CEA PREP: FULL PRACTICE EXAM
The=patient=is=exhibiting=a=productive=cough=and=a=low-grade=fever.=Chest=X-
ray=on=PA=view=shows=a=left=lower=chest=area=of=consolidation=adjacent=to=the=left=bo
rder=of=the=heart=approximately=2=rib=spaces=above=the=costophrenic=angle.=The=later
al=x-
ray=view=shows=this=lesion=absent=of=the=window=posterior=to=the=cardiac=silhouette.=
Which=is=the=most=likely=location=of=this=area=of=focal=consolidation?
*Left=upper=lobe=apex
*Right=middle=lobe
*Left=upper=lobe=lingula
*Left=lower=lobe=-=ans-✔✔Left=upper=lobe=lingula
Ratonale:=Lingular=consolidation=is=described=in=this=question=precisely.=If=the=cardiac=
margin/
silhouette=is=obliterated=by=the=mass,=the=lesion=is=either=right=middle=lobe=or=left=upp
er=lobe=lingula.
The=inability=to=fully=relax=the=myocardium=during=relaxation=is=a=trademark=of=which=
of=the=following=diagnoses?=-=ans-✔✔Diastolic=dysfunction
Rationale:=The=inability=for=the=heart=to=relax=is=a=trademark=of=the=diagnosis=of=diast
olic=dysfunction=and=is=common=in=patients=with=thickened=hypertrophic=myocardium.
An=otherwise=healthy=African=American=adult=male=has=been=diagnosed=with=hyperten
sion.=He=has=been=restricting=his=salt=intake,=eating=a=DASH=(Dietary=Approaches=to=
Stop=Hypertension)=diet,=and=exercising=more,=but=his=blood=pressure=is=still=elevated.
=Which=is=the=BEST=medication=to=prescribe=him?=-=ans-✔✔Calcium=channel=blocker
Rationale:=African=American=patients=per=JNC8=Hypertension=Guidelines=should=be=m
anaged=with=a=dihydropyridine=calcium=channel=blocker=such=as=amlodipine=(Norvasc)
=as=first=line=management=therapy=for=hypertension=not=at=goal=with=DASH=and=lifestyl
e=modifications.
Your=patient=has=been=diagnosed=with=a=4.5cm=ascending=aortic=aneurysm.=Which=m
edical=imaging=is=considered=standard=of=care=for=serial=surveillance?=-=ans-
✔✔CT=angiography=of=the=chest
Rationale:=CT=angiography=is=considered=the=standard=of=care=for=measuring=vascular
=luminal=dimensions=with=contrast.=CT=PE=protocol=is=not=timed=properly=for=the=aorta=
(it's=timed=for=the=pulmonary=artery).=Although=a=plain=film=is=able=to=catch=large=aneu
rysms=at=times,=they=are=not=able=to=provide=multi-
,axis=reconstruction=needed=to=accurately=measure=the=size.=Transesophageal=echo=is
=not=needed=to=accurately=measure=the=aorta=and=requires=the=patient=to=undergo=sed
ation=which=is=unnecessary.
Which=of=the=following=medications=does=not=cause=beta=1=stimulation?=-=ans-
✔✔phenylephrine
Rationale:=Phenylephrine=only=stimulates=alpha=1=receptors.=The=remaining=three=all=h
ave=beta=receptor=activity.
A=50-year-
old=woman=with=a=history=of=hypertension=presents=with=dyspnea=on=exertion=and=orth
opnea.=On=examination,=she=has=jugular=venous=distention=and=bilateral=crackles=on=l
ung=auscultation.=What=is=the=most=likely=diagnosis?=-=ans-
✔✔Congestive=heart=failure
Rationale:=Of=the=available=options,=the=most=accurate=response=is=congestive=heart=f
ailure=as=it=is=signifying=both=a=right=ventricular=back=up=with=jugular=venous=extension
=and=crackles=on=lung=assault,=which=are=suggestive=of=left=ventricular=back=up.=it=is=p
ossible=the=patient=may=have=an=acute=myocardial=infarction=that=precipitated=this,=ho
wever,=a=patient=has=not=described=that,=rather=is=only=describing=dyspnea=on=exertio
n=and=orthopnea,=which=both=speak=to=a=state=of=fluid=overload.=The=only=appropriate
=response=of=these=available=is=congestive=heart=failure.
