NR 547 CEA
CONSISTS OF 150 QUESTIONS
Verified Questions & Answers With Rationales
(Differential Diagnosis Across the Lifespan Practicum)
Chamberlain
,1. A nurse is performing a physical examination on a 58-year-old male patient. While
percussing the right upper quadrant over the liver area, the nurse notes a change in
percussion sound. What percussion change is observed while percussing over the
liver?
A. Percussion changes from resonant to hyperresonant
B. Percussion changes from dull to tympany
C. Percussion changes from flat to dull
D. Percussion changes from tympany to resonant
Correct Answer:
B. Percussion changes from dull to tympany
Rationale:
The liver is a solid organ that normally produces a dull percussion sound. As percussion
moves from the liver toward the gastric air bubble or intestines, the sound changes to
tympany. This transition point helps estimate liver size and identify organ boundaries.
Option A describes changes associated with pneumothorax. Option C describes normal
lung-to-liver transition. Option D is the reverse of the correct progression.
2. A 45-year-old construction worker presents to the clinic complaining of shoulder
pain that worsens when he lifts his arm above his head. During the physical
examination, the nurse practitioner notes pain and weakness with shoulder
abduction and external rotation. What injury is suggested by these findings?
A. Rotator cuff injury
B. Adhesive capsulitis
C. Glenohumeral joint dislocation
D. Acromioclavicular joint sprain
Correct Answer:
A. Rotator cuff injury
Rationale:
The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) are
primarily responsible for shoulder abduction and external rotation. Pain and weakness
with these specific movements are hallmark signs of rotator cuff pathology, particularly
supraspinatus involvement. Adhesive capsulitis (B) presents with global restriction of
passive and active range of motion. Glenohumeral dislocation (C) presents with a deformed
,shoulder and inability to move the arm. AC joint sprain (D) causes pain at the top of the
shoulder, particularly with cross-body adduction.
3. During a school physical examination of a 14-year-old adolescent, the nurse
observes that the patient's shoulders are not level and there is a visible lateral
curvature of the spine when the patient bends forward. What condition is indicated
by unequal shoulder height and a lateral spinal curve?
A. Kyphosis
B. Lordosis
C. Scoliosis
D. Spondylolisthesis
Correct Answer:
C. Scoliosis
Rationale:
Scoliosis is defined as a lateral (side-to-side) curvature of the spine, often accompanied by
vertebral rotation, rib hump, and unequal shoulder heights. The Adams forward bend test is
the standard screening tool. Kyphosis (A) is an exaggerated posterior curvature
(hunchback). Lordosis (B) is an exaggerated anterior curvature (swayback).
Spondylolisthesis (D) involves forward slippage of one vertebra over another and does not
typically present with lateral curvature.
4. A 62-year-old patient receiving chemotherapy complains of a terrible taste in their
mouth that makes eating difficult. What is the term for an awful taste sensation?
A. Olfactory
B. Gustatory
C. Auditory
D. Tactile
Correct Answer:
B. Gustatory
Rationale:
Gustatory refers to the sense of taste. Dysgeusia (distortion of taste) and ageusia (loss of
taste) are common gustatory disturbances, particularly in chemotherapy patients. Olfactory
(A) refers to the sense of smell. Auditory (C) refers to hearing. Tactile (D) refers to the sense
,of touch. Chemotherapy-induced dysgeusia significantly impacts nutritional intake and
quality of life.
5. A 43-year-old male patient presents with fatigue, pallor, and paresthesia in his
extremities. Laboratory studies reveal a mean corpuscular volume (MCV) of 110 fL.
What deficiency causes macrocytic anemia in this patient?
