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APEA PREDICTOR EXAM 2025 ACTUAL EXAM
COMPLETE 250 QUESTIONS AND CORRECT DETAILED
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- 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 teratogenic effects is given during pregnancy. Therefore, it is
a pregnancy category X.
- An 18 y/o woman is taking a combined hormonal oral contraceptive. She should be
instructed to use a backup method for the prevention of pregnancy a. Throughout the
week of placebo pills
b. If prescribed topiramate (Topamax) for the treatment of migraines.
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 medications for emergency
contraception.” The NP replies affirmatively. This is: a. Grounds for dismissal
b. An ethical dilemma for the NP
c. Illegal according to the standards of nursing
d. Patient abandonment.
Explanation: in this instance, the NP has a difference of opinion with her employer
based on her religious or moral belief about providing emergency contraception. This
situation is an example of an ethical dilemma. Failure to participate in the provision of
care to the patient based on the NP’s beliefs is neither against the law nor a violation of
the standards of practice
- A patient presents with pruritic lesions on both knees. There are visible silver
scales. How Should this condition be managed?
a. Topical antifungal cream or ointment
b. Oral antibiotics
c. Topical corticosteroids cream
d. Topical anti-fungal/ steroid cream
Explanation: Psoriasis is characterized by erythematous papules, as well as itchy, red,
precisely defined plaques with silvery scales. Auspitz sings is another common finding.
Topical agents containing tar and salicylic acid may be used. Topical steroids, such as
betamethasone, may also be ordered.
- 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 : an increased incidence of bacteriuria is found in all the population listed.
However, bacteriuria in pregnant women increases the mother…..Also increased is the
risk of a pre-term delivery, which then increases perinatal and fetal morbidity and
mortality. The recommended it….
- What diabetic complications result from hyperglycemia?
- According to the JNC 8 guideline hypertension in a 40 y/o can be diagnosed when
blood pressure exceeds a. 140/90 b. 130/90 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.
b. Counsel the mother that if it happens again it will be reported to child protection
service.
c. Ask the child what she did to cause the punishment
d. Refer the family to the National Domestic Violence hotline.
Explanation: An awareness of all the unique presentations of child abuse, subjective or
objective, physical, sexual, or neglect, is essential for NPs. Objective findings, such as
broken bones, burns, and bruises, may be as a result of an intentional injury from
physical abuse or from an unintentional injury as a result of neglect. Both must be
considered. Repeated visits to the emergency department, frequent or suspicious
injuries, or bilateral or multiple healing fractures are often indicators of physical abuse.
Once the diagnosis of child abuse has been made, the primary role of the NP is to ensure
the child is safe. If the NP suspect that a child is undergoing abuse, it’s critical to report
it—and to continue reporting each separate incidence if it continues to recur.
- A 1-month-old presents with reported recurrent diarrhea, screaming, and drawing
up of the legs followed by periods of lethargy. On physical examination, a “sausage-
like” mass in the upper right quadrant of the distended abdomen. Which of the
following is the most likely diagnosis? a. Intussusception b. Volvulus
c. Crohn’s disease
d. Foreign body in the GI tract explanation: Intussusception is one of the most
common causes of abdominal obstruction in children prior 2 years of age; is best
described as a
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 – 30 years of age.
- 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,
a. Refer to a cardiologist as soon as possible
b. Prescribe long-acting nitroglycerin
c. Order treadmill stress test
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, nontender, and stone-like in
consistency. Nodes are pea-sized, nontender, mobile, discrete and reflect
preexistent 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
c. The infant car seat may be front facing when the infant is 1 year old
d. A rear or front-facing infant car seat must be secured in the back seat until the
infant weight 20 lbs.
Explanation: The American Academy of Pediatrics (AAP) recommends that infants
and toddlers ride in a rear-facing seat until they are 2 years old or until they have
reached the maximum weight and height limits recommended by the manufacturer
- A 13 y/o pt. complains that he fell while running during football practice. Now his
knee hurts and sometimes “lucks”. The NP conducts McMurrays test. Which of the
following is TRUE about this test?
a. An audible or palpated “click” is positive for a torn meniscus
b. A various stress is applied to the flexed knee
c. The straight leg is internally rotated with the patient supine and flat
d. The knee is grasped with the examiner’s fingers placed laterally.
Explanation: Mac Murray’s test is conducted while the patient is in the supine position.
The NP places the distal hand on the foot and raises the knee slowly, keeping the foot and
knee externally rotated with the proximal hand resting on the join line. The knee is flexed
and then quickly straightened. If an audible or palpable click occurs during the this test,
the outcome is positive for medial meniscal injury.
- 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.
- 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
A rear-facing infant car seat secured in the backseat is required until the infant
weight 20
lbs.
ethnicity, cigarette smoking, inactive lifestyle, low weight and postmenopausal estrogen
deficiency including premature menopause.
