[Document title]
APEA PRE-PREDICTOR NP EXAM
Initial treatment of a child presenting with a severe head injury is:: aimedat resuscitation,
then maintenance of oxygenation and blood flow.
A head-injured patient requires that all related injuries be identified and treated, butthe most
immediate need is airway resuscitation, maintenance of oxygenation, andmaintenance of blood
flow. Cerebral edema, a major complication of head injury, ismanaged with adequate
oxygenation, elevation of the head and trunk to facilitate venous return from the head, isotonic
intravenous fluid administration maintaining low central venous pressure, and maintenance of
normal body temperature.
Eligibility requirements for the ANP or FNP exam include all of the follow-ing EXCEPT::
a masters degree in nursing or an area.
Today, NP students are prepared at the graduate level.There are nurse practitionerswho have
completed an accredited or approved non-graduate level educational program prior to
implementation of graduate level education requirements. Most states have "grandfathered" these
NPs into practice.
A 12-year-old presents with ear pain of 36 hours duration. The nurse practitioner
diagnoses acute otitis media because the:: bony landmarks are obscured and the tympanic
membrane is mildly erythematous, dull, and immobile.
APEA PRE-PREDICTOR NP EXAM
Serous otitis media typically presents with a flat or bulging and tympanic membranewith a fluid
line and/or tiny bubbles visible posteriorly. The tympanic membrane maybe immobile and retracted
against the bony landmarks when the eustachian tube isswollen or congested as with the common
cold or allergies. Narrowing of the externalcanal with erythema and extreme tenderness of the
canal wall is indicative of otitisexterna.
An appropriate initial treatment for external genital warts caused by humanpapilloma virus
(HPV) in a non-pregnant patient is:: topical trichloroacetic acid (TCA).
Appropriate initial treatment of external genital warts caused by HPV includes cryotherapy with
liquid nitrogen or cryoprobe, self-treatment with podofilox 0.5% solution, podophyllin 10%-25%,
trichloroacetic acid (TCA), or electrodesiccation orelectrocautery. 5-fluorouracil cream has not
been evaluated in controlled studies andis not recommended for treatment of genital warts.
Intralesional interferon is used for treatment of persistent and recurrent genital warts, but is not
recommended by the CDC. Topical acyclovir is not indicated for treatment of genital warts.
A 6-year-old presents with complaints of sore throat and fever for 2 days.He has multiple
vesiculated ulcerations on his tonsils and uvula.There are noother remarkable findings.
What is the most likely diagnosis?: Herpangina
Herpangina is a viral infection common in toddlers and young children caused by Coxsackie
virus. The clinical findings of numerous, small (1-2 mm) ulcerations on the tonsils and uvula are
typical of herpangina. The ulcerations can be very painfulbut usually resolve in 7 to 10 days.
Treatment is symptomatic.
The daughter of a 75-year-old patient reports that her mother roams thehouse at night
saying she cannot fall asleep. She has fallen twice. Of the following choices, which would be
1 20241007204521_6704486147D6E_APEA_PRE_PREDICTOR_NP_EXAM_____________________________________
,[Document title]
the most appropriate to treat her insom-nia?: doxepin (Sinequan)
Low dose doxepin (Sinequan) has been proven efficacious in the therapy of transientinsomnia,
producing improvements in wake after sleep onset, total sleep time and sleep-onset latency. Since
this patient is having difficulty falling asleep, she needs a drug which will produce drowsiness at
bedtime (sleep-onset latency). At low doses (<6mg/day), doxepin also has a good efficacy and
safety profile in elderly patients with chronic insomnia, with a safety profile comparable to placebo.
Elderly ordebilitated patients may be especially sensitive to the effects of zolpidem (Ambien).
Ambien can increase the risk of falls, as well as cause confusion. Although the other choices
would provide sedation, they have longer half-lives and would likely cause drowsiness the next
morning/day. Additionally, use of the other drugs listed for primary treatment of insomnia would
be off-label.
Which antibiotic is demonstrated to be the most effective treatment for
community acquired pneumonia (CAP) in young adults without any co-morbidconditions?:
clarithromycin (Biaxin)
Clarithromycin is an antibiotic recommended by the American Thoracic Society fortreatment of
community acquired pneumonia (CAP) in young adults without co-mor-bid conditions.
