APEA Pre-Predictor Exam 2026 – Comprehensive
Questions with Verified Correct Answers for
Advanced Practice Nursing Review
Section 1: Advanced Physical Assessment
Q1. A 58-year-old male with type 2 diabetes reports burning foot pain worse at
night. Exam shows diminished pinprick sensation distal to ankles and absent
Achilles reflexes. What is the most likely diagnosis?
• A) Peripheral artery disease
• B) Lumbar radiculopathy
• C) Diabetic peripheral neuropathy
• D) Vitamin B12 deficiency
Correct Answer: C
Rationale: Distal symmetric polyneuropathy in diabetes presents with burning
pain, nocturnal exacerbation, distal loss of sensation, and areflexia. Peripheral
artery disease would present with claudication and diminished pulses, not sensory
loss.
Q2. A 45-year-old woman has BP 152/96 mmHg on two visits. No comorbidities.
According to ACC/AHA guidelines, what is the first step?
• A) Start amlodipine 5 mg daily
• B) Start lisinopril 10 mg daily
• C) Recommend DASH diet and exercise for 4–6 months
• D) Order renal artery duplex ultrasound
,Correct Answer: C
Rationale: Stage 2 hypertension without comorbidities or target organ damage
first receives therapeutic lifestyle changes (DASH diet, exercise, weight loss) for 4–
6 months before initiating pharmacotherapy.
Q3. A 70-year-old woman reports progressive forgetfulness over 2 years. Exam
shows difficulty with word finding, apraxia, and agnosia. MMSE 22/30. No
fluctuation in cognition. What is the most likely diagnosis?
• A) Alzheimer's disease
• B) Lewy body dementia
• C) Frontotemporal dementia
• D) Vascular dementia
Correct Answer: A
Rationale: Alzheimer's disease presents with gradual onset of memory loss with
progressive cognitive decline including aphasia, apraxia, and agnosia. Lewy body
dementia features fluctuations and visual hallucinations. Vascular dementia has
stepwise deterioration.
Q4. A 72-year-old female is brought in by family who reports she has become
increasingly confused, forgetful, and has started wandering at night over the
past 18 months. MMSE score is 18/30. What is the most likely underlying
pathology?
• A) Accumulation of beta-amyloid plaques and neurofibrillary tangles
• B) Ischemic focal microvascular brain injury
• C) Lewy bodies within the brainstem and cortex
• D) Rapidly progressive prion-induced encephalopathy
Correct Answer: A
,Rationale: Alzheimer's disease is characterized pathologically by extracellular
beta-amyloid plaques and intracellular neurofibrillary tangles. This is the most
common cause of dementia in older adults with gradual decline.
Q5. A 62-year-old woman presents for a routine wellness exam. DEXA scan
reveals a T-score of -2.7 in the lumbar spine. What is the diagnosis and initial
management?
• A) Osteopenia; recommend calcium, Vitamin D, and weight-bearing
exercises
• B) Osteoporosis; initiate alendronate therapy along with calcium and
Vitamin D
• C) Osteopenia; initiate hormone replacement therapy
• D) Osteoporosis; initiate teriparatide therapy immediately
Correct Answer: B
Rationale: A T-score of -2.5 or lower on DEXA establishes the diagnosis of
osteoporosis. First-line pharmacological management involves oral
bisphosphonates such as alendronate alongside calcium and Vitamin D
supplementation.
Q6. A 68-year-old woman with osteoporosis on alendronate for 5 years develops
severe thigh and groin pain. X-ray shows transverse cortical thickening. What is
the most likely diagnosis?
• A) Osteosarcoma
• B) Atypical femoral fracture precursor
• C) Paget's disease
• D) Osteomalacia
Correct Answer: B
Rationale: Atypical femoral fractures from long-term bisphosphonate use present
with prodromal thigh pain and radiographic cortical beaking/thickening. This
, requires immediate discontinuation of the bisphosphonate and orthopedic
evaluation.
Q7. A 65-year-old male with a 40-pack-year smoking history presents with
chronic cough and dyspnea. PFT shows FEV1/FVC ratio of 0.62. Which diagnosis
is most consistent?
• A) Restrictive lung disease
• B) COPD
• C) Asthma
• D) Pulmonary fibrosis
Correct Answer: B
Rationale: An FEV1/FVC ratio less than 0.70 indicates airflow obstruction, which is
diagnostic for COPD. Restrictive diseases show reduced FVC with normal or
increased ratio.
Q8. A child presents with barking cough, stridor, and respiratory distress. What
is the most likely diagnosis?
• A) Epiglottitis
• B) Croup
• C) Asthma
• D) Bronchiolitis
Correct Answer: B
Rationale: A barking cough is classic for croup (laryngotracheobronchitis), typically
caused by parainfluenza virus. Epiglottitis presents with drooling, tripod
positioning, and a toxic appearance.
Q9. A patient presents with persistent cough, night sweats, weight loss, and
upper lobe infiltrates. What is the most likely diagnosis?
