APEA Predictor Exam Questions and 100% Correct Answers with Rationale Pre-Predictor
2024/3030 LATEST VERSION
FINAL EXAM
A 15 years old high school student with a mild sore throat and the low-grade fever has been haspersistedforabout3weeks. She reports
general malaise, fatigue, and loss of appetite. The NP suspects mono nucleosides. Which of the following is the LEAST appropriate
intervention?
Palpate the lymph nodes and spleen Examinetheposteriororopharynxforpetechiae
Obtain a CBC, throat culture, and heterophil antibody test. Obtain urinalyses and serum for LFTs and amylase
Explanation: mononucleosis is a symptomatic infection caused by the Epstein-Bar virus. Common is people 15-24 years of age. Following the
incubation period (1-2 months), common signs and symptoms include fatigue, chills, malaise, anorexia, white tonsillar exudates, and
lymphadenopathy or posterior cervical region. Splenomegaly can be present. A maculopapular or occasionally petechial rash occurs in less than
15% of patients. A diagnosis is usually made using the Monospot.In addition,neutropeniaandlymphocytosisareusuallydetectedintheCBC.
A 32-year-old male patient complaint of urinary frequency and burning on urination for three days. Urinalyses reveal bacteriuria and positive
nitrites. He denies any past hx. Of urinary tract infections. The initial treatment should be:
a. trimethoprim-sulfamethoxazole(Bactrim,Sulfatrim)for7-10day ciprofloxacin(Cipro)for3-5days
Trimethoprim-Sulfamethoxazolefor3days 750mg ciprofloxacinasa one-timedose
Explanation: trimethoprim-sulfamethoxazole(TMPS)is usually n appropriate medication for most patients' urinary tract infections.In the case of
community resistancetoTMPS
>20%^, another medication should be substituted. In men, the appropriate length of time is 7-10 days.Womenmaybetreatedfor3 days for
uncomplicated UTI
Which agent is most effective for the treatment of nodulocystic acne? Benzoyl peroxide(Benzac)
Retinoic acid(RetinA)
Topical tetracycline
Isotretinoin)
Explanation: Isotretinoin (Accutane) is a systemic agent indicated for treating severe inflammatory acne. The patient must clearly understand
the guidelines for its use. A woman of childbearing age must use an effective method of contraception because isotretinoin is teratogenic.
Many restrictions are in prescribing this medication because of the teratogenic effects given during pregnancy. Therefore, it is a pregnancy
category X.
An 18 y/o woman is taking a combined hormonal oral contraceptive. She should be instructed to use a backup method for the
prevention of pregnancy
Throughouttheweekofplacebopills
If prescribed to piramate(Topamax)for the treatment of migraines.
, Ifprescribedamoxicillin/clavulanate(Augmentin)for sinus infection if she forgets totakeasingledoseofthecontraceptive
Explanation: Anticonvulsants, including phenytoin (Dilantin), carbamazepine (Tegretol), primidone (Mysoline), topiramate (Topamax) and
oxcarbazepine (Trileptal)reduce the effectiveness of contraceptives. Depo-medroxyprogesterone acetate injections or levonorgestrel-releasing
intrauterine devices would be a better method of contraception for patients taking anticonvulsants. Most commonly used antibiotics have not been proven
to reduce the effectiveness of contraceptives.
Rifampin is an exception, and additional…. Be used by women
taking this drug and using oral contraceptives, transdermal, or vaginal ring preparations. Additional backup contraception should be used if
taking antifungal agents. No additional protection is needed thought the week of placebo pills. Missing one contraceptive dose does not require
additional protection; missing more than one dose does.
A 44 years old female patient has diabetes. Her total cholesterol (TC) is 250 mg/dl (6.5mmol/L), LDL= 190 mg/dL (4.94 mmol/L), HDL= 25
mg/dL (65 mmol/L), and triglycerides=344mg/dL(8.94mmol/L).What agent significantly improves her lipid profile and reduces morbidity and
mortality associated with dyslipidemia?
a.
Niacin(Niaspan) Atorvastatin Omega3fattyacids Fenofibrates
Explanation: First and foremost, educating individuals on a heart-healthy lifestyle is essential. LDL-C is one of the major culprits in the development
of atherosclerotic heart disease. The target level of LDL-C is between 50 to 70mg/dl to prevent plaque formation in the blood vessels.
Guidelines strongly recommend statin therapy because they primarily lower LDL-C levels but also has the secondary effects of lowering triglyceride and
increasing HDL-C levels.
A 30 years old female comes into a clinic with classic signs and symptoms of appendicitis. The NP fails to refer the patient to a surgeon.
The appendix ruptures and the woman dies. This is an example of
Failureofdiligence Professional liability Negligence
. Malpractice
Explanation: malpractice, a negligence tort, occurs when a healthcare professional’s actions fall Bellow the appropriate standard of care and
hurts the patient. In this case, the patient came with signs and symptoms indicating appendicitis and the NP failed