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APEA Predictor Exam – Complete Practice Test (2026) 120+
Comprehensive Practice Questions and Answers with Rationales 100%
Correct 2026 UPDATE | 100% Correct.
Instructions: Detailed rationales are provided to reinforce advanced clinical
reasoning.
Domain 1: Health Promotion & Disease Prevention (Screening, Immunizations,
Counseling)
1. A 45-year-old female presents for a routine health maintenance visit. She has
no significant medical history. According to the USPSTF (U.S. Preventive Services
Task Force), which of the following screening recommendations is appropriate
for this patient?
A) Mammogram every 2 years starting at age 50 (Grade B recommendation)
B) Pap smear every 3 years if she has had a hysterectomy for benign disease
C) Colonoscopy at age 50 for colorectal cancer screening (Grade A
recommendation)
D) Routine ECG for cardiovascular disease screening
Answer: C
Rationale: The USPSTF recommends colorectal cancer screening starting at age 50
for average-risk adults (Grade A). Mammography is recommended starting at age
50 (Grade B) with shared decision-making for ages 40-49. Pap smears are not
needed after total hysterectomy for benign disease. Routine ECG is not
recommended for asymptomatic low-risk patients.
2. A 25-year-old female presents for her annual exam. She is sexually active with
one male partner and has never been pregnant. Which of the following is the
most appropriate cervical cancer screening recommendation for this patient?
A) Begin Pap smears at age 21, regardless of sexual activity, and continue every 3
years until age 29
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B) Begin Pap smears at age 21, then co-testing (Pap + HPV) every 3 years until age
65
C) Begin Pap smears at the onset of sexual activity, then every 2 years
D) No Pap smear needed until age 25 if she is low-risk
Answer: A
Rationale: According to the ACS and USPSTF, cervical cancer screening with Pap
smears alone should begin at age 21, regardless of sexual history, and
continue every 3 years until age 29. For women ages 30-65, co-testing (Pap + HPV)
every 5 years is preferred. Screening is not recommended before age 21.
3. A 68-year-old male presents for his annual wellness visit. He has a history of
hypertension and smoking. The NP recommends a one-time screening
ultrasound for abdominal aortic aneurysm (AAA). According to the USPSTF,
which population benefits most from this screening?
A) All men over age 65, regardless of smoking history (Grade B)
B) Men aged 65-75 who have ever smoked (Grade B)
C) Men aged 55-60 who have never smoked
D) Women over age 65 with a history of smoking
Answer: B
Rationale: The USPSTF recommends one-time AAA screening by
ultrasound for men aged 65-75 who have ever smoked (Grade B). Screening is
not recommended for men who have never smoked, and is not recommended for
women.
4. A 32-year-old female presents for a wellness visit. She is up-to-date on all
routine immunizations. She asks about the HPV (human papillomavirus) vaccine.
Which of the following is the most accurate recommendation?
A) The HPV vaccine is only recommended for adolescents aged 11-12.
B) The HPV vaccine is recommended for all individuals up to age 26, and shared
decision-making is recommended for adults ages 27-45.
C) The HPV vaccine is contraindicated in women over age 25.
D) The HPV vaccine is only for females.
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Answer: B
Rationale: The ACIP and CDC recommend the HPV vaccine for all individuals
through age 26. For adults ages 27-45, shared clinical decision-making is
recommended. The vaccine is approved for both males and females.
5. A 50-year-old female presents for a wellness exam. She has a family history of
breast cancer (mother diagnosed at age 55). The NP discusses screening options.
Which of the following is the most appropriate recommendation?
A) Begin mammography at age 40 and screen annually (Grade B for ages 40-49,
Grade B for ages 50-74).
B) Wait until age 50 to begin mammography.
C) Begin mammography at age 35 because of her family history.
D) Recommend MRI screening instead of mammography.
Answer: A
Rationale: The USPSTF recommends biennial mammography for women aged 50-
74 (Grade B). For women aged 40-49, the decision to start screening should be
individualized. Given her family history, the NP should discuss the benefits and
harms and offer the patient the choice to begin at age 40.
6. A 67-year-old male presents for a wellness visit. He is a former smoker (quit 2
years ago) and has a history of atrial fibrillation. He is not on anticoagulation.
The NP should screen for which of the following conditions?
