NR 603
NR 603 Week 4 APEA Predictor Exam Review 2026 |
Practice Questions with Correct Answers & Rationales
| Latest Updated Version Graded A+
A 55-year-old female with a history of hypertension and type 2 diabetes presents with a
2-week history of progressive weakness in her right arm and leg, along with difficulty finding
words during conversation. Her symptoms are most pronounced in the morning and improve
slightly as the day progresses. A non-contrast head CT is normal. What is the most appropriate
next step?
○ A. Administer IV tPA immediately
○ B. Obtain an MRI of the brain with diffusion-weighted imaging
○ C. Start aspirin 325 mg daily
○ D. Refer for carotid endarterectomy
CORRECT ANSWER: B. Obtain an MRI of the brain with diffusion-weighted imaging
RATIONALE: The clinical presentation of unilateral weakness and expressive aphasia that
fluctuates suggests a transient ischemic attack (TIA) or an acute ischemic stroke. A normal
non-contrast head CT within the first 24 hours does not rule out an acute infarction, as early
ischemic changes may not be visible. Diffusion-weighted imaging (DWI) on MRI is the most
sensitive modality for detecting acute ischemic stroke within minutes of onset. IV tPA (A) is
time-sensitive and requires confirmation of stroke and exclusion of hemorrhage, which would
require more than a normal CT in this subacute/fluctuating scenario. Aspirin (C) is appropriate
secondary prevention but not the immediate diagnostic next step. Carotid endarterectomy (D)
is a surgical intervention for significant carotid stenosis, which would be evaluated only after
imaging confirms the diagnosis and etiology.
A 72-year-old man with a history of benign prostatic hyperplasia presents with acute urinary
retention and suprapubic pain. He has a distended bladder on palpation. Which of the
following is the most appropriate immediate intervention?
○ A. Prescribe tamsulosin
○ B. Perform a urethral catheterization
○ C. Schedule a transurethral resection of the prostate
○ D. Order a serum PSA level
CORRECT ANSWER: B. Perform a urethral catheterization
,NR 603
RATIONALE: Acute urinary retention with a palpable distended bladder is a medical
emergency that requires immediate bladder decompression. Urethral catheterization is the
standard first-line intervention to relieve obstruction, prevent bladder wall ischemia, and avoid
renal impairment. Tamsulosin (A) is an alpha-blocker used for chronic symptomatic
management but takes days to have effect and does not relieve acute obstruction rapidly.
Transurethral resection (C) is a surgical procedure indicated for refractory cases after initial
stabilization, not as an immediate step. Serum PSA (D) would be falsely elevated in acute
retention and is not appropriate during an acute episode; it should be deferred until the
retention is resolved.
A 34-year-old pregnant woman at 28 weeks gestation presents with a 3-day history of
progressively worsening headache, blurred vision, and epigastric pain. Her blood pressure is
168/102 mmHg and urine dipstick shows 3+ protein. What is the most likely diagnosis?
○ A. Gestational hypertension
○ B. Preeclampsia with severe features
○ C. Acute fatty liver of pregnancy
○ D. Migraine with aura
CORRECT ANSWER: B. Preeclampsia with severe features
RATIONALE: The presence of new-onset hypertension (≥160/110 mmHg) with proteinuria and
symptoms of severe headache, visual disturbances, and epigastric pain at ≥20 weeks gestation
is classic for preeclampsia with severe features. This is a hypertensive emergency of pregnancy
that carries high maternal and fetal risk. Gestational hypertension (A) is hypertension without
proteinuria or end-organ symptoms. Acute fatty liver of pregnancy (C) typically presents with
jaundice, hypoglycemia, and elevated liver enzymes, not primarily with hypertension and
proteinuria. Migraine with aura (D) does not explain the elevated blood pressure, proteinuria,
or epigastric pain, which suggests hepatic involvement in preeclampsia.
A 6-year-old child presents with a 2-day history of fever, sore throat, and a fine, sandpaper-like
rash that began on the trunk and spread to the extremities. The tonsils are erythematous and
covered with a white exudate. What is the most appropriate diagnostic test?
