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NR 603 CEA EXAM /ACTUAL NR 603 CEA FINAL EXAM
2026/2027 BANK QUESTIONS WITH DETAILED VERIFIED
ANSWERS EXAM QUESTIONS WILL COME FROM HERE
(100% CORRECT ANSWERS A+ GRADED
1. A 58‑year‑old male with a history of hypertension presents with
acute onset of severe, tearing chest pain radiating to the back. Blood
pressure is 160/90 mm Hg in the right arm and 110/70 mm Hg in the
left arm. Which diagnosis is most likely?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Explanation: Aortic dissection classically presents with tearing chest
pain radiating to the back and asymmetric blood pressures between the
upper extremities. Myocardial infarction pain is more pressure‑like
without differential arm pressures. Pulmonary embolism typically
causes dyspnea and pleuritic chest pain. Pericarditis pain is sharp,
positional, and relieved by leaning forward.
2. A 72‑year‑old woman presents with sudden onset of slurred speech,
left facial droop, and left arm weakness. Symptoms began 45 minutes
,2|Page
ago. Her blood pressure is 185/110 mm Hg. What is the most
appropriate next step?
A) Administer aspirin 325 mg orally
B) Lower blood pressure to less than 130/80 mm Hg immediately
C) Obtain non‑contrast head CT stat
D) Start intravenous heparin
Answer: C) Obtain non‑contrast head CT stat
Explanation: In acute stroke, a non‑contrast head CT must be obtained
urgently to rule out intracranial hemorrhage before any antiplatelet or
thrombolytic therapy. Blood pressure is not lowered acutely unless
extremely high (e.g., >220/120) or specific thrombolytic criteria are
met. Aspirin and heparin are not given until hemorrhage is excluded.
3. A 35‑year‑old otherwise healthy patient reports recurrent episodes
of throbbing headache, palpitations, and diaphoresis lasting 15‑20
minutes. Blood pressure during an episode is 200/110 mm Hg. Which
test is most useful for diagnosis?
A) 24‑hour ambulatory blood pressure monitoring
B) Plasma metanephrines
C) Renal artery duplex ultrasound
D) Thyroid function tests
Answer: B) Plasma metanephrines
Explanation: The episodic hypertension, headache, palpitations, and
diaphoresis suggest pheochromocytoma. Plasma free metanephrines or
urinary fractionated metanephrines are the best screening tests.
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Ambulatory monitoring is nonspecific. Renal artery ultrasound is for
renovascular hypertension. Thyroid tests do not explain paroxysmal
hypertension.
4. A 50‑year‑old with type 2 diabetes and CKD stage 3 has a blood
pressure of 145/90 mm Hg despite lifestyle changes. Her urine
albumin‑to‑creatinine ratio is 300 mg/g. Which antihypertensive should
be added first?
A) Hydrochlorothiazide
B) Amlodipine
C) Lisinopril
D) Metoprolol
Answer: C) Lisinopril
Explanation: In diabetic kidney disease with albuminuria, an ACE
inhibitor (or ARB) is first‑line to slow progression of nephropathy and
reduce cardiovascular risk. Thiazides and amlodipine are second‑line or
adjunctive. Beta‑blockers are not renoprotective in this setting.
5. A 28‑year‑old woman presents with fatigue, weight gain,
constipation, and cold intolerance. Labs show TSH 15 mIU/L (normal
0.4‑4.0), free T4 0.5 ng/dL (normal 0.8‑1.8). What is the most
appropriate treatment?
A) Methimazole
B) Levothyroxine 1.6 mcg/kg/day
C) Radioactive iodine ablation
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D) Levothyroxine 25 mcg/day with gradual upward titration
Answer: D) Levothyroxine 25 mcg/day with gradual upward titration
Explanation: Overt hypothyroidism requires levothyroxine replacement.
In young, otherwise healthy patients, starting with a full replacement
dose (1.6 mcg/kg) is acceptable, but many clinicians start lower (25‑50
mcg) in those with possible underlying heart disease or longer duration.
Among options, gradual titration is safest and most physiologic.
6. A 62‑year‑old man with COPD presents with worsening dyspnea,
increased sputum purulence, and fever. Chest X‑ray shows no infiltrate.
Which antibiotic regimen is most appropriate for outpatient
management?
A) Doxycycline 100 mg BID
B) Levofloxacin 750 mg daily
C) Amoxicillin‑clavulanate 875/125 mg BID
D) Azithromycin 500 mg once then 250 mg daily
Answer: A) Doxycycline
Explanation: Acute exacerbation of COPD without pneumonia is often
treated with doxycycline or a macrolide in outpatients with no risk
factors for resistant organisms. Doxycycline is guideline‑preferred given
lower resistance and fewer cardiac risks than macrolides. Levofloxacin
is reserved for more severe exacerbations or antibiotic allergies.
