2026/2027
NR 603 Clinical Exam Assessment
(CEA) Comprehensive Exam
Preparation, Practice Questions, Test
Bank Review, and Study Guide for
2026/2027
Question 1:
A 60-year-old woman with a history of hypertension and diabetes presents with
progressive fatigue and anemia. Her laboratory results show microcytic hypochromic
anemia. What is the most likely diagnosis?
A. Aplastic anemia
B. Iron deficiency anemia
C. Hemolytic anemia
D. Thalassemia major
Correct Answer: B. Iron deficiency anemia
Rationale:
Microcytic hypochromic anemia is most commonly caused by iron deficiency anemia,
especially in adults with chronic disease or potential occult blood loss. Iron deficiency
leads to reduced hemoglobin synthesis, resulting in smaller (microcytic) and paler
(hypochromic) red blood cells. Aplastic anemia typically presents with pancytopenia
rather than isolated microcytosis. Hemolytic anemia is usually normocytic or
macrocytic due to increased reticulocyte production. Thalassemia may also present
with microcytosis, but it is usually lifelong and associated with a different clinical
history.
Question 2:
Which of the following is included in the treatment plan for symptomatic aplastic
anemia?
A. Iron supplementation only
B. Bone marrow transplant and transfusions
C. High-dose vitamin K therapy
D. Anticoagulation therapy
Correct Answer: B. Bone marrow transplant and transfusions
,2026/2027
Rationale:
Aplastic anemia involves bone marrow failure leading to pancytopenia. Definitive
treatment includes bone marrow transplantation in eligible patients. Supportive care
includes PRBC, platelet, and sometimes WBC transfusions, along with prophylactic
antibiotics to reduce infection risk. Iron supplementation and vitamin K are not
effective because the issue is marrow failure, not nutrient deficiency or clotting factor
depletion. Anticoagulation is contraindicated due to bleeding risk.
Question 3:
A patient presents with hemoglobin of 6.5 g/dL, SOB, fatigue, and chest pain. Which
laboratory findings would support iron deficiency anemia?
A. MCV 90, MCHC 33
B. MCV 110, MCHC 36
C. MCV 67, MCHC 29
D. MCV 100, MCHC 34
Correct Answer: C. MCV 67, MCHC 29
Rationale:
Iron deficiency anemia typically presents as microcytic (low MCV) and hypochromic
(low MCHC) anemia due to impaired hemoglobin synthesis. An MCV of 67 and
MCHC of 29 strongly support this diagnosis. Normal or elevated MCV values suggest
normocytic or macrocytic anemia, which are seen in other conditions such as B12
deficiency or hemolysis.
Question 4:
An elderly patient with a history of cancer presents with pancytopenia and dysplastic
changes on peripheral smear. What diagnostic test is most appropriate next?
A. Serum iron studies
B. Bone marrow biopsy and flow cytometry
C. Vitamin B12 level
D. Coagulation profile
Correct Answer: B. Bone marrow biopsy and flow cytometry
Rationale:
Pancytopenia with dysplastic changes raises concern for bone marrow disorders such
as myelodysplastic syndrome or leukemia. Bone marrow biopsy with flow cytometry
is essential for definitive diagnosis. Iron studies and B12 levels are not sufficient to
evaluate marrow pathology. Coagulation studies do not assess cellular production
defects.
Question 5:
,2026/2027
A patient with intrinsic factor autoantibodies is at risk for which condition?
A. Iron deficiency anemia
B. Pernicious anemia with B12 deficiency
C. Folate deficiency anemia
D. Hemolytic anemia
Correct Answer: B. Pernicious anemia with B12 deficiency
Rationale:
Intrinsic factor is required for vitamin B12 absorption in the terminal ileum.
Autoantibodies against intrinsic factor lead to pernicious anemia, a form of
megaloblastic anemia caused by B12 deficiency. Iron and folate deficiencies involve
different absorption pathways. Hemolytic anemia is unrelated to vitamin absorption.
Question 6:
A patient with sickle cell disease presents with severe vaso-occlusive pain crisis.
What is the most appropriate initial management?
