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APEA Pre-Predictor Actual Exam Question
Bank (Newest 2026) | 100 Verified Q & A
with Detailed Rationales | Grade A
Subject: Nursing/Advanced Practice Exam Preparation (APEA Pre
Predictor)
Source: APEA Pre Predictor Exam Question Bank (2026 Edition)
Format: Q&A with Rationales (Multiple-Choice, Clinical Focus)
1. An elderly patient is taking an effective dose of doxepin
(Sinequan) for treatment of agitated depression with insomnia.
Constipation has become a significant problem, even though the
patient has been vigilant about maintaining adequate hydration and
uses bulk laxatives frequently. Which of the following is the course of
action most likely to be successful?
A. Stop the doxepin and initiate trazodone (Desyrel)
B. Initiate a daily enema
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C. Continue doxepin and add a stimulant laxative
D. Stop the doxepin and initiate fluoxetine (Prozac)
Correct Answer: A. Stop the doxepin and initiate trazodone (Desyrel)
Rationale:
1. Doxepin is a tricyclic antidepressant (TCA) with strong
anticholinergic effects, a common cause of constipation.
2. Trazodone is a sedating antidepressant with similar benefits for
insomnia and depression but lacks significant anticholinergic activity.
3. Switching to trazodone addresses the side effect while maintaining
therapeutic efficacy for depression and insomnia.
2. A 12 y/o presents with ear pain of 36 hours duration. The NP
diagnoses acute otitis media because the:
A. Tympanic membrane is bulging and glossy with tiny bubbles visible
posteriorly
B. Tympanic membrane is retracted against bony landmarks
C. Bony landmarks are obscured, and the tympanic membrane is mildly
erythematous, dull and immobile
D. Canal is narrowed, erythematous, and exquisitely tender with speculum
contact
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Correct Answer: C. Bony landmarks are obscured, and the tympanic
membrane is mildly erythematous, dull and immobile
Rationale:
1. Acute otitis media (AOM) typically presents with a bulging, opaque,
erythematous, and immobile tympanic membrane.
2. Obscured bony landmarks indicate effusion or inflammation within
the middle ear.
3. Options A and B describe serous otitis media, while option D
describes otitis externa.
3. The NP should instruct the mother of an infant with thrush to:
A. Take oral nystatin since she is breastfeeding
B. Stop breastfeeding until the thrush has resolved
C. Administer antifungal medication to the infant prior to feeding
D. Sterilize pacifiers and bottle nipples
Correct Answer: D. Sterilize pacifiers and bottle nipples
Rationale:
1. Thrush is caused by Candida albicans, which can colonize feeding
equipment.
2. Sterilizing pacifiers, bottle nipples, and other mouth toys helps
prevent reinfection and spread.
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3. Antifungal medication is given to the infant, not the mother, and
breastfeeding does not need to be discontinued.
4. A 26 y/o patient, 18 weeks pregnant with twins, has been
healthy and has followed recommendations of her nurse midwife. She
is in the office to discuss results of her maternal serum
alphafetoprotein (MSAFP) test. Which shows elevation in this
particular pregnancy?
A. Elevated MSAFP is an indicator of Down Syndrome
B. Low MSAFP is expected at 18 weeks' gestation
C. Neural tube defects are highly probable
D. Elevated MSAFP is an expected finding
Correct Answer: D. Elevated MSAFP is an expected finding
Rationale:
1. MSAFP levels are typically elevated in multiple pregnancies (e.g.,
twins) due to increased fetal tissue production.
2. Elevated MSAFP alone is not diagnostic for neural tube defects or
Down Syndrome in the context of a twin pregnancy.
5. The hallmark of neurofibromatosis (von Recklinghausen
disease) present in almost 100% of patients is:
APEA Pre-Predictor Actual Exam Question
Bank (Newest 2026) | 100 Verified Q & A
with Detailed Rationales | Grade A
Subject: Nursing/Advanced Practice Exam Preparation (APEA Pre
Predictor)
Source: APEA Pre Predictor Exam Question Bank (2026 Edition)
Format: Q&A with Rationales (Multiple-Choice, Clinical Focus)
1. An elderly patient is taking an effective dose of doxepin
(Sinequan) for treatment of agitated depression with insomnia.
Constipation has become a significant problem, even though the
patient has been vigilant about maintaining adequate hydration and
uses bulk laxatives frequently. Which of the following is the course of
action most likely to be successful?
A. Stop the doxepin and initiate trazodone (Desyrel)
B. Initiate a daily enema
, 2|Page
C. Continue doxepin and add a stimulant laxative
D. Stop the doxepin and initiate fluoxetine (Prozac)
Correct Answer: A. Stop the doxepin and initiate trazodone (Desyrel)
Rationale:
1. Doxepin is a tricyclic antidepressant (TCA) with strong
anticholinergic effects, a common cause of constipation.
2. Trazodone is a sedating antidepressant with similar benefits for
insomnia and depression but lacks significant anticholinergic activity.
3. Switching to trazodone addresses the side effect while maintaining
therapeutic efficacy for depression and insomnia.
2. A 12 y/o presents with ear pain of 36 hours duration. The NP
diagnoses acute otitis media because the:
A. Tympanic membrane is bulging and glossy with tiny bubbles visible
posteriorly
B. Tympanic membrane is retracted against bony landmarks
C. Bony landmarks are obscured, and the tympanic membrane is mildly
erythematous, dull and immobile
D. Canal is narrowed, erythematous, and exquisitely tender with speculum
contact
, 3|Page
Correct Answer: C. Bony landmarks are obscured, and the tympanic
membrane is mildly erythematous, dull and immobile
Rationale:
1. Acute otitis media (AOM) typically presents with a bulging, opaque,
erythematous, and immobile tympanic membrane.
2. Obscured bony landmarks indicate effusion or inflammation within
the middle ear.
3. Options A and B describe serous otitis media, while option D
describes otitis externa.
3. The NP should instruct the mother of an infant with thrush to:
A. Take oral nystatin since she is breastfeeding
B. Stop breastfeeding until the thrush has resolved
C. Administer antifungal medication to the infant prior to feeding
D. Sterilize pacifiers and bottle nipples
Correct Answer: D. Sterilize pacifiers and bottle nipples
Rationale:
1. Thrush is caused by Candida albicans, which can colonize feeding
equipment.
2. Sterilizing pacifiers, bottle nipples, and other mouth toys helps
prevent reinfection and spread.
, 4|Page
3. Antifungal medication is given to the infant, not the mother, and
breastfeeding does not need to be discontinued.
4. A 26 y/o patient, 18 weeks pregnant with twins, has been
healthy and has followed recommendations of her nurse midwife. She
is in the office to discuss results of her maternal serum
alphafetoprotein (MSAFP) test. Which shows elevation in this
particular pregnancy?
A. Elevated MSAFP is an indicator of Down Syndrome
B. Low MSAFP is expected at 18 weeks' gestation
C. Neural tube defects are highly probable
D. Elevated MSAFP is an expected finding
Correct Answer: D. Elevated MSAFP is an expected finding
Rationale:
1. MSAFP levels are typically elevated in multiple pregnancies (e.g.,
twins) due to increased fetal tissue production.
2. Elevated MSAFP alone is not diagnostic for neural tube defects or
Down Syndrome in the context of a twin pregnancy.
5. The hallmark of neurofibromatosis (von Recklinghausen
disease) present in almost 100% of patients is:
