NR 667 Comprehensive Exit Examination CEA
ACTUAL EXAM 2026 | Final Exam Question
Bank | 350 Questions | Correct Answers |
Chamberlain University | Examplify Online
Proctored | Verified Q&A - A+ Graded
DOMAIN 1: ADVANCED HEALTH ASSESSMENT AND
DIAGNOSIS (90 Questions)
Q1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, constipation, and dry
skin. Physical examination reveals bradycardia, delayed deep tendon reflexes, and a palpable
goiter. What is the most appropriate initial diagnostic test?
A. Free T4 and TSH [CORRECT]
B. Thyroid ultrasound
C. Thyroid antibody panel
D. Thyroid scan
Correct Answer: A
Rationale: TSH and free T4 are the initial tests for suspected thyroid dysfunction. TSH is the most
sensitive marker for hypothyroidism (elevated). Free T4 confirms the diagnosis. Ultrasound (B) is
indicated for nodule evaluation. Antibodies (C) confirm autoimmune etiology (Hashimoto's) but are
not initial. Thyroid scan (D) is for hyperthyroidism or nodule evaluation.
Q2. A 68-year-old male with a 50-pack-year smoking history presents with chronic cough,
hemoptysis, and unintentional weight loss. Which initial imaging study is most appropriate?
A. Chest X-ray [CORRECT]
B. CT chest with contrast
C. PET-CT
D. MRI chest
,Correct Answer: A
Rationale: Chest X-ray is the initial imaging study for suspected lung cancer. If abnormal, CT chest
is indicated for further characterization. PET-CT (C) is used for staging after diagnosis. MRI (D) is
not first-line for pulmonary evaluation.
Q3. A 28-year-old female presents with episodic severe headaches described as "the worst
headache of my life" accompanied by photophobia and nausea. Physical examination reveals
nuchal rigidity. Which diagnostic test should be performed immediately?
A. CT head without contrast [CORRECT]
B. MRI brain with contrast
C. Lumbar puncture
D. CT angiography
Correct Answer: A
Rationale: Non-contrast CT is the initial test of choice for suspected subarachnoid hemorrhage to
detect acute bleeding. Sensitivity approaches 100% within 6 hours. MRI (B) is not first-line for acute
bleeding. Lumbar puncture (C) is performed if CT is negative but suspicion remains high. CT
angiography (D) identifies aneurysms after initial diagnosis.
Q4. A 55-year-old male with diabetes presents with chest pain radiating to the jaw and left arm.
ECG shows ST-segment elevation in leads V1-V4. Which cardiac biomarker rises within 3-4 hours
and is the preferred marker for myocardial infarction diagnosis?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin I [CORRECT]
D. B-type natriuretic peptide (BNP)
Correct Answer: C
Rationale: Troponin I is the preferred biomarker for MI diagnosis due to high sensitivity and
specificity for myocardial necrosis. It rises within 3-4 hours and remains elevated for 7-10 days.
CK-MB (A) rises within 4-6 hours but is less specific. Myoglobin (B) rises earliest but lacks
specificity. BNP (D) indicates heart failure, not acute MI.
Q5. A 6-month-old infant presents for a well-child visit. According to developmental milestones,
which skill should the nurse practitioner expect to observe?
A. Saying "mama" or "dada" specifically
B. Sitting without support [CORRECT]
C. Walking with assistance
D. Using a pincer grasp
Correct Answer: B
,Rationale: Infants typically sit without support by 6 months. Saying specific words (A) occurs around
9-12 months. Walking with assistance (C) occurs at 9-12 months. Pincer grasp (D) develops
around 9-10 months.
Q6. A 72-year-old female presents with confusion, lethargy, and dehydration. Laboratory studies
reveal sodium 158 mEq/L, potassium 4.2 mEq/L, chloride 120 mEq/L, and CO2 24 mEq/L. Which
fluid should be administered?
A. 0.9% Normal Saline [CORRECT]
B. 3% Normal Saline
C. D5W (Dextrose 5% in Water)
D. Lactated Ringer's
Correct Answer: A
Rationale: Hypernatremia (Na >145 mEq/L) indicates water deficit. Initial treatment is 0.9% NS to
restore volume and gradually lower sodium (max 0.5-1 mEq/L/hour to prevent cerebral edema). 3%
saline (B) is for severe hyponatremia. D5W (C) can be used after volume resuscitation but requires
careful monitoring. Lactated Ringer's (D) contains potassium and lactate, not ideal for
hypernatremia correction.
Q7. During a mental status examination, a patient demonstrates inability to name familiar objects
despite intact comprehension and repetition. This finding indicates:
A. Broca's aphasia
B. Wernicke's aphasia
C. Anomic aphasia [CORRECT]
D. Global aphasia
Correct Answer: C
Rationale: Anomic (nominal) aphasia is characterized by word-finding difficulties with intact
comprehension and fluent speech. Broca's aphasia (A) is non-fluent with intact comprehension.
Wernicke's aphasia (B) is fluent but nonsensical with poor comprehension. Global aphasia (D)
affects all language domains.
Q8. A 35-year-old female presents with joint pain and morning stiffness lasting 2 hours. Physical
examination reveals symmetric swelling of MCP and PIP joints with ulnar deviation. Which
laboratory finding is most specific for this condition?
A. Positive rheumatoid factor (RF)
B. Elevated anti-CCP antibodies [CORRECT]
C. Positive ANA
D. Elevated ESR
Correct Answer: B
, Rationale: Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific (>95%) for
rheumatoid arthritis. RF (A) is sensitive but less specific. ANA (C) indicates autoimmune conditions
but is not specific for RA. ESR (D) indicates inflammation but is nonspecific.
Q9. A 42-year-old male presents with epigastric pain, nausea, and black tarry stools. Vital signs
show HR 110, BP 98/62. Which laboratory finding indicates significant blood loss?
A. Hemoglobin 14.2 g/dL
B. Hematocrit 39%
C. BUN 48 mg/dL with normal creatinine [CORRECT]
D. Platelet count 450,000/μL
Correct Answer: C
Rationale: Elevated BUN out of proportion to creatinine (BUN:Cr ratio >20:1) suggests upper GI
bleeding due to blood protein digestion and absorption. Hemoglobin (A) and hematocrit (B) may be
normal initially due to hemoconcentration. Thrombocytosis (D) is not indicative of acute blood loss.
Q10. A 19-year-old college student presents with sore throat, fever, and fatigue. Physical
examination reveals posterior cervical lymphadenopathy, splenomegaly, and pharyngitis with
exudates. Which diagnostic test confirms the suspected diagnosis?
A. Throat culture for streptococcus
B. Monospot test for heterophile antibodies [CORRECT]
C. CMV IgM antibodies
D. HIV antibody test
Correct Answer: B
Rationale: The presentation is classic for infectious mononucleosis (Epstein-Barr virus). The
Monospot test detects heterophile antibodies with 70-90% sensitivity in adults. Throat culture (A)
rules out strep but doesn't confirm mono. CMV (C) causes similar symptoms but is
heterophile-negative. HIV (D) acute retroviral syndrome is a differential but Monospot is specific for
EBV.
Q11. A 65-year-old male with COPD presents with acute dyspnea. Arterial blood gas reveals pH
7.28, PaCO2 68 mmHg, HCO3 30 mEq/L, and PaO2 58 mmHg. Which acid-base disorder is
present?
A. Respiratory acidosis with metabolic compensation [CORRECT]
B. Metabolic acidosis with respiratory compensation
C. Respiratory alkalosis
D. Mixed acidosis
Correct Answer: A
ACTUAL EXAM 2026 | Final Exam Question
Bank | 350 Questions | Correct Answers |
Chamberlain University | Examplify Online
Proctored | Verified Q&A - A+ Graded
DOMAIN 1: ADVANCED HEALTH ASSESSMENT AND
DIAGNOSIS (90 Questions)
Q1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, constipation, and dry
skin. Physical examination reveals bradycardia, delayed deep tendon reflexes, and a palpable
goiter. What is the most appropriate initial diagnostic test?
A. Free T4 and TSH [CORRECT]
B. Thyroid ultrasound
C. Thyroid antibody panel
D. Thyroid scan
Correct Answer: A
Rationale: TSH and free T4 are the initial tests for suspected thyroid dysfunction. TSH is the most
sensitive marker for hypothyroidism (elevated). Free T4 confirms the diagnosis. Ultrasound (B) is
indicated for nodule evaluation. Antibodies (C) confirm autoimmune etiology (Hashimoto's) but are
not initial. Thyroid scan (D) is for hyperthyroidism or nodule evaluation.
Q2. A 68-year-old male with a 50-pack-year smoking history presents with chronic cough,
hemoptysis, and unintentional weight loss. Which initial imaging study is most appropriate?
A. Chest X-ray [CORRECT]
B. CT chest with contrast
C. PET-CT
D. MRI chest
,Correct Answer: A
Rationale: Chest X-ray is the initial imaging study for suspected lung cancer. If abnormal, CT chest
is indicated for further characterization. PET-CT (C) is used for staging after diagnosis. MRI (D) is
not first-line for pulmonary evaluation.
Q3. A 28-year-old female presents with episodic severe headaches described as "the worst
headache of my life" accompanied by photophobia and nausea. Physical examination reveals
nuchal rigidity. Which diagnostic test should be performed immediately?
A. CT head without contrast [CORRECT]
B. MRI brain with contrast
C. Lumbar puncture
D. CT angiography
Correct Answer: A
Rationale: Non-contrast CT is the initial test of choice for suspected subarachnoid hemorrhage to
detect acute bleeding. Sensitivity approaches 100% within 6 hours. MRI (B) is not first-line for acute
bleeding. Lumbar puncture (C) is performed if CT is negative but suspicion remains high. CT
angiography (D) identifies aneurysms after initial diagnosis.
Q4. A 55-year-old male with diabetes presents with chest pain radiating to the jaw and left arm.
