NR 603 CEA EXAM /ACTUAL NR 603 CEA FINAL EXAM 2026/2027 PRACTICE
QUESTIONS AND STUDY GUIDE COMPLETE ACCURATE EXAM REAL QUESTIONS
AND CORRECT DETAILED SOLUTIONS WITH RATIONALES (100% EXPERT
VERIFIED ANSWERS) LATEST UPDATED VERSION 2026 EDITION |GUARANTEED
SUCCESS A+ |JUST RELEASED
A 65-year-old male with a history of hypertension and type 2 diabetes presents
with sudden onset of right-sided weakness and aphasia. His symptoms began 2
hours ago. His blood pressure is 185/110 mm Hg. Non-contrast head CT shows no
evidence of hemorrhage. Which of the following is the most appropriate next step?
A) Administer intravenous aspirin 325 mg
B) Lower blood pressure to below 140/90 mm Hg immediately
C) Administer intravenous alteplase (tPA) if no contraindications
D) Start oral clopidogrel 300 mg loading dose
E) Obtain an emergent magnetic resonance angiogram (MRA) of the brain
CORRECT ANSWER: C – For acute ischemic stroke within 3 hours of symptom
onset, intravenous alteplase is indicated if no hemorrhage on CT and no other
contraindications. Blood pressure should be managed but not aggressively lowered
unless it exceeds 185/110 (for tPA eligibility) or there are other specific
indications. Aspirin and clopidogrel are not first-line acute treatments and may
increase bleeding risk if tPA is given. MRA may be considered but should not
delay thrombolysis.
A 72-year-old woman with chronic kidney disease stage 3 and heart failure with
reduced ejection fraction presents with worsening dyspnea, orthopnea, and bilateral
pedal edema. Her medications include lisinopril 20 mg daily, furosemide 40 mg
daily, and metoprolol succinate 100 mg daily. Her potassium is 5.8 mEq/L,
creatinine 2.2 mg/dL (baseline 1.5), and BNP 1200 pg/mL. Which of the following
medication adjustments is most appropriate?
A) Increase furosemide to 80 mg daily
B) Discontinue lisinopril and add hydralazine/isosorbide dinitrate
C) Add spironolactone 25 mg daily
,D) Increase metoprolol succinate to 200 mg daily
E) Add digoxin 0.125 mg daily
CORRECT ANSWER: B – The patient has hyperkalemia (K 5.8) and worsening
renal function, likely from ACE inhibitor (lisinopril) use. Discontinuing the ACE
inhibitor is necessary. Hydralazine/isosorbide dinitrate is an alternative vasodilator
for heart failure with reduced EF, especially in patients with hyperkalemia or renal
dysfunction. Increasing furosemide may help edema but does not address the cause
of hyperkalemia. Spironolactone would worsen hyperkalemia. Increasing
metoprolol or adding digoxin does not address the ACE inhibitor complication.
A 45-year-old otherwise healthy male presents with acute onset of severe, tearing
chest pain radiating to the back. His blood pressure is 160/90 mm Hg in the right
arm and 100/70 mm Hg in the left arm. Heart rate is 110 bpm. ECG shows no
ischemic changes. Which imaging study is most appropriate for initial diagnosis?
A) Chest X-ray
B) Transthoracic echocardiogram
C) CT angiography of the chest
D) Transesophageal echocardiogram (TEE)
E) Magnetic resonance angiography (MRA)
CORRECT ANSWER: C – The presentation suggests acute aortic dissection with
unequal blood pressures. CT angiography of the chest is widely available, rapid,
and has high sensitivity/specificity for aortic dissection. TEE is also sensitive but
more invasive and operator-dependent. Chest X-ray may show widened
mediastinum but is not diagnostic. MRA takes too long in an acute setting.
Transthoracic echo is less sensitive for thoracic aortic dissection.
A 30-year-old woman at 28 weeks gestation presents with a 2-day history of
headache, blurred vision, and epigastric pain. Her blood pressure is 165/105 mm
Hg, and urinalysis shows 3+ protein. Platelet count is 90,000/mcL, and AST is 120
U/L. Which of the following is the most appropriate definitive management?
A) IV labetalol and expectant management with close monitoring
,B) IV magnesium sulfate and delivery of the fetus
C) Oral nifedipine and hospital bed rest
D) IV hydralazine and outpatient follow-up
E) Aspirin 81 mg daily and continued pregnancy
CORRECT ANSWER: B – This patient has severe preeclampsia with HELLP
syndrome features (thrombocytopenia, elevated liver enzymes). The only definitive
treatment is delivery. IV magnesium sulfate is given for seizure prophylaxis.
Expectant management is not appropriate in severe preeclampsia near term.
Outpatient management is unsafe. Aspirin is for prevention, not treatment.
A 55-year-old male with a 30-pack-year smoking history presents with a chronic
cough, hemoptysis, and 15-pound unintentional weight loss over 2 months. Chest
X-ray shows a right hilar mass. Which of the following diagnostic tests should be
performed next?
