PEA Pre-Predictor Exam Advanced Practice
Nurse Comprehensive Review Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: ADVANCED HEALTH ASSESSMENT & DIAGNOSTIC REASONING Q1 –
Q10
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Question 1 of 50
A 58-year-old man with hypertension and hyperlipidemia reports progressive exertional chest
pressure that resolves with rest. On exam, a harsh crescendo-decrescendo systolic murmur
is heard best at the right upper sternal border with radiation to the carotid arteries. The NP
suspects a valvular disorder and must select the most appropriate initial diagnostic test.
A. Schedule an exercise stress test to evaluate for concurrent coronary artery disease
B. Obtain a transthoracic echocardiogram to assess aortic valve area and transvalvular
gradient ✓ CORRECT
C. Request a transesophageal echocardiogram to evaluate mitral valve prolapse
D. Order cardiac catheterization to measure transaortic pressure gradients directly
Correct Answer: B
Rationale: Transthoracic echocardiography is the initial diagnostic test of choice for
suspected aortic stenosis, providing direct visualization of valve morphology and
hemodynamic assessment through calculated valve area and pressure gradients. Cardiac
catheterization is reserved for symptomatic patients when noninvasive testing is
inconclusive or when coronary angiography is indicated prior to valve replacement. Exercise
stress testing is contraindicated in symptomatic aortic stenosis due to risk of hemodynamic
compromise.
Question 2 of 50
A 42-year-old woman presents with six months of palpitations, heat intolerance, and 15-pound
weight loss despite increased appetite. Physical exam reveals a diffusely enlarged,
,non-tender thyroid, fine tremor, and lid lag. Laboratory studies show suppressed TSH and
elevated free T4.
A. Order a thyroid ultrasound with fine-needle aspiration of dominant nodules
B. Prescribe methimazole and propranolol without additional testing
C. Obtain thyroid peroxidase and thyroglobulin antibodies to confirm Hashimoto thyroiditis
D. Measure TSH receptor antibodies and perform a radioactive iodine uptake scan ✓
CORRECT
Correct Answer: D
Rationale: The presentation is classic for Graves disease, and confirming the diagnosis
requires TSH receptor antibody testing along with radioactive iodine uptake to distinguish it
from thyroiditis; uptake will be diffusely increased in Graves and decreased in thyroiditis.
Fine-needle aspiration is indicated for evaluation of thyroid nodules, not diffuse goiter with
biochemical hyperthyroidism. Methimazole should not be initiated until the etiology is
confirmed, as thyroiditis requires different management.
Question 3 of 50
A 67-year-old woman reports sudden, painless monocular vision loss in her left eye that
occurred yesterday. She has experienced new left-sided temporal headaches, jaw
claudication, and fatigue over the past three weeks. On funduscopic exam, the left optic disc
appears pale and swollen.
A. Initiate high-dose prednisone immediately and schedule temporal artery biopsy within one
week ✓ CORRECT
B. Order carotid duplex ultrasound to evaluate for significant stenosis
C. Obtain brain MRI with magnetic resonance angiography to rule out vertebrobasilar
insufficiency
D. Start low-dose aspirin and refer urgently to ophthalmology for cataract evaluation
Correct Answer: A
Rationale: The presentation of acute monocular vision loss with temporal headache, jaw
claudication, and elevated inflammatory markers in an older adult is classic for giant cell
arteritis, requiring immediate high-dose corticosteroid therapy to prevent contralateral vision
loss, with temporal artery biopsy performed promptly to confirm the diagnosis. Carotid
duplex and MRA are not indicated in this presentation, as the findings localize to the
ophthalmic artery rather than the carotid or vertebrobasilar systems. Cataracts do not cause
acute vision loss with disc pallor.
Question 4 of 50
A 35-year-old man injured his right knee during a basketball game, reporting a twisting
mechanism with immediate swelling and inability to continue playing. On exam, there is a
, moderate effusion, positive Lachman test, and negative McMurray test. The NP suspects a
specific ligamentous injury.
A. Order weight-bearing radiographs to evaluate for tibial plateau fracture
B. Apply a hinged knee brace and recommend early range-of-motion exercises
C. Refer for urgent MRI to confirm anterior cruciate ligament rupture ✓ CORRECT
D. Recommend RICE therapy and schedule follow-up in six weeks for reassessment
Correct Answer: C
Rationale: The positive Lachman test in the setting of acute traumatic knee effusion
following a twisting injury is highly sensitive for anterior cruciate ligament rupture, and MRI is
the definitive imaging study to confirm the diagnosis and evaluate for associated meniscal or
chondral injuries. Early range-of-motion exercises without immobilization are inappropriate
for an acute ACL tear with hemarthrosis, as they may worsen instability. Radiographs are
indicated to rule out fracture but do not evaluate ligamentous integrity.
Question 5 of 50
A 28-year-old woman at 32 weeks gestation presents with a new-onset headache and visual
scotomata. Her blood pressure is 158/104 mmHg, up from her baseline of 118/76 mmHg at
her 20-week visit. Urine dipstick shows 2+ protein, and her deep tendon reflexes are brisk
with bilateral clonus.
A. Prescribe oral labetalol and schedule routine prenatal follow-up in two weeks
B. Admit immediately for magnesium sulfate administration and blood pressure management
✓ CORRECT
C. Order a 24-hour urine protein collection and discharge home with home blood pressure
monitoring
D. Initiate low-dose aspirin and recommend modified bed rest until delivery
Correct Answer: B
Rationale: The presence of severe-range blood pressure with neurological symptoms and
hyperreflexia with clonus indicates severe preeclampsia, requiring immediate hospitalization
for intravenous magnesium sulfate seizure prophylaxis and controlled delivery planning.
Outpatient management with oral antihypertensives or delayed testing is contraindicated due
to the high risk of eclampsia and stroke. Low-dose aspirin is used for preeclampsia
prevention, not treatment of established severe disease.
Question 6 of 50
A 61-year-old man with a 40-pack-year smoking history and severe COPD presents with
increased dyspnea, purulent sputum, and fever to 38.6°C over the past 48 hours. Lung
auscultation reveals decreased breath sounds and dullness to percussion at the left lung
base. Chest radiograph confirms a left lower lobe infiltrate.
Nurse Comprehensive Review Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: ADVANCED HEALTH ASSESSMENT & DIAGNOSTIC REASONING Q1 –
Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old man with hypertension and hyperlipidemia reports progressive exertional chest
pressure that resolves with rest. On exam, a harsh crescendo-decrescendo systolic murmur
is heard best at the right upper sternal border with radiation to the carotid arteries. The NP
suspects a valvular disorder and must select the most appropriate initial diagnostic test.
A. Schedule an exercise stress test to evaluate for concurrent coronary artery disease
B. Obtain a transthoracic echocardiogram to assess aortic valve area and transvalvular
gradient ✓ CORRECT
C. Request a transesophageal echocardiogram to evaluate mitral valve prolapse
D. Order cardiac catheterization to measure transaortic pressure gradients directly
Correct Answer: B
Rationale: Transthoracic echocardiography is the initial diagnostic test of choice for
suspected aortic stenosis, providing direct visualization of valve morphology and
hemodynamic assessment through calculated valve area and pressure gradients. Cardiac
catheterization is reserved for symptomatic patients when noninvasive testing is
inconclusive or when coronary angiography is indicated prior to valve replacement. Exercise
stress testing is contraindicated in symptomatic aortic stenosis due to risk of hemodynamic
compromise.
Question 2 of 50
A 42-year-old woman presents with six months of palpitations, heat intolerance, and 15-pound
weight loss despite increased appetite. Physical exam reveals a diffusely enlarged,
,non-tender thyroid, fine tremor, and lid lag. Laboratory studies show suppressed TSH and
elevated free T4.
A. Order a thyroid ultrasound with fine-needle aspiration of dominant nodules
B. Prescribe methimazole and propranolol without additional testing
C. Obtain thyroid peroxidase and thyroglobulin antibodies to confirm Hashimoto thyroiditis
D. Measure TSH receptor antibodies and perform a radioactive iodine uptake scan ✓
CORRECT
Correct Answer: D
Rationale: The presentation is classic for Graves disease, and confirming the diagnosis
requires TSH receptor antibody testing along with radioactive iodine uptake to distinguish it
from thyroiditis; uptake will be diffusely increased in Graves and decreased in thyroiditis.
Fine-needle aspiration is indicated for evaluation of thyroid nodules, not diffuse goiter with
biochemical hyperthyroidism. Methimazole should not be initiated until the etiology is
confirmed, as thyroiditis requires different management.
Question 3 of 50
A 67-year-old woman reports sudden, painless monocular vision loss in her left eye that
occurred yesterday. She has experienced new left-sided temporal headaches, jaw
claudication, and fatigue over the past three weeks. On funduscopic exam, the left optic disc
appears pale and swollen.
A. Initiate high-dose prednisone immediately and schedule temporal artery biopsy within one
week ✓ CORRECT
B. Order carotid duplex ultrasound to evaluate for significant stenosis
C. Obtain brain MRI with magnetic resonance angiography to rule out vertebrobasilar
insufficiency
D. Start low-dose aspirin and refer urgently to ophthalmology for cataract evaluation
Correct Answer: A
Rationale: The presentation of acute monocular vision loss with temporal headache, jaw
claudication, and elevated inflammatory markers in an older adult is classic for giant cell
arteritis, requiring immediate high-dose corticosteroid therapy to prevent contralateral vision
loss, with temporal artery biopsy performed promptly to confirm the diagnosis. Carotid
duplex and MRA are not indicated in this presentation, as the findings localize to the
ophthalmic artery rather than the carotid or vertebrobasilar systems. Cataracts do not cause
acute vision loss with disc pallor.
Question 4 of 50
A 35-year-old man injured his right knee during a basketball game, reporting a twisting
mechanism with immediate swelling and inability to continue playing. On exam, there is a
, moderate effusion, positive Lachman test, and negative McMurray test. The NP suspects a
specific ligamentous injury.
A. Order weight-bearing radiographs to evaluate for tibial plateau fracture
B. Apply a hinged knee brace and recommend early range-of-motion exercises
C. Refer for urgent MRI to confirm anterior cruciate ligament rupture ✓ CORRECT
D. Recommend RICE therapy and schedule follow-up in six weeks for reassessment
Correct Answer: C
Rationale: The positive Lachman test in the setting of acute traumatic knee effusion
following a twisting injury is highly sensitive for anterior cruciate ligament rupture, and MRI is
the definitive imaging study to confirm the diagnosis and evaluate for associated meniscal or
chondral injuries. Early range-of-motion exercises without immobilization are inappropriate
for an acute ACL tear with hemarthrosis, as they may worsen instability. Radiographs are
indicated to rule out fracture but do not evaluate ligamentous integrity.
Question 5 of 50
A 28-year-old woman at 32 weeks gestation presents with a new-onset headache and visual
scotomata. Her blood pressure is 158/104 mmHg, up from her baseline of 118/76 mmHg at
her 20-week visit. Urine dipstick shows 2+ protein, and her deep tendon reflexes are brisk
with bilateral clonus.
A. Prescribe oral labetalol and schedule routine prenatal follow-up in two weeks
B. Admit immediately for magnesium sulfate administration and blood pressure management
✓ CORRECT
C. Order a 24-hour urine protein collection and discharge home with home blood pressure
monitoring
D. Initiate low-dose aspirin and recommend modified bed rest until delivery
Correct Answer: B
Rationale: The presence of severe-range blood pressure with neurological symptoms and
hyperreflexia with clonus indicates severe preeclampsia, requiring immediate hospitalization
for intravenous magnesium sulfate seizure prophylaxis and controlled delivery planning.
Outpatient management with oral antihypertensives or delayed testing is contraindicated due
to the high risk of eclampsia and stroke. Low-dose aspirin is used for preeclampsia
prevention, not treatment of established severe disease.
Question 6 of 50
A 61-year-old man with a 40-pack-year smoking history and severe COPD presents with
increased dyspnea, purulent sputum, and fever to 38.6°C over the past 48 hours. Lung
auscultation reveals decreased breath sounds and dullness to percussion at the left lung
base. Chest radiograph confirms a left lower lobe infiltrate.
