APEA Predictor Exam for Nurse Practitioners — Questions and Answers

Question 1: A nurse practitioner prescribes methotrexate for rheumatoid arthritis. Which supplement should be co-prescribed to reduce mucosal and hematologic toxicity?

Vitamin D
Folic acid (Correct answer)
Vitamin B12
Zinc

Correct answer: Folic acid

Methotrexate inhibits folate metabolism; supplementing with folic acid reduces side effects such as oral ulcers, nausea, and cytopenias without reducing efficacy.

Question 2: A patient with asthma requires an antihypertensive. Which class is contraindicated due to risk of bronchospasm?

Non-selective beta-blockers (Correct answer)
Calcium channel blockers
Thiazide diuretics
ACE inhibitors

Correct answer: Non-selective beta-blockers

Non-selective beta-blockers block both beta-1 and beta-2 receptors, causing bronchospasm in patients with reactive airway disease.

Question 3: An 82-year-old is brought in with new confusion over the past 2 days, fluctuating attention, and a urinary tract infection. What is the most likely diagnosis?

Lewy body dementia
Major depressive disorder
Delirium (Correct answer)
Alzheimer disease

Correct answer: Delirium

Delirium is an acute change in attention and cognition that fluctuates and has a medical trigger such as infection. Dementia is gradual and progressive. The first step is to find and treat the underlying cause.

Question 4: A patient with CHF exacerbation presents with orthopnea, 3+ pitting edema, and weight gain of 8 lbs in 5 days. The immediate management priority is:

Oral furosemide and outpatient follow-up in 1 week
Dietary counseling and sodium restriction alone
ACE inhibitor dose increase only
IV furosemide and close monitoring of urine output (Correct answer)

Correct answer: IV furosemide and close monitoring of urine output

Acute CHF exacerbation with significant fluid overload requires IV diuresis for rapid volume removal, with urine output monitoring to guide therapy.

Question 5: Why are benzodiazepines generally avoided for insomnia or anxiety in adults over 65 according to the Beers Criteria?

They cause hyperkalemia
They are ineffective in older adults
They cause severe hypertension
They increase the risk of cognitive impairment, delirium, falls, and fractures (Correct answer)

Correct answer: They increase the risk of cognitive impairment, delirium, falls, and fractures

Older adults are more sensitive to benzodiazepines and have slower metabolism, raising the risk of falls and cognitive effects.

Question 6: According to APEA board prep principles, which of the following is the primary benefit of a customizable study plan compared to a fixed curriculum?

It guarantees a passing score
It costs less money
It adapts to individual performance data to optimize preparation efficiency (Correct answer)
It allows learners to skip required content

Correct answer: It adapts to individual performance data to optimize preparation efficiency

Customizable study plans respond to individual assessment performance, allowing learners to allocate time where it is most needed rather than following a uniform schedule.

Question 7: APEA performance tracking shows a student's scores have plateaued at 68% for 3 weeks despite continued studying. The most appropriate strategy to break through the plateau is:

Take a break from studying entirely for 2 weeks
Change study methods: shift from passive re-reading to active recall strategies, mixed practice testing, and prioritizing untested weak areas (Correct answer)
Accept the plateau as the student's maximum potential
Switch to a completely different board prep company

Correct answer: Change study methods: shift from passive re-reading to active recall strategies, mixed practice testing, and prioritizing untested weak areas

Score plateaus typically result from using ineffective study methods rather than reaching a learning ceiling. Shifting to active recall, mixed practice, and targeting specific weak areas often produces renewed score improvement.

Question 8: When auscultating heart sounds, which position best accentuates the murmur of mitral stenosis?

Standing
Sitting forward
Left lateral decubitus (Correct answer)
Supine

Correct answer: Left lateral decubitus

The left lateral decubitus position brings the mitral valve closer to the chest wall and is optimal for hearing the low-pitched diastolic rumble of mitral stenosis.

Question 9: A core APEA board exam topic is recognizing elder abuse. Which finding most strongly suggests physical abuse in an elderly patient?