A) Sputum cytology
B) PET/CT scan
C) Bronchoscopy with biopsy
D) CT-guided transthoracic needle biopsy
E) Serum tumor markers (CEA, NSE)
CORRECT ANSWER: C – Bronchoscopy with biopsy is the next step for a central
hilar mass to obtain tissue diagnosis. Sputum cytology has low sensitivity. PET/CT
is staging after diagnosis. CT-guided biopsy is better for peripheral lesions. Tumor
markers are not diagnostic.
A 68-year-old woman with osteoarthritis presents with a 3-day history of acute,
painful swelling of the right great toe. She denies trauma. She takes
hydrochlorothiazide for hypertension. Physical exam reveals a warm,
erythematous, tender first metatarsophalangeal joint. Serum uric acid is 9.5 mg/dL.
Which of the following is the most appropriate initial treatment?
A) Allopurinol 300 mg daily
, B) Colchicine 0.6 mg twice daily
C) Indomethacin 50 mg three times daily
D) Febuxostat 40 mg daily
E) Intravenous methylprednisolone 100 mg
CORRECT ANSWER: C – This is acute gouty arthritis. NSAIDs such as
indomethacin are first-line for acute flares if no contraindications. Colchicine is
also an option but is second-line due to side effects. Allopurinol and febuxostat are
for chronic urate-lowering and should not be started during an acute flare. Oral
corticosteroids are alternatives but not first-line for a single joint with normal renal
function.
A 22-year-old college student presents with fever, sore throat, fatigue, and
posterior cervical lymphadenopathy. Rapid strep test is negative. Monospot test is
positive. She develops severe abdominal pain on day 5 of illness. Which of the
following is the most concerning complication?
A) Splenic rupture
B) Peritonsillar abscess
C) Acute glomerulonephritis
D) Rheumatic fever
E) Meningitis
CORRECT ANSWER: A – Infectious mononucleosis (Epstein-Barr virus) can
cause splenomegaly with risk of splenic rupture, especially after trauma or
straining. Abdominal pain warrants evaluation for splenic rupture. Peritonsillar
abscess is more common with strep. Glomerulonephritis and rheumatic fever are
post-streptococcal, not EBV.
A 60-year-old male with cirrhosis secondary to nonalcoholic steatohepatitis
presents with confusion, asterixis, and jaundice. His ammonia level is 150 mcg/dL.
Which medication is first-line for acute management of his encephalopathy?
A) Rifaximin 550 mg twice daily
QUESTIONS AND STUDY GUIDE COMPLETE ACCURATE EXAM REAL QUESTIONS
AND CORRECT DETAILED SOLUTIONS WITH RATIONALES (100% EXPERT
VERIFIED ANSWERS) LATEST UPDATED VERSION 2026 EDITION |GUARANTEED
SUCCESS A+ |JUST RELEASED
A 65-year-old male with a history of hypertension and type 2 diabetes presents
with sudden onset of right-sided weakness and aphasia. His symptoms began 2
hours ago. His blood pressure is 185/110 mm Hg. Non-contrast head CT shows no
evidence of hemorrhage. Which of the following is the most appropriate next step?
A) Administer intravenous aspirin 325 mg
B) Lower blood pressure to below 140/90 mm Hg immediately
C) Administer intravenous alteplase (tPA) if no contraindications
D) Start oral clopidogrel 300 mg loading dose
E) Obtain an emergent magnetic resonance angiogram (MRA) of the brain
CORRECT ANSWER: C – For acute ischemic stroke within 3 hours of symptom
onset, intravenous alteplase is indicated if no hemorrhage on CT and no other
contraindications. Blood pressure should be managed but not aggressively lowered
unless it exceeds 185/110 (for tPA eligibility) or there are other specific
indications. Aspirin and clopidogrel are not first-line acute treatments and may
increase bleeding risk if tPA is given. MRA may be considered but should not
delay thrombolysis.
A 72-year-old woman with chronic kidney disease stage 3 and heart failure with
reduced ejection fraction presents with worsening dyspnea, orthopnea, and bilateral
pedal edema. Her medications include lisinopril 20 mg daily, furosemide 40 mg
daily, and metoprolol succinate 100 mg daily. Her potassium is 5.8 mEq/L,
creatinine 2.2 mg/dL (baseline 1.5), and BNP 1200 pg/mL. Which of the following
medication adjustments is most appropriate?
A) Increase furosemide to 80 mg daily
B) Discontinue lisinopril and add hydralazine/isosorbide dinitrate
C) Add spironolactone 25 mg daily
,D) Increase metoprolol succinate to 200 mg daily
E) Add digoxin 0.125 mg daily
CORRECT ANSWER: B – The patient has hyperkalemia (K 5.8) and worsening
renal function, likely from ACE inhibitor (lisinopril) use. Discontinuing the ACE
inhibitor is necessary. Hydralazine/isosorbide dinitrate is an alternative vasodilator
for heart failure with reduced EF, especially in patients with hyperkalemia or renal
dysfunction. Increasing furosemide may help edema but does not address the cause
of hyperkalemia. Spironolactone would worsen hyperkalemia. Increasing
metoprolol or adding digoxin does not address the ACE inhibitor complication.
