NR511 CEA Exam (2025-2026 UPDATE)
with 150 Questions and Verified
Rationalized Answers.
Section I: Primary Care Fundamentals & Clinical Reasoning (Q1-15)
Q1. A 55-year-old male presents with fatigue, unintentional weight loss, and low-grade fever for
3 weeks. What is the most appropriate initial approach?
A) Reassure the patient and schedule follow-up in 3 months
B) Order a comprehensive metabolic panel, CBC with differential, and ESR/CRP
C) Prescribe antibiotics for presumed infection
D) Refer immediately to oncology
Answer: B
Rationale: Unexplained weight loss with constitutional symptoms (fever, night sweats, fatigue)
warrants initial laboratory evaluation to screen for infection, chronic inflammation, or malignancy
.
Q2. Which of the following is a key component of the "5 A's" model for behavioral counseling in
primary care?
A) Ask, Advise, Assess, Assist, Arrange
B) Assess, Advise, Agree, Assist, Arrange
C) Admit, Advise, Agree, Assist, Arrange
D) Assess, Advise, Administer, Arrange, Adhere
Answer: B
Rationale: The 5 A's model (Assess, Advise, Agree, Assist, Arrange) is an evidence-based
framework for health behavior counseling in primary care settings, covering smoking cessation,
weight management, and physical activity .
Q3. A 68-year-old female presents with a chief complaint of "dizziness." Which question is most
important to differentiate between vertigo and lightheadedness?
A) "Do you feel like the room is spinning?"
B) "Do you feel faint or like you might pass out?"
C) "Do you have a headache?"
D) "Do you have chest pain?"
Answer: A
,Rationale: Vertigo is the illusion of movement (spinning) and suggests vestibular dysfunction.
Lightheadedness (near-syncope) suggests cardiovascular or metabolic causes. Differentiating
the quality of dizziness directs the differential diagnosis .
Q4. A 62-year-old male with hypertension and diabetes is due for colorectal cancer screening.
He has no personal or family history of colorectal cancer or polyps. What is the most appropriate
screening test?
A) Colonoscopy every 10 years
B) Fecal immunochemical test (FIT) annually
C) CT colonography every 5 years
D) Any of the above are acceptable options
Answer: D
Rationale: Multiple screening options are acceptable for average-risk adults aged 45-75,
including colonoscopy (every 10 years), FIT (annually), or CT colonography (every 5 years).
Choice depends on patient preference and resource availability .
Q5. When is screening for type 2 diabetes recommended by the USPSTF?
A) All adults starting at age 35
B) Adults aged 35-70 with overweight or obesity
C) Screen only if symptoms are present
D) Screen only if a first-degree relative has diabetes
Answer: B
Rationale: The USPSTF recommends screening adults aged 35 to 70 who have overweight or
obesity for prediabetes and type 2 diabetes. Earlier screening may be considered for high-risk
populations .
Q6. A 55-year-old adult with no known liver disease asks whether hepatitis C screening is
indicated. What is the best answer?
A) No, only people with a history of IV drug use should be screened
B) Yes, adults aged 18 to 79 should have one-time hepatitis C screening
C) Yes, but only if liver enzymes are elevated
D) No, screening is recommended only after age 65
Answer: B
Rationale: The USPSTF recommends one-time screening for hepatitis C in all adults aged 18 to
79, regardless of risk factors, due to high cure rates with direct-acting antivirals .
Q7. A 62-year-old with a 30-pack-year smoking history quit 10 years ago. Which lung cancer
screening recommendation is most appropriate?
A) Annual low-dose chest CT is recommended
B) Annual chest x-ray is recommended
C) No screening is needed because the patient quit smoking
,D) PET-CT is preferred for screening
Answer: A
Rationale: USPSTF recommends annual low-dose CT for adults aged 50-80 with at least a
20-pack-year history who currently smoke or quit within the past 15 years. This patient meets
criteria despite having quit 10 years ago .
Q8. A 24-year-old sexually active woman asks whether chlamydia screening is needed even
though she has no symptoms. What is the best answer?
A) No, screening is done only if symptoms develop
B) Yes, sexually active women aged 24 or younger should be screened
C) Only gonorrhea screening is recommended
D) Screening is recommended only during pregnancy
Answer: B
Rationale: USPSTF recommends screening sexually active women aged 24 and younger for
chlamydia and gonorrhea, and older women when risk is increased, as most infections are
asymptomatic .
Q9. Which vaccine statement is most accurate for a healthy 68-year-old presenting for routine
care during influenza season?
A) Influenza vaccine is optional after age 65
B) High-dose, adjuvanted, or recombinant influenza vaccine is preferred in adults aged 65 and
older
C) Live attenuated influenza vaccine is preferred after age 65
D) Influenza vaccine should be given every 5 years after age 65
Answer: B
Rationale: CDC adult immunization guidance states that influenza vaccination is recommended
annually, and high-dose, adjuvanted, or recombinant formulations are preferred for adults aged
65 and older due to enhanced immunogenicity .
