypoxemia but not as the primary intervention for exacerbation.
, 4. A 45-year-old female presents with a blood pressure of 158/98 mmHg on
two separate occasions. She has no other cardiovascular risk factors.
According to the 2017 ACC/AHA guidelines, which classification is correct?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 1 hypertension
D. Stage 2 hypertension
D. Stage 2 hypertension
RATIONALE: Stage 2 hypertension is defined as systolic ≥140 mmHg or
diastolic ≥90 mmHg. Stage 1 is 130–139/80–89. Elevated is 120–129/<80.
5. A 60-year-old male with type 2 diabetes has an HbA1c of 9.2% on metformin
monotherapy. Which medication class should be added for its cardiovascular
and renal benefits?
A. Sulfonylurea
B. SGLT2 inhibitor
C. Insulin
D. DPP-4 inhibitor
B. SGLT2 inhibitor
RATIONALE: SGLT2 inhibitors (empagliflozin, dapagliflozin) have demonstrated
cardiovascular and renal protective effects in patients with type 2 diabetes.
Sulfonylureas and DPP-4 inhibitors do not have this benefit.
6. A 28-year-old female presents with palpitations and heat intolerance. TSH is
suppressed and free T4 is elevated. Which medication is first-line for symptom
control?
A. Levothyroxine
B. Methimazole
C. Propranolol
D. Radioactive iodine
C. Propranolol
RATIONALE: Beta-blockers such as propranolol provide rapid symptomatic
relief of adrenergic symptoms (palpitations, tremor, anxiety) in hyperthyroidism.
Methimazole and radioactive iodine address the underlying thyroid dysfunction but
take weeks to work.