Your=patient=with=a=history=of=HFrEF=(heart=failure=with=reduced=ejection=fraction)=with
=an=ejection=fraction=of=40%=who=is=also=not=on=optimal=medical=therapy=has=been=di
agnosed=with=a=myocardial=infarction=this=admission=and=received=emergent=placeme
nt=of=a=drug-
eluting=stent=to=the=left=anterior=descending=artery.=As=the=medical=home=who=will=ma
nage=this=patient=after=discharge,=which=medication=strategy=would=you=expect=to=be=
a=priority=in=the=patient's=care?=-=ans-
✔✔Ordering=a=transthoracic=echocardiogram=and=order=a=Lifevest=if=EF=is=less=than=3
5%
Rationale:=The=patient=should=have=a=protective=mechanism=such=as=an=implantable=
automated=cardioverter=defibrillator=(AICD)=or=a=Lifevest=if=the=EF=is=less=than=35%=d
ue=to=the=increased=risk=of=sudden=cardiac=death=with=low=EF=states.=Since=most=pati
ents=are=not=eligible=for=90=days=for=an=AICD=in=this=state,=optimizing=their=medication
=regimen=and=repeating=an=echo=in=2-3=months=to=re-
evaluate=for=improvement=in=their=EF=is=required=by=most=insurance=companies.=A=ba
seline=echo=is=needed=at=discharge=to=provide=a=baseline=for=improvement=vs=their=re
peat=echo=in=2-3=months.
Dual=anti-platelet=therapy=is=required=for=12=months=minimum=post-MI.=
A=Holter=monitor=does=not=provide=any=conceivable=benefit=for=this=patient=as=present
ed.
Which=of=the=following=people=groups=represent=the=least=risk=of=cardiac=disease?=-
=ans-✔✔Caucasians
,Rationale:=Statistically=African=Americans,=Native=Hawaiians,=and=American=Indians=ar
e=at=at=increased=risk=of=cardiac=disease=due=to=higher=rates=of=hypertension,=diabete
s,=and=obesity=than=Caucasians.
A=65-year-old=woman=presents=for=a=follow-
up=examination.=She=is=a=smoker,=and=her=hypertension=is=now=adequately=controlled
=with=medication.=Her=mother=died=at=age=40=from=a=heart=attack.=The=fasting=lipid=pr
ofile=shows=cholesterol===240=mg/
dL,=HDL===30,=and=LDL===200.=In=addition=to=starting=therapeutic=lifestyle=changes,=th
e=nurse=practitioner=should=start=the=patient=on:=-=ans-✔✔a=statin=drug.
Rationale:=Bile=acid=sequestrants=and=cholesterol=absorption=inhibitors=may=be=useful=
in=reducing=ASVD=risk,=but=for=a=patient=who=is=an=active=smoker=with=premature=cor
onary=disease=history=(less=than=age=65=for=women),=has=hypertension=and=is=far=fro
m=an=LDL=goal,=this=patient=is=most=certainly=a=candidate=for=statin=therapy,=which=re
presents=the=most=aggressive=therapy=option=of=these=four=listed.
Which=of=the=following=end-
organ=sequelae=is=not=directly=caused=by=uncontrolled=hypertension?=-=ans-
✔✔Peripheral=neuropathy
Ratioanle:=Although=patients=with=hypertension=frequently=have=peripheral=neuropathy,
=it=is=only=directly=attributed=to=patients=who=are=also=diabetic=and=is=commonly=found
=in=non-
hypertensive=diabetic=patients.=Proteinuria,=AV=nicking,=and=hemorrhagic=stroke=are=al
l=caused=by=uncontrolled=hypertension.
Preventive=cardiac=care=should=focus=primarily=on=addressing=all=the=following=except
?=-=ans-✔✔Genetic=predisposition
Rationale:=Smoking=cessation,=exercise,=and=medication=compliance=all=represent=mo
difiable=risk=factors=and=should=be=the=focus=of=preventive=care.=Non-
modifiable=risk=factors=such=as=age,=gender,=genetic/
family=history=should=not=be=the=primary=focus=of=prevention.
A=33-year-
old=woman=presents=with=irregular=menstrual=cycles,=hirsutism,=and=obesity.=Laborator
y=tests=reveal=elevated=serum=testosterone=and=LH=ratio=>=2:1.=What=is=the=most=app
ropriate=initial=treatment?=-=ans-✔✔Oral=contraceptives
Rationale:=These=are=classic=symptoms=of=polycystic=ovarian=syndrome=and=the=patie
nt=should=be=treated=with=oral=contraceptives=to=help=stabilize=their=estrogen=and=prog
esterone.=Additionally,=they=may=be=managed=on=metformin=and/
or=spironolactone=for=their=PCOS.
