NSG 6998 APEA PREDICTOR FINAL COMPREHENSIVE ACTUAL EXAM 2026/2027 |
EXPERT VERIFIED | MAXIMUM COVERAGE PREDICTOR EXAM | SOUTH UNIVERSITY
& NIGHTINGALE COLLEGE | 200 QUESTIONS & RATIONALES - GRADED A+
INSTRUCTIONS:
This exam contains 200 multiple-choice questions
Select the best answer for each question
Answers and rationales are provided after each question
Time suggested: 3.5 hours (simulated certification environment)
Q1. A 65-year-old male presents with sudden onset of severe, tearing chest pain radiating to the back. Blood
pressure is 100/50 in the right arm and 140/80 in the left arm. Which diagnosis is most likely?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing chest pain radiating to the back and
differential blood pressures between arms (or pulse deficits). This is a surgical emergency (Type A involves
ascending aorta, requires emergent surgery; Type B may be managed medically). Immediate CT angiography
or transesophageal echocardiogram for diagnosis. MI, PE, and pericarditis do not cause differential BP.
Q2. A client with heart failure is prescribed carvedilol. Which assessment finding would indicate the
medication is having the desired therapeutic effect?
A) Increased blood pressure
, NSG 6998 APEA PREDICTOR FINAL COMPREHENSIVE ACTUAL EXAM 2026/2027 |
EXPERT VERIFIED | MAXIMUM COVERAGE PREDICTOR EXAM | SOUTH UNIVERSITY
& NIGHTINGALE COLLEGE | 200 QUESTIONS & RATIONALES - GRADED A+
B) Decreased heart rate and improved ejection fraction
C) Increased shortness of breath
D) Weight gain of 3 pounds in 24 hours
Answer: B
Rationale: Carvedilol is a beta-blocker used in heart failure to reduce heart rate, decrease myocardial oxygen
demand, and improve left ventricular ejection fraction (LVEF) over time (3-6 months). Desired effects:
reduced HR (60-70 bpm), improved EF, reduced symptoms (dyspnea, fatigue), reduced hospitalizations. Beta-
blockers should be started at low dose and titrated slowly.
Q3. A nurse is assessing a client with infective endocarditis. Which finding is most consistent with this
diagnosis?
A) Splinter hemorrhages
B) Osler's nodes
C) Janeway lesions
D) All of the above
Answer: D
Rationale: Splinter hemorrhages (linear red or brown lines under the nails), Osler's nodes (tender, red nodules
on fingers/toes), and Janeway lesions (non-tender macules on palms/soles) are all classic peripheral stigmata
of infective endocarditis. Other signs: Roth spots (retinal hemorrhages), clubbing, petechiae, fever, heart
murmur (often regurgitant). Blood cultures (3 sets) and echocardiography (TTE/TEE) are diagnostic.
Q4. A client with hypertension is prescribed lisinopril. The nurse should instruct the client to avoid which
supplement due to the risk of hyperkalemia?
A) Vitamin C
, NSG 6998 APEA PREDICTOR FINAL COMPREHENSIVE ACTUAL EXAM 2026/2027 |
EXPERT VERIFIED | MAXIMUM COVERAGE PREDICTOR EXAM | SOUTH UNIVERSITY
& NIGHTINGALE COLLEGE | 200 QUESTIONS & RATIONALES - GRADED A+
B) Vitamin D
C) Potassium-containing salt substitutes
D) Calcium
Answer: C
Rationale: ACE inhibitors (lisinopril, enalapril, ramipril) can cause hyperkalemia by reducing aldosterone
secretion (decreased potassium excretion in collecting duct). Potassium supplements and potassium-
containing salt substitutes (e.g., "No Salt," "Nu-Salt") should be avoided. Also avoid combined use with
potassium-sparing diuretics (spironolactone), ARBs, NSAIDs, TMP-SMX. Monitor potassium and creatinine.
Q5. A client with atrial fibrillation is prescribed apixaban (Eliquis). Which statement by the client indicates
understanding of this medication?
A) "I will need monthly blood tests to check my levels."
B) "I will stop taking this medication if I notice bruising."
C) "I will report any signs of bleeding, such as blood in my urine or black tarry stools."
D) "I will take this medication with food every morning."
Answer: C
Rationale: DOACs (apixaban, rivaroxaban, edoxaban, dabigatran) do not require routine INR monitoring, but
patients must be educated about signs of bleeding. Black tarry stools (melena) may indicate GI bleeding.