A) Lung cancer with low-dose computed tomography (LDCT) (Grade B
recommendation for ages 50-80 with a 20-pack-year history)
B) Prostate-specific antigen (PSA) for prostate cancer (Grade C recommendation)
C) Carotid artery stenosis with ultrasound
D) Abdominal aortic aneurysm (AAA) only if he has a family history
Answer: A
Rationale: The USPSTF recommends annual lung cancer screening with LDCT for
adults aged 50-80 who have a 20-pack-year smoking history and currently smoke
or have quit within the last 15 years. This patient meets the criteria (quit 2 years
ago, 50 years old, 20+ pack-years).
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7. A 78-year-old female is seen for a wellness visit. She reports occasional falls.
The NP should recommend which of the following for fall prevention?
A) Vitamin D supplementation and a supervised exercise program (Grade B
recommendation)
B) Routine bone density scan
C) Prescription of a walker
D) Home safety evaluation only
Answer: A
Rationale: The USPSTF recommends vitamin D supplementation and
exercise/physical therapy for fall prevention in community-dwelling older adults
at increased risk for falls (Grade B). Home safety evaluations are also beneficial,
but the combination of vitamin D and exercise is a strong recommendation.
Domain 2: Assessment & Diagnosis (History, Physical Exam, Differential
Diagnosis)
8. A 45-year-old male presents with a 3-month history of intermittent, burning
epigastric pain that worsens 30-60 minutes after meals and improves with
antacids. He has no weight loss or GI bleeding. What is the most likely
diagnosis?
A) Gastric ulcer
B) Duodenal ulcer
C) Gastroesophageal reflux disease (GERD)
D) Pancreatitis
Answer: A
Rationale: Gastric ulcers typically present with epigastric pain that worsens
within 30-60 minutes of eating. Duodenal ulcers present with pain that occurs 2-3
hours after meals and is relieved by food or antacids. The key differentiator here is
the timing: gastric ulcer pain is early post-prandial.
9. A 28-year-old female presents with a 2-week history of painless, non-tender,
firm, rubbery lymphadenopathy in the cervical and supraclavicular regions. She
APEA Predictor Exam – Complete Practice Test (2026) 120+
Comprehensive Practice Questions and Answers with Rationales 100%
Correct 2026 UPDATE | 100% Correct.
Instructions: Detailed rationales are provided to reinforce advanced clinical
reasoning.
Domain 1: Health Promotion & Disease Prevention (Screening, Immunizations,
Counseling)
1. A 45-year-old female presents for a routine health maintenance visit. She has
no significant medical history. According to the USPSTF (U.S. Preventive Services
Task Force), which of the following screening recommendations is appropriate
for this patient?
A) Mammogram every 2 years starting at age 50 (Grade B recommendation)
B) Pap smear every 3 years if she has had a hysterectomy for benign disease
C) Colonoscopy at age 50 for colorectal cancer screening (Grade A
recommendation)
D) Routine ECG for cardiovascular disease screening
Answer: C
Rationale: The USPSTF recommends colorectal cancer screening starting at age 50
for average-risk adults (Grade A). Mammography is recommended starting at age
50 (Grade B) with shared decision-making for ages 40-49. Pap smears are not
needed after total hysterectomy for benign disease. Routine ECG is not
recommended for asymptomatic low-risk patients.
2. A 25-year-old female presents for her annual exam. She is sexually active with
one male partner and has never been pregnant. Which of the following is the
most appropriate cervical cancer screening recommendation for this patient?
A) Begin Pap smears at age 21, regardless of sexual activity, and continue every 3
years until age 29
, Page |2
B) Begin Pap smears at age 21, then co-testing (Pap + HPV) every 3 years until age
65
C) Begin Pap smears at the onset of sexual activity, then every 2 years
D) No Pap smear needed until age 25 if she is low-risk
Answer: A
Rationale: According to the ACS and USPSTF, cervical cancer screening with Pap
smears alone should begin at age 21, regardless of sexual history, and
continue every 3 years until age 29. For women ages 30-65, co-testing (Pap + HPV)
every 5 years is preferred. Screening is not recommended before age 21.
3. A 68-year-old male presents for his annual wellness visit. He has a history of
hypertension and smoking. The NP recommends a one-time screening
ultrasound for abdominal aortic aneurysm (AAA). According to the USPSTF,
which population benefits most from this screening?
