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APEA PREDICTOR EXAM REAL EXAM 2025
LATEST QUESTIONS AND CORRECT
ANSWERS GRADE A
- A 15 years old high school student with a mild sore throat
and low-grade fever that has persisted for about 3 weeks. She
reports general malaise, fatigue, and loss of appetite. The NP
suspects mononucleosis. Which of the following is the
LEAST appropriate intervention? a. Palpate the lymph
nodes and spleen
b. Examine the posterior oropharynx for petechiae
c. Obtain a CBC, throat culture, and heterophil antibody test.
d. Obtain an urinalyses and serum for LFTs and amylase
Explanation: mononucleosis is a symptomatic infection caused
by the Epstein-Bar virus. Common is people 15-24 years of age.
Common signs and symptoms following incubation period (1- 2
months) include fatigue, chills, malaise, anorexia, white
tonsillar exudates and lymphadenopathy or posterior cervical
region. Splenomegaly can be present. A maculopapular or
occasionally a petechial rash occurs in less than 15% of
patients. A diagnosis is usually made using the Monospot. In
addition, neutropenia and lymphocytosis are usually detected in
the CBC.
- A 32 years old male patient complaint of urinary frequency
and burning on urination for 3 days. Urinalyses reveals
bacteriuria and positive nitrites. He denies any past hx. Of
urinary tract infections. The initial treatment should be:
a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-
10 day
b. ciprofloxacin (Cipro) for 3-5 days
c. Trimethoprim-Sulfamethoxazole for 3 days
d. 750 mg ciprofloxacin as a one-time dose
Explanation: trimethoprim-sulfamethoxazole (TMPS) is
usually n appropriate medication to treat urinary tract infections
in most patients. In the case of community resistance to TMPS
20%^, another medication should be substituted. In men, the
appropriate length of time is 7-10 days. Women may be treated
for 3 days for uncomplicated UTI
- Which agent is most effective for the treatment
of nodulocystic acne? a. Benzoyl peroxide
(Benzac) b. Retinoic acid (Retin A)
c. Topical tetracycline
d. Isotretinoin)
Explanation: Isotretinoin (Accutane) is a systemic agent
indicated for treatment with severe inflammatory acne.
Guidelines for its use must be clearly understood by the patient.
A woman of childbearing age must use an effective method of
contraception because isotretinoin is teratogenic. There are
many restrictions in prescribing this medication because of the
c. If prescribed amoxicillin/clavulanate (Augmentin) for a
sinus infection
d. if she forgets to take a single dose of the contraceptive
Explanation: Anticonvulsant including phenytoin (Dilantin),
carbamazepine (Tegretol), primidone (Mysoline), topiramate
(Topamax) and oxcarbazepine (Trileptal) reduce the
effectiveness of contraceptives. Depo-medroxyprogesterone
acetate injections or levonorgestrel- releasing intrauterine
devices would be a better method of contraceptive for patients
taking anticonvulsants. Most commonly used antibiotics have
not been proven to reduce the effectiveness of contraceptives.
Rifampin is an exception, and additional …. Be used by women
taking this drug and using oral contraceptives, transdermal, or
vaginal ring preparations. Additional backup contraception
should be used if taking antifungal agents. No additional
protection is needed thought the week of placebo pills. Missing
one single dose of contraceptive does not require additional
protection, missing more than one doses does.
- A 44 years old female patient has diabetes. Her total
cholesterol (TC) is 250 mg/dl (6.5 mmol/L), LDL= 190 mg/dL
(4.94 mmol/L), HDL= 25 mg/dL (65 mmol/L), and
triglycerides= 344 mg/dL (8.94 mmol/L). What agent have the
greatest effect on improving her lipid profile and reducing
morbidity and mortality associates with dyslipidemia? a.
Niacin (Niaspan)
Omega 3 fatty acids
Explanation: First and foremost, it is essential to
educate individuals on a heart-healthy lifestyle. LDL-C is one of
the major culprits in the development of atherosclerotic heart
disease. The target level of LDL-C is between 50 to 70mg/dl to
prevent plaque formation in the blood vessels. Guidelines
strongly recommend statin therapy because they primarily lower
LDL-C levels, but they also have the secondary effects of
lowering triglyceride and increasing HDL-C levels.
