APEA Pre-Predictor Practice Exam
Family Nurse Practitioner Certification Review • 120 Questions with Answers and
Rationales
1. A 58-year-old man with a history of hypertension presents with a blood
pressure of 152/94 mmHg on two separate office visits despite adherence to
lisinopril 20 mg daily. He has no known kidney disease and a normal potassium
level. Which class of medication is the most appropriate next step?
A. Thiazide diuretic
B. Beta-blocker
C. Alpha-1 blocker
D. Central alpha-2 agonist
Correct Answer: A
Rationale: Current hypertension guidelines recommend combination therapy when
blood pressure remains above goal on a single first-line agent. Adding a thiazide-type
diuretic (or a calcium channel blocker) to an ACE inhibitor is first-line combination
therapy. Beta-blockers are not first-line for uncomplicated hypertension, and
alpha-blockers/central agonists are reserved for resistant cases or specific
comorbidities.
2. Which finding on physical examination is most consistent with aortic
stenosis?
A. Widened pulse pressure
B. Crescendo-decrescendo systolic murmur radiating to the carotids
C. Holosystolic murmur at the apex radiating to the axilla
D. Diastolic murmur best heard at the left lower sternal border
Correct Answer: B
Rationale: Aortic stenosis classically produces a harsh crescendo-decrescendo
(ejection) systolic murmur heard best at the right upper sternal border that radiates to
the carotid arteries, often accompanied by a delayed and diminished carotid upstroke
(pulsus parvus et tardus). A holosystolic murmur radiating to the axilla suggests mitral
regurgitation, and widened pulse pressure is more typical of aortic regurgitation.
,3. A patient taking warfarin presents with an INR of 8.0 and no active bleeding.
What is the most appropriate initial management?
A. Continue current dose and recheck INR in one week
B. Administer intravenous vitamin K and admit for observation
C. Hold warfarin and give oral vitamin K
D. Administer fresh frozen plasma immediately
Correct Answer: C
Rationale: For an INR greater than 5 without significant bleeding, guidelines
recommend holding warfarin and administering low-dose oral vitamin K to reduce the
INR into a safer range while minimizing the risk of overcorrection. IV vitamin K and
FFP are reserved for serious or life-threatening bleeding.
4. Which ECG finding is most characteristic of hyperkalemia?
A. Peaked T waves
B. U waves
C. Prolonged QT interval
D. Delta waves
Correct Answer: A
Rationale: Hyperkalemia classically produces peaked, narrow T waves early on,
progressing to widened QRS complexes and loss of P waves as potassium rises
further. U waves and QT prolongation are associated with hypokalemia, while delta
waves are seen in Wolff-Parkinson-White syndrome.
5. A 65-year-old woman reports exertional dyspnea and bilateral lower
extremity edema. Physical exam reveals jugular venous distension and an S3
gallop. Which diagnosis is most likely?
A. Chronic obstructive pulmonary disease
B. Heart failure with reduced ejection fraction
C. Pulmonary embolism
D. Deep vein thrombosis
Correct Answer: B
Rationale: An S3 gallop, jugular venous distension, and peripheral edema in the
setting of exertional dyspnea are classic findings of heart failure with volume
overload. An S3 is produced by rapid ventricular filling into a noncompliant, dilated
ventricle.
,6. Which lipid-lowering agent is most associated with myopathy and
rhabdomyolysis, especially when combined with certain antibiotics such as
clarithromycin?
A. Ezetimibe
B. Statins
C. Fibrates alone
D. Bile acid sequestrants
Correct Answer: B
Rationale: Statins carry a risk of myopathy and, rarely, rhabdomyolysis, particularly
when combined with CYP3A4 inhibitors such as clarithromycin, which raise statin
serum levels. Patients should be counseled to report unexplained muscle pain, and
creatine kinase should be checked if symptoms occur.
7. A patient presents with sudden-onset unilateral leg swelling, warmth, and
tenderness along the calf. Which tool is used to estimate pretest probability
before ordering further testing?
A. CHA2DS2-VASc score
B. Wells criteria
C. HEART score
D. Centor criteria
Correct Answer: B
Rationale: The Wells criteria for deep vein thrombosis help stratify pretest probability
and guide the decision to obtain a D-dimer versus proceeding directly to compression
ultrasonography. CHA2DS2-VASc estimates stroke risk in atrial fibrillation, HEART
score risk-stratifies chest pain, and Centor criteria assess likelihood of streptococcal
pharyngitis.
, 8. Which medication class is contraindicated in a patient with a history of
angioedema?
A. ACE inhibitors
B. Calcium channel blockers
C. Thiazide diuretics
D. Beta-blockers
Correct Answer: A
Rationale: ACE inhibitors are contraindicated in patients with a history of angioedema
because they inhibit bradykinin breakdown, which can precipitate recurrent,
potentially life-threatening angioedema. ARBs carry a lower but still present risk and
should be used cautiously.
9. A 70-year-old man on amiodarone for atrial fibrillation should be monitored
periodically for which of the following adverse effects?
A. Thyroid dysfunction and pulmonary fibrosis
B. Hyperkalemia and gynecomastia
C. Nephrotoxicity and ototoxicity
D. Hemolytic anemia and hyperglycemia
Correct Answer: A
Rationale: Amiodarone contains iodine and can cause both hypothyroidism and
hyperthyroidism, as well as pulmonary fibrosis, hepatotoxicity, and corneal
microdeposits. Baseline and periodic monitoring of thyroid function tests, liver
enzymes, and pulmonary function/chest imaging is recommended.