Multiple bruises in various stages of healing (Correct answer)
Weight loss over 6 months
Single bruise after a documented fall
Confusion and memory loss

Correct answer: Multiple bruises in various stages of healing

Multiple bruises in various healing stages suggest repeated trauma inconsistent with accidental injury and is a key indicator of physical abuse.

Question 10: When building an APEA customizable study plan, which of the following should be established first?

Reviewing only the most recent APEA practice exam without a schedule
Target exam date and working backward to set weekly milestones (Correct answer)
Number of practice questions to complete each day regardless of content gaps
Memorizing all drug brand names before any content review

Correct answer: Target exam date and working backward to set weekly milestones

Setting the exam date and working backward to create weekly milestones is the foundational step. This approach ensures adequate time for each phase: content review, practice questions, and final preparation.

Question 11: A 40-year-old female presents with her 5th urinary tract infection in 12 months. Urine cultures consistently grow E. coli. The most appropriate management to prevent recurrent UTIs is:

Long-term high-dose ciprofloxacin
Recommend cranberry juice as the sole preventive strategy
Evaluate for structural urinary abnormalities; consider prophylactic antibiotics (TMP-SMX or nitrofurantoin), post-coital antibiotics if coitally related, or patient-initiated therapy (Correct answer)
Increase fluid intake alone without further evaluation

Correct answer: Evaluate for structural urinary abnormalities; consider prophylactic antibiotics (TMP-SMX or nitrofurantoin), post-coital antibiotics if coitally related, or patient-initiated therapy

Recurrent UTIs (2 or more in 6 months or 3 or more in 12 months) warrant evaluation for predisposing factors and management with evidence-based prophylactic strategies.

Question 12: When prescribing clindamycin, the NP must counsel the patient about which potentially life-threatening adverse effect?

Anaphylaxis
Agranulocytosis
Stevens-Johnson syndrome
Clostridioides difficile colitis (Correct answer)

Correct answer: Clostridioides difficile colitis

Clindamycin has a high risk of disrupting colonic flora and promoting C. difficile overgrowth, leading to pseudomembranous colitis.

Question 13: A patient with acute deep vein thrombosis has no contraindications. Which anticoagulation management is preferred per current guidelines?

Low-molecular-weight heparin indefinitely
Inpatient IV heparin bridge to warfarin only
Aspirin for 3 months
Direct oral anticoagulant (DOAC) as outpatient therapy (Correct answer)

Correct answer: Direct oral anticoagulant (DOAC) as outpatient therapy

DOACs such as rivaroxaban or apixaban are the preferred first-line treatment for DVT due to efficacy, safety profile, and convenience of outpatient oral dosing.

Question 14: A 28-year-old woman with a first episode of uncomplicated cystitis is best treated with which antibiotic per IDSA guidelines?

Nitrofurantoin for 5 days or TMP-SMX for 3 days (Correct answer)
Cephalexin for 7 days
Amoxicillin for 7 days
Ciprofloxacin for 3 days

Correct answer: Nitrofurantoin for 5 days or TMP-SMX for 3 days

IDSA guidelines recommend nitrofurantoin or TMP-SMX as first-line agents for uncomplicated cystitis; fluoroquinolones are reserved for complicated infections.

Question 15: A patient with persistent asthma not controlled on low-dose ICS alone should have which medication added per NAEPP guidelines?

Oral corticosteroid
Long-acting beta-agonist (LABA) (Correct answer)
Cromolyn sodium
Short-acting beta-agonist (SABA) scheduled dosing

Correct answer: Long-acting beta-agonist (LABA)

For asthma uncontrolled on low-dose ICS, NAEPP guidelines recommend adding a LABA as the preferred step-up therapy before increasing ICS dose.

Question 16: An APEA expert instructor explains that the 'most important next step' in a clinical scenario question typically refers to:

The action that the student personally prefers
The most expensive treatment option
The immediate action that ensures patient safety or confirms the working diagnosis (Correct answer)
The most invasive diagnostic procedure available

Correct answer: The immediate action that ensures patient safety or confirms the working diagnosis

Board exam questions asking for the most important next step test clinical prioritization. The correct answer is usually the safest, most immediate action — often ruling out life-threatening conditions first or confirming the primary diagnosis.

