NUR 504 3P APEA EXAM (PDF) | 2026 EXAM QUESTIONS AND
ANSWERS + RATIONALES | STUDY GUIDE | 100% CORRECT
1. A 35-year-old woman with a history of extreme nervousness has been treated with
diazepam for 4 weeks. She shows some improvement. Today her pulse is 112 bpm and
BP is 130/92 mmHg. She is 5'4" and weighs 105 pounds. What is the most likely
diagnosis?
A) Anxiety
B) Somatization
C) Cushing's syndrome
D) Hyperthyroidism
Correct Answer: D) Hyperthyroidism
Rationale: The patient's tachycardia, hypertension, weight loss despite nervousness that has not
fully responded to benzodiazepines suggest hyperthyroidism. Diazepam treats symptoms but not
the underlying thyroid condition.
2. A patient’s Snellen chart evaluation indicates 20/30 vision. What is the proper description
of this result?
A) At 20 ft, this patient can see what a person with normal vision can see at 30 ft
B) At 30 ft, this patient can see what a person with normal vision can see at 20 ft
C) At 20 ft, this patient can see what few people can see at 30 ft
D) This patient has sight abilities worse than a patient with 20/40 vision
Correct Answer: A) At 20 ft, this patient can see what a person with normal vision can see at 30
ft
Rationale: 20/30 vision means the patient can read at 20 feet what a person with normal vision
can read at 30 feet.
3. A 73-year-old presents with a very sore, glossy, smooth, beefy-red tongue. This clinical
presentation most likely reflects:
A) Iron deficiency anemia
B) Pernicious anemia, due to insufficient intrinsic factor
C) Folic acid deficiency
D) Vitamin C deficiency
Correct Answer: B) Pernicious anemia, due to insufficient intrinsic factor
Rationale: A beefy-red, smooth, glossy tongue (glossitis) is a classic sign of pernicious anemia
caused by vitamin B12 deficiency due to lack of intrinsic factor.
4. Which red blood cell (RBC) index is most useful for differentiating types of anemias?
A) Mean corpuscular volume (MCV)
B) Mean corpuscular hemoglobin concentration (MCHC)
, C) Hematocrit (HCT)
D) Platelet count
Correct Answer: A) Mean corpuscular volume (MCV)
Rationale: MCV is the RBC index most useful for differentiating types of anemias—microcytic
(low MCV), normocytic (normal MCV), and macrocytic (high MCV).
5. A Tzanck test is used to diagnose which condition?
A) Mastoiditis
B) Trichomoniasis
C) Hyphema
D) Herpes virus infection
Correct Answer: D) Herpes virus infection
Rationale: A Tzanck smear is a rapid diagnostic test used to identify herpesvirus infections (HSV
and VZV) by detecting multinucleated giant cells.
6. A 16-year-old sexually active female presents to the clinic. She has never had
vaccinations for hepatitis A or B. She has had one MMR immunization, and her last
tetanus vaccination was 4 years ago. Which vaccination would be contraindicated without
further testing?
A) Hepatitis B
B) Hepatitis A
C) MMR
D) Tetanus
Correct Answer: C) MMR
Rationale: MMR is a live-virus vaccine. In an adolescent without a documented second dose or
serologic evidence of immunity, serologic testing for measles, mumps, and rubella immunity
should be done before administration, especially if pregnancy cannot be ruled out.
7. Following the finding of prostate gland abnormalities on DRE, the NP orders appropriate
labs. All of the following are true EXCEPT:
A) Normal PSA is 10 mg/ml or less
B) PSA is elevated in the presence of malignant prostate epithelium
C) PSA is elevated in the presence of BPH
D) Positive serum acid phosphatase reflects malignancy with bone metastasis
Correct Answer: A) Normal PSA is 10 mg/ml or less
Rationale: The normal PSA level is generally considered to be less than 4 ng/mL (not 10
mg/mL). PSA can be elevated in prostate cancer, BPH, and prostatitis.
