APEA Predictor Exam for Nurse Practitioners — Questions and Answers

Question 1: A patient with community-acquired MRSA skin infection has a fluctuant abscess with surrounding cellulitis. The primary treatment is:

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

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 2: APEA instructors teach students to identify 'distractors' in board exam questions. A distractor is best defined as:

An incorrect answer choice designed to attract students who lack full conceptual understanding (Correct answer)
A bonus question that does not affect scoring
The correct answer hidden among wrong choices
A question about obscure medications rarely encountered in practice

Correct answer: An incorrect answer choice designed to attract students who lack full conceptual understanding

Distractors are carefully written incorrect answer choices that test whether students truly understand the concept or are guessing based on partial knowledge. Recognizing common distractor patterns improves exam performance.

Question 3: A patient on warfarin starts taking trimethoprim-sulfamethoxazole for a UTI. The NP should anticipate which effect on the INR?

INR will remain unchanged
INR is unpredictable
INR will decrease
INR will increase (Correct answer)

Correct answer: INR will increase

TMP-SMX inhibits CYP2C9, reducing warfarin metabolism and increasing its anticoagulant effect, thereby raising the INR.

Question 4: When building an APEA customizable study plan, which of the following should be established first?

Memorizing all drug brand names before any content review
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

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 5: A 38-year-old woman asks about osteoporosis screening. Per USPSTF recommendations, when should osteoporosis screening with DEXA scan begin for women?

Age 65 for all women, or earlier for postmenopausal women under 65 with increased osteoporosis risk based on FRAX or a similar tool (Correct answer)
Only after the first fragility fracture
Age 50 for all women
Age 30 for all women regardless of risk

Correct answer: Age 65 for all women, or earlier for postmenopausal women under 65 with increased osteoporosis risk based on FRAX or a similar tool

USPSTF recommends DEXA screening for all women 65 and older and for postmenopausal women under 65 whose fracture risk is equal to or greater than that of a 65-year-old white woman with no additional risk factors, based on risk assessment tools like FRAX.

Question 6: A patient presents with acute onset severe headache described as 'the worst headache of my life.' The NP's priority differential is:

Meningitis
Migraine
Subarachnoid hemorrhage (Correct answer)
Tension headache

Correct answer: Subarachnoid hemorrhage

A 'thunderclap headache' reaching maximum intensity instantly is the hallmark of subarachnoid hemorrhage until proven otherwise, requiring emergency CT imaging.

Question 7: Pain and crepitus over the patella suggests?

Salty taste on the skin
Dilation of the pupils
Roughening of the patellar undersurface (Correct answer)
In the right lateral fornix

Correct answer: Roughening of the patellar undersurface

Pain and crepitus (a crackling or grinding sound/sensation) over the patella are classic signs of patellofemoral pain syndrome or chondromalacia patellae. These conditions are characterized by the softening or roughening of the cartilage on the undersurface of the kneecap (patella) where it articulates with the femur. This roughening causes friction and abnormal tracking during knee movement, leading to pain and the characteristic crepitus.

Question 8: A nurse practitioner prescribes methotrexate for rheumatoid arthritis. Which supplement should be co-prescribed to reduce mucosal and hematologic toxicity?

Vitamin B12
Vitamin D
Zinc
Folic acid (Correct answer)

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

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

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 10: A patient with GERD fails twice-daily PPI therapy after 8 weeks. The next appropriate management step is:

Add antacids to current regimen
Refer for upper endoscopy to rule out complications (Correct answer)
Switch to H2 blocker therapy
Discontinue PPI and start prokinetic agent

Correct answer: Refer for upper endoscopy to rule out complications

Persistent GERD symptoms despite adequate PPI therapy warrant upper endoscopy to evaluate for Barrett's esophagus, erosive esophagitis, or alternative diagnoses.

Question 11: A 50-year-old male with a history of heavy alcohol use presents with tremors, confusion, and visual hallucinations. What is the most likely diagnosis?

Wernicke's encephalopathy
Alcohol withdrawal syndrome
Hepatic encephalopathy
Delirium tremens (Correct answer)

Correct answer: Delirium tremens

Delirium tremens (DTs) is the most likely diagnosis for a patient with a history of heavy alcohol use presenting with tremors, confusion, and visual hallucinations. DTs represent a severe form of alcohol withdrawal, characterized by autonomic instability and profound neurological symptoms, and is a medical emergency requiring immediate treatment.

Question 12: A patient with well-controlled HIV presents for routine care. The NP notes CD4 count is 450 cells/mcL and viral load is undetectable. The appropriate next step is:

Initiate Pneumocystis prophylaxis
Change antiretroviral regimen due to falling CD4 count
Continue current antiretroviral therapy and schedule follow-up in 3-6 months (Correct answer)
Refer immediately to infectious disease

Correct answer: Continue current antiretroviral therapy and schedule follow-up in 3-6 months

A CD4 count of 450 with undetectable viral load indicates well-controlled HIV; continuing current ART with routine 3-6 month follow-up is appropriate.

Question 13: A patient with migraine with aura asks about contraceptive options. Which contraceptive is contraindicated due to increased stroke risk?

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

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 14: A 32-year-old male with type 1 diabetes presents with blood glucose 485 mg/dL, arterial pH 7.22, bicarbonate 12 mEq/L, anion gap 22, and moderate ketonuria. The primary treatment priority is:

IV fluid resuscitation (normal saline) followed by insulin infusion with potassium replacement monitoring — hospital admission required (Correct answer)
Subcutaneous insulin and oral fluids in clinic
Sodium bicarbonate infusion immediately to correct acidosis
Insulin and furosemide to correct hyperglycemia and reduce fluid retention

Correct answer: IV fluid resuscitation (normal saline) followed by insulin infusion with potassium replacement monitoring — hospital admission required

DKA management priority: IV fluid resuscitation first, then insulin infusion with aggressive potassium monitoring. Hypokalemia is the leading cause of DKA mortality as insulin drives K+ intracellularly.

Question 15: Which vaccine is contraindicated in a child with a severe anaphylactic egg allergy?

Hepatitis B
Varicella (chickenpox)
Yellow fever (Correct answer)
MMR (measles, mumps, rubella)

Correct answer: Yellow fever

Yellow fever vaccine is produced in eggs and contains significant egg protein, making it contraindicated in individuals with severe egg anaphylaxis; MMR is safe despite the egg allergy misconception.

Question 16: A 42-year-old patient with bipolar I disorder presents to primary care reporting 4 days of decreased need for sleep, grandiosity, and pressured speech. The most appropriate management is:

Reassure the patient that this is a normal mood variation
Start an SSRI immediately for mood stabilization
Consult psychiatry urgently; avoid SSRIs (can precipitate mania); ensure mood stabilizer is at therapeutic levels (Correct answer)
Prescribe benzodiazepines as the primary treatment

Correct answer: Consult psychiatry urgently; avoid SSRIs (can precipitate mania); ensure mood stabilizer is at therapeutic levels

Active mania requires urgent psychiatric consultation and mood stabilizer optimization. SSRIs are contraindicated during manic episodes as they can worsen or precipitate mania.

Question 17: 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
Amoxicillin for 5 days
Amoxicillin for 10 days (Correct answer)
Watchful waiting without antibiotics

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 18: For the APEA NP board exam, a question about Healthy People 2030 focuses on leading health indicators. Which is a key social determinant of health addressed by this initiative?

Mental health disorders exclusively
Environmental toxin exposure only
Economic stability and food security (Correct answer)
Only physical health metrics

Correct answer: Economic stability and food security

Healthy People 2030 expands focus to social determinants including economic stability, education, food security, and neighborhood environment as health drivers.

Question 19: A 40-year-old presents with symmetric joint pain, morning stiffness lasting over 1 hour, and fatigue. Which diagnosis best fits this presentation?

Osteoarthritis
Psoriatic arthritis
Gout
Rheumatoid arthritis (Correct answer)

Correct answer: Rheumatoid arthritis

Symmetric joint involvement, prolonged morning stiffness exceeding 1 hour, and fatigue are hallmarks of rheumatoid arthritis, an autoimmune inflammatory arthropathy.

Question 20: APEA emphasizes professionalism. A patient asks the NP to falsify insurance documentation to get approval for a necessary medication. The NP should:

Comply since the medication is clinically indicated
Document the patient's request only without taking action
Ask the supervising physician to sign instead
Refuse and explore legitimate alternative options (Correct answer)

Correct answer: Refuse and explore legitimate alternative options

Falsifying medical records or insurance documents is fraudulent and unethical regardless of the clinical indication; the NP must refuse and pursue legitimate prior authorization pathways.

Question 21: A child presents with a 'slapped cheek' rash followed by a lacy reticular rash on the extremities. Which pathogen is responsible?

Human herpesvirus 6
Parvovirus B19 (Correct answer)
Rubella virus
Varicella-zoster virus

Correct answer: Parvovirus B19

Parvovirus B19 causes erythema infectiosum (Fifth Disease), characterized by the classic 'slapped cheek' facial erythema followed by a reticular rash on the trunk and extremities.

Question 22: A patient taking amiodarone for atrial fibrillation requires monitoring for which thyroid-related adverse effect?

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

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

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

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 24: Which medication used in COPD management is associated with the adverse effect of oral candidiasis and requires rinsing the mouth after use?

Inhaled corticosteroids (Correct answer)
Long-acting muscarinic antagonists
Short-acting beta agonists
Long-acting beta agonists

Correct answer: Inhaled corticosteroids

Inhaled corticosteroids can deposit in the oropharynx and suppress local immunity, promoting Candida overgrowth; rinsing the mouth after use reduces this risk.

Question 25: 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:

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

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 26: During a musculoskeletal exam, the NP notes a positive Phalen test. Which condition does this suggest?

Carpal tunnel syndrome (Correct answer)
De Quervain tenosynovitis
Trigger finger
Dupuytren contracture

Correct answer: Carpal tunnel syndrome

Phalen's test reproduces paresthesias in the median nerve distribution by maintaining wrist flexion, indicating carpal tunnel syndrome.

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

Cardiac arrhythmia
Increased nitrate toxicity
Severe hypotension (Correct answer)
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: A 55-year-old patient has a 10-year ASCVD risk of 12%. Per ACC/AHA guidelines, which intervention is indicated?

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

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 29: A 6-month-old is brought in with a bulging anterior fontanelle, fever, and irritability. The NP's immediate priority is:

Obtain CT scan before lumbar puncture in office
Observe in office for 2 hours and reassess
Administer oral amoxicillin and recheck in 24 hours
Transfer to ED for lumbar puncture and empiric antibiotics (Correct answer)

Correct answer: Transfer to ED for lumbar puncture and empiric antibiotics

Bulging fontanelle with fever and irritability in an infant strongly suggests bacterial meningitis requiring immediate emergency transfer for lumbar puncture and IV antibiotics.

Question 30: When assessing a patient for appendicitis, which sign involves pain at McBurney's point with rebound tenderness?

Blumberg sign (Correct answer)
Obturator sign
Psoas sign
Rovsing sign

Correct answer: Blumberg sign

Blumberg sign refers to rebound tenderness at McBurney's point, indicating peritoneal irritation consistent with appendicitis.

Question 31: A patient with persistent asthma not controlled on low-dose ICS alone should have which medication added per NAEPP guidelines?

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

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.

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%

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