Q10. Which tetanus-containing vaccine recommendation is correct for a pregnant patient?
A) Tdap should be given only if the patient has never received it before
B) Tdap should be given during each pregnancy
C) Tdap is contraindicated during pregnancy
D) Td is preferred over Tdap during pregnancy
Answer: B
Rationale: CDC recommends one dose of Tdap during each pregnancy (preferably at 27-36
weeks gestation) to provide passive antibody protection to the newborn against pertussis .
Q11. What is the correct location of the point of maximum impulse (PMI) in a healthy adult?
A) Left 2nd intercostal space, midaxillary line
, B) Left 5th intercostal space, midclavicular line
C) Right 4th intercostal space, midaxillary line
D) Right 2nd intercostal space, midclavicular line
Answer: B
Rationale: The PMI (apical impulse) is normally located in the 5th intercostal space at the left
midclavicular line, reflecting the apex of the left ventricle .
Q12. During which phase of the cardiac cycle would you anticipate auscultation of an S3 or S4
heart sound?
A) Systole
B) Diastole
C) Both systole and diastole
D) Neither
Answer: B
Rationale: S3 and S4 are diastolic filling sounds. S3 (ventricular gallop) occurs in early diastole;
S4 (atrial gallop) occurs in late diastole. Both are associated with heart failure and volume
overload .
Q13. Where would the S1 heart sound correlate on the electrocardiogram?
A) Peak of the T wave
B) Onset of the QRS complex
C) Peak of the R wave
D) End of the T wave
Answer: C
Rationale: The S1 heart sound ("lub") correlates with the peak of the R wave on EKG, marking
the beginning of systole and the start of ventricular contraction .
Q14. Which dermatologic lesion is precancerous and likely due to prolonged exposure to UV-B?
A) Actinic keratosis
B) Basal cell carcinoma
C) Verruca (wart)
D) Seborrheic keratosis
Answer: A
Rationale: Actinic keratoses are rough, scaly patches caused by years of sun exposure. They
are considered precancerous because they have the potential to progress to squamous cell
carcinoma .
Q15. Based on the ABCDEs of melanoma, which finding is most suspicious for malignancy?
A) Symmetrical shape
B) Irregular borders
with 150 Questions and Verified
Rationalized Answers.
Section I: Primary Care Fundamentals & Clinical Reasoning (Q1-15)
Q1. A 55-year-old male presents with fatigue, unintentional weight loss, and low-grade fever for
3 weeks. What is the most appropriate initial approach?
A) Reassure the patient and schedule follow-up in 3 months
B) Order a comprehensive metabolic panel, CBC with differential, and ESR/CRP
C) Prescribe antibiotics for presumed infection
D) Refer immediately to oncology
Answer: B
Rationale: Unexplained weight loss with constitutional symptoms (fever, night sweats, fatigue)
warrants initial laboratory evaluation to screen for infection, chronic inflammation, or malignancy
.
Q2. Which of the following is a key component of the "5 A's" model for behavioral counseling in
primary care?
A) Ask, Advise, Assess, Assist, Arrange
B) Assess, Advise, Agree, Assist, Arrange
C) Admit, Advise, Agree, Assist, Arrange
D) Assess, Advise, Administer, Arrange, Adhere
Answer: B
Rationale: The 5 A's model (Assess, Advise, Agree, Assist, Arrange) is an evidence-based
framework for health behavior counseling in primary care settings, covering smoking cessation,
weight management, and physical activity .
Q3. A 68-year-old female presents with a chief complaint of "dizziness." Which question is most
important to differentiate between vertigo and lightheadedness?
A) "Do you feel like the room is spinning?"
B) "Do you feel faint or like you might pass out?"
C) "Do you have a headache?"
D) "Do you have chest pain?"
Answer: A
,Rationale: Vertigo is the illusion of movement (spinning) and suggests vestibular dysfunction.
Lightheadedness (near-syncope) suggests cardiovascular or metabolic causes. Differentiating
the quality of dizziness directs the differential diagnosis .
Q4. A 62-year-old male with hypertension and diabetes is due for colorectal cancer screening.
He has no personal or family history of colorectal cancer or polyps. What is the most appropriate
screening test?
A) Colonoscopy every 10 years
B) Fecal immunochemical test (FIT) annually
C) CT colonography every 5 years
D) Any of the above are acceptable options
Answer: D
Rationale: Multiple screening options are acceptable for average-risk adults aged 45-75,
including colonoscopy (every 10 years), FIT (annually), or CT colonography (every 5 years).
Choice depends on patient preference and resource availability .