Question 17: A patient taking amiodarone for atrial fibrillation requires monitoring for which thyroid-related adverse effect?

Hypothyroidism only
Hyperthyroidism only
Both hypothyroidism and hyperthyroidism (Correct answer)
Thyroid cancer

Correct answer: Both hypothyroidism and hyperthyroidism

Amiodarone contains high iodine content and can cause both hypo- and hyperthyroidism; thyroid function must be monitored every 6 months.

Question 18: A patient with community-acquired pneumonia has a CURB-65 score of 2. The appropriate management is:

Home IV antibiotics without hospitalization
Immediate ICU admission
Outpatient oral antibiotics only
Short-term inpatient admission or close outpatient follow-up (Correct answer)

Correct answer: Short-term inpatient admission or close outpatient follow-up

A CURB-65 score of 2 indicates intermediate severity CAP; guidelines recommend either brief hospitalization or close outpatient monitoring with low-risk criteria.

Question 19: A 22-year-old male patient screens positive on the PC-PTSD-5. Which exposure history is required to diagnose PTSD per DSM-5?

Repeated failure or academic disappointment
Any significantly stressful life event including job loss or divorce
Physical illness requiring hospitalization
Direct exposure to, witnessing, or learning about actual or threatened death, serious injury, or sexual violence (Correct answer)

Correct answer: Direct exposure to, witnessing, or learning about actual or threatened death, serious injury, or sexual violence

DSM-5 PTSD requires exposure to actual or threatened death, serious injury, or sexual violence — either directly experienced, witnessed, learned about in a close person, or through repeated extreme exposure as in first responders.

Question 20: A patient with migraine with aura asks about contraceptive options. Which contraceptive is contraindicated due to increased stroke risk?

Copper IUD
Combined oral contraceptive pills (Correct answer)
Levonorgestrel IUD
Progestin-only pills

Correct answer: Combined oral contraceptive pills

Combined oral contraceptives are contraindicated in migraine with aura (WHO Category 4) due to synergistic increased risk of ischemic stroke.

Question 21: Which antihypertensive medication is contraindicated in pregnancy due to teratogenic effects including renal dysgenesis and skull hypoplasia?

Calcium channel blockers
Beta-blockers
Alpha-methyldopa
ACE inhibitors (Correct answer)

Correct answer: ACE inhibitors

ACE inhibitors are absolutely contraindicated in pregnancy (FDA category D/X in 2nd-3rd trimester) due to fetal renal toxicity and hypotension.

Question 22: A patient presents with unilateral facial pain, vesicular rash along the jaw line, and ear pain. The most likely diagnosis is:

Herpes zoster (shingles) (Correct answer)
Bell's palsy
Dental abscess
Trigeminal neuralgia

Correct answer: Herpes zoster (shingles)

Unilateral dermatomal vesicular rash with pain in the facial area represents herpes zoster reactivation along the trigeminal nerve distribution.

Question 23: A student's APEA performance tracking shows strong performance in diagnosis questions but poor performance in management and treatment questions. This pattern most likely reflects:

Random variation with no clinical significance
A deficiency in anatomical knowledge
Strong assessment skills but gaps in evidence-based treatment guidelines and pharmacology (Correct answer)
The student is better at reading long questions than short questions

Correct answer: Strong assessment skills but gaps in evidence-based treatment guidelines and pharmacology

Strong diagnostic performance with weak management performance indicates that the student understands disease recognition but lacks depth in evidence-based treatment decisions, pharmacology, and clinical guideline application.

Question 24: A 55-year-old patient has a 10-year ASCVD risk of 12%. Per ACC/AHA guidelines, which intervention is indicated?

Fibrate therapy for triglycerides
Moderate-to-high intensity statin therapy (Correct answer)
Aspirin plus statin combination
Lifestyle modification only for 6 months

Correct answer: Moderate-to-high intensity statin therapy

A 10-year ASCVD risk ≥7.5% in patients aged 40-75 meets the threshold for initiating moderate-to-high intensity statin therapy per ACC/AHA guidelines.

