APEA PRE-PREDICTOR 2026 COMPLETE
REVIEW MANUAL | COMPREHENSIVE
LEARNING BLUEPRINT & PRACTICE
TOPICS || UPDATED COURSE VERSION
Domain: Advanced Health Assessment & Diagnostic Reasoning (Questions 1-25)
1. During a cardiac assessment, a holosystolic murmur is heard best at the apex and
radiates to the axilla. This finding is most characteristic of:
A) Aortic stenosis
B) Mitral regurgitation
C) Tricuspid regurgitation
D) Aortic regurgitation
2. The most common cause of acute pancreatitis in adults is:
A) Autoimmune disease
B) Gallstones and alcohol use
C) Hypertriglyceridemia
D) Trauma
3. A positive McMurray test is indicative of injury to which structure?
A) Anterior cruciate ligament (ACL)
B) Medial meniscus
C) Lateral collateral ligament (LCL)
D) Patellar tendon
4. When percussing the posterior chest, a dull note over the left lower scapular area is
most likely indicative of:
A) Consolidation (e.g., pneumonia)
B) Pleural effusion
C) Normal lung tissue
D) Enlarged spleen (splenomegaly)
5. The NP inspects a patient's tympanic membrane and notes a chalky white plaque on
the malleus. This is most consistent with:
, A) Acute otitis media with effusion
B) Cholesteatoma
C) Tympanosclerosis
D) Otitis externa
6. A 65-year-old patient presents with painless jaundice, clay-colored stools, and a
palpable gallbladder (Courvoisier's sign). This triad is classic for:
A) Alcoholic hepatitis
B) Cholelithiasis
C) Carcinoma of the head of the pancreas
D) Viral hepatitis
7. Which cranial nerve is being assessed when testing the gag reflex?
A) CN IX (Glossopharyngeal) and CN X (Vagus)
B) CN V (Trigeminal) and CN VII (Facial)
C) CN XII (Hypoglossal)
D) CN II (Optic) and CN III (Oculomotor)
8. A positive Rovsing's sign (RLQ pain with palpation of LLQ) suggests:
A) Cholecystitis
B) Appendicitis
C) Diverticulitis
D) Pyelonephritis
9. Which lymph node region drains the breast most directly?
A) Cervical
B) Axillary
C) Supraclavicular
D) Inguinal
10. A patient with hyperthyroidism would most likely exhibit which set of findings?
A) Bradycardia, weight gain, cold intolerance
B) Tachycardia, weight loss, heat intolerance
C) Hypotension, constipation, fatigue
D) Hypothermia, dry skin, hoarseness
11. The "dowager's hump" or exaggerated thoracic kyphosis is most associated with:
A) Ankylosing spondylitis
B) Osteoarthritis
, C) Osteoporosis
D) Scoliosis
12. A patient has pitting edema, jugular venous distention (JVD), and an S3 gallop. These
are hallmark signs of:
A) Left-sided heart failure
B) Right-sided heart failure
C) Biventricular heart failure
D) Pericardial tamponade
13. To assess for rotator cuff tendinitis (specifically the supraspinatus), the NP would
perform which maneuver?
A) Neer's impingement sign
B) Hawkins-Kennedy impingement sign
C) Empty can test (Jobe's test)
D) Apley scratch test
14. A Brudzinski's sign (flexion of hips/knees when neck is flexed) is a classic sign of:
A) Meningitis
B) Cervical nerve root compression
C) Parkinson's disease
D) Cerebellar ataxia
15. A peau d'orange appearance and nipple retraction on breast exam are red flags for:
A) Fibrocystic breast changes
B) Mastitis
C) Invasive breast carcinoma
D) Ductal ectasia
16. Heberden's nodes are bony enlargements associated with osteoarthritis and are
located on the:
A) Proximal interphalangeal (PIP) joints
B) Distal interphalangeal (DIP) joints
C) Metacarpophalangeal (MCP) joints
D) Wrist joints
17. A patient with chronic obstructive pulmonary disease (COPD) typically exhibits which
chest shape?
A) Pectus excavatum
B) Barrel chest
, C) Pectus carinatum
D) Flail chest
18. To differentiate conductive from sensorineural hearing loss, the NP would perform:
A) Otoscopy
B) Whisper test
C) Rinne and Weber tests
D) Tympanometry
19. Pain that is referred to the right scapula is most commonly associated with pathology
of the:
A) Heart
B) Pancreas
C) Gallbladder
D) Appendix
20. A positive Homans' sign (calf pain on dorsiflexion of the foot) is a classic, though
unreliable, indicator of:
A) Plantar fasciitis
B) Achilles tendonitis
C) Deep vein thrombosis (DVT)
D) Peripheral artery disease
21. The NP observes Kayser-Fleischer rings on corneal exam. This finding is
pathognomonic for:
A) Hyperthyroidism
B) Wilson's disease (copper accumulation)
C) Hypercholesterolemia
D) Cataracts
22. Which finding is expected in a patient with a lower motor neuron lesion (e.g.,
herniated disc)?
A) Hyperreflexia and spasticity
B) Flaccidity, atrophy, and hyporeflexia
C) Positive Babinski sign
D) Clonus
23. A palpable, pulsatile mass in the mid-abdomen suggests:
A) Abdominal aortic aneurysm
B) Pancreatic pseudocyst
REVIEW MANUAL | COMPREHENSIVE
LEARNING BLUEPRINT & PRACTICE
TOPICS || UPDATED COURSE VERSION
Domain: Advanced Health Assessment & Diagnostic Reasoning (Questions 1-25)
1. During a cardiac assessment, a holosystolic murmur is heard best at the apex and
radiates to the axilla. This finding is most characteristic of:
A) Aortic stenosis
B) Mitral regurgitation
C) Tricuspid regurgitation
D) Aortic regurgitation
2. The most common cause of acute pancreatitis in adults is:
A) Autoimmune disease
B) Gallstones and alcohol use
C) Hypertriglyceridemia
D) Trauma
3. A positive McMurray test is indicative of injury to which structure?
A) Anterior cruciate ligament (ACL)
B) Medial meniscus
C) Lateral collateral ligament (LCL)
D) Patellar tendon
4. When percussing the posterior chest, a dull note over the left lower scapular area is
most likely indicative of:
A) Consolidation (e.g., pneumonia)
B) Pleural effusion
C) Normal lung tissue
D) Enlarged spleen (splenomegaly)
5. The NP inspects a patient's tympanic membrane and notes a chalky white plaque on
the malleus. This is most consistent with:
, A) Acute otitis media with effusion
B) Cholesteatoma
C) Tympanosclerosis
D) Otitis externa
6. A 65-year-old patient presents with painless jaundice, clay-colored stools, and a
palpable gallbladder (Courvoisier's sign). This triad is classic for:
A) Alcoholic hepatitis
B) Cholelithiasis
C) Carcinoma of the head of the pancreas
D) Viral hepatitis
7. Which cranial nerve is being assessed when testing the gag reflex?
A) CN IX (Glossopharyngeal) and CN X (Vagus)
B) CN V (Trigeminal) and CN VII (Facial)
C) CN XII (Hypoglossal)
D) CN II (Optic) and CN III (Oculomotor)
8. A positive Rovsing's sign (RLQ pain with palpation of LLQ) suggests:
A) Cholecystitis
B) Appendicitis
C) Diverticulitis
D) Pyelonephritis
9. Which lymph node region drains the breast most directly?
A) Cervical
B) Axillary
C) Supraclavicular
D) Inguinal
10. A patient with hyperthyroidism would most likely exhibit which set of findings?
A) Bradycardia, weight gain, cold intolerance
B) Tachycardia, weight loss, heat intolerance
C) Hypotension, constipation, fatigue
D) Hypothermia, dry skin, hoarseness
11. The "dowager's hump" or exaggerated thoracic kyphosis is most associated with:
A) Ankylosing spondylitis
B) Osteoarthritis
, C) Osteoporosis
D) Scoliosis
12. A patient has pitting edema, jugular venous distention (JVD), and an S3 gallop. These
are hallmark signs of:
A) Left-sided heart failure
B) Right-sided heart failure
C) Biventricular heart failure
D) Pericardial tamponade
13. To assess for rotator cuff tendinitis (specifically the supraspinatus), the NP would
perform which maneuver?
A) Neer's impingement sign
B) Hawkins-Kennedy impingement sign
C) Empty can test (Jobe's test)
D) Apley scratch test
14. A Brudzinski's sign (flexion of hips/knees when neck is flexed) is a classic sign of:
A) Meningitis
B) Cervical nerve root compression
C) Parkinson's disease
D) Cerebellar ataxia
15. A peau d'orange appearance and nipple retraction on breast exam are red flags for:
A) Fibrocystic breast changes
B) Mastitis
C) Invasive breast carcinoma
D) Ductal ectasia
16. Heberden's nodes are bony enlargements associated with osteoarthritis and are
located on the:
A) Proximal interphalangeal (PIP) joints
B) Distal interphalangeal (DIP) joints
C) Metacarpophalangeal (MCP) joints
D) Wrist joints
17. A patient with chronic obstructive pulmonary disease (COPD) typically exhibits which
chest shape?
A) Pectus excavatum
B) Barrel chest
, C) Pectus carinatum
D) Flail chest
18. To differentiate conductive from sensorineural hearing loss, the NP would perform:
A) Otoscopy
B) Whisper test
C) Rinne and Weber tests
D) Tympanometry
19. Pain that is referred to the right scapula is most commonly associated with pathology
of the:
A) Heart
B) Pancreas
C) Gallbladder
D) Appendix
20. A positive Homans' sign (calf pain on dorsiflexion of the foot) is a classic, though
unreliable, indicator of:
A) Plantar fasciitis
B) Achilles tendonitis
C) Deep vein thrombosis (DVT)
D) Peripheral artery disease
21. The NP observes Kayser-Fleischer rings on corneal exam. This finding is
pathognomonic for:
A) Hyperthyroidism
B) Wilson's disease (copper accumulation)
C) Hypercholesterolemia
D) Cataracts
22. Which finding is expected in a patient with a lower motor neuron lesion (e.g.,
herniated disc)?
A) Hyperreflexia and spasticity
B) Flaccidity, atrophy, and hyporeflexia
C) Positive Babinski sign
D) Clonus
23. A palpable, pulsatile mass in the mid-abdomen suggests:
A) Abdominal aortic aneurysm
B) Pancreatic pseudocyst
