1|Page
2025 CEA PREP FULL PRACTICE EXAM ACTUAL QUESTIONS
WITH VERIFIED ANSWERS, EXAMS OF NURSING
Your patient presents with a blowing systolic murmur rated 3/6 that is heard best over the left
chest at the 5th intercostal space, left midclavicular space, radiating to the left axilla. This likely
represents which cardiac finding? - ANSWER-Mitral Regurgitation
Rationale: The inadequate coaptation (closing together) of the two leaflets of the mitral valve
under systole with left chest wall radiation are classic signs of mitral regurgitation. Aortic
stenosis is also a systolic murmur, but is heard best over the 2nd intercostal space right sternal
border and tends to radiate to the neck. Aortic regurgitation (insufficiency) and mitral stenosis
are both diastolic murmurs.
Ophthalmic examination of a patient with a 10-year history of poorly controlled hypertension,
despite three-drug-therapy, would most likely reveal: - ANSWER-Arteriolar narrowing
Your patient admitted with crushing chest pain just converted from sinus rhythm to sinus
bradycardia and developed elevated ST segments in lead II, III, and aVF. What intervention is the
priority for this patient's care? - ANSWER-Activating the cardiac cath lab team for STEMI
Rationale: Time is muscle. Early activation of the interventional cardiology team is key to long-
term cardiac salvage in the setting of STEMI. SL nitro poses a risk for hypotension and further
decompensation in a inferior/RCA territory MI. CT chest is not indicated as a priority in the
presence of a cardiac-type pain with positive EKG findings. Although vasoactive support is
possible, this is not the highest priority of care.
Which of the following medications does not cause beta 1 stimulation? - ANSWER-
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have beta
receptor activity.
A 55 year-old female patient with no previous cardiac history and no family history of
hyperlipidemia with an acute myocardial infarction is treated successfully with a drug-eluting
,2|Page
stent during a recent hospitalization. As their long-term care provider, you anticipate they were
most likely to be also started on which of the following lipid-lowering agents at discharge? -
ANSWER-High intensity statin therapy
Rationale: Patients with proven cardiac disease should be on high intensity statin therapy.
PCSK9 therapy is only indicated for homozygous familial hyperlipidemia or proven cardiac
disease with proven failure to tolerate multiple attempts at statin therapy.
Which of the following antibiotic agents should be avoided in a 35 year-old female patient with
a diagnosis of Marfan's Syndrome? - ANSWER-Ciprofloxacin
Rationale: Fluoroquinolone antibiotics must be avoided for patients with connective tissue
disorders due to the risk of aneurysm associated with their use. Ciprofloxacin is the only
fluoroquinolone antibiotic listed.
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? - ANSWER-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.
What is the key long-term benefit of using carvedilol for patients with coronary artery disease
and heart failure with reduced ejection fraction (HFrEF)? - ANSWER-Potential increase in
ejection fraction
Rationale: EF increase is a key reason for using carvedilol over metoprolol for patients with low
EF states. Libido unfortunately can be negatively impacted by any beta blocker. Cardiac output
should only improve with long term use, not decrease, and beta blockers may reduce blood
pressure slightly, but that is not their key long-term benefit. In fact, they are not even
considered for routine anti-hypertensive management per JNC-8 guidelines.
A patient has been complaining of palpitations for the past week and presents to you at an
urgent care clinic for evaluation. You perform a 12 lead EKG and identify atrial fibrillation with a
,3|Page
hear rate of 122 beats per minute. What is your next order? - ANSWER-Order a stat
transthoracic (2D) echocardiogram and prepare the patient for trasnport to the closest
appropriate hospital for inpatient evaluation
Rationale: A wearable monitor does not provide you with actionable information until it is read,
and the patient is already identified as being in atrial fibrillation. Warfarin without bridging will
take several days to achieve a therapeutic INR and without bridging (as it is not mentioned)
would potentially increase prothrombotic state for first few days due to inhibition of protein C
and S. Amiodarone is a rhythm conversion medication and should not be given unless first
identifying any evidence of clot burden with an echocardiogram.
A 49-year-old male presents to your service with symptoms of fever 102.3, jaundice, and
abdominal pain. Imagining reveals a biliary obstruction. Which diagnosis is most likely for this
patient? - ANSWER-Cholangitis
Rationale: The most likely cause for this patients' symptoms is cholangitis, which has a typically
presentation of fever, jaundice, and abdominal pain. The most common cause of this is a biliary
stone causing obstruction and allowing for ascending of bacteria and infection
Which of the following gastrointestinal changes is associated with normal aging? - ANSWER-
Decreased production of gastric acid
Rationale: Normal GI changes with aging include decreased production of gastric acid, increase
incidence of gallstone, decreased salivation, and decrease esophageal emptying.
