2026/2027
NR 603 CEA Midterm Exam Clinical
Diagnosis Comprehensive Review
and Practice Questions Study Guide
2026/2027 for Exam Preparation and
Success
Question 1:
A 60-year-old woman with a history of hypertension and type 2 diabetes mellitus
presents with progressive fatigue, exertional dyspnea, and generalized weakness.
Laboratory studies reveal a hemoglobin level of 8.5 g/dL with microcytic,
hypochromic red blood cells on peripheral smear. Which diagnosis is most likely?
A. Pernicious anemia
B. Iron deficiency anemia
C. Aplastic anemia
D. Sickle cell anemia
Correct Answer: B. Iron deficiency anemia
Rationale: Iron deficiency anemia is the most common cause of microcytic
hypochromic anemia and is characterized by decreased hemoglobin synthesis due to
inadequate iron availability. Patients often present with fatigue, pallor, weakness, and
exertional dyspnea. Pernicious anemia typically produces macrocytic anemia due to
vitamin B12 deficiency. Aplastic anemia causes pancytopenia with normocytic or
macrocytic indices, while sickle cell disease usually presents with normocytic
hemolytic anemia and vaso-occlusive complications rather than microcytosis.
Question 2:
Which of the following is considered a definitive treatment option for a patient with
symptomatic severe aplastic anemia?
A. Oral iron supplementation
B. Bone marrow transplantation
C. Vitamin B12 injections
D. Corticosteroid monotherapy
Correct Answer: B. Bone marrow transplantation
Rationale: Bone marrow transplantation is considered the definitive treatment for
eligible patients with severe aplastic anemia because it restores normal hematopoiesis.
,2026/2027
Supportive management may include transfusions and prophylactic antibiotics, but
these do not cure the disease. Iron supplementation and vitamin B12 therapy are
useful only when specific deficiencies are present. Corticosteroids alone do not
adequately address bone marrow failure.
Question 3:
A patient presents with shortness of breath, fatigue, headache, and chest discomfort.
Cardiac evaluation is negative. CBC demonstrates hemoglobin of 6.5 g/dL. Which
laboratory findings would most strongly suggest iron deficiency anemia?
A. MCV 105 fL and MCHC 37 g/dL
B. MCV 90 fL and MCHC 34 g/dL
C. MCV 67 fL and MCHC 29 g/dL
D. MCV 85 fL and MCHC 32 g/dL
Correct Answer: C. MCV 67 fL and MCHC 29 g/dL
Rationale: Iron deficiency anemia is characterized by microcytosis (low MCV) and
hypochromia (low MCHC). An MCV of 67 fL and MCHC of 29 g/dL indicate small,
pale red blood cells consistent with iron deficiency. Macrocytic values suggest
megaloblastic processes such as vitamin B12 or folate deficiency. Normal indices
would suggest alternative causes of anemia.
Question 4:
A 78-year-old man with a history of rectal adenocarcinoma treated with
chemotherapy and radiation presents with fatigue, recurrent infections, fever, and
bruising. CBC reveals pancytopenia, and peripheral smear demonstrates dysplastic
changes. Which diagnostic study should be performed next?
A. Colonoscopy
B. Echocardiography
C. Bone marrow biopsy with flow cytometry
D. Abdominal ultrasound
Correct Answer: C. Bone marrow biopsy with flow cytometry
Rationale: Pancytopenia accompanied by dysplastic changes raises concern for
myelodysplastic syndrome, leukemia, or therapy-related marrow disorders. Bone
marrow biopsy with flow cytometry provides definitive evaluation of marrow
architecture and cellular composition. Colonoscopy and abdominal ultrasound would
not identify marrow pathology, while echocardiography has no role in diagnosing
hematologic malignancies.
Question 5:
,2026/2027
A patient with intrinsic factor autoantibodies is at highest risk for developing which
condition?
A. Folate deficiency anemia
B. Iron deficiency anemia
C. Pernicious anemia with vitamin B12 deficiency
D. Hemolytic anemia
Correct Answer: C. Pernicious anemia with vitamin B12 deficiency
Rationale: Intrinsic factor is required for vitamin B12 absorption in the terminal ileum.
Autoimmune destruction of intrinsic factor results in pernicious anemia, causing
vitamin B12 deficiency and megaloblastic anemia. Folate deficiency occurs through
different mechanisms. Iron deficiency and hemolytic anemia are unrelated to intrinsic
factor abnormalities.
Question 6:
A 35-year-old man with sickle cell disease presents with severe pain involving the
chest, back, and extremities. Which intervention is most appropriate during an acute
vaso-occlusive crisis?
