APEA Pre-Predictor & NP Board Exam
Mega Test Bank (Questions 1-300) – High-
Yield Practice Q&As with Comprehensive
Rationales (Updated for AANP/ANCC
Blueprints)
Section 1: Cardiovascular (Questions 1-10)
nb nb nb nb
1. A 68-year-
nb nb
old male with a history of hypertension and type 2 diabetes presents for a routine check
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
-
up. His blood pressure is 145/90 mmHg. An ECG reveals left ventricular hypertrophy. Wh
nb nb nb nb nb nb nb nb nb nb nb nb nb
ich medication class is considered first-
nb nb nb nb nb
line for managing his hypertension to specifically reduce the risk of stroke and cardiovas
nb nb nb nb nb nb nb nb nb nb nb nb nb
cular mortality? nb
A) Beta-blockers
nb
B) ACE inhibitors
nb nb
C) Thiazide diuretics
nb nb
D) Calcium channel blockers
nb nb nb
2. A 72-year-
nb nb
old female complains of chest pain that occurs with exertion and is relieved by rest. She
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
describes it as a "heavy pressure" in the substernal area radiating to her left shoulder. W
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
hich of the following physical exam findings would be most concerning for a poor progn
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
osis in a patient with this presentation?
nb nb nb nb nb nb
A) S4 gallop
nb nb
B) Carotid bruit
nb nb
C) Systolic ejection murmur at the left sternal border
nb nb nb nb nb nb nb nb
D) Diminished dorsalis pedis pulses
nb nb nb nb
3. A 55-year-
nb nb
old male is diagnosed with heart failure with reduced ejection fraction (HFrEF). He has a
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
history of chronic kidney disease (Stage 3). Which of the following medication combinati
nb nb nb nb nb nb nb nb nb nb nb nb
ons has been shown to provide the most significant mortality benefit and is considered f
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
oundational therapy? nb
A) ACE inhibitor + Thiazide diuretic
nb nb nb nb nb
B) Beta-blocker (Carvedilol) + ARB
nb nb nb nb
,C) ARNI (Sacubitril/Valsartan) + Beta-blocker + Mineralocorticoid receptor antagonist
nb nb nb nb nb nb nb nb
D) Digoxin + Loop diuretic
nb nb nb nb
4. A patient presents with acute onset of severe, tearing chest pain radiating to the back.
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
Blood pressure is 180/100 in the right arm and 140/80 in the left arm. What is the most
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb n
appropriate initial diagnostic test?
b nb nb nb
A) CT angiography of the chest
nb nb nb nb nb
B) Transthoracic echocardiogram
nb nb
C) Standard 12-lead ECG
nb nb nb
D) Chest X-ray
nb nb
5. A 30-year-
nb nb
old female with palpitations is found to have a heart rate of 180 bpm on ECG. The rhyth
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
m is regular, and there are no visible P waves. What is the most appropriate initial mana
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
gement for this stable patient? nb nb nb nb
A) Immediate synchronized cardioversion
nb nb nb
B) IV Adenosine
nb nb
C) IV Amiodarone
nb nb
D) Vagal maneuvers
nb nb
6. A 45-year-
nb nb
old obese male has a blood pressure of 150/95 mmHg. His labs show a potassium of 3.0
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
mEq/L and an elevated serum glucose. Which diagnosis is most strongly suggested by th
nb nb nb nb nb nb nb nb nb nb nb nb nb
is triad of hypertension, hypokalemia, and hyperglycemia?
nb nb nb nb nb nb
A) Pheochromocytoma
nb
B) Cushing’s syndrome
nb nb
C) Primary aldosteronism
nb nb
D) Renal artery stenosis
nb nb nb
7. A 67-year-
nb nb
old male with a history of CAD is being managed on Aspirin, Atorvastatin, and Metoprol
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
ol. He reports new-onset, worsening shortness of breath and a non-
nb nb nb nb nb nb nb nb nb nb
productive cough. Auscultation reveals crackles at the lung bases. Which medication is m
nb nb nb nb nb nb nb nb nb nb nb nb
ost likely contributing to his new symptoms?
