APEA PRE-PREDICTOR EXAM
WITH CORRECT ANSWERS
2025
Prescriptive authority:( correct answers ) may be exercised by giving
a verbal
medication order to a
pharmacist.
An example of exercising prescriptive authority is giving a verbal
order to a or writing an order for a prescription medication. Prescriptive
pharmacist
rules and regulations vary from state to state. Prescriptive authority is
authority
granted
those APRNs
only towho meet the requirements of the governing body for the
stateAPRN
the in which
practices.
When examining a pregnant patient, where should the fundal height be at
22 weeks?
correct answers ) Above the (
umbilicus
Between 18 and 32 weeks, there is good correlation between fundal
height and age of the fetus. The expected heights are: 10-12 weeks:
gestational
fundus the
above slightly
symphysis pubis 16 weeks: fundus midway between the
symphysis20
umbilicus pubis
weeks:and fundus at the level of umbilicus 28
weeks: fundus 3
fingerbreadths above the umbilicus 36 weeks: fundus just below the
xiphoid process
What intervention does the American College of Rheumatology
recommend
line therapy as for first-
osteoarthritis? ( correct answers ) Exercise and
weight loss
Exercise, weight loss, and rest are recommended by the American
College of
Rheumatology guidelines for the initial management of osteoarthritis
(OA). Given
adverse effects
the of medications used to treat OA, it is best to minimize
dosageuse
delay and as long as possible. An extensive diagnostic workup is not
unless the presentation is in question. Patients who have severe
recommended
degenerative
disease (DJD),joint
joint fusion, or whose pain severity is not relieved by more
therapies may be candidates for joint replacement. Acetaminophen is
conservative
recommended
a first-line as
medication.
A 63-year-old male retired accountant complains of pain and stiffness in
his feetofand
hands several years duration. He reports that the pain and stiffness
become
with worse
activity. On examination, he is noted to have Heberden's nodes but
no other bony
deformities. Which of the following is the most probable diagnosis?
answers ) Osteoarthritis
( correct
(OA)
,Although his vocation involved sedentary activity, this patient is not at
great risk for Rheumatoid arthritis is characterized by several joint
osteoarthritis.
usually bilaterally symmetrical. RA is characterized by inflammatory
deformities,
processes,
OA is not. RAwhile
and OA are chronic conditions. Gout is
characterized by
exacerbations related
acuteto a defect in purine metabolism, increased uric acid
or decreased uric acid
production,
excretion.
The family of a 78-year-old man moved him into an assisted living center
because
can no longer
he be left at home alone. He is unable to toilet when asked to
do so
has had and
several
he episodes of incontinence. He has walked out of the
facilityunable
been twice to
andfind his way back from 3 blocks away. On examination,
he ismildly
but pleasant
confused. Which of his medications is LEAST likely
contributing
behavior? ( correct
to his answers ) ramipril (Altace®)
Tricyclic antidepressants, like amitriptyline, have anticholinergic side effects
which are problematic in the elderly because they contribute to
especially
urinary retention.
Hydrochlorothiazide is a diuretic and may contribute to his incontinence.
Cimetidine
well known is to produce adverse reactions such as confusion in elders.
Ramipril,
ACE an is unlikely to contribute to this patient's incontinence or
inhibitor,
confusion.
Toileting may be a complicated by the anticholinergic medication and/or
the diuretic
causing diuresis, urge incontinence, and inability to
void at will.
A patient with no significant medical history has varicose veins. She
complains
"aching of The intervention that will provide the greatest relief for her
legs".
complaint
to: is answers ) elevate her legs
( correct
periodically.
The intervention that will provide the greatest relief for this patient is
elevating
legs periodically.
her This will facilitate venous return. Use of support
stockings
prolong the
willlength of time she is able to stand in place, but will not
provide
her legs relief
beginafter
aching. Support stockings should be applied prior to getting
out of bed.
Stress urinary incontinence is: ( correct answers ) may be aggravated
by caffeine or alcohol.
Stress urinary incontinence is not expected as a result of the normal
aging process.
The primary problem is sphincter incompetence. The ingestion of caffeine
or alcohol
decreases sphincter control. Anticholinergic and antidepressant
primary underlying
medications are problem causing urge
incontinence.
causative factors related to overflow incontinence. Detrusor muscle
Which commonly
instability is the used herbal remedy is NOT associated with
anxiety and/or depressive symptom relief? ( correct answers )
Ginkgo biloba
,Ginkgo biloba is a common herbal remedy associated with enhancement
of vascular
and cerebral perfusion and memory. The nurse practitioner should be
aware when
patient is taking
the any herbal supplement to avoid risk of drug
interactions.