Clarithromycin provides antimicrobial activity against Streptococcuspneumoniae, the most
common causative organism in CAP, and provides coveragefor other less common pathogens,
including Mycoplasma pneumoniae, Chlamydiapneumoniae, and Legionella pneumophlia
All of the following are associated with erectile dysfunction (ED) EXCEPT:-
: NSAIDs and oral hypoglycemic agents
APEA PRE-PREDICTOR NP EXAM
Neither NSAIDs nor hypoglycemic agents are associated with erectile dysfunction (ED). Male
diabetics frequently have ED, but it is due to the disease, not the medications used to treat
diabetes. Erectile dysfunction may also be caused by diuretics, spironolactone, anti-depressants,
peripheral neuropathy, and spinal injuryat S2 to S4 or higher.
The nurse practitioner suspects migraine in a 6 year old male with a 2 month history of
recurrent headache.What finding would support a diagnosisof migraine headache?: Family
history of migraine headache
The most common recurrent headache in children is migraine. There is a positivefamily history
75% of cases.
A 49 year old man sees the nurse practitioner for evaluation of a 2 millime-ter macular
lesion on his back. The lesion is brown with regular borders. Themost appropriate action for
the nurse practitioner is to:: reassure the patient that this lesion is not suspicious for pathology.
Lesions that are less than 5 millimeters, flat, with regular borders and even color,are not
suspicious for malignancy. This patient should be reassured.
A 45 year old with Type 1 diabetes mellitus has had itching and burning lesions between
her toes for 6 months. Scrapings of the lesions confirm the diagnosis tinea pedis. What is the
best treatment option for this patient?: Pre-scribe an anti-fungal powder for application
between her toes and in her shoes anda topical prescription strength anti-fungal cream for other
affected areas. Monitor fora secondary bacterial infection.
If the patient follows the treatment plan as outlined in choice "A", she should getsome relief in a
couple of weeks and resolution in 4 to 6 weeks. She should
2 20241007204521_6704486147D6E_APEA_PRE_PREDICTOR_NP_EXAM_____________________________________
,[Document title]
also monitor for a secondary bacterial infection. She has diabetes, may have poorcirculation, and
thus, might be expected to have a more difficult resolution of this
problem might be more difficult. If this course of treatment fails, the nurse practitionershould
consider oral antifungal therapy.
The nurse practitioner strongly suspects hyperthyroidism in a 62-year-oldpatient. Which
of the following would NOT be an appropriate initial interven- tion?: Start levothyroxine
(Synthroid) 0.025 mg (25 mcg) daily and re-assess in 2 weeks.
A common finding in hyperthyroidism is atrial fibrillation. A beta-adrenergic blockerwill treat
the A-fib and help control the anxiety and nervousness associated with uncontrolled
hyperthyroidism. A thyroid scan with radio opaque iodine will reveal any thyroid nodules (seen
as "hot spots"). The patient will require medical ablation or surgical removal of the thyroid gland,
so referral to an endocrinologist is indicated.Following correction of the hyperthyroid condition,
thyroid hormone replacement therapy for elders should begin with a low daily dose of 0.025 mg.
The most appropriate treatment for a child with mild croup is:: a cool mistvaporizer.
Mild croup usually does not need treatment. However, a cool mist vaporizer may beof benefit.
Croup is characterized by a barking cough and inspiratory stridor. A childwith inspiratory stridor
at rest probably needs hospitalization. Emergency treatmentof croup consists of an aerosolized
bronchodilator and dexamethasone.
A patient presents to the nurse practitioner with complaints of diarrhea and malaise
which started at 2:00 am the morning of the visit. After history and examination, the nurse
APEA
practitioner advises the patient thatPRE-PREDICTOR NPbe
the problem should EXAM
self-limiting. If the diarrhea does
not resolve, when should the nursepractitioner advise the patient to return?: 3 days
Diarrhea without systemic symptoms and fever should resolve in 3 days. If it does not, laboratory
studies and further testing may be necessary to identify the causativeorganism.
An obese 43-year-old has recurrent superficial fungal skin infections overthe past 2 years.
Today, she presents with intertriginous candida. Her skin
is macerated from frequent rubbing and scratching. The plan of care for thispatient should
include:: recommended screening for diabetes mellitus and HIV infection.
Skin infection with Candida albicans, a fungus, is characterized by shiny, red, plaques with
papules, and satellite lesions. Frequent fungal infection is an indicationfor screening for diseases
associated with decreased immunity, such as diabetes
3 20241007204521_6704486147D6E_APEA_PRE_PREDICTOR_NP_EXAM_____________________________________
, [Document title]
mellitus and HIV infection. Cornstarch powder absorbs and retains moisture and, therefore,
should not be used. Application of a moisturizing cream preparation wouldbe contraindicated. A
topical antibiotic is only indicated if a super-imposed bacterialinfection presents.