A. Iron deficiency
B. Vitamin B12 deficiency
C. Folate deficiency
D. Vitamin C deficiency
Correct Answer:
B. Vitamin B12 deficiency
Rationale:
Macrocytic anemia (MCV >100 fL) in a 43-year-old male with neurological symptoms
(paresthesia) strongly suggests vitamin B12 (cobalamin) deficiency. B12 deficiency causes
megaloblastic anemia and can lead to irreversible neurological damage if untreated due to
demyelination of the spinal cord and peripheral nerves. Iron deficiency (A) causes
microcytic anemia. Folate deficiency (C) also causes macrocytic anemia but typically
without neurological symptoms. Vitamin C deficiency (D) causes scurvy and may contribute
to anemia through impaired iron absorption but does not cause macrocytosis.
6. A 24-year-old female presents with persistent redness and papules on her cheeks
and nose that worsens with sun exposure and alcohol consumption. What is the
common treatment for erythema on the face in this patient?
A. Topical corticosteroids
B. Doxycycline
C. Oral antifungals
D. Benzoyl peroxide
Correct Answer:
B. Doxycycline
Rationale:
The presentation is consistent with rosacea, characterized by facial erythema, papules, and
telangiectasia. Doxycycline, particularly in sub-antimicrobial doses (40 mg delayed-
release), is a first-line treatment for inflammatory rosacea due to its anti-inflammatory
,properties. Topical corticosteroids (A) are contraindicated as they can worsen rosacea. Oral
antifungals (C) are used for fungal infections, not rosacea. Benzoyl peroxide (D) is used for
acne vulgaris and may irritate rosacea-prone skin.
7. A 35-year-old female presents with weight loss, heat intolerance, palpitations, and
a fine tremor. The nurse practitioner suspects hyperthyroidism. What tests are used
to assess hyperthyroidism?
A. TSH and Free T4
B. T3 and TSH receptor antibodies only
C. Total T4 and T3 uptake
D. Thyroglobulin and calcitonin
Correct Answer:
A. TSH and Free T4
Rationale:
The initial evaluation for thyroid dysfunction includes TSH (thyroid-stimulating hormone)
and free T4. In hyperthyroidism, TSH is suppressed (typically <0.01 mIU/L) and free T4 is
elevated. This combination provides the most sensitive and specific assessment of thyroid
function. TSH receptor antibodies (B) confirm Graves' disease but are not initial screening
tests. Total T4 (C) is affected by protein binding and is less reliable. Thyroglobulin and
calcitonin (D) are tumor markers for thyroid cancer, not functional assessment.
8. A 28-year-old female presents with joint pain, photosensitivity, and a distinctive
rash across her cheeks and bridge of her nose. What is the hallmark sign of systemic
lupus erythematosus?
A. Malar rash
B. Gottron papules
C. Heliotrope rash
D. Discoid rash
Correct Answer:
A. Butterfly rash on the face (Malar rash)
Rationale:
The malar or "butterfly" rash is the hallmark cutaneous manifestation of systemic lupus
erythematosus (SLE), appearing across the cheeks and bridge of the nose while sparing the
nasolabial folds. It is photosensitive and occurs in approximately 50% of SLE patients.
,Gottron papules (B) and heliotrope rash (C) are characteristic of dermatomyositis. Discoid
rash (D) is a chronic cutaneous form of lupus but is not the hallmark sign of systemic lupus.
9. An 82-year-old patient with a history of high myopia presents with sudden onset of
floaters, flashes of light, and a "curtain" over their visual field. The ophthalmologist
diagnoses retinal detachment. In elderly patients with retinal detachment, what type
of pneumopexy is used?
A. Anterior only
B. Posterior only
C. Panretinal
D. Scleral buckle only
Correct Answer:
B. Posterior only
Rationale:
In elderly patients with retinal detachment, particularly those with high myopia or
posterior segment pathology, posterior pneumatic retinopexy (pneumopexy) is the
preferred approach. This involves injecting an intraocular gas bubble into the posterior
vitreous cavity to tamponade the retinal break. Elderly patients often have posteriorly
located breaks and less vitreous traction, making posterior pneumopexy more appropriate.
Anterior approaches (A) are used for anterior breaks. Panretinal photocoagulation (C) is
used for proliferative diabetic retinopathy. Scleral buckle (D) is a surgical alternative, not a
type of pneumopexy.