Upon ophthalmoscopic examination of a 78-year-old patient, the nurse
observes dark spots against a red retina. What diagnosis is this
practitioner
finding most
consistent with? ( correct answers )
Cataract
A cataract opacity is seen as a dark disruption of the red reflex on
ophthalmoscopic exam.
A 72 year old female patient reports a 6 month history of progressively
morepainful
and swollen
distal interphalangeal (DIP) joints of one hand. There are
no systemicbut the erythrocyte sedimentation rate (ESR), antinuclear
symptoms
antibody
and rheumatoid
(ANA), factor (RF) are all minimally elevated. What is the
most likely ( correct answers ) Osteoarthritis
diagnosis?
When osteoarthritis affects the hands, the distal interphalangeal (DIP)
joints are
usually involved. Rheumatoid arthritis is usually symmetrical, and
the proximal
interphalangeal (PIP) joints are more often affected. Inflammation
often develops
quickly, not gradually. This patient is elderly; therefore, it is expected
that the
ANA, andESR,
RF will be only somewhat elevated. Over-interpretation of
laboratory
without tests of systemic inflammation can lead to misdiagnosis.
evidence
The nurse practitioner is evaluating a 35-year-old female nurse. She has a
history of
hospitalization for hepatitis B infection 2 years ago. Her laboratory tests
demonstrate
positive HBsAg. The nurse practitioner would most likely diagnose:
)( correct
chronicanswers
hepatitis B infection.
Presence of hepatitis B surface antigen at this time indicates chronic
infection with hepatitis B. Lab studies indicating a positive surface antigen
on 2 separate occasions at least 6 months apart indicate chronic infection.
Immunization produces positive hepatitis B antibodies in most instances.
Hepatitis B surface antigen would not be present in a person who has
recovered from hepatitis B infection. This case would not be an acute
episode because of the history of hepatitis B infection 2 years prior.
One exception to the recommendation to limit dietary fat intake is:
( correct answers
) children under 2 years-of-age.
In order for myelinization of the nervous system to occur, children under
2 years-of- age require > 30% daily dietary fat.
The most effective primary prevention of skin cancer is to educate the
public about:
( correct answers ) limiting exposure to natural solar radiation.
, Primary prevention of skin cancer includes limiting sun exposure,
avoiding tanning
facilities, and applying sunscreen. Examining the skin and recognizing
melanoma
both secondaryare prevention
measures.
A patient has experienced nausea and vomiting, headache, malaise, low-
grade fever,cramps, and diarrhea for 32 hours. The white count is slightly
abdominal
elevated
a shift to with
the left. He is requesting medication for diarrhea. What
is the most response? ( correct answers ) Offer an anti-emetic
appropriate
medication such as
prochlorperazine (Compazine®) and provide oral fluid and electrolyte
instructio
replacement
n.
Enterocolitis is the most common clinical presentation of salmonellosis.
Diagnosis
made by clinical
is presentation, and can be confirmed only with stool or
bloodhealthy
Most cultures.adults have a course that is self-limiting to 72 hours.
Antibiotics
be used very should
discriminantly as resistance approaches 50%. Anti-
diarrheal agents
potentially increase complications and predispose the patient to
bacteremia.
A child with Type 1 diabetes mellitus brings in a glucose diary
indicatinghyperglycemia.
morning consistent How can the nurse practitioner differentiate
the Somogyi
effect from dawn phenomenon? ( correct answers ) Instruct the
parent
the bloodto monitor
glucose at
3:00 am.
Dawn phenomenon is an early morning rise in plasma glucose. It
indicates ainsulin.
increased need for The Somogyi effect is a rise in plasma glucose in
response to
hypoglycemia. It is usually accompanied by weight gain and hunger and is
corrected bythe evening insulin dose. A series of 3 early morning
decreasing
measurements
blood glucose will of help differentiate between the 2
conditions.
Of the following signs and symptoms of heart failure (HF), the
earliest clinicalis:( correct answers ) weight
manifestation
gain.
The earliest and most sensitive clinical indicator of HF is weight gain. A
patient be
should withinstructed
HF to weigh himself daily to note changes in his
weight.
time of day
The to best
weigh is early morning. The other clinical
manifestations
present after the listed
weight
will gain. Another early, clinical manifestation of
CHF not
above is listed
fatigue.
The mother of a 6-month-old infant asks about the use of an infant
walker. The most
appropriate response is to: ( correct answers ) discourage the use of
walkers andparental holding and floor
encourage
play.
Baby walkers are a significant cause of injuries in young children. Their
use should be
discouraged and parental holding and floor play should be
encouraged instead.
WITH CORRECT ANSWERS
2025
Prescriptive authority:( correct answers ) may be exercised by giving
a verbal
medication order to a
pharmacist.
An example of exercising prescriptive authority is giving a verbal
order to a or writing an order for a prescription medication. Prescriptive
pharmacist
rules and regulations vary from state to state. Prescriptive authority is
authority
granted
those APRNs
only towho meet the requirements of the governing body for the
stateAPRN
the in which
practices.
When examining a pregnant patient, where should the fundal height be at
22 weeks?
correct answers ) Above the (
umbilicus
Between 18 and 32 weeks, there is good correlation between fundal
height and age of the fetus. The expected heights are: 10-12 weeks:
gestational
fundus the
above slightly
symphysis pubis 16 weeks: fundus midway between the
symphysis20
umbilicus pubis
weeks:and fundus at the level of umbilicus 28
weeks: fundus 3
fingerbreadths above the umbilicus 36 weeks: fundus just below the
xiphoid process
What intervention does the American College of Rheumatology
recommend
line therapy as for first-
osteoarthritis? ( correct answers ) Exercise and
weight loss
Exercise, weight loss, and rest are recommended by the American
College of
Rheumatology guidelines for the initial management of osteoarthritis
(OA). Given
adverse effects
the of medications used to treat OA, it is best to minimize
dosageuse
delay and as long as possible. An extensive diagnostic workup is not
unless the presentation is in question. Patients who have severe
recommended
degenerative
disease (DJD),joint
joint fusion, or whose pain severity is not relieved by more
therapies may be candidates for joint replacement. Acetaminophen is
conservative
recommended
a first-line as
medication.
A 63-year-old male retired accountant complains of pain and stiffness in
his feetofand
hands several years duration. He reports that the pain and stiffness
become
with worse
activity. On examination, he is noted to have Heberden's nodes but
no other bony
deformities. Which of the following is the most probable diagnosis?
answers ) Osteoarthritis
( correct
(OA)
,Although his vocation involved sedentary activity, this patient is not at
great risk for Rheumatoid arthritis is characterized by several joint
osteoarthritis.
usually bilaterally symmetrical. RA is characterized by inflammatory
deformities,
processes,
OA is not. RAwhile
and OA are chronic conditions. Gout is
characterized by
exacerbations related
acuteto a defect in purine metabolism, increased uric acid
or decreased uric acid
production,
excretion.
The family of a 78-year-old man moved him into an assisted living center
because
can no longer
he be left at home alone. He is unable to toilet when asked to
do so
has had and
several
he episodes of incontinence. He has walked out of the
facilityunable
been twice to
andfind his way back from 3 blocks away. On examination,
he ismildly
but pleasant
confused. Which of his medications is LEAST likely
contributing
behavior? ( correct
to his answers ) ramipril (Altace®)
Tricyclic antidepressants, like amitriptyline, have anticholinergic side effects
which are problematic in the elderly because they contribute to
especially
urinary retention.
Hydrochlorothiazide is a diuretic and may contribute to his incontinence.
Cimetidine
well known is to produce adverse reactions such as confusion in elders.
Ramipril,
ACE an is unlikely to contribute to this patient's incontinence or
inhibitor,
confusion.
Toileting may be a complicated by the anticholinergic medication and/or
the diuretic
causing diuresis, urge incontinence, and inability to
void at will.
A patient with no significant medical history has varicose veins. She
complains
"aching of The intervention that will provide the greatest relief for her
legs".
complaint
to: is answers ) elevate her legs
( correct
periodically.
The intervention that will provide the greatest relief for this patient is
elevating
legs periodically.
her This will facilitate venous return. Use of support
stockings
prolong the
willlength of time she is able to stand in place, but will not
provide
her legs relief
beginafter
aching. Support stockings should be applied prior to getting
out of bed.
Stress urinary incontinence is: ( correct answers ) may be aggravated
by caffeine or alcohol.
Stress urinary incontinence is not expected as a result of the normal
aging process.
The primary problem is sphincter incompetence. The ingestion of caffeine
or alcohol
decreases sphincter control. Anticholinergic and antidepressant
primary underlying
medications are problem causing urge
incontinence.
causative factors related to overflow incontinence. Detrusor muscle
Which commonly
instability is the used herbal remedy is NOT associated with
anxiety and/or depressive symptom relief? ( correct answers )
Ginkgo biloba
,Ginkgo biloba is a common herbal remedy associated with enhancement
of vascular
and cerebral perfusion and memory. The nurse practitioner should be
aware when
patient is taking
the any herbal supplement to avoid risk of drug
interactions.
Upon ophthalmoscopic examination of a 78-year-old patient, the nurse
observes dark spots against a red retina. What diagnosis is this
practitioner
finding most
consistent with? ( correct answers )
Cataract
A cataract opacity is seen as a dark disruption of the red reflex on
ophthalmoscopic exam.
A 72 year old female patient reports a 6 month history of progressively
morepainful
and swollen
distal interphalangeal (DIP) joints of one hand. There are
no systemicbut the erythrocyte sedimentation rate (ESR), antinuclear
symptoms
antibody
and rheumatoid
(ANA), factor (RF) are all minimally elevated. What is the
most likely ( correct answers ) Osteoarthritis
diagnosis?
When osteoarthritis affects the hands, the distal interphalangeal (DIP)
joints are
usually involved. Rheumatoid arthritis is usually symmetrical, and
the proximal
interphalangeal (PIP) joints are more often affected. Inflammation
often develops
quickly, not gradually. This patient is elderly; therefore, it is expected
that the
ANA, andESR,
RF will be only somewhat elevated. Over-interpretation of
laboratory
without tests of systemic inflammation can lead to misdiagnosis.
evidence
The nurse practitioner is evaluating a 35-year-old female nurse. She has a
history of
hospitalization for hepatitis B infection 2 years ago. Her laboratory tests
demonstrate
positive HBsAg. The nurse practitioner would most likely diagnose:
)( correct
chronicanswers
hepatitis B infection.
Presence of hepatitis B surface antigen at this time indicates chronic
infection with hepatitis B. Lab studies indicating a positive surface antigen
on 2 separate occasions at least 6 months apart indicate chronic infection.
Immunization produces positive hepatitis B antibodies in most instances.
Hepatitis B surface antigen would not be present in a person who has
recovered from hepatitis B infection. This case would not be an acute
episode because of the history of hepatitis B infection 2 years prior.
One exception to the recommendation to limit dietary fat intake is:
( correct answers
) children under 2 years-of-age.
In order for myelinization of the nervous system to occur, children under
2 years-of- age require > 30% daily dietary fat.
The most effective primary prevention of skin cancer is to educate the
public about:
( correct answers ) limiting exposure to natural solar radiation.
, Primary prevention of skin cancer includes limiting sun exposure,
avoiding tanning
facilities, and applying sunscreen. Examining the skin and recognizing
melanoma
both secondaryare prevention
measures.
A patient has experienced nausea and vomiting, headache, malaise, low-
grade fever,cramps, and diarrhea for 32 hours. The white count is slightly
abdominal
elevated
a shift to with
the left. He is requesting medication for diarrhea. What
is the most response? ( correct answers ) Offer an anti-emetic
appropriate
medication such as
prochlorperazine (Compazine®) and provide oral fluid and electrolyte
instructio
replacement
n.
Enterocolitis is the most common clinical presentation of salmonellosis.
Diagnosis
made by clinical
is presentation, and can be confirmed only with stool or
bloodhealthy
Most cultures.adults have a course that is self-limiting to 72 hours.
Antibiotics
be used very should
discriminantly as resistance approaches 50%. Anti-
diarrheal agents
potentially increase complications and predispose the patient to
bacteremia.
A child with Type 1 diabetes mellitus brings in a glucose diary
indicatinghyperglycemia.
morning consistent How can the nurse practitioner differentiate
the Somogyi
effect from dawn phenomenon? ( correct answers ) Instruct the
parent
the bloodto monitor
glucose at
3:00 am.
Dawn phenomenon is an early morning rise in plasma glucose. It
indicates ainsulin.
increased need for The Somogyi effect is a rise in plasma glucose in
response to
hypoglycemia. It is usually accompanied by weight gain and hunger and is
corrected bythe evening insulin dose. A series of 3 early morning
decreasing
measurements
blood glucose will of help differentiate between the 2
conditions.
Of the following signs and symptoms of heart failure (HF), the
earliest clinicalis:( correct answers ) weight
manifestation
gain.
The earliest and most sensitive clinical indicator of HF is weight gain. A
patient be
should withinstructed
HF to weigh himself daily to note changes in his
weight.
time of day
The to best
weigh is early morning. The other clinical
manifestations
present after the listed
weight
will gain. Another early, clinical manifestation of
CHF not
above is listed
fatigue.
The mother of a 6-month-old infant asks about the use of an infant
walker. The most
appropriate response is to: ( correct answers ) discourage the use of
walkers andparental holding and floor
encourage
play.
Baby walkers are a significant cause of injuries in young children. Their
use should be
discouraged and parental holding and floor play should be
encouraged instead.