A. Immediate splenectomy
B. Hospitalization with intravenous fluids and opioid analgesics
C. Iron supplementation
D. Broad-spectrum antibiotics only
Correct Answer: B. Hospitalization with intravenous fluids and opioid analgesics
Rationale: Acute sickle cell pain crises require aggressive hydration and adequate
pain control, often with opioid medications. These interventions reduce sickling and
improve patient comfort. Splenectomy is not a treatment for acute crises. Iron
supplementation is not routinely indicated, and antibiotics are used only when
infection is suspected.
Question 7:
Which medication class forms a cornerstone of heart failure management and has
consistently demonstrated a reduction in mortality?
A. Nitrates
B. Beta blockers
C. Digoxin
D. Calcium channel blockers
Correct Answer: B. Beta blockers
, 2026/2027
Rationale: Evidence-based beta blockers improve survival, reduce hospitalization
rates, and slow disease progression in heart failure with reduced ejection fraction.
While nitrates and digoxin may improve symptoms, they do not provide the same
mortality benefit. Most calcium channel blockers have no established mortality
benefit in systolic heart failure.
Question 8:
A patient with rheumatoid arthritis taking methotrexate and frequent ibuprofen
develops severe abdominal pain, cramping, and dark stools. Which condition should
be suspected?
A. Crohn disease
B. Gastric ulceration
C. Cholelithiasis
D. Appendicitis
Correct Answer: B. Gastric ulceration
Rationale: Chronic NSAID use significantly increases the risk of gastric ulcer
formation and gastrointestinal bleeding. Dark stools suggest melena from upper GI
bleeding. Crohn disease, gallstones, and appendicitis do not commonly produce
melena associated with NSAID use.
Question 9:
A patient with chronic GERD undergoes biopsy during upper endoscopy. Which
finding confirms Barrett esophagus?
A. Squamous dysplasia without metaplasia
B. Eosinophilic infiltration
C. Intestinal metaplasia with goblet cells
D. Gastric ulceration
Correct Answer: C. Intestinal metaplasia with goblet cells
Rationale: Barrett esophagus is diagnosed histologically by the presence of
specialized intestinal metaplasia containing goblet cells in the distal esophagus. This
condition develops secondary to chronic acid exposure and increases the risk of
esophageal adenocarcinoma. The other findings do not establish the diagnosis.
Question 10:
A worker experiences unilateral eye pain after chemical exposure. Which technique is
commonly used to facilitate ocular irrigation and removal of contaminants?
NR 603 CEA Midterm Exam Clinical
Diagnosis Comprehensive Review
and Practice Questions Study Guide
2026/2027 for Exam Preparation and
Success
Question 1:
A 60-year-old woman with a history of hypertension and type 2 diabetes mellitus
presents with progressive fatigue, exertional dyspnea, and generalized weakness.
Laboratory studies reveal a hemoglobin level of 8.5 g/dL with microcytic,
hypochromic red blood cells on peripheral smear. Which diagnosis is most likely?
A. Pernicious anemia
B. Iron deficiency anemia
C. Aplastic anemia
D. Sickle cell anemia
Correct Answer: B. Iron deficiency anemia
Rationale: Iron deficiency anemia is the most common cause of microcytic
hypochromic anemia and is characterized by decreased hemoglobin synthesis due to
inadequate iron availability. Patients often present with fatigue, pallor, weakness, and
exertional dyspnea. Pernicious anemia typically produces macrocytic anemia due to
vitamin B12 deficiency. Aplastic anemia causes pancytopenia with normocytic or
macrocytic indices, while sickle cell disease usually presents with normocytic
hemolytic anemia and vaso-occlusive complications rather than microcytosis.
Question 2:
Which of the following is considered a definitive treatment option for a patient with
symptomatic severe aplastic anemia?
A. Oral iron supplementation
B. Bone marrow transplantation
C. Vitamin B12 injections
D. Corticosteroid monotherapy
Correct Answer: B. Bone marrow transplantation
Rationale: Bone marrow transplantation is considered the definitive treatment for
eligible patients with severe aplastic anemia because it restores normal hematopoiesis.
,2026/2027
Supportive management may include transfusions and prophylactic antibiotics, but
these do not cure the disease. Iron supplementation and vitamin B12 therapy are
useful only when specific deficiencies are present. Corticosteroids alone do not
adequately address bone marrow failure.
Question 3:
A patient presents with shortness of breath, fatigue, headache, and chest discomfort.
Cardiac evaluation is negative. CBC demonstrates hemoglobin of 6.5 g/dL. Which
laboratory findings would most strongly suggest iron deficiency anemia?