Hematuria, hematemesis, hemoptysis, easy bruising, prolonged bleeding should be reported. Do not stop
DOACs without provider instructions (increases stroke risk). Apixaban is taken BID (not once daily). Take
with or without food.
Q6. A client with peripheral arterial disease (PAD) reports pain in the calves when walking that resolves with
rest. Which instruction should the nurse provide?
, NSG 6998 APEA PREDICTOR FINAL COMPREHENSIVE ACTUAL EXAM 2026/2027 |
EXPERT VERIFIED | MAXIMUM COVERAGE PREDICTOR EXAM | SOUTH UNIVERSITY
& NIGHTINGALE COLLEGE | 200 QUESTIONS & RATIONALES - GRADED A+
A) "Limit your walking to avoid pain."
B) "Walk to the point of pain, rest, then continue walking."
C) "Elevate your legs above the heart when resting."
D) "Apply heat to your legs before walking."
Answer: B
Rationale: A structured walking program (walk to pain, rest, resume) promotes collateral circulation
(arteriogenesis) and improves symptoms of intermittent claudication (increases pain-free walking distance).
This is first-line non-pharmacologic therapy for PAD (Grade 1A evidence). Elevation worsens PAD pain
(arterial insufficiency). Heat may increase oxygen demand. Smoking cessation, antiplatelet therapy (aspirin,
clopidogrel), statin, cilostazol are also indicated.
Q7. A client with heart failure has an ejection fraction (EF) of 25%. The nurse understands that this indicates:
A) Normal cardiac function
B) Mildly reduced ejection fraction
C) Moderately reduced ejection fraction
D) Severely reduced ejection fraction
Answer: D
Rationale: Normal EF is 50-70%. An EF of 25% indicates severely reduced ejection fraction (heart failure with
reduced ejection fraction, HFrEF). HFpEF (preserved EF) is EF ≥50%. HFmrEF (mid
-range) is 40-49%.
Treatment for HFrEF includes ACEi/ARB/ARNI, beta-blocker, MRA, SGLT2i, diuretics. Target EF
improvement with GDMT.
Q8. A client with deep vein thrombosis (DVT) is receiving enoxaparin (Lovenox) subcutaneously. Which
technique should the nurse use to administer this medication?
EXPERT VERIFIED | MAXIMUM COVERAGE PREDICTOR EXAM | SOUTH UNIVERSITY
& NIGHTINGALE COLLEGE | 200 QUESTIONS & RATIONALES - GRADED A+
INSTRUCTIONS:
This exam contains 200 multiple-choice questions
Select the best answer for each question
Answers and rationales are provided after each question
Time suggested: 3.5 hours (simulated certification environment)
Q1. A 65-year-old male presents with sudden onset of severe, tearing chest pain radiating to the back. Blood
pressure is 100/50 in the right arm and 140/80 in the left arm. Which diagnosis is most likely?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing chest pain radiating to the back and
differential blood pressures between arms (or pulse deficits). This is a surgical emergency (Type A involves
ascending aorta, requires emergent surgery; Type B may be managed medically). Immediate CT angiography
or transesophageal echocardiogram for diagnosis. MI, PE, and pericarditis do not cause differential BP.
Q2. A client with heart failure is prescribed carvedilol. Which assessment finding would indicate the
medication is having the desired therapeutic effect?
A) Increased blood pressure
, NSG 6998 APEA PREDICTOR FINAL COMPREHENSIVE ACTUAL EXAM 2026/2027 |
EXPERT VERIFIED | MAXIMUM COVERAGE PREDICTOR EXAM | SOUTH UNIVERSITY
& NIGHTINGALE COLLEGE | 200 QUESTIONS & RATIONALES - GRADED A+
B) Decreased heart rate and improved ejection fraction
C) Increased shortness of breath
D) Weight gain of 3 pounds in 24 hours
Answer: B
Rationale: Carvedilol is a beta-blocker used in heart failure to reduce heart rate, decrease myocardial oxygen
demand, and improve left ventricular ejection fraction (LVEF) over time (3-6 months). Desired effects:
reduced HR (60-70 bpm), improved EF, reduced symptoms (dyspnea, fatigue), reduced hospitalizations. Beta-
blockers should be started at low dose and titrated slowly.
Q3. A nurse is assessing a client with infective endocarditis. Which finding is most consistent with this
diagnosis?
