1
CEA Advanced Nursing Practice Actual Exam
2026/2027 Questions and Elaborated Complete
Solutions | Complete Questions and Answers |
Pass Guaranteed - A+ Graded
SECTION 1: Advanced Health Assessment & Differential Diagnosis (15 Questions)
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to the left arm,
diaphoresis, and nausea. Vital signs: BP 88/52 mmHg, HR 110 bpm, RR 24, SpO2 91% on room
air. EKG shows ST-segment elevation in leads V1-V4. Which action should the NP prioritize?
A. Administer sublingual nitroglycerin every 5 minutes
B. Obtain CT angiography to rule out pulmonary embolism
C. Activate emergency cardiac catheterization team and administer aspirin 325 mg [CORRECT]
D. Schedule outpatient stress testing within 48 hours
Correct Answer: C
Rationale: This patient presents with an acute anterior ST-elevation myocardial infarction
(STEMI) based on clinical presentation and EKG findings (ST elevation V1-V4 indicating left
anterior descending artery occlusion). The hemodynamic instability (hypotension, tachycardia)
suggests extensive myocardial involvement. Per 2023 ACC/AHA STEMI guidelines, immediate
reperfusion therapy (primary PCI within 90 minutes) is indicated. Aspirin 325 mg should be
administered immediately unless contraindicated. Nitroglycerin (Option A) is contraindicated in
inferior STEMI (may precipitate hypotension) and is secondary to reperfusion. CT angiography
(Option B) delays definitive therapy. Outpatient stress testing (Option D) is inappropriate for
acute coronary syndrome.
Q2: A 42-year-old female reports episodic vertigo lasting 2-3 hours, associated with tinnitus and
aural fullness in the right ear. She denies hearing loss. Physical examination reveals horizontal
nystagmus during episodes. Which diagnosis is most likely?
A. Vestibular neuritis
B. Benign paroxysmal positional vertigo (BPPV)
C. Ménière's disease [CORRECT]
D. Vestibular migraine
Correct Answer: C
,2
Rationale: The classic triad of episodic vertigo (20 minutes to 12 hours), tinnitus, and aural
fullness constitutes Ménière's disease, caused by endolymphatic hydrops. The symptom duration
(2-3 hours) distinguishes it from BPPV (seconds to minutes) and vestibular neuritis (days to
weeks). While vestibular migraine (Option D) can cause vertigo, it typically lacks aural
symptoms. Early Ménière's may have fluctuating hearing loss not yet perceived by the patient.
Diagnosis is clinical; audiometry typically shows low-frequency sensorineural hearing loss.
Treatment includes sodium restriction, diuretics, and vestibular suppressants during acute
episodes.
Q3: A 67-year-old male with COPD presents with increased dyspnea, productive cough with
purulent sputum, and fever 101.2°F. Chest auscultation reveals decreased breath sounds and
dullness to percussion at the right base. Chest X-ray confirms right lower lobe consolidation.
Which organism is most likely responsible?
A. Pseudomonas aeruginosa
B. Streptococcus pneumoniae [CORRECT]
C. Mycoplasma pneumoniae
D. Staphylococcus aureus
Correct Answer: B
Rationale: In patients with COPD presenting with community-acquired pneumonia (CAP),
Streptococcus pneumoniae remains the most common pathogen despite vaccination programs.
The clinical presentation (acute onset, fever, purulent sputum, lobar consolidation) is classic for
pneumococcal pneumonia. While Pseudomonas (Option A) is a concern in severe COPD with
frequent exacerbations or prior hospitalization, it typically causes bronchopneumonia rather than
lobar consolidation. Mycoplasma (Option C) causes atypical pneumonia with interstitial patterns
and dry cough. Staphylococcus aureus (Option D) is associated with post-influenza pneumonia
and cavitary lesions. Empiric therapy should cover typical pathogens including S. pneumoniae
and Haemophilus influenzae.
Q4: A 35-year-old female presents with fatigue, joint pain in hands and knees, and a facial rash
that worsens with sun exposure. Physical examination reveals malar erythema and painless oral
ulcers. Laboratory studies show ANA positive 1:640, anti-dsDNA positive, and C3/C4 decreased.
Which additional finding would confirm the most likely diagnosis?
A. Rheumatoid factor positive
B. Anti-citrullinated peptide antibodies positive
C. Proteinuria >0.5 g/day [CORRECT]
D. Anti-Ro/SSA antibodies positive
,3
Correct Answer: C
Rationale: This presentation is classic for systemic lupus erythematosus (SLE): young female,
malar rash, photosensitivity, oral ulcers, arthritis, positive ANA and anti-dsDNA with
hypocomplementemia. Per 2023 EULAR/ACR SLE classification criteria, renal involvement
(proteinuria >0.5 g/day or active urinary sediment) carries significant weight in diagnosis
confirmation and indicates lupus nephritis requiring urgent evaluation. While anti-Ro/SSA
(Option D) is associated with Sjögren's syndrome and neonatal lupus, it does not confirm SLE
specifically. Rheumatoid factor (Option A) and anti-CCP (Option B) indicate rheumatoid
arthritis, which lacks the systemic features and specific autoantibodies seen here.
Q5: A 28-year-old male presents with acute onset of severe headache ("worst headache of life"),
nausea, and photophobia. He is alert and oriented. Neurological examination is non-focal. Which
diagnostic study should be performed immediately?
A. MRI brain with and without contrast
B. Non-contrast CT head [CORRECT]
C. Lumbar puncture without imaging
D. CT angiography of head and neck
Correct Answer: B
Rationale: "Thunderclap" headache requires immediate exclusion of subarachnoid hemorrhage
(SAH), which occurs in 10-15% of such presentations. Non-contrast CT head is the initial
imaging study of choice, detecting >95% of SAH within 6 hours of symptom onset with high
sensitivity. If CT is negative but clinical suspicion remains high, lumbar puncture for
xanthochromia is indicated. MRI (Option A) is less sensitive for acute blood and takes longer.
CT angiography (Option D) identifies aneurysms but is secondary to ruling out acute
hemorrhage. Lumbar puncture without prior imaging (Option C) is contraindicated if mass effect
or increased intracranial pressure is suspected.
Q6: A 55-year-old male with type 2 diabetes presents with burning pain, paresthesia, and
allodynia in both feet, worse at night. Monofilament testing reveals decreased sensation. Which
medication is first-line for symptomatic treatment?
A. Ibuprofen 800 mg three times daily
B. Gabapentin 300 mg at bedtime, titrating upward [CORRECT]
C. Oxycodone 5 mg every 6 hours as needed
D. Prednisone 20 mg daily
Correct Answer: B
, 4
Rationale: This patient has painful diabetic peripheral neuropathy (DPN), the most common
complication of diabetes affecting 50% of patients. First-line pharmacologic therapy includes
gabapentinoids (gabapentin, pregabalin), serotonin-norepinephrine reuptake inhibitors
(duloxetine, venlafaxine), or tricyclic antidepressants (amitriptyline). Gabapentin requires dose
titration (300 mg at bedtime, increasing to 300 mg three times daily, then higher as needed up to
1800-3600 mg/day). NSAIDs (Option A) are ineffective for neuropathic pain. Opioids (Option
C) are not first-line due to poor risk-benefit profile. Corticosteroids (Option D) have no role in
diabetic neuropathy and may worsen glycemic control.
Q7: A 45-year-old female presents with palpitations, heat intolerance, weight loss, and tremor.
Physical examination reveals tachycardia, fine tremor, and diffuse thyroid enlargement.
Laboratory studies: TSH 0.01 mIU/L (low), free T4 2.8 ng/dL (elevated). Which test is most
appropriate to determine the etiology?
A. Thyroid ultrasound
B. Radioactive iodine uptake and scan [CORRECT]
C. Thyroid fine needle aspiration
D. CT neck with contrast
Correct Answer: B
Rationale: This presentation indicates hyperthyroidism with thyrotoxicosis. Radioactive iodine
uptake (RAIU) and scan differentiate causes: Graves' disease (diffusely increased uptake), toxic
multinodular goiter (focal increased uptake), and thyroiditis (decreased uptake). This distinction
is critical for treatment—Graves' disease and toxic nodules are treated with antithyroid drugs,
RAI, or surgery, while thyroiditis is managed with beta-blockers and NSAIDs. Ultrasound
(Option A) assesses structure but not function. FNA (Option C) evaluates nodules for
malignancy, not diffuse hyperthyroidism. CT with contrast (Option D) is contraindicated in
thyrotoxicosis due to iodine load potentially worsening hyperthyroidism.
Q8: A 62-year-old male presents with progressive dysphagia to solids initially, then liquids,
along with regurgitation of undigested food and halitosis. He has lost 15 pounds over 3 months.
Barium swallow reveals a dilated esophagus with "bird's beak" tapering at the lower esophageal
sphincter. Which diagnosis is most likely?
A. Esophageal adenocarcinoma
B. Achalasia [CORRECT]
C. Gastroesophageal reflux disease (GERD)
D. Esophageal stricture from reflux
Correct Answer: B
CEA Advanced Nursing Practice Actual Exam
2026/2027 Questions and Elaborated Complete
Solutions | Complete Questions and Answers |
Pass Guaranteed - A+ Graded
SECTION 1: Advanced Health Assessment & Differential Diagnosis (15 Questions)
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to the left arm,
diaphoresis, and nausea. Vital signs: BP 88/52 mmHg, HR 110 bpm, RR 24, SpO2 91% on room
air. EKG shows ST-segment elevation in leads V1-V4. Which action should the NP prioritize?
A. Administer sublingual nitroglycerin every 5 minutes
B. Obtain CT angiography to rule out pulmonary embolism
C. Activate emergency cardiac catheterization team and administer aspirin 325 mg [CORRECT]
D. Schedule outpatient stress testing within 48 hours
Correct Answer: C
Rationale: This patient presents with an acute anterior ST-elevation myocardial infarction
(STEMI) based on clinical presentation and EKG findings (ST elevation V1-V4 indicating left
anterior descending artery occlusion). The hemodynamic instability (hypotension, tachycardia)
suggests extensive myocardial involvement. Per 2023 ACC/AHA STEMI guidelines, immediate
reperfusion therapy (primary PCI within 90 minutes) is indicated. Aspirin 325 mg should be
administered immediately unless contraindicated. Nitroglycerin (Option A) is contraindicated in
inferior STEMI (may precipitate hypotension) and is secondary to reperfusion. CT angiography
(Option B) delays definitive therapy. Outpatient stress testing (Option D) is inappropriate for
acute coronary syndrome.
Q2: A 42-year-old female reports episodic vertigo lasting 2-3 hours, associated with tinnitus and
aural fullness in the right ear. She denies hearing loss. Physical examination reveals horizontal
nystagmus during episodes. Which diagnosis is most likely?
A. Vestibular neuritis
B. Benign paroxysmal positional vertigo (BPPV)
C. Ménière's disease [CORRECT]
D. Vestibular migraine
Correct Answer: C
,2
Rationale: The classic triad of episodic vertigo (20 minutes to 12 hours), tinnitus, and aural
fullness constitutes Ménière's disease, caused by endolymphatic hydrops. The symptom duration
(2-3 hours) distinguishes it from BPPV (seconds to minutes) and vestibular neuritis (days to
weeks). While vestibular migraine (Option D) can cause vertigo, it typically lacks aural
symptoms. Early Ménière's may have fluctuating hearing loss not yet perceived by the patient.
Diagnosis is clinical; audiometry typically shows low-frequency sensorineural hearing loss.
Treatment includes sodium restriction, diuretics, and vestibular suppressants during acute
episodes.
Q3: A 67-year-old male with COPD presents with increased dyspnea, productive cough with
purulent sputum, and fever 101.2°F. Chest auscultation reveals decreased breath sounds and
dullness to percussion at the right base. Chest X-ray confirms right lower lobe consolidation.
Which organism is most likely responsible?
A. Pseudomonas aeruginosa
B. Streptococcus pneumoniae [CORRECT]
C. Mycoplasma pneumoniae
D. Staphylococcus aureus
Correct Answer: B
Rationale: In patients with COPD presenting with community-acquired pneumonia (CAP),
Streptococcus pneumoniae remains the most common pathogen despite vaccination programs.
The clinical presentation (acute onset, fever, purulent sputum, lobar consolidation) is classic for
pneumococcal pneumonia. While Pseudomonas (Option A) is a concern in severe COPD with
frequent exacerbations or prior hospitalization, it typically causes bronchopneumonia rather than
lobar consolidation. Mycoplasma (Option C) causes atypical pneumonia with interstitial patterns
and dry cough. Staphylococcus aureus (Option D) is associated with post-influenza pneumonia
and cavitary lesions. Empiric therapy should cover typical pathogens including S. pneumoniae
and Haemophilus influenzae.
Q4: A 35-year-old female presents with fatigue, joint pain in hands and knees, and a facial rash
that worsens with sun exposure. Physical examination reveals malar erythema and painless oral
ulcers. Laboratory studies show ANA positive 1:640, anti-dsDNA positive, and C3/C4 decreased.
Which additional finding would confirm the most likely diagnosis?
A. Rheumatoid factor positive
B. Anti-citrullinated peptide antibodies positive
C. Proteinuria >0.5 g/day [CORRECT]
D. Anti-Ro/SSA antibodies positive
,3
Correct Answer: C
Rationale: This presentation is classic for systemic lupus erythematosus (SLE): young female,
malar rash, photosensitivity, oral ulcers, arthritis, positive ANA and anti-dsDNA with
hypocomplementemia. Per 2023 EULAR/ACR SLE classification criteria, renal involvement
(proteinuria >0.5 g/day or active urinary sediment) carries significant weight in diagnosis
confirmation and indicates lupus nephritis requiring urgent evaluation. While anti-Ro/SSA
(Option D) is associated with Sjögren's syndrome and neonatal lupus, it does not confirm SLE
specifically. Rheumatoid factor (Option A) and anti-CCP (Option B) indicate rheumatoid
arthritis, which lacks the systemic features and specific autoantibodies seen here.
Q5: A 28-year-old male presents with acute onset of severe headache ("worst headache of life"),
nausea, and photophobia. He is alert and oriented. Neurological examination is non-focal. Which
diagnostic study should be performed immediately?
A. MRI brain with and without contrast
B. Non-contrast CT head [CORRECT]
C. Lumbar puncture without imaging
D. CT angiography of head and neck
Correct Answer: B
Rationale: "Thunderclap" headache requires immediate exclusion of subarachnoid hemorrhage
(SAH), which occurs in 10-15% of such presentations. Non-contrast CT head is the initial
imaging study of choice, detecting >95% of SAH within 6 hours of symptom onset with high
sensitivity. If CT is negative but clinical suspicion remains high, lumbar puncture for
xanthochromia is indicated. MRI (Option A) is less sensitive for acute blood and takes longer.
CT angiography (Option D) identifies aneurysms but is secondary to ruling out acute
hemorrhage. Lumbar puncture without prior imaging (Option C) is contraindicated if mass effect
or increased intracranial pressure is suspected.
Q6: A 55-year-old male with type 2 diabetes presents with burning pain, paresthesia, and
allodynia in both feet, worse at night. Monofilament testing reveals decreased sensation. Which
medication is first-line for symptomatic treatment?
A. Ibuprofen 800 mg three times daily
B. Gabapentin 300 mg at bedtime, titrating upward [CORRECT]
C. Oxycodone 5 mg every 6 hours as needed
D. Prednisone 20 mg daily
Correct Answer: B
, 4
Rationale: This patient has painful diabetic peripheral neuropathy (DPN), the most common
complication of diabetes affecting 50% of patients. First-line pharmacologic therapy includes
gabapentinoids (gabapentin, pregabalin), serotonin-norepinephrine reuptake inhibitors
(duloxetine, venlafaxine), or tricyclic antidepressants (amitriptyline). Gabapentin requires dose
titration (300 mg at bedtime, increasing to 300 mg three times daily, then higher as needed up to
1800-3600 mg/day). NSAIDs (Option A) are ineffective for neuropathic pain. Opioids (Option
C) are not first-line due to poor risk-benefit profile. Corticosteroids (Option D) have no role in
diabetic neuropathy and may worsen glycemic control.
Q7: A 45-year-old female presents with palpitations, heat intolerance, weight loss, and tremor.
Physical examination reveals tachycardia, fine tremor, and diffuse thyroid enlargement.
Laboratory studies: TSH 0.01 mIU/L (low), free T4 2.8 ng/dL (elevated). Which test is most
appropriate to determine the etiology?
A. Thyroid ultrasound
B. Radioactive iodine uptake and scan [CORRECT]
C. Thyroid fine needle aspiration
D. CT neck with contrast
Correct Answer: B
Rationale: This presentation indicates hyperthyroidism with thyrotoxicosis. Radioactive iodine
uptake (RAIU) and scan differentiate causes: Graves' disease (diffusely increased uptake), toxic
multinodular goiter (focal increased uptake), and thyroiditis (decreased uptake). This distinction
is critical for treatment—Graves' disease and toxic nodules are treated with antithyroid drugs,
RAI, or surgery, while thyroiditis is managed with beta-blockers and NSAIDs. Ultrasound
(Option A) assesses structure but not function. FNA (Option C) evaluates nodules for
malignancy, not diffuse hyperthyroidism. CT with contrast (Option D) is contraindicated in
thyrotoxicosis due to iodine load potentially worsening hyperthyroidism.
Q8: A 62-year-old male presents with progressive dysphagia to solids initially, then liquids,
along with regurgitation of undigested food and halitosis. He has lost 15 pounds over 3 months.
Barium swallow reveals a dilated esophagus with "bird's beak" tapering at the lower esophageal
sphincter. Which diagnosis is most likely?
A. Esophageal adenocarcinoma
B. Achalasia [CORRECT]
C. Gastroesophageal reflux disease (GERD)
D. Esophageal stricture from reflux
Correct Answer: B
