NR667- CEA Verified Multiple Choice and Conceptual
Actual Emended Exam Questions With Reviewed
100% Correct Detailed Answers
Guaranteed Pass!!Current Update
1. 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: - ANSWER 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.
2. Which of the following end-organ sequelae is not directly caused by
uncontrolled hypertension? - ANSWER Peripheral neuropathy
Rationale: 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.
3. Preventive cardiac care should focus primarily on addressing all the following
except? - ANSWER 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.
4. 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? - ANSWER 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
5. 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? - ANSWER 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.
6. Which of the following is at highest risk for DMII? - ANSWER 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.
7. A starting dose for a elderly adult patient with a BMI of 20 needing
levothryoxine - ANSWER 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.
8. 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? - ANSWER 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).
9. All the following are symptoms of hypocalcemia except: - ANSWER Visual
field deficits
Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All
other are symptoms related to hypocalcemia.
10. An adult patient diagnosed with type 2 diabetes mellitus presents for a
recheck. The patient follows a carbohydrate counting diet and walks 30 minutes 5
times weekly. Current fasting blood glucose = 116 mg/dL [normal = less than 99
mg/dL] and A1c = 6.3% [normal = less than 7.0%]. In accordance with the
American Diabetes Association, the nurse practitioner would recommend that the
next follow-up appointment be scheduled for: - ANSWER 6 months.
Rationale: Based off of the ADA recommendation, this patient should be
evaluated in six months. They are actually showing good control and excellent
compliance with diet and exercise management strategies. If there compliance
was worse or they were not controlled with their A1c, this would likely be a three
month follow up.
Actual Emended Exam Questions With Reviewed
100% Correct Detailed Answers
Guaranteed Pass!!Current Update
1. 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: - ANSWER 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.
2. Which of the following end-organ sequelae is not directly caused by
uncontrolled hypertension? - ANSWER Peripheral neuropathy
Rationale: 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.
3. Preventive cardiac care should focus primarily on addressing all the following
except? - ANSWER 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.
4. 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? - ANSWER 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
5. 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? - ANSWER 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.
6. Which of the following is at highest risk for DMII? - ANSWER 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.
7. A starting dose for a elderly adult patient with a BMI of 20 needing
levothryoxine - ANSWER 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.
8. 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? - ANSWER 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).
9. All the following are symptoms of hypocalcemia except: - ANSWER Visual
field deficits
Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All
other are symptoms related to hypocalcemia.
10. An adult patient diagnosed with type 2 diabetes mellitus presents for a
recheck. The patient follows a carbohydrate counting diet and walks 30 minutes 5
times weekly. Current fasting blood glucose = 116 mg/dL [normal = less than 99
mg/dL] and A1c = 6.3% [normal = less than 7.0%]. In accordance with the
American Diabetes Association, the nurse practitioner would recommend that the
next follow-up appointment be scheduled for: - ANSWER 6 months.
Rationale: Based off of the ADA recommendation, this patient should be
evaluated in six months. They are actually showing good control and excellent
compliance with diet and exercise management strategies. If there compliance
was worse or they were not controlled with their A1c, this would likely be a three
month follow up.
