2026/2027
NR 603 CEA Final Exam Clinical
Diagnosis Exam Preparation and
Assessment Review 2026/2027:
Advanced Practice Questions,
Clinical Decision-Making Exercises,
and Study Companion
Question 1
An 18-year-old patient recently treated for streptococcal throat infection now presents
with cola-colored urine. Urinalysis reveals red blood cell casts. What is the most
likely diagnosis?
A. Acute cystitis
B. Acute glomerulonephritis
C. Pyelonephritis
D. Nephrolithiasis
Correct Answer: B. Acute glomerulonephritis
Rationale: Post-streptococcal glomerulonephritis commonly occurs after streptococcal
infections and presents with hematuria, cola-colored urine, and RBC casts, which
indicate glomerular inflammation. Cystitis and pyelonephritis typically present with
urinary symptoms and white blood cell casts, not RBC casts. Nephrolithiasis causes
hematuria but does not produce casts.
Question 2
Which test is most appropriate for early detection of renal damage in a patient with
diabetes and hypertension?
A. Serum creatinine only
B. Urinalysis with microalbumin
C. Abdominal CT scan
D. Electrolyte panel
Correct Answer: B. Urinalysis with microalbumin
,2026/2027
Rationale: Microalbuminuria is the earliest marker of kidney damage in both diabetes
and hypertension. Serum creatinine rises late in disease progression. Imaging studies
and electrolytes are not sensitive for early nephropathy.
Question 3
A patient presents with atrial fibrillation, heart rate of 100 bpm, and stable vital signs.
What is the most appropriate initial management?
A. Immediate cardioversion
B. Rate control and anticoagulation
C. Thrombolytic therapy
D. Observation only
Correct Answer: B. Rate control and anticoagulation
Rationale: In stable atrial fibrillation, the priority is controlling ventricular rate and
preventing thromboembolism with anticoagulation. Cardioversion is reserved for
unstable patients or after anticoagulation. Thrombolytics are not indicated.
Question 4
Which finding indicates well-controlled HIV infection?
A. CD4 count <200 cells/mm³
B. CD4 count around 500 cells/mm³
C. Rising viral load
D. Persistent leukopenia
Correct Answer: B. CD4 count around 500 cells/mm³
Rationale: A CD4 count near or above 500 indicates strong immune function and
effective HIV control, especially when viral load is undetectable. A CD4 count below
200 suggests AIDS.
Question 5
A patient presents with a raised, dark, “stuck-on” waxy lesion on the skin. What is the
most likely diagnosis?
A. Melanoma
B. Seborrheic keratosis
C. Basal cell carcinoma
D. Actinic keratosis
Correct Answer: B. Seborrheic keratosis
,2026/2027
Rationale: Seborrheic keratosis is a benign skin lesion that appears waxy, pigmented,
and “stuck-on.” Melanoma is irregular and asymmetrical, basal cell carcinoma has
pearly edges, and actinic keratosis is rough and precancerous.
Question 6
A patient has gained 21 pounds, bilateral crackles, and severe generalized edema
extending to the abdomen and sacrum. What condition is this?
A. Ascites
B. Anasarca
C. Lymphedema
D. Pleural effusion
Correct Answer: B. Anasarca
Rationale: Anasarca refers to generalized, massive body edema often caused by heart
failure, renal failure, or liver disease. Ascites is localized to the abdomen, and
lymphedema is localized swelling of extremities.
Question 7
Crackles are heard in the left lower lung field but disappear after the patient coughs.
What is the most likely cause?
A. Pneumonia
B. Atelectasis
C. Pleural effusion
D. COPD
Correct Answer: B. Atelectasis
Rationale: Atelectasis involves alveolar collapse and can improve with coughing or
deep breathing. Pneumonia crackles persist despite coughing.
Question 8
A patient with elevated TSH and low T4 is most likely to exhibit which symptom?
A. Heat intolerance
B. Weight loss
C. Cold intolerance
D. Tachycardia
Correct Answer: C. Cold intolerance
, 2026/2027
Rationale: Hypothyroidism reduces metabolic rate, leading to cold intolerance, fatigue,
and weight gain. Hyperthyroidism causes heat intolerance and weight loss.
Question 9
Tongue deviation to the left indicates damage to which nerve?
A. Right hypoglossal nerve
B. Left hypoglossal nerve
C. Facial nerve
D. Vagus nerve
Correct Answer: B. Left hypoglossal nerve
Rationale: The tongue deviates toward the side of the lesion in hypoglossal nerve
palsy due to weakness of tongue muscles.
Question 10
A urine culture shows gram-negative rods. Which organism is least likely?
A. E. coli
B. Klebsiella
C. Proteus
D. Enterococcus
Correct Answer: D. Enterococcus
Rationale: Enterococcus is gram-positive, whereas E. coli, Klebsiella, and Proteus are
gram-negative organisms commonly associated with UTIs.
Question 11
Which beta-blocker is safest for a patient with COPD and coronary artery disease?
A. Propranolol
B. Metoprolol (Lopressor)
C. Timolol
D. Nadolol
Correct Answer: B. Metoprolol (Lopressor)
Rationale: Metoprolol is cardioselective (beta-1 selective), making it safer in COPD
patients compared to non-selective beta-blockers that may cause bronchospasm.