A. Oral antibiotics and discharge
B. Hospitalization with IV fluids and opioids
C. High-dose iron therapy
D. Immediate splenectomy
Correct Answer: B. Hospitalization with IV fluids and opioids
Rationale:
Sickle cell crisis is managed with aggressive pain control using opioids and hydration
to reduce sickling and improve circulation. Hospitalization is often required for severe
cases. Antibiotics are only used if infection is suspected. Iron therapy is not indicated.
Splenectomy is not an acute intervention.
Question 7:
Which medication class reduces mortality in heart failure patients?
A. Calcium channel blockers
B. Beta blockers
C. Loop diuretics
D. Nitrates
Correct Answer: B. Beta blockers
Rationale:
Beta blockers improve survival in heart failure by reducing sympathetic overactivity,
decreasing myocardial oxygen demand, and improving cardiac remodeling. Calcium
, 2026/2027
channel blockers do not reduce mortality in heart failure. Diuretics relieve symptoms
but do not improve survival. Nitrates are used for symptom relief only.
Question 8:
A patient on methotrexate and ibuprofen presents with abdominal pain and melena.
What is the most likely diagnosis?
A. Pancreatitis
B. Gastric ulceration
C. Appendicitis
D. Diverticulitis
Correct Answer: B. Gastric ulceration
Rationale:
NSAIDs like ibuprofen and methotrexate increase risk of gastric mucosal injury,
leading to ulceration and possible GI bleeding (melena). Pancreatitis presents with
epigastric pain radiating to the back. Appendicitis causes localized right lower
quadrant pain. Diverticulitis presents with left lower quadrant pain and fever.
Question 9:
Biopsy findings of intestinal metaplasia with goblet cells are diagnostic of:
A. Gastritis
B. Barrett’s esophagus
C. Esophageal varices
D. Peptic ulcer disease
Correct Answer: B. Barrett’s esophagus
Rationale:
Barrett’s esophagus is characterized by replacement of normal squamous epithelium
with intestinal-type columnar epithelium containing goblet cells due to chronic GERD.
Gastritis involves inflammation without metaplasia. Varices are dilated veins. Peptic
ulcers involve mucosal erosion but not metaplasia.
Question 10:
Which technique is most appropriate for removing a chemical irritant from the eye?
A. Eye patching
B. Warm compress
C. Morgan lens irrigation
D. Topical antibiotics only
NR 603 Clinical Exam Assessment
(CEA) Comprehensive Exam
Preparation, Practice Questions, Test
Bank Review, and Study Guide for
2026/2027
Question 1:
A 60-year-old woman with a history of hypertension and diabetes presents with
progressive fatigue and anemia. Her laboratory results show microcytic hypochromic
anemia. What is the most likely diagnosis?
A. Aplastic anemia
B. Iron deficiency anemia
C. Hemolytic anemia
D. Thalassemia major
Correct Answer: B. Iron deficiency anemia
Rationale:
Microcytic hypochromic anemia is most commonly caused by iron deficiency anemia,
especially in adults with chronic disease or potential occult blood loss. Iron deficiency
leads to reduced hemoglobin synthesis, resulting in smaller (microcytic) and paler
(hypochromic) red blood cells. Aplastic anemia typically presents with pancytopenia
rather than isolated microcytosis. Hemolytic anemia is usually normocytic or
macrocytic due to increased reticulocyte production. Thalassemia may also present
with microcytosis, but it is usually lifelong and associated with a different clinical
history.
Question 2:
Which of the following is included in the treatment plan for symptomatic aplastic
anemia?
A. Iron supplementation only
B. Bone marrow transplant and transfusions
C. High-dose vitamin K therapy
D. Anticoagulation therapy
Correct Answer: B. Bone marrow transplant and transfusions
,2026/2027
Rationale:
Aplastic anemia involves bone marrow failure leading to pancytopenia. Definitive
treatment includes bone marrow transplantation in eligible patients. Supportive care
includes PRBC, platelet, and sometimes WBC transfusions, along with prophylactic
antibiotics to reduce infection risk. Iron supplementation and vitamin K are not
effective because the issue is marrow failure, not nutrient deficiency or clotting factor
depletion. Anticoagulation is contraindicated due to bleeding risk.
Question 3:
A patient presents with hemoglobin of 6.5 g/dL, SOB, fatigue, and chest pain. Which
laboratory findings would support iron deficiency anemia?
