NURSE PRACTITIONER CERTIFICATION
APEA Predictor Exam A+
Blueprint 2026/2027
Official-Style Practice Examination for Family & Adult-Gerontology Primary Care Nurse Practitioner
Candidates
A+ QUESTIONS
VERIFIED
5 SECTIONS
COVERED
100% RATIONALES
INCLUDED
CATEGORIES
■ Section 1 — Assessment (History, Physical Examination, Risk Stratification)
■ Section 2 — Diagnosis (Differential Diagnosis, Diagnostic Reasoning, Interpretation)
■ Section 3 — Planning (Evidence-Based Plans, Pharmacologic & Non-Pharmacologic Strategies)
■ Section 4 — Implementation (Prescribing, Patient Education, Monitoring Initiation)
■ Section 5 — Evaluation (Therapeutic Response, Safety Monitoring, Outcome Assessment)
STUVIAACTUALEXAM
Passing Score: 75% | 1 mark per question | Advanced Difficulty | Application/Analysis Level
,Section 1: Assessment
Q1. A 58-year-old man with a 30-pack-year smoking history presents for an annual wellness visit. He reports a
nonproductive cough for six weeks and mild dyspnea on exertion. Vital signs are normal. Lung examination
reveals decreased breath sounds at the right apex. Which element of the history is most critical to elicit next to
guide the physical examination and differential?
A. Occupational exposure to asbestos or silica
B. Family history of early-onset coronary disease
C. Recent travel to a tuberculosis-endemic region
D. Dietary intake of leafy green vegetables
Correct Answer: A
Rationale: Occupational exposures such as asbestos or silica significantly elevate risk for interstitial lung disease and malignancy
and directly influence the differential for apical findings and chronic cough. The other options, while potentially relevant to general
health, do not address the pulmonary findings as specifically.
Q2. A 42-year-old woman presents with intermittent palpitations and fatigue. She denies chest pain. Blood
pressure is 128/78 mm Hg and heart rate is 92 bpm and irregular. The nurse practitioner auscultates an
irregularly irregular rhythm without murmurs. Which additional physical finding would most strongly support
further evaluation for atrial fibrillation with rapid ventricular response?
A. Variable intensity of the first heart sound
B. Presence of an S3 gallop at the apex
C. Fixed splitting of the second heart sound
D. A mid-systolic click at the left sternal border
Correct Answer: A
Rationale: In atrial fibrillation the intensity of S1 varies because of fluctuating diastolic filling times. An S3 suggests volume overload,
fixed splitting points to atrial septal defect, and a mid-systolic click is classic for mitral-valve prolapse.
Q3. A 67-year-old woman with type 2 diabetes and hypertension is seen for a routine visit. She reports new
bilateral lower-extremity swelling that worsens by evening. On examination the ankles show 2+ pitting edema
without erythema or warmth. Which focused historical detail is most important to obtain before ordering
diagnostic studies?
A. Recent initiation or dose increase of a dihydropyridine calcium-channel blocker
B. Family history of deep-vein thrombosis
C. Use of over-the-counter antihistamines
D. Number of hours spent standing at work
Correct Answer: A
Rationale: Dihydropyridine calcium-channel blockers commonly cause dose-dependent peripheral edema through arteriolar dilation.
Establishing a temporal relationship with medication changes can avoid unnecessary venous studies and guide therapy adjustment.
Q4. A 29-year-old woman who is 28 weeks pregnant presents with sudden onset of dyspnea and right-sided
pleuritic chest pain. She has no fever. Oxygen saturation is 94% on room air. Which element of the physical
examination should be prioritized to refine the differential diagnosis of pulmonary embolism versus other
pregnancy-related causes?
A. Percussion of the lung bases for dullness
B. Auscultation for a pericardial friction rub
C. Palpation of the thyroid for nodules
D. Inspection of the lower extremities for unilateral swelling or calf tenderness
Correct Answer: D
Rationale: Pregnancy is a hypercoagulable state; unilateral leg findings raise the pretest probability of deep-vein thrombosis with
secondary pulmonary embolism and help triage imaging decisions. The other maneuvers address less likely competing diagnoses in
this acute setting.
STUVIAACTUALEXAM | Page 2 of 30
, Q5. A 51-year-old man with known alcohol-use disorder is brought by family because of progressive confusion
over three days. He is afebrile, blood pressure 110/70 mm Hg, and has asterixis. Abdominal examination reveals
a firm liver edge 4 cm below the costal margin. Which additional physical finding is most useful in assessing the
severity of hepatic decompensation?
