NR 668 CEA FINAL EXAM 2026 150
VERIFIED Q and A WITH DETAILED
CLINICAL RATIONALES ADVANCED
PRACTICE NURSING A+ GUARANTEED!
NR 668 CEA Final Exam (2026): Comprehensive
Review of Clinical Evaluation & Assessment in
Advanced Practice Nursing (Questions 1–150)
Question 1
A 45-year-old male presents with a 3-month history of
progressive dysphagia to solids, unintentional weight loss of 15
lbs, and occasional regurgitation. He has a 20-pack-year
smoking history and drinks alcohol socially. On physical
examination, you note supraclavicular lymphadenopathy. What
is the most appropriate next step in management?
A) Prescribe a proton pump inhibitor (PPI) for 8 weeks and
reassess.
B) Perform an upper endoscopy (EGD) with biopsy
immediately.
C) Order a barium swallow study to evaluate for motility
disorders.
D) Refer for esophageal manometry to rule out achalasia.
Correct Answer: B
Rationale: Dysphagia accompanied by "alarm symptoms"
such as unintentional weight loss, age >45-50, and
lymphadenopathy raises high suspicion for esophageal
malignancy. Immediate upper endoscopy with biopsy is
required to visualize the lesion and obtain tissue diagnosis.
,Empiric PPI therapy is inappropriate when alarm features are
present.
Question 2
A 60-year-old female with a history of hypertension and type 2
diabetes presents with sudden onset of right-sided weakness
and aphasia that resolved completely within 45 minutes. Her
CT head is negative for hemorrhage. What is the most likely
diagnosis and immediate priority?
A) Migraine with aura; prescribe sumatriptan.
B) Transient Ischemic Attack (TIA); initiate urgent stroke
workup and secondary prevention.
C) Hypoglycemic episode; administer oral glucose.
D) Bell’s Palsy; start prednisone.
Correct Answer: B
Rationale: A TIA is defined by transient neurological deficits
caused by focal brain ischemia without acute infarction. It is a
medical emergency because it signals a high risk of impending
stroke. The priority is urgent evaluation (MRI, vascular
imaging, cardiac monitoring) and initiation of antiplatelet
therapy and risk factor modification.
Question 3
A 25-year-old female presents with fatigue, pallor, and pica
(craving ice). Laboratory results show Hgb 9.2 g/dL, MCV 72
fL, and low ferritin. What is the most appropriate initial
treatment?
A) Intramuscular Vitamin B12 injection.
B) Oral ferrous sulfate 325 mg daily.
C) Folic acid supplementation.
D) Blood transfusion.
,Correct Answer: B
Rationale: The patient presents with classic signs of iron
deficiency anemia (microcytic anemia, low ferritin, pica). Oral
iron supplementation is the first-line treatment for stable
patients. Vitamin B12 is for macrocytic anemia, folic acid for
folate deficiency, and transfusion is reserved for severe
symptomatic anemia or hemodynamic instability.
Question 4
A 55-year-old male smoker presents with a chronic cough,
increased sputum production, and dyspnea on exertion.
Pulmonary function tests show an FEV1/FVC ratio of 0.65 post-
bronchodilator. What is the diagnosis?
A) Asthma.
B) Chronic Obstructive Pulmonary Disease (COPD).
C) Restrictive lung disease.
D) Bronchiectasis.
Correct Answer: B
Rationale: COPD is diagnosed by spirometry showing
persistent airflow limitation, defined as an FEV1/FVC ratio
<0.70 after bronchodilator administration. The clinical history
of smoking, chronic cough, and dyspnea supports this
diagnosis. Asthma typically shows reversibility, and restrictive
disease shows a normal or high ratio with reduced volumes.
Question 5
A 30-year-old female presents with palpitations, heat
intolerance, weight loss despite increased appetite, and
tremors. Physical exam reveals a diffuse goiter and
exophthalmos. Which laboratory finding confirms the
diagnosis?
, A) Elevated TSH, Low T4.
B) Low TSH, Elevated Free T4, Positive TSI antibodies.
C) Normal TSH, Elevated T3.
D) Elevated TSH, Elevated T4.
Correct Answer: B
Rationale: The clinical presentation is classic for Graves’
disease (hyperthyroidism). Labs will show suppressed TSH due
to negative feedback from elevated thyroid hormones (Free
T4/T3). Thyroid-Stimulating Immunoglobulins (TSI) are
specific for Graves’ disease. Option A is hypothyroidism, D is
secondary hyperthyroidism or assay interference.
Question 6
A 70-year-old male presents with sudden, severe tearing chest
pain radiating to the back. Blood pressure is 190/110 mmHg in
the right arm and 160/90 mmHg in the left arm. What is the
most critical diagnostic test?
A) Electrocardiogram (ECG).
B) Chest X-ray.
C) CT Angiography of the chest/aorta.
D) Transthoracic Echocardiogram.
Correct Answer: C
Rationale: The presentation suggests aortic dissection. CT
Angiography is the gold standard for rapid diagnosis. While
ECG is done to rule out MI, it does not diagnose dissection. A
widened mediastinum on CXR is suggestive but not diagnostic.
BP discrepancy between arms is a hallmark sign.