nb nb nb nb nb nb
A) Aspirin
nb
B) Atorvastatin
nb
C) Metoprolol
nb
D) All of the above
nb nb nb nb
8. A 60-year-old female is 2 days post-
nb nb nb nb nb nb nb
operative from a total hip replacement. She suddenly develops dyspnea, pleuritic chest p
nb nb nb nb nb nb nb nb nb nb nb nb
ain, and hemoptysis. Her heart rate is 110, respiratory rate is 28, and O2 sat is 90% on ro
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
om air. What is the most likely diagnosis?
nb nb nb nb nb nb nb
,A) Aortic dissection
nb nb
B) Myocardial infarction
nb nb
C) Pulmonary embolism
nb nb
D) Pneumothorax
nb
9. A patient with chronic atrial fibrillation is on Warfarin. Her INR is 6.5. She has no sign
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
s of bleeding. What is the most appropriate management?
nb nb nb nb nb nb nb nb
A) Hold Warfarin and administer Vitamin K 1 mg PO
nb nb nb nb nb nb nb nb nb
B) Hold Warfarin and administer fresh frozen plasma
nb nb nb nb nb nb nb
C) Hold Warfarin and restart when INR < 5
nb nb nb nb nb nb nb nb
D) Administer Vitamin K 10 mg IV immediately
nb nb nb nb nb nb nb
10. A characteristic auscultatory finding of aortic stenosis is:
nb nb nb nb nb nb nb nb
A) A holosystolic murmur at the apex that radiates to the axilla
nb nb nb nb nb nb nb nb nb nb nb
B) A systolic ejection murmur at the right upper sternal border that radiates to the carotids
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
C) A diastolic decrescendo murmur at the left lower sternal border
nb nb nb nb nb nb nb nb nb nb
D) A continuous "machine-like" murmur at the left upper sternal border
nb nb nb nb nb nb nb nb nb nb
Section 2: Pulmonology (Questions 11-18)
nb nb nb nb
11. A 6-year-
nb nb
old child presents with a harsh, "barking" cough, stridor, and hoarseness that developed
nb nb nb nb nb nb nb nb nb nb nb nb nb
suddenly at night. The child is afebrile. What is the most likely diagnosis?
nb nb nb nb nb nb nb nb nb nb nb nb
A) Bacterial tracheitis
nb nb
B) Epiglottitis
nb
C) Croup (Laryngotracheobronchitis)
nb nb
D) Foreign body aspiration
nb nb nb
12. A 25-year-
nb nb
old with a history of asthma presents with increased use of his rescue inhaler. Spirometr
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
y shows a FEV1/FVC ratio of 65% and a significant improvement in FEV1 after bronchodi
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
lator administration. This confirms:
nb nb nb
A) Restrictive lung disease
nb nb nb
B) Reversible airway obstruction
nb nb nb
C) Fixed airway obstruction
nb nb nb
D) Poor effort on spirometry
nb nb nb nb
13. A 50-year-
nb nb
old smoker presents with progressive dyspnea and a chronic productive cough. Chest X-
nb nb nb nb nb nb nb nb nb nb nb nb
ray shows hyperinflation and flattened diaphragms. Which of the following is the best in
nb nb nb nb nb nb nb nb nb nb nb nb nb
itial pharmacologic therapy to reduce exacerbations and improve quality of life?
nb nb nb nb nb nb nb nb nb nb
A) Inhaled corticosteroids alone
nb nb nb
, B) Long-acting muscarinic antagonist (LAMA)
nb nb nb nb
C) Oral theophylline
nb nb
D) Antibiotics
nb
14. A patient with COPD is being discharged after a severe exacerbation. What vaccinati
nb nb nb nb nb nb nb nb nb nb nb nb nb
on is most critical to recommend for this patient to prevent future hospitalizations?
