APEA PRE-PREDICTOR 2025-2026 ACTUAL EXAM 150 QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+ // most tested questions covered
1. A 6-year-old had an acute onset of fever, pharyngitis, and headache 2 days ago. Today, he presents
with cervical lymphadenopathy and sandpaper textured rash everywhere except on his face. A rapid
streptococcal antigen test is positive. What is the most likely diagnosis and most appropriate action?
A) Measles; supportive care
B) Rubella; supportive care
C) ☑ Scarlet fever; treat with antibiotics
D) Varicella; antiviral therapy
Rationale: This disease is due to Group A Beta-hemolytic streptococcus. The rash is caused by a toxin,
fades with pressure, and ultimately desquamates. Pastia lines are nonblanching lines on flexor surfaces.
2. A 72-year-old female presents with sleep disturbances, reluctance to go out, and continual fatigue
one year after her husband's death. Differential diagnoses include:
A) Stroke, depression, and hyperthyroidism
B) ☑ Depression, unresolved grief, and hypothyroidism
C) Migraine, anxiety disorder, and hypertension
D) Dementia, delirium, and pneumonia
Rationale: The history suggests depressive symptoms with grief; hypothyroidism must be considered as
it can mimic depression.
3. A 40-year-old male presents with a 2-week history of rectal pain and itching, constipation, and
bright red blood on toilet paper. Rectal exam reveals a tender, swollen, bluish, ovoid mass. Stool
guaiac test is negative. Which action should the nurse practitioner take?
A) Prescribe diphenoxylate/atropine (Lomotil)
B) Schedule a colonoscopy
C) Repeat the guaiac test three times and obtain CBC
D) ☑ Prescribe bulk-forming agents and hydrocortisone suppositories
Rationale: Symptoms are consistent with hemorrhoids; conservative management with stool softeners
and topical treatment is appropriate.
4. A 17-year-old female is suspected of having polycystic ovary syndrome (PCOS). In addition to
testosterone, which diagnostic tests are most appropriate?
A) BUN, creatinine, electrolytes, DHEA
B) CBC, BUN, creatinine, estrone
,C) FBS, CBC, BUN, sex hormone binding globulin
D) ☑ FSH, LH, prolactin, and TSH
Rationale: FSH, LH, prolactin, and TSH are used to evaluate endocrine causes of menstrual irregularity
and rule out other hormonal disorders.
5. Which wet-mount result confirms bacterial vaginosis?
A) ☑ Squamous epithelial cells with stippling appearance, indistinct borders, no lactobacillus rods, many
WBC
B) Squamous epithelial cells with clear cytoplasm, many lactobacillus rods, occasional WBC
C) Organisms about size of WBC with undulating flagellum, occasional lactobacillus rods, many WBC
D) Hyphae and spores, few lactobacillus rods, occasional WBC
Rationale: Bacterial vaginosis is associated with clue cells (squamous cells with stippling, no
lactobacillus) and many WBCs.
6. An 85-year-old patient experienced sudden loss of vision in the right eye, described as "a bunch of
lights" and a "curtain came down." Most likely diagnosis is:
A) Vitreal hemorrhage
B) Optic nerve lesion
C) Central retinal artery occlusion
D) ☑ Retinal detachment
Rationale: Retinal detachment presents with sudden visual field loss, flashes, and a curtain-like shadow.
Immediate ophthalmology referral is required.
7. Assessment findings supporting mitral regurgitation include:
A) Atrial fibrillation with summation gallop
B) ☑ Loud, high-pitched pansystolic murmur
C) Diastolic murmur with split S1
D) Early diastolic murmur with S3 wave
Rationale: Mitral regurgitation produces a high-pitched, holosystolic murmur best heard at the apex.
8. During an employment physical exam, bruising around the areola is noted in a 21-year-old female.
Which history is least relevant?
A) Current social relationships
B) History of present or past trauma
C) Mental health status
D) ☑ Socioeconomic status
,Rationale: Socioeconomic status does not directly inform potential physical abuse; other factors assess
risk and safety.
9. According to the American Diabetes Association, fasting plasma glucose diagnostic for diabetes
mellitus is:
A) 100 mg/dL
B) ☑ 126 mg/dL
C) 140 mg/dL
D) 180 mg/dL
Rationale: ADA defines fasting plasma glucose ≥126 mg/dL on two occasions as diagnostic for diabetes.
10. Pulmonary rehabilitation in a 75-year-old patient with COPD results in all EXCEPT:
A) Enhanced quality of life
B) ☑ Increased lung capacity
C) Decreased in-patient hospitalizations
D) Improved exercise capacity
Rationale: Pulmonary rehab improves exercise tolerance and quality of life, but does not increase lung
capacity.
11. A 2-month-old infant presents with a diffusely erythematous macular rash in the diaper area,
sparing inguinal folds. Most likely cause:
A) Candida albicans infection
B) Eczema
C) Seborrheic dermatitis
D) ☑ Contact dermatitis
Rationale: Sparing of folds and absence of satellite lesions suggest irritation from contact rather than
yeast infection.
12. A patient with diverticulosis presents with left lower quadrant discomfort, a palpable mass, mild
leukocytosis, and T=100°F. Tolerates fluids. Appropriate plan:
A) Barium enema and NPO
B) ☑ Clear liquids and antibiotics
C) Low-fiber diet and referral
D) Hospital admission for IV antibiotics
Rationale: Mild diverticulitis in a stable patient can be managed outpatient with clear liquids and oral
antibiotics.
, 13. Which criterion differentiates a TIA from a stroke?
A) Focal symptoms
B) Amnesia of incident
C) Slowness of onset
D) ☑ Absence of residual symptoms
Rationale: TIA symptoms resolve within 24 hours with no lasting deficits.
14. A patient with macular degeneration has difficulty seeing:
A) From a distance
B) ☑ In the center of the visual field
C) At reading distance
D) In the peripheral fields
Rationale: Macular degeneration primarily affects central vision, while peripheral vision remains intact.
15. In most children, the first permanent teeth erupt at age 6. Which teeth appear first?
A) ☑ First molars
B) Second molars
C) Lower or upper incisors
D) Canines
Rationale: The first permanent molars erupt around age 6, before permanent incisors.
16. All of the following are activities of daily living (ADLs) EXCEPT:
A) Ability to feed self
B) Ability to manage bladder/bowel
C) Personal hygiene and grooming
D) ☑ Grocery shopping
Rationale: ADLs are basic self-care tasks; grocery shopping is considered an instrumental activity of daily
living (IADL).
17. A 37-year-old primigravida at 30 weeks gestation has urinalysis showing leukocytes=trace,
nitrite=negative, protein=2+, blood=negative, and weight gain of 5 lbs/week. Most likely:
A) HELLP syndrome
B) ☑ Pregnancy-induced hypertension (pre-eclampsia)
C) Eclampsia
D) Primary hypertension
Rationale: Pre-eclampsia is characterized by hypertension, edema (weight gain), and proteinuria.
CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+ // most tested questions covered
1. A 6-year-old had an acute onset of fever, pharyngitis, and headache 2 days ago. Today, he presents
with cervical lymphadenopathy and sandpaper textured rash everywhere except on his face. A rapid
streptococcal antigen test is positive. What is the most likely diagnosis and most appropriate action?
A) Measles; supportive care
B) Rubella; supportive care
C) ☑ Scarlet fever; treat with antibiotics
D) Varicella; antiviral therapy
Rationale: This disease is due to Group A Beta-hemolytic streptococcus. The rash is caused by a toxin,
fades with pressure, and ultimately desquamates. Pastia lines are nonblanching lines on flexor surfaces.
2. A 72-year-old female presents with sleep disturbances, reluctance to go out, and continual fatigue
one year after her husband's death. Differential diagnoses include:
A) Stroke, depression, and hyperthyroidism
B) ☑ Depression, unresolved grief, and hypothyroidism
C) Migraine, anxiety disorder, and hypertension
D) Dementia, delirium, and pneumonia
Rationale: The history suggests depressive symptoms with grief; hypothyroidism must be considered as
it can mimic depression.
3. A 40-year-old male presents with a 2-week history of rectal pain and itching, constipation, and
bright red blood on toilet paper. Rectal exam reveals a tender, swollen, bluish, ovoid mass. Stool
guaiac test is negative. Which action should the nurse practitioner take?
A) Prescribe diphenoxylate/atropine (Lomotil)
B) Schedule a colonoscopy
C) Repeat the guaiac test three times and obtain CBC
D) ☑ Prescribe bulk-forming agents and hydrocortisone suppositories
Rationale: Symptoms are consistent with hemorrhoids; conservative management with stool softeners
and topical treatment is appropriate.
4. A 17-year-old female is suspected of having polycystic ovary syndrome (PCOS). In addition to
testosterone, which diagnostic tests are most appropriate?
A) BUN, creatinine, electrolytes, DHEA
B) CBC, BUN, creatinine, estrone
,C) FBS, CBC, BUN, sex hormone binding globulin
D) ☑ FSH, LH, prolactin, and TSH
Rationale: FSH, LH, prolactin, and TSH are used to evaluate endocrine causes of menstrual irregularity
and rule out other hormonal disorders.
5. Which wet-mount result confirms bacterial vaginosis?
A) ☑ Squamous epithelial cells with stippling appearance, indistinct borders, no lactobacillus rods, many
WBC
B) Squamous epithelial cells with clear cytoplasm, many lactobacillus rods, occasional WBC
C) Organisms about size of WBC with undulating flagellum, occasional lactobacillus rods, many WBC
D) Hyphae and spores, few lactobacillus rods, occasional WBC
Rationale: Bacterial vaginosis is associated with clue cells (squamous cells with stippling, no
lactobacillus) and many WBCs.
6. An 85-year-old patient experienced sudden loss of vision in the right eye, described as "a bunch of
lights" and a "curtain came down." Most likely diagnosis is:
A) Vitreal hemorrhage
B) Optic nerve lesion
C) Central retinal artery occlusion
D) ☑ Retinal detachment
Rationale: Retinal detachment presents with sudden visual field loss, flashes, and a curtain-like shadow.
Immediate ophthalmology referral is required.
7. Assessment findings supporting mitral regurgitation include:
A) Atrial fibrillation with summation gallop
B) ☑ Loud, high-pitched pansystolic murmur
C) Diastolic murmur with split S1
D) Early diastolic murmur with S3 wave
Rationale: Mitral regurgitation produces a high-pitched, holosystolic murmur best heard at the apex.
8. During an employment physical exam, bruising around the areola is noted in a 21-year-old female.
Which history is least relevant?
A) Current social relationships
B) History of present or past trauma
C) Mental health status
D) ☑ Socioeconomic status
,Rationale: Socioeconomic status does not directly inform potential physical abuse; other factors assess
risk and safety.
9. According to the American Diabetes Association, fasting plasma glucose diagnostic for diabetes
mellitus is:
A) 100 mg/dL
B) ☑ 126 mg/dL
C) 140 mg/dL
D) 180 mg/dL
Rationale: ADA defines fasting plasma glucose ≥126 mg/dL on two occasions as diagnostic for diabetes.
10. Pulmonary rehabilitation in a 75-year-old patient with COPD results in all EXCEPT:
A) Enhanced quality of life
B) ☑ Increased lung capacity
C) Decreased in-patient hospitalizations
D) Improved exercise capacity
Rationale: Pulmonary rehab improves exercise tolerance and quality of life, but does not increase lung
capacity.
11. A 2-month-old infant presents with a diffusely erythematous macular rash in the diaper area,
sparing inguinal folds. Most likely cause:
A) Candida albicans infection
B) Eczema
C) Seborrheic dermatitis
D) ☑ Contact dermatitis
Rationale: Sparing of folds and absence of satellite lesions suggest irritation from contact rather than
yeast infection.
12. A patient with diverticulosis presents with left lower quadrant discomfort, a palpable mass, mild
leukocytosis, and T=100°F. Tolerates fluids. Appropriate plan:
A) Barium enema and NPO
B) ☑ Clear liquids and antibiotics
C) Low-fiber diet and referral
D) Hospital admission for IV antibiotics
Rationale: Mild diverticulitis in a stable patient can be managed outpatient with clear liquids and oral
antibiotics.
, 13. Which criterion differentiates a TIA from a stroke?
A) Focal symptoms
B) Amnesia of incident
C) Slowness of onset
D) ☑ Absence of residual symptoms
Rationale: TIA symptoms resolve within 24 hours with no lasting deficits.
14. A patient with macular degeneration has difficulty seeing:
A) From a distance
B) ☑ In the center of the visual field
C) At reading distance
D) In the peripheral fields
Rationale: Macular degeneration primarily affects central vision, while peripheral vision remains intact.
15. In most children, the first permanent teeth erupt at age 6. Which teeth appear first?
A) ☑ First molars
B) Second molars
C) Lower or upper incisors
D) Canines
Rationale: The first permanent molars erupt around age 6, before permanent incisors.
16. All of the following are activities of daily living (ADLs) EXCEPT:
A) Ability to feed self
B) Ability to manage bladder/bowel
C) Personal hygiene and grooming
D) ☑ Grocery shopping
Rationale: ADLs are basic self-care tasks; grocery shopping is considered an instrumental activity of daily
living (IADL).
17. A 37-year-old primigravida at 30 weeks gestation has urinalysis showing leukocytes=trace,
nitrite=negative, protein=2+, blood=negative, and weight gain of 5 lbs/week. Most likely:
A) HELLP syndrome
B) ☑ Pregnancy-induced hypertension (pre-eclampsia)
C) Eclampsia
D) Primary hypertension
Rationale: Pre-eclampsia is characterized by hypertension, edema (weight gain), and proteinuria.
