CEA Prep: Full Practice Exam 324
Questions and Answers A+ Guide
The patient is exhibiting a productive cough and a low-grade fever. Chest X-
ray on PA view shows a left lower chest area of consolidation adjacent to the
left border of the heart approximately 2 rib spaces above the 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 - correct answers✅✅Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If the
cardiac margin/silhouette is obliterated by the mass, the lesion is either right
middle lobe or left upper lobe lingula.
The inability to fully relax the myocardium during relaxation is a trademark
of which of the following diagnoses? - correct answers✅✅Diastolic
dysfunction
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 been diagnosed with
hypertension. He has been restricting his salt intake, eating a DASH (Dietary
Approaches to Stop Hypertension) diet, and exercising more, but his blood
pressure is still elevated. Which is the BEST medication to prescribe him? -
correct answers✅✅Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines
should be managed with a dihydropyridine calcium channel blocker such as
amlodipine (Norvasc) as first line management therapy for hypertension not
at goal with DASH and lifestyle modifications.
,CEA Prep: Full Practice Exam 324
Questions and Answers A+ Guide
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm.
Which medical imaging is considered standard of care for serial surveillance?
- correct answers✅✅CT angiography of the chest
Rationale: CT angiography is considered the standard of care for measuring
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 stimulation? -
correct answers✅✅phenylephrine
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 presents with dyspnea
on exertion and orthopnea. On examination, she has jugular venous
distention and bilateral crackles on lung auscultation. What is the most likely
diagnosis? - correct answers✅✅Congestive heart failure
Rationale: Of the available options, the most accurate response is congestive
heart failure as it is signifying both a right ventricular back up with jugular
venous extension and crackles on lung assault, which are suggestive of left
ventricular back 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 reduced ejection
fraction) with an ejection fraction of 40% who is also not on optimal medical
therapy has been diagnosed with a myocardial infarction this admission and
received emergent placement of a drug-eluting stent to the left anterior
,CEA Prep: Full Practice Exam 324
Questions and Answers A+ Guide
descending artery. As the medical home who will manage this patient after
discharge, which medication strategy would you expect to be a priority in the
patient's care? - correct answers✅✅Ordering a transthoracic
echocardiogram and order a Lifevest if EF is less than 35%
Rationale: The patient should have a protective mechanism such as an
implantable automated cardioverter defibrillator (AICD) or a Lifevest if the EF
is less than 35% due to the increased risk of sudden cardiac death with low
EF states. Since most patients are not eligible for 90 days for an AICD in this
state, optimizing their medication regimen and repeating an echo in 2-3
months to re-evaluate for improvement in their EF is required by most
insurance companies. A baseline echo is needed at discharge to provide a
baseline for improvement vs their repeat echo in 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 risk of cardiac
disease? - correct answers✅✅Caucasians
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.
A 65-year-old woman presents for a follow-up examination. She is a smoker,
and her hypertension is now adequately controlled with medication. Her
mother died at age 40 from a heart attack. The fasting lipid profile shows
cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting
therapeutic lifestyle changes, the nurse practitioner should start the patient
on: - correct answers✅✅a statin drug.
Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may
be useful in reducing ASVD risk, but for a patient who is an active smoker
with premature coronary disease history (less than age 65 for women), has
hypertension and is far from an LDL goal, this patient is most certainly a
, CEA Prep: Full Practice Exam 324
Questions and Answers A+ Guide
candidate for statin therapy, which represents the most aggressive therapy
option of these four listed.
Which of the following end-organ sequelae is not directly caused by
uncontrolled hypertension? - correct answers✅✅Peripheral neuropathy
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 addressing all the following
except? - correct answers✅✅Genetic predisposition
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 cycles, hirsutism, and
obesity. Laboratory tests reveal elevated serum testosterone and LH ratio >
2:1. What is the most appropriate initial treatment? - correct
answers✅✅Oral contraceptives
Rationale: These are classic symptoms of polycystic ovarian syndrome and
the patient should be treated with oral contraceptives to help stabilize their
estrogen 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.