8. A 59-year-old post-menopausal woman has atrophic vaginitis and a history of breast
cancer at age 40 years. What is the appropriate initial treatment for this patient?
A) Oral conjugated estrogens
, B) Oral medroxyprogesterone acetate
C) Topical medroxyprogesterone acetate
D) Topical conjugated estrogen cream
Correct Answer: D) Topical conjugated estrogen cream
Rationale: Topical estrogen is the preferred treatment for atrophic vaginitis. While systemic
estrogen is typically avoided in breast cancer survivors, low-dose vaginal estrogen is considered
safe and effective when non-hormonal options fail.
9. Which of the following physical modalities recommended for treatment of rheumatoid
arthritis provides the most effective long-term pain relief?
A) Superficial and deep heat
B) Application of cold
C) Transcutaneous electrical nerve stimulation (TENS)
D) Exercise
Correct Answer: D) Exercise
Rationale: Exercise—including range-of-motion, strengthening, and aerobic exercise—is the
most effective long-term physical modality for managing RA pain and maintaining joint
function.
10. A patient with moderate persistent asthma will most likely be effectively managed with
daily:
A) Oral leukotriene blockers
B) Short and long acting bronchodilators
C) Inhaled steroids and long-acting bronchodilators
D) Oral steroids and short-acting bronchodilators
Correct Answer: C) Inhaled steroids and long-acting bronchodilators
Rationale: Step 3 (moderate persistent asthma) treatment is low-dose inhaled corticosteroid plus
long-acting beta-agonist (LABA), or medium-dose ICS. Inhaled corticosteroids are the most
effective long-term control medication.
11. A 40-year-old female with history of frequent sun exposure presents with a multicolored
lesion on her back. It has irregular borders and is about 11 mm in diameter. What should
the NP suspect?
A) Squamous cell carcinoma
B) Malignant melanoma
C) Common nevus
D) Basal cell carcinoma
Correct Answer: B) Malignant melanoma
ANSWERS + RATIONALES | STUDY GUIDE | 100% CORRECT
1. A 35-year-old woman with a history of extreme nervousness has been treated with
diazepam for 4 weeks. She shows some improvement. Today her pulse is 112 bpm and
BP is 130/92 mmHg. She is 5'4" and weighs 105 pounds. What is the most likely
diagnosis?
A) Anxiety
B) Somatization
C) Cushing's syndrome
D) Hyperthyroidism
Correct Answer: D) Hyperthyroidism
Rationale: The patient's tachycardia, hypertension, weight loss despite nervousness that has not
fully responded to benzodiazepines suggest hyperthyroidism. Diazepam treats symptoms but not
the underlying thyroid condition.
2. A patient’s Snellen chart evaluation indicates 20/30 vision. What is the proper description
of this result?
A) At 20 ft, this patient can see what a person with normal vision can see at 30 ft
B) At 30 ft, this patient can see what a person with normal vision can see at 20 ft
C) At 20 ft, this patient can see what few people can see at 30 ft
D) This patient has sight abilities worse than a patient with 20/40 vision
Correct Answer: A) At 20 ft, this patient can see what a person with normal vision can see at 30
ft
Rationale: 20/30 vision means the patient can read at 20 feet what a person with normal vision
can read at 30 feet.
3. A 73-year-old presents with a very sore, glossy, smooth, beefy-red tongue. This clinical
presentation most likely reflects:
A) Iron deficiency anemia
B) Pernicious anemia, due to insufficient intrinsic factor
C) Folic acid deficiency
D) Vitamin C deficiency
Correct Answer: B) Pernicious anemia, due to insufficient intrinsic factor
Rationale: A beefy-red, smooth, glossy tongue (glossitis) is a classic sign of pernicious anemia
caused by vitamin B12 deficiency due to lack of intrinsic factor.
