CEA Prep: Full Practice Exam \FINAL EXAM LATEST
VERSION A& B REAL EXAM (COMPLETE EXAM)
QUESTIONS AND CORRECT ANSWERS|AGRADE
\LATEST UPDATE
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.
VERSION A& B REAL EXAM (COMPLETE EXAM)
QUESTIONS AND CORRECT ANSWERS|AGRADE
\LATEST UPDATE
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.