- A 30 years old female comes into a clinic with classic signs
and symptoms of appendicitis. The NP fails to refer the patient
to a surgeon. The appendix ruptures and the woman die. This is
an example of
a. Failure of diligence
b. Professional liability
c. Negligence
d.Malpractice
Explanation : malpractice, a negligence tort, occurs when a
health care professional’s actions fall bellow the appropriate
standard of care and hurts the patient. In this case the patient
came with sings and symptoms indicating appendicitis and the
NP failed to refer the patient..
- A NP has recently been hired to work in a fast track facility.
The NP employer asked if she has “a problem prescribing
b.Atorvastatin
c.
d. Fenofibrates
- Antidepressant discontinuation syndrome is less likely if the
patient a.
Is male
b. Is less than 35 y/o
c. Has taken an SSRI with a short half life
d. Gradually tapers
SSRI use
Explanation: Antidepressant discontinuation syndrome is most
often seen in the primary care office in association with SSRI
discontinuation, because SSRIs are the most commonly
prescribed class of antidepressant medications. Interruption of
treatment with an anti-depressant medication is sometimes
associated with an antidepressant discontinuation syndrome; in
early reports it was referred to as a “withdrawal reaction.
Symptoms of antidepressant discontinuation syndrome can
include flu-like symptoms, insomnia, nausea, imbalance,
sensory disturbances, and hyperarousal. Tapering is
recommended by experts.
- Patient with benign prostatic hyperplasia (BPH) should be
taught to avoid which one of the following drug classes?
a. Alpha adrenergic antagonist
b. Anti-androgen agents
c. Tricyclic antidepressant (TCA)
d. Sulfonamides
Explanation: tricyclic antidepressant should not be used by
men with benign prostatic hyperplasia because of the increased
risk of urinary retention secondary to the anticholigergic
effects of TCAs.
- Which of the following is the best response to a woman who
has just admitted she is a victim of spousal abuse?
a. What was if you did to make him angry?
b. You must seek refuge immediately
c. I am concerned about your safety
d. I am going to call a shelter for you
Explanation: The first step is to establish trust in the
therapeutic relationship. without trust future collaboration,
intervention and client outcome cannot be accomplished to
facilitate appropriate and safe behavior. The experience of
abuse is a traumatic psychological crisis that must be addressed
as such. The healthcare providers must emphasize the fact that
the victim has not done anything wrong and they must also
emphasize the fact that the victim's life and the lives of their
children can be in danger if the abuse is not addressed. It will
not disappear with a lack of action. An order of protection
against the perpetrator is often recommended.
- For which patient group does the US Preventive Services
Task Force recommend routine screening for asymptomatic
bacteriuria a. pregnant woman
b. Children
c. Patients with diabetes
d. patients over the age of 70
Explanation: Herpangina is a viral infection common in
toddlers and young children caused by Coxsackie virus. The
clinical findings of numerous, small (1-2 mm) ulcerations on the
tonsils and uvula are typical of herpangina. The ulcerations can
be very painful but usually resolve in 7 to 10 days. Treatment is
symptomatic.
- A patient has Kawasaki syndrome. Which characteristics
would be UNUSUAL? a.
Age > 15 years
b. Fever > 101 F (38.3 C)
c. Exudative pharyngitis
d. Painful rash explanation: Kawasaki disease is an acute
febrile vasculitis syndrome that evolves inflammation of
the blood vessels. This condition often causes cardiac
complication in children by damaging the coronary arteries
is most prevalent in children of Asian ethnicity. Diagnosis
of Kawasaki disease requires presentation of fever and 4 of
the following criteria: bilateral bulbar conjunctival
injection, oral mucous membrane changes, peripheral
extremity changes, polymorphous rash, and cervical
lymphadenopathy.
- According to the JNC 8 guideline hypertension in a 40
y/o can be diagnosed when blood pressure exceeds a.
140/90 b. 130/
c. 125/
d. 150/
Explanation: According to JNC 8 guidelines, hypertension is a
sustained elevation of systolic BP greater than or equal to 140
mmHg or diastolic BP greater or equal than 90mmHg, taken
from 2 or more readings on 2 different occasions after an initial
screening.
