APEA Predictor Exam Questions – All-New
Combined 7 Test Bank & All Versions Exam
Bundle – Updated 2025/2026 NP
Certification Prep with Detailed Rationales
A 15 years old high school student with a mild sore throat and low-grade
fever that has persisted for about 3 weeks. She reports general malaise,
fatigue, and loss of appetite. The NP suspects mononucleosis. Which of the
following is the LEAST appropriate intervention?
Palpate the lymph nodes and spleen
Examine the posterior oropharynx for petechiae Obtain a CBC, throat
culture, and heterophil antibody test.
Obtain an urinalyses and serum for LFTs and amylase - Answer-:Obtain
an urinalyses and serum for LFTs and amylase
Explanation: mononucleosis is a symptomatic infection caused by the
Epstein-Bar virus. Common is people 15-24 years of age. Common signs
and symptoms following incubation period (1-2 months) include fatigue,
chills, malaise, anorexia, white tonsillar exudates and lymphadenopathy or
posterior cervical region. Splenomegaly can be present. A maculopapular or
occasionally a petechial rash occurs in less than 15% of patients. A diagnosis
is usually made using the Monospot. In addition, neutropenia and
lymphocytosis are usually detected in the CBC
A 32 years old male patient complaint of urinary frequency and burning on
urination for 3 days. Urinalyses reveals bacteriuria and positive nitrites. He
denies any past hx. Of urinary tract infections. The initial treatment should
be:
,a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day
b. ciprofloxacin (Cipro) for 3-5 days
c. Trimethoprim-Sulfamethoxazole for 3 days
d. 750 mg ciprofloxacin as a one-time dose - Answer-:. trimethoprim-
sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day
Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n
appropriate medication to treat urinary tract infections in most patients. In
the case of community resistance to TMPS >20%^, another medication
should be substituted. In men, the appropriate length of time is 7 10 days.
Women may be treated for 3 days for uncomplicated UTI
Question 1
A 68-year-old African American male with a 15-year history of type 2
diabetes, hypertension, and stage 3B CKD (eGFR 38 mL/min) presents for
annual wellness. Medications: metformin 1000 mg BID, lisinopril 40 mg
daily, atorvastatin 40 mg daily, aspirin 81 mg. Today’s labs: A1c 8.9%,
potassium 5.4 mEq/L, eGFR 35 mL/min (down from 42 last year), urine
albumin/creatinine ratio 480 mg/g. BP 148/88 mmHg. He denies
symptoms. According to the 2025 ADA Standards of Care and KDIGO CKD
guidelines, what is the single best next pharmacologic step?
A. Discontinue metformin and start sitagliptin 25 mg daily
B. Add empagliflozin 10 mg daily
C. Increase lisinopril to 80 mg daily
D. Add semaglutide 0.5 mg subcutaneously weekly
Answer-: B
Explanation: This patient has diabetic kidney disease (DKD) with
macroalbuminuria (>300 mg/g) and progressive eGFR decline. The 2025
ADA and KDIGO guidelines give a Grade A recommendation for SGLT2
inhibitors (empagliflozin, dapagliflozin, canagliflozin) in all type 2 diabetics
,with CKD (eGFR ≥20 mL/min) regardless of A1c, because they reduce
progression of CKD by 30–40%, decrease heart failure hospitalization by
35%, and reduce cardiovascular death by 30% (DAPA-CKD, EMPA-
KIDNEY, CREDENCE trials). Benefits are seen even on maximal RAAS
blockade and are additive to GLP-1 RA therapy. Metformin can still be used
down to eGFR 30 (option A incorrect). Semaglutide (option D) is excellent
for glycemic control and CV protection but has weaker renal protection data
compared to SGLT2i in patients with established albuminuric DKD.
Increasing lisinopril beyond 40 mg (option C) provides no additional
benefit and increases hyperkalemia risk. Correct action: start empagliflozin
10 mg daily (can initiate at eGFR ≥20), continue metformin (still safe),
monitor potassium and volume status.
Question 2
A 24-year-old female G1P0 at 28 weeks gestation presents with new-onset
severe-range hypertension (162/108 mmHg confirmed on two readings)
and 2+ proteinuria on dipstick. She has headache and right upper quadrant
pain. Labs: platelets 98,000/mm³, AST 98 U/L, creatinine 1.1 mg/dL.
Diagnosis: preeclampsia with severe features. According to 2025 ACOG
guidelines, what is the definitive treatment?
