APEA Predictor Exam for Nurse Practitioners — Questions and Answers

Question 1: A 65-year-old patient has an HbA1c of 7.9% on metformin alone. The NP adds a second agent. Per ADA guidelines, which comorbidity would favor adding an SGLT-2 inhibitor over a sulfonylurea?

Peripheral neuropathy
Stage 1 CKD
Obesity alone
Established cardiovascular disease (Correct answer)

Correct answer: Established cardiovascular disease

SGLT-2 inhibitors have demonstrated cardiovascular mortality benefit in patients with established CVD, making them preferred second-line agents in this population.

Question 2: Which APEA study plan feature allows students to track progress across multiple content domains over time?

Performance analytics dashboard showing domain-level scores and trends (Correct answer)
Static PDF syllabus printed at enrollment
Email newsletter with weekly study tips
Instructor phone consultations only

Correct answer: Performance analytics dashboard showing domain-level scores and trends

APEA's performance analytics dashboard provides domain-level tracking so students can visualize improvement, identify persistent weak areas, and adjust their study plans dynamically throughout preparation.

Question 3: A student's APEA study plan indicates they have mastered cardiovascular content but struggle with endocrinology. The most appropriate next step is to:

Shift primary study time to endocrinology while doing maintenance review of cardiovascular (Correct answer)
Drop endocrinology and accept lower scores in that domain
Continue studying cardiovascular to maintain mastery
Restart the entire study plan from the beginning

Correct answer: Shift primary study time to endocrinology while doing maintenance review of cardiovascular

Once mastery is demonstrated in one domain, study time should shift to underperforming domains. Brief maintenance review of mastered content prevents decay without over-investing time.

Question 4: An 8-year-old is diagnosed with streptococcal pharyngitis confirmed by rapid strep test. The treatment of choice to prevent rheumatic fever is:

Azithromycin Z-pack for 5 days
Watchful waiting without antibiotics
Amoxicillin for 10 days (Correct answer)
Amoxicillin for 5 days

Correct answer: Amoxicillin for 10 days

A full 10-day course of amoxicillin is the recommended treatment for streptococcal pharyngitis to eradicate the organism and prevent acute rheumatic fever.

Question 5: A 55-year-old male smoker presents with hemoptysis, weight loss, and a new cough. The NP's first priority differential is:

Lung cancer (Correct answer)
Pulmonary tuberculosis
Bronchiectasis
COPD exacerbation

Correct answer: Lung cancer

In a middle-aged smoker, hemoptysis with constitutional symptoms (weight loss) must raise lung cancer as the top priority until proven otherwise.

Question 6: Which credential is most commonly held by APEA expert instructors who teach FNP board review content?

PhD in basic science research without clinical practice
Medical doctor (MD) specializing in internal medicine
FNP-C or FNP-BC with active or recent clinical NP practice (Correct answer)
RN license only without advanced practice certification

Correct answer: FNP-C or FNP-BC with active or recent clinical NP practice

APEA instructors are board-certified FNPs (FNP-C via AANP or FNP-BC via ANCC) with active or recent clinical practice, ensuring they teach content that reflects real NP scope and current evidence.

Question 7: Which medication used for osteoporosis requires the patient to remain upright for 30-60 minutes after administration to prevent esophageal injury?

Alendronate (Correct answer)
Denosumab
Teriparatide
Raloxifene

Correct answer: Alendronate

Oral bisphosphonates like alendronate can cause esophageal ulceration if they remain in contact with the esophageal mucosa, requiring upright positioning.

Question 8: 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 9: APEA board review covers preventive care. Per USPSTF guidelines, which adults should receive aspirin for primary prevention of cardiovascular disease?

Adults with a family history of MI
The USPSTF recommends against initiating aspirin for primary prevention in adults 60 and older (Correct answer)
All adults over 40 with any cardiovascular risk factor
Adults over 50 with diabetes

Correct answer: The USPSTF recommends against initiating aspirin for primary prevention in adults 60 and older

In 2022, USPSTF updated guidance to recommend against initiating aspirin for primary CVD prevention in adults 60 or older due to bleeding risk outweighing benefit.