10. A nurse is reviewing evidence to develop a new protocol for pressure injury
prevention. The team wants to ensure they are using the most reliable evidence
available. What is the highest level of research quality?
A. Randomized controlled trial
B. Cohort study
C. Systematic review
D. Case-control study
Correct Answer:
C. Systematic review
Rationale:
Systematic reviews, particularly those with meta-analysis, represent the highest level of
,evidence in the evidence hierarchy. They systematically search, appraise, and synthesize all
relevant studies on a specific question, reducing bias and increasing reliability. While
randomized controlled trials (A) are the gold standard for individual studies, systematic
reviews aggregate multiple RCTs to provide stronger evidence. Cohort studies (B) and case-
control studies (D) are observational designs at lower evidence levels.
11. A patient with a history of Graves' disease presents to the emergency department
with high fever, tachycardia, agitation, and vomiting. The nurse suspects a thyroid
emergency. What symptom is associated with a hyperthyroid crisis?
A. Bradycardia
B. Tachycardia
C. Hypothermia
D. Hypotension
Correct Answer:
B. Tachycardia
Rationale:
Thyroid storm (hyperthyroid crisis) is a life-threatening exacerbation of hyperthyroidism
characterized by extreme elevations in thyroid hormones. Tachycardia (often >140 bpm)
and atrial fibrillation are cardinal cardiovascular manifestations due to increased beta-
adrenergic activity. Bradycardia (A) and hypothermia (C) are associated with
hypothyroidism/myxedema coma. While hypotension (D) may develop in late stages due to
cardiovascular collapse, tachycardia is the hallmark and most consistent finding.
12. A 55-year-old patient with type 2 diabetes has been taking metformin for six
months. Their most recent HbA1c is 8.0%. According to current guidelines, what is
the second oral anti-diabetic agent added when A1C is 8.0%?
A. Increase metformin to maximum dose
B. Add a second agent (e.g., GLP-1 agonist or SGLT2 inhibitor)
C. Initiate basal insulin
D. Add a sulfonylurea only
Correct Answer:
B. Add a second agent (e.g., GLP-1 agonist or SGLT2 inhibitor)
Rationale:
ADA guidelines recommend adding a second agent when HbA1c remains ≥7.5-8.0% after 3
, months of metformin monotherapy at a tolerated dose. GLP-1 receptor agonists and SGLT2
inhibitors are preferred as second-line agents due to their cardiovascular benefits, weight
loss effects, and low hypoglycemia risk. Simply increasing metformin (A) is unlikely to
achieve adequate control. Basal insulin (C) is typically reserved for A1c >10% or
symptomatic hyperglycemia. Sulfonylureas (D) are no longer preferred due to
hypoglycemia and weight gain risks.
13. A 16-year-old patient with persistent asthma has been prescribed an inhaled
corticosteroid and a long-acting beta-agonist (LABA). The patient's mother asks why
two medications are needed. Which drug is not used as monotherapy for asthma?
A. Inhaled corticosteroid
B. Long-acting beta-agonist (LABA)
C. Leukotriene receptor antagonist
D. Short-acting beta-agonist
Correct Answer:
B. Long-acting beta-agonist (LABA)
Rationale:
LABAs (e.g., salmeterol, formoterol) are contraindicated as monotherapy for asthma due to
the risk of asthma-related death, as demonstrated in the SMART trial. They must always be
combined with an inhaled corticosteroid (ICS). ICS (A) are the cornerstone of asthma
maintenance therapy and can be used as monotherapy. Leukotriene receptor antagonists
(C) like montelukast can be used as monotherapy for mild persistent asthma. Short-acting
beta-agonists (D) are rescue medications used alone for acute symptoms.
14. A 10-year-old child presents with tea-colored urine, periorbital edema, and a
history of streptococcal pharyngitis two weeks ago. What condition is indicated by
hematuria following a strep infection?
A. Pyelonephritis
B. Glomerulonephritis
C. Nephrotic syndrome
D. Interstitial nephritis
Correct Answer:
B. Glomerulonephritis
CONSISTS OF 150 QUESTIONS
Verified Questions & Answers With Rationales
(Differential Diagnosis Across the Lifespan Practicum)
Chamberlain
,1. A nurse is performing a physical examination on a 58-year-old male patient. While
percussing the right upper quadrant over the liver area, the nurse notes a change in
percussion sound. What percussion change is observed while percussing over the
liver?
A. Percussion changes from resonant to hyperresonant
B. Percussion changes from dull to tympany
C. Percussion changes from flat to dull
D. Percussion changes from tympany to resonant
Correct Answer:
B. Percussion changes from dull to tympany
Rationale:
The liver is a solid organ that normally produces a dull percussion sound. As percussion
moves from the liver toward the gastric air bubble or intestines, the sound changes to
tympany. This transition point helps estimate liver size and identify organ boundaries.
Option A describes changes associated with pneumothorax. Option C describes normal
lung-to-liver transition. Option D is the reverse of the correct progression.
2. A 45-year-old construction worker presents to the clinic complaining of shoulder
pain that worsens when he lifts his arm above his head. During the physical
examination, the nurse practitioner notes pain and weakness with shoulder
abduction and external rotation. What injury is suggested by these findings?
A. Rotator cuff injury
B. Adhesive capsulitis
C. Glenohumeral joint dislocation
D. Acromioclavicular joint sprain
Correct Answer:
A. Rotator cuff injury
Rationale:
The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) are
primarily responsible for shoulder abduction and external rotation. Pain and weakness
with these specific movements are hallmark signs of rotator cuff pathology, particularly
supraspinatus involvement. Adhesive capsulitis (B) presents with global restriction of
passive and active range of motion. Glenohumeral dislocation (C) presents with a deformed
,shoulder and inability to move the arm. AC joint sprain (D) causes pain at the top of the
shoulder, particularly with cross-body adduction.
3. During a school physical examination of a 14-year-old adolescent, the nurse
observes that the patient's shoulders are not level and there is a visible lateral
curvature of the spine when the patient bends forward. What condition is indicated
by unequal shoulder height and a lateral spinal curve?
A. Kyphosis
B. Lordosis
C. Scoliosis
D. Spondylolisthesis
Correct Answer:
C. Scoliosis
Rationale:
Scoliosis is defined as a lateral (side-to-side) curvature of the spine, often accompanied by
vertebral rotation, rib hump, and unequal shoulder heights. The Adams forward bend test is
the standard screening tool. Kyphosis (A) is an exaggerated posterior curvature
(hunchback). Lordosis (B) is an exaggerated anterior curvature (swayback).
Spondylolisthesis (D) involves forward slippage of one vertebra over another and does not
typically present with lateral curvature.
4. A 62-year-old patient receiving chemotherapy complains of a terrible taste in their
mouth that makes eating difficult. What is the term for an awful taste sensation?
A. Olfactory
B. Gustatory
C. Auditory
D. Tactile
Correct Answer:
B. Gustatory
Rationale:
Gustatory refers to the sense of taste. Dysgeusia (distortion of taste) and ageusia (loss of
taste) are common gustatory disturbances, particularly in chemotherapy patients. Olfactory
(A) refers to the sense of smell. Auditory (C) refers to hearing. Tactile (D) refers to the sense
,of touch. Chemotherapy-induced dysgeusia significantly impacts nutritional intake and
quality of life.
5. A 43-year-old male patient presents with fatigue, pallor, and paresthesia in his
extremities. Laboratory studies reveal a mean corpuscular volume (MCV) of 110 fL.
What deficiency causes macrocytic anemia in this patient?
A. Iron deficiency
B. Vitamin B12 deficiency
C. Folate deficiency
D. Vitamin C deficiency
Correct Answer:
B. Vitamin B12 deficiency
Rationale:
Macrocytic anemia (MCV >100 fL) in a 43-year-old male with neurological symptoms
(paresthesia) strongly suggests vitamin B12 (cobalamin) deficiency. B12 deficiency causes
megaloblastic anemia and can lead to irreversible neurological damage if untreated due to
demyelination of the spinal cord and peripheral nerves. Iron deficiency (A) causes
microcytic anemia. Folate deficiency (C) also causes macrocytic anemia but typically
without neurological symptoms. Vitamin C deficiency (D) causes scurvy and may contribute
to anemia through impaired iron absorption but does not cause macrocytosis.
