APEA Predictor Exam - Pre-Predictor Test
Questions and Answers 2026/2027
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
149 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This pre-predictor examination assesses readiness for the APEA (American Academy of Nurse Practitioners
Certification Program style) Family and Adult-Gerontology Primary Care certification predictor exam. It covers
advanced health assessment, pathophysiology, pharmacology, diagnostic reasoning, and evidence-based
management across the lifespan, with emphasis on current clinical guidelines and safe prescribing.
STUDY GUIDE
Recommended duration: 2 hours. Passing target: 80% (40/50 correct) recommended for predictor readiness.
HIGHP - Page 1 of 47
,1. A patient presents with unilateral, throbbing headache, nausea, and photophobia that
worsens with routine activity. Which class of medication is most appropriate for acute
abortive therapy according to current guidelines?
[ ] A. Beta-blockers
[ ] B. Triptans
[ ] C. Tricyclic antidepressants
[ ] D. Antiepileptic drugs
CORRECT: B. Triptans
Triptans are first-line acute abortive therapy for moderate to severe migraine with or without aura.
Beta-blockers, tricyclics, and antiepileptics are used for prophylaxis, not acute abortion. The clinical
presentation is classic for migraine, making triptans the correct choice.
2. A patient with type 2 diabetes has an eGFR of 45 mL/min/1.73 m² and albuminuria.
Which medication class is recommended to slow CKD progression and reduce
cardiovascular events?
[ ] A. SGLT2 inhibitors
[ ] B. Sulfonylureas
[ ] C. DPP-4 inhibitors
[ ] D. Thiazolidinediones
CORRECT: A. SGLT2 inhibitors
SGLT2 inhibitors have robust evidence for slowing CKD progression and reducing cardiovascular events in
diabetic kidney disease, even with reduced eGFR. Sulfonylureas, DPP-4 inhibitors, and thiazolidinediones
lack this renal and cardiovascular benefit. Current ADA/KDIGO guidelines recommend SGLT2 inhibitors in
this scenario.
3. Which of the following physical examination findings is most consistent with a
diagnosis of acute bacterial rhinosinusitis rather than viral rhinosinusitis?
[ ] A. Clear rhinorrhea and sneezing
[ ] B. Symptoms lasting less than 10 days without worsening
[ ] C. Facial pain and purulent nasal discharge lasting >10 days without improvement
[ ] D. Itching of the eyes and nose
CORRECT: C. Facial pain and purulent nasal discharge lasting >10 days without improvement
Acute bacterial rhinosinusitis is suggested by symptoms lasting >10 days without improvement, severe
symptoms (fever >39°C, purulent discharge, facial pain) for 3-4 days, or 'double worsening'. Viral
rhinosinusitis typically improves within 10 days and features clear discharge and itching. Options A, B, and D
are more consistent with viral or allergic rhinitis.
HIGHP - Page 2 of 47
,4. A patient on warfarin for atrial fibrillation has an INR of 6.5 and no bleeding. Which is
the most appropriate immediate management?
[ ] A. Administer vitamin K 10 mg IV
[ ] B. Hold warfarin and administer vitamin K 2.5 mg PO
[ ] C. Continue warfarin and recheck INR in 1 week
[ ] D. Administer fresh frozen plasma
CORRECT: B. Hold warfarin and administer vitamin K 2.5 mg PO
For INR >5 but <9 without bleeding, guidelines recommend holding warfarin and giving low-dose oral vitamin
K (2.5 mg) to gradually reverse anticoagulation. IV vitamin K and FFP are reserved for major bleeding or
life-threatening situations. Continuing warfarin would increase bleeding risk.
5. Which diagnostic study is the gold standard for confirming a diagnosis of pulmonary
embolism in a hemodynamically stable patient with a high pretest probability?
[ ] A. D-dimer
[ ] B. CT pulmonary angiography
[ ] C. Chest X-ray
[ ] D. V/Q scan
CORRECT: B. CT pulmonary angiography
CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism in stable patients with
high pretest probability. D-dimer is used for low/intermediate probability to rule out PE, not confirm. Chest
X-ray is nonspecific, and V/Q scan is reserved for contrast allergy or renal impairment.
6. A patient with heart failure with reduced ejection fraction (HFrEF) is started on
sacubitril/valsartan. Which monitoring parameter is most critical within the first 2 weeks?
[ ] A. Serum potassium and creatinine
[ ] B. Liver function tests
[ ] C. Fasting blood glucose
[ ] D. Thyroid-stimulating hormone
CORRECT: A. Serum potassium and creatinine
Sacubitril/valsartan can cause hyperkalemia and renal impairment, especially when combined with other
RAAS inhibitors. Monitoring potassium and creatinine within 1-2 weeks is essential. Liver enzymes, glucose,
and TSH are not primary concerns with this medication.
7. A patient presents with sudden onset of severe unilateral flank pain radiating to the
groin, hematuria, and nausea. Which initial imaging study is preferred for suspected
nephrolithiasis in a non-pregnant adult?
[ ] A. Non-contrast CT of the abdomen and pelvis
HIGHP - Page 3 of 47
, [ ] B. Abdominal ultrasound
[ ] C. Intravenous pyelogram
[ ] D. MRI of the abdomen
CORRECT: A. Non-contrast CT of the abdomen and pelvis
Non-contrast CT of the abdomen and pelvis is the imaging modality of choice for suspected nephrolithiasis in
non-pregnant adults due to high sensitivity and specificity. Ultrasound is preferred in pregnancy or to avoid
radiation. IVP is rarely used now, and MRI is less sensitive for stones.
8. Which of the following is the most appropriate first-line pharmacologic therapy for a
patient with newly diagnosed primary open-angle glaucoma?
[ ] A. Topical beta-blocker
[ ] B. Oral carbonic anhydrase inhibitor
[ ] C. Topical prostaglandin analog
[ ] D. Topical alpha-2 agonist
CORRECT: C. Topical prostaglandin analog
Topical prostaglandin analogs (e.g., latanoprost) are first-line for open-angle glaucoma because they
effectively lower intraocular pressure with once-daily dosing and fewer systemic side effects. Beta-blockers,
alpha-2 agonists, and oral CAIs are alternatives or adjuncts. Current AAO guidelines favor prostaglandin
analogs.
9. A patient with major depressive disorder is started on sertraline. Which of the following
adverse effects should the provider warn the patient about during the first week of
therapy?
[ ] A. Increased suicidal ideation
[ ] B. Hypertensive crisis
[ ] C. Weight gain
[ ] D. Sedation
CORRECT: A. Increased suicidal ideation
SSRIs like sertraline can transiently increase suicidal ideation, especially in young adults and during the first
weeks of treatment. Hypertensive crisis is associated with MAOIs and tyramine. Weight gain and sedation
are less immediate concerns. Close monitoring is required initially.
10. Which of the following findings on a 12-lead ECG is most indicative of an acute
ST-elevation myocardial infarction (STEMI) in the presence of reciprocal changes?
[ ] A. ST depression in leads V1-V2
[ ] B. ST elevation in contiguous leads with reciprocal ST depression
[ ] C. T-wave inversion in lead III
HIGHP - Page 4 of 47
Questions and Answers 2026/2027
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
149 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This pre-predictor examination assesses readiness for the APEA (American Academy of Nurse Practitioners
Certification Program style) Family and Adult-Gerontology Primary Care certification predictor exam. It covers
advanced health assessment, pathophysiology, pharmacology, diagnostic reasoning, and evidence-based
management across the lifespan, with emphasis on current clinical guidelines and safe prescribing.
STUDY GUIDE
Recommended duration: 2 hours. Passing target: 80% (40/50 correct) recommended for predictor readiness.
HIGHP - Page 1 of 47
,1. A patient presents with unilateral, throbbing headache, nausea, and photophobia that
worsens with routine activity. Which class of medication is most appropriate for acute
abortive therapy according to current guidelines?
[ ] A. Beta-blockers
[ ] B. Triptans
[ ] C. Tricyclic antidepressants
[ ] D. Antiepileptic drugs
CORRECT: B. Triptans
Triptans are first-line acute abortive therapy for moderate to severe migraine with or without aura.
Beta-blockers, tricyclics, and antiepileptics are used for prophylaxis, not acute abortion. The clinical
presentation is classic for migraine, making triptans the correct choice.
2. A patient with type 2 diabetes has an eGFR of 45 mL/min/1.73 m² and albuminuria.
Which medication class is recommended to slow CKD progression and reduce
cardiovascular events?
[ ] A. SGLT2 inhibitors
[ ] B. Sulfonylureas
[ ] C. DPP-4 inhibitors
[ ] D. Thiazolidinediones
CORRECT: A. SGLT2 inhibitors
SGLT2 inhibitors have robust evidence for slowing CKD progression and reducing cardiovascular events in
diabetic kidney disease, even with reduced eGFR. Sulfonylureas, DPP-4 inhibitors, and thiazolidinediones
lack this renal and cardiovascular benefit. Current ADA/KDIGO guidelines recommend SGLT2 inhibitors in
this scenario.
3. Which of the following physical examination findings is most consistent with a
diagnosis of acute bacterial rhinosinusitis rather than viral rhinosinusitis?