- A 48 y/o female complains of pain and stiffness in her
right hip and knee that is mild on awakening in the morning,
get worse as the day progresses and is relived with hot baths
and ibuprofen. Crepitus is palpated on range of motion of the
knee. Signs of inflammation are notably absent. What is the
most likely diagnosis? a. Rheumatoid arthritis (RA) b.
Gout
c. Osteoarthritis (OA)
d. Osteoporosis
Explanation: Rheumatoid arthritis is characterized by several
joint deformities, usually bilaterally symmetrical. RA is
characterized by inflammatory processes, while OA is not. RA
and OA are chronic conditions. Gout is characterized by acute
exacerbations related to a defect in purine metabolism,
increased uric acid production, or decreased uric acid excretion.
- A 7-year old female patient presents with severe injuries
that are inconsistent with the explanation given for them. The
nurse practitioner questions the mother about abuse. She admits
that her husband, the child’s father, beat the child. How should
the nurse practitioner proceed? a. Inform the mother that
the abuse must be reported to child protection authorities.
portion of the intestine which telescopes into a more distal
intestinal segment. The classic triad of intussusception
include crampy
(intermittent, also known as colicky) abdominal pain, vomiting,
and bloody stools. The patient may pull up his knees with
crying. The patient may develop vomiting with bilious emesis.
Progressive lethargy/altered level of consciousness and pallor is
common. The etiology of this lethargic presentation is not
known, but it tends to occur in younger infants. As
intussusception progresses, a palpable, sausage-shape mass may
develop. Some hypothesize that this is due to release of
endogenous opioids or endotoxins released from ischemic
bowel. Intussusception in a child presenting with lethargy is
often difficult to diagnose since other causes of lethargy such as
dehydration, hypoglycemia, sepsis, toxic ingestion, post-ictal
state, etc., must also be considered. Ultrasound is the preferred
diagnostic test. Enemas is considered the first line of treatment
prior surgery. Volvulus occurs more frequently in middle-aged
and elderly men. Cronos’s is most often diagnosed between 13
- A middle-aged female complains of insomnia, night sweats,
feeling intensely hot, emotional lability, extreme nervousness
and impatience. The LEAST likely cause of her symptoms is a.
Thyrotoxicosis
b. Menopausal vasomotor instability
c. Alcohol or another drug withdrawal
d. New onset type 2
diabetes mellitus
Explanation: New onset diabetes produces elevated serum
glucose levels less than 200 mg/dL (7.0 mmol/L) and usually no
clinical signs or symptoms. At higher levels, the patient may
report lethargy, fatigue, weakness, weight loss, and polydipsia,
polyuria, and/or polyphagia. Complaints of insomnia, night
sweats, feeling intensely hot, emotional lability, and extreme
nervousness may be caused by thyroxine excess, menopausal
instability, or withdrawal from alcohol or other drugs of
addiction.
- Which of the following indicated need for further
evaluation? a.
A 7 y/o girl with vaginal bleeding
b. A 7 years old girl with no true pubic hair
c. A 12 years old boy with sparse, slightly pigmented pubic
hair
d. A 12-year-old girl with breast buds explanation: In
newborn girls, withdrawal bleeding may occur as a normal
response to maternal estrogen leaving the infant’s uterine
lining. Vaginal bleeding after the first few weeks of life and
before puberty is considered abnormal. Early vaginal
bleeding can indicate trauma, foreign bodies (toilet paper is
the most common), vulvovaginitis, hemangiomas, benign
polyps, precocious puberty, or sexual abuse.
d. Prescribe an ACE inhibitor and re-evaluate in 24 to 48
hours
Explanation: The patient has at least a 70% occlusion of a
major coronary artery. For a patient to be considered for
CABG, the coronary arteries to be bypassed must have
approximately a 70% occlusion (60% if in the left main
coronary artery).
- A 3 y/o has enlarged, warm, tender cervical
lymph nodes, indicating: a. Infection proximal to
the nodes b. A possible cancer diagnosis
c. Shorty nodes, a common normal variant in children
d. An infectious process distal to the nodes explanation: size
of lymph nodes is important. Nodes > 1 cm are significant
and should be asses carefully. Nodes > 5 cm are almost
always neoplastic. Tenderness of a node usually suggest
inflammation. Cancerous nodes frequently are larger, non-
tender, and stone-like in consistency. Nodes are pea-sized,
nontender, mobile, discrete and reflect pre-existent
infection.