4. Which red blood cell (RBC) index is most useful for differentiating types of anemias?
A) Mean corpuscular volume (MCV)
B) Mean corpuscular hemoglobin concentration (MCHC)
, C) Hematocrit (HCT)
D) Platelet count
Correct Answer: A) Mean corpuscular volume (MCV)
Rationale: MCV is the RBC index most useful for differentiating types of anemias—microcytic
(low MCV), normocytic (normal MCV), and macrocytic (high MCV).
5. A Tzanck test is used to diagnose which condition?
A) Mastoiditis
B) Trichomoniasis
C) Hyphema
D) Herpes virus infection
Correct Answer: D) Herpes virus infection
Rationale: A Tzanck smear is a rapid diagnostic test used to identify herpesvirus infections (HSV
and VZV) by detecting multinucleated giant cells.
6. A 16-year-old sexually active female presents to the clinic. She has never had
vaccinations for hepatitis A or B. She has had one MMR immunization, and her last
tetanus vaccination was 4 years ago. Which vaccination would be contraindicated without
further testing?
A) Hepatitis B
B) Hepatitis A
C) MMR
D) Tetanus
Correct Answer: C) MMR
Rationale: MMR is a live-virus vaccine. In an adolescent without a documented second dose or
serologic evidence of immunity, serologic testing for measles, mumps, and rubella immunity
should be done before administration, especially if pregnancy cannot be ruled out.
7. Following the finding of prostate gland abnormalities on DRE, the NP orders appropriate
labs. All of the following are true EXCEPT:
A) Normal PSA is 10 mg/ml or less
B) PSA is elevated in the presence of malignant prostate epithelium
C) PSA is elevated in the presence of BPH
D) Positive serum acid phosphatase reflects malignancy with bone metastasis
Correct Answer: A) Normal PSA is 10 mg/ml or less
Rationale: The normal PSA level is generally considered to be less than 4 ng/mL (not 10
mg/mL). PSA can be elevated in prostate cancer, BPH, and prostatitis.
8. A 59-year-old post-menopausal woman has atrophic vaginitis and a history of breast
cancer at age 40 years. What is the appropriate initial treatment for this patient?
A) Oral conjugated estrogens
, B) Oral medroxyprogesterone acetate
C) Topical medroxyprogesterone acetate
D) Topical conjugated estrogen cream
Correct Answer: D) Topical conjugated estrogen cream
Rationale: Topical estrogen is the preferred treatment for atrophic vaginitis. While systemic
estrogen is typically avoided in breast cancer survivors, low-dose vaginal estrogen is considered
safe and effective when non-hormonal options fail.
9. Which of the following physical modalities recommended for treatment of rheumatoid
arthritis provides the most effective long-term pain relief?
A) Superficial and deep heat
B) Application of cold
C) Transcutaneous electrical nerve stimulation (TENS)
D) Exercise
Correct Answer: D) Exercise
Rationale: Exercise—including range-of-motion, strengthening, and aerobic exercise—is the
most effective long-term physical modality for managing RA pain and maintaining joint
function.
10. A patient with moderate persistent asthma will most likely be effectively managed with
daily:
A) Oral leukotriene blockers
B) Short and long acting bronchodilators
C) Inhaled steroids and long-acting bronchodilators
D) Oral steroids and short-acting bronchodilators
Correct Answer: C) Inhaled steroids and long-acting bronchodilators
Rationale: Step 3 (moderate persistent asthma) treatment is low-dose inhaled corticosteroid plus
long-acting beta-agonist (LABA), or medium-dose ICS. Inhaled corticosteroids are the most
effective long-term control medication.
11. A 40-year-old female with history of frequent sun exposure presents with a multicolored
lesion on her back. It has irregular borders and is about 11 mm in diameter. What should
the NP suspect?
A) Squamous cell carcinoma
B) Malignant melanoma
C) Common nevus
D) Basal cell carcinoma
Correct Answer: B) Malignant melanoma
