NSG 6998 APEA PRE-PREDICTOR EXAM PRACTICE (250 MCQS
TOTAL). EXAM | QUESTIONS AND ANSWERS | VERIFIED
ANSWERS PLUS RATIONALES | EXAM ALREADY GRADED
A+ | LATEST EXAM
1. A 65-year-old male presents with crushing substernal chest pain radiating to the left
arm. The most appropriate initial diagnostic test is:
A. Chest X-ray
B. Troponin level
C. ECG
D. BNP
Answer: C. ECG
Rationale: An ECG should be performed within 10 minutes of presentation to evaluate for
STEMI or other acute ischemic changes.
2. A patient with type 2 diabetes has an A1C of 9.5% despite metformin therapy. The next
best step is:
A. Discontinue metformin
B. Add basal insulin
C. Lifestyle modification only
D. Repeat A1C in 6 months
Answer: B. Add basal insulin
Rationale: An A1C >9% suggests need for dual therapy or insulin. Basal insulin is appropriate
when oral therapy fails.
3. The most common cause of hypothyroidism in the United States is:
A. Iodine deficiency
B. Graves disease
C. Hashimoto thyroiditis
D. Subacute thyroiditis
Answer: C. Hashimoto thyroiditis
Rationale: Autoimmune destruction of the thyroid gland is the leading cause of hypothyroidism
in the U.S.
4. A patient with COPD presents with increased dyspnea and purulent sputum. First-line
antibiotic therapy is:
,A. Amoxicillin
B. Azithromycin
C. Ciprofloxacin
D. Vancomycin
Answer: B. Azithromycin
Rationale: Macrolides are commonly used for COPD exacerbations with suspected bacterial
infection.
5. Which murmur is associated with hypertrophic cardiomyopathy?
A. Diastolic rumble
B. Holosystolic murmur
C. Crescendo-decrescendo systolic murmur
D. Continuous murmur
Answer: C. Crescendo-decrescendo systolic murmur
Rationale: HCM produces a systolic ejection murmur that increases with Valsalva.
6. The drug of choice for anaphylaxis is:
A. Diphenhydramine
B. Albuterol
C. Epinephrine IM
D. Prednisone
Answer: C. Epinephrine IM
Rationale: Intramuscular epinephrine is the first-line life-saving treatment for anaphylaxis.
7. A patient presents with unilateral facial droop and inability to close the eye. The likely
diagnosis is:
A. Stroke
B. Bell palsy
C. Myasthenia gravis
D. Trigeminal neuralgia
Answer: B. Bell palsy
Rationale: Peripheral facial nerve paralysis affects both upper and lower face.
8. First-line treatment for uncomplicated cystitis in a healthy woman:
A. Nitrofurantoin
B. Levofloxacin
C. Ceftriaxone IM
D. Doxycycline
,Answer: A. Nitrofurantoin
Rationale: Nitrofurantoin is recommended first-line for uncomplicated UTI.
9. The most common cause of iron deficiency anemia in adults is:
A. Poor diet
B. Chronic kidney disease
C. Blood loss
D. B12 deficiency
Answer: C. Blood loss
Rationale: In adults, iron deficiency anemia is most commonly due to chronic blood loss, often
GI.
10. Which medication is contraindicated in pregnancy?
A. Labetalol
B. Methyldopa
C. Lisinopril
D. Nifedipine
Answer: C. Lisinopril
Rationale: ACE inhibitors are teratogenic and contraindicated in pregnancy.
11. The hallmark lab finding in DKA is:
A. Metabolic alkalosis
B. Hyperkalemia with normal glucose
C. Metabolic acidosis with elevated anion gap
D. Hypoglycemia
Answer: C. Metabolic acidosis with elevated anion gap
Rationale: DKA presents with high glucose, ketones, and an anion gap metabolic acidosis.
12. Which vaccine is contraindicated in immunocompromised patients?
A. Influenza (inactivated)
B. Pneumococcal
C. MMR
D. Tdap
Answer: C. MMR
Rationale: MMR is a live attenuated vaccine and contraindicated in immunocompromised
individuals.
13. First-line therapy for GERD:
, A. H2 blocker
B. Proton pump inhibitor
C. Antacid only
D. Sucralfate
Answer: B. Proton pump inhibitor
Rationale: PPIs are the most effective therapy for GERD symptom control and healing.
14. The most sensitive test for pulmonary embolism in stable patients:
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
D. ABG
Answer: C. CT pulmonary angiography
Rationale: CT angiography is the diagnostic test of choice in stable patients.
15. A painless thyroid nodule should be evaluated first with:
A. TSH
B. T3
C. Ultrasound
D. Biopsy
Answer: A. TSH
Rationale: TSH determines thyroid function and guides further imaging.
16. The classic rash of Lyme disease is:
A. Vesicular
B. Petechial
C. Bullseye (erythema migrans)
D. Maculopapular
Answer: C. Bullseye (erythema migrans)
Rationale: Erythema migrans is pathognomonic for Lyme disease.