A) All men over age 65, regardless of smoking history (Grade B)
B) Men aged 65-75 who have ever smoked (Grade B)
C) Men aged 55-60 who have never smoked
D) Women over age 65 with a history of smoking
Answer: B
Rationale: The USPSTF recommends one-time AAA screening by
ultrasound for men aged 65-75 who have ever smoked (Grade B). Screening is
not recommended for men who have never smoked, and is not recommended for
women.
4. A 32-year-old female presents for a wellness visit. She is up-to-date on all
routine immunizations. She asks about the HPV (human papillomavirus) vaccine.
Which of the following is the most accurate recommendation?
A) The HPV vaccine is only recommended for adolescents aged 11-12.
B) The HPV vaccine is recommended for all individuals up to age 26, and shared
decision-making is recommended for adults ages 27-45.
C) The HPV vaccine is contraindicated in women over age 25.
D) The HPV vaccine is only for females.
, Page |3
Answer: B
Rationale: The ACIP and CDC recommend the HPV vaccine for all individuals
through age 26. For adults ages 27-45, shared clinical decision-making is
recommended. The vaccine is approved for both males and females.
5. A 50-year-old female presents for a wellness exam. She has a family history of
breast cancer (mother diagnosed at age 55). The NP discusses screening options.
Which of the following is the most appropriate recommendation?
A) Begin mammography at age 40 and screen annually (Grade B for ages 40-49,
Grade B for ages 50-74).
B) Wait until age 50 to begin mammography.
C) Begin mammography at age 35 because of her family history.
D) Recommend MRI screening instead of mammography.
Answer: A
Rationale: The USPSTF recommends biennial mammography for women aged 50-
74 (Grade B). For women aged 40-49, the decision to start screening should be
individualized. Given her family history, the NP should discuss the benefits and
harms and offer the patient the choice to begin at age 40.
6. A 67-year-old male presents for a wellness visit. He is a former smoker (quit 2
years ago) and has a history of atrial fibrillation. He is not on anticoagulation.
The NP should screen for which of the following conditions?
A) Lung cancer with low-dose computed tomography (LDCT) (Grade B
recommendation for ages 50-80 with a 20-pack-year history)
B) Prostate-specific antigen (PSA) for prostate cancer (Grade C recommendation)
C) Carotid artery stenosis with ultrasound
D) Abdominal aortic aneurysm (AAA) only if he has a family history
Answer: A
Rationale: The USPSTF recommends annual lung cancer screening with LDCT for
adults aged 50-80 who have a 20-pack-year smoking history and currently smoke
or have quit within the last 15 years. This patient meets the criteria (quit 2 years
ago, 50 years old, 20+ pack-years).
, Page |4
7. A 78-year-old female is seen for a wellness visit. She reports occasional falls.
The NP should recommend which of the following for fall prevention?
A) Vitamin D supplementation and a supervised exercise program (Grade B
recommendation)
B) Routine bone density scan
C) Prescription of a walker
D) Home safety evaluation only
Answer: A
Rationale: The USPSTF recommends vitamin D supplementation and
exercise/physical therapy for fall prevention in community-dwelling older adults
at increased risk for falls (Grade B). Home safety evaluations are also beneficial,
but the combination of vitamin D and exercise is a strong recommendation.
Domain 2: Assessment & Diagnosis (History, Physical Exam, Differential
Diagnosis)
8. A 45-year-old male presents with a 3-month history of intermittent, burning
epigastric pain that worsens 30-60 minutes after meals and improves with
antacids. He has no weight loss or GI bleeding. What is the most likely
diagnosis?
A) Gastric ulcer
B) Duodenal ulcer
C) Gastroesophageal reflux disease (GERD)
D) Pancreatitis
Answer: A
Rationale: Gastric ulcers typically present with epigastric pain that worsens
within 30-60 minutes of eating. Duodenal ulcers present with pain that occurs 2-3
hours after meals and is relieved by food or antacids. The key differentiator here is
the timing: gastric ulcer pain is early post-prandial.
9. A 28-year-old female presents with a 2-week history of painless, non-tender,
firm, rubbery lymphadenopathy in the cervical and supraclavicular regions. She
