Page 1 of 37
NR 575 CEA ACTUAL EXAM PREP 2026
150 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH
RATIONALES ALREADY A GRADED
WITH EXPERT FEEDBACK
|CURRENTLY TESTING |NEW AND
REVISED
1. A 68-year-old man presents with sudden onset left-sided weakness and
slurred speech for 45 minutes. Which action is the highest priority?
A. Order a noncontrast head CT and notify stroke team immediately
B. Assess airway, breathing, circulation and prepare for rapid stroke
evaluation
C. Provide oral aspirin immediately without imaging
D. Schedule MRI for next day
Rationale: Immediate ABC assessment and rapid stroke pathway
activation are critical within the thrombolytic window; imaging follows
stabilization.
2. A 32-year-old woman reports sharp pleuritic chest pain and shortness of
breath after a long flight. Which test most rapidly helps confirm pulmonary
embolism at bedside?
A. Chest x-ray
B. D-dimer
C. Arterial blood gas only
D. Echocardiogram
Rationale: D-dimer is a rapid screening test (high sensitivity) in low-to-
moderate pretest probability; imaging (CT pulmonary angiography)
confirms diagnosis.
3. A patient has focal neurological deficits and CT shows an intracerebral
hemorrhage. Which blood pressure goal is appropriate initially?
A. Allow systolic BP up to 220 mm Hg
,Page 2 of 37
B. Lower systolic BP to <140–160 mm Hg per acute hemorrhage
guidelines
C. Aggressively reduce systolic BP to <90 mm Hg immediately
D. No blood pressure management needed
Rationale: Controlled reduction to target ranges reduces hematoma
expansion; hypotension risks ischemia.
4. A 45-year-old with asthma uses albuterol frequently (multiple times/day)
and reports nighttime symptoms. Which step is most appropriate?
A. Continue albuterol only as needed
B. Initiate or step up daily inhaled corticosteroid therapy and assess
control
C. Add ipratropium as monotherapy
D. Recommend oral corticosteroids for indefinite use
Rationale: Frequent SABA use and nocturnal symptoms indicate poor
control; controller therapy (ICS) is indicated.
5. Which finding on cardiac auscultation suggests mitral regurgitation?
A. Loud S1 with fixed split S2
B. Holosystolic (pansystolic) murmur radiating to the axilla
C. Early diastolic decrescendo murmur at left sternal border
D. Systolic ejection click at apex only
Rationale: Mitral regurgitation classically produces a holosystolic
murmur best heard at apex with axillary radiation.
6. A 24-hour ambulatory blood pressure monitor shows mean BP 145/92 mm
Hg. How should the clinician respond?
A. Diagnose white-coat hypertension and do nothing
B. Diagnose hypertension and begin lifestyle modifications and consider
pharmacotherapy
C. Immediately admit to ICU
D. Reassure patient and avoid follow-up
Rationale: Persistent elevated ambulatory readings confirm hypertension;
management includes lifestyle and possibly medications depending on
risk.
7. A 72-year-old diabetic with decreased foot sensation has a foot ulcer with
purulent drainage. What is the best initial management step?
A. Prescribe topical antifungal only
B. Obtain wound culture and start empiric broad-spectrum antibiotics
covering MRSA and gram-negatives
C. Observe without treatment for 2 weeks
D. Refer to podiatry without starting antibiotics
,Page 3 of 37
Rationale: Diabetic foot infections risk rapid progression; culture and
appropriate empiric systemic antibiotics pending results are indicated.
8. A patient with COPD has oxygen saturation 88% on room air and CO₂
retention history. Which oxygen prescription is most appropriate initial
approach?
A. High-flow oxygen to target SpO₂ >99%
B. Administer controlled low-flow oxygen to target SpO₂ 88–92% and
monitor CO₂
C. No oxygen therapy warranted
D. Use CPAP immediately without assessment
Rationale: In COPD with hypercapnic tendencies, titrate oxygen carefully
to avoid CO₂ retention while maintaining adequate saturation.
9. A 28-year-old woman presents with sudden severe abdominal pain,
amenorrhea, and vaginal bleeding. What is the highest-priority diagnostic
test?
A. Serum CA-125
B. Transvaginal ultrasound to evaluate for ectopic pregnancy
C. Laparoscopy without imaging
D. Abdominal x-ray
Rationale: Transvaginal ultrasound rapidly assesses for intrauterine vs
ectopic pregnancy and free fluid; β-hCG also informs diagnosis.
10.A 60-year-old on warfarin presents with INR 7.2 but no bleeding. What is
appropriate management?
A. Immediate vitamin K and hospitalize for reversal
B. Hold warfarin and administer low-dose oral vitamin K (1–2.5 mg)
with close INR monitoring
C. Continue warfarin and repeat INR in 2 weeks
D. Give prothrombin complex concentrate emergently
Rationale: Extremely high INR without bleeding often managed with
holding warfarin and low-dose oral vitamin K; PCC reserved for serious
bleeding.
11.A patient presents with suspected acute coronary syndrome. Which
biomarker change is most diagnostic for myocardial infarction?
A. Immediate troponin elevation at 5 minutes after chest pain onset
B. Rising and/or falling troponin levels with at least one value above the
99th percentile
C. CK-MB alone without troponin
D. Normal troponin throughout first 24 hours
Rationale: Dynamic troponin changes (rise/fall) with clinical context
confirm MI; timing matters as troponin rises over hours.
, Page 4 of 37
12.A 35-year-old with suspected bacterial meningitis arrives. Which immediate
therapy should not be delayed pending imaging?
A. Lumbar puncture only
B. Empiric IV antibiotics (and dexamethasone if indicated) immediately
after obtaining blood cultures
C. Wait for MRI results before treating
D. Oral antibiotics at home
Rationale: Empiric IV antibiotics should be administered promptly after
blood cultures; LP/imaging can be performed as appropriate.
13.A patient with suspected sepsis demonstrates hypotension and lactate >4
mmol/L. What is initial fluid resuscitation goal?
A. Bolus 10 mL total then reassess in 24 hours
B. Administer 30 mL/kg isotonic crystalloid within first 3 hours
C. Use colloids only
D. Restrict fluids to avoid edema
Rationale: Early aggressive crystalloid resuscitation (≈30 mL/kg) is
recommended in septic shock initial management.
14.A 50-year-old with hyperthyroidism has tachycardia, fever, and altered
mental status—likely thyroid storm. What is first-line immediate therapy?
A. Beta-blocker, antithyroid medication, iodide, and supportive care
B. Begin propranolol, high-dose PTU or methimazole, glucocorticoids,
and iodine after antithyroid drug
C. Only radioactive iodine therapy
D. Immediate thyroidectomy without stabilization
Rationale: Thyroid storm requires multi-pronged urgent therapy: beta-
blockade, antithyroid drugs, iodine (afterative), steroids, and supportive
care.
15.A 42-year-old woman has a new-onset generalized tonic-clonic seizure with
no prior history. What is the clinician’s priority in the ED?
A. Long-term anticonvulsant initiation only after EEG
B. Protect airway, ensure breathing/circulation, check glucose, and
manage status epilepticus if prolonged
C. Immediately discharge home once seizure stops
D. Prescribe benzodiazepines for home use only
Rationale: Acute management prioritizes airway/breathing/circulation and
treat reversible causes (e.g., hypoglycemia); benzodiazepines for prolonged
seizures.
16.A patient with chronic kidney disease (CKD) stage 4 has hyperkalemia with
ECG changes. Which intervention is urgent?
A. Recheck labs in 48 hours
NR 575 CEA ACTUAL EXAM PREP 2026
150 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH
RATIONALES ALREADY A GRADED
WITH EXPERT FEEDBACK
|CURRENTLY TESTING |NEW AND
REVISED
1. A 68-year-old man presents with sudden onset left-sided weakness and
slurred speech for 45 minutes. Which action is the highest priority?
A. Order a noncontrast head CT and notify stroke team immediately
B. Assess airway, breathing, circulation and prepare for rapid stroke
evaluation
C. Provide oral aspirin immediately without imaging
D. Schedule MRI for next day
Rationale: Immediate ABC assessment and rapid stroke pathway
activation are critical within the thrombolytic window; imaging follows
stabilization.
2. A 32-year-old woman reports sharp pleuritic chest pain and shortness of
breath after a long flight. Which test most rapidly helps confirm pulmonary
embolism at bedside?
A. Chest x-ray
B. D-dimer
C. Arterial blood gas only
D. Echocardiogram
Rationale: D-dimer is a rapid screening test (high sensitivity) in low-to-
moderate pretest probability; imaging (CT pulmonary angiography)
confirms diagnosis.
3. A patient has focal neurological deficits and CT shows an intracerebral
hemorrhage. Which blood pressure goal is appropriate initially?
A. Allow systolic BP up to 220 mm Hg
,Page 2 of 37
B. Lower systolic BP to <140–160 mm Hg per acute hemorrhage
guidelines
C. Aggressively reduce systolic BP to <90 mm Hg immediately
D. No blood pressure management needed
Rationale: Controlled reduction to target ranges reduces hematoma
expansion; hypotension risks ischemia.
4. A 45-year-old with asthma uses albuterol frequently (multiple times/day)
and reports nighttime symptoms. Which step is most appropriate?
A. Continue albuterol only as needed
B. Initiate or step up daily inhaled corticosteroid therapy and assess
control
C. Add ipratropium as monotherapy
D. Recommend oral corticosteroids for indefinite use
Rationale: Frequent SABA use and nocturnal symptoms indicate poor
control; controller therapy (ICS) is indicated.
5. Which finding on cardiac auscultation suggests mitral regurgitation?
A. Loud S1 with fixed split S2
B. Holosystolic (pansystolic) murmur radiating to the axilla
C. Early diastolic decrescendo murmur at left sternal border
D. Systolic ejection click at apex only
Rationale: Mitral regurgitation classically produces a holosystolic
murmur best heard at apex with axillary radiation.
6. A 24-hour ambulatory blood pressure monitor shows mean BP 145/92 mm
Hg. How should the clinician respond?
A. Diagnose white-coat hypertension and do nothing
B. Diagnose hypertension and begin lifestyle modifications and consider
pharmacotherapy
C. Immediately admit to ICU
D. Reassure patient and avoid follow-up
Rationale: Persistent elevated ambulatory readings confirm hypertension;
management includes lifestyle and possibly medications depending on
risk.
7. A 72-year-old diabetic with decreased foot sensation has a foot ulcer with
purulent drainage. What is the best initial management step?
A. Prescribe topical antifungal only
B. Obtain wound culture and start empiric broad-spectrum antibiotics
covering MRSA and gram-negatives
C. Observe without treatment for 2 weeks
D. Refer to podiatry without starting antibiotics
,Page 3 of 37
Rationale: Diabetic foot infections risk rapid progression; culture and
appropriate empiric systemic antibiotics pending results are indicated.
8. A patient with COPD has oxygen saturation 88% on room air and CO₂
retention history. Which oxygen prescription is most appropriate initial
approach?
A. High-flow oxygen to target SpO₂ >99%
B. Administer controlled low-flow oxygen to target SpO₂ 88–92% and
monitor CO₂
C. No oxygen therapy warranted
D. Use CPAP immediately without assessment
Rationale: In COPD with hypercapnic tendencies, titrate oxygen carefully
to avoid CO₂ retention while maintaining adequate saturation.
9. A 28-year-old woman presents with sudden severe abdominal pain,
amenorrhea, and vaginal bleeding. What is the highest-priority diagnostic
test?
A. Serum CA-125
B. Transvaginal ultrasound to evaluate for ectopic pregnancy
C. Laparoscopy without imaging
D. Abdominal x-ray
Rationale: Transvaginal ultrasound rapidly assesses for intrauterine vs
ectopic pregnancy and free fluid; β-hCG also informs diagnosis.
10.A 60-year-old on warfarin presents with INR 7.2 but no bleeding. What is
appropriate management?
A. Immediate vitamin K and hospitalize for reversal
B. Hold warfarin and administer low-dose oral vitamin K (1–2.5 mg)
with close INR monitoring
C. Continue warfarin and repeat INR in 2 weeks
D. Give prothrombin complex concentrate emergently
Rationale: Extremely high INR without bleeding often managed with
holding warfarin and low-dose oral vitamin K; PCC reserved for serious
bleeding.
11.A patient presents with suspected acute coronary syndrome. Which
biomarker change is most diagnostic for myocardial infarction?
A. Immediate troponin elevation at 5 minutes after chest pain onset
B. Rising and/or falling troponin levels with at least one value above the
99th percentile
C. CK-MB alone without troponin
D. Normal troponin throughout first 24 hours
Rationale: Dynamic troponin changes (rise/fall) with clinical context
confirm MI; timing matters as troponin rises over hours.
, Page 4 of 37
12.A 35-year-old with suspected bacterial meningitis arrives. Which immediate
therapy should not be delayed pending imaging?
A. Lumbar puncture only
B. Empiric IV antibiotics (and dexamethasone if indicated) immediately
after obtaining blood cultures
C. Wait for MRI results before treating
D. Oral antibiotics at home
Rationale: Empiric IV antibiotics should be administered promptly after
blood cultures; LP/imaging can be performed as appropriate.
13.A patient with suspected sepsis demonstrates hypotension and lactate >4
mmol/L. What is initial fluid resuscitation goal?
A. Bolus 10 mL total then reassess in 24 hours
B. Administer 30 mL/kg isotonic crystalloid within first 3 hours
C. Use colloids only
D. Restrict fluids to avoid edema
Rationale: Early aggressive crystalloid resuscitation (≈30 mL/kg) is
recommended in septic shock initial management.
14.A 50-year-old with hyperthyroidism has tachycardia, fever, and altered
mental status—likely thyroid storm. What is first-line immediate therapy?
A. Beta-blocker, antithyroid medication, iodide, and supportive care
B. Begin propranolol, high-dose PTU or methimazole, glucocorticoids,
and iodine after antithyroid drug
C. Only radioactive iodine therapy
D. Immediate thyroidectomy without stabilization
Rationale: Thyroid storm requires multi-pronged urgent therapy: beta-
blockade, antithyroid drugs, iodine (afterative), steroids, and supportive
care.
15.A 42-year-old woman has a new-onset generalized tonic-clonic seizure with
no prior history. What is the clinician’s priority in the ED?
A. Long-term anticonvulsant initiation only after EEG
B. Protect airway, ensure breathing/circulation, check glucose, and
manage status epilepticus if prolonged
C. Immediately discharge home once seizure stops
D. Prescribe benzodiazepines for home use only
Rationale: Acute management prioritizes airway/breathing/circulation and
treat reversible causes (e.g., hypoglycemia); benzodiazepines for prolonged
seizures.
16.A patient with chronic kidney disease (CKD) stage 4 has hyperkalemia with
ECG changes. Which intervention is urgent?
A. Recheck labs in 48 hours
