APEA PRE-PREDICTOR: 900 PRACTICE QUESTIONS
WITH 100% CORRECT ANSWERS & DETAILED
RATIONALES | NP BOARD EXAM STUDY GUIDE
1. A client who is 2 days post-operative following a left total knee arthroplasty
reports sudden onset of chest pain and shortness of breath. Which of these
actions should the nurse take first?
a. Administer sublingual nitroglycerin as prescribed.
b. Apply oxygen via nasal cannula at 2 L/min.
c. Notify the healthcare provider immediately.
d. Elevate the head of the bed to a high Fowler's position.
Correct Answer: d. Elevate the head of the bed to a high Fowler's position.
Rationale: The client is at risk for a pulmonary embolism (PE) post-operatively.
The immediate priority is to position the client in high Fowler's to maximize
ventilation and oxygenation. Oxygen administration and notifying the provider are
important but follow positioning. Nitroglycerin is not indicated for a PE.
2. A nurse is providing discharge teaching to a client with heart failure. Which of
these statements by the client indicates a need for further teaching?
a. "I will weigh myself every morning before breakfast."
b. "I should limit my daily sodium intake to less than 2 grams."
c. "I can stop my diuretic if I feel dizzy."
d. "I need to monitor for swelling in my feet and ankles."
Correct Answer: c. "I can stop my diuretic if I feel dizzy."
Rationale: Dizziness may indicate hypotension or electrolyte imbalance, but the
client should notify the provider rather than stop the medication. Daily weights,
sodium restriction, and edema monitoring are appropriate self-care measures.
,3. A child with acute glomerulonephritis has decreased urine output and mild
edema. Which of these interventions should the nurse anticipate implementing?
a. Administer a loop diuretic as prescribed.
b. Encourage a high-protein diet.
c. Restrict oral fluids to 500 mL per day.
d. Prepare for hemodialysis.
Correct Answer: a. Administer a loop diuretic as prescribed.
Rationale: In acute glomerulonephritis, fluid retention and edema are managed
with diuretics to reduce fluid overload. Fluid restriction may be used but is not the
first-line intervention. Protein is not restricted unless uremia is present, and
dialysis is reserved for severe cases.
4. A client with chronic obstructive pulmonary disease (COPD) has an arterial
blood gas result showing pH 7.32, PaCO2 58 mm Hg, and HCO3- 30 mEq/L. The
nurse should interpret this as which of the following?
a. Uncompensated respiratory acidosis.
b. Fully compensated metabolic alkalosis.
c. Partially compensated respiratory acidosis.
d. Partially compensated metabolic acidosis.
Correct Answer: c. Partially compensated respiratory acidosis.
Rationale: The pH is low (acidosis), PaCO2 is elevated (respiratory cause), and
HCO3- is elevated (metabolic compensation). Since the pH is still abnormal,
compensation is partial, not complete.
5. A client who had removal of a cataract in the left eye asks the nurse about
resuming normal activities. Which of these instructions should the nurse
include?
a. "Forcefully cough and take deep breaths every two hours to keep your airway
clear."
,b. "Perform prescribed eye exercises each day to strengthen your eye muscles."
c. "Rinse your eyes with saline each morning to prevent postoperative infection."
d. "Take the prescribed stool softener to avoid increasing intraocular pressure."
Correct Answer: d. "Take the prescribed stool softener to avoid increasing
intraocular pressure."
Rationale: Straining during a bowel movement via the Valsalva maneuver
significantly increases intraocular pressure (IOP), which can compromise the
surgical incision and intraocular structures after cataract surgery. Preventing
constipation is a critical postoperative instruction. The other actions are not
standard; coughing forcefully can increase IOP, eye exercises are not prescribed,
and rinsing could introduce infection.
6. A school-aged child is admitted during a sickle cell crisis episode. Which of
these measures should the nurse prioritize when planning care?
a. Monitoring for signs of bleeding.
b. Providing pain relief.
c. Administering cool sponge baths to reduce fevers.
d. Offering a high-calorie diet.
