Chamberlain NR 575 Clinical Evaluation
Assessment (CEA) — Comprehensive Exam
Preparation 2026/2027
Section 1: Health Assessment and Physical Examination
1. A 19-year-old patient presents with a new-onset cough. The nurse practitioner
performs percussion of the thorax. How does percussion assist in the physical
examination?
A. To confirm the cardiac origin of angina
B. To assess for deep-seated lesions and tumors
C. To assess for pain or discomfort prior to palpation
D. To identify if underlying tissues are air-filled, fluid-filled, or consolidated
Answer: D. To identify if underlying tissues are air-filled, fluid-filled, or
consolidated
Rationale: Percussion of the thorax produces different sounds based on the density
of underlying structures. Normal lung tissue is air-filled and produces a resonant
sound. Fluid (pleural effusion) or consolidated tissue (pneumonia, tumor) produces
dullness. Hyperresonance indicates trapped air (COPD, pneumothorax).
2. A 50-year-old Caucasian male presents for an initial history and physical after
20+ years without primary care. Examination reveals nonpitting periorbital
edema, very dry thinned hair, and loss of the lateral third of the eyebrows.
Which diagnosis should the NP suspect?
A. Addison's disease
B. Graves' disease
C. Severe hypothyroidism (myxedema)
D. Alzheimer's disease
, Answer: C. Severe hypothyroidism (myxedema)
Rationale: Severe or long-standing hypothyroidism (myxedema) presents with
nonpitting periorbital edema due to glycosaminoglycan deposition in the dermis,
which attracts water and causes boggy swelling. Hair changes include dry, brittle,
thinning hair and loss of the lateral third of the eyebrows (Queen Anne's sign).
Addison's disease presents with hyperpigmentation. Graves' disease presents with
exophthalmos.
3. A 40-year-old African American female presents with severe exophthalmos.
What diagnosis is highest on the differential?
A. Bilateral conjunctivitis
B. Hyperthyroidism (Graves' disease)
C. Hypothyroidism
D. Myxedema
Answer: B. Hyperthyroidism (Graves' disease)
Rationale: Exophthalmos (protrusion of the eyeballs) is a classic manifestation of
Graves' disease, the most common cause of hyperthyroidism. The pathophysiology
involves autoimmune stimulation of the thyroid gland and orbital fibroblasts,
causing inflammation, edema, and hypertrophy of extraocular muscles and retro-
orbital fat. Conjunctivitis causes redness and swelling but not protrusion.
Hypothyroidism and myxedema are associated with periorbital edema, not
exophthalmos.
4. A 32-year-old female with a diagnosis of hyperthyroidism presents for
evaluation. In addition to TSH and T4 lab work, which typical sign is expected on
examination?
A. Hypersomnia
B. Tachycardia
C. Lethargy
D. Recent unplanned weight gain
Answer: B. Tachycardia
Assessment (CEA) — Comprehensive Exam
Preparation 2026/2027
Section 1: Health Assessment and Physical Examination
1. A 19-year-old patient presents with a new-onset cough. The nurse practitioner
performs percussion of the thorax. How does percussion assist in the physical
examination?
A. To confirm the cardiac origin of angina
B. To assess for deep-seated lesions and tumors
C. To assess for pain or discomfort prior to palpation
D. To identify if underlying tissues are air-filled, fluid-filled, or consolidated
Answer: D. To identify if underlying tissues are air-filled, fluid-filled, or
consolidated
Rationale: Percussion of the thorax produces different sounds based on the density
of underlying structures. Normal lung tissue is air-filled and produces a resonant
sound. Fluid (pleural effusion) or consolidated tissue (pneumonia, tumor) produces
dullness. Hyperresonance indicates trapped air (COPD, pneumothorax).
2. A 50-year-old Caucasian male presents for an initial history and physical after
20+ years without primary care. Examination reveals nonpitting periorbital
edema, very dry thinned hair, and loss of the lateral third of the eyebrows.
Which diagnosis should the NP suspect?
A. Addison's disease
B. Graves' disease
C. Severe hypothyroidism (myxedema)
D. Alzheimer's disease
, Answer: C. Severe hypothyroidism (myxedema)
Rationale: Severe or long-standing hypothyroidism (myxedema) presents with
nonpitting periorbital edema due to glycosaminoglycan deposition in the dermis,
which attracts water and causes boggy swelling. Hair changes include dry, brittle,
thinning hair and loss of the lateral third of the eyebrows (Queen Anne's sign).
Addison's disease presents with hyperpigmentation. Graves' disease presents with
exophthalmos.
3. A 40-year-old African American female presents with severe exophthalmos.
What diagnosis is highest on the differential?
A. Bilateral conjunctivitis
B. Hyperthyroidism (Graves' disease)
C. Hypothyroidism
D. Myxedema
Answer: B. Hyperthyroidism (Graves' disease)
Rationale: Exophthalmos (protrusion of the eyeballs) is a classic manifestation of
Graves' disease, the most common cause of hyperthyroidism. The pathophysiology
involves autoimmune stimulation of the thyroid gland and orbital fibroblasts,
causing inflammation, edema, and hypertrophy of extraocular muscles and retro-
orbital fat. Conjunctivitis causes redness and swelling but not protrusion.
Hypothyroidism and myxedema are associated with periorbital edema, not
exophthalmos.
4. A 32-year-old female with a diagnosis of hyperthyroidism presents for
evaluation. In addition to TSH and T4 lab work, which typical sign is expected on
examination?
A. Hypersomnia
B. Tachycardia
C. Lethargy
D. Recent unplanned weight gain
Answer: B. Tachycardia