An older adult patient with new onset GERD, cough, heartburn. Initial tx - ANSWER-Antacid and
lifestyle modification/weight loss
Rationale: Before initiating a PPI or H2RA, it would always be wise to initiate diet/exercise and
symptom management when present with an antacid. Loss of weight/dieting is most likely to
deal with obesity as the most common underlying cause of GERD.
A 39-year-old female is being seen by your service for diarrhea. Patient reports 3-4 loose stools
a day. She also reports mild cramping. Which labs would be helpful in further workup of a
diagnosis? - ANSWER-ESR, fecal occult, Stool culture
Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to determine the
potential cause of her symptoms.
, 4|Page
A 45-year-old man presents with epigastric pain that is relieved by eating and antacids. He also
reports experiencing nausea and occasional vomiting. What is the most likely diagnosis? -
ANSWER-Peptic ulcer disease
Rationale: having nausea and vomiting are more consistent with PUD rather than GERD and
should include a workup for H Pylori as a cause.
An adult female returns to the clinic with severe profuse watery diarrhea, abdominal pain, and
cramping after treatment with Cipro x 10 days. WBC is 12.5, stool culture is positive for c diff.
The NP would recommend: - ANSWER-Metronidazole 500 tid for 10-14 days
Rationale: Treatment of C Diff should include metronidazole (Flagyl) or PO vancomycin. Of these
options, the only correct option is metronidazole.
The most common side effect of the oral ribavirin used in the treatment of hepatitis C is: -
ANSWER-hemolytic anemia.
Rationale: It is important to note that ribavirin will not treat hepatitis C unless it is taken with
another medication called pegylated-interferon α (PEG-IFNα). This therapy is not considered
evidence based anymore due to better options now available and the considerable side effect
profile of ribavirin which includes hemolytic anemia as it's most significant side effect affecting
10-15% of those taking it.
Which of the following findings is typically a sign of acute appendicitis? - ANSWER-A positive
Rovsing's sign
Rationale: A positive Rovsing's sign is characterized by right lower abdominal pain upon
palpation of the left side of the lower abdomen.
Prehn's sign is used to determine if the patient has testicular torsion or epididymitis.
Murphy's sign is elicited in patients with acute cholecystitis by asking the patient to take in and
hold a deep breath while palpating the right subcostal area.
The psoas sign, also known as Cope's sign or Obraztsova's sign, is used to detect for pathology in
the abdomen and commonly is associated with appendicitis
2025 CEA PREP FULL PRACTICE EXAM ACTUAL QUESTIONS
WITH VERIFIED ANSWERS, EXAMS OF NURSING
Your patient presents with a blowing systolic murmur rated 3/6 that is heard best over the left
chest at the 5th intercostal space, left midclavicular space, radiating to the left axilla. This likely
represents which cardiac finding? - ANSWER-Mitral Regurgitation
Rationale: The inadequate coaptation (closing together) of the two leaflets of the mitral valve
under systole with left chest wall radiation are classic signs of mitral regurgitation. Aortic
stenosis is also a systolic murmur, but is heard best over the 2nd intercostal space right sternal
border and tends to radiate to the neck. Aortic regurgitation (insufficiency) and mitral stenosis
are both diastolic murmurs.
Ophthalmic examination of a patient with a 10-year history of poorly controlled hypertension,
despite three-drug-therapy, would most likely reveal: - ANSWER-Arteriolar narrowing
Your patient admitted with crushing chest pain just converted from sinus rhythm to sinus
bradycardia and developed elevated ST segments in lead II, III, and aVF. What intervention is the
priority for this patient's care? - ANSWER-Activating the cardiac cath lab team for STEMI
Rationale: Time is muscle. Early activation of the interventional cardiology team is key to long-
term cardiac salvage in the setting of STEMI. SL nitro poses a risk for hypotension and further
decompensation in a inferior/RCA territory MI. CT chest is not indicated as a priority in the
presence of a cardiac-type pain with positive EKG findings. Although vasoactive support is
possible, this is not the highest priority of care.
Which of the following medications does not cause beta 1 stimulation? - ANSWER-
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have beta
receptor activity.
A 55 year-old female patient with no previous cardiac history and no family history of
hyperlipidemia with an acute myocardial infarction is treated successfully with a drug-eluting
,2|Page
stent during a recent hospitalization. As their long-term care provider, you anticipate they were
most likely to be also started on which of the following lipid-lowering agents at discharge? -
ANSWER-High intensity statin therapy
Rationale: Patients with proven cardiac disease should be on high intensity statin therapy.
PCSK9 therapy is only indicated for homozygous familial hyperlipidemia or proven cardiac
disease with proven failure to tolerate multiple attempts at statin therapy.