Oral=contraceptive=pills=(OCPs)=are=often=the=first=pharmacological=treatment=for=polyc
ystic=ovary=syndrome=(PCOS)=because=they=help=manage=in=several=ways:
Menstrual=irregularities:=OCPs=can=help=regulate=menstrual=cycles,=making=periods=lig
hter=and=more=regular.=This=is=important=because=irregular=ovulation=can=lead=to=endo
metrial=hyperplasia,=which=is=a=buildup=of=uterine=tissue=that=can=increase=the=risk=of=
uterine=cancer.
, Androgen=excess:=OCPs=can=reduce=androgen=production=and=increase=sex=hormone
-
binding=globulin=(SHBG),=which=binds=androgens.=This=can=help=reduce=symptoms=lik
e=acne,=hirsutism=(unwanted=body=and=facial=hair),=and=androgenic=alopecia=(male=pa
ttern=baldness).
Endometrium=protection:=OCPs=can=protect=the=endometrium=by=ensuring=regular=ovul
ation
A=50-year-old=woman=with=hypertension=and=diabetes=comes=in=for=a=routine=check-
up.=What=screening=test=should=be=regularly=performed=to=monitor=for=early=signs=of=d
iabetic=nephropathy?=-=ans-✔✔Urine=dipstick=for=protein
Rationale:=The=most=sensitive=indicator=of=diabetic=nephropathy=would=be=the=evidenc
e=of=small=proteins=in=the=urine=(proteinuria)=as=found=on=urinalysis.=The=other=options
=might=describe=macro-organ=function=(such=as=BUN/
Creat=from=a=BMP,=a=renal=biopsy=which=is=not=indicated=for=routine=diabetic=nephrop
athy=testing,=and=a=Abd=CT,=which=is=more=akin=to=evaluation=of=less=subtle=findings),
=but=at=the=functional=level=of=the=nephron,=namely=the=glomerulus,=evidence=of=gluco
se-related=damage=is=easily=identified=with=proteinuria=from=a=UA.
Which=of=the=following=is=at=highest=risk=for=DMII?=-=ans-
✔✔An=adult=woman=with=a=BMI=of=27=who=just=delivered=a=baby=weighing=9=1/2=lbs
Rationale:=Of=these=options,=an=adult=woman=with=a=BMI=of=27=who=just=delivered=a=b
aby=weighing=9=1/2=lbs=is=the=most=likely=due=to=their=increased=BMI=and=the=large=si
ze=of=the=baby.=giving=birth=to=a=large=baby,=also=known=as=a=large-for-gestational-
age=(LGA)=baby,=can=increase=the=risk=of=developing=type=2=diabetes=later=in=life.=Wo
men=who=give=birth=to=a=LGA=baby=are=10%=more=likely=to=develop=DMII=10-
14=years=after=pregnancy=compared=to=women=who=give=birth=to=babies=of=average=g
estational=age=(AGA).=This=increased=risk=is=even=after=adjusting=for=other=risk=factors
,=such=as=age,=obesity,=high=blood=pressure,=and=family=history=of=diabetes.
A=starting=dose=for=a=elderly=adult=patient=with=a=BMI=of=20=needing=levothryoxine=-
=ans-✔✔25=mcg
Rationale:=The=widely=considered=best=practice=for=treatment=of=hypothyroidism=in=the
=elderly=is=to="go=slow=and=start=low".=25=mcg=is=the=most=appropriate=low=dose=to=sta
rt=with=of=these=options.=It=is=possible=that=over=time=the=dose=will=be=increased=until=t
herapeutic=levels=are=obtained,=but=the=risk=of=over-
dosing=the=patient=outweighs=the=desire=to=quickly=achieve=this=state.
An=adult=female=who=recently=returned=for=a=recheck=appointment.=The=only=remarkab
le=laboratory=result=is=for=thyroid-stimulating=hormone=(TSH),=at=0.3=microunits/
mL=(normal===0.4-6=microunits/
mL).=The=patient=reports=that=her=neck=hurts;=examination=reveals=thyroid=tenderness.
