NSG 6998 – APEA Predictor Preparation
Pre-Predictor (Exam 1) & Post-Predictor
(Exam 2) Original FNP-Style Questions
with Rationales
1. 68-year-old male with sudden tearing chest pain radiating
to back, BP 190/100 right arm 150/80 left arm, diastolic
murmur – Diagnosis?
A. MI
B. Aortic dissection Type A – Tearing pain radiating to back, BP
differential >20 mmHg, diastolic murmur aortic regurgitation
due to dissection affecting aortic valve – Emergency – CT
angiography – Control HR and BP esmolol + nitroprusside –
Refer ED STAT – Not MI – Risk HTN
C. PE
D. Pneumothorax
Answer: B
Rationale: Tearing chest pain radiating to back + BP differential
= dissection – Type A ascending involves coronary + aortic valve
– Diastolic murmur – Surgical emergency.
2. 55-year-old female with exertional chest pressure relieved
by rest, EKG normal – Next step?
A. Reassure
,B. Stable angina – Risk factors – Stress test – Refer cardiology –
Aspirin statin lifestyle – Nitroglycerin SL – Monitor
C. No workup needed
D. D-dimer
Answer: B
3. 70-year-old with AFib on warfarin INR 2.5 – CHA2DS2-VASc
4 – Continue?
A. Stop warfarin
B. Continue anticoagulation – AFib nonvalvular – CHA2DS2-VASc
≥2 male ≥3 female anticoag – INR 2-3 therapeutic – DOAC
preferred over warfarin now unless mechanical valve – Monitor
bleeding – Rate control
C. No anticoag needed
D. Aspirin only
Answer: B
4. 60-year-old with HF exacerbation – Daily weight gain 4 lb in
2 days, crackles, JVD – Management?
A. No action
B. Fluid overload – Daily weights 2-3 lb/day or 5 lb/week report
– Low Na 2g, fluid restriction 2L, diuretic furosemide, monitor K
renal, high Fowler, O2 – GDMT ARNI + beta blocker + MRA +
SGLT2
C. No diuretic
D. High Na diet
,Answer: B
5. 28-year-old asthma – Uses albuterol 4x/week, nighttime
2x/month – Classification?
A. Intermittent
B. Mild persistent – Not well controlled – Daytime >2 days/week
or nighttime >2x/month or SABA >2 days/week = persistent –
Step up low-dose ICS – Inhaler technique spacer rinse mouth
thrush – Action plan green/yellow/red
C. Well controlled
D. No ICS needed
Answer: B
6. 65-year-old smoker COPD GOLD B – Treatment?
A. SABA only
B. GOLD B – LAMA tiotropium or LABA – Smoking cessation
varenicline, vaccines influenza pneumonia, pulmonary rehab,
low flow O2 target 88-92% – Avoid high O2 hypercapnia
C. ICS alone first line
D. No vaccines
Answer: B
7. 45-year-old acute bronchitis 10 days cough afebrile –
Antibiotics?
A. Yes always
B. No – Viral 90% – Supportive – No antibiotics – Cough may last
3 weeks – Red flags fever dyspnea
, C. Azithromycin always
D. No counseling
Answer: B
8. 50-year-old CAP CURB-65 1 – Outpatient treatment?
A. Admit
B. CURB-65 1 outpatient – Amoxicillin or doxycycline or
macrolide if low resistance – If comorbidities amox/clav +
macrolide or fluoroquinolone – Follow up 48-72 hr
C. No antibiotics
D. Admit all pneumonia
Answer: B
9. 52-year-old T2DM A1c 8.5% metformin 1000 BID – Next per
ADA?
A. Continue metformin alone
B. Add second agent per comorbidities – ASCVD/HF/CKD add
GLP-1 semaglutide or SGLT2 empagliflozin – If need weight loss
GLP-1 – Goal A1c <7% – Monitor microalbuminuria retinopathy
foot
C. Stop metformin
D. No add needed
Answer: B
10. 30-year-old female fatigue weight gain cold intolerance
TSH 12 low free T4 – Diagnosis?
Pre-Predictor (Exam 1) & Post-Predictor
(Exam 2) Original FNP-Style Questions
with Rationales
1. 68-year-old male with sudden tearing chest pain radiating
to back, BP 190/100 right arm 150/80 left arm, diastolic
murmur – Diagnosis?
A. MI
B. Aortic dissection Type A – Tearing pain radiating to back, BP
differential >20 mmHg, diastolic murmur aortic regurgitation
due to dissection affecting aortic valve – Emergency – CT
angiography – Control HR and BP esmolol + nitroprusside –
Refer ED STAT – Not MI – Risk HTN
C. PE
D. Pneumothorax
Answer: B
Rationale: Tearing chest pain radiating to back + BP differential
= dissection – Type A ascending involves coronary + aortic valve
– Diastolic murmur – Surgical emergency.
2. 55-year-old female with exertional chest pressure relieved
by rest, EKG normal – Next step?
A. Reassure
,B. Stable angina – Risk factors – Stress test – Refer cardiology –
Aspirin statin lifestyle – Nitroglycerin SL – Monitor
C. No workup needed
D. D-dimer
Answer: B
3. 70-year-old with AFib on warfarin INR 2.5 – CHA2DS2-VASc
4 – Continue?
A. Stop warfarin
B. Continue anticoagulation – AFib nonvalvular – CHA2DS2-VASc
≥2 male ≥3 female anticoag – INR 2-3 therapeutic – DOAC
preferred over warfarin now unless mechanical valve – Monitor
bleeding – Rate control
C. No anticoag needed
D. Aspirin only
Answer: B
4. 60-year-old with HF exacerbation – Daily weight gain 4 lb in
2 days, crackles, JVD – Management?
A. No action
B. Fluid overload – Daily weights 2-3 lb/day or 5 lb/week report
– Low Na 2g, fluid restriction 2L, diuretic furosemide, monitor K
renal, high Fowler, O2 – GDMT ARNI + beta blocker + MRA +
SGLT2
C. No diuretic
D. High Na diet
,Answer: B
5. 28-year-old asthma – Uses albuterol 4x/week, nighttime
2x/month – Classification?
A. Intermittent
B. Mild persistent – Not well controlled – Daytime >2 days/week
or nighttime >2x/month or SABA >2 days/week = persistent –
Step up low-dose ICS – Inhaler technique spacer rinse mouth
thrush – Action plan green/yellow/red
C. Well controlled
D. No ICS needed
Answer: B
6. 65-year-old smoker COPD GOLD B – Treatment?
A. SABA only
B. GOLD B – LAMA tiotropium or LABA – Smoking cessation
varenicline, vaccines influenza pneumonia, pulmonary rehab,
low flow O2 target 88-92% – Avoid high O2 hypercapnia
C. ICS alone first line
D. No vaccines
Answer: B
7. 45-year-old acute bronchitis 10 days cough afebrile –
Antibiotics?
A. Yes always
B. No – Viral 90% – Supportive – No antibiotics – Cough may last
3 weeks – Red flags fever dyspnea
, C. Azithromycin always
D. No counseling
Answer: B
8. 50-year-old CAP CURB-65 1 – Outpatient treatment?
A. Admit
B. CURB-65 1 outpatient – Amoxicillin or doxycycline or
macrolide if low resistance – If comorbidities amox/clav +
macrolide or fluoroquinolone – Follow up 48-72 hr
C. No antibiotics
D. Admit all pneumonia
Answer: B
9. 52-year-old T2DM A1c 8.5% metformin 1000 BID – Next per
ADA?
A. Continue metformin alone
B. Add second agent per comorbidities – ASCVD/HF/CKD add
GLP-1 semaglutide or SGLT2 empagliflozin – If need weight loss
GLP-1 – Goal A1c <7% – Monitor microalbuminuria retinopathy
foot
C. Stop metformin
D. No add needed
Answer: B
10. 30-year-old female fatigue weight gain cold intolerance
TSH 12 low free T4 – Diagnosis?