An obese hyperlipidemic patient, newly diagnosed with type 2 diabetes mellitus has
fasting blood glucose values 180 to 250 mg/dL (10.1-14 mmol/L).What is the most
appropriate initial treatment to consider?: A sulfonylurea and/or metformin (Glucophage -
XR)
Insulin should be considered in patients in whom life-style changes have been ineffective or in
patients who are symptomatic due to hyperglycemia. However, oralsare preferred by patients and
are usually initiated when clinically possible. Good oral choices initially are metformin, an
insulin sensitizer (thiazolidinedione), or a sulfonylurea. Beginning with insulin therapy is not
necessary unless the FBS is > 250 mg/dL (14 mmol/L) and quick control is needed.
Which of the following set of symptoms should raise suspicion of a braintumor?:
Holocranial headaches present in the morning and accompanied by pro- jectile vomiting without
nausea
Brain tumor size (mass) increases intracranial pressure which manifests as a holocranial headache
on morning awakening, often accompanied by projectile vomiting. Personality changes and focal
neurological deficits are other frequentlyassociated clinical findings.
A 15-year-old high school student presents with a mild sore throat andlow-grade fever
that has persisted for about 3 weeks. She reports gener- al malaise, fatigue, and loss of
appetite. The nurse practitioner suspects mononucleosis. Which of the following is the
LEAST appropriate interven- APEA PRE-PREDICTOR
tion?: Obtain a urinalysisNP EXAM
and serum for LFTs and amylase.
The clinical presentation of this patient is typical of mononucleosis. Lymphadenopa-thy,
splenomegaly, pharyngeal petechiae, and leukocytosis are common additionalfindings. Urinalysis,
serum amylase, and LFTs would not yield information regardingthe diagnosis. The confirmatory
tests are throat culture and the heterophil antibodytest.
A patient with shortness of breath has suspected heart failure. What eval-uation would
best help determine this?: BNP (brain natriuretic peptide)
BNP stands for B type natriuretic peptide. It is a hormone involved in regulation ofblood pressure
and fluid volume. When the BNP level is 80 pg/mL or greater, the
4 20241007204521_6704486147D6E_APEA_PRE_PREDICTOR_NP_EXAM_____________________________________
APEA PRE-PREDICTOR NP EXAM
Initial treatment of a child presenting with a severe head injury is:: aimedat resuscitation,
then maintenance of oxygenation and blood flow.
A head-injured patient requires that all related injuries be identified and treated, butthe most
immediate need is airway resuscitation, maintenance of oxygenation, andmaintenance of blood
flow. Cerebral edema, a major complication of head injury, ismanaged with adequate
oxygenation, elevation of the head and trunk to facilitate venous return from the head, isotonic
intravenous fluid administration maintaining low central venous pressure, and maintenance of
normal body temperature.
Eligibility requirements for the ANP or FNP exam include all of the follow-ing EXCEPT::
a masters degree in nursing or an area.
Today, NP students are prepared at the graduate level.There are nurse practitionerswho have
completed an accredited or approved non-graduate level educational program prior to
implementation of graduate level education requirements. Most states have "grandfathered" these
NPs into practice.
A 12-year-old presents with ear pain of 36 hours duration. The nurse practitioner
diagnoses acute otitis media because the:: bony landmarks are obscured and the tympanic
membrane is mildly erythematous, dull, and immobile.
APEA PRE-PREDICTOR NP EXAM
Serous otitis media typically presents with a flat or bulging and tympanic membranewith a fluid
line and/or tiny bubbles visible posteriorly. The tympanic membrane maybe immobile and retracted
against the bony landmarks when the eustachian tube isswollen or congested as with the common
cold or allergies. Narrowing of the externalcanal with erythema and extreme tenderness of the
canal wall is indicative of otitisexterna.
An appropriate initial treatment for external genital warts caused by humanpapilloma virus
(HPV) in a non-pregnant patient is:: topical trichloroacetic acid (TCA).
Appropriate initial treatment of external genital warts caused by HPV includes cryotherapy with
liquid nitrogen or cryoprobe, self-treatment with podofilox 0.5% solution, podophyllin 10%-25%,
trichloroacetic acid (TCA), or electrodesiccation orelectrocautery. 5-fluorouracil cream has not
been evaluated in controlled studies andis not recommended for treatment of genital warts.
Intralesional interferon is used for treatment of persistent and recurrent genital warts, but is not
recommended by the CDC. Topical acyclovir is not indicated for treatment of genital warts.
