APEA Pre-Predictor & NP Board Exam Mega Test Bank (Questions 1-300) – High-Yield Practice Q&As with Comprehensive Rationales (Updated for AANP/ANCC Blueprints)

APEA Pre-Predictor & NP Board Exam
Mega Test Bank (Questions 1-300) – High-
Yield Practice Q&As with Comprehensive
Rationales (Updated for AANP/ANCC
Blueprints)

Section 1: Cardiovascular (Questions 1-10)
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1. A 68-year-
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old male with a history of hypertension and type 2 diabetes presents for a routine check
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-
up. His blood pressure is 145/90 mmHg. An ECG reveals left ventricular hypertrophy. Wh
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ich medication class is considered first-
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line for managing his hypertension to specifically reduce the risk of stroke and cardiovas
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cular mortality? nb




A) Beta-blockers
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B) ACE inhibitors
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C) Thiazide diuretics
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D) Calcium channel blockers
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2. A 72-year-
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old female complains of chest pain that occurs with exertion and is relieved by rest. She
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describes it as a "heavy pressure" in the substernal area radiating to her left shoulder. W
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hich of the following physical exam findings would be most concerning for a poor progn
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osis in a patient with this presentation?
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A) S4 gallop
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B) Carotid bruit
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C) Systolic ejection murmur at the left sternal border
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D) Diminished dorsalis pedis pulses
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3. A 55-year-
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old male is diagnosed with heart failure with reduced ejection fraction (HFrEF). He has a
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history of chronic kidney disease (Stage 3). Which of the following medication combinati
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ons has been shown to provide the most significant mortality benefit and is considered f
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oundational therapy? nb




A) ACE inhibitor + Thiazide diuretic
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B) Beta-blocker (Carvedilol) + ARB
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,C) ARNI (Sacubitril/Valsartan) + Beta-blocker + Mineralocorticoid receptor antagonist
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D) Digoxin + Loop diuretic
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4. A patient presents with acute onset of severe, tearing chest pain radiating to the back.
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Blood pressure is 180/100 in the right arm and 140/80 in the left arm. What is the most
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appropriate initial diagnostic test?
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A) CT angiography of the chest
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B) Transthoracic echocardiogram
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C) Standard 12-lead ECG
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D) Chest X-ray
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5. A 30-year-
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old female with palpitations is found to have a heart rate of 180 bpm on ECG. The rhyth
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m is regular, and there are no visible P waves. What is the most appropriate initial mana
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gement for this stable patient? nb nb nb nb




A) Immediate synchronized cardioversion
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B) IV Adenosine
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C) IV Amiodarone
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D) Vagal maneuvers
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6. A 45-year-
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old obese male has a blood pressure of 150/95 mmHg. His labs show a potassium of 3.0
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mEq/L and an elevated serum glucose. Which diagnosis is most strongly suggested by th
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is triad of hypertension, hypokalemia, and hyperglycemia?
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A) Pheochromocytoma
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B) Cushing’s syndrome
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C) Primary aldosteronism
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D) Renal artery stenosis
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7. A 67-year-
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old male with a history of CAD is being managed on Aspirin, Atorvastatin, and Metoprol
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ol. He reports new-onset, worsening shortness of breath and a non-
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productive cough. Auscultation reveals crackles at the lung bases. Which medication is m
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ost likely contributing to his new symptoms?
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A) Aspirin
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B) Atorvastatin
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C) Metoprolol
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D) All of the above
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8. A 60-year-old female is 2 days post-
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operative from a total hip replacement. She suddenly develops dyspnea, pleuritic chest p
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ain, and hemoptysis. Her heart rate is 110, respiratory rate is 28, and O2 sat is 90% on ro
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om air. What is the most likely diagnosis?
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,A) Aortic dissection
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B) Myocardial infarction
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C) Pulmonary embolism
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D) Pneumothorax
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9. A patient with chronic atrial fibrillation is on Warfarin. Her INR is 6.5. She has no sign
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s of bleeding. What is the most appropriate management?
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A) Hold Warfarin and administer Vitamin K 1 mg PO
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B) Hold Warfarin and administer fresh frozen plasma
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C) Hold Warfarin and restart when INR < 5
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D) Administer Vitamin K 10 mg IV immediately
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10. A characteristic auscultatory finding of aortic stenosis is:
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A) A holosystolic murmur at the apex that radiates to the axilla
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B) A systolic ejection murmur at the right upper sternal border that radiates to the carotids
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C) A diastolic decrescendo murmur at the left lower sternal border
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D) A continuous "machine-like" murmur at the left upper sternal border
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Section 2: Pulmonology (Questions 11-18)
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11. A 6-year-
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old child presents with a harsh, "barking" cough, stridor, and hoarseness that developed
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suddenly at night. The child is afebrile. What is the most likely diagnosis?
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A) Bacterial tracheitis
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B) Epiglottitis
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C) Croup (Laryngotracheobronchitis)
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D) Foreign body aspiration
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12. A 25-year-
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old with a history of asthma presents with increased use of his rescue inhaler. Spirometr
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y shows a FEV1/FVC ratio of 65% and a significant improvement in FEV1 after bronchodi
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lator administration. This confirms:
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A) Restrictive lung disease
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B) Reversible airway obstruction
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C) Fixed airway obstruction
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D) Poor effort on spirometry
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13. A 50-year-
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old smoker presents with progressive dyspnea and a chronic productive cough. Chest X-
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ray shows hyperinflation and flattened diaphragms. Which of the following is the best in
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itial pharmacologic therapy to reduce exacerbations and improve quality of life?
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A) Inhaled corticosteroids alone
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, B) Long-acting muscarinic antagonist (LAMA)
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C) Oral theophylline
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D) Antibiotics
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14. A patient with COPD is being discharged after a severe exacerbation. What vaccinati
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on is most critical to recommend for this patient to prevent future hospitalizations?
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A) Zoster vaccine
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B) Pneumococcal conjugate vaccine (PCV20)
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C) Meningococcal vaccine
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D) Haemophilus influenzae type B vaccine
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15. A 32-year- nb nb




old female presents with acute onset of sharp chest pain that is worse with inspiration. S
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he is tachypneic but not hypoxic. She has no risk factors for DVT. What is the most likely
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diagnosis?
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A) Pulmonary embolism
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B) Pericarditis
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C) Spontaneous pneumothorax
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D) Pleurisy (Viral)
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16. A 55-year- nb nb




old male presents with hemoptysis, weight loss, and hoarseness. He has a 40-pack-
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year smoking history. A chest X-
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ray reveals a hilar mass. What physical exam finding would suggest Horner's syndrome r
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elated to a Pancoast tumor? nb nb nb nb




A) Miosis and ptosis
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B) Mydriasis and exophthalmos
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C) Bilateral lower extremity edema
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D) Clubbing of the fingers
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17. A 4-year- nb nb




old presents with drooling, tripod positioning, and a muffled voice. The child appears an
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xious and has a high fever. What is the most appropriate next step?
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A) Perform a throat culture
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B) Inspect the oropharynx with a tongue depressor
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C) Prepare for emergent intubation in the OR
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D) Administer a nebulized epinephrine treatment
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18. A patient with a history of GERD and hypertension presents with a chronic cough. Th
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e cough is worse at night and when lying down. Which medication is most likely contrib
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uting to the cough? nb nb nb




A) Lisinopril
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B) Omeprazole
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