NSG 6998 APEA PREDICTOR EXAM COMPLETE Actual
Exam 2026/2027 Complete Questions and Verified Answers
with Detailed Rationales 100% Verified Solutions Graded A
Pass Guaranteed - A+ Graded
SECTION 1: ASSESSMENT AND DIAGNOSIS (Questions 1–20)
Q1: A 55-year-old male presents for a routine physical. He has no
significant past medical history and feels well. His blood pressure is
145/92 mm Hg on three separate readings today. According to the
ACC/AHA hypertension guidelines, how should this patient be
classified and managed?
A. Normal BP; reassurance and return in 1 year
B. Elevated BP; lifestyle modifications only
C. Stage 1 hypertension; lifestyle modifications and consider
pharmacotherapy based on ASCVD risk
D. Stage 2 hypertension; initiate pharmacotherapy along with lifestyle
modifications [CORRECT]
Rationale: According to ACC/AHA guidelines, stage 2 hypertension is
defined as systolic ≥140 or diastolic ≥90 mm Hg. This patient's BP of
145/92 meets criteria for stage 2 hypertension, requiring both lifestyle
modifications and pharmacotherapy initiation.
Q2: A 42-year-old female presents with fatigue, weight gain, and cold
intolerance. Physical exam reveals dry skin, periorbital edema, and
delayed deep tendon reflexes. Laboratory studies show TSH 12.5
mIU/L (normal 0.4–4.0) and free T4 0.6 ng/dL (normal 0.8–1.8). What
is the most likely diagnosis?
,A. Graves' disease
B. Hashimoto's thyroiditis [CORRECT]
C. Subacute thyroiditis
D. Toxic multinodular goiter
Rationale: Elevated TSH with low free T4 indicates primary
hypothyroidism. Hashimoto's thyroiditis is the most common cause of
primary hypothyroidism in the United States, especially in middle-aged
women presenting with these classic symptoms and physical findings.
Q3: A 68-year-old male with a history of smoking presents with
hemoptysis, weight loss, and a new cough. Chest X-ray reveals a 3 cm
spiculated mass in the right upper lobe. What is the most appropriate
next step in management?
A. Start broad-spectrum antibiotics
B. Obtain a CT chest with contrast and tissue diagnosis [CORRECT]
C. Schedule follow-up CXR in 3 months
D. Begin empiric anti-tuberculosis therapy
Rationale: A spiculated mass in a smoker with constitutional symptoms
is highly suspicious for lung cancer. The appropriate next step is staging
with CT chest and obtaining tissue diagnosis via bronchoscopy or CT-
guided biopsy to confirm malignancy and determine histology.
Q4: A 28-year-old female presents with acute onset of pleuritic chest
pain and dyspnea. Vital signs: HR 110, BP 100/60, RR 24, O₂ sat 89%
on room air. Wells score is calculated at 6. D-dimer is 1800 ng/mL.
What is the most appropriate diagnostic test?
,A. Ventilation-perfusion scan
B. CT pulmonary angiography (CTPA) [CORRECT]
C. Lower extremity Doppler ultrasound
D. Echocardiogram
Rationale: With intermediate-to-high pretest probability (Wells score
≥4) and elevated D-dimer, CTPA is the imaging study of choice for
diagnosing pulmonary embolism. It provides direct visualization of
pulmonary arteries and can identify alternative diagnoses.
Q5: A 35-year-old male presents with epigastric pain, nausea, and black
tarry stools for 2 days. Vital signs show HR 108, BP 92/58. Hemoglobin
is 8.2 g/dL (baseline 14.5). What is the immediate priority in
management?
A. Outpatient referral for esophagogastroduodenoscopy (EGD)
B. Urgent EGD with hemodynamic stabilization [CORRECT]
C. Start proton pump inhibitor and discharge home
D. Barium swallow study
Rationale: This patient has signs of upper GI bleeding with
hemodynamic instability (tachycardia, hypotension) and significant
anemia. The priority is immediate hemodynamic stabilization with IV
fluids/blood products and urgent EGD for diagnosis and potential
intervention.
, Q6:A 45-year-old female with type 2 diabetes presents for routine
follow-up. Her HbA1c is 8.2% despite metformin 1000 mg BID. She
has no cardiovascular disease. According to ADA guidelines, what is the
most appropriate next step?
A. Add basal insulin immediately
B. Add a GLP-1 receptor agonist or SGLT2 inhibitor [CORRECT]
C. Increase metformin to 2000 mg BID
D. Add a sulfonylurea as the preferred second agent
Rationale: ADA guidelines recommend adding a GLP-1 RA with
proven cardiovascular benefit or an SGLT2 inhibitor with
cardiovascular/renal benefit as preferred second-line agents after
metformin, especially given this patient's HbA1c above target.
Q7:A 62-year-old male presents with crushing substernal chest pain
radiating to the left arm, diaphoresis, and nausea. EKG shows ST-
segment elevation in leads V1–V4. Troponin I is pending. What is the
immediate management priority?
A. Aspirin, nitroglycerin, morphine, and emergent reperfusion
[CORRECT]
B. Aspirin and observation in the emergency department
C. Stress test after pain resolution
D. Cardiac catheterization scheduled for tomorrow
Rationale: This patient presents with an acute STEMI (anterior wall
based on V1–V4 changes). Immediate management follows the MONA
protocol (Morphine, Oxygen, Nitrates, Aspirin) plus emergent
reperfusion therapy—primary PCI within 90 minutes or thrombolytics if
PCI is unavailable.
Exam 2026/2027 Complete Questions and Verified Answers
with Detailed Rationales 100% Verified Solutions Graded A
Pass Guaranteed - A+ Graded
SECTION 1: ASSESSMENT AND DIAGNOSIS (Questions 1–20)
Q1: A 55-year-old male presents for a routine physical. He has no
significant past medical history and feels well. His blood pressure is
145/92 mm Hg on three separate readings today. According to the
ACC/AHA hypertension guidelines, how should this patient be
classified and managed?
A. Normal BP; reassurance and return in 1 year
B. Elevated BP; lifestyle modifications only
C. Stage 1 hypertension; lifestyle modifications and consider
pharmacotherapy based on ASCVD risk
D. Stage 2 hypertension; initiate pharmacotherapy along with lifestyle
modifications [CORRECT]
Rationale: According to ACC/AHA guidelines, stage 2 hypertension is
defined as systolic ≥140 or diastolic ≥90 mm Hg. This patient's BP of
145/92 meets criteria for stage 2 hypertension, requiring both lifestyle
modifications and pharmacotherapy initiation.
Q2: A 42-year-old female presents with fatigue, weight gain, and cold
intolerance. Physical exam reveals dry skin, periorbital edema, and
delayed deep tendon reflexes. Laboratory studies show TSH 12.5
mIU/L (normal 0.4–4.0) and free T4 0.6 ng/dL (normal 0.8–1.8). What
is the most likely diagnosis?
,A. Graves' disease
B. Hashimoto's thyroiditis [CORRECT]
C. Subacute thyroiditis
D. Toxic multinodular goiter
Rationale: Elevated TSH with low free T4 indicates primary
hypothyroidism. Hashimoto's thyroiditis is the most common cause of
primary hypothyroidism in the United States, especially in middle-aged
women presenting with these classic symptoms and physical findings.
Q3: A 68-year-old male with a history of smoking presents with
hemoptysis, weight loss, and a new cough. Chest X-ray reveals a 3 cm
spiculated mass in the right upper lobe. What is the most appropriate
next step in management?
A. Start broad-spectrum antibiotics
B. Obtain a CT chest with contrast and tissue diagnosis [CORRECT]
C. Schedule follow-up CXR in 3 months
D. Begin empiric anti-tuberculosis therapy
Rationale: A spiculated mass in a smoker with constitutional symptoms
is highly suspicious for lung cancer. The appropriate next step is staging
with CT chest and obtaining tissue diagnosis via bronchoscopy or CT-
guided biopsy to confirm malignancy and determine histology.
Q4: A 28-year-old female presents with acute onset of pleuritic chest
pain and dyspnea. Vital signs: HR 110, BP 100/60, RR 24, O₂ sat 89%
on room air. Wells score is calculated at 6. D-dimer is 1800 ng/mL.
What is the most appropriate diagnostic test?
,A. Ventilation-perfusion scan
B. CT pulmonary angiography (CTPA) [CORRECT]
C. Lower extremity Doppler ultrasound
D. Echocardiogram
Rationale: With intermediate-to-high pretest probability (Wells score
≥4) and elevated D-dimer, CTPA is the imaging study of choice for
diagnosing pulmonary embolism. It provides direct visualization of
pulmonary arteries and can identify alternative diagnoses.
Q5: A 35-year-old male presents with epigastric pain, nausea, and black
tarry stools for 2 days. Vital signs show HR 108, BP 92/58. Hemoglobin
is 8.2 g/dL (baseline 14.5). What is the immediate priority in
management?
A. Outpatient referral for esophagogastroduodenoscopy (EGD)
B. Urgent EGD with hemodynamic stabilization [CORRECT]
C. Start proton pump inhibitor and discharge home
D. Barium swallow study
Rationale: This patient has signs of upper GI bleeding with
hemodynamic instability (tachycardia, hypotension) and significant
anemia. The priority is immediate hemodynamic stabilization with IV
fluids/blood products and urgent EGD for diagnosis and potential
intervention.
, Q6:A 45-year-old female with type 2 diabetes presents for routine
follow-up. Her HbA1c is 8.2% despite metformin 1000 mg BID. She
has no cardiovascular disease. According to ADA guidelines, what is the
most appropriate next step?
A. Add basal insulin immediately
B. Add a GLP-1 receptor agonist or SGLT2 inhibitor [CORRECT]
C. Increase metformin to 2000 mg BID
D. Add a sulfonylurea as the preferred second agent
Rationale: ADA guidelines recommend adding a GLP-1 RA with
proven cardiovascular benefit or an SGLT2 inhibitor with
cardiovascular/renal benefit as preferred second-line agents after
metformin, especially given this patient's HbA1c above target.
Q7:A 62-year-old male presents with crushing substernal chest pain
radiating to the left arm, diaphoresis, and nausea. EKG shows ST-
segment elevation in leads V1–V4. Troponin I is pending. What is the
immediate management priority?
A. Aspirin, nitroglycerin, morphine, and emergent reperfusion
[CORRECT]
B. Aspirin and observation in the emergency department
C. Stress test after pain resolution
D. Cardiac catheterization scheduled for tomorrow
Rationale: This patient presents with an acute STEMI (anterior wall
based on V1–V4 changes). Immediate management follows the MONA
protocol (Morphine, Oxygen, Nitrates, Aspirin) plus emergent
reperfusion therapy—primary PCI within 90 minutes or thrombolytics if
PCI is unavailable.