nb nb nb nb nb nb nb nb nb nb nb nb
A) Zoster vaccine
nb nb
B) Pneumococcal conjugate vaccine (PCV20)
nb nb nb nb
C) Meningococcal vaccine
nb nb
D) Haemophilus influenzae type B vaccine
nb nb nb nb nb
15. A 32-year- nb nb
old female presents with acute onset of sharp chest pain that is worse with inspiration. S
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
he is tachypneic but not hypoxic. She has no risk factors for DVT. What is the most likely
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
diagnosis?
nb
A) Pulmonary embolism
nb nb
B) Pericarditis
nb
C) Spontaneous pneumothorax
nb nb
D) Pleurisy (Viral)
nb nb
16. A 55-year- nb nb
old male presents with hemoptysis, weight loss, and hoarseness. He has a 40-pack-
nb nb nb nb nb nb nb nb nb nb nb nb
year smoking history. A chest X-
nb nb nb nb nb
ray reveals a hilar mass. What physical exam finding would suggest Horner's syndrome r
nb nb nb nb nb nb nb nb nb nb nb nb nb
elated to a Pancoast tumor? nb nb nb nb
A) Miosis and ptosis
nb nb nb
B) Mydriasis and exophthalmos
nb nb nb
C) Bilateral lower extremity edema
nb nb nb nb
D) Clubbing of the fingers
nb nb nb nb
17. A 4-year- nb nb
old presents with drooling, tripod positioning, and a muffled voice. The child appears an
nb nb nb nb nb nb nb nb nb nb nb nb nb
xious and has a high fever. What is the most appropriate next step?
nb nb nb nb nb nb nb nb nb nb nb nb
A) Perform a throat culture
nb nb nb nb
B) Inspect the oropharynx with a tongue depressor
nb nb nb nb nb nb nb
C) Prepare for emergent intubation in the OR
nb nb nb nb nb nb nb
D) Administer a nebulized epinephrine treatment
nb nb nb nb nb
18. A patient with a history of GERD and hypertension presents with a chronic cough. Th
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
e cough is worse at night and when lying down. Which medication is most likely contrib
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
uting to the cough? nb nb nb
A) Lisinopril
nb
B) Omeprazole
nb
Mega Test Bank (Questions 1-300) – High-
Yield Practice Q&As with Comprehensive
Rationales (Updated for AANP/ANCC
Blueprints)
Section 1: Cardiovascular (Questions 1-10)
nb nb nb nb
1. A 68-year-
nb nb
old male with a history of hypertension and type 2 diabetes presents for a routine check
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
-
up. His blood pressure is 145/90 mmHg. An ECG reveals left ventricular hypertrophy. Wh
nb nb nb nb nb nb nb nb nb nb nb nb nb
ich medication class is considered first-
nb nb nb nb nb
line for managing his hypertension to specifically reduce the risk of stroke and cardiovas
nb nb nb nb nb nb nb nb nb nb nb nb nb
cular mortality? nb
A) Beta-blockers
nb
B) ACE inhibitors
nb nb
C) Thiazide diuretics
nb nb
D) Calcium channel blockers
nb nb nb
2. A 72-year-
nb nb
old female complains of chest pain that occurs with exertion and is relieved by rest. She
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
describes it as a "heavy pressure" in the substernal area radiating to her left shoulder. W
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
hich of the following physical exam findings would be most concerning for a poor progn
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
osis in a patient with this presentation?
nb nb nb nb nb nb
A) S4 gallop
nb nb
B) Carotid bruit
nb nb
C) Systolic ejection murmur at the left sternal border
nb nb nb nb nb nb nb nb
D) Diminished dorsalis pedis pulses
nb nb nb nb
3. A 55-year-
nb nb
old male is diagnosed with heart failure with reduced ejection fraction (HFrEF). He has a
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
history of chronic kidney disease (Stage 3). Which of the following medication combinati
nb nb nb nb nb nb nb nb nb nb nb nb
ons has been shown to provide the most significant mortality benefit and is considered f
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
oundational therapy? nb
A) ACE inhibitor + Thiazide diuretic
nb nb nb nb nb
B) Beta-blocker (Carvedilol) + ARB
nb nb nb nb
,C) ARNI (Sacubitril/Valsartan) + Beta-blocker + Mineralocorticoid receptor antagonist
nb nb nb nb nb nb nb nb
D) Digoxin + Loop diuretic
nb nb nb nb
4. A patient presents with acute onset of severe, tearing chest pain radiating to the back.
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
Blood pressure is 180/100 in the right arm and 140/80 in the left arm. What is the most
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb n
appropriate initial diagnostic test?
b nb nb nb
A) CT angiography of the chest
nb nb nb nb nb
B) Transthoracic echocardiogram
nb nb
C) Standard 12-lead ECG
nb nb nb
D) Chest X-ray
nb nb
5. A 30-year-
nb nb
old female with palpitations is found to have a heart rate of 180 bpm on ECG. The rhyth
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
m is regular, and there are no visible P waves. What is the most appropriate initial mana
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
gement for this stable patient? nb nb nb nb
A) Immediate synchronized cardioversion
nb nb nb
B) IV Adenosine
nb nb
C) IV Amiodarone
nb nb
D) Vagal maneuvers
nb nb
6. A 45-year-
nb nb
old obese male has a blood pressure of 150/95 mmHg. His labs show a potassium of 3.0
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
mEq/L and an elevated serum glucose. Which diagnosis is most strongly suggested by th
nb nb nb nb nb nb nb nb nb nb nb nb nb
is triad of hypertension, hypokalemia, and hyperglycemia?
nb nb nb nb nb nb
A) Pheochromocytoma
nb
B) Cushing’s syndrome
nb nb
C) Primary aldosteronism
nb nb
D) Renal artery stenosis
nb nb nb
7. A 67-year-
nb nb
old male with a history of CAD is being managed on Aspirin, Atorvastatin, and Metoprol
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
ol. He reports new-onset, worsening shortness of breath and a non-
nb nb nb nb nb nb nb nb nb nb
productive cough. Auscultation reveals crackles at the lung bases. Which medication is m
nb nb nb nb nb nb nb nb nb nb nb nb
ost likely contributing to his new symptoms?
nb nb nb nb nb nb
A) Aspirin
nb
B) Atorvastatin
nb
C) Metoprolol
nb
D) All of the above
nb nb nb nb
8. A 60-year-old female is 2 days post-
nb nb nb nb nb nb nb
operative from a total hip replacement. She suddenly develops dyspnea, pleuritic chest p
nb nb nb nb nb nb nb nb nb nb nb nb
ain, and hemoptysis. Her heart rate is 110, respiratory rate is 28, and O2 sat is 90% on ro
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
om air. What is the most likely diagnosis?
nb nb nb nb nb nb nb
,A) Aortic dissection
nb nb
B) Myocardial infarction
nb nb
C) Pulmonary embolism
nb nb
D) Pneumothorax
nb
9. A patient with chronic atrial fibrillation is on Warfarin. Her INR is 6.5. She has no sign
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
s of bleeding. What is the most appropriate management?
nb nb nb nb nb nb nb nb
A) Hold Warfarin and administer Vitamin K 1 mg PO
nb nb nb nb nb nb nb nb nb
B) Hold Warfarin and administer fresh frozen plasma
nb nb nb nb nb nb nb
C) Hold Warfarin and restart when INR < 5
nb nb nb nb nb nb nb nb
D) Administer Vitamin K 10 mg IV immediately
nb nb nb nb nb nb nb
10. A characteristic auscultatory finding of aortic stenosis is:
nb nb nb nb nb nb nb nb
A) A holosystolic murmur at the apex that radiates to the axilla
nb nb nb nb nb nb nb nb nb nb nb
B) A systolic ejection murmur at the right upper sternal border that radiates to the carotids
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
C) A diastolic decrescendo murmur at the left lower sternal border
nb nb nb nb nb nb nb nb nb nb
D) A continuous "machine-like" murmur at the left upper sternal border
nb nb nb nb nb nb nb nb nb nb
Section 2: Pulmonology (Questions 11-18)
nb nb nb nb
11. A 6-year-
nb nb
old child presents with a harsh, "barking" cough, stridor, and hoarseness that developed
nb nb nb nb nb nb nb nb nb nb nb nb nb
suddenly at night. The child is afebrile. What is the most likely diagnosis?