=Which=of=the=following=laboratory=tests=should=the=nurse=practitioner=order=now?=-
=ans-✔✔Triiodothyronine=(T3)=and=free=thyroxine=(FT4)
Rationale:=Remember=that=a=patient=with=low=TSH=is=suspicious=of=hyperthyroidism=wi
th=a=corresponding=finding=of=elevated=T3/
The=patient=is=exhibiting=a=productive=cough=and=a=low-grade=fever.=Chest=X-
ray=on=PA=view=shows=a=left=lower=chest=area=of=consolidation=adjacent=to=the=left=bo
rder=of=the=heart=approximately=2=rib=spaces=above=the=costophrenic=angle.=The=later
al=x-
ray=view=shows=this=lesion=absent=of=the=window=posterior=to=the=cardiac=silhouette.=
Which=is=the=most=likely=location=of=this=area=of=focal=consolidation?
*Left=upper=lobe=apex
*Right=middle=lobe
*Left=upper=lobe=lingula
*Left=lower=lobe=-=ans-✔✔Left=upper=lobe=lingula
Ratonale:=Lingular=consolidation=is=described=in=this=question=precisely.=If=the=cardiac=
margin/
silhouette=is=obliterated=by=the=mass,=the=lesion=is=either=right=middle=lobe=or=left=upp
er=lobe=lingula.
The=inability=to=fully=relax=the=myocardium=during=relaxation=is=a=trademark=of=which=
of=the=following=diagnoses?=-=ans-✔✔Diastolic=dysfunction
Rationale:=The=inability=for=the=heart=to=relax=is=a=trademark=of=the=diagnosis=of=diast
olic=dysfunction=and=is=common=in=patients=with=thickened=hypertrophic=myocardium.
An=otherwise=healthy=African=American=adult=male=has=been=diagnosed=with=hyperten
sion.=He=has=been=restricting=his=salt=intake,=eating=a=DASH=(Dietary=Approaches=to=
Stop=Hypertension)=diet,=and=exercising=more,=but=his=blood=pressure=is=still=elevated.
=Which=is=the=BEST=medication=to=prescribe=him?=-=ans-✔✔Calcium=channel=blocker
Rationale:=African=American=patients=per=JNC8=Hypertension=Guidelines=should=be=m
anaged=with=a=dihydropyridine=calcium=channel=blocker=such=as=amlodipine=(Norvasc)
=as=first=line=management=therapy=for=hypertension=not=at=goal=with=DASH=and=lifestyl
e=modifications.
Your=patient=has=been=diagnosed=with=a=4.5cm=ascending=aortic=aneurysm.=Which=m
edical=imaging=is=considered=standard=of=care=for=serial=surveillance?=-=ans-
✔✔CT=angiography=of=the=chest
Rationale:=CT=angiography=is=considered=the=standard=of=care=for=measuring=vascular
=luminal=dimensions=with=contrast.=CT=PE=protocol=is=not=timed=properly=for=the=aorta=
(it's=timed=for=the=pulmonary=artery).=Although=a=plain=film=is=able=to=catch=large=aneu
rysms=at=times,=they=are=not=able=to=provide=multi-
,axis=reconstruction=needed=to=accurately=measure=the=size.=Transesophageal=echo=is
=not=needed=to=accurately=measure=the=aorta=and=requires=the=patient=to=undergo=sed
ation=which=is=unnecessary.
Which=of=the=following=medications=does=not=cause=beta=1=stimulation?=-=ans-
✔✔phenylephrine
Rationale:=Phenylephrine=only=stimulates=alpha=1=receptors.=The=remaining=three=all=h
ave=beta=receptor=activity.
A=50-year-
old=woman=with=a=history=of=hypertension=presents=with=dyspnea=on=exertion=and=orth
opnea.=On=examination,=she=has=jugular=venous=distention=and=bilateral=crackles=on=l
ung=auscultation.=What=is=the=most=likely=diagnosis?=-=ans-
✔✔Congestive=heart=failure
Rationale:=Of=the=available=options,=the=most=accurate=response=is=congestive=heart=f
ailure=as=it=is=signifying=both=a=right=ventricular=back=up=with=jugular=venous=extension
=and=crackles=on=lung=assault,=which=are=suggestive=of=left=ventricular=back=up.=it=is=p
ossible=the=patient=may=have=an=acute=myocardial=infarction=that=precipitated=this,=ho
wever,=a=patient=has=not=described=that,=rather=is=only=describing=dyspnea=on=exertio
n=and=orthopnea,=which=both=speak=to=a=state=of=fluid=overload.=The=only=appropriate
=response=of=these=available=is=congestive=heart=failure.