Q5. When is screening for type 2 diabetes recommended by the USPSTF?
A) All adults starting at age 35
B) Adults aged 35-70 with overweight or obesity
C) Screen only if symptoms are present
D) Screen only if a first-degree relative has diabetes
Answer: B
Rationale: The USPSTF recommends screening adults aged 35 to 70 who have overweight or
obesity for prediabetes and type 2 diabetes. Earlier screening may be considered for high-risk
populations .
Q6. A 55-year-old adult with no known liver disease asks whether hepatitis C screening is
indicated. What is the best answer?
A) No, only people with a history of IV drug use should be screened
B) Yes, adults aged 18 to 79 should have one-time hepatitis C screening
C) Yes, but only if liver enzymes are elevated
D) No, screening is recommended only after age 65
Answer: B
Rationale: The USPSTF recommends one-time screening for hepatitis C in all adults aged 18 to
79, regardless of risk factors, due to high cure rates with direct-acting antivirals .
Q7. A 62-year-old with a 30-pack-year smoking history quit 10 years ago. Which lung cancer
screening recommendation is most appropriate?
A) Annual low-dose chest CT is recommended
B) Annual chest x-ray is recommended
C) No screening is needed because the patient quit smoking
,D) PET-CT is preferred for screening
Answer: A
Rationale: USPSTF recommends annual low-dose CT for adults aged 50-80 with at least a
20-pack-year history who currently smoke or quit within the past 15 years. This patient meets
criteria despite having quit 10 years ago .
Q8. A 24-year-old sexually active woman asks whether chlamydia screening is needed even
though she has no symptoms. What is the best answer?
A) No, screening is done only if symptoms develop
B) Yes, sexually active women aged 24 or younger should be screened
C) Only gonorrhea screening is recommended
D) Screening is recommended only during pregnancy
Answer: B
Rationale: USPSTF recommends screening sexually active women aged 24 and younger for
chlamydia and gonorrhea, and older women when risk is increased, as most infections are
asymptomatic .
Q9. Which vaccine statement is most accurate for a healthy 68-year-old presenting for routine
care during influenza season?
A) Influenza vaccine is optional after age 65
B) High-dose, adjuvanted, or recombinant influenza vaccine is preferred in adults aged 65 and
older
C) Live attenuated influenza vaccine is preferred after age 65
D) Influenza vaccine should be given every 5 years after age 65
Answer: B
Rationale: CDC adult immunization guidance states that influenza vaccination is recommended
annually, and high-dose, adjuvanted, or recombinant formulations are preferred for adults aged
65 and older due to enhanced immunogenicity .
Q10. Which tetanus-containing vaccine recommendation is correct for a pregnant patient?
A) Tdap should be given only if the patient has never received it before
B) Tdap should be given during each pregnancy
C) Tdap is contraindicated during pregnancy
D) Td is preferred over Tdap during pregnancy
Answer: B
Rationale: CDC recommends one dose of Tdap during each pregnancy (preferably at 27-36
weeks gestation) to provide passive antibody protection to the newborn against pertussis .
Q11. What is the correct location of the point of maximum impulse (PMI) in a healthy adult?
A) Left 2nd intercostal space, midaxillary line
, B) Left 5th intercostal space, midclavicular line
C) Right 4th intercostal space, midaxillary line
D) Right 2nd intercostal space, midclavicular line
Answer: B
Rationale: The PMI (apical impulse) is normally located in the 5th intercostal space at the left
midclavicular line, reflecting the apex of the left ventricle .
Q12. During which phase of the cardiac cycle would you anticipate auscultation of an S3 or S4
heart sound?
A) Systole
B) Diastole
C) Both systole and diastole
D) Neither
Answer: B
Rationale: S3 and S4 are diastolic filling sounds. S3 (ventricular gallop) occurs in early diastole;
S4 (atrial gallop) occurs in late diastole. Both are associated with heart failure and volume
overload .
Q13. Where would the S1 heart sound correlate on the electrocardiogram?
A) Peak of the T wave
B) Onset of the QRS complex
C) Peak of the R wave
D) End of the T wave
Answer: C
Rationale: The S1 heart sound ("lub") correlates with the peak of the R wave on EKG, marking
the beginning of systole and the start of ventricular contraction .
Q14. Which dermatologic lesion is precancerous and likely due to prolonged exposure to UV-B?
A) Actinic keratosis
B) Basal cell carcinoma
C) Verruca (wart)
D) Seborrheic keratosis
Answer: A
Rationale: Actinic keratoses are rough, scaly patches caused by years of sun exposure. They
are considered precancerous because they have the potential to progress to squamous cell
carcinoma .
Q15. Based on the ABCDEs of melanoma, which finding is most suspicious for malignancy?
A) Symmetrical shape
B) Irregular borders