A 45-year-old otherwise healthy male presents with acute onset of severe, tearing
chest pain radiating to the back. His blood pressure is 160/90 mm Hg in the right
arm and 100/70 mm Hg in the left arm. Heart rate is 110 bpm. ECG shows no
ischemic changes. Which imaging study is most appropriate for initial diagnosis?
A) Chest X-ray
B) Transthoracic echocardiogram
C) CT angiography of the chest
D) Transesophageal echocardiogram (TEE)
E) Magnetic resonance angiography (MRA)
CORRECT ANSWER: C – The presentation suggests acute aortic dissection with
unequal blood pressures. CT angiography of the chest is widely available, rapid,
and has high sensitivity/specificity for aortic dissection. TEE is also sensitive but
more invasive and operator-dependent. Chest X-ray may show widened
mediastinum but is not diagnostic. MRA takes too long in an acute setting.
Transthoracic echo is less sensitive for thoracic aortic dissection.
A 30-year-old woman at 28 weeks gestation presents with a 2-day history of
headache, blurred vision, and epigastric pain. Her blood pressure is 165/105 mm
Hg, and urinalysis shows 3+ protein. Platelet count is 90,000/mcL, and AST is 120
U/L. Which of the following is the most appropriate definitive management?
A) IV labetalol and expectant management with close monitoring
,B) IV magnesium sulfate and delivery of the fetus
C) Oral nifedipine and hospital bed rest
D) IV hydralazine and outpatient follow-up
E) Aspirin 81 mg daily and continued pregnancy
CORRECT ANSWER: B – This patient has severe preeclampsia with HELLP
syndrome features (thrombocytopenia, elevated liver enzymes). The only definitive
treatment is delivery. IV magnesium sulfate is given for seizure prophylaxis.
Expectant management is not appropriate in severe preeclampsia near term.
Outpatient management is unsafe. Aspirin is for prevention, not treatment.
A 55-year-old male with a 30-pack-year smoking history presents with a chronic
cough, hemoptysis, and 15-pound unintentional weight loss over 2 months. Chest
X-ray shows a right hilar mass. Which of the following diagnostic tests should be
performed next?
A) Sputum cytology
B) PET/CT scan
C) Bronchoscopy with biopsy
D) CT-guided transthoracic needle biopsy
E) Serum tumor markers (CEA, NSE)
CORRECT ANSWER: C – Bronchoscopy with biopsy is the next step for a central
hilar mass to obtain tissue diagnosis. Sputum cytology has low sensitivity. PET/CT
is staging after diagnosis. CT-guided biopsy is better for peripheral lesions. Tumor
markers are not diagnostic.
A 68-year-old woman with osteoarthritis presents with a 3-day history of acute,
painful swelling of the right great toe. She denies trauma. She takes
hydrochlorothiazide for hypertension. Physical exam reveals a warm,
erythematous, tender first metatarsophalangeal joint. Serum uric acid is 9.5 mg/dL.
Which of the following is the most appropriate initial treatment?
A) Allopurinol 300 mg daily
, B) Colchicine 0.6 mg twice daily
C) Indomethacin 50 mg three times daily
D) Febuxostat 40 mg daily
E) Intravenous methylprednisolone 100 mg
CORRECT ANSWER: C – This is acute gouty arthritis. NSAIDs such as
indomethacin are first-line for acute flares if no contraindications. Colchicine is
also an option but is second-line due to side effects. Allopurinol and febuxostat are
for chronic urate-lowering and should not be started during an acute flare. Oral
corticosteroids are alternatives but not first-line for a single joint with normal renal
function.
A 22-year-old college student presents with fever, sore throat, fatigue, and
posterior cervical lymphadenopathy. Rapid strep test is negative. Monospot test is
positive. She develops severe abdominal pain on day 5 of illness. Which of the
following is the most concerning complication?
A) Splenic rupture
B) Peritonsillar abscess
C) Acute glomerulonephritis
D) Rheumatic fever
E) Meningitis
CORRECT ANSWER: A – Infectious mononucleosis (Epstein-Barr virus) can
cause splenomegaly with risk of splenic rupture, especially after trauma or
straining. Abdominal pain warrants evaluation for splenic rupture. Peritonsillar
abscess is more common with strep. Glomerulonephritis and rheumatic fever are
post-streptococcal, not EBV.
A 60-year-old male with cirrhosis secondary to nonalcoholic steatohepatitis
presents with confusion, asterixis, and jaundice. His ammonia level is 150 mcg/dL.
Which medication is first-line for acute management of his encephalopathy?
A) Rifaximin 550 mg twice daily