Your=patient=with=a=history=of=HFrEF=(heart=failure=with=reduced=ejection=fraction)=with
=an=ejection=fraction=of=40%=who=is=also=not=on=optimal=medical=therapy=has=been=di
agnosed=with=a=myocardial=infarction=this=admission=and=received=emergent=placeme
nt=of=a=drug-
eluting=stent=to=the=left=anterior=descending=artery.=As=the=medical=home=who=will=ma
nage=this=patient=after=discharge,=which=medication=strategy=would=you=expect=to=be=
a=priority=in=the=patient's=care?=-=ans-
✔✔Ordering=a=transthoracic=echocardiogram=and=order=a=Lifevest=if=EF=is=less=than=3
5%
Rationale:=The=patient=should=have=a=protective=mechanism=such=as=an=implantable=
automated=cardioverter=defibrillator=(AICD)=or=a=Lifevest=if=the=EF=is=less=than=35%=d
ue=to=the=increased=risk=of=sudden=cardiac=death=with=low=EF=states.=Since=most=pati
ents=are=not=eligible=for=90=days=for=an=AICD=in=this=state,=optimizing=their=medication
=regimen=and=repeating=an=echo=in=2-3=months=to=re-
evaluate=for=improvement=in=their=EF=is=required=by=most=insurance=companies.=A=ba
seline=echo=is=needed=at=discharge=to=provide=a=baseline=for=improvement=vs=their=re
peat=echo=in=2-3=months.
Dual=anti-platelet=therapy=is=required=for=12=months=minimum=post-MI.=
A=Holter=monitor=does=not=provide=any=conceivable=benefit=for=this=patient=as=present
ed.
Which=of=the=following=people=groups=represent=the=least=risk=of=cardiac=disease?=-
=ans-✔✔Caucasians
,Rationale:=Statistically=African=Americans,=Native=Hawaiians,=and=American=Indians=ar
e=at=at=increased=risk=of=cardiac=disease=due=to=higher=rates=of=hypertension,=diabete
s,=and=obesity=than=Caucasians.
A=65-year-old=woman=presents=for=a=follow-
up=examination.=She=is=a=smoker,=and=her=hypertension=is=now=adequately=controlled
=with=medication.=Her=mother=died=at=age=40=from=a=heart=attack.=The=fasting=lipid=pr
ofile=shows=cholesterol===240=mg/
dL,=HDL===30,=and=LDL===200.=In=addition=to=starting=therapeutic=lifestyle=changes,=th
e=nurse=practitioner=should=start=the=patient=on:=-=ans-✔✔a=statin=drug.
Rationale:=Bile=acid=sequestrants=and=cholesterol=absorption=inhibitors=may=be=useful=
in=reducing=ASVD=risk,=but=for=a=patient=who=is=an=active=smoker=with=premature=cor
onary=disease=history=(less=than=age=65=for=women),=has=hypertension=and=is=far=fro
m=an=LDL=goal,=this=patient=is=most=certainly=a=candidate=for=statin=therapy,=which=re
presents=the=most=aggressive=therapy=option=of=these=four=listed.
Which=of=the=following=end-
organ=sequelae=is=not=directly=caused=by=uncontrolled=hypertension?=-=ans-
✔✔Peripheral=neuropathy
Ratioanle:=Although=patients=with=hypertension=frequently=have=peripheral=neuropathy,
=it=is=only=directly=attributed=to=patients=who=are=also=diabetic=and=is=commonly=found
=in=non-
hypertensive=diabetic=patients.=Proteinuria,=AV=nicking,=and=hemorrhagic=stroke=are=al
l=caused=by=uncontrolled=hypertension.
Preventive=cardiac=care=should=focus=primarily=on=addressing=all=the=following=except
?=-=ans-✔✔Genetic=predisposition
Rationale:=Smoking=cessation,=exercise,=and=medication=compliance=all=represent=mo
difiable=risk=factors=and=should=be=the=focus=of=preventive=care.=Non-
modifiable=risk=factors=such=as=age,=gender,=genetic/
family=history=should=not=be=the=primary=focus=of=prevention.
A=33-year-
old=woman=presents=with=irregular=menstrual=cycles,=hirsutism,=and=obesity.=Laborator
y=tests=reveal=elevated=serum=testosterone=and=LH=ratio=>=2:1.=What=is=the=most=app
ropriate=initial=treatment?=-=ans-✔✔Oral=contraceptives
Rationale:=These=are=classic=symptoms=of=polycystic=ovarian=syndrome=and=the=patie
nt=should=be=treated=with=oral=contraceptives=to=help=stabilize=their=estrogen=and=prog
esterone.=Additionally,=they=may=be=managed=on=metformin=and/
or=spironolactone=for=their=PCOS.