- According to Erickson, the developmental task of the elderly adult is: a.
Intimacy VS isolation explanation:
b. Ego integrity VS
despair
c. Industry VS self-
doubt Trust Vs
mistrust
d.
- Moderate weight loss, particularly of visceral adipose tissue in patients with
type 2 diabetes mellitus may have all of the following beneficial effects
EXCEPT: a.
Improved insulin sensitivity
b. Increased glucose uptake and utilization by the cells
c. Increase lean muscle mass’
d. Improved lipid profile
Explanation: Regular, consistent exercise is an essential part of diabetes and
prediabetes management. The ADA recommends that people with diabetes perform at
least 30 minutes, 5 days/wk of a moderate-intensity aerobic physical activity. The ADA
also encourages people with type 2 diabetes to perform resistance training 3Xwk in the
absence of contraindications. Exercise contributes to weight loss, which further
decreases insulin resistance. The therapeutic benefits of regular physical activity may
result in a decreased need for diabetes medications to reach target blood glucose goals.
Regular exercise may also help reduce triglyceride and lowdensity lipoprotein (LDL)
cholesterol levels, increase high-density lipoprotein (HDL), reduce BP, and improve
circulation. Patients who use insulin, sulfonylureas, or meglitinides are at increased risk
for hypoglycemia when they increase physical activity.
- A 12 y/o presents with eat pain or 36 hours duration. The
NP diagnoses acute otitis media because the
a. Tympanic membrane is bulging and glossy with tiny bubbles visible posteriorly
b. Tympanic membrane is retracted against boy landmarks
c. Bony landmarks are obscured, and the tympanic membrane is mildly
erythematous, dulls and immobile.
d. Canal is narrowed, erythematous, and exquisitely tender with speculum contact
Explanation: Serous otitis media typically presents with a flat or bulging and
tympanic membrane with a fluid line and/or tiny bubbles visible posteriorly. The
tympanic membrane may be immobile and retracted against the bony landmarks
when the eustachian tube is swollen or congested as with the common cold or
allergies. Narrowing of the external canal with erythema and extreme tenderness
of the canal wall is indicative of otitis externa.
- The NP should instruct the mother of an infant with thrush to: a.
Take oral nystatin since she is breastfeeding
b. Stop breast feeding until the thrush has resolved
c. administer antifungal medication to the infant prior to feeding
d. sterilized pacifiers and bottle nipples
explanation : Most bouts of oral thrush occur for no apparent reason. However,
regularly sterilization of pacifiers, bottlesfeed and other mouth toys used by the baby
may help to prevent some bouts.
remember ever getting that shot” She has negative serologic evidence of rubella
antibody. The NP should:
a. Tell her that her serologic evidence demonstrates that she is immune to the rubella
and that
she probably has the disease as a child
b. Administer the vaccination after a negative pregnancy test and advise the patient
that she
must not get pregnant for 28 days
c. Tell her that she needs the immunization and can get today if her pregnancy test is
negative
d. Administer the rubella vaccination after a negative pregnancy test and advise her
not to get
pregnant for at least 6 months.
Explanation: Due to this very small chance of illness, the Centers for Disease Control
and Prevention (CDC) recommend waiting 28 days after getting the MMR vaccine
before trying to get pregnant.
- A 45 y/o obese pre-menopausal female complains of indigestion, flatulence, RUQ
pain and epigastric “crampy pain”. Symptoms are exacerbated by high-fat meal. What is
the most likely diagnosis? a. Hepatitis b. Chronic cholecystitis
c. Acute pancreatitis
d. Myocarditis
Explanation: The “typical” patient with chronic cholecystitis is
“female, fat, fertile, and (over)
40” years of age. Myocarditis produces retrosternal pain that is not related to diet. The
pain of pancreatitis radiates to the back. The pain of hepatitis is non-specific upper
quadrant pain.
- A 16 y/o male presents w/ mild sore throat, fever, fatigue, posterior cervical
adenopathy, and palatine petechia. With for this patient, what drug would be the LEAST
appropriate to prescribe? a. Ibuprofen
b. Erythromycin
c. Ampicillin
d. Doxycycline
Explanation: Mono can be managed with supportive care, including NSAIDs,
and warm sailing gargles. patients with strep throat should be prescribed penny
ceiling or every throw myosin instead of amoxicillin or ampicillin because
amoxicillin and ampicillin often cause a rash in mono patients.
- A characteristic of delirium that is typically absent in dementia is
a. Acute onset of confusion in a previously alert and oriented patient
b. Gradual loss of short-term memory
c. Loss of language skills
d. Long term memory gaps filled in with confabulation Explanation : Delirium is
acute confusional state, is potentially a reversible cognitive impairment that often
has a physiological cause; physiological causes include electrolyte imbalances,
cerebral anoxia (an absence of oxygen); hypoglycemia; medication effects;
tumors; subdural hematoma; and cerebral infection, infarction, or hemorrhage.