Question 10: Which antihypertensive medication is contraindicated in pregnancy due to teratogenic effects including renal dysgenesis and skull hypoplasia?

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

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 11: 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:

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

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

Calcium channel blockers
Non-selective beta-blockers (Correct answer)
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 13: A patient with persistent asthma not controlled on low-dose ICS alone should have which medication added per NAEPP guidelines?

Cromolyn sodium
Oral corticosteroid
Long-acting beta-agonist (LABA) (Correct answer)
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 14: A 25-year-old woman presents with dysmenorrhea, dyspareunia, and infertility. Which diagnosis should be investigated?

Endometriosis (Correct answer)
Polycystic ovary syndrome
Uterine fibroids
Pelvic inflammatory disease

Correct answer: Endometriosis

The triad of dysmenorrhea, dyspareunia, and infertility in a reproductive-age woman is highly characteristic of endometriosis.

Question 15: A student has 8 weeks before the FNP board exam. According to best APEA study plan principles, which schedule structure is most effective?

Weeks 1-8: Read all textbooks cover to cover
Weeks 1-8: Focus only on pharmacology since it is the hardest section
Weeks 1-4: Content review by domain; Weeks 5-7: Practice questions and weak-area review; Week 8: Light review and rest (Correct answer)
Weeks 1-8: Take full-length practice exams daily

Correct answer: Weeks 1-4: Content review by domain; Weeks 5-7: Practice questions and weak-area review; Week 8: Light review and rest

An effective 8-week plan phases content review, practice questions, and consolidation. Content first builds foundational knowledge; practice questions identify gaps; the final week avoids overload and promotes retention.

Question 16: On the APEA predictor exam, questions about prescribing controlled substances require knowledge that Schedule II substances have which characteristic?

Can be refilled up to 5 times in 6 months
No accepted medical use in the US
High abuse potential with accepted medical use (Correct answer)
Low potential for physical dependence

Correct answer: High abuse potential with accepted medical use

Schedule II drugs have high abuse potential but accepted medical uses; they require written prescriptions, cannot be called in, and have no refills.

Question 17: Which of the following best describes how APEA customizable study plans align with the FNP certification exam blueprint?

Plans are organized by body system only, without reference to exam weighting
Plans cover only the top 3 most-tested topics
Plans are identical for all students regardless of background
Plans map content domains and time allocation to the percentage distribution of topics on the certification exam (Correct answer)

Correct answer: Plans map content domains and time allocation to the percentage distribution of topics on the certification exam

Effective board prep study plans align content emphasis with the exam blueprint's topic weighting. APEA plans are structured to reflect how frequently each domain appears on the AANP or ANCC FNP exam.

Question 18: A young woman presents with episodic headache, diaphoresis, and hypertension with heart palpitations. Which rare diagnosis must be considered?

Primary hypertension
Pheochromocytoma (Correct answer)
Panic disorder
Migraine with aura

Correct answer: Pheochromocytoma

The triad of episodic headache, diaphoresis, and hypertension is the classic presentation of pheochromocytoma, a catecholamine-secreting adrenal tumor.

Question 19: A 78-year-old nursing home patient presents with fever, altered mental status, and decreased urine output. Vital signs: BP 88/60, HR 118, RR 26, Temp 38.9°C. Suspected source is urinary. Per Sepsis-3 criteria, which finding most strongly suggests septic shock?

Fever alone in an elderly patient
Altered mental status without other vital sign changes
Elevated WBC above 12,000
Hypotension requiring vasopressors to maintain MAP of 65 mmHg or higher with elevated lactate above 2 mmol/L despite adequate fluid resuscitation (Correct answer)

Correct answer: Hypotension requiring vasopressors to maintain MAP of 65 mmHg or higher with elevated lactate above 2 mmol/L despite adequate fluid resuscitation

Sepsis-3 defines septic shock as sepsis with vasopressor requirement to maintain MAP of 65 mmHg or higher and serum lactate above 2 mmol/L despite adequate fluid resuscitation.

