APEA POST PREDICTOR EXAM 300 ACTUAL
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALE LATEST UPDATE ALREADY GRADED A+
ASSURED PASS
This comprehensive practice examination contains 300 unique multiple-choice
questions covering all clinical domains tested on the APEA Post Predictor Exam,
which is administered at the end of the last semester to predict likelihood of
success on national NP certification exams such as AANP and ANCC. Questions
are organized into sections including cardiovascular, respiratory, endocrine,
neurological, dermatologic, infectious diseases, renal, gastrointestinal,
rheumatologic, hematologic, women's health, pediatrics, pharmacology, and health
promotion. Each question includes four answer choices, the correct answer, and a
detailed rationale explaining the underlying clinical reasoning and evidence-based
practice. This resource is ideal for self-study, exam review, and building
confidence before taking the official 150-question, 3-hour post-predictor
assessment.
Section 1: Cardiovascular and Respiratory Conditions
1. A 68-year-old male with a history of hypertension presents with acute onset of
tearing chest pain radiating to his back. His blood pressure is 160/90 mmHg in the
right arm and 110/70 mmHg in the left arm. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: The classic presentation of aortic dissection is acute, severe, tearing
chest pain that often radiates to the back. A difference in blood pressure between
arms is a hallmark sign due to differential involvement of the aortic arch vessels .
,2. A 23-year-old presents with acute onset of sharp chest pain, dyspnea, and no
history of trauma. The pain worsens with inspiration. Which diagnosis should be
considered first?
A) Pericarditis
B) Spontaneous pneumothorax
C) Musculoskeletal chest pain
D) Costochondritis
Answer: B
Rationale: Spontaneous pneumothorax often presents in young, tall, thin
individuals with sudden sharp chest pain and dyspnea that is pleuritic (worsens
with inspiration) .
3. A 58-year-old male with a history of hypertension is prescribed lisinopril. He
returns complaining of a persistent dry cough. What is the most appropriate next
step?
A) Add a beta-blocker
B) Switch to an ARB (e.g., losartan)
C) Add a calcium channel blocker
D) Continue lisinopril and add a bronchodilator
Answer: B
Rationale: ACE inhibitors commonly cause a dry cough due to accumulation of
bradykinin. Switching to an angiotensin II receptor blocker (ARB) is an
appropriate alternative as ARBs do not affect bradykinin and rarely cause cough .
4. A 55-year-old male with a history of hypertension and hyperlipidemia presents
with substernal chest pain that occurs with exertion and is relieved with rest. What
is the most likely diagnosis?
A) Unstable angina
B) Stable angina
C) NSTEMI
D) STEMI
Answer: B
Rationale: Stable angina is characterized by chest pain that occurs with exertion
and is relieved with rest. It is typically caused by fixed coronary artery obstruction.
Unstable angina occurs at rest or with minimal exertion .
5. A 70-year-old female presents with a sudden onset of severe, tearing chest pain
that radiates to her back. Her blood pressure is 180/100 mmHg. A chest X-ray
shows a widened mediastinum. What is the most likely diagnosis?
A) Acute myocardial infarction
,B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Answer: B
Rationale: Aortic dissection classically presents with sudden, severe, tearing chest
pain radiating to the back. A widened mediastinum on chest X-ray is a classic
finding. Hypertension is a major risk factor .
6. A 58-year-old male with a history of hypertension presents with sudden onset
chest pain radiating to the left arm. ECG shows ST elevation in leads II, III, and
aVF. What is the most likely diagnosis?
A) Anterior STEMI
B) Inferior STEMI
C) Unstable angina
D) NSTEMI
Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior myocardial
infarction typically involving the right coronary artery. Anterior STEMI would
involve V1-V4 .
7. A patient with COPD is prescribed a beta-blocker for hypertension. Which beta-
blocker is most appropriate?
A) Propranolol
B) Atenolol
C) Metoprolol succinate
D) Nadolol
Answer: C
Rationale: Cardioselective beta-blockers such as metoprolol succinate are preferred
in patients with COPD as they are less likely to cause bronchospasm compared to
non-selective agents like propranolol and nadolol.
8. A 65-year-old patient presents with chronic productive cough for at least 3
months per year for 2 consecutive years. What is the most likely diagnosis?
A) Emphysema
B) Chronic bronchitis
C) Asthma
D) Bronchiectasis
Answer: B
, Rationale: Chronic bronchitis is defined by a productive cough lasting at least 3
months per year for 2 consecutive years. Emphysema involves alveolar destruction
without chronic productive cough .
9. What is the hallmark symptom of Peripheral Arterial Disease (PAD)?
A) Edema
B) Bruising
C) Rash
D) Intermittent claudication
Answer: D
Rationale: Intermittent claudication is the hallmark symptom of PAD. It refers to
muscle pain or cramping in the legs that occurs with exercise and is relieved by
rest .
10. Which test is best to confirm Peripheral Arterial Disease (PAD)?
A) ECG
B) ABI (Ankle-Brachial Index)
C) Echocardiogram
D) Angiography
Answer: B
Rationale: The ABI is a simple, non-invasive test that compares blood pressure in
the ankle to that in the arm. An ABI of <0.90 is diagnostic for PAD .
Section 2: Endocrine and Metabolic Disorders
11. A 45-year-old female presents with fatigue, weight gain, constipation, and cold
intolerance. Her TSH is 8 mU/L (reference range: 0.4-4.0 mU/L). What should be
done next?
A) Check free T4
B) Start levothyroxine
C) Repeat TSH in 6 weeks
D) Order thyroid ultrasound
Answer: A
Rationale: An elevated TSH indicates hypothyroidism. Checking free T4 helps
confirm the diagnosis and determine the severity of hypothyroidism before
initiating treatment .
12. A 32-year-old female presents with palpitations, heat intolerance, and weight
loss despite increased appetite. On examination, you note a fine tremor,
tachycardia, and a diffuse goiter. What is the most likely diagnosis?
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALE LATEST UPDATE ALREADY GRADED A+
ASSURED PASS
This comprehensive practice examination contains 300 unique multiple-choice
questions covering all clinical domains tested on the APEA Post Predictor Exam,
which is administered at the end of the last semester to predict likelihood of
success on national NP certification exams such as AANP and ANCC. Questions
are organized into sections including cardiovascular, respiratory, endocrine,
neurological, dermatologic, infectious diseases, renal, gastrointestinal,
rheumatologic, hematologic, women's health, pediatrics, pharmacology, and health
promotion. Each question includes four answer choices, the correct answer, and a
detailed rationale explaining the underlying clinical reasoning and evidence-based
practice. This resource is ideal for self-study, exam review, and building
confidence before taking the official 150-question, 3-hour post-predictor
assessment.
Section 1: Cardiovascular and Respiratory Conditions
1. A 68-year-old male with a history of hypertension presents with acute onset of
tearing chest pain radiating to his back. His blood pressure is 160/90 mmHg in the
right arm and 110/70 mmHg in the left arm. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: The classic presentation of aortic dissection is acute, severe, tearing
chest pain that often radiates to the back. A difference in blood pressure between
arms is a hallmark sign due to differential involvement of the aortic arch vessels .
,2. A 23-year-old presents with acute onset of sharp chest pain, dyspnea, and no
history of trauma. The pain worsens with inspiration. Which diagnosis should be
considered first?
A) Pericarditis
B) Spontaneous pneumothorax
C) Musculoskeletal chest pain
D) Costochondritis
Answer: B
Rationale: Spontaneous pneumothorax often presents in young, tall, thin
individuals with sudden sharp chest pain and dyspnea that is pleuritic (worsens
with inspiration) .
3. A 58-year-old male with a history of hypertension is prescribed lisinopril. He
returns complaining of a persistent dry cough. What is the most appropriate next
step?
A) Add a beta-blocker
B) Switch to an ARB (e.g., losartan)
C) Add a calcium channel blocker
D) Continue lisinopril and add a bronchodilator
Answer: B
Rationale: ACE inhibitors commonly cause a dry cough due to accumulation of
bradykinin. Switching to an angiotensin II receptor blocker (ARB) is an
appropriate alternative as ARBs do not affect bradykinin and rarely cause cough .
4. A 55-year-old male with a history of hypertension and hyperlipidemia presents
with substernal chest pain that occurs with exertion and is relieved with rest. What
is the most likely diagnosis?
A) Unstable angina
B) Stable angina
C) NSTEMI
D) STEMI
Answer: B
Rationale: Stable angina is characterized by chest pain that occurs with exertion
and is relieved with rest. It is typically caused by fixed coronary artery obstruction.
Unstable angina occurs at rest or with minimal exertion .
5. A 70-year-old female presents with a sudden onset of severe, tearing chest pain
that radiates to her back. Her blood pressure is 180/100 mmHg. A chest X-ray
shows a widened mediastinum. What is the most likely diagnosis?
A) Acute myocardial infarction
,B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Answer: B
Rationale: Aortic dissection classically presents with sudden, severe, tearing chest
pain radiating to the back. A widened mediastinum on chest X-ray is a classic
finding. Hypertension is a major risk factor .
6. A 58-year-old male with a history of hypertension presents with sudden onset
chest pain radiating to the left arm. ECG shows ST elevation in leads II, III, and
aVF. What is the most likely diagnosis?
A) Anterior STEMI
B) Inferior STEMI
C) Unstable angina
D) NSTEMI
Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior myocardial
infarction typically involving the right coronary artery. Anterior STEMI would
involve V1-V4 .
7. A patient with COPD is prescribed a beta-blocker for hypertension. Which beta-
blocker is most appropriate?
A) Propranolol
B) Atenolol
C) Metoprolol succinate
D) Nadolol
Answer: C
Rationale: Cardioselective beta-blockers such as metoprolol succinate are preferred
in patients with COPD as they are less likely to cause bronchospasm compared to
non-selective agents like propranolol and nadolol.
8. A 65-year-old patient presents with chronic productive cough for at least 3
months per year for 2 consecutive years. What is the most likely diagnosis?
A) Emphysema
B) Chronic bronchitis
C) Asthma
D) Bronchiectasis
Answer: B
, Rationale: Chronic bronchitis is defined by a productive cough lasting at least 3
months per year for 2 consecutive years. Emphysema involves alveolar destruction
without chronic productive cough .
9. What is the hallmark symptom of Peripheral Arterial Disease (PAD)?
A) Edema
B) Bruising
C) Rash
D) Intermittent claudication
Answer: D
Rationale: Intermittent claudication is the hallmark symptom of PAD. It refers to
muscle pain or cramping in the legs that occurs with exercise and is relieved by
rest .
10. Which test is best to confirm Peripheral Arterial Disease (PAD)?
A) ECG
B) ABI (Ankle-Brachial Index)
C) Echocardiogram
D) Angiography
Answer: B
Rationale: The ABI is a simple, non-invasive test that compares blood pressure in
the ankle to that in the arm. An ABI of <0.90 is diagnostic for PAD .
Section 2: Endocrine and Metabolic Disorders
11. A 45-year-old female presents with fatigue, weight gain, constipation, and cold
intolerance. Her TSH is 8 mU/L (reference range: 0.4-4.0 mU/L). What should be
done next?
A) Check free T4
B) Start levothyroxine
C) Repeat TSH in 6 weeks
D) Order thyroid ultrasound
Answer: A
Rationale: An elevated TSH indicates hypothyroidism. Checking free T4 helps
confirm the diagnosis and determine the severity of hypothyroidism before
initiating treatment .
12. A 32-year-old female presents with palpitations, heat intolerance, and weight
loss despite increased appetite. On examination, you note a fine tremor,
tachycardia, and a diffuse goiter. What is the most likely diagnosis?