[ ] A. Clear rhinorrhea and sneezing
[ ] B. Symptoms lasting less than 10 days without worsening
[ ] C. Facial pain and purulent nasal discharge lasting >10 days without improvement
[ ] D. Itching of the eyes and nose
CORRECT: C. Facial pain and purulent nasal discharge lasting >10 days without improvement
Acute bacterial rhinosinusitis is suggested by symptoms lasting >10 days without improvement, severe
symptoms (fever >39°C, purulent discharge, facial pain) for 3-4 days, or 'double worsening'. Viral
rhinosinusitis typically improves within 10 days and features clear discharge and itching. Options A, B, and D
are more consistent with viral or allergic rhinitis.
HIGHP - Page 2 of 47
,4. A patient on warfarin for atrial fibrillation has an INR of 6.5 and no bleeding. Which is
the most appropriate immediate management?
[ ] A. Administer vitamin K 10 mg IV
[ ] B. Hold warfarin and administer vitamin K 2.5 mg PO
[ ] C. Continue warfarin and recheck INR in 1 week
[ ] D. Administer fresh frozen plasma
CORRECT: B. Hold warfarin and administer vitamin K 2.5 mg PO
For INR >5 but <9 without bleeding, guidelines recommend holding warfarin and giving low-dose oral vitamin
K (2.5 mg) to gradually reverse anticoagulation. IV vitamin K and FFP are reserved for major bleeding or
life-threatening situations. Continuing warfarin would increase bleeding risk.
5. Which diagnostic study is the gold standard for confirming a diagnosis of pulmonary
embolism in a hemodynamically stable patient with a high pretest probability?
[ ] A. D-dimer
[ ] B. CT pulmonary angiography
[ ] C. Chest X-ray
[ ] D. V/Q scan
CORRECT: B. CT pulmonary angiography
CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism in stable patients with
high pretest probability. D-dimer is used for low/intermediate probability to rule out PE, not confirm. Chest
X-ray is nonspecific, and V/Q scan is reserved for contrast allergy or renal impairment.
6. A patient with heart failure with reduced ejection fraction (HFrEF) is started on
sacubitril/valsartan. Which monitoring parameter is most critical within the first 2 weeks?
[ ] A. Serum potassium and creatinine
[ ] B. Liver function tests
[ ] C. Fasting blood glucose
[ ] D. Thyroid-stimulating hormone
CORRECT: A. Serum potassium and creatinine
Sacubitril/valsartan can cause hyperkalemia and renal impairment, especially when combined with other
RAAS inhibitors. Monitoring potassium and creatinine within 1-2 weeks is essential. Liver enzymes, glucose,
and TSH are not primary concerns with this medication.
7. A patient presents with sudden onset of severe unilateral flank pain radiating to the
groin, hematuria, and nausea. Which initial imaging study is preferred for suspected
nephrolithiasis in a non-pregnant adult?
[ ] A. Non-contrast CT of the abdomen and pelvis
HIGHP - Page 3 of 47
, [ ] B. Abdominal ultrasound
[ ] C. Intravenous pyelogram
[ ] D. MRI of the abdomen
CORRECT: A. Non-contrast CT of the abdomen and pelvis
Non-contrast CT of the abdomen and pelvis is the imaging modality of choice for suspected nephrolithiasis in
non-pregnant adults due to high sensitivity and specificity. Ultrasound is preferred in pregnancy or to avoid
radiation. IVP is rarely used now, and MRI is less sensitive for stones.
8. Which of the following is the most appropriate first-line pharmacologic therapy for a
patient with newly diagnosed primary open-angle glaucoma?
[ ] A. Topical beta-blocker
[ ] B. Oral carbonic anhydrase inhibitor
[ ] C. Topical prostaglandin analog
[ ] D. Topical alpha-2 agonist
CORRECT: C. Topical prostaglandin analog
Topical prostaglandin analogs (e.g., latanoprost) are first-line for open-angle glaucoma because they
effectively lower intraocular pressure with once-daily dosing and fewer systemic side effects. Beta-blockers,
alpha-2 agonists, and oral CAIs are alternatives or adjuncts. Current AAO guidelines favor prostaglandin
analogs.
9. A patient with major depressive disorder is started on sertraline. Which of the following
adverse effects should the provider warn the patient about during the first week of
therapy?
[ ] A. Increased suicidal ideation
[ ] B. Hypertensive crisis
[ ] C. Weight gain
[ ] D. Sedation
CORRECT: A. Increased suicidal ideation
SSRIs like sertraline can transiently increase suicidal ideation, especially in young adults and during the first
weeks of treatment. Hypertensive crisis is associated with MAOIs and tyramine. Weight gain and sedation
are less immediate concerns. Close monitoring is required initially.
10. Which of the following findings on a 12-lead ECG is most indicative of an acute
ST-elevation myocardial infarction (STEMI) in the presence of reciprocal changes?
[ ] A. ST depression in leads V1-V2
[ ] B. ST elevation in contiguous leads with reciprocal ST depression
[ ] C. T-wave inversion in lead III
HIGHP - Page 4 of 47