17. Which antihypertensive is first-line in diabetic patients?
A. Beta blocker
B. ACE inhibitor
C. Calcium channel blocker
D. Clonidine
TOTAL). EXAM | QUESTIONS AND ANSWERS | VERIFIED
ANSWERS PLUS RATIONALES | EXAM ALREADY GRADED
A+ | LATEST EXAM
1. A 65-year-old male presents with crushing substernal chest pain radiating to the left
arm. The most appropriate initial diagnostic test is:
A. Chest X-ray
B. Troponin level
C. ECG
D. BNP
Answer: C. ECG
Rationale: An ECG should be performed within 10 minutes of presentation to evaluate for
STEMI or other acute ischemic changes.
2. A patient with type 2 diabetes has an A1C of 9.5% despite metformin therapy. The next
best step is:
A. Discontinue metformin
B. Add basal insulin
C. Lifestyle modification only
D. Repeat A1C in 6 months
Answer: B. Add basal insulin
Rationale: An A1C >9% suggests need for dual therapy or insulin. Basal insulin is appropriate
when oral therapy fails.
3. The most common cause of hypothyroidism in the United States is:
A. Iodine deficiency
B. Graves disease
C. Hashimoto thyroiditis
D. Subacute thyroiditis
Answer: C. Hashimoto thyroiditis
Rationale: Autoimmune destruction of the thyroid gland is the leading cause of hypothyroidism
in the U.S.
4. A patient with COPD presents with increased dyspnea and purulent sputum. First-line
antibiotic therapy is:
,A. Amoxicillin
B. Azithromycin
C. Ciprofloxacin
D. Vancomycin
Answer: B. Azithromycin
Rationale: Macrolides are commonly used for COPD exacerbations with suspected bacterial
infection.
5. Which murmur is associated with hypertrophic cardiomyopathy?
A. Diastolic rumble
B. Holosystolic murmur
C. Crescendo-decrescendo systolic murmur
D. Continuous murmur
Answer: C. Crescendo-decrescendo systolic murmur
Rationale: HCM produces a systolic ejection murmur that increases with Valsalva.
6. The drug of choice for anaphylaxis is:
A. Diphenhydramine
B. Albuterol
C. Epinephrine IM
D. Prednisone
Answer: C. Epinephrine IM
Rationale: Intramuscular epinephrine is the first-line life-saving treatment for anaphylaxis.
7. A patient presents with unilateral facial droop and inability to close the eye. The likely
diagnosis is:
A. Stroke
B. Bell palsy
C. Myasthenia gravis
D. Trigeminal neuralgia
Answer: B. Bell palsy
Rationale: Peripheral facial nerve paralysis affects both upper and lower face.
8. First-line treatment for uncomplicated cystitis in a healthy woman:
A. Nitrofurantoin
B. Levofloxacin
C. Ceftriaxone IM
D. Doxycycline
,Answer: A. Nitrofurantoin
Rationale: Nitrofurantoin is recommended first-line for uncomplicated UTI.
9. The most common cause of iron deficiency anemia in adults is:
A. Poor diet
B. Chronic kidney disease
C. Blood loss
D. B12 deficiency
Answer: C. Blood loss
Rationale: In adults, iron deficiency anemia is most commonly due to chronic blood loss, often
GI.
10. Which medication is contraindicated in pregnancy?
A. Labetalol
B. Methyldopa
C. Lisinopril
D. Nifedipine
Answer: C. Lisinopril
Rationale: ACE inhibitors are teratogenic and contraindicated in pregnancy.
11. The hallmark lab finding in DKA is:
A. Metabolic alkalosis
B. Hyperkalemia with normal glucose
C. Metabolic acidosis with elevated anion gap
D. Hypoglycemia
Answer: C. Metabolic acidosis with elevated anion gap
Rationale: DKA presents with high glucose, ketones, and an anion gap metabolic acidosis.
12. Which vaccine is contraindicated in immunocompromised patients?
A. Influenza (inactivated)
B. Pneumococcal
C. MMR
D. Tdap
Answer: C. MMR
Rationale: MMR is a live attenuated vaccine and contraindicated in immunocompromised
individuals.
13. First-line therapy for GERD:
, A. H2 blocker
B. Proton pump inhibitor
C. Antacid only
D. Sucralfate
Answer: B. Proton pump inhibitor
Rationale: PPIs are the most effective therapy for GERD symptom control and healing.
14. The most sensitive test for pulmonary embolism in stable patients:
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
D. ABG
Answer: C. CT pulmonary angiography
Rationale: CT angiography is the diagnostic test of choice in stable patients.
15. A painless thyroid nodule should be evaluated first with:
A. TSH
B. T3
C. Ultrasound
D. Biopsy
Answer: A. TSH
Rationale: TSH determines thyroid function and guides further imaging.
16. The classic rash of Lyme disease is:
A. Vesicular
B. Petechial
C. Bullseye (erythema migrans)
D. Maculopapular
Answer: C. Bullseye (erythema migrans)
Rationale: Erythema migrans is pathognomonic for Lyme disease.
17. Which antihypertensive is first-line in diabetic patients?
A. Beta blocker
B. ACE inhibitor
C. Calcium channel blocker
D. Clonidine
