APEA Predictor Exam Test Bank 2026 | Complete
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Questions 1–10: Clinical Scenarios & Diagnostics
Q1. A 14-year-old male presents following a fall onto an outstretched hand (FOOSH).
He complains of proximal forearm pain. An elbow X-ray reveals a positive posterior
fat pad sign. What is the most likely diagnosis?
A) Colles fracture
B) Radial head fracture
C) Scaphoid fracture
D) Olecranon bursitis
Answer: B
Rationale: A positive fat pad sign (especially posterior) on an elbow X-ray after a FOOSH
injury in adolescents/adults strongly indicates an occult intra-articular fracture, most
commonly a radial head fracture.
Q2. A 10-month-old infant is brought in with a 3-day history of low-grade fever, runny
nose, harsh cough, and conjunctivitis. Physical exam reveals small, cluster-like white
lesions on an erythematous base on the buccal mucosa. What is the diagnosis?
A) Hand-foot-and-mouth disease
B) Herpangina
C) Measles (Rubeola)
D) Aphthous stomatitis
Answer: C
,Rationale: Koplik spots (white papules on an erythematous buccal mucosa) are
pathognomonic for Measles (Rubeola) and appear during the prodromal phase alongside
the classic triad of cough, coryza, and conjunctivitis.
Q3. A 15-year-old female presents with dysuria 2 weeks after finishing treatment for
trichomonas vaginitis. What immediate diagnostic test should the NP perform?
A) Vaginal wet mount
B) Microscopic examination of urine
C) Urine culture and sensitivity
D) Pelvic ultrasound
Answer: B
Rationale: Re-evaluating urinary symptoms post-treatment for vaginitis requires microscopic
urinalysis to check for white blood cells, nitrites, or bacteria indicating a secondary or co-
existing urinary tract infection (UTI).
Q4. A 15-year-old male with a history of surgically repaired cryptorchidism presents
for a routine sports physical. Which health teaching is most critical for this patient?
A) Annual renal ultrasound screening
B) Routine testicular self-examination (TSE)
C) Limiting high-impact physical activities
D) Daily pelvic floor exercises
Answer: B
Rationale: A history of cryptorchidism increases the lifelong risk of testicular cancer, even
after surgical correction (orchidopexy). Teaching routine testicular self-examination is
essential.
Q5. A school nurse evaluates a child with type 1 diabetes mellitus who experiences
sweating, tremor, and confusion shortly after an insulin injection. What is the priority
immediate action?
A) Administer a complex carbohydrate snack
, B) Measure the blood glucose level
C) Administer regular subcutaneous insulin
D) Notify the parents
Answer: B
Rationale: Immediate assessment of blood glucose verifies severe hypoglycemia before
initiating targeted therapy (e.g., rapid-acting oral glucose or glucagon).
Q6. A 16-year-old female taking Ortho-Novum 7/7/7 (triphasic OCP) reports mild
midcycle spotting. She denies missed doses. What is the NP's best response?
A) Discontinue the current OCP immediately
B) Order a pelvic ultrasound
C) Provide reassurance that breakthrough bleeding is common and often benign
D) Switch immediately to a high-dose estrogen contraceptive
Answer: C
Rationale: Breakthrough spotting during the first few months on multiphasic oral
contraceptives is common, self-limiting, and requires reassurance once pregnancy and
missed doses are ruled out.
Q7. What laboratory tests should be ordered alongside serum testosterone when
evaluating a 17-year-old female suspected of Polycystic Ovary Syndrome (PCOS)?
A) Estradiol, progesterone, and prolactin
B) FSH, LH, and TSH
C) Cortisol, aldosterone, and renin
D) DHEA-S, hCG, and CA-125
Answer: B
Rationale: Evaluating LH and FSH (often showing an elevated LH:FSH ratio > 2:1 or 3:1)
along with TSH (to rule out thyroid failure causing secondary polycystic changes) is crucial
in diagnosing PCOS.
, Q8. A 17-year-old female has never experienced menses. Physical exam shows
normal breast development and public hair distribution (Tanner stage III). What
condition is suspected?
A) Secondary amenorrhea
B) Primary amenorrhea
C) PCOS
D) Premature ovarian failure
Answer: B
Rationale: Primary amenorrhea is defined as the absence of menarche by age 15 in the
presence of normal secondary sexual characteristics or by age 13 in their absence.
Q9. A 21-year-old female presents with severe left eye redness, eyelid edema, and
marked, copious purulent discharge. What is the most likely diagnosis?
A) Viral conjunctivitis
B) Allergic conjunctivitis
C) Gonococcal conjunctivitis
D) Chlamydia conjunctivitis
Answer: C
Rationale: Neisseria gonorrhoeae conjunctivitis is characterized by rapid onset,
hyperpurulent discharge, and severe inflammation, requiring urgent parenteral antibiotics to
prevent corneal perforation.
Q10. A 21-year-old patient presents with acute abdominal pain, guarding, involuntary
rigidity, and marked rebound tenderness at McBurney's point. What is the expected
diagnostic finding?