A. Unequal pupil size
B. Absent bowel sounds in all quadrants
C. Bilateral flank bruising
D. Presence of spider angiomata and palmar erythema
Correct Answer: D
Rationale: Spider angiomata and palmar erythema are classic cutaneous markers of chronic liver disease and portal hypertension;
their presence supports the diagnosis of hepatic encephalopathy secondary to decompensated cirrhosis. The other findings suggest
alternative acute abdominal or neurologic processes.
Q6. A 34-year-old woman presents with three days of dysuria, frequency, and suprapubic discomfort. She denies
fever, flank pain, or vaginal discharge. Urine dipstick shows leukocyte esterase and nitrites. Which aspect of the
sexual and gynecologic history is most relevant to obtaining before selecting empiric therapy?
A. Number of prior pregnancies
B. Age at menarche
C. Recent change in sexual partners or unprotected intercourse
D. History of childhood urinary-tract infections
Correct Answer: C
Rationale: Recent sexual activity and partner change increase the likelihood of sexually transmitted pathogens that may coexist with
or mimic uncomplicated cystitis and influence the need for additional testing or broader coverage.
Q7. A 72-year-old man with a history of coronary artery disease reports progressive shortness of breath over the
past month. He sleeps on three pillows. Jugular venous pressure is elevated and there is a soft holosystolic
murmur at the apex radiating to the axilla. Which additional examination maneuver best characterizes the
murmur’s hemodynamic significance?
A. Sitting forward and holding expiration for aortic findings
B. Valsalva maneuver to evaluate for hypertrophic cardiomyopathy
C. Hand-grip isometric exercise to assess intensity change
D. Squatting to differentiate fixed from dynamic obstruction
Correct Answer: C
Rationale: Isometric hand-grip increases afterload and intensifies most mitral-regurgitation murmurs, helping confirm the apical
findings as clinically relevant mitral regurgitation contributing to the heart-failure presentation.
Q8. A 19-year-old college student presents with two weeks of fatigue, sore throat, and low-grade fever. Cervical
lymphadenopathy is present. Which physical-examination finding, if present, would most strongly suggest the
need for abdominal imaging or laboratory evaluation for splenic involvement?
A. Left-upper-quadrant tenderness or palpable spleen tip
B. Bilateral basilar crackles
C. Symmetric polyarticular joint swelling
D. Painless oral ulcers
Correct Answer: A
Rationale: Splenomegaly is a classic feature of infectious mononucleosis; left-upper-quadrant findings raise concern for splenic
enlargement and potential rupture risk, guiding activity restriction and further testing.
STUVIAACTUALEXAM | Page 3 of 30
APEA Predictor Exam A+
Blueprint 2026/2027
Official-Style Practice Examination for Family & Adult-Gerontology Primary Care Nurse Practitioner
Candidates
A+ QUESTIONS
VERIFIED
5 SECTIONS
COVERED
100% RATIONALES
INCLUDED
CATEGORIES
■ Section 1 — Assessment (History, Physical Examination, Risk Stratification)
■ Section 2 — Diagnosis (Differential Diagnosis, Diagnostic Reasoning, Interpretation)
■ Section 3 — Planning (Evidence-Based Plans, Pharmacologic & Non-Pharmacologic Strategies)
■ Section 4 — Implementation (Prescribing, Patient Education, Monitoring Initiation)
■ Section 5 — Evaluation (Therapeutic Response, Safety Monitoring, Outcome Assessment)
STUVIAACTUALEXAM
Passing Score: 75% | 1 mark per question | Advanced Difficulty | Application/Analysis Level
,Section 1: Assessment
Q1. A 58-year-old man with a 30-pack-year smoking history presents for an annual wellness visit. He reports a
nonproductive cough for six weeks and mild dyspnea on exertion. Vital signs are normal. Lung examination
reveals decreased breath sounds at the right apex. Which element of the history is most critical to elicit next to
guide the physical examination and differential?
A. Occupational exposure to asbestos or silica
B. Family history of early-onset coronary disease
C. Recent travel to a tuberculosis-endemic region
D. Dietary intake of leafy green vegetables
Correct Answer: A
Rationale: Occupational exposures such as asbestos or silica significantly elevate risk for interstitial lung disease and malignancy
and directly influence the differential for apical findings and chronic cough. The other options, while potentially relevant to general
health, do not address the pulmonary findings as specifically.
Q2. A 42-year-old woman presents with intermittent palpitations and fatigue. She denies chest pain. Blood
pressure is 128/78 mm Hg and heart rate is 92 bpm and irregular. The nurse practitioner auscultates an
irregularly irregular rhythm without murmurs. Which additional physical finding would most strongly support
further evaluation for atrial fibrillation with rapid ventricular response?
A. Variable intensity of the first heart sound
B. Presence of an S3 gallop at the apex
C. Fixed splitting of the second heart sound
D. A mid-systolic click at the left sternal border
Correct Answer: A
Rationale: In atrial fibrillation the intensity of S1 varies because of fluctuating diastolic filling times. An S3 suggests volume overload,
fixed splitting points to atrial septal defect, and a mid-systolic click is classic for mitral-valve prolapse.