A. Start oral labetalol 200 mg BID and continue pregnancy to 37 weeks
B. Immediate delivery (vaginal or cesarean) after betamethasone and
magnesium seizure prophylaxis
C. Start IV hydralazine and nifedipine and plan delivery at 34 weeks
D. Hospitalize for bed rest and daily fetal testing until 37 weeks
Answer-: B
Explanation: ACOG 2025 re-classifies preeclampsia with severe features
(including thrombocytopenia <100,000, transaminitis ≥2× ULN, RUQ
pain, or new cerebral/visual symptoms) as an indication for delivery at ≥34
weeks after corticosteroid administration for lung maturity (if <34 weeks)
and magnesium sulfate seizure prophylaxis. Delivery is the only definitive
cure. Expectant management is no longer recommended once severe
, features are present due to increased risk of abruption, eclampsia, HELLP,
and maternal stroke (relative risk increase 4–10×). Oral antihypertensives
(option A) are insufficient for severe-range BP. Hydralazine/nifedipine
(option C) are used intrapartum but do not alter the need for delivery. Bed
rest (option D) is harmful and abandoned.
Question 3
A 58-year-old postmenopausal female presents with a 3-day history of
dysuria, urgency, frequency, and suprapubic pain. She has had 4
documented UTIs in the past year. Urinalysis: >50 WBC/hpf, nitrites
positive, 2+ LE, no blood. She is afebrile, no flank pain. According to the
2025 AUA/IDSA uncomplicated cystitis guidelines in the era of increasing
resistance, what is the best empiric regimen?
A. Nitrofurantoin monohydrate 100 mg BID × 5 days
B. Trimethoprim-sulfamethoxazole DS BID × 3 days
C. Ciprofloxacin 250 mg BID × 3 days
D. Cephalexin 500 mg QID × 7 days
Answer-: A
Explanation: Nitrofurantoin remains first-line for uncomplicated cystitis in
2025 (resistance <3% nationally) with excellent tissue penetration, minimal
collateral damage to vaginal/vaginal flora, and preserved efficacy. Local E.
coli resistance to TMP-SMX now exceeds 25–30% in most U.S. regions,
making it second-line unless susceptibility confirmed. Fluoroquinolones
(ciprofloxacin) are now reserve agents due to FDA black-box warnings
(tendinopathy, aortic dissection, neuropathy) and should be avoided when
alternatives exist. Beta-lactams (cephalexin) have higher resistance and
require longer courses. For recurrent UTI (>3/year), consider post-coital
prophylaxis or daily nitrofurantoin 50–100 mg.
Question 4
A 42-year-old male with alcohol use disorder (10 drinks/day) presents to
the ED intoxicated after a fall. He is agitated, HR 118, BP 168/98,
Combined 7 Test Bank & All Versions Exam
Bundle – Updated 2025/2026 NP
Certification Prep with Detailed Rationales
A 15 years old high school student with a mild sore throat and low-grade
fever that has persisted for about 3 weeks. She reports general malaise,
fatigue, and loss of appetite. The NP suspects mononucleosis. Which of the
following is the LEAST appropriate intervention?
Palpate the lymph nodes and spleen
Examine the posterior oropharynx for petechiae Obtain a CBC, throat
culture, and heterophil antibody test.
Obtain an urinalyses and serum for LFTs and amylase - Answer-:Obtain
an urinalyses and serum for LFTs and amylase
Explanation: mononucleosis is a symptomatic infection caused by the
Epstein-Bar virus. Common is people 15-24 years of age. Common signs
and symptoms following incubation period (1-2 months) include fatigue,
chills, malaise, anorexia, white tonsillar exudates and lymphadenopathy or
posterior cervical region. Splenomegaly can be present. A maculopapular or
occasionally a petechial rash occurs in less than 15% of patients. A diagnosis
is usually made using the Monospot. In addition, neutropenia and
lymphocytosis are usually detected in the CBC
A 32 years old male patient complaint of urinary frequency and burning on
urination for 3 days. Urinalyses reveals bacteriuria and positive nitrites. He
denies any past hx. Of urinary tract infections. The initial treatment should
be:
,a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day
b. ciprofloxacin (Cipro) for 3-5 days
c. Trimethoprim-Sulfamethoxazole for 3 days
d. 750 mg ciprofloxacin as a one-time dose - Answer-:. trimethoprim-
sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day
Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n
appropriate medication to treat urinary tract infections in most patients. In
the case of community resistance to TMPS >20%^, another medication
should be substituted. In men, the appropriate length of time is 7 10 days.
Women may be treated for 3 days for uncomplicated UTI
Question 1
A 68-year-old African American male with a 15-year history of type 2
diabetes, hypertension, and stage 3B CKD (eGFR 38 mL/min) presents for
annual wellness. Medications: metformin 1000 mg BID, lisinopril 40 mg
daily, atorvastatin 40 mg daily, aspirin 81 mg. Today’s labs: A1c 8.9%,
potassium 5.4 mEq/L, eGFR 35 mL/min (down from 42 last year), urine
albumin/creatinine ratio 480 mg/g. BP 148/88 mmHg. He denies
symptoms. According to the 2025 ADA Standards of Care and KDIGO CKD
guidelines, what is the single best next pharmacologic step?
