APEA Pre-Predictor question and answer
100% graded A+ 2024-2025
14 year old patient who fell on a outstretched hand complains of proximal forearm pain.
X-ray reveals a positive fat pad sign, and the patient is unable to fully extend the elbow.
No definitive bony changes are seen on xray. The most likely working diagnosis is:
A. upper arm sprain
B. lateral epicondylitis
C. Radial head fracture
D. Olecranon bursitis - CORRECT ANSWER C. Radial head fracture.
2 year old child is diagnosed with radial head subluxation ("nursemaid's elbow"). After
closed manipulation, the best indication of successful treatment is that:
A. Swelling dissipates immediately
B. Pulse and sensation are restored
C. The child quickly begins to use the affected arm
D. A click is felt while the child is extending and rotating the arm - CORRECT ANSWER
C. The child quickly begins to use the affected arm.
A 10-month old presents with a rash, runny nose, and cough. Examination reveals a
cluster of tiny white papuls with an erythematous base on the buccal mucosa. What
does this suggest?
A. Scarlet fever
B. Rubella
C. Erythema infectiosum
D. Measles - CORRECT ANSWER D. Measles
A 12-month-old child is playing with the father. Which of these behaviors indicates that
the child is demonstrating object permanence?
a. The child transfers a toy to the other hand when given another one.
b. The child returns a block to the same spot on the table.
c. The child looks for a toy that the father has hidden under the table.
d. The child recognizes that a ball of clay is the same when flattened out. - CORRECT
ANSWER c. The child looks for a toy that the father has hidden under the table.
A 14yo male with bronchitis is being treated with fluids and expectorants. He returns to
the clinic with a fever of 103F, right pleuritic chest pain, and green sputum. Which of the
following examination results would be expected?
A. Right lower lobe crackles
B. Decreased Fremitus
C. Bilateral Wheezing
D. Normal Percussion - CORRECT ANSWER A. Right lower lobe crackles.
, A 15 year old patients returns for contraceptive services 2 weeks after a diagnosis of
trichomonas vaginitis and treatment with 2gm of metronidazole (Flagyl). She reports
that discharge and itching are gone, but she is urinating frequently, accompanied with
alot of burning. The patient has not resumed sexual activity and has menstrated since
her last visit. Examination reveals mild suprapubic tenderness, no leukorrhea, and a
normal wet mount. Gonococcal culture and chlamydia tests are negative. Which
diagnostic test should be performed immediately?
A. Urine pregnancy test
B. Microscopic exam of urine
C. Herpes simplex virus culture
D. Repeat chlamydia test. - CORRECT ANSWER B. Microscopic exam of urine.
A 15 yo malue has a history of cryptorchidism which was surgically repaired. Because
of this information, it is essential for the nurse practitioner to teach him about: -
CORRECT ANSWER testicular self-examination.
Cryptorchidism, even with surgical repair, is associated with increased risk for testicular
cancer.
A 15-year-old child who has type I diabetes mellitus receives an injection of regular
insulin 5 units and isophane (NPH) insulin 15 units subcutaneously at 7:00 A.M. before
eating breakfast. At 10:30 A.M., the child tells the school nurse, "I am sweating and feel
weak." Which of these actions should the nurse take first?
a. Measure the blood sugar.
b. Determine what the child ate for breakfast.
c. Give a simple carbohydrate.
d. Contact the physician. - CORRECT ANSWER a. Measure the blood sugar.
A 16 year old female in the first month of taking Ortho-Novum 7/7/7 complains of
midcycle spotting. She hasn't missed any doses and uses no other medication. Which
of the following is appropriate?
A. Modifying use
B. Double dosing for 2 days
C. Changing to Ortho-Novum 1/35
D. Providing reassurance - CORRECT ANSWER D. Providing reassurance
A 17 year old female is suspected of having polycystic ovary syndrome. In addition to
testosterone, the most appropriate diagnostic tests to order would be:
A. BUN, creatinine, electrolytes, and dehydroepiandrosterone(DHEA)
B. CBC, BUN, creatinine, and estrone
C. Fasting blood sugar (FBS), complete blood count (CBC), BUN, and sex hormone
binding globulin
D. Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), prolactin, and thyroid-
stimulating hormone (TSH) - CORRECT ANSWER D. FSH, LH, TSH
, A 17 year old femlae has never had her menses. She is at Tanner stage III of sexual
development. Her physical exam in completely normal, and her weight is appropriate for
her age and height. What is the most likely diagnosis?
A. Ovarian dysgenesis
B. Dysmenorrhea
C. Primary amenorrhea
D. Secondary amenorrhea - CORRECT ANSWER C. Primary amenorrhea
A 20 yo male presents with a 1 month history of a " bump on my testicle" He reports
being sexually active, frequent episodes of unprotected intercourse with multiple
partners. Which condition should be suspected?
A. Cancer of the testicles
B. Torsion of the testicles
C. Acute epididymitis
D. Gonorrhea - CORRECT ANSWER A. Cancer of the testicles
A 21 yo college student presents to the sudent health center with copious, markedly
purulent discharge from her left eye. The nurse practitioner should suspect: -
CORRECT ANSWER gonococcal conjunctivitis.
A purulent and copious discharge should alert the nurse practitioner to the likely
possibility of gonococcal or chlamydial conjunctivitis. Noth require systemic anitbiotic
treatment and immediate referral to an opthalmologist for evaluation.
A 21-yo patient presents with abdominal guarding, rigid abdominal musculature,
rebound tenderness at McBurney's point, and leukocytosis. What is the most likely
diagnosis? - CORRECT ANSWER Appendicitis.
McBurney's point is the RLQ abdominal landmark for the appendix. Rigid abdominal
musculature, rebound tenderness, and positive psoas sign (inflamed psoas muscle),
indicates inflammation of the peritoneum. Cholecystitis presents with RUQ pain and
positive Murphy's inspriatory arrest. Ilcerative colitis presents with LLQ pain. Pain
associated with pancreatitis is typically in the epigastric region.
A 22-year-old college student has a heart rate that is 48/minute and regular during a
routine physical examination. Which of these questions should a nurse consider when
analyzing this heart rate?
a. Is this student an athlete?
b. Does this student smoke?
c. How much alcohol does this student drink?
d. Is this student feeling anxious? - CORRECT ANSWER a. Is this student an athlete?
A 24 yo female taking an oral contraceptive has missed her last 2 pills. What should the
nurse practitioner advise her to do to minimize her risk of pregnancy? - CORRECT
ANSWER Double today's dose and tomorrow's dose and use a barrier method for the
rest of the month.
If 2 mills are missed on consecutive days, the next 2 days' doseages should be doubled
and a barrier method recommended for the remainder of the cycle.
, A 25 yo female has a history of frequent candidal vaginal infections in the past year.
She is in a monogamous sexual relationship and uses and IUD for contraception. Of the
following, which is the most likely underlying conidition predisposing her to recurring
candidal vaginitis? - CORRECT ANSWER Diabetes.
A common underlying cause of frequent infections is diabetes mellitus. Pregnancy
increases the incidence of candidiasis, but is unlikely a factor with this patient.
A 25-year old presents with the chief complaint of decreased mobility and pain of the
right shoulder exacerbated with movement. The patient reports that he participated in
extensive house painting 24 hours prior to the onset of pain. He denies any trauma.
Passive ROM is intact. No redness or ecchymosis is present. What is the next step that
should be taken in order to make a diagnosis?
A. Palpate structures around the shoulder
B. Obtain an MRI to evaluate the shoulder
C. Order an Xray of the shoulder
D. Request an EMG - CORRECT ANSWER A. Palpate the structures around the
shoulder
A 25-yo female patient presents for a routine well-women exam. On physical exam, the
NP notes a scant nipple discharge, absence of palpable mass, and absence of lymph
node enlargement. What is the most likely diagnosis? - CORRECT ANSWER Itraductal
papilloma.
Intraductal papilloma often presents as a non-tender mass with serous or bloody nipple
discharge located in the ductal system near the areola. Breast cancer, although usually
non-tender, may present with pain. Chest wall syndrome may present in some women
as breast pain. Fibrocystic breast disease often presents with bilateral breast pain.
A 29-year old male with noncomplicated Chlamidia infection may exhibit:
A. Urticaria
B. No remarkable clinical symptoms
C. A green mucoid penile discharge
D. A penile ulcer - CORRECT ANSWER B. No remarkable clinical symptoms
A 2month old infant is presented for examination and immunizations. History includes
an uncomplicated full-term delivery and hepatitis B virus immunization shortly after birth.
Examination is unremarkable except for a diffusely erythematous (not beet red) macular
rash in the diaper area., sparing the inguinal folds. No satellite lesions are noted . The
infant's rash is most likely caused by.
A. Candida albicans infections.
B. Eczema
C. Seborrheic dermatitis
D. Contact dermatitis - CORRECT ANSWER D. Contact dermatitis
100% graded A+ 2024-2025
14 year old patient who fell on a outstretched hand complains of proximal forearm pain.
X-ray reveals a positive fat pad sign, and the patient is unable to fully extend the elbow.
No definitive bony changes are seen on xray. The most likely working diagnosis is:
A. upper arm sprain
B. lateral epicondylitis
C. Radial head fracture
D. Olecranon bursitis - CORRECT ANSWER C. Radial head fracture.
2 year old child is diagnosed with radial head subluxation ("nursemaid's elbow"). After
closed manipulation, the best indication of successful treatment is that:
A. Swelling dissipates immediately
B. Pulse and sensation are restored
C. The child quickly begins to use the affected arm
D. A click is felt while the child is extending and rotating the arm - CORRECT ANSWER
C. The child quickly begins to use the affected arm.
A 10-month old presents with a rash, runny nose, and cough. Examination reveals a
cluster of tiny white papuls with an erythematous base on the buccal mucosa. What
does this suggest?
A. Scarlet fever
B. Rubella
C. Erythema infectiosum
D. Measles - CORRECT ANSWER D. Measles
A 12-month-old child is playing with the father. Which of these behaviors indicates that
the child is demonstrating object permanence?
a. The child transfers a toy to the other hand when given another one.
b. The child returns a block to the same spot on the table.
c. The child looks for a toy that the father has hidden under the table.
d. The child recognizes that a ball of clay is the same when flattened out. - CORRECT
ANSWER c. The child looks for a toy that the father has hidden under the table.
A 14yo male with bronchitis is being treated with fluids and expectorants. He returns to
the clinic with a fever of 103F, right pleuritic chest pain, and green sputum. Which of the
following examination results would be expected?
A. Right lower lobe crackles
B. Decreased Fremitus
C. Bilateral Wheezing
D. Normal Percussion - CORRECT ANSWER A. Right lower lobe crackles.
, A 15 year old patients returns for contraceptive services 2 weeks after a diagnosis of
trichomonas vaginitis and treatment with 2gm of metronidazole (Flagyl). She reports
that discharge and itching are gone, but she is urinating frequently, accompanied with
alot of burning. The patient has not resumed sexual activity and has menstrated since
her last visit. Examination reveals mild suprapubic tenderness, no leukorrhea, and a
normal wet mount. Gonococcal culture and chlamydia tests are negative. Which
diagnostic test should be performed immediately?
A. Urine pregnancy test
B. Microscopic exam of urine
C. Herpes simplex virus culture
D. Repeat chlamydia test. - CORRECT ANSWER B. Microscopic exam of urine.
A 15 yo malue has a history of cryptorchidism which was surgically repaired. Because
of this information, it is essential for the nurse practitioner to teach him about: -
CORRECT ANSWER testicular self-examination.
Cryptorchidism, even with surgical repair, is associated with increased risk for testicular
cancer.
A 15-year-old child who has type I diabetes mellitus receives an injection of regular
insulin 5 units and isophane (NPH) insulin 15 units subcutaneously at 7:00 A.M. before
eating breakfast. At 10:30 A.M., the child tells the school nurse, "I am sweating and feel
weak." Which of these actions should the nurse take first?
a. Measure the blood sugar.
b. Determine what the child ate for breakfast.
c. Give a simple carbohydrate.
d. Contact the physician. - CORRECT ANSWER a. Measure the blood sugar.
A 16 year old female in the first month of taking Ortho-Novum 7/7/7 complains of
midcycle spotting. She hasn't missed any doses and uses no other medication. Which
of the following is appropriate?
A. Modifying use
B. Double dosing for 2 days
C. Changing to Ortho-Novum 1/35
D. Providing reassurance - CORRECT ANSWER D. Providing reassurance
A 17 year old female is suspected of having polycystic ovary syndrome. In addition to
testosterone, the most appropriate diagnostic tests to order would be:
A. BUN, creatinine, electrolytes, and dehydroepiandrosterone(DHEA)
B. CBC, BUN, creatinine, and estrone
C. Fasting blood sugar (FBS), complete blood count (CBC), BUN, and sex hormone
binding globulin
D. Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), prolactin, and thyroid-
stimulating hormone (TSH) - CORRECT ANSWER D. FSH, LH, TSH
, A 17 year old femlae has never had her menses. She is at Tanner stage III of sexual
development. Her physical exam in completely normal, and her weight is appropriate for
her age and height. What is the most likely diagnosis?
A. Ovarian dysgenesis
B. Dysmenorrhea
C. Primary amenorrhea
D. Secondary amenorrhea - CORRECT ANSWER C. Primary amenorrhea
A 20 yo male presents with a 1 month history of a " bump on my testicle" He reports
being sexually active, frequent episodes of unprotected intercourse with multiple
partners. Which condition should be suspected?
A. Cancer of the testicles
B. Torsion of the testicles
C. Acute epididymitis
D. Gonorrhea - CORRECT ANSWER A. Cancer of the testicles
A 21 yo college student presents to the sudent health center with copious, markedly
purulent discharge from her left eye. The nurse practitioner should suspect: -
CORRECT ANSWER gonococcal conjunctivitis.
A purulent and copious discharge should alert the nurse practitioner to the likely
possibility of gonococcal or chlamydial conjunctivitis. Noth require systemic anitbiotic
treatment and immediate referral to an opthalmologist for evaluation.
A 21-yo patient presents with abdominal guarding, rigid abdominal musculature,
rebound tenderness at McBurney's point, and leukocytosis. What is the most likely
diagnosis? - CORRECT ANSWER Appendicitis.
McBurney's point is the RLQ abdominal landmark for the appendix. Rigid abdominal
musculature, rebound tenderness, and positive psoas sign (inflamed psoas muscle),
indicates inflammation of the peritoneum. Cholecystitis presents with RUQ pain and
positive Murphy's inspriatory arrest. Ilcerative colitis presents with LLQ pain. Pain
associated with pancreatitis is typically in the epigastric region.
A 22-year-old college student has a heart rate that is 48/minute and regular during a
routine physical examination. Which of these questions should a nurse consider when
analyzing this heart rate?
a. Is this student an athlete?
b. Does this student smoke?
c. How much alcohol does this student drink?
d. Is this student feeling anxious? - CORRECT ANSWER a. Is this student an athlete?
A 24 yo female taking an oral contraceptive has missed her last 2 pills. What should the
nurse practitioner advise her to do to minimize her risk of pregnancy? - CORRECT
ANSWER Double today's dose and tomorrow's dose and use a barrier method for the
rest of the month.
If 2 mills are missed on consecutive days, the next 2 days' doseages should be doubled
and a barrier method recommended for the remainder of the cycle.
, A 25 yo female has a history of frequent candidal vaginal infections in the past year.
She is in a monogamous sexual relationship and uses and IUD for contraception. Of the
following, which is the most likely underlying conidition predisposing her to recurring
candidal vaginitis? - CORRECT ANSWER Diabetes.
A common underlying cause of frequent infections is diabetes mellitus. Pregnancy
increases the incidence of candidiasis, but is unlikely a factor with this patient.
A 25-year old presents with the chief complaint of decreased mobility and pain of the
right shoulder exacerbated with movement. The patient reports that he participated in
extensive house painting 24 hours prior to the onset of pain. He denies any trauma.
Passive ROM is intact. No redness or ecchymosis is present. What is the next step that
should be taken in order to make a diagnosis?
A. Palpate structures around the shoulder
B. Obtain an MRI to evaluate the shoulder
C. Order an Xray of the shoulder
D. Request an EMG - CORRECT ANSWER A. Palpate the structures around the
shoulder
A 25-yo female patient presents for a routine well-women exam. On physical exam, the
NP notes a scant nipple discharge, absence of palpable mass, and absence of lymph
node enlargement. What is the most likely diagnosis? - CORRECT ANSWER Itraductal
papilloma.
Intraductal papilloma often presents as a non-tender mass with serous or bloody nipple
discharge located in the ductal system near the areola. Breast cancer, although usually
non-tender, may present with pain. Chest wall syndrome may present in some women
as breast pain. Fibrocystic breast disease often presents with bilateral breast pain.
A 29-year old male with noncomplicated Chlamidia infection may exhibit:
A. Urticaria
B. No remarkable clinical symptoms
C. A green mucoid penile discharge
D. A penile ulcer - CORRECT ANSWER B. No remarkable clinical symptoms
A 2month old infant is presented for examination and immunizations. History includes
an uncomplicated full-term delivery and hepatitis B virus immunization shortly after birth.
Examination is unremarkable except for a diffusely erythematous (not beet red) macular
rash in the diaper area., sparing the inguinal folds. No satellite lesions are noted . The
infant's rash is most likely caused by.
A. Candida albicans infections.
B. Eczema
C. Seborrheic dermatitis
D. Contact dermatitis - CORRECT ANSWER D. Contact dermatitis