A) Elevated serum lipase
B) Leukocytosis with left shift
C) Positive Murphy's sign
D) Elevated bilirubin
Question Review, Answers & High-Yield
Rationales | latest update this year instant pdf
download
Questions 1–10: Clinical Scenarios & Diagnostics
Q1. A 14-year-old male presents following a fall onto an outstretched hand (FOOSH).
He complains of proximal forearm pain. An elbow X-ray reveals a positive posterior
fat pad sign. What is the most likely diagnosis?
A) Colles fracture
B) Radial head fracture
C) Scaphoid fracture
D) Olecranon bursitis
Answer: B
Rationale: A positive fat pad sign (especially posterior) on an elbow X-ray after a FOOSH
injury in adolescents/adults strongly indicates an occult intra-articular fracture, most
commonly a radial head fracture.
Q2. A 10-month-old infant is brought in with a 3-day history of low-grade fever, runny
nose, harsh cough, and conjunctivitis. Physical exam reveals small, cluster-like white
lesions on an erythematous base on the buccal mucosa. What is the diagnosis?
A) Hand-foot-and-mouth disease
B) Herpangina
C) Measles (Rubeola)
D) Aphthous stomatitis
Answer: C
,Rationale: Koplik spots (white papules on an erythematous buccal mucosa) are
pathognomonic for Measles (Rubeola) and appear during the prodromal phase alongside
the classic triad of cough, coryza, and conjunctivitis.
Q3. A 15-year-old female presents with dysuria 2 weeks after finishing treatment for
trichomonas vaginitis. What immediate diagnostic test should the NP perform?
A) Vaginal wet mount
B) Microscopic examination of urine
C) Urine culture and sensitivity
D) Pelvic ultrasound
Answer: B
Rationale: Re-evaluating urinary symptoms post-treatment for vaginitis requires microscopic
urinalysis to check for white blood cells, nitrites, or bacteria indicating a secondary or co-
existing urinary tract infection (UTI).
Q4. A 15-year-old male with a history of surgically repaired cryptorchidism presents
for a routine sports physical. Which health teaching is most critical for this patient?
A) Annual renal ultrasound screening
B) Routine testicular self-examination (TSE)
C) Limiting high-impact physical activities
D) Daily pelvic floor exercises
Answer: B
Rationale: A history of cryptorchidism increases the lifelong risk of testicular cancer, even
after surgical correction (orchidopexy). Teaching routine testicular self-examination is
essential.
Q5. A school nurse evaluates a child with type 1 diabetes mellitus who experiences
sweating, tremor, and confusion shortly after an insulin injection. What is the priority
immediate action?
A) Administer a complex carbohydrate snack
, B) Measure the blood glucose level
C) Administer regular subcutaneous insulin
D) Notify the parents
Answer: B
Rationale: Immediate assessment of blood glucose verifies severe hypoglycemia before
initiating targeted therapy (e.g., rapid-acting oral glucose or glucagon).
Q6. A 16-year-old female taking Ortho-Novum 7/7/7 (triphasic OCP) reports mild
midcycle spotting. She denies missed doses. What is the NP's best response?
A) Discontinue the current OCP immediately
B) Order a pelvic ultrasound
C) Provide reassurance that breakthrough bleeding is common and often benign
D) Switch immediately to a high-dose estrogen contraceptive
Answer: C
Rationale: Breakthrough spotting during the first few months on multiphasic oral
contraceptives is common, self-limiting, and requires reassurance once pregnancy and
missed doses are ruled out.
Q7. What laboratory tests should be ordered alongside serum testosterone when
evaluating a 17-year-old female suspected of Polycystic Ovary Syndrome (PCOS)?
A) Estradiol, progesterone, and prolactin
B) FSH, LH, and TSH
C) Cortisol, aldosterone, and renin
D) DHEA-S, hCG, and CA-125
Answer: B
Rationale: Evaluating LH and FSH (often showing an elevated LH:FSH ratio > 2:1 or 3:1)
along with TSH (to rule out thyroid failure causing secondary polycystic changes) is crucial
in diagnosing PCOS.
, Q8. A 17-year-old female has never experienced menses. Physical exam shows
normal breast development and public hair distribution (Tanner stage III). What
condition is suspected?
A) Secondary amenorrhea
B) Primary amenorrhea
C) PCOS
D) Premature ovarian failure
Answer: B
Rationale: Primary amenorrhea is defined as the absence of menarche by age 15 in the
presence of normal secondary sexual characteristics or by age 13 in their absence.
Q9. A 21-year-old female presents with severe left eye redness, eyelid edema, and
marked, copious purulent discharge. What is the most likely diagnosis?
A) Viral conjunctivitis
B) Allergic conjunctivitis
C) Gonococcal conjunctivitis
D) Chlamydia conjunctivitis
Answer: C
Rationale: Neisseria gonorrhoeae conjunctivitis is characterized by rapid onset,
hyperpurulent discharge, and severe inflammation, requiring urgent parenteral antibiotics to
prevent corneal perforation.
Q10. A 21-year-old patient presents with acute abdominal pain, guarding, involuntary
rigidity, and marked rebound tenderness at McBurney's point. What is the expected
diagnostic finding?
A) Elevated serum lipase
B) Leukocytosis with left shift
C) Positive Murphy's sign
D) Elevated bilirubin