6. A 24-year-old female presents with persistent redness and papules on her cheeks
and nose that worsens with sun exposure and alcohol consumption. What is the
common treatment for erythema on the face in this patient?
A. Topical corticosteroids
B. Doxycycline
C. Oral antifungals
D. Benzoyl peroxide
Correct Answer:
B. Doxycycline
Rationale:
The presentation is consistent with rosacea, characterized by facial erythema, papules, and
telangiectasia. Doxycycline, particularly in sub-antimicrobial doses (40 mg delayed-
release), is a first-line treatment for inflammatory rosacea due to its anti-inflammatory
,properties. Topical corticosteroids (A) are contraindicated as they can worsen rosacea. Oral
antifungals (C) are used for fungal infections, not rosacea. Benzoyl peroxide (D) is used for
acne vulgaris and may irritate rosacea-prone skin.
7. A 35-year-old female presents with weight loss, heat intolerance, palpitations, and
a fine tremor. The nurse practitioner suspects hyperthyroidism. What tests are used
to assess hyperthyroidism?
A. TSH and Free T4
B. T3 and TSH receptor antibodies only
C. Total T4 and T3 uptake
D. Thyroglobulin and calcitonin
Correct Answer:
A. TSH and Free T4
Rationale:
The initial evaluation for thyroid dysfunction includes TSH (thyroid-stimulating hormone)
and free T4. In hyperthyroidism, TSH is suppressed (typically <0.01 mIU/L) and free T4 is
elevated. This combination provides the most sensitive and specific assessment of thyroid
function. TSH receptor antibodies (B) confirm Graves' disease but are not initial screening
tests. Total T4 (C) is affected by protein binding and is less reliable. Thyroglobulin and
calcitonin (D) are tumor markers for thyroid cancer, not functional assessment.
8. A 28-year-old female presents with joint pain, photosensitivity, and a distinctive
rash across her cheeks and bridge of her nose. What is the hallmark sign of systemic
lupus erythematosus?
A. Malar rash
B. Gottron papules
C. Heliotrope rash
D. Discoid rash
Correct Answer:
A. Butterfly rash on the face (Malar rash)
Rationale:
The malar or "butterfly" rash is the hallmark cutaneous manifestation of systemic lupus
erythematosus (SLE), appearing across the cheeks and bridge of the nose while sparing the
nasolabial folds. It is photosensitive and occurs in approximately 50% of SLE patients.
,Gottron papules (B) and heliotrope rash (C) are characteristic of dermatomyositis. Discoid
rash (D) is a chronic cutaneous form of lupus but is not the hallmark sign of systemic lupus.
9. An 82-year-old patient with a history of high myopia presents with sudden onset of
floaters, flashes of light, and a "curtain" over their visual field. The ophthalmologist
diagnoses retinal detachment. In elderly patients with retinal detachment, what type
of pneumopexy is used?
A. Anterior only
B. Posterior only
C. Panretinal
D. Scleral buckle only
Correct Answer:
B. Posterior only
Rationale:
In elderly patients with retinal detachment, particularly those with high myopia or
posterior segment pathology, posterior pneumatic retinopexy (pneumopexy) is the
preferred approach. This involves injecting an intraocular gas bubble into the posterior
vitreous cavity to tamponade the retinal break. Elderly patients often have posteriorly
located breaks and less vitreous traction, making posterior pneumopexy more appropriate.
Anterior approaches (A) are used for anterior breaks. Panretinal photocoagulation (C) is
used for proliferative diabetic retinopathy. Scleral buckle (D) is a surgical alternative, not a
type of pneumopexy.