ECG shows ST-segment elevation in leads V1-V4. Which cardiac biomarker rises within 3-4 hours
and is the preferred marker for myocardial infarction diagnosis?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin I [CORRECT]
D. B-type natriuretic peptide (BNP)
Correct Answer: C
Rationale: Troponin I is the preferred biomarker for MI diagnosis due to high sensitivity and
specificity for myocardial necrosis. It rises within 3-4 hours and remains elevated for 7-10 days.
CK-MB (A) rises within 4-6 hours but is less specific. Myoglobin (B) rises earliest but lacks
specificity. BNP (D) indicates heart failure, not acute MI.
Q5. A 6-month-old infant presents for a well-child visit. According to developmental milestones,
which skill should the nurse practitioner expect to observe?
A. Saying "mama" or "dada" specifically
B. Sitting without support [CORRECT]
C. Walking with assistance
D. Using a pincer grasp
Correct Answer: B
,Rationale: Infants typically sit without support by 6 months. Saying specific words (A) occurs around
9-12 months. Walking with assistance (C) occurs at 9-12 months. Pincer grasp (D) develops
around 9-10 months.
Q6. A 72-year-old female presents with confusion, lethargy, and dehydration. Laboratory studies
reveal sodium 158 mEq/L, potassium 4.2 mEq/L, chloride 120 mEq/L, and CO2 24 mEq/L. Which
fluid should be administered?
A. 0.9% Normal Saline [CORRECT]
B. 3% Normal Saline
C. D5W (Dextrose 5% in Water)
D. Lactated Ringer's
Correct Answer: A
Rationale: Hypernatremia (Na >145 mEq/L) indicates water deficit. Initial treatment is 0.9% NS to
restore volume and gradually lower sodium (max 0.5-1 mEq/L/hour to prevent cerebral edema). 3%
saline (B) is for severe hyponatremia. D5W (C) can be used after volume resuscitation but requires
careful monitoring. Lactated Ringer's (D) contains potassium and lactate, not ideal for
hypernatremia correction.
Q7. During a mental status examination, a patient demonstrates inability to name familiar objects
despite intact comprehension and repetition. This finding indicates:
A. Broca's aphasia
B. Wernicke's aphasia
C. Anomic aphasia [CORRECT]
D. Global aphasia
Correct Answer: C
Rationale: Anomic (nominal) aphasia is characterized by word-finding difficulties with intact
comprehension and fluent speech. Broca's aphasia (A) is non-fluent with intact comprehension.
Wernicke's aphasia (B) is fluent but nonsensical with poor comprehension. Global aphasia (D)
affects all language domains.
Q8. A 35-year-old female presents with joint pain and morning stiffness lasting 2 hours. Physical
examination reveals symmetric swelling of MCP and PIP joints with ulnar deviation. Which
laboratory finding is most specific for this condition?
A. Positive rheumatoid factor (RF)
B. Elevated anti-CCP antibodies [CORRECT]
C. Positive ANA
D. Elevated ESR
Correct Answer: B
, Rationale: Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific (>95%) for
rheumatoid arthritis. RF (A) is sensitive but less specific. ANA (C) indicates autoimmune conditions
but is not specific for RA. ESR (D) indicates inflammation but is nonspecific.
Q9. A 42-year-old male presents with epigastric pain, nausea, and black tarry stools. Vital signs
show HR 110, BP 98/62. Which laboratory finding indicates significant blood loss?
A. Hemoglobin 14.2 g/dL
B. Hematocrit 39%
C. BUN 48 mg/dL with normal creatinine [CORRECT]
D. Platelet count 450,000/μL
Correct Answer: C
Rationale: Elevated BUN out of proportion to creatinine (BUN:Cr ratio >20:1) suggests upper GI
bleeding due to blood protein digestion and absorption. Hemoglobin (A) and hematocrit (B) may be
normal initially due to hemoconcentration. Thrombocytosis (D) is not indicative of acute blood loss.
Q10. A 19-year-old college student presents with sore throat, fever, and fatigue. Physical
examination reveals posterior cervical lymphadenopathy, splenomegaly, and pharyngitis with
exudates. Which diagnostic test confirms the suspected diagnosis?
A. Throat culture for streptococcus
B. Monospot test for heterophile antibodies [CORRECT]
C. CMV IgM antibodies
D. HIV antibody test
Correct Answer: B
Rationale: The presentation is classic for infectious mononucleosis (Epstein-Barr virus). The
Monospot test detects heterophile antibodies with 70-90% sensitivity in adults. Throat culture (A)
rules out strep but doesn't confirm mono. CMV (C) causes similar symptoms but is
heterophile-negative. HIV (D) acute retroviral syndrome is a differential but Monospot is specific for
EBV.
Q11. A 65-year-old male with COPD presents with acute dyspnea. Arterial blood gas reveals pH
7.28, PaCO2 68 mmHg, HCO3 30 mEq/L, and PaO2 58 mmHg. Which acid-base disorder is
present?
A. Respiratory acidosis with metabolic compensation [CORRECT]
B. Metabolic acidosis with respiratory compensation
C. Respiratory alkalosis
D. Mixed acidosis
Correct Answer: A
