APEA Predictor 2026/2027 Exam Comprehensive FNP Practice
Exam with verified answers with rationales
1. A 54-year-old woman presents with fatigue, weight gain, constipation, and cold
intolerance. TSH is elevated and free T4 is decreased. What is the most likely
diagnosis?
A. Graves disease
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Subclinical hyperthyroidism
Answer: B. Primary hypothyroidism
Rationale: Primary hypothyroidism is characterized by decreased thyroid hormone production,
resulting in an elevated TSH and low free T4.
2. Which medication is first-line therapy for primary hypothyroidism?
A. Methimazole
B. Propylthiouracil
C. Levothyroxine
D. Propranolol
Answer: C. Levothyroxine
Rationale: Levothyroxine is synthetic T4 and is the standard replacement treatment for primary
hypothyroidism.
3. A patient taking levothyroxine asks when to take the medication. What is the
best instruction?
A. Take it with calcium supplements
B. Take it on an empty stomach consistently
C. Take it only when symptoms occur
D. Take it with an iron tablet
Answer: B. Take it on an empty stomach consistently
,Rationale: Levothyroxine absorption can be reduced by food, calcium, and iron. Consistent
administration on an empty stomach improves absorption.
4. A 29-year-old woman has dysuria and urinary frequency without fever, flank
pain, or vaginal symptoms. What is the most likely diagnosis?
A. Pyelonephritis
B. Acute uncomplicated cystitis
C. Nephrolithiasis
D. Vaginitis
Answer: B. Acute uncomplicated cystitis
Rationale: Dysuria and frequency without systemic illness or flank pain are classic for
uncomplicated lower urinary tract infection.
5. Which symptom would most strongly suggest pyelonephritis rather than
uncomplicated cystitis?
A. Urinary frequency
B. Dysuria
C. Costovertebral-angle tenderness
D. Suprapubic discomfort
Answer: C. Costovertebral-angle tenderness
Rationale: Fever, flank pain, and CVA tenderness suggest upper urinary tract involvement.
6. A patient with hypertension has a blood pressure of 168/104 mmHg but denies
chest pain, neurologic symptoms, dyspnea, or visual changes. What is the most
appropriate initial approach?
A. Immediately diagnose hypertensive emergency
B. Assess the patient, confirm the reading, and initiate appropriate outpatient management
C. Send the patient directly to surgery
D. Give thrombolytic therapy
Answer: B. Assess the patient, confirm the reading, and initiate appropriate outpatient
management
,Rationale: Severe hypertension without evidence of acute target-organ injury is not
automatically a hypertensive emergency. The clinician should confirm the measurement and
assess for symptoms or end-organ damage.
7. Which finding is most concerning for hypertensive emergency?
A. BP 160/96 mmHg without symptoms
B. Mild ankle edema
C. Acute neurologic deficit
D. History of hypertension
Answer: C. Acute neurologic deficit
Rationale: Acute neurologic findings may indicate target-organ injury such as stroke or
hypertensive encephalopathy.
8. A patient with diabetes reports sweating, tremor, hunger, and confusion. What
should the NP suspect?
A. Hypercalcemia
B. Hypoglycemia
C. Hypernatremia
D. Hyperthyroidism
Answer: B. Hypoglycemia
Rationale: Adrenergic symptoms such as sweating and tremor followed by neuroglycopenic
symptoms such as confusion are characteristic of hypoglycemia.
9. A conscious patient with symptomatic hypoglycemia has a glucose level of 54
mg/dL. What is the appropriate initial treatment?
A. Oral rapid-acting carbohydrate
B. Long-acting insulin
C. Restrict carbohydrates
D. Administer a beta blocker
Answer: A. Oral rapid-acting carbohydrate
, Rationale: A conscious patient who can safely swallow should receive a rapid source of glucose,
followed by reassessment.
10. Which laboratory test is most useful for monitoring long-term glycemic
control?
A. Random glucose
B. HbA1c
C. Serum sodium
D. Urine ketones alone
Answer: B. HbA1c
Rationale: HbA1c reflects average blood glucose over approximately the preceding 2–3 months.
11. A 45-year-old patient has repeated fasting glucose values of 132 mg/dL.
Which diagnosis is most consistent with these results?
A. Normal glucose tolerance
B. Diabetes mellitus
C. Hypoglycemia
D. Reactive hypoglycemia
Answer: B. Diabetes mellitus
Rationale: Repeated fasting plasma glucose values at or above the diagnostic threshold for
diabetes support a diagnosis when appropriately confirmed.
12. Which medication class is associated with a risk of genital mycotic infections
and volume depletion?