Q3. A 67-year-old woman with type 2 diabetes and hypertension is seen for a routine visit. She reports new
bilateral lower-extremity swelling that worsens by evening. On examination the ankles show 2+ pitting edema
without erythema or warmth. Which focused historical detail is most important to obtain before ordering
diagnostic studies?
A. Recent initiation or dose increase of a dihydropyridine calcium-channel blocker
B. Family history of deep-vein thrombosis
C. Use of over-the-counter antihistamines
D. Number of hours spent standing at work
Correct Answer: A
Rationale: Dihydropyridine calcium-channel blockers commonly cause dose-dependent peripheral edema through arteriolar dilation.
Establishing a temporal relationship with medication changes can avoid unnecessary venous studies and guide therapy adjustment.
Q4. A 29-year-old woman who is 28 weeks pregnant presents with sudden onset of dyspnea and right-sided
pleuritic chest pain. She has no fever. Oxygen saturation is 94% on room air. Which element of the physical
examination should be prioritized to refine the differential diagnosis of pulmonary embolism versus other
pregnancy-related causes?
A. Percussion of the lung bases for dullness
B. Auscultation for a pericardial friction rub
C. Palpation of the thyroid for nodules
D. Inspection of the lower extremities for unilateral swelling or calf tenderness
Correct Answer: D
Rationale: Pregnancy is a hypercoagulable state; unilateral leg findings raise the pretest probability of deep-vein thrombosis with
secondary pulmonary embolism and help triage imaging decisions. The other maneuvers address less likely competing diagnoses in
this acute setting.
STUVIAACTUALEXAM | Page 2 of 30
, Q5. A 51-year-old man with known alcohol-use disorder is brought by family because of progressive confusion
over three days. He is afebrile, blood pressure 110/70 mm Hg, and has asterixis. Abdominal examination reveals
a firm liver edge 4 cm below the costal margin. Which additional physical finding is most useful in assessing the
severity of hepatic decompensation?
A. Unequal pupil size
B. Absent bowel sounds in all quadrants
C. Bilateral flank bruising
D. Presence of spider angiomata and palmar erythema
Correct Answer: D
Rationale: Spider angiomata and palmar erythema are classic cutaneous markers of chronic liver disease and portal hypertension;
their presence supports the diagnosis of hepatic encephalopathy secondary to decompensated cirrhosis. The other findings suggest
alternative acute abdominal or neurologic processes.
Q6. A 34-year-old woman presents with three days of dysuria, frequency, and suprapubic discomfort. She denies
fever, flank pain, or vaginal discharge. Urine dipstick shows leukocyte esterase and nitrites. Which aspect of the
sexual and gynecologic history is most relevant to obtaining before selecting empiric therapy?
A. Number of prior pregnancies
B. Age at menarche
C. Recent change in sexual partners or unprotected intercourse
D. History of childhood urinary-tract infections
Correct Answer: C
Rationale: Recent sexual activity and partner change increase the likelihood of sexually transmitted pathogens that may coexist with
or mimic uncomplicated cystitis and influence the need for additional testing or broader coverage.
Q7. A 72-year-old man with a history of coronary artery disease reports progressive shortness of breath over the
past month. He sleeps on three pillows. Jugular venous pressure is elevated and there is a soft holosystolic
murmur at the apex radiating to the axilla. Which additional examination maneuver best characterizes the
murmur’s hemodynamic significance?
A. Sitting forward and holding expiration for aortic findings
B. Valsalva maneuver to evaluate for hypertrophic cardiomyopathy
C. Hand-grip isometric exercise to assess intensity change
D. Squatting to differentiate fixed from dynamic obstruction
Correct Answer: C
Rationale: Isometric hand-grip increases afterload and intensifies most mitral-regurgitation murmurs, helping confirm the apical
findings as clinically relevant mitral regurgitation contributing to the heart-failure presentation.
Q8. A 19-year-old college student presents with two weeks of fatigue, sore throat, and low-grade fever. Cervical
lymphadenopathy is present. Which physical-examination finding, if present, would most strongly suggest the
need for abdominal imaging or laboratory evaluation for splenic involvement?
A. Left-upper-quadrant tenderness or palpable spleen tip
B. Bilateral basilar crackles
C. Symmetric polyarticular joint swelling
D. Painless oral ulcers
Correct Answer: A
Rationale: Splenomegaly is a classic feature of infectious mononucleosis; left-upper-quadrant findings raise concern for splenic
enlargement and potential rupture risk, guiding activity restriction and further testing.
STUVIAACTUALEXAM | Page 3 of 30
