CEA Prep: Full Practice Exam | 324 Questions & Answers
1. The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray on PA view shows a left lower
chest area of consolidation adjacent to the left border of the heart approximately 2 rib spaces above the
costophrenic angle. The lateral x-ray view shows this lesion absent of the window posterior to the cardiac
silhouette. Which is the most likely location of this area of focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe: Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If the cardiac margin/silhouette is obliterated by
the mass, the lesion is either right middle lobe or left upper lobe lingula.
2. The inability to fully relax the myocardium during relaxation is a trademark of which of the following
diagnoses?: Diastolic dysfunction
Rationale: The inability for the heart to relax is a trademark of the diagnosis of dias- tolic dysfunction and is common in
patients with thickened hypertrophic myocardium.
3. An otherwise healthy African American adult male has been diagnosed with hypertension. He has been
restricting his salt intake, eating a DASH (Dietary Approaches to Stop Hypertension) diet, and exercising more,
but his blood pressure is still elevated. Which is the BEST medication to prescribe him?: Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines should be managed with a dihydropyridine
calcium channel blocker such as amlodipine (Norvasc) as first line management therapy for hypertension not at goal with
DASH and lifestyle modifications.
4. Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which medical imaging is
considered standard of care for serial surveillance?-
: CT angiography of the chest
Rationale: CT angiography is considered the standard of care for measuring vascu- lar luminal dimensions with contrast.
CT PE protocol is not timed properly for the aorta (it's timed for the pulmonary artery). Although a plain film is able to
catch large aneurysms at times, they are not able to provide multi-axis reconstruction needed to accurately measure the
size. Transesophageal echo is not needed to accurately measure the aorta and requires the patient to undergo sedation
which is unnecessary.
5. Which of the following medications does not cause beta 1 stimulation?: -
phenylephrine
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, CEA Prep: Full Practice Exam | 324 Questions & Answers
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have beta receptor activity.
6. A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and orthopnea. On
examination, she has jugular venous distention and bilateral crackles on lung auscultation. What is the most likely
diagnosis?-
: Congestive heart failure
Rationale: Of the available options, the most accurate response is congestive heart failure as it is signifying both a right
ventricular back up with jugular venous extension and crackles on lung assault, which are suggestive of left ventricular
back up. it
is possible the patient may have an acute myocardial infarction that precipitated this, however, a patient has not
described that, rather is only describing dyspnea on exertion and orthopnea, which both speak to a state of fluid overload.
The only appropriate response of these available is congestive heart failure.
7. Your patient with a history of HFrEF (heart failure with reduced ejection fraction) with an ejection fraction of
40% who is also not on optimal med- ical therapy has been diagnosed with a myocardial infarction this admission
and received emergent placement of a drug-eluting stent to the left anterior descending artery. As the medical
home who will manage this patient after discharge, which medication strategy would you expect to be a priority in
the patient's care?: Ordering a transthoracic echocardiogram and order a Lifevest if EF is less than 35%
Rationale: The patient should have a protective mechanism such as an implantable automated cardioverter defibrillator
(AICD) or a Lifevest if the EF is less than
35% due to the increased risk of sudden cardiac death with low EF states. Since most patients are not eligible for 90
days for an AICD in this state, optimizing their medication regimen and repeating an echo in 2-3 months to re-
evaluate for
improvement in their EF is required by most insurance companies. A baseline echo is needed at discharge to provide a
baseline for improvement vs their repeat echo in 2-3 months.
Dual anti-platelet therapy is required for 12 months minimum post-MI.
A Holter monitor does not provide any conceivable benefit for this patient as present- ed.
8. Which of the following people groups represent the least risk of cardiac disease?: Caucasians
Rationale: Statistically African Americans, Native Hawaiians, and American Indians are at at increased risk of cardiac
disease due to higher rates of hypertension, diabetes, and obesity than Caucasians.
9. 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 moth-
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119
, CEA Prep: Full Practice Exam | 324 Questions & Answers
er 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.
10.Which of the following end-organ sequelae is not directly caused by un- controlled hypertension?:
Peripheral neuropathy
Ratioanle: Although patients with hypertension frequently have peripheral neuropa- thy, it is only directly attributed to
patients who are also diabetic and is commonly found in non-hypertensive diabetic patients. Proteinuria, AV nicking, and
hemorrhag- ic stroke are all caused by uncontrolled hypertension.
11.Preventive cardiac care should focus primarily on addressing all the fol- lowing 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.
12.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 spirono- lactone 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
a buildup of uterine tissue that can increase the risk of uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex hor- mone-binding globulin (SHBG), which
binds androgens. This can help reduce symp- toms like acne, hirsutism (unwanted body and facial hair), and androgenic
alopecia (male pattern baldness).
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, CEA Prep: Full Practice Exam | 324 Questions & Answers
Endometrium protection: OCPs can protect the endometrium by ensuring regular ovulation
13.A 50-year-old woman with hypertension and diabetes comes in for a rou- tine 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 evi- dence 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.
14.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-
gestation- al-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.
15.A starting dose for a elderly adult patient with a BMI of 20 needing levothry- oxine: 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.