A. MCV 105 fL and MCHC 37 g/dL
B. MCV 90 fL and MCHC 34 g/dL
C. MCV 67 fL and MCHC 29 g/dL
D. MCV 85 fL and MCHC 32 g/dL
Correct Answer: C. MCV 67 fL and MCHC 29 g/dL
Rationale: Iron deficiency anemia is characterized by microcytosis (low MCV) and
hypochromia (low MCHC). An MCV of 67 fL and MCHC of 29 g/dL indicate small,
pale red blood cells consistent with iron deficiency. Macrocytic values suggest
megaloblastic processes such as vitamin B12 or folate deficiency. Normal indices
would suggest alternative causes of anemia.
Question 4:
A 78-year-old man with a history of rectal adenocarcinoma treated with
chemotherapy and radiation presents with fatigue, recurrent infections, fever, and
bruising. CBC reveals pancytopenia, and peripheral smear demonstrates dysplastic
changes. Which diagnostic study should be performed next?
A. Colonoscopy
B. Echocardiography
C. Bone marrow biopsy with flow cytometry
D. Abdominal ultrasound
Correct Answer: C. Bone marrow biopsy with flow cytometry
Rationale: Pancytopenia accompanied by dysplastic changes raises concern for
myelodysplastic syndrome, leukemia, or therapy-related marrow disorders. Bone
marrow biopsy with flow cytometry provides definitive evaluation of marrow
architecture and cellular composition. Colonoscopy and abdominal ultrasound would
not identify marrow pathology, while echocardiography has no role in diagnosing
hematologic malignancies.
Question 5:
,2026/2027
A patient with intrinsic factor autoantibodies is at highest risk for developing which
condition?
A. Folate deficiency anemia
B. Iron deficiency anemia
C. Pernicious anemia with vitamin B12 deficiency
D. Hemolytic anemia
Correct Answer: C. Pernicious anemia with vitamin B12 deficiency
Rationale: Intrinsic factor is required for vitamin B12 absorption in the terminal ileum.
Autoimmune destruction of intrinsic factor results in pernicious anemia, causing
vitamin B12 deficiency and megaloblastic anemia. Folate deficiency occurs through
different mechanisms. Iron deficiency and hemolytic anemia are unrelated to intrinsic
factor abnormalities.
Question 6:
A 35-year-old man with sickle cell disease presents with severe pain involving the
chest, back, and extremities. Which intervention is most appropriate during an acute
vaso-occlusive crisis?
A. Immediate splenectomy
B. Hospitalization with intravenous fluids and opioid analgesics
C. Iron supplementation
D. Broad-spectrum antibiotics only
Correct Answer: B. Hospitalization with intravenous fluids and opioid analgesics
Rationale: Acute sickle cell pain crises require aggressive hydration and adequate
pain control, often with opioid medications. These interventions reduce sickling and
improve patient comfort. Splenectomy is not a treatment for acute crises. Iron
supplementation is not routinely indicated, and antibiotics are used only when
infection is suspected.
Question 7:
Which medication class forms a cornerstone of heart failure management and has
consistently demonstrated a reduction in mortality?
A. Nitrates
B. Beta blockers
C. Digoxin
D. Calcium channel blockers
Correct Answer: B. Beta blockers
, 2026/2027
Rationale: Evidence-based beta blockers improve survival, reduce hospitalization
rates, and slow disease progression in heart failure with reduced ejection fraction.
While nitrates and digoxin may improve symptoms, they do not provide the same
mortality benefit. Most calcium channel blockers have no established mortality
benefit in systolic heart failure.
Question 8:
A patient with rheumatoid arthritis taking methotrexate and frequent ibuprofen
develops severe abdominal pain, cramping, and dark stools. Which condition should
be suspected?
A. Crohn disease
B. Gastric ulceration
C. Cholelithiasis
D. Appendicitis
Correct Answer: B. Gastric ulceration
Rationale: Chronic NSAID use significantly increases the risk of gastric ulcer
formation and gastrointestinal bleeding. Dark stools suggest melena from upper GI
bleeding. Crohn disease, gallstones, and appendicitis do not commonly produce
melena associated with NSAID use.
Question 9:
A patient with chronic GERD undergoes biopsy during upper endoscopy. Which
finding confirms Barrett esophagus?
A. Squamous dysplasia without metaplasia
B. Eosinophilic infiltration
C. Intestinal metaplasia with goblet cells
D. Gastric ulceration
Correct Answer: C. Intestinal metaplasia with goblet cells
Rationale: Barrett esophagus is diagnosed histologically by the presence of
specialized intestinal metaplasia containing goblet cells in the distal esophagus. This
condition develops secondary to chronic acid exposure and increases the risk of
esophageal adenocarcinoma. The other findings do not establish the diagnosis.
Question 10:
A worker experiences unilateral eye pain after chemical exposure. Which technique is
commonly used to facilitate ocular irrigation and removal of contaminants?