7. A 40‑year‑old with palpitations has an ECG showing regular
narrow‑complex tachycardia at 180 bpm without visible P waves. Vagal
NR 603 CEA EXAM /ACTUAL NR 603 CEA FINAL EXAM
2026/2027 BANK QUESTIONS WITH DETAILED VERIFIED
ANSWERS EXAM QUESTIONS WILL COME FROM HERE
(100% CORRECT ANSWERS A+ GRADED
1. A 58‑year‑old male with a history of hypertension presents with
acute onset of severe, tearing chest pain radiating to the back. Blood
pressure is 160/90 mm Hg in the right arm and 110/70 mm Hg in the
left arm. Which diagnosis is most likely?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Explanation: Aortic dissection classically presents with tearing chest
pain radiating to the back and asymmetric blood pressures between the
upper extremities. Myocardial infarction pain is more pressure‑like
without differential arm pressures. Pulmonary embolism typically
causes dyspnea and pleuritic chest pain. Pericarditis pain is sharp,
positional, and relieved by leaning forward.
2. A 72‑year‑old woman presents with sudden onset of slurred speech,
left facial droop, and left arm weakness. Symptoms began 45 minutes
,2|Page
ago. Her blood pressure is 185/110 mm Hg. What is the most
appropriate next step?
A) Administer aspirin 325 mg orally
B) Lower blood pressure to less than 130/80 mm Hg immediately
C) Obtain non‑contrast head CT stat
D) Start intravenous heparin
Answer: C) Obtain non‑contrast head CT stat
Explanation: In acute stroke, a non‑contrast head CT must be obtained
urgently to rule out intracranial hemorrhage before any antiplatelet or
thrombolytic therapy. Blood pressure is not lowered acutely unless
extremely high (e.g., >220/120) or specific thrombolytic criteria are
met. Aspirin and heparin are not given until hemorrhage is excluded.
3. A 35‑year‑old otherwise healthy patient reports recurrent episodes
of throbbing headache, palpitations, and diaphoresis lasting 15‑20
minutes. Blood pressure during an episode is 200/110 mm Hg. Which
test is most useful for diagnosis?
A) 24‑hour ambulatory blood pressure monitoring
B) Plasma metanephrines
C) Renal artery duplex ultrasound
D) Thyroid function tests
Answer: B) Plasma metanephrines
Explanation: The episodic hypertension, headache, palpitations, and
diaphoresis suggest pheochromocytoma. Plasma free metanephrines or
urinary fractionated metanephrines are the best screening tests.
,3|Page
Ambulatory monitoring is nonspecific. Renal artery ultrasound is for
renovascular hypertension. Thyroid tests do not explain paroxysmal
hypertension.
4. A 50‑year‑old with type 2 diabetes and CKD stage 3 has a blood
pressure of 145/90 mm Hg despite lifestyle changes. Her urine
albumin‑to‑creatinine ratio is 300 mg/g. Which antihypertensive should
be added first?
A) Hydrochlorothiazide
B) Amlodipine
C) Lisinopril
D) Metoprolol
Answer: C) Lisinopril
Explanation: In diabetic kidney disease with albuminuria, an ACE
inhibitor (or ARB) is first‑line to slow progression of nephropathy and
reduce cardiovascular risk. Thiazides and amlodipine are second‑line or
adjunctive. Beta‑blockers are not renoprotective in this setting.
5. A 28‑year‑old woman presents with fatigue, weight gain,
constipation, and cold intolerance. Labs show TSH 15 mIU/L (normal
0.4‑4.0), free T4 0.5 ng/dL (normal 0.8‑1.8). What is the most
appropriate treatment?
A) Methimazole
B) Levothyroxine 1.6 mcg/kg/day
C) Radioactive iodine ablation
, 4|Page
D) Levothyroxine 25 mcg/day with gradual upward titration
Answer: D) Levothyroxine 25 mcg/day with gradual upward titration
Explanation: Overt hypothyroidism requires levothyroxine replacement.
In young, otherwise healthy patients, starting with a full replacement
dose (1.6 mcg/kg) is acceptable, but many clinicians start lower (25‑50
mcg) in those with possible underlying heart disease or longer duration.
Among options, gradual titration is safest and most physiologic.
6. A 62‑year‑old man with COPD presents with worsening dyspnea,
increased sputum purulence, and fever. Chest X‑ray shows no infiltrate.
Which antibiotic regimen is most appropriate for outpatient
management?
A) Doxycycline 100 mg BID
B) Levofloxacin 750 mg daily
C) Amoxicillin‑clavulanate 875/125 mg BID
D) Azithromycin 500 mg once then 250 mg daily
Answer: A) Doxycycline
Explanation: Acute exacerbation of COPD without pneumonia is often
treated with doxycycline or a macrolide in outpatients with no risk
factors for resistant organisms. Doxycycline is guideline‑preferred given
lower resistance and fewer cardiac risks than macrolides. Levofloxacin
is reserved for more severe exacerbations or antibiotic allergies.
7. A 40‑year‑old with palpitations has an ECG showing regular
narrow‑complex tachycardia at 180 bpm without visible P waves. Vagal