Oral=contraceptive=pills=(OCPs)=are=often=the=first=pharmacological=treatment=for=polyc
ystic=ovary=syndrome=(PCOS)=because=they=help=manage=in=several=ways:
Menstrual=irregularities:=OCPs=can=help=regulate=menstrual=cycles,=making=periods=lig
hter=and=more=regular.=This=is=important=because=irregular=ovulation=can=lead=to=endo
metrial=hyperplasia,=which=is=a=buildup=of=uterine=tissue=that=can=increase=the=risk=of=
uterine=cancer.
, Androgen=excess:=OCPs=can=reduce=androgen=production=and=increase=sex=hormone
-
binding=globulin=(SHBG),=which=binds=androgens.=This=can=help=reduce=symptoms=lik
e=acne,=hirsutism=(unwanted=body=and=facial=hair),=and=androgenic=alopecia=(male=pa
ttern=baldness).
Endometrium=protection:=OCPs=can=protect=the=endometrium=by=ensuring=regular=ovul
ation
A=50-year-old=woman=with=hypertension=and=diabetes=comes=in=for=a=routine=check-
up.=What=screening=test=should=be=regularly=performed=to=monitor=for=early=signs=of=d
iabetic=nephropathy?=-=ans-✔✔Urine=dipstick=for=protein
Rationale:=The=most=sensitive=indicator=of=diabetic=nephropathy=would=be=the=evidenc
e=of=small=proteins=in=the=urine=(proteinuria)=as=found=on=urinalysis.=The=other=options
=might=describe=macro-organ=function=(such=as=BUN/
Creat=from=a=BMP,=a=renal=biopsy=which=is=not=indicated=for=routine=diabetic=nephrop
athy=testing,=and=a=Abd=CT,=which=is=more=akin=to=evaluation=of=less=subtle=findings),
=but=at=the=functional=level=of=the=nephron,=namely=the=glomerulus,=evidence=of=gluco
se-related=damage=is=easily=identified=with=proteinuria=from=a=UA.
Which=of=the=following=is=at=highest=risk=for=DMII?=-=ans-
✔✔An=adult=woman=with=a=BMI=of=27=who=just=delivered=a=baby=weighing=9=1/2=lbs
Rationale:=Of=these=options,=an=adult=woman=with=a=BMI=of=27=who=just=delivered=a=b
aby=weighing=9=1/2=lbs=is=the=most=likely=due=to=their=increased=BMI=and=the=large=si
ze=of=the=baby.=giving=birth=to=a=large=baby,=also=known=as=a=large-for-gestational-
age=(LGA)=baby,=can=increase=the=risk=of=developing=type=2=diabetes=later=in=life.=Wo
men=who=give=birth=to=a=LGA=baby=are=10%=more=likely=to=develop=DMII=10-
14=years=after=pregnancy=compared=to=women=who=give=birth=to=babies=of=average=g
estational=age=(AGA).=This=increased=risk=is=even=after=adjusting=for=other=risk=factors
,=such=as=age,=obesity,=high=blood=pressure,=and=family=history=of=diabetes.
A=starting=dose=for=a=elderly=adult=patient=with=a=BMI=of=20=needing=levothryoxine=-
=ans-✔✔25=mcg
Rationale:=The=widely=considered=best=practice=for=treatment=of=hypothyroidism=in=the
=elderly=is=to="go=slow=and=start=low".=25=mcg=is=the=most=appropriate=low=dose=to=sta
rt=with=of=these=options.=It=is=possible=that=over=time=the=dose=will=be=increased=until=t
herapeutic=levels=are=obtained,=but=the=risk=of=over-
dosing=the=patient=outweighs=the=desire=to=quickly=achieve=this=state.
An=adult=female=who=recently=returned=for=a=recheck=appointment.=The=only=remarkab
le=laboratory=result=is=for=thyroid-stimulating=hormone=(TSH),=at=0.3=microunits/
mL=(normal===0.4-6=microunits/
mL).=The=patient=reports=that=her=neck=hurts;=examination=reveals=thyroid=tenderness.
=Which=of=the=following=laboratory=tests=should=the=nurse=practitioner=order=now?=-
=ans-✔✔Triiodothyronine=(T3)=and=free=thyroxine=(FT4)
Rationale:=Remember=that=a=patient=with=low=TSH=is=suspicious=of=hyperthyroidism=wi
th=a=corresponding=finding=of=elevated=T3/