A 6-year-old presents with complaints of sore throat and fever for 2 days.He has multiple
vesiculated ulcerations on his tonsils and uvula.There are noother remarkable findings.
What is the most likely diagnosis?: Herpangina
Herpangina is a viral infection common in toddlers and young children caused by Coxsackie
virus. The clinical findings of numerous, small (1-2 mm) ulcerations on the tonsils and uvula are
typical of herpangina. The ulcerations can be very painfulbut usually resolve in 7 to 10 days.
Treatment is symptomatic.
The daughter of a 75-year-old patient reports that her mother roams thehouse at night
saying she cannot fall asleep. She has fallen twice. Of the following choices, which would be
1 20241007204521_6704486147D6E_APEA_PRE_PREDICTOR_NP_EXAM_____________________________________
,[Document title]
the most appropriate to treat her insom-nia?: doxepin (Sinequan)
Low dose doxepin (Sinequan) has been proven efficacious in the therapy of transientinsomnia,
producing improvements in wake after sleep onset, total sleep time and sleep-onset latency. Since
this patient is having difficulty falling asleep, she needs a drug which will produce drowsiness at
bedtime (sleep-onset latency). At low doses (<6mg/day), doxepin also has a good efficacy and
safety profile in elderly patients with chronic insomnia, with a safety profile comparable to placebo.
Elderly ordebilitated patients may be especially sensitive to the effects of zolpidem (Ambien).
Ambien can increase the risk of falls, as well as cause confusion. Although the other choices
would provide sedation, they have longer half-lives and would likely cause drowsiness the next
morning/day. Additionally, use of the other drugs listed for primary treatment of insomnia would
be off-label.
Which antibiotic is demonstrated to be the most effective treatment for
community acquired pneumonia (CAP) in young adults without any co-morbidconditions?:
clarithromycin (Biaxin)
Clarithromycin is an antibiotic recommended by the American Thoracic Society fortreatment of
community acquired pneumonia (CAP) in young adults without co-mor-bid conditions.
Clarithromycin provides antimicrobial activity against Streptococcuspneumoniae, the most
common causative organism in CAP, and provides coveragefor other less common pathogens,
including Mycoplasma pneumoniae, Chlamydiapneumoniae, and Legionella pneumophlia
All of the following are associated with erectile dysfunction (ED) EXCEPT:-
: NSAIDs and oral hypoglycemic agents
APEA PRE-PREDICTOR NP EXAM
Neither NSAIDs nor hypoglycemic agents are associated with erectile dysfunction (ED). Male
diabetics frequently have ED, but it is due to the disease, not the medications used to treat
diabetes. Erectile dysfunction may also be caused by diuretics, spironolactone, anti-depressants,
peripheral neuropathy, and spinal injuryat S2 to S4 or higher.
The nurse practitioner suspects migraine in a 6 year old male with a 2 month history of
recurrent headache.What finding would support a diagnosisof migraine headache?: Family
history of migraine headache
The most common recurrent headache in children is migraine. There is a positivefamily history
75% of cases.
A 49 year old man sees the nurse practitioner for evaluation of a 2 millime-ter macular
lesion on his back. The lesion is brown with regular borders. Themost appropriate action for
the nurse practitioner is to:: reassure the patient that this lesion is not suspicious for pathology.
Lesions that are less than 5 millimeters, flat, with regular borders and even color,are not
suspicious for malignancy. This patient should be reassured.
A 45 year old with Type 1 diabetes mellitus has had itching and burning lesions between
her toes for 6 months. Scrapings of the lesions confirm the diagnosis tinea pedis. What is the
best treatment option for this patient?: Pre-scribe an anti-fungal powder for application
between her toes and in her shoes anda topical prescription strength anti-fungal cream for other
affected areas. Monitor fora secondary bacterial infection.
If the patient follows the treatment plan as outlined in choice "A", she should getsome relief in a
couple of weeks and resolution in 4 to 6 weeks. She should
2 20241007204521_6704486147D6E_APEA_PRE_PREDICTOR_NP_EXAM_____________________________________
,[Document title]
also monitor for a secondary bacterial infection. She has diabetes, may have poorcirculation, and
thus, might be expected to have a more difficult resolution of this
problem might be more difficult. If this course of treatment fails, the nurse practitionershould
consider oral antifungal therapy.
The nurse practitioner strongly suspects hyperthyroidism in a 62-year-oldpatient. Which
of the following would NOT be an appropriate initial interven- tion?: Start levothyroxine
(Synthroid) 0.025 mg (25 mcg) daily and re-assess in 2 weeks.