Correct Answer: b. Providing pain relief.
Rationale: The defining feature of a vaso-occlusive crisis (the most common type
of sickle cell crisis) is severe pain caused by ischemic tissue injury from blocked
microvasculature. Therefore, aggressive analgesia is the cornerstone of
management. While monitoring for other complications, managing fever, and
ensuring nutrition are supportive, pain relief is the immediate priority.
7. An adolescent has a nursing diagnosis of fatigue related to inadequate intake
of iron-rich foods. Selection of which of these lunches by the client indicates a
correct understanding of foods high in iron content?
a. Peanut butter and jam sandwich.
b. Chicken nuggets with rice.
, c. Tuna salad sandwich.
d. Beefburger with cheese.
Correct Answer: d. Beefburger with cheese.
Rationale: Heme iron from animal sources, particularly red meat like beef, is the
most bioavailable form of dietary iron. A beefburger is an excellent source. Peanut
butter, processed chicken nuggets, tuna (which has some iron), and cheese
provide significantly less iron, and it is in the non-heme form, which is less
efficiently absorbed.
8. A client has been admitted with acute pancreatitis. Which of these laboratory
test results supports this diagnosis?
a. Elevated serum potassium level.
b. Elevated serum amylase level.
c. Elevated serum sodium level.
d. Elevated serum creatinine level.
Correct Answer: b. Elevated serum amylase level.
Rationale: Serum amylase (and lipase) are digestive enzymes released from
damaged pancreatic acinar cells into the bloodstream during pancreatitis. A
significant elevation (often 3 times the upper limit of normal) is a cardinal
laboratory finding. Electrolyte imbalances (K+, Na+) and elevated creatinine
(indicating renal function) may occur as complications but are not specific to the
diagnosis of pancreatitis itself.
9. When discussing weight gain during pregnancy, a nurse should recommend
that the total weight gain for a pregnant client who is at ideal body weight for
her height is which of the following?
a. At least 15 pounds.
b. 15 to 20 pounds.
c. 25 to 35 pounds.
d. At least 45 pounds.
WITH 100% CORRECT ANSWERS & DETAILED
RATIONALES | NP BOARD EXAM STUDY GUIDE
1. A client who is 2 days post-operative following a left total knee arthroplasty
reports sudden onset of chest pain and shortness of breath. Which of these
actions should the nurse take first?
a. Administer sublingual nitroglycerin as prescribed.
b. Apply oxygen via nasal cannula at 2 L/min.
c. Notify the healthcare provider immediately.
d. Elevate the head of the bed to a high Fowler's position.
Correct Answer: d. Elevate the head of the bed to a high Fowler's position.
Rationale: The client is at risk for a pulmonary embolism (PE) post-operatively.
The immediate priority is to position the client in high Fowler's to maximize
ventilation and oxygenation. Oxygen administration and notifying the provider are
important but follow positioning. Nitroglycerin is not indicated for a PE.
2. A nurse is providing discharge teaching to a client with heart failure. Which of
these statements by the client indicates a need for further teaching?
a. "I will weigh myself every morning before breakfast."
b. "I should limit my daily sodium intake to less than 2 grams."
c. "I can stop my diuretic if I feel dizzy."
d. "I need to monitor for swelling in my feet and ankles."
Correct Answer: c. "I can stop my diuretic if I feel dizzy."
Rationale: Dizziness may indicate hypotension or electrolyte imbalance, but the
client should notify the provider rather than stop the medication. Daily weights,
sodium restriction, and edema monitoring are appropriate self-care measures.
,3. A child with acute glomerulonephritis has decreased urine output and mild
edema. Which of these interventions should the nurse anticipate implementing?
a. Administer a loop diuretic as prescribed.
b. Encourage a high-protein diet.
c. Restrict oral fluids to 500 mL per day.
d. Prepare for hemodialysis.
Correct Answer: a. Administer a loop diuretic as prescribed.
Rationale: In acute glomerulonephritis, fluid retention and edema are managed
with diuretics to reduce fluid overload. Fluid restriction may be used but is not the
first-line intervention. Protein is not restricted unless uremia is present, and
dialysis is reserved for severe cases.
4. A client with chronic obstructive pulmonary disease (COPD) has an arterial
blood gas result showing pH 7.32, PaCO2 58 mm Hg, and HCO3- 30 mEq/L. The
nurse should interpret this as which of the following?
a. Uncompensated respiratory acidosis.
b. Fully compensated metabolic alkalosis.
c. Partially compensated respiratory acidosis.
d. Partially compensated metabolic acidosis.
Correct Answer: c. Partially compensated respiratory acidosis.
Rationale: The pH is low (acidosis), PaCO2 is elevated (respiratory cause), and
HCO3- is elevated (metabolic compensation). Since the pH is still abnormal,
compensation is partial, not complete.
5. A client who had removal of a cataract in the left eye asks the nurse about
resuming normal activities. Which of these instructions should the nurse
include?
a. "Forcefully cough and take deep breaths every two hours to keep your airway
clear."
,b. "Perform prescribed eye exercises each day to strengthen your eye muscles."
c. "Rinse your eyes with saline each morning to prevent postoperative infection."
d. "Take the prescribed stool softener to avoid increasing intraocular pressure."
Correct Answer: d. "Take the prescribed stool softener to avoid increasing
intraocular pressure."
Rationale: Straining during a bowel movement via the Valsalva maneuver
significantly increases intraocular pressure (IOP), which can compromise the
surgical incision and intraocular structures after cataract surgery. Preventing
constipation is a critical postoperative instruction. The other actions are not
standard; coughing forcefully can increase IOP, eye exercises are not prescribed,
and rinsing could introduce infection.
6. A school-aged child is admitted during a sickle cell crisis episode. Which of
these measures should the nurse prioritize when planning care?
a. Monitoring for signs of bleeding.
b. Providing pain relief.
c. Administering cool sponge baths to reduce fevers.
d. Offering a high-calorie diet.
Correct Answer: b. Providing pain relief.
Rationale: The defining feature of a vaso-occlusive crisis (the most common type
of sickle cell crisis) is severe pain caused by ischemic tissue injury from blocked
microvasculature. Therefore, aggressive analgesia is the cornerstone of
management. While monitoring for other complications, managing fever, and
ensuring nutrition are supportive, pain relief is the immediate priority.
7. An adolescent has a nursing diagnosis of fatigue related to inadequate intake
of iron-rich foods. Selection of which of these lunches by the client indicates a
correct understanding of foods high in iron content?
a. Peanut butter and jam sandwich.
b. Chicken nuggets with rice.
, c. Tuna salad sandwich.
d. Beefburger with cheese.
Correct Answer: d. Beefburger with cheese.
Rationale: Heme iron from animal sources, particularly red meat like beef, is the
most bioavailable form of dietary iron. A beefburger is an excellent source. Peanut
butter, processed chicken nuggets, tuna (which has some iron), and cheese
provide significantly less iron, and it is in the non-heme form, which is less
efficiently absorbed.
8. A client has been admitted with acute pancreatitis. Which of these laboratory
test results supports this diagnosis?
a. Elevated serum potassium level.
b. Elevated serum amylase level.
c. Elevated serum sodium level.
d. Elevated serum creatinine level.
Correct Answer: b. Elevated serum amylase level.
Rationale: Serum amylase (and lipase) are digestive enzymes released from
damaged pancreatic acinar cells into the bloodstream during pancreatitis. A
significant elevation (often 3 times the upper limit of normal) is a cardinal
laboratory finding. Electrolyte imbalances (K+, Na+) and elevated creatinine
(indicating renal function) may occur as complications but are not specific to the
diagnosis of pancreatitis itself.
9. When discussing weight gain during pregnancy, a nurse should recommend
that the total weight gain for a pregnant client who is at ideal body weight for
her height is which of the following?
a. At least 15 pounds.
b. 15 to 20 pounds.
c. 25 to 35 pounds.
d. At least 45 pounds.