A) Splinter hemorrhages
B) Osler's nodes
C) Janeway lesions
D) All of the above
Answer: D
Rationale: Splinter hemorrhages (linear red or brown lines under the nails), Osler's nodes (tender, red nodules
on fingers/toes), and Janeway lesions (non-tender macules on palms/soles) are all classic peripheral stigmata
of infective endocarditis. Other signs: Roth spots (retinal hemorrhages), clubbing, petechiae, fever, heart
murmur (often regurgitant). Blood cultures (3 sets) and echocardiography (TTE/TEE) are diagnostic.
Q4. A client with hypertension is prescribed lisinopril. The nurse should instruct the client to avoid which
supplement due to the risk of hyperkalemia?
A) Vitamin C
, NSG 6998 APEA PREDICTOR FINAL COMPREHENSIVE ACTUAL EXAM 2026/2027 |
EXPERT VERIFIED | MAXIMUM COVERAGE PREDICTOR EXAM | SOUTH UNIVERSITY
& NIGHTINGALE COLLEGE | 200 QUESTIONS & RATIONALES - GRADED A+
B) Vitamin D
C) Potassium-containing salt substitutes
D) Calcium
Answer: C
Rationale: ACE inhibitors (lisinopril, enalapril, ramipril) can cause hyperkalemia by reducing aldosterone
secretion (decreased potassium excretion in collecting duct). Potassium supplements and potassium-
containing salt substitutes (e.g., "No Salt," "Nu-Salt") should be avoided. Also avoid combined use with
potassium-sparing diuretics (spironolactone), ARBs, NSAIDs, TMP-SMX. Monitor potassium and creatinine.
Q5. A client with atrial fibrillation is prescribed apixaban (Eliquis). Which statement by the client indicates
understanding of this medication?
A) "I will need monthly blood tests to check my levels."
B) "I will stop taking this medication if I notice bruising."
C) "I will report any signs of bleeding, such as blood in my urine or black tarry stools."
D) "I will take this medication with food every morning."
Answer: C
Rationale: DOACs (apixaban, rivaroxaban, edoxaban, dabigatran) do not require routine INR monitoring, but
patients must be educated about signs of bleeding. Black tarry stools (melena) may indicate GI bleeding.
Hematuria, hematemesis, hemoptysis, easy bruising, prolonged bleeding should be reported. Do not stop
DOACs without provider instructions (increases stroke risk). Apixaban is taken BID (not once daily). Take
with or without food.
Q6. A client with peripheral arterial disease (PAD) reports pain in the calves when walking that resolves with
rest. Which instruction should the nurse provide?
, NSG 6998 APEA PREDICTOR FINAL COMPREHENSIVE ACTUAL EXAM 2026/2027 |
EXPERT VERIFIED | MAXIMUM COVERAGE PREDICTOR EXAM | SOUTH UNIVERSITY
& NIGHTINGALE COLLEGE | 200 QUESTIONS & RATIONALES - GRADED A+
A) "Limit your walking to avoid pain."
B) "Walk to the point of pain, rest, then continue walking."
C) "Elevate your legs above the heart when resting."
D) "Apply heat to your legs before walking."
Answer: B
Rationale: A structured walking program (walk to pain, rest, resume) promotes collateral circulation
(arteriogenesis) and improves symptoms of intermittent claudication (increases pain-free walking distance).
This is first-line non-pharmacologic therapy for PAD (Grade 1A evidence). Elevation worsens PAD pain
(arterial insufficiency). Heat may increase oxygen demand. Smoking cessation, antiplatelet therapy (aspirin,
clopidogrel), statin, cilostazol are also indicated.
Q7. A client with heart failure has an ejection fraction (EF) of 25%. The nurse understands that this indicates:
A) Normal cardiac function
B) Mildly reduced ejection fraction
C) Moderately reduced ejection fraction
D) Severely reduced ejection fraction
Answer: D
Rationale: Normal EF is 50-70%. An EF of 25% indicates severely reduced ejection fraction (heart failure with
reduced ejection fraction, HFrEF). HFpEF (preserved EF) is EF ≥50%. HFmrEF (mid
-range) is 40-49%.
Treatment for HFrEF includes ACEi/ARB/ARNI, beta-blocker, MRA, SGLT2i, diuretics. Target EF
improvement with GDMT.
Q8. A client with deep vein thrombosis (DVT) is receiving enoxaparin (Lovenox) subcutaneously. Which
technique should the nurse use to administer this medication?