Question 7
VERIFIED Q and A WITH DETAILED
CLINICAL RATIONALES ADVANCED
PRACTICE NURSING A+ GUARANTEED!
NR 668 CEA Final Exam (2026): Comprehensive
Review of Clinical Evaluation & Assessment in
Advanced Practice Nursing (Questions 1–150)
Question 1
A 45-year-old male presents with a 3-month history of
progressive dysphagia to solids, unintentional weight loss of 15
lbs, and occasional regurgitation. He has a 20-pack-year
smoking history and drinks alcohol socially. On physical
examination, you note supraclavicular lymphadenopathy. What
is the most appropriate next step in management?
A) Prescribe a proton pump inhibitor (PPI) for 8 weeks and
reassess.
B) Perform an upper endoscopy (EGD) with biopsy
immediately.
C) Order a barium swallow study to evaluate for motility
disorders.
D) Refer for esophageal manometry to rule out achalasia.
Correct Answer: B
Rationale: Dysphagia accompanied by "alarm symptoms"
such as unintentional weight loss, age >45-50, and
lymphadenopathy raises high suspicion for esophageal
malignancy. Immediate upper endoscopy with biopsy is
required to visualize the lesion and obtain tissue diagnosis.
,Empiric PPI therapy is inappropriate when alarm features are
present.
Question 2
A 60-year-old female with a history of hypertension and type 2
diabetes presents with sudden onset of right-sided weakness
and aphasia that resolved completely within 45 minutes. Her
CT head is negative for hemorrhage. What is the most likely
diagnosis and immediate priority?
A) Migraine with aura; prescribe sumatriptan.
B) Transient Ischemic Attack (TIA); initiate urgent stroke
workup and secondary prevention.
C) Hypoglycemic episode; administer oral glucose.
D) Bell’s Palsy; start prednisone.
Correct Answer: B
Rationale: A TIA is defined by transient neurological deficits
caused by focal brain ischemia without acute infarction. It is a
medical emergency because it signals a high risk of impending
stroke. The priority is urgent evaluation (MRI, vascular
imaging, cardiac monitoring) and initiation of antiplatelet
therapy and risk factor modification.
Question 3
A 25-year-old female presents with fatigue, pallor, and pica
(craving ice). Laboratory results show Hgb 9.2 g/dL, MCV 72
fL, and low ferritin. What is the most appropriate initial
treatment?
A) Intramuscular Vitamin B12 injection.
B) Oral ferrous sulfate 325 mg daily.
C) Folic acid supplementation.
D) Blood transfusion.
,Correct Answer: B
Rationale: The patient presents with classic signs of iron
deficiency anemia (microcytic anemia, low ferritin, pica). Oral
iron supplementation is the first-line treatment for stable
patients. Vitamin B12 is for macrocytic anemia, folic acid for
folate deficiency, and transfusion is reserved for severe
symptomatic anemia or hemodynamic instability.
Question 4
A 55-year-old male smoker presents with a chronic cough,
increased sputum production, and dyspnea on exertion.
Pulmonary function tests show an FEV1/FVC ratio of 0.65 post-
bronchodilator. What is the diagnosis?
A) Asthma.
B) Chronic Obstructive Pulmonary Disease (COPD).
C) Restrictive lung disease.
D) Bronchiectasis.
Correct Answer: B
Rationale: COPD is diagnosed by spirometry showing
persistent airflow limitation, defined as an FEV1/FVC ratio
<0.70 after bronchodilator administration. The clinical history
of smoking, chronic cough, and dyspnea supports this
diagnosis. Asthma typically shows reversibility, and restrictive
disease shows a normal or high ratio with reduced volumes.
Question 5
A 30-year-old female presents with palpitations, heat
intolerance, weight loss despite increased appetite, and
tremors. Physical exam reveals a diffuse goiter and
exophthalmos. Which laboratory finding confirms the
diagnosis?
, A) Elevated TSH, Low T4.
B) Low TSH, Elevated Free T4, Positive TSI antibodies.
C) Normal TSH, Elevated T3.
D) Elevated TSH, Elevated T4.
Correct Answer: B
Rationale: The clinical presentation is classic for Graves’
disease (hyperthyroidism). Labs will show suppressed TSH due
to negative feedback from elevated thyroid hormones (Free
T4/T3). Thyroid-Stimulating Immunoglobulins (TSI) are
specific for Graves’ disease. Option A is hypothyroidism, D is
secondary hyperthyroidism or assay interference.
Question 6
A 70-year-old male presents with sudden, severe tearing chest
pain radiating to the back. Blood pressure is 190/110 mmHg in
the right arm and 160/90 mmHg in the left arm. What is the
most critical diagnostic test?
A) Electrocardiogram (ECG).
B) Chest X-ray.
C) CT Angiography of the chest/aorta.
D) Transthoracic Echocardiogram.
Correct Answer: C
Rationale: The presentation suggests aortic dissection. CT
Angiography is the gold standard for rapid diagnosis. While
ECG is done to rule out MI, it does not diagnose dissection. A
widened mediastinum on CXR is suggestive but not diagnostic.
BP discrepancy between arms is a hallmark sign.
Question 7