nb nb nb nb nb nb nb nb nb nb nb nb
A) Bacterial tracheitis
nb nb
B) Epiglottitis
nb
C) Croup (Laryngotracheobronchitis)
nb nb
D) Foreign body aspiration
nb nb nb
12. A 25-year-
nb nb
old with a history of asthma presents with increased use of his rescue inhaler. Spirometr
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
y shows a FEV1/FVC ratio of 65% and a significant improvement in FEV1 after bronchodi
nb nb nb nb nb nb nb nb nb nb nb nb nb nb
lator administration. This confirms:
nb nb nb
A) Restrictive lung disease
nb nb nb
B) Reversible airway obstruction
nb nb nb
C) Fixed airway obstruction
nb nb nb
D) Poor effort on spirometry
nb nb nb nb
13. A 50-year-
nb nb
old smoker presents with progressive dyspnea and a chronic productive cough. Chest X-
nb nb nb nb nb nb nb nb nb nb nb nb
ray shows hyperinflation and flattened diaphragms. Which of the following is the best in
nb nb nb nb nb nb nb nb nb nb nb nb nb
itial pharmacologic therapy to reduce exacerbations and improve quality of life?
nb nb nb nb nb nb nb nb nb nb
A) Inhaled corticosteroids alone
nb nb nb
, B) Long-acting muscarinic antagonist (LAMA)
nb nb nb nb
C) Oral theophylline
nb nb
D) Antibiotics
nb
14. A patient with COPD is being discharged after a severe exacerbation. What vaccinati
nb nb nb nb nb nb nb nb nb nb nb nb nb
on is most critical to recommend for this patient to prevent future hospitalizations?
nb nb nb nb nb nb nb nb nb nb nb nb
A) Zoster vaccine
nb nb
B) Pneumococcal conjugate vaccine (PCV20)
nb nb nb nb
C) Meningococcal vaccine
nb nb
D) Haemophilus influenzae type B vaccine
nb nb nb nb nb
15. A 32-year- nb nb
old female presents with acute onset of sharp chest pain that is worse with inspiration. S
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
he is tachypneic but not hypoxic. She has no risk factors for DVT. What is the most likely
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
diagnosis?
nb
A) Pulmonary embolism
nb nb
B) Pericarditis
nb
C) Spontaneous pneumothorax
nb nb
D) Pleurisy (Viral)
nb nb
16. A 55-year- nb nb
old male presents with hemoptysis, weight loss, and hoarseness. He has a 40-pack-
nb nb nb nb nb nb nb nb nb nb nb nb
year smoking history. A chest X-
nb nb nb nb nb
ray reveals a hilar mass. What physical exam finding would suggest Horner's syndrome r
nb nb nb nb nb nb nb nb nb nb nb nb nb
elated to a Pancoast tumor? nb nb nb nb
A) Miosis and ptosis
nb nb nb
B) Mydriasis and exophthalmos
nb nb nb
C) Bilateral lower extremity edema
nb nb nb nb
D) Clubbing of the fingers
nb nb nb nb
17. A 4-year- nb nb
old presents with drooling, tripod positioning, and a muffled voice. The child appears an
nb nb nb nb nb nb nb nb nb nb nb nb nb
xious and has a high fever. What is the most appropriate next step?
nb nb nb nb nb nb nb nb nb nb nb nb
A) Perform a throat culture
nb nb nb nb
B) Inspect the oropharynx with a tongue depressor
nb nb nb nb nb nb nb
C) Prepare for emergent intubation in the OR
nb nb nb nb nb nb nb
D) Administer a nebulized epinephrine treatment
nb nb nb nb nb
18. A patient with a history of GERD and hypertension presents with a chronic cough. Th
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
e cough is worse at night and when lying down. Which medication is most likely contrib
nb nb nb nb nb nb nb nb nb nb nb nb nb nb nb
uting to the cough? nb nb nb
A) Lisinopril
nb
B) Omeprazole
nb
