CEA Prep Full Practice Exam Objectives
Questions and Verified Answers Graded A+
Which of the following people groups represent the least risk
of cardiac disease?
Caucasians
Rationale: Statistically African Americans, Native Hawaiians, and
American Indians are at at increased risk of cardiac disease due
to higher rates of hypertension, diabetes, 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 profile shows cholesterol = 240
mg/dL, HDL = 30, and LDL = 200. In addition to starting
therapeutic lifestyle changes, the nurse practitioner should
start the patient on:
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 coronary disease history
(less than age 65 for women), has hypertension and is far from an
LDL goal, this patient is most certainly a candidate for statin
therapy, which represents the most aggressive therapy option of
these four listed.
Which of the following end-organ sequelae is not directly
caused by uncontrolled hypertension?
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 all caused by uncontrolled hypertension.
Preventive cardiac care should focus primarily on
addressing all the following except?
Genetic predisposition
Rationale: Smoking cessation, exercise, and medication
compliance all represent modifiable 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. 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.
Which of the following is at highest risk for DMII?
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 baby weighing 9 1/2 lbs is the most likely due to
their increased BMI and the large size 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. Women 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 gestational 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
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
Questions and Verified Answers Graded A+
Which of the following people groups represent the least risk
of cardiac disease?
Caucasians
Rationale: Statistically African Americans, Native Hawaiians, and
American Indians are at at increased risk of cardiac disease due
to higher rates of hypertension, diabetes, 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 profile shows cholesterol = 240
mg/dL, HDL = 30, and LDL = 200. In addition to starting
therapeutic lifestyle changes, the nurse practitioner should
start the patient on:
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 coronary disease history
(less than age 65 for women), has hypertension and is far from an
LDL goal, this patient is most certainly a candidate for statin
therapy, which represents the most aggressive therapy option of
these four listed.
Which of the following end-organ sequelae is not directly
caused by uncontrolled hypertension?
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 all caused by uncontrolled hypertension.
Preventive cardiac care should focus primarily on
addressing all the following except?
Genetic predisposition
Rationale: Smoking cessation, exercise, and medication
compliance all represent modifiable 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. 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.
Which of the following is at highest risk for DMII?
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 baby weighing 9 1/2 lbs is the most likely due to
their increased BMI and the large size 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. Women 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 gestational 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
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