○ A. Rapid strep antigen test
○ B. Throat culture for viral pathogens
○ C. Complete blood count with differential
○ D. Monospot test
CORRECT ANSWER: A. Rapid strep antigen test
,NR 603
RATIONALE: The classic presentation of fever, pharyngitis with exudate, and a sandpaper-like
rash (scarlatiniform) in a school-age child is highly suggestive of group A Streptococcus
pharyngitis (scarlet fever). A rapid strep antigen test is the most appropriate initial diagnostic
test because it provides results quickly and has high specificity, allowing prompt antibiotic
therapy to prevent rheumatic fever and other complications. Throat culture for viral pathogens
(B) is not indicated when bacterial pharyngitis is strongly suspected. A CBC (C) is non-specific
and not diagnostically helpful in this scenario. The Monospot test (D) is used for infectious
mononucleosis, which typically presents with fatigue, splenomegaly, and atypical lymphocytes,
not a sandpaper rash.
A 62-year-old male with a 30-year history of type 2 diabetes presents with a non-healing ulcer
on the plantar surface of his left foot. The ulcer is 2 cm in diameter, has a yellowish base with
surrounding erythema, and there is no palpable dorsalis pedis or posterior tibial pulse. Which
of the following is the most important initial step in management?
○ A. Start broad-spectrum oral antibiotics
○ B. Obtain an ankle-brachial index and vascular consult
○ C. Debride the ulcer and apply a moist dressing
○ D. Order a plain radiograph of the foot
CORRECT ANSWER: B. Obtain an ankle-brachial index and vascular consult
RATIONALE: In a diabetic patient with a non-healing plantar ulcer and absent pedal pulses,
peripheral arterial disease (PAD) is a major concern. The most important initial step is to assess
vascular status with an ankle-brachial index (ABI) and obtain a vascular surgery consultation, as
inadequate perfusion is the primary barrier to wound healing and may require
revascularization. Antibiotics (A) are not the first step until infection is confirmed and vascular
status is known. Debridement (C) without assessing perfusion can worsen the ulcer if blood
supply is inadequate. Plain radiograph (D) is useful for osteomyelitis but does not address the
critical vascular assessment needed first.
A 28-year-old female presents with palpitations, heat intolerance, weight loss despite increased
appetite, and fine tremors of her hands. On examination, she has a diffuse, non-tender goiter
and mild exophthalmos. What is the most likely diagnosis?
○ A. Hashimoto thyroiditis
○ B. Graves disease
○ C. Subacute thyroiditis
○ D. Toxic multinodular goiter
, NR 603
CORRECT ANSWER: B. Graves disease
RATIONALE: The classic triad of hyperthyroidism (palpitations, heat intolerance, weight loss),
diffuse goiter, and ophthalmopathy (exophthalmos) is pathognomonic for Graves disease, an
autoimmune disorder causing thyroid-stimulating antibodies. Hashimoto thyroiditis (A)
typically causes hypothyroidism, not hyperthyroidism. Subacute thyroiditis (C) presents with a
painful goiter and often follows a viral illness. Toxic multinodular goiter (D) occurs in older
adults, lacks ophthalmopathy, and presents with a nodular rather than diffuse goiter.
A 45-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and
nystagmus. He reports that he has been eating poorly for weeks. What is the most likely
vitamin deficiency causing his symptoms?
○ A. Vitamin B12
○ B. Thiamine (B1)
○ C. Folate
○ D. Vitamin D
CORRECT ANSWER: B. Thiamine (B1)
RATIONALE: The classic triad of confusion, ataxia, and nystagmus/ophthalmoplegia in a
patient with chronic alcohol use and poor nutrition is Wernicke encephalopathy, caused by
severe thiamine (vitamin B1) deficiency. This is a medical emergency requiring prompt
parenteral thiamine replacement to prevent progression to Korsakoff syndrome or permanent
brain damage. Vitamin B12 deficiency (A) causes subacute combined degeneration with
peripheral neuropathy and dorsal column signs, not this specific triad. Folate deficiency (C)
causes megaloblastic anemia and glossitis, not ataxia and nystagmus. Vitamin D deficiency (D)
causes bone pain and muscle weakness, not encephalopathy.
A 50-year-old female presents with a 3-month history of progressive proximal muscle
weakness, making it difficult to rise from a chair and comb her hair. She also reports a
heliotrope rash on her eyelids and Gottron papules on her knuckles. Which of the following is
the most specific diagnostic test?
