CEA Prep Full Practice Exam 2 Objectives
Questions and Verified Answers Latest A+
A 33-year-old woman presents with irregular
menstrual cycles, hirsutism, and obesity. Laboratory
tests reveal elevated serum testosterone and LH ratio
> 2:1. What is the most appropriate initial treatment?
Oral contraceptives
Rationale: These are classic symptoms of polycystic
ovarian syndrome and the patient should be treated with
oral contraceptives to help stabilize their estrogen and
progesterone. Additionally, they may be managed on
metformin and/or spironolactone for their PCOS.
Oral contraceptive pills (OCPs) are often the first
pharmacological treatment for polycystic ovary syndrome
(PCOS) because they help manage in several ways:
Menstrual irregularities: OCPs can help regulate menstrual
cycles, making periods lighter and more regular. This is
important because irregular ovulation can lead to
endometrial 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 like
acne, hirsutism (unwanted body and facial hair), and
androgenic alopecia (male pattern baldness).
,Endometrium protection: OCPs can protect the
endometrium by ensuring regular ovulation
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 diabetic nephropathy?
Urine dipstick for protein
Rationale: The most sensitive indicator of diabetic
nephropathy would be the evidence 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 nephropathy 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 glucose-related damage is
easily identified with proteinuria from a UA.
A starting dose for a elderly adult patient with a BMI of
20 needing levothryoxine
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
start with of these options. It is possible that over time the
dose will be increased until therapeutic 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 remarkable 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?
Triiodothyronine (T3) and free thyroxine (FT4)
Rationale: Remember that a patient with low TSH is
suspicious of hyperthyroidism with a corresponding finding
of elevated T3/T4 and clinical symptoms of a goiter,
tremulousness, anxiety, palpitations, weight loss,
insomnia, diarrhea, etc. This patient is describing a sore
neck as well, which is suggestive of Graves disease
(hyperthyroid state).
All the following are symptoms of hypocalcemia
except:
Visual field deficits
Rationale: Visual field deficits is a potential symptom of
pituitary adenoma. All other are symptoms related to
hypocalcemia.
An adult patient diagnosed with type 2 diabetes
mellitus presents for a recheck. The patient follows a
carbohydrate counting diet and walks 30 minutes 5
times weekly. Current fasting blood glucose = 116
mg/dL [normal = less than 99 mg/dL] and A1c = 6.3%
, [normal = less than 7.0%]. In accordance with the
American Diabetes Association, the nurse practitioner
would recommend that the next follow-up
appointment be scheduled for:
6 months.
Rationale: Based off of the ADA recommendation, this
patient should be evaluated in six months. They are
actually showing good control and excellent compliance
with diet and exercise management strategies. If there
compliance was worse or they were not controlled with
their A1c, this would likely be a three month follow up.
Your patient has a diagnosis of Hashimoto's and is on
Levothyroxine 75 mcg daily. Her recent TSH was
elevated at 15 uU/mL. Your next best action is to:
Increase Levothyroxine to 100 mcg daily
Rationale: When the TSH is elevated the patient needs
more thyroid hormone. Once diagnosed with Hashimoto's
there is no clinical need/benefit to repeating anti bodies.
A patient has a 3 cm pituitary mass noted on CT. What
is your next step in evaluating the patient?
Screen for hormone deficiencies
Rationale: Initial work up includes hormone testing.
Cabergoline is the treatment for prolactinoma. Surgery
consult is indicated when there are VF deficits and/or
abutment/compression on optic nerves or chiasm or if
adenoma is hyperfunctioning. Adenomas >1 cm with no
Questions and Verified Answers Latest A+
A 33-year-old woman presents with irregular
menstrual cycles, hirsutism, and obesity. Laboratory
tests reveal elevated serum testosterone and LH ratio
> 2:1. What is the most appropriate initial treatment?
Oral contraceptives
Rationale: These are classic symptoms of polycystic
ovarian syndrome and the patient should be treated with
oral contraceptives to help stabilize their estrogen and
progesterone. Additionally, they may be managed on
metformin and/or spironolactone for their PCOS.
Oral contraceptive pills (OCPs) are often the first
pharmacological treatment for polycystic ovary syndrome
(PCOS) because they help manage in several ways:
Menstrual irregularities: OCPs can help regulate menstrual
cycles, making periods lighter and more regular. This is
important because irregular ovulation can lead to
endometrial 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 like
acne, hirsutism (unwanted body and facial hair), and
androgenic alopecia (male pattern baldness).
,Endometrium protection: OCPs can protect the
endometrium by ensuring regular ovulation
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 diabetic nephropathy?
Urine dipstick for protein
Rationale: The most sensitive indicator of diabetic
nephropathy would be the evidence 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 nephropathy 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 glucose-related damage is
easily identified with proteinuria from a UA.
A starting dose for a elderly adult patient with a BMI of
20 needing levothryoxine
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
start with of these options. It is possible that over time the
dose will be increased until therapeutic 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 remarkable 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?
Triiodothyronine (T3) and free thyroxine (FT4)
Rationale: Remember that a patient with low TSH is
suspicious of hyperthyroidism with a corresponding finding
of elevated T3/T4 and clinical symptoms of a goiter,
tremulousness, anxiety, palpitations, weight loss,
insomnia, diarrhea, etc. This patient is describing a sore
neck as well, which is suggestive of Graves disease
(hyperthyroid state).
All the following are symptoms of hypocalcemia
except:
Visual field deficits
Rationale: Visual field deficits is a potential symptom of
pituitary adenoma. All other are symptoms related to
hypocalcemia.
An adult patient diagnosed with type 2 diabetes
mellitus presents for a recheck. The patient follows a
carbohydrate counting diet and walks 30 minutes 5
times weekly. Current fasting blood glucose = 116
mg/dL [normal = less than 99 mg/dL] and A1c = 6.3%
, [normal = less than 7.0%]. In accordance with the
American Diabetes Association, the nurse practitioner
would recommend that the next follow-up
appointment be scheduled for:
6 months.
Rationale: Based off of the ADA recommendation, this
patient should be evaluated in six months. They are
actually showing good control and excellent compliance
with diet and exercise management strategies. If there
compliance was worse or they were not controlled with
their A1c, this would likely be a three month follow up.
Your patient has a diagnosis of Hashimoto's and is on
Levothyroxine 75 mcg daily. Her recent TSH was
elevated at 15 uU/mL. Your next best action is to:
Increase Levothyroxine to 100 mcg daily
Rationale: When the TSH is elevated the patient needs
more thyroid hormone. Once diagnosed with Hashimoto's
there is no clinical need/benefit to repeating anti bodies.
A patient has a 3 cm pituitary mass noted on CT. What
is your next step in evaluating the patient?
Screen for hormone deficiencies
Rationale: Initial work up includes hormone testing.
Cabergoline is the treatment for prolactinoma. Surgery
consult is indicated when there are VF deficits and/or
abutment/compression on optic nerves or chiasm or if
adenoma is hyperfunctioning. Adenomas >1 cm with no