10. A nurse is reviewing evidence to develop a new protocol for pressure injury
prevention. The team wants to ensure they are using the most reliable evidence
available. What is the highest level of research quality?
A. Randomized controlled trial
B. Cohort study
C. Systematic review
D. Case-control study
Correct Answer:
C. Systematic review
Rationale:
Systematic reviews, particularly those with meta-analysis, represent the highest level of
,evidence in the evidence hierarchy. They systematically search, appraise, and synthesize all
relevant studies on a specific question, reducing bias and increasing reliability. While
randomized controlled trials (A) are the gold standard for individual studies, systematic
reviews aggregate multiple RCTs to provide stronger evidence. Cohort studies (B) and case-
control studies (D) are observational designs at lower evidence levels.
11. A patient with a history of Graves' disease presents to the emergency department
with high fever, tachycardia, agitation, and vomiting. The nurse suspects a thyroid
emergency. What symptom is associated with a hyperthyroid crisis?
A. Bradycardia
B. Tachycardia
C. Hypothermia
D. Hypotension
Correct Answer:
B. Tachycardia
Rationale:
Thyroid storm (hyperthyroid crisis) is a life-threatening exacerbation of hyperthyroidism
characterized by extreme elevations in thyroid hormones. Tachycardia (often >140 bpm)
and atrial fibrillation are cardinal cardiovascular manifestations due to increased beta-
adrenergic activity. Bradycardia (A) and hypothermia (C) are associated with
hypothyroidism/myxedema coma. While hypotension (D) may develop in late stages due to
cardiovascular collapse, tachycardia is the hallmark and most consistent finding.
12. A 55-year-old patient with type 2 diabetes has been taking metformin for six
months. Their most recent HbA1c is 8.0%. According to current guidelines, what is
the second oral anti-diabetic agent added when A1C is 8.0%?
A. Increase metformin to maximum dose
B. Add a second agent (e.g., GLP-1 agonist or SGLT2 inhibitor)
C. Initiate basal insulin
D. Add a sulfonylurea only
Correct Answer:
B. Add a second agent (e.g., GLP-1 agonist or SGLT2 inhibitor)
Rationale:
ADA guidelines recommend adding a second agent when HbA1c remains ≥7.5-8.0% after 3
, months of metformin monotherapy at a tolerated dose. GLP-1 receptor agonists and SGLT2
inhibitors are preferred as second-line agents due to their cardiovascular benefits, weight
loss effects, and low hypoglycemia risk. Simply increasing metformin (A) is unlikely to
achieve adequate control. Basal insulin (C) is typically reserved for A1c >10% or
symptomatic hyperglycemia. Sulfonylureas (D) are no longer preferred due to
hypoglycemia and weight gain risks.
13. A 16-year-old patient with persistent asthma has been prescribed an inhaled
corticosteroid and a long-acting beta-agonist (LABA). The patient's mother asks why
two medications are needed. Which drug is not used as monotherapy for asthma?
A. Inhaled corticosteroid
B. Long-acting beta-agonist (LABA)
C. Leukotriene receptor antagonist
D. Short-acting beta-agonist
Correct Answer:
B. Long-acting beta-agonist (LABA)
Rationale:
LABAs (e.g., salmeterol, formoterol) are contraindicated as monotherapy for asthma due to
the risk of asthma-related death, as demonstrated in the SMART trial. They must always be
combined with an inhaled corticosteroid (ICS). ICS (A) are the cornerstone of asthma
maintenance therapy and can be used as monotherapy. Leukotriene receptor antagonists
(C) like montelukast can be used as monotherapy for mild persistent asthma. Short-acting
beta-agonists (D) are rescue medications used alone for acute symptoms.
14. A 10-year-old child presents with tea-colored urine, periorbital edema, and a
history of streptococcal pharyngitis two weeks ago. What condition is indicated by
hematuria following a strep infection?
A. Pyelonephritis
B. Glomerulonephritis
C. Nephrotic syndrome
D. Interstitial nephritis
Correct Answer:
B. Glomerulonephritis