16.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 goi-
ter, tremulousness, anxiety, palpitations, weight loss, insomnia, diarrhea, etc. This
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119
1. The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray on PA view shows a left lower
chest area of consolidation adjacent to the left border of the heart approximately 2 rib spaces above the
costophrenic angle. The lateral x-ray view shows this lesion absent of the window posterior to the cardiac
silhouette. Which is the most likely location of this area of focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe: Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If the cardiac margin/silhouette is obliterated by
the mass, the lesion is either right middle lobe or left upper lobe lingula.
2. The inability to fully relax the myocardium during relaxation is a trademark of which of the following
diagnoses?: Diastolic dysfunction
Rationale: The inability for the heart to relax is a trademark of the diagnosis of dias- tolic dysfunction and is common in
patients with thickened hypertrophic myocardium.
3. An otherwise healthy African American adult male has been diagnosed with hypertension. He has been
restricting his salt intake, eating a DASH (Dietary Approaches to Stop Hypertension) diet, and exercising more,
but his blood pressure is still elevated. Which is the BEST medication to prescribe him?: Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines should be managed with a dihydropyridine
calcium channel blocker such as amlodipine (Norvasc) as first line management therapy for hypertension not at goal with
DASH and lifestyle modifications.
4. Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which medical imaging is
considered standard of care for serial surveillance?-
: CT angiography of the chest
Rationale: CT angiography is considered the standard of care for measuring vascu- lar luminal dimensions with contrast.
CT PE protocol is not timed properly for the aorta (it's timed for the pulmonary artery). Although a plain film is able to
catch large aneurysms at times, they are not able to provide multi-axis reconstruction needed to accurately measure the
size. Transesophageal echo is not needed to accurately measure the aorta and requires the patient to undergo sedation
which is unnecessary.
5. Which of the following medications does not cause beta 1 stimulation?: -
phenylephrine
1/
119
, CEA Prep: Full Practice Exam | 324 Questions & Answers
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have beta receptor activity.
6. A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and orthopnea. On
examination, she has jugular venous distention and bilateral crackles on lung auscultation. What is the most likely
diagnosis?-
: Congestive heart failure
Rationale: Of the available options, the most accurate response is congestive heart failure as it is signifying both a right
ventricular back up with jugular venous extension and crackles on lung assault, which are suggestive of left ventricular
back up. it
is possible the patient may have an acute myocardial infarction that precipitated this, however, a patient has not
described that, rather is only describing dyspnea on exertion and orthopnea, which both speak to a state of fluid overload.
The only appropriate response of these available is congestive heart failure.
7. Your patient with a history of HFrEF (heart failure with reduced ejection fraction) with an ejection fraction of
40% who is also not on optimal med- ical therapy has been diagnosed with a myocardial infarction this admission
and received emergent placement of a drug-eluting stent to the left anterior descending artery. As the medical
home who will manage this patient after discharge, which medication strategy would you expect to be a priority in
the patient's care?: Ordering a transthoracic echocardiogram and order a Lifevest if EF is less than 35%
Rationale: The patient should have a protective mechanism such as an implantable automated cardioverter defibrillator
(AICD) or a Lifevest if the EF is less than
35% due to the increased risk of sudden cardiac death with low EF states. Since most patients are not eligible for 90
days for an AICD in this state, optimizing their medication regimen and repeating an echo in 2-3 months to re-
evaluate for
improvement in their EF is required by most insurance companies. A baseline echo is needed at discharge to provide a
baseline for improvement vs their repeat echo in 2-3 months.
Dual anti-platelet therapy is required for 12 months minimum post-MI.
A Holter monitor does not provide any conceivable benefit for this patient as present- ed.
8. Which of the following people groups represent the least risk of cardiac disease?: Caucasians
Rationale: Statistically African Americans, Native Hawaiians, and American Indians are at at increased risk of cardiac
disease due to higher rates of hypertension, diabetes, and obesity than Caucasians.
9. 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 moth-
2/
119
, CEA Prep: Full Practice Exam | 324 Questions & Answers
er 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.
10.Which of the following end-organ sequelae is not directly caused by un- controlled hypertension?:
Peripheral neuropathy
Ratioanle: Although patients with hypertension frequently have peripheral neuropa- thy, it is only directly attributed to
patients who are also diabetic and is commonly found in non-hypertensive diabetic patients. Proteinuria, AV nicking, and
hemorrhag- ic stroke are all caused by uncontrolled hypertension.
11.Preventive cardiac care should focus primarily on addressing all the fol- lowing 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.
12.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 spirono- lactone 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
a buildup of uterine tissue that can increase the risk of uterine cancer.
Androgen excess: OCPs can reduce androgen production and increase sex hor- mone-binding globulin (SHBG), which
binds androgens. This can help reduce symp- toms like acne, hirsutism (unwanted body and facial hair), and androgenic
alopecia (male pattern baldness).
3/
119
, CEA Prep: Full Practice Exam | 324 Questions & Answers
Endometrium protection: OCPs can protect the endometrium by ensuring regular ovulation
13.A 50-year-old woman with hypertension and diabetes comes in for a rou- tine 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 evi- dence 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.
14.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-
gestation- al-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.
15.A starting dose for a elderly adult patient with a BMI of 20 needing levothry- oxine: 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.
16.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 goi-
ter, tremulousness, anxiety, palpitations, weight loss, insomnia, diarrhea, etc. This
4/
119