Questions and Answers A+ Guide
The patient is exhibiting a productive cough and a low-grade fever. Chest X-
ray on PA view shows a left lower chest area of consolidation adjacent to the
left border of the heart approximately 2 rib spaces above the 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 - correct answers✅✅Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If the
cardiac margin/silhouette is obliterated by the mass, the lesion is either right
middle lobe or left upper lobe lingula.
The inability to fully relax the myocardium during relaxation is a trademark
of which of the following diagnoses? - correct answers✅✅Diastolic
dysfunction
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 been diagnosed with
hypertension. He has been restricting his salt intake, eating a DASH (Dietary
Approaches to Stop Hypertension) diet, and exercising more, but his blood
pressure is still elevated. Which is the BEST medication to prescribe him? -
correct answers✅✅Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines
should be managed with a dihydropyridine calcium channel blocker such as
amlodipine (Norvasc) as first line management therapy for hypertension not
at goal with DASH and lifestyle modifications.
,CEA Prep: Full Practice Exam 324
Questions and Answers A+ Guide
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm.
Which medical imaging is considered standard of care for serial surveillance?
- correct answers✅✅CT angiography of the chest
Rationale: CT angiography is considered the standard of care for measuring
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 stimulation? -
correct answers✅✅phenylephrine
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 presents with dyspnea
on exertion and orthopnea. On examination, she has jugular venous
distention and bilateral crackles on lung auscultation. What is the most likely
diagnosis? - correct answers✅✅Congestive heart failure
Rationale: Of the available options, the most accurate response is congestive
heart failure as it is signifying both a right ventricular back up with jugular
venous extension and crackles on lung assault, which are suggestive of left
ventricular back 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 reduced ejection
fraction) with an ejection fraction of 40% who is also not on optimal medical
therapy has been diagnosed with a myocardial infarction this admission and
received emergent placement of a drug-eluting stent to the left anterior
,CEA Prep: Full Practice Exam 324
Questions and Answers A+ Guide
descending artery. As the medical home who will manage this patient after
discharge, which medication strategy would you expect to be a priority in the
patient's care? - correct answers✅✅Ordering a transthoracic
echocardiogram and order a Lifevest if EF is less than 35%
Rationale: The patient should have a protective mechanism such as an
implantable automated cardioverter defibrillator (AICD) or a Lifevest if the EF
is less than 35% due to the increased risk of sudden cardiac death with low
EF states. Since most patients are not eligible for 90 days for an AICD in this
state, optimizing their medication regimen and repeating an echo in 2-3
months to re-evaluate for improvement in their EF is required by most
insurance companies. A baseline echo is needed at discharge to provide a
baseline for improvement vs their repeat echo in 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 risk of cardiac
disease? - correct answers✅✅Caucasians
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.
A 65-year-old woman presents for a follow-up examination. She is a smoker,
and her hypertension is now adequately controlled with medication. Her
mother died at age 40 from a heart attack. The fasting lipid profile shows
cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting
therapeutic lifestyle changes, the nurse practitioner should start the patient
on: - correct answers✅✅a statin drug.
Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may
be useful in reducing ASVD risk, but for a patient who is an active smoker
with premature coronary disease history (less than age 65 for women), has
hypertension and is far from an LDL goal, this patient is most certainly a
, CEA Prep: Full Practice Exam 324
Questions and Answers A+ Guide
candidate for statin therapy, which represents the most aggressive therapy
option of these four listed.
Which of the following end-organ sequelae is not directly caused by
uncontrolled hypertension? - correct answers✅✅Peripheral neuropathy
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 addressing all the following
except? - correct answers✅✅Genetic predisposition
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 cycles, hirsutism, and
obesity. Laboratory tests reveal elevated serum testosterone and LH ratio >
2:1. What is the most appropriate initial treatment? - correct
answers✅✅Oral contraceptives
Rationale: These are classic symptoms of polycystic ovarian syndrome and
the patient should be treated with oral contraceptives to help stabilize their
estrogen 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.