Question 25: A patient with known COPD presents with increased dyspnea, change in sputum color to green, and increased sputum volume. The most appropriate treatment is:

Short-acting bronchodilator plus antibiotic (Correct answer)
Refer to pulmonology before treating
Antibiotic only without bronchodilator
Oral corticosteroid alone

Correct answer: Short-acting bronchodilator plus antibiotic

COPD exacerbation with purulent sputum meets criteria for antibiotic treatment; short-acting bronchodilators are added to address bronchospasm and dyspnea.

Question 26: When performing a rectal exam, the NP palpates the prostate and notes a hard, irregular nodule. The most appropriate next step is:

Refer for PSA and urology evaluation (Correct answer)
Order pelvic ultrasound only
Reassure the patient this is a normal variant
Repeat rectal exam in 6 months

Correct answer: Refer for PSA and urology evaluation

A hard, irregular prostate nodule raises concern for prostate cancer and requires PSA testing and urology referral for further workup.

Question 27: A patient with newly diagnosed hypertension has a BP of 148/92 on two separate visits with no end-organ damage or comorbidities. The first-line treatment is:

Immediate referral to cardiology
Immediate ACE inhibitor therapy
Lifestyle modification for 3-6 months plus thiazide diuretic (Correct answer)
Beta-blocker initiation

Correct answer: Lifestyle modification for 3-6 months plus thiazide diuretic

For Stage 1 hypertension without compelling indications, JNC guidelines recommend lifestyle modifications alongside initiation of a thiazide diuretic as first-line pharmacotherapy.

Question 28: A patient with community-acquired MRSA skin infection has a fluctuant abscess with surrounding cellulitis. The primary treatment is:

Topical mupirocin and warm compresses
Oral clindamycin alone
IV vancomycin only
Incision and drainage plus TMP-SMX (Correct answer)

Correct answer: Incision and drainage plus TMP-SMX

Fluctuant abscesses require incision and drainage as the primary treatment; TMP-SMX is added to cover MRSA in the surrounding cellulitis.

Question 29: According to APEA board review, which patient has met criteria for metabolic syndrome requiring aggressive cardiovascular risk counseling?

BMI 28, BP 118/76, fasting glucose 95, triglycerides 145, HDL 52
Waist 36 inches, BP 140/90, fasting glucose 88, triglycerides 130, HDL 45
BMI 32, BP 126/82, fasting glucose 100, triglycerides 148, HDL 48
Waist >40 inches, BP 132/86, fasting glucose 105, triglycerides 155, HDL 38 (Correct answer)

Correct answer: Waist >40 inches, BP 132/86, fasting glucose 105, triglycerides 155, HDL 38

Metabolic syndrome requires 3 of 5 criteria: abdominal obesity, elevated BP, impaired fasting glucose, hypertriglyceridemia, and low HDL — the first patient meets all 5.

Question 30: A patient on lithium therapy presents with tremor, polyuria, and confusion. These signs suggest which complication?

Lithium-induced hypothyroidism
Lithium toxicity (Correct answer)
Serotonin syndrome
Nephrogenic diabetes insipidus only

Correct answer: Lithium toxicity

Coarse tremor, cognitive changes, and polyuria in a lithium patient indicate toxicity, which can occur with therapeutic doses if fluid/sodium intake changes.

Question 31: According to the AGS Beers Criteria, which medication should generally be avoided in a 78-year-old patient with insomnia?

Sleep hygiene counseling
Diphenhydramine (Correct answer)
Cognitive behavioral therapy for insomnia
Melatonin

Correct answer: Diphenhydramine

First-generation antihistamines such as diphenhydramine are strongly anticholinergic. In older adults they raise the risk of confusion, urinary retention, constipation, and falls.

APEA Predictor Exam for Nurse Practitioners

The APEA Predictor Exam is a 150-question practice assessment that mirrors the AANP and ANCC board certification exams, helping nurse practitioner candidates measure readiness and identify knowledge gaps across clinical domains before sitting for boards.

Questions

35 min

Time Limit

70%

To Pass

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Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

apea.com — Time limit, fees, score release, exam format · verified Oct 2026