A. SGLT2 inhibitors
B. Statins
C. Sulfonylureas
D. DPP-4 inhibitors
Answer: A. SGLT2 inhibitors
Exam with verified answers with rationales
1. A 54-year-old woman presents with fatigue, weight gain, constipation, and cold
intolerance. TSH is elevated and free T4 is decreased. What is the most likely
diagnosis?
A. Graves disease
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Subclinical hyperthyroidism
Answer: B. Primary hypothyroidism
Rationale: Primary hypothyroidism is characterized by decreased thyroid hormone production,
resulting in an elevated TSH and low free T4.
2. Which medication is first-line therapy for primary hypothyroidism?
A. Methimazole
B. Propylthiouracil
C. Levothyroxine
D. Propranolol
Answer: C. Levothyroxine
Rationale: Levothyroxine is synthetic T4 and is the standard replacement treatment for primary
hypothyroidism.
3. A patient taking levothyroxine asks when to take the medication. What is the
best instruction?
A. Take it with calcium supplements
B. Take it on an empty stomach consistently
C. Take it only when symptoms occur
D. Take it with an iron tablet
Answer: B. Take it on an empty stomach consistently
,Rationale: Levothyroxine absorption can be reduced by food, calcium, and iron. Consistent
administration on an empty stomach improves absorption.
4. A 29-year-old woman has dysuria and urinary frequency without fever, flank
pain, or vaginal symptoms. What is the most likely diagnosis?
A. Pyelonephritis
B. Acute uncomplicated cystitis
C. Nephrolithiasis
D. Vaginitis
Answer: B. Acute uncomplicated cystitis
Rationale: Dysuria and frequency without systemic illness or flank pain are classic for
uncomplicated lower urinary tract infection.
5. Which symptom would most strongly suggest pyelonephritis rather than
uncomplicated cystitis?
A. Urinary frequency
B. Dysuria
C. Costovertebral-angle tenderness
D. Suprapubic discomfort
Answer: C. Costovertebral-angle tenderness
Rationale: Fever, flank pain, and CVA tenderness suggest upper urinary tract involvement.
6. A patient with hypertension has a blood pressure of 168/104 mmHg but denies
chest pain, neurologic symptoms, dyspnea, or visual changes. What is the most
appropriate initial approach?
A. Immediately diagnose hypertensive emergency
B. Assess the patient, confirm the reading, and initiate appropriate outpatient management
C. Send the patient directly to surgery
D. Give thrombolytic therapy
Answer: B. Assess the patient, confirm the reading, and initiate appropriate outpatient
management
,Rationale: Severe hypertension without evidence of acute target-organ injury is not
automatically a hypertensive emergency. The clinician should confirm the measurement and
assess for symptoms or end-organ damage.
7. Which finding is most concerning for hypertensive emergency?
A. BP 160/96 mmHg without symptoms
B. Mild ankle edema
C. Acute neurologic deficit
D. History of hypertension
Answer: C. Acute neurologic deficit
Rationale: Acute neurologic findings may indicate target-organ injury such as stroke or
hypertensive encephalopathy.
8. A patient with diabetes reports sweating, tremor, hunger, and confusion. What
should the NP suspect?
A. Hypercalcemia
B. Hypoglycemia
C. Hypernatremia
D. Hyperthyroidism
Answer: B. Hypoglycemia
Rationale: Adrenergic symptoms such as sweating and tremor followed by neuroglycopenic
symptoms such as confusion are characteristic of hypoglycemia.
9. A conscious patient with symptomatic hypoglycemia has a glucose level of 54
mg/dL. What is the appropriate initial treatment?
A. Oral rapid-acting carbohydrate
B. Long-acting insulin
C. Restrict carbohydrates
D. Administer a beta blocker
Answer: A. Oral rapid-acting carbohydrate
, Rationale: A conscious patient who can safely swallow should receive a rapid source of glucose,
followed by reassessment.
10. Which laboratory test is most useful for monitoring long-term glycemic
control?
A. Random glucose
B. HbA1c
C. Serum sodium
D. Urine ketones alone
Answer: B. HbA1c
Rationale: HbA1c reflects average blood glucose over approximately the preceding 2–3 months.
11. A 45-year-old patient has repeated fasting glucose values of 132 mg/dL.
Which diagnosis is most consistent with these results?
A. Normal glucose tolerance
B. Diabetes mellitus
C. Hypoglycemia
D. Reactive hypoglycemia
Answer: B. Diabetes mellitus
Rationale: Repeated fasting plasma glucose values at or above the diagnostic threshold for
diabetes support a diagnosis when appropriately confirmed.
12. Which medication class is associated with a risk of genital mycotic infections
and volume depletion?
A. SGLT2 inhibitors
B. Statins
C. Sulfonylureas
D. DPP-4 inhibitors
Answer: A. SGLT2 inhibitors