Which of the following antibiotic agents should be avoided in a 35 year-old female patient with
a diagnosis of Marfan's Syndrome? - ANSWER-Ciprofloxacin
Rationale: Fluoroquinolone antibiotics must be avoided for patients with connective tissue
disorders due to the risk of aneurysm associated with their use. Ciprofloxacin is the only
fluoroquinolone antibiotic listed.
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? - ANSWER-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.
What is the key long-term benefit of using carvedilol for patients with coronary artery disease
and heart failure with reduced ejection fraction (HFrEF)? - ANSWER-Potential increase in
ejection fraction
Rationale: EF increase is a key reason for using carvedilol over metoprolol for patients with low
EF states. Libido unfortunately can be negatively impacted by any beta blocker. Cardiac output
should only improve with long term use, not decrease, and beta blockers may reduce blood
pressure slightly, but that is not their key long-term benefit. In fact, they are not even
considered for routine anti-hypertensive management per JNC-8 guidelines.
A patient has been complaining of palpitations for the past week and presents to you at an
urgent care clinic for evaluation. You perform a 12 lead EKG and identify atrial fibrillation with a
,3|Page
hear rate of 122 beats per minute. What is your next order? - ANSWER-Order a stat
transthoracic (2D) echocardiogram and prepare the patient for trasnport to the closest
appropriate hospital for inpatient evaluation
Rationale: A wearable monitor does not provide you with actionable information until it is read,
and the patient is already identified as being in atrial fibrillation. Warfarin without bridging will
take several days to achieve a therapeutic INR and without bridging (as it is not mentioned)
would potentially increase prothrombotic state for first few days due to inhibition of protein C
and S. Amiodarone is a rhythm conversion medication and should not be given unless first
identifying any evidence of clot burden with an echocardiogram.
A 49-year-old male presents to your service with symptoms of fever 102.3, jaundice, and
abdominal pain. Imagining reveals a biliary obstruction. Which diagnosis is most likely for this
patient? - ANSWER-Cholangitis
Rationale: The most likely cause for this patients' symptoms is cholangitis, which has a typically
presentation of fever, jaundice, and abdominal pain. The most common cause of this is a biliary
stone causing obstruction and allowing for ascending of bacteria and infection
Which of the following gastrointestinal changes is associated with normal aging? - ANSWER-
Decreased production of gastric acid
Rationale: Normal GI changes with aging include decreased production of gastric acid, increase
incidence of gallstone, decreased salivation, and decrease esophageal emptying.
An older adult patient with new onset GERD, cough, heartburn. Initial tx - ANSWER-Antacid and
lifestyle modification/weight loss
Rationale: Before initiating a PPI or H2RA, it would always be wise to initiate diet/exercise and
symptom management when present with an antacid. Loss of weight/dieting is most likely to
deal with obesity as the most common underlying cause of GERD.
A 39-year-old female is being seen by your service for diarrhea. Patient reports 3-4 loose stools
a day. She also reports mild cramping. Which labs would be helpful in further workup of a
diagnosis? - ANSWER-ESR, fecal occult, Stool culture
Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to determine the
potential cause of her symptoms.
, 4|Page
A 45-year-old man presents with epigastric pain that is relieved by eating and antacids. He also
reports experiencing nausea and occasional vomiting. What is the most likely diagnosis? -
ANSWER-Peptic ulcer disease
Rationale: having nausea and vomiting are more consistent with PUD rather than GERD and
should include a workup for H Pylori as a cause.
An adult female returns to the clinic with severe profuse watery diarrhea, abdominal pain, and
cramping after treatment with Cipro x 10 days. WBC is 12.5, stool culture is positive for c diff.
The NP would recommend: - ANSWER-Metronidazole 500 tid for 10-14 days
Rationale: Treatment of C Diff should include metronidazole (Flagyl) or PO vancomycin. Of these
options, the only correct option is metronidazole.
The most common side effect of the oral ribavirin used in the treatment of hepatitis C is: -
ANSWER-hemolytic anemia.
Rationale: It is important to note that ribavirin will not treat hepatitis C unless it is taken with
another medication called pegylated-interferon α (PEG-IFNα). This therapy is not considered
evidence based anymore due to better options now available and the considerable side effect
profile of ribavirin which includes hemolytic anemia as it's most significant side effect affecting
10-15% of those taking it.
Which of the following findings is typically a sign of acute appendicitis? - ANSWER-A positive
Rovsing's sign
Rationale: A positive Rovsing's sign is characterized by right lower abdominal pain upon
palpation of the left side of the lower abdomen.
Prehn's sign is used to determine if the patient has testicular torsion or epididymitis.
Murphy's sign is elicited in patients with acute cholecystitis by asking the patient to take in and
hold a deep breath while palpating the right subcostal area.
The psoas sign, also known as Cope's sign or Obraztsova's sign, is used to detect for pathology in
the abdomen and commonly is associated with appendicitis