Question 20: 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:

Strong assessment skills but gaps in evidence-based treatment guidelines and pharmacology (Correct answer)
Random variation with no clinical significance
A deficiency in anatomical knowledge
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 21: A patient with community-acquired pneumonia has a CURB-65 score of 2. The appropriate management is:

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

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 22: A patient with type 2 diabetes and CKD stage 3 needs a second oral antidiabetic agent. Which medication should be avoided due to risk of lactic acidosis?

Empagliflozin
Metformin (Correct answer)
Glipizide
Sitagliptin

Correct answer: Metformin

Metformin is contraindicated when eGFR falls below 30 mL/min and should be used cautiously below 45 mL/min due to lactic acidosis risk.

Question 23: Which medication requires monitoring for hyperkalemia when combined with an ACE inhibitor in a heart failure patient?

Furosemide
Digoxin
Carvedilol
Spironolactone (Correct answer)

Correct answer: Spironolactone

Spironolactone is a potassium-sparing diuretic; combining it with an ACE inhibitor (which also raises potassium) significantly increases hyperkalemia risk.

Question 24: A 3-year-old child presents with sudden onset inspiratory stridor, drooling, and a toxic appearance, sitting in a tripod position. The NP's priority action is:

Transfer immediately to ED without examining throat (Correct answer)
Perform throat exam and obtain lateral neck X-ray
Obtain throat culture for strep
Administer nebulized racemic epinephrine

Correct answer: Transfer immediately to ED without examining throat

The presentation suggests epiglottitis; examining the throat can precipitate complete airway obstruction — immediate transfer to an ED with airway management capability is the priority.

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

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

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 27: Which drug-drug interaction occurs when a patient takes sildenafil with a nitrate, requiring the NP to avoid co-prescription?

Increased nitrate toxicity
Severe hypotension (Correct answer)
Cardiac arrhythmia
Reduced erectile efficacy

Correct answer: Severe hypotension

Both sildenafil and nitrates cause vasodilation; their combination produces additive nitric oxide effects resulting in profound, potentially fatal hypotension.

Question 28: In primary prevention counseling, which lifestyle modification has the strongest evidence for reducing all-cause cardiovascular mortality in adults?

Regular aerobic exercise of at least 150 minutes of moderate-intensity activity per week (Correct answer)
Eliminating all dietary fat
Daily red wine consumption for polyphenols
Vitamin E supplementation

Correct answer: Regular aerobic exercise of at least 150 minutes of moderate-intensity activity per week

Regular aerobic exercise meeting AHA guidelines of at least 150 minutes per week of moderate intensity has the strongest evidence base for reducing cardiovascular mortality through multiple mechanisms.

Question 29: Which histological type of cervical cancer is most commonly associated with high-risk HPV infection?

Squamous cell carcinoma (Correct answer)
Clear cell carcinoma
Adenocarcinoma
Small cell neuroendocrine carcinoma

Correct answer: Squamous cell carcinoma

Squamous cell carcinoma accounts for approximately 70–75% of all cervical cancers and is strongly associated with high-risk HPV types 16 and 18.

Question 30: A 10-year-old child presents with high fever, severe odynophagia, uvular deviation, drooling, and a muffled 'hot potato' voice. This presentation is most concerning for:

Peritonsillar abscess (PTA) requiring drainage and IV antibiotics (Correct answer)
Viral tonsillitis requiring supportive care
Streptococcal pharyngitis requiring amoxicillin
Epiglottitis requiring immediate airway assessment

Correct answer: Peritonsillar abscess (PTA) requiring drainage and IV antibiotics

Peritonsillar abscess presents with fever, severe throat pain, uvular deviation away from the abscess, drooling, and muffled hot potato voice due to peritonsillar pus collection. Treatment: needle aspiration or incision and drainage plus IV antibiotics.

Question 31: A patient with type 2 DM has a urine albumin-to-creatinine ratio of 45 mg/g on two separate tests. The most appropriate treatment to slow CKD progression is:

Increase metformin dose
Start an ACE inhibitor or ARB (Correct answer)
Start a loop diuretic
Refer immediately to nephrology

Correct answer: Start an ACE inhibitor or ARB

ACE inhibitors or ARBs are the first-line treatment for diabetic nephropathy; they reduce proteinuria and slow progression of CKD through angiotensin blockade.

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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