NR 668 CEA Final Exam (2026) | Chamberlain
Practicum – Actual Questions, Answers &
Rationales (PDF), Exams of Nursing
Section 1: Advanced Health Assessment & Clinical Reasoning (Questions 1–
30)
1. A 58-year-old male presents with substernal chest pressure radiating to the
left arm, diaphoresis, and nausea for 45 minutes. Which of the following is
the priority action?
A) Obtain a detailed family history
B) Perform a complete physical examination
C) Administer aspirin and obtain a STAT ECG
D) Schedule a stress test for tomorrow
Answer: C) Administer aspirin and obtain a STAT ECG
Rationale: This presentation is concerning for acute myocardial
infarction. The priority is to administer aspirin (antiplatelet) and
obtain a STAT ECG to assess for ST-segment elevation, which guides
reperfusion therapy. Time is muscle.
2. When using the clinical reasoning process, which of the following best
describes "pattern recognition"?
A) Generating an exhaustive list of all possible diagnoses
B) Identifying a clinical presentation that matches a known disease
pattern
C) Ordering all available diagnostic tests
D) Consulting a specialist for every patient
,Answer: B) Identifying a clinical presentation that matches a known disease
pattern
Rationale: Pattern recognition is an intuitive form of clinical
reasoning where the clinician rapidly identifies a presentation that
matches a known disease pattern based on experience and knowledge.
3. A 72-year-old female with dementia is brought in by her daughter for a
"check-up." The patient is unable to provide a reliable history. Which of the
following is the most appropriate approach to obtaining the history?
A) Skip the history and proceed directly to physical exam
B) Obtain history from the daughter/caregiver and review available
medical records
C) Rely solely on the patient's prior medical records
D) Perform a comprehensive physical exam without any history
Answer: B) Obtain history from the daughter/caregiver and review
available medical records
Rationale: When a patient cannot provide a reliable history, the
clinician should obtain information from family members, caregivers,
and available medical records to ensure a complete assessment.
4. Which of the following is a component of the "OLDCARTS" mnemonic for
HPI?
A) Onset, Location, Duration, Character, Aggravating/Alleviating, Radiation,
Timing, Severity
B) Observation, Listening, Diagnosis, Care, Assessment, Response,
Treatment, Summary
,C) Oxygen, Lungs, Diaphragm, Chest, Auscultation, Respiration, Tachypnea,
SpO2
D) Only, Limited, Data, Collection, Assessment, Review, Treatment, System
Answer: A) Onset, Location, Duration, Character,
Aggravating/Alleviating, Radiation, Timing, Severity
Rationale: OLDCARTS is a mnemonic for gathering comprehensive
History of Present Illness (HPI) data to characterize a patient's chief
complaint.
5. A 45-year-old female presents with fatigue, weight gain, cold intolerance,
and constipation. Which of the following physical exam findings would be
most consistent with her likely diagnosis?
A) Tachycardia and warm, moist skin
B) Delayed relaxation of deep tendon reflexes
C) Exophthalmos and lid lag
D) Pretibial myxedema
Answer: B) Delayed relaxation of deep tendon reflexes
Rationale: The presentation is consistent with hypothyroidism.
Delayed relaxation of deep tendon reflexes (hung-up reflexes) is a
classic physical exam finding in hypothyroidism.
6. When performing a cardiovascular examination, the S1 heart sound
corresponds to:
A) Closure of the aortic and pulmonic valves
B) Closure of the mitral and tricuspid valves
C) Rapid ventricular filling
, D) Atrial contraction
Answer: B) Closure of the mitral and tricuspid valves
Rationale: S1 (lub) is caused by closure of the atrioventricular valves
(mitral and tricuspid) at the beginning of systole.
7. A patient presents with acute onset of severe, unilateral headache,
temporal tenderness, and jaw claudication. ESR is 85 mm/hr. What is the
most appropriate next step?
A) Order an MRI of the brain
B) Prescribe sumatriptan for migraine
C) Initiate high-dose corticosteroids immediately
D) Schedule a dental consult
Answer: C) Initiate high-dose corticosteroids immediately
Rationale: This presentation is classic for giant cell arteritis (temporal
arteritis), which can cause permanent vision loss. High-dose
corticosteroids should be initiated immediately, even before temporal
artery biopsy.
8. Which of the following is the most sensitive physical examination
maneuver for detecting knee effusion?
A) Lachman test
B) Ballottement of the patella
C) McMurray test
D) Anterior drawer test
Answer: B) Ballottement of the patella
Practicum – Actual Questions, Answers &
Rationales (PDF), Exams of Nursing
Section 1: Advanced Health Assessment & Clinical Reasoning (Questions 1–
30)
1. A 58-year-old male presents with substernal chest pressure radiating to the
left arm, diaphoresis, and nausea for 45 minutes. Which of the following is
the priority action?
A) Obtain a detailed family history
B) Perform a complete physical examination
C) Administer aspirin and obtain a STAT ECG
D) Schedule a stress test for tomorrow
Answer: C) Administer aspirin and obtain a STAT ECG
Rationale: This presentation is concerning for acute myocardial
infarction. The priority is to administer aspirin (antiplatelet) and
obtain a STAT ECG to assess for ST-segment elevation, which guides
reperfusion therapy. Time is muscle.
2. When using the clinical reasoning process, which of the following best
describes "pattern recognition"?
A) Generating an exhaustive list of all possible diagnoses
B) Identifying a clinical presentation that matches a known disease
pattern
C) Ordering all available diagnostic tests
D) Consulting a specialist for every patient
,Answer: B) Identifying a clinical presentation that matches a known disease
pattern
Rationale: Pattern recognition is an intuitive form of clinical
reasoning where the clinician rapidly identifies a presentation that
matches a known disease pattern based on experience and knowledge.
3. A 72-year-old female with dementia is brought in by her daughter for a
"check-up." The patient is unable to provide a reliable history. Which of the
following is the most appropriate approach to obtaining the history?
A) Skip the history and proceed directly to physical exam
B) Obtain history from the daughter/caregiver and review available
medical records
C) Rely solely on the patient's prior medical records
D) Perform a comprehensive physical exam without any history
Answer: B) Obtain history from the daughter/caregiver and review
available medical records
Rationale: When a patient cannot provide a reliable history, the
clinician should obtain information from family members, caregivers,
and available medical records to ensure a complete assessment.
4. Which of the following is a component of the "OLDCARTS" mnemonic for
HPI?
A) Onset, Location, Duration, Character, Aggravating/Alleviating, Radiation,
Timing, Severity
B) Observation, Listening, Diagnosis, Care, Assessment, Response,
Treatment, Summary
,C) Oxygen, Lungs, Diaphragm, Chest, Auscultation, Respiration, Tachypnea,
SpO2
D) Only, Limited, Data, Collection, Assessment, Review, Treatment, System
Answer: A) Onset, Location, Duration, Character,
Aggravating/Alleviating, Radiation, Timing, Severity
Rationale: OLDCARTS is a mnemonic for gathering comprehensive
History of Present Illness (HPI) data to characterize a patient's chief
complaint.
5. A 45-year-old female presents with fatigue, weight gain, cold intolerance,
and constipation. Which of the following physical exam findings would be
most consistent with her likely diagnosis?
A) Tachycardia and warm, moist skin
B) Delayed relaxation of deep tendon reflexes
C) Exophthalmos and lid lag
D) Pretibial myxedema
Answer: B) Delayed relaxation of deep tendon reflexes
Rationale: The presentation is consistent with hypothyroidism.
Delayed relaxation of deep tendon reflexes (hung-up reflexes) is a
classic physical exam finding in hypothyroidism.
6. When performing a cardiovascular examination, the S1 heart sound
corresponds to:
A) Closure of the aortic and pulmonic valves
B) Closure of the mitral and tricuspid valves
C) Rapid ventricular filling
, D) Atrial contraction
Answer: B) Closure of the mitral and tricuspid valves
Rationale: S1 (lub) is caused by closure of the atrioventricular valves
(mitral and tricuspid) at the beginning of systole.
7. A patient presents with acute onset of severe, unilateral headache,
temporal tenderness, and jaw claudication. ESR is 85 mm/hr. What is the
most appropriate next step?
A) Order an MRI of the brain
B) Prescribe sumatriptan for migraine
C) Initiate high-dose corticosteroids immediately
D) Schedule a dental consult
Answer: C) Initiate high-dose corticosteroids immediately
Rationale: This presentation is classic for giant cell arteritis (temporal
arteritis), which can cause permanent vision loss. High-dose
corticosteroids should be initiated immediately, even before temporal
artery biopsy.
8. Which of the following is the most sensitive physical examination
maneuver for detecting knee effusion?
A) Lachman test
B) Ballottement of the patella
C) McMurray test
D) Anterior drawer test
Answer: B) Ballottement of the patella
