CEA Prep: Full Practice Exam
Study online at https://quizlet.com/_fe5v7n
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
, CEA Prep: Full Practice Exam
Study online at https://quizlet.com/_fe5v7n
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-
, CEA Prep: Full Practice Exam
Study online at https://quizlet.com/_fe5v7n
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 is 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).
, CEA Prep: Full Practice Exam
Study online at https://quizlet.com/_fe5v7n
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
Study online at https://quizlet.com/_fe5v7n
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
, CEA Prep: Full Practice Exam
Study online at https://quizlet.com/_fe5v7n
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-
, CEA Prep: Full Practice Exam
Study online at https://quizlet.com/_fe5v7n
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 is 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).
, CEA Prep: Full Practice Exam
Study online at https://quizlet.com/_fe5v7n
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