○ A. Serum creatine kinase (CK)
○ B. Antinuclear antibody (ANA)
○ C. Anti-Jo-1 antibody
○ D. Muscle biopsy
CORRECT ANSWER: C. Anti-Jo-1 antibody
NR 603 Week 4 APEA Predictor Exam Review 2026 |
Practice Questions with Correct Answers & Rationales
| Latest Updated Version Graded A+
A 55-year-old female with a history of hypertension and type 2 diabetes presents with a
2-week history of progressive weakness in her right arm and leg, along with difficulty finding
words during conversation. Her symptoms are most pronounced in the morning and improve
slightly as the day progresses. A non-contrast head CT is normal. What is the most appropriate
next step?
○ A. Administer IV tPA immediately
○ B. Obtain an MRI of the brain with diffusion-weighted imaging
○ C. Start aspirin 325 mg daily
○ D. Refer for carotid endarterectomy
CORRECT ANSWER: B. Obtain an MRI of the brain with diffusion-weighted imaging
RATIONALE: The clinical presentation of unilateral weakness and expressive aphasia that
fluctuates suggests a transient ischemic attack (TIA) or an acute ischemic stroke. A normal
non-contrast head CT within the first 24 hours does not rule out an acute infarction, as early
ischemic changes may not be visible. Diffusion-weighted imaging (DWI) on MRI is the most
sensitive modality for detecting acute ischemic stroke within minutes of onset. IV tPA (A) is
time-sensitive and requires confirmation of stroke and exclusion of hemorrhage, which would
require more than a normal CT in this subacute/fluctuating scenario. Aspirin (C) is appropriate
secondary prevention but not the immediate diagnostic next step. Carotid endarterectomy (D)
is a surgical intervention for significant carotid stenosis, which would be evaluated only after
imaging confirms the diagnosis and etiology.
A 72-year-old man with a history of benign prostatic hyperplasia presents with acute urinary
retention and suprapubic pain. He has a distended bladder on palpation. Which of the
following is the most appropriate immediate intervention?
○ A. Prescribe tamsulosin
○ B. Perform a urethral catheterization
○ C. Schedule a transurethral resection of the prostate
○ D. Order a serum PSA level
CORRECT ANSWER: B. Perform a urethral catheterization
,NR 603
RATIONALE: Acute urinary retention with a palpable distended bladder is a medical
emergency that requires immediate bladder decompression. Urethral catheterization is the
standard first-line intervention to relieve obstruction, prevent bladder wall ischemia, and avoid
renal impairment. Tamsulosin (A) is an alpha-blocker used for chronic symptomatic
management but takes days to have effect and does not relieve acute obstruction rapidly.
Transurethral resection (C) is a surgical procedure indicated for refractory cases after initial
stabilization, not as an immediate step. Serum PSA (D) would be falsely elevated in acute
retention and is not appropriate during an acute episode; it should be deferred until the
retention is resolved.
A 34-year-old pregnant woman at 28 weeks gestation presents with a 3-day history of
progressively worsening headache, blurred vision, and epigastric pain. Her blood pressure is
168/102 mmHg and urine dipstick shows 3+ protein. What is the most likely diagnosis?
○ A. Gestational hypertension
○ B. Preeclampsia with severe features
○ C. Acute fatty liver of pregnancy
○ D. Migraine with aura
CORRECT ANSWER: B. Preeclampsia with severe features
RATIONALE: The presence of new-onset hypertension (≥160/110 mmHg) with proteinuria and
symptoms of severe headache, visual disturbances, and epigastric pain at ≥20 weeks gestation
is classic for preeclampsia with severe features. This is a hypertensive emergency of pregnancy
that carries high maternal and fetal risk. Gestational hypertension (A) is hypertension without
proteinuria or end-organ symptoms. Acute fatty liver of pregnancy (C) typically presents with
jaundice, hypoglycemia, and elevated liver enzymes, not primarily with hypertension and
proteinuria. Migraine with aura (D) does not explain the elevated blood pressure, proteinuria,
or epigastric pain, which suggests hepatic involvement in preeclampsia.
A 6-year-old child presents with a 2-day history of fever, sore throat, and a fine, sandpaper-like
rash that began on the trunk and spread to the extremities. The tonsils are erythematous and
covered with a white exudate. What is the most appropriate diagnostic test?