• A) Viral pneumonia
Questions with Verified Correct Answers for
Advanced Practice Nursing Review
Section 1: Advanced Physical Assessment
Q1. A 58-year-old male with type 2 diabetes reports burning foot pain worse at
night. Exam shows diminished pinprick sensation distal to ankles and absent
Achilles reflexes. What is the most likely diagnosis?
• A) Peripheral artery disease
• B) Lumbar radiculopathy
• C) Diabetic peripheral neuropathy
• D) Vitamin B12 deficiency
Correct Answer: C
Rationale: Distal symmetric polyneuropathy in diabetes presents with burning
pain, nocturnal exacerbation, distal loss of sensation, and areflexia. Peripheral
artery disease would present with claudication and diminished pulses, not sensory
loss.
Q2. A 45-year-old woman has BP 152/96 mmHg on two visits. No comorbidities.
According to ACC/AHA guidelines, what is the first step?
• A) Start amlodipine 5 mg daily
• B) Start lisinopril 10 mg daily
• C) Recommend DASH diet and exercise for 4–6 months
• D) Order renal artery duplex ultrasound
,Correct Answer: C
Rationale: Stage 2 hypertension without comorbidities or target organ damage
first receives therapeutic lifestyle changes (DASH diet, exercise, weight loss) for 4–
6 months before initiating pharmacotherapy.
Q3. A 70-year-old woman reports progressive forgetfulness over 2 years. Exam
shows difficulty with word finding, apraxia, and agnosia. MMSE 22/30. No
fluctuation in cognition. What is the most likely diagnosis?
• A) Alzheimer's disease
• B) Lewy body dementia
• C) Frontotemporal dementia
• D) Vascular dementia
Correct Answer: A
Rationale: Alzheimer's disease presents with gradual onset of memory loss with
progressive cognitive decline including aphasia, apraxia, and agnosia. Lewy body
dementia features fluctuations and visual hallucinations. Vascular dementia has
stepwise deterioration.
Q4. A 72-year-old female is brought in by family who reports she has become
increasingly confused, forgetful, and has started wandering at night over the
past 18 months. MMSE score is 18/30. What is the most likely underlying
pathology?
• A) Accumulation of beta-amyloid plaques and neurofibrillary tangles
• B) Ischemic focal microvascular brain injury
• C) Lewy bodies within the brainstem and cortex
• D) Rapidly progressive prion-induced encephalopathy
Correct Answer: A
,Rationale: Alzheimer's disease is characterized pathologically by extracellular
beta-amyloid plaques and intracellular neurofibrillary tangles. This is the most
common cause of dementia in older adults with gradual decline.
Q5. A 62-year-old woman presents for a routine wellness exam. DEXA scan
reveals a T-score of -2.7 in the lumbar spine. What is the diagnosis and initial
management?
• A) Osteopenia; recommend calcium, Vitamin D, and weight-bearing
exercises
• B) Osteoporosis; initiate alendronate therapy along with calcium and
Vitamin D
• C) Osteopenia; initiate hormone replacement therapy
• D) Osteoporosis; initiate teriparatide therapy immediately
Correct Answer: B
Rationale: A T-score of -2.5 or lower on DEXA establishes the diagnosis of
osteoporosis. First-line pharmacological management involves oral
bisphosphonates such as alendronate alongside calcium and Vitamin D
supplementation.
Q6. A 68-year-old woman with osteoporosis on alendronate for 5 years develops
severe thigh and groin pain. X-ray shows transverse cortical thickening. What is
the most likely diagnosis?
• A) Osteosarcoma
• B) Atypical femoral fracture precursor
• C) Paget's disease
• D) Osteomalacia
Correct Answer: B
Rationale: Atypical femoral fractures from long-term bisphosphonate use present
with prodromal thigh pain and radiographic cortical beaking/thickening. This
, requires immediate discontinuation of the bisphosphonate and orthopedic
evaluation.
Q7. A 65-year-old male with a 40-pack-year smoking history presents with
chronic cough and dyspnea. PFT shows FEV1/FVC ratio of 0.62. Which diagnosis
is most consistent?
• A) Restrictive lung disease
• B) COPD
• C) Asthma
• D) Pulmonary fibrosis
Correct Answer: B
Rationale: An FEV1/FVC ratio less than 0.70 indicates airflow obstruction, which is
diagnostic for COPD. Restrictive diseases show reduced FVC with normal or
increased ratio.
Q8. A child presents with barking cough, stridor, and respiratory distress. What
is the most likely diagnosis?
• A) Epiglottitis
• B) Croup
• C) Asthma
• D) Bronchiolitis
Correct Answer: B
Rationale: A barking cough is classic for croup (laryngotracheobronchitis), typically
caused by parainfluenza virus. Epiglottitis presents with drooling, tripod
positioning, and a toxic appearance.
Q9. A patient presents with persistent cough, night sweats, weight loss, and
upper lobe infiltrates. What is the most likely diagnosis?
• A) Viral pneumonia