A common finding in hyperthyroidism is atrial fibrillation. A beta-adrenergic blockerwill treat
the A-fib and help control the anxiety and nervousness associated with uncontrolled
hyperthyroidism. A thyroid scan with radio opaque iodine will reveal any thyroid nodules (seen
as "hot spots"). The patient will require medical ablation or surgical removal of the thyroid gland,
so referral to an endocrinologist is indicated.Following correction of the hyperthyroid condition,
thyroid hormone replacement therapy for elders should begin with a low daily dose of 0.025 mg.
The most appropriate treatment for a child with mild croup is:: a cool mistvaporizer.
Mild croup usually does not need treatment. However, a cool mist vaporizer may beof benefit.
Croup is characterized by a barking cough and inspiratory stridor. A childwith inspiratory stridor
at rest probably needs hospitalization. Emergency treatmentof croup consists of an aerosolized
bronchodilator and dexamethasone.
A patient presents to the nurse practitioner with complaints of diarrhea and malaise
which started at 2:00 am the morning of the visit. After history and examination, the nurse
APEA
practitioner advises the patient thatPRE-PREDICTOR NPbe
the problem should EXAM
self-limiting. If the diarrhea does
not resolve, when should the nursepractitioner advise the patient to return?: 3 days
Diarrhea without systemic symptoms and fever should resolve in 3 days. If it does not, laboratory
studies and further testing may be necessary to identify the causativeorganism.
An obese 43-year-old has recurrent superficial fungal skin infections overthe past 2 years.
Today, she presents with intertriginous candida. Her skin
is macerated from frequent rubbing and scratching. The plan of care for thispatient should
include:: recommended screening for diabetes mellitus and HIV infection.
Skin infection with Candida albicans, a fungus, is characterized by shiny, red, plaques with
papules, and satellite lesions. Frequent fungal infection is an indicationfor screening for diseases
associated with decreased immunity, such as diabetes
3 20241007204521_6704486147D6E_APEA_PRE_PREDICTOR_NP_EXAM_____________________________________
, [Document title]
mellitus and HIV infection. Cornstarch powder absorbs and retains moisture and, therefore,
should not be used. Application of a moisturizing cream preparation wouldbe contraindicated. A
topical antibiotic is only indicated if a super-imposed bacterialinfection presents.
An obese hyperlipidemic patient, newly diagnosed with type 2 diabetes mellitus has
fasting blood glucose values 180 to 250 mg/dL (10.1-14 mmol/L).What is the most
appropriate initial treatment to consider?: A sulfonylurea and/or metformin (Glucophage -
XR)
Insulin should be considered in patients in whom life-style changes have been ineffective or in
patients who are symptomatic due to hyperglycemia. However, oralsare preferred by patients and
are usually initiated when clinically possible. Good oral choices initially are metformin, an
insulin sensitizer (thiazolidinedione), or a sulfonylurea. Beginning with insulin therapy is not
necessary unless the FBS is > 250 mg/dL (14 mmol/L) and quick control is needed.
Which of the following set of symptoms should raise suspicion of a braintumor?:
Holocranial headaches present in the morning and accompanied by pro- jectile vomiting without
nausea
Brain tumor size (mass) increases intracranial pressure which manifests as a holocranial headache
on morning awakening, often accompanied by projectile vomiting. Personality changes and focal
neurological deficits are other frequentlyassociated clinical findings.
A 15-year-old high school student presents with a mild sore throat andlow-grade fever
that has persisted for about 3 weeks. She reports gener- al malaise, fatigue, and loss of
appetite. The nurse practitioner suspects mononucleosis. Which of the following is the
LEAST appropriate interven- APEA PRE-PREDICTOR
tion?: Obtain a urinalysisNP EXAM
and serum for LFTs and amylase.
The clinical presentation of this patient is typical of mononucleosis. Lymphadenopa-thy,
splenomegaly, pharyngeal petechiae, and leukocytosis are common additionalfindings. Urinalysis,
serum amylase, and LFTs would not yield information regardingthe diagnosis. The confirmatory
tests are throat culture and the heterophil antibodytest.
A patient with shortness of breath has suspected heart failure. What eval-uation would
best help determine this?: BNP (brain natriuretic peptide)
BNP stands for B type natriuretic peptide. It is a hormone involved in regulation ofblood pressure
and fluid volume. When the BNP level is 80 pg/mL or greater, the
4 20241007204521_6704486147D6E_APEA_PRE_PREDICTOR_NP_EXAM_____________________________________