NR 603 CEA Final Exam Clinical
Diagnosis Exam Preparation and
Assessment Review 2026/2027:
Advanced Practice Questions,
Clinical Decision-Making Exercises,
and Study Companion
Question 1
An 18-year-old patient recently treated for streptococcal throat infection now presents
with cola-colored urine. Urinalysis reveals red blood cell casts. What is the most
likely diagnosis?
A. Acute cystitis
B. Acute glomerulonephritis
C. Pyelonephritis
D. Nephrolithiasis
Correct Answer: B. Acute glomerulonephritis
Rationale: Post-streptococcal glomerulonephritis commonly occurs after streptococcal
infections and presents with hematuria, cola-colored urine, and RBC casts, which
indicate glomerular inflammation. Cystitis and pyelonephritis typically present with
urinary symptoms and white blood cell casts, not RBC casts. Nephrolithiasis causes
hematuria but does not produce casts.
Question 2
Which test is most appropriate for early detection of renal damage in a patient with
diabetes and hypertension?
A. Serum creatinine only
B. Urinalysis with microalbumin
C. Abdominal CT scan
D. Electrolyte panel
Correct Answer: B. Urinalysis with microalbumin
,2026/2027
Rationale: Microalbuminuria is the earliest marker of kidney damage in both diabetes
and hypertension. Serum creatinine rises late in disease progression. Imaging studies
and electrolytes are not sensitive for early nephropathy.
Question 3
A patient presents with atrial fibrillation, heart rate of 100 bpm, and stable vital signs.
What is the most appropriate initial management?
A. Immediate cardioversion
B. Rate control and anticoagulation
C. Thrombolytic therapy
D. Observation only
Correct Answer: B. Rate control and anticoagulation
Rationale: In stable atrial fibrillation, the priority is controlling ventricular rate and
preventing thromboembolism with anticoagulation. Cardioversion is reserved for
unstable patients or after anticoagulation. Thrombolytics are not indicated.
Question 4
Which finding indicates well-controlled HIV infection?
A. CD4 count <200 cells/mm³
B. CD4 count around 500 cells/mm³
C. Rising viral load
D. Persistent leukopenia
Correct Answer: B. CD4 count around 500 cells/mm³
Rationale: A CD4 count near or above 500 indicates strong immune function and
effective HIV control, especially when viral load is undetectable. A CD4 count below
200 suggests AIDS.
Question 5
A patient presents with a raised, dark, “stuck-on” waxy lesion on the skin. What is the
most likely diagnosis?
A. Melanoma
B. Seborrheic keratosis
C. Basal cell carcinoma
D. Actinic keratosis
Correct Answer: B. Seborrheic keratosis
,2026/2027
Rationale: Seborrheic keratosis is a benign skin lesion that appears waxy, pigmented,
and “stuck-on.” Melanoma is irregular and asymmetrical, basal cell carcinoma has
pearly edges, and actinic keratosis is rough and precancerous.
Question 6
A patient has gained 21 pounds, bilateral crackles, and severe generalized edema
extending to the abdomen and sacrum. What condition is this?
A. Ascites
B. Anasarca
C. Lymphedema
D. Pleural effusion
Correct Answer: B. Anasarca
Rationale: Anasarca refers to generalized, massive body edema often caused by heart
failure, renal failure, or liver disease. Ascites is localized to the abdomen, and
lymphedema is localized swelling of extremities.
Question 7
Crackles are heard in the left lower lung field but disappear after the patient coughs.
What is the most likely cause?
A. Pneumonia
B. Atelectasis
C. Pleural effusion
D. COPD
Correct Answer: B. Atelectasis
Rationale: Atelectasis involves alveolar collapse and can improve with coughing or
deep breathing. Pneumonia crackles persist despite coughing.
Question 8
A patient with elevated TSH and low T4 is most likely to exhibit which symptom?
A. Heat intolerance
B. Weight loss
C. Cold intolerance
D. Tachycardia
Correct Answer: C. Cold intolerance
, 2026/2027
Rationale: Hypothyroidism reduces metabolic rate, leading to cold intolerance, fatigue,
and weight gain. Hyperthyroidism causes heat intolerance and weight loss.
Question 9
Tongue deviation to the left indicates damage to which nerve?
A. Right hypoglossal nerve
B. Left hypoglossal nerve
C. Facial nerve
D. Vagus nerve
Correct Answer: B. Left hypoglossal nerve
Rationale: The tongue deviates toward the side of the lesion in hypoglossal nerve
palsy due to weakness of tongue muscles.
Question 10
A urine culture shows gram-negative rods. Which organism is least likely?
A. E. coli
B. Klebsiella
C. Proteus
D. Enterococcus
Correct Answer: D. Enterococcus
Rationale: Enterococcus is gram-positive, whereas E. coli, Klebsiella, and Proteus are
gram-negative organisms commonly associated with UTIs.
Question 11
Which beta-blocker is safest for a patient with COPD and coronary artery disease?
A. Propranolol
B. Metoprolol (Lopressor)
C. Timolol
D. Nadolol
Correct Answer: B. Metoprolol (Lopressor)
Rationale: Metoprolol is cardioselective (beta-1 selective), making it safer in COPD
patients compared to non-selective beta-blockers that may cause bronchospasm.