A. MCV 90, MCHC 33
B. MCV 110, MCHC 36
C. MCV 67, MCHC 29
D. MCV 100, MCHC 34
Correct Answer: C. MCV 67, MCHC 29
Rationale:
Iron deficiency anemia typically presents as microcytic (low MCV) and hypochromic
(low MCHC) anemia due to impaired hemoglobin synthesis. An MCV of 67 and
MCHC of 29 strongly support this diagnosis. Normal or elevated MCV values suggest
normocytic or macrocytic anemia, which are seen in other conditions such as B12
deficiency or hemolysis.
Question 4:
An elderly patient with a history of cancer presents with pancytopenia and dysplastic
changes on peripheral smear. What diagnostic test is most appropriate next?
A. Serum iron studies
B. Bone marrow biopsy and flow cytometry
C. Vitamin B12 level
D. Coagulation profile
Correct Answer: B. Bone marrow biopsy and flow cytometry
Rationale:
Pancytopenia with dysplastic changes raises concern for bone marrow disorders such
as myelodysplastic syndrome or leukemia. Bone marrow biopsy with flow cytometry
is essential for definitive diagnosis. Iron studies and B12 levels are not sufficient to
evaluate marrow pathology. Coagulation studies do not assess cellular production
defects.
Question 5:
,2026/2027
A patient with intrinsic factor autoantibodies is at risk for which condition?
A. Iron deficiency anemia
B. Pernicious anemia with B12 deficiency
C. Folate deficiency anemia
D. Hemolytic anemia
Correct Answer: B. Pernicious anemia with B12 deficiency
Rationale:
Intrinsic factor is required for vitamin B12 absorption in the terminal ileum.
Autoantibodies against intrinsic factor lead to pernicious anemia, a form of
megaloblastic anemia caused by B12 deficiency. Iron and folate deficiencies involve
different absorption pathways. Hemolytic anemia is unrelated to vitamin absorption.
Question 6:
A patient with sickle cell disease presents with severe vaso-occlusive pain crisis.
What is the most appropriate initial management?
A. Oral antibiotics and discharge
B. Hospitalization with IV fluids and opioids
C. High-dose iron therapy
D. Immediate splenectomy
Correct Answer: B. Hospitalization with IV fluids and opioids
Rationale:
Sickle cell crisis is managed with aggressive pain control using opioids and hydration
to reduce sickling and improve circulation. Hospitalization is often required for severe
cases. Antibiotics are only used if infection is suspected. Iron therapy is not indicated.
Splenectomy is not an acute intervention.
Question 7:
Which medication class reduces mortality in heart failure patients?
A. Calcium channel blockers
B. Beta blockers
C. Loop diuretics
D. Nitrates
Correct Answer: B. Beta blockers
Rationale:
Beta blockers improve survival in heart failure by reducing sympathetic overactivity,
decreasing myocardial oxygen demand, and improving cardiac remodeling. Calcium
, 2026/2027
channel blockers do not reduce mortality in heart failure. Diuretics relieve symptoms
but do not improve survival. Nitrates are used for symptom relief only.
Question 8:
A patient on methotrexate and ibuprofen presents with abdominal pain and melena.
What is the most likely diagnosis?
A. Pancreatitis
B. Gastric ulceration
C. Appendicitis
D. Diverticulitis
Correct Answer: B. Gastric ulceration
Rationale:
NSAIDs like ibuprofen and methotrexate increase risk of gastric mucosal injury,
leading to ulceration and possible GI bleeding (melena). Pancreatitis presents with
epigastric pain radiating to the back. Appendicitis causes localized right lower
quadrant pain. Diverticulitis presents with left lower quadrant pain and fever.
Question 9:
Biopsy findings of intestinal metaplasia with goblet cells are diagnostic of:
A. Gastritis
B. Barrett’s esophagus
C. Esophageal varices
D. Peptic ulcer disease
Correct Answer: B. Barrett’s esophagus
Rationale:
Barrett’s esophagus is characterized by replacement of normal squamous epithelium
with intestinal-type columnar epithelium containing goblet cells due to chronic GERD.
Gastritis involves inflammation without metaplasia. Varices are dilated veins. Peptic
ulcers involve mucosal erosion but not metaplasia.
Question 10:
Which technique is most appropriate for removing a chemical irritant from the eye?
A. Eye patching
B. Warm compress
C. Morgan lens irrigation
D. Topical antibiotics only
