NR 603 CEA Midterm Exam: Advanced Clinical Diagnosis 2026/2027
Chamberlain College
1. A 65-year-old patient presents with a blood pressure of 152/94 mmHg on two
separate visits. According to JNC 8 guidelines, what is the initial recommended
pharmacological treatment for a non-black patient without CKD?
A. Metoprolol
B. Lisinopril
C. Spironolactone
D. Hydralazine
Answer: B
Rationale: For non-black patients, first-line agents include ACE inhibitors (like Lisinopril),
ARBs, Thiazide diuretics, or Calcium Channel Blockers. Beta-blockers are not first-line for
uncomplicated HTN.
2. Which of the following laboratory findings is most characteristic of Iron
Deficiency Anemia?
A. High Ferritin and Low TIBC
B. Low Ferritin and High TIBC
C. High MCV and High MCH
D. Low Ferritin and Low TIBC
Answer: B
Rationale: Iron deficiency is characterized by low serum iron, low ferritin (the most
sensitive marker), and an elevated Total Iron Binding Capacity (TIBC) as the body seeks
more iron.
,3. A 72-year-old male with heart failure (EF 35%) reports symptoms with
ordinary physical activity but is comfortable at rest. What is his NYHA Functional
Classification?
A. Class I
B. Class III
C. Class II
D. Class IV
Answer: C
Rationale: NYHA Class II involves slight limitation of physical activity where ordinary
activity results in fatigue or dyspnea, but the patient is comfortable at rest.
4. What is the gold standard for diagnosing Chronic Obstructive Pulmonary
Disease (COPD)?
A. Chest X-ray
B. Spirometry
C. Peak Flow Meter
D. Arterial Blood Gas
Answer: B
Rationale: Spirometry is required to make a clinical diagnosis of COPD; a post-
bronchodilator FEV1/FVC ratio < 0.70 confirms persistent airflow limitation.
5. In a patient with Type 2 Diabetes, which medication class is preferred for its
proven cardiovascular and renal protective benefits?
A. Sulfonylureas
B. DPP-4 Inhibitors
C. Meglitinides
D. SGLT2 Inhibitors
Answer: D
, Rationale: SGLT2 inhibitors and GLP-1 receptor agonists are preferred in patients with
established CVD or CKD due to their evidence-based protective outcomes.
6. A patient’s TSH is 8.5 mIU/L (High) and Free T4 is 0.9 ng/dL (Normal). How
should this be classified?
A. Overt Hypothyroidism
B. Subclinical Hypothyroidism
C. Secondary Hypothyroidism
D. Hyperthyroidism
Answer: B
Rationale: Subclinical hypothyroidism is defined as an elevated TSH in the presence of a
normal Free T4.
7. Which physical exam finding is most indicative of an S3 heart sound?
A. It is heard during mid-systole following a click.
B. It is heard in late diastole and suggests a stiff ventricle.
C. It is heard in early diastole and suggests fluid overload.
D. It is always a benign finding in the elderly.
Answer: C
Rationale: The S3 gallop (Ventricular Gallop) occurs in early diastole during rapid
ventricular filling and is often associated with heart failure and fluid overload in adults.
8. What is the first-line treatment for a patient diagnosed with mild-to-
moderate Gastroesophageal Reflux Disease (GERD) who fails lifestyle
modifications?
A. H2 Receptor Antagonists
B. Nissen Fundoplication
C. Sucralfate
D. Proton Pump Inhibitors (PPIs)
Answer: D
Chamberlain College
1. A 65-year-old patient presents with a blood pressure of 152/94 mmHg on two
separate visits. According to JNC 8 guidelines, what is the initial recommended
pharmacological treatment for a non-black patient without CKD?
A. Metoprolol
B. Lisinopril
C. Spironolactone
D. Hydralazine
Answer: B
Rationale: For non-black patients, first-line agents include ACE inhibitors (like Lisinopril),
ARBs, Thiazide diuretics, or Calcium Channel Blockers. Beta-blockers are not first-line for
uncomplicated HTN.
2. Which of the following laboratory findings is most characteristic of Iron
Deficiency Anemia?
A. High Ferritin and Low TIBC
B. Low Ferritin and High TIBC
C. High MCV and High MCH
D. Low Ferritin and Low TIBC
Answer: B
Rationale: Iron deficiency is characterized by low serum iron, low ferritin (the most
sensitive marker), and an elevated Total Iron Binding Capacity (TIBC) as the body seeks
more iron.
,3. A 72-year-old male with heart failure (EF 35%) reports symptoms with
ordinary physical activity but is comfortable at rest. What is his NYHA Functional
Classification?
A. Class I
B. Class III
C. Class II
D. Class IV
Answer: C
Rationale: NYHA Class II involves slight limitation of physical activity where ordinary
activity results in fatigue or dyspnea, but the patient is comfortable at rest.
4. What is the gold standard for diagnosing Chronic Obstructive Pulmonary
Disease (COPD)?
A. Chest X-ray
B. Spirometry
C. Peak Flow Meter
D. Arterial Blood Gas
Answer: B
Rationale: Spirometry is required to make a clinical diagnosis of COPD; a post-
bronchodilator FEV1/FVC ratio < 0.70 confirms persistent airflow limitation.
5. In a patient with Type 2 Diabetes, which medication class is preferred for its
proven cardiovascular and renal protective benefits?
A. Sulfonylureas
B. DPP-4 Inhibitors
C. Meglitinides
D. SGLT2 Inhibitors
Answer: D
, Rationale: SGLT2 inhibitors and GLP-1 receptor agonists are preferred in patients with
established CVD or CKD due to their evidence-based protective outcomes.
6. A patient’s TSH is 8.5 mIU/L (High) and Free T4 is 0.9 ng/dL (Normal). How
should this be classified?
A. Overt Hypothyroidism
B. Subclinical Hypothyroidism
C. Secondary Hypothyroidism
D. Hyperthyroidism
Answer: B
Rationale: Subclinical hypothyroidism is defined as an elevated TSH in the presence of a
normal Free T4.
7. Which physical exam finding is most indicative of an S3 heart sound?
A. It is heard during mid-systole following a click.
B. It is heard in late diastole and suggests a stiff ventricle.
C. It is heard in early diastole and suggests fluid overload.
D. It is always a benign finding in the elderly.
Answer: C
Rationale: The S3 gallop (Ventricular Gallop) occurs in early diastole during rapid
ventricular filling and is often associated with heart failure and fluid overload in adults.
8. What is the first-line treatment for a patient diagnosed with mild-to-
moderate Gastroesophageal Reflux Disease (GERD) who fails lifestyle
modifications?
A. H2 Receptor Antagonists
B. Nissen Fundoplication
C. Sucralfate
D. Proton Pump Inhibitors (PPIs)
Answer: D