Dementia is a generalized impairment of intellectual functioning that interferes
with social and occupational functioning. It is an umbrella term that includes
Alzheimer's disease, Lewy body disease, frontaltemporal dementia, and vascular
dementia.
- It is imperative that the NP teach patients taking oral contraceptives to
report any of the danger signs of complications. Which of the following would
be the LEAST concern to the NP? a. Lower leg pain b. Upper abdominal
pain c. Chest pain
d. Weight gain
Explanation: Common side effects of OCP includes: bleeding between periods, nausea,
breast tenderness, headaches and weight gain. The symptoms often subside after a few
months of use. Lower Leg pain can be indicative of- DVT. Other major complication
can include the liver, gallbladder or the cardiac organ.
- Which of the following oral medications should be avoided in a child under 8 years
of age? a. Cephalexin (Keflex) b. Tetracycline c. Rifampin
d. Metronidazole (flaggyl)
Explanation: Children younger than 8 years old should not take tetracycline.
Deposition in the bone and primary dentition occurs during calcification in growing
children. This causes discoloration and hypoplasia of the teeth and a temporary stunting
of growth.
- Which of the following descriptions of Denver II Developmental Screening Test is
most accurate?
- which oral hypoglycemic agent would be safest for an elderly patient
if hypoglycemia is a major concern? a. Tolbutamide (orinase) b.
Glipizide (Glucotrol)
c. Metformin (Glucophage)
d. Chlorpropamide (diabinese)
Explanation: When used alone, metformin typically does not cause hypoglycemia
and is usually weight neutral or causes modest weight loss. Given the low risk of
hypoglycemia, metformin has an important role in elderly patients with diabetes, as
long as patients are selected appropriately to avoid the risk of lactic acidosis.
- the components of the Denver II Developmental screening test are: a.
Personal/social, fine motor, gross motor, language
b. Intelligence, motor performance, language development
c. Vocabulary, clarity of speech, abstract thinking
d. Problem-solving, speech, gross motor, fine motor Explanation: The Denver II
Developmental Screening Test is the most widely used tool to assess early
childhood development and rates the categories of personal–social, fine motor–
adaptive, language, and gross motor skills. The nurse should explain to the parent
before administering the test that this test does not measure intelligence but of
the child's level of development or ability to perform age-appropriate tasks.
DDST II Assesses: Gross motor function
Language development
Fine motor-adaptive skills
Personal-social skills
- A patient has been taking fluoxetine (prozar) since being diagnosed with major
depression 7 month ago. She reports considerable empowerment in her symptoms and
her intention to discontinue the medication what should be the NP’s recommendation?
a. Advice the patient to stop the antidepressant medication
b. Question the patient to determine if the self-assessment is correct before advising
her to discontinue the medication
c. Recommend that the patient continue the antidepressant medication for at least 4
more
month
d. Discuss with the patient that need to take the antidepressant medication indefinitely
Explanation: Anxiety Treatment Clinical guidelines for managing MDD also
recommend that patients should maintain antidepressant use for at least 6–9 months
after full symptom remission and that patients with some risk factors.
- for the general adult population, total dietary fat intake should be no more than
what percent of total calories? a) 10% b) 20% c) 30%
d)40%
Explanation: Clinical trials suggest that heart disease mortality rates un the US could
be lowered by 5 to 20% if all Americans restricted their fat intake to less than 30% of
total daily calories, 7% from saturated fat.
- A 30 y/o female patient is being seen by the NP for the first time. She is seeking
advice from the NP about becoming pregnant. She is currently taking an oral
contraceptive. She gives a hx of having hydatidiform molar pregnancy 2 years ago. An
appropriate plan of care for this
a. patient should include
b. Delaying pregnancy for 1 more year
c. Measuring serum chorionic gonadotropin level
d. Discontinuing oral contraceptive
e. Recommending permanent sterilization
Explanation: A Women should be instructed to use birth control for 1 year after treatment
for a hydatidiform mole. Pregnancy
raises hCG levels which increases the risk for choriocarcinoma.
- which of the following is NOT a goal for treatment for the patient with cystic
fibrosis? a. Prevent intestinal obstruction b. Provide adequate nutrition
c. Promote clearance of secretions
d. Replace water soluble vitamins
Explanation: most patients with cystic fibrosis have insufficient release of pancreatic
enzymes. This results in malabsorption of the fat-soluble vitamins….meconium ileus ,
resembles appendicitis in these patients
- A 24 y/o female taking oral contraceptive has missed her last 2 pills. What should
the NP advise her to do to minimize her risk of pregnancy?
a. Take today’s dose and do not miss any more during this month
Double today’s dose and tomorrow’s dose and use a barrier
method for the rest of this