A. Discontinue metformin and start sitagliptin 25 mg daily
B. Add empagliflozin 10 mg daily
C. Increase lisinopril to 80 mg daily
D. Add semaglutide 0.5 mg subcutaneously weekly
Answer-: B
Explanation: This patient has diabetic kidney disease (DKD) with
macroalbuminuria (>300 mg/g) and progressive eGFR decline. The 2025
ADA and KDIGO guidelines give a Grade A recommendation for SGLT2
inhibitors (empagliflozin, dapagliflozin, canagliflozin) in all type 2 diabetics
,with CKD (eGFR ≥20 mL/min) regardless of A1c, because they reduce
progression of CKD by 30–40%, decrease heart failure hospitalization by
35%, and reduce cardiovascular death by 30% (DAPA-CKD, EMPA-
KIDNEY, CREDENCE trials). Benefits are seen even on maximal RAAS
blockade and are additive to GLP-1 RA therapy. Metformin can still be used
down to eGFR 30 (option A incorrect). Semaglutide (option D) is excellent
for glycemic control and CV protection but has weaker renal protection data
compared to SGLT2i in patients with established albuminuric DKD.
Increasing lisinopril beyond 40 mg (option C) provides no additional
benefit and increases hyperkalemia risk. Correct action: start empagliflozin
10 mg daily (can initiate at eGFR ≥20), continue metformin (still safe),
monitor potassium and volume status.
Question 2
A 24-year-old female G1P0 at 28 weeks gestation presents with new-onset
severe-range hypertension (162/108 mmHg confirmed on two readings)
and 2+ proteinuria on dipstick. She has headache and right upper quadrant
pain. Labs: platelets 98,000/mm³, AST 98 U/L, creatinine 1.1 mg/dL.
Diagnosis: preeclampsia with severe features. According to 2025 ACOG
guidelines, what is the definitive treatment?
A. Start oral labetalol 200 mg BID and continue pregnancy to 37 weeks
B. Immediate delivery (vaginal or cesarean) after betamethasone and
magnesium seizure prophylaxis
C. Start IV hydralazine and nifedipine and plan delivery at 34 weeks
D. Hospitalize for bed rest and daily fetal testing until 37 weeks
Answer-: B
Explanation: ACOG 2025 re-classifies preeclampsia with severe features
(including thrombocytopenia <100,000, transaminitis ≥2× ULN, RUQ
pain, or new cerebral/visual symptoms) as an indication for delivery at ≥34
weeks after corticosteroid administration for lung maturity (if <34 weeks)
and magnesium sulfate seizure prophylaxis. Delivery is the only definitive
cure. Expectant management is no longer recommended once severe
, features are present due to increased risk of abruption, eclampsia, HELLP,
and maternal stroke (relative risk increase 4–10×). Oral antihypertensives
(option A) are insufficient for severe-range BP. Hydralazine/nifedipine
(option C) are used intrapartum but do not alter the need for delivery. Bed
rest (option D) is harmful and abandoned.
Question 3
A 58-year-old postmenopausal female presents with a 3-day history of
dysuria, urgency, frequency, and suprapubic pain. She has had 4
documented UTIs in the past year. Urinalysis: >50 WBC/hpf, nitrites
positive, 2+ LE, no blood. She is afebrile, no flank pain. According to the
2025 AUA/IDSA uncomplicated cystitis guidelines in the era of increasing
resistance, what is the best empiric regimen?
A. Nitrofurantoin monohydrate 100 mg BID × 5 days
B. Trimethoprim-sulfamethoxazole DS BID × 3 days
C. Ciprofloxacin 250 mg BID × 3 days
D. Cephalexin 500 mg QID × 7 days
Answer-: A
Explanation: Nitrofurantoin remains first-line for uncomplicated cystitis in
2025 (resistance <3% nationally) with excellent tissue penetration, minimal
collateral damage to vaginal/vaginal flora, and preserved efficacy. Local E.
coli resistance to TMP-SMX now exceeds 25–30% in most U.S. regions,
making it second-line unless susceptibility confirmed. Fluoroquinolones
(ciprofloxacin) are now reserve agents due to FDA black-box warnings
(tendinopathy, aortic dissection, neuropathy) and should be avoided when
alternatives exist. Beta-lactams (cephalexin) have higher resistance and
require longer courses. For recurrent UTI (>3/year), consider post-coital
prophylaxis or daily nitrofurantoin 50–100 mg.
Question 4
A 42-year-old male with alcohol use disorder (10 drinks/day) presents to
the ED intoxicated after a fall. He is agitated, HR 118, BP 168/98,