- The NP examines a 2-month-old with unequal gluteal and
thigh skin folds. What should the NP do next?
a. Send the infant for x-ray of the hips
b. Send the infant for ultrasound of the hips
c. Perform Ortolani and Barlow test
d. Examine the infant for unequal arm length
Explanation: Gluteal and thigh skin fold asymmetry may
indicate congenital hip dysplasia. X- ray studies are not useful
before 3 months-of-age because the femoral head has not
completely ossified.
- A very active 35 years old male has painful hemorrhoid, but
he does not want hemorrhoidal surgery at this time. His diet has
been indiscriminate as his job requires frequent travel. The most
appropriate recommendation is for him to select food that are: a.
Low in fiber such as milk and other dairy products
b. High in simple carbohydrates such as white bread and
mashed potatoes
c. High in fiber such as bran, complex carbohydrates and fresh
fruit
d. High protein such a meat, poultry and fish
Explanation : Hemorrhoid disease is the most common reason
patients seek evaluation by a colon and rectal surgeon. The
majority of hemorrhoids can be managed nonoperatively with
medical management or office-based procedures. Patients
should benefit from minimizing straining and avoiding
constipation. Bulking of the stool facilitates this and can be
accomplished by increasing dietary fiber and fluid intake. Stool
softeners may also be used.
- Correct instructions to give new parent who are transporting
their newborn infant is
a.
b. The infant car set may be secured in the back or front seat,
but must rear-facing
A rear-facing infant car seat secured in the backseat is
required until the infant weight 20
lbs.
- A 20 y/o male patient complains of “scrotal swelling”. He
states his scrotum feels heavy but denies pain. On examination,
the NP notes transillumination of the scrotum. What is the most
likely diagnosis? a. Hydrocele
b. Orchitis
c. Testicular torsion
d. Indirect inguinal hernia
Explanation: Hydrocele is common in newborns and usually
disappears without treatment within the first year. Older men
can develop hydroceles, sometimes due to inflammation or
injury. Hydroceles are usually painless, but may become large
and inconvenient. An ultrasound may be needed to diagnose the
condition.
30 ) A 15 y/o male has a hx of cryptorchidism which was
surgically repaired. Because of this information, it is essential
for the NP to teach him about a. Testicular self-examination
b. Protection of the testes during sports activities
c. Risk of testicular torsion
d. Practicing safer sex
Explanation: Cryptorchidism, even with surgical repair, is
associated with increased risk for testicular cancer.
- A pt. present with classic symptoms of gastroesophageal
reflux diseases’ (GERD). He is instructed in lifestyle
modification, and drug initialed. Two month later, he returns and
report that he still has symptoms. The next steps are to.
a) Refer for surgical interventions such as partial or complete
fundoplication.
b) Refer for endoscopy, namometry, and/or PH testing
c) Repeat the 8*-week course of drug therapy while
continuing lifestyles modifications.
d) Review proper proton pump inhibitor dosing time and
adherence with the patient. Explanation: poor adherence
is an importance cause of inadequate acid suppression and
refractory GERD. Determining adherence to proton pump
inhibitor (PPI) therapy and superficially timing in relation
to meals, should be sought first alarm features such as iron
deficiency anemia, unexplained weight loss, and persistent
vomiting would precipitate the need for further diagnostic
testing. Diagnostic testing procedures should proceed any
surgical intervention like fundoplication.
- A 51 – year- old post-menopausal female, request
guidance regarding osteoporosis risk. The NP would be
correct to recommend all of the following EXCEPT a.
Moderate weight bearing exercise 3 times per week b.
1200 – 1500 mg calcium daily
c. Avoidance of alcoholic beverages
d. Weight loss
Explanation: the recommended calcium intake is 1,200 mg –
1500 mg a day. Regular weightbearing and muscle-
strengthening exercise reduce the risk of falls and fractures.
Moderate alcohol intake has no known negative effect on bone
and may even be associated with slightly higher bone density
and lower risk of fracture in postmenopausal women. However,
alcohol intake of more than two drinks per day for women or
three drinks a day for men may be detrimental to bone health,