Family Nurse Practitioner Certification Review • 120 Questions with Answers and
Rationales
1. A 58-year-old man with a history of hypertension presents with a blood
pressure of 152/94 mmHg on two separate office visits despite adherence to
lisinopril 20 mg daily. He has no known kidney disease and a normal potassium
level. Which class of medication is the most appropriate next step?
A. Thiazide diuretic
B. Beta-blocker
C. Alpha-1 blocker
D. Central alpha-2 agonist
Correct Answer: A
Rationale: Current hypertension guidelines recommend combination therapy when
blood pressure remains above goal on a single first-line agent. Adding a thiazide-type
diuretic (or a calcium channel blocker) to an ACE inhibitor is first-line combination
therapy. Beta-blockers are not first-line for uncomplicated hypertension, and
alpha-blockers/central agonists are reserved for resistant cases or specific
comorbidities.
2. Which finding on physical examination is most consistent with aortic
stenosis?
A. Widened pulse pressure
B. Crescendo-decrescendo systolic murmur radiating to the carotids
C. Holosystolic murmur at the apex radiating to the axilla
D. Diastolic murmur best heard at the left lower sternal border
Correct Answer: B
Rationale: Aortic stenosis classically produces a harsh crescendo-decrescendo
(ejection) systolic murmur heard best at the right upper sternal border that radiates to
the carotid arteries, often accompanied by a delayed and diminished carotid upstroke
(pulsus parvus et tardus). A holosystolic murmur radiating to the axilla suggests mitral
regurgitation, and widened pulse pressure is more typical of aortic regurgitation.
,3. A patient taking warfarin presents with an INR of 8.0 and no active bleeding.
What is the most appropriate initial management?
A. Continue current dose and recheck INR in one week
B. Administer intravenous vitamin K and admit for observation
C. Hold warfarin and give oral vitamin K
D. Administer fresh frozen plasma immediately
Correct Answer: C
Rationale: For an INR greater than 5 without significant bleeding, guidelines
recommend holding warfarin and administering low-dose oral vitamin K to reduce the
INR into a safer range while minimizing the risk of overcorrection. IV vitamin K and
FFP are reserved for serious or life-threatening bleeding.
4. Which ECG finding is most characteristic of hyperkalemia?
A. Peaked T waves
B. U waves
C. Prolonged QT interval
D. Delta waves
Correct Answer: A
Rationale: Hyperkalemia classically produces peaked, narrow T waves early on,
progressing to widened QRS complexes and loss of P waves as potassium rises
further. U waves and QT prolongation are associated with hypokalemia, while delta
waves are seen in Wolff-Parkinson-White syndrome.
5. A 65-year-old woman reports exertional dyspnea and bilateral lower
extremity edema. Physical exam reveals jugular venous distension and an S3
gallop. Which diagnosis is most likely?
A. Chronic obstructive pulmonary disease
B. Heart failure with reduced ejection fraction
C. Pulmonary embolism
D. Deep vein thrombosis
Correct Answer: B
Rationale: An S3 gallop, jugular venous distension, and peripheral edema in the
setting of exertional dyspnea are classic findings of heart failure with volume
overload. An S3 is produced by rapid ventricular filling into a noncompliant, dilated
ventricle.
,6. Which lipid-lowering agent is most associated with myopathy and
rhabdomyolysis, especially when combined with certain antibiotics such as
clarithromycin?
A. Ezetimibe
B. Statins
C. Fibrates alone
D. Bile acid sequestrants
Correct Answer: B
Rationale: Statins carry a risk of myopathy and, rarely, rhabdomyolysis, particularly
when combined with CYP3A4 inhibitors such as clarithromycin, which raise statin
serum levels. Patients should be counseled to report unexplained muscle pain, and
creatine kinase should be checked if symptoms occur.
7. A patient presents with sudden-onset unilateral leg swelling, warmth, and
tenderness along the calf. Which tool is used to estimate pretest probability
before ordering further testing?
A. CHA2DS2-VASc score
B. Wells criteria
C. HEART score
D. Centor criteria
Correct Answer: B
Rationale: The Wells criteria for deep vein thrombosis help stratify pretest probability
and guide the decision to obtain a D-dimer versus proceeding directly to compression
ultrasonography. CHA2DS2-VASc estimates stroke risk in atrial fibrillation, HEART
score risk-stratifies chest pain, and Centor criteria assess likelihood of streptococcal
pharyngitis.
, 8. Which medication class is contraindicated in a patient with a history of
angioedema?
A. ACE inhibitors
B. Calcium channel blockers
C. Thiazide diuretics
D. Beta-blockers
Correct Answer: A
Rationale: ACE inhibitors are contraindicated in patients with a history of angioedema
because they inhibit bradykinin breakdown, which can precipitate recurrent,
potentially life-threatening angioedema. ARBs carry a lower but still present risk and
should be used cautiously.
9. A 70-year-old man on amiodarone for atrial fibrillation should be monitored
periodically for which of the following adverse effects?
A. Thyroid dysfunction and pulmonary fibrosis
B. Hyperkalemia and gynecomastia
C. Nephrotoxicity and ototoxicity
D. Hemolytic anemia and hyperglycemia
Correct Answer: A
Rationale: Amiodarone contains iodine and can cause both hypothyroidism and
hyperthyroidism, as well as pulmonary fibrosis, hepatotoxicity, and corneal
microdeposits. Baseline and periodic monitoring of thyroid function tests, liver
enzymes, and pulmonary function/chest imaging is recommended.