○ A. Rapid strep antigen test
○ B. Throat culture for viral pathogens
○ C. Complete blood count with differential
○ D. Monospot test
CORRECT ANSWER: A. Rapid strep antigen test
,NR 603
RATIONALE: The classic presentation of fever, pharyngitis with exudate, and a sandpaper-like
rash (scarlatiniform) in a school-age child is highly suggestive of group A Streptococcus
pharyngitis (scarlet fever). A rapid strep antigen test is the most appropriate initial diagnostic
test because it provides results quickly and has high specificity, allowing prompt antibiotic
therapy to prevent rheumatic fever and other complications. Throat culture for viral pathogens
(B) is not indicated when bacterial pharyngitis is strongly suspected. A CBC (C) is non-specific
and not diagnostically helpful in this scenario. The Monospot test (D) is used for infectious
mononucleosis, which typically presents with fatigue, splenomegaly, and atypical lymphocytes,
not a sandpaper rash.
A 62-year-old male with a 30-year history of type 2 diabetes presents with a non-healing ulcer
on the plantar surface of his left foot. The ulcer is 2 cm in diameter, has a yellowish base with
surrounding erythema, and there is no palpable dorsalis pedis or posterior tibial pulse. Which
of the following is the most important initial step in management?
○ A. Start broad-spectrum oral antibiotics
○ B. Obtain an ankle-brachial index and vascular consult
○ C. Debride the ulcer and apply a moist dressing
○ D. Order a plain radiograph of the foot
CORRECT ANSWER: B. Obtain an ankle-brachial index and vascular consult
RATIONALE: In a diabetic patient with a non-healing plantar ulcer and absent pedal pulses,
peripheral arterial disease (PAD) is a major concern. The most important initial step is to assess
vascular status with an ankle-brachial index (ABI) and obtain a vascular surgery consultation, as
inadequate perfusion is the primary barrier to wound healing and may require
revascularization. Antibiotics (A) are not the first step until infection is confirmed and vascular
status is known. Debridement (C) without assessing perfusion can worsen the ulcer if blood
supply is inadequate. Plain radiograph (D) is useful for osteomyelitis but does not address the
critical vascular assessment needed first.
A 28-year-old female presents with palpitations, heat intolerance, weight loss despite increased
appetite, and fine tremors of her hands. On examination, she has a diffuse, non-tender goiter
and mild exophthalmos. What is the most likely diagnosis?
○ A. Hashimoto thyroiditis
○ B. Graves disease
○ C. Subacute thyroiditis
○ D. Toxic multinodular goiter
, NR 603
CORRECT ANSWER: B. Graves disease
RATIONALE: The classic triad of hyperthyroidism (palpitations, heat intolerance, weight loss),
diffuse goiter, and ophthalmopathy (exophthalmos) is pathognomonic for Graves disease, an
autoimmune disorder causing thyroid-stimulating antibodies. Hashimoto thyroiditis (A)
typically causes hypothyroidism, not hyperthyroidism. Subacute thyroiditis (C) presents with a
painful goiter and often follows a viral illness. Toxic multinodular goiter (D) occurs in older
adults, lacks ophthalmopathy, and presents with a nodular rather than diffuse goiter.
A 45-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and
nystagmus. He reports that he has been eating poorly for weeks. What is the most likely
vitamin deficiency causing his symptoms?
○ A. Vitamin B12
○ B. Thiamine (B1)
○ C. Folate
○ D. Vitamin D
CORRECT ANSWER: B. Thiamine (B1)
RATIONALE: The classic triad of confusion, ataxia, and nystagmus/ophthalmoplegia in a
patient with chronic alcohol use and poor nutrition is Wernicke encephalopathy, caused by
severe thiamine (vitamin B1) deficiency. This is a medical emergency requiring prompt
parenteral thiamine replacement to prevent progression to Korsakoff syndrome or permanent
brain damage. Vitamin B12 deficiency (A) causes subacute combined degeneration with
peripheral neuropathy and dorsal column signs, not this specific triad. Folate deficiency (C)
causes megaloblastic anemia and glossitis, not ataxia and nystagmus. Vitamin D deficiency (D)
causes bone pain and muscle weakness, not encephalopathy.
A 50-year-old female presents with a 3-month history of progressive proximal muscle
weakness, making it difficult to rise from a chair and comb her hair. She also reports a
heliotrope rash on her eyelids and Gottron papules on her knuckles. Which of the following is
the most specific diagnostic test?
○ A. Serum creatine kinase (CK)
○ B. Antinuclear antibody (ANA)
○ C. Anti-Jo-1 antibody
○ D. Muscle biopsy
CORRECT ANSWER: C. Anti-Jo-1 antibody
