3P APEA Practice Exam 2025/26: Full-Length
NP Review with Key Concepts & Clinical
Rationales
, 1.
A 58-year-old with type 2 diabetes is prescribed metformin. Which instruction is most
important?
A. Take with meals to reduce GI upset
B. Avoid grapefruit juice
C. Discontinue immediately if blood glucose normalizes
D. Take on an empty stomach
✅ Answer: A
Rationale: Metformin causes GI irritation; taking with food minimizes side effects. It should not
be stopped abruptly.
2.
A patient on lisinopril develops a persistent dry cough. What is the best alternative?
A. Switch to an ARB such as losartan
B. Add hydrochlorothiazide
C. Reduce the dose
D. Continue and reassess in 6 months
✅ Answer: A
Rationale: ACE inhibitors can cause cough due to bradykinin buildup; ARBs don’t have this
effect.
3.
Which antibiotic is contraindicated in pregnancy?
A. Amoxicillin
B. Azithromycin
C. Doxycycline
D. Cephalexin
✅ Answer: C
Rationale: Tetracyclines (like doxycycline) can cause fetal bone and teeth malformations.
4.
NP Review with Key Concepts & Clinical
Rationales
, 1.
A 58-year-old with type 2 diabetes is prescribed metformin. Which instruction is most
important?
A. Take with meals to reduce GI upset
B. Avoid grapefruit juice
C. Discontinue immediately if blood glucose normalizes
D. Take on an empty stomach
✅ Answer: A
Rationale: Metformin causes GI irritation; taking with food minimizes side effects. It should not
be stopped abruptly.
2.
A patient on lisinopril develops a persistent dry cough. What is the best alternative?
A. Switch to an ARB such as losartan
B. Add hydrochlorothiazide
C. Reduce the dose
D. Continue and reassess in 6 months
✅ Answer: A
Rationale: ACE inhibitors can cause cough due to bradykinin buildup; ARBs don’t have this
effect.
3.
Which antibiotic is contraindicated in pregnancy?
A. Amoxicillin
B. Azithromycin
C. Doxycycline
D. Cephalexin
✅ Answer: C
Rationale: Tetracyclines (like doxycycline) can cause fetal bone and teeth malformations.
4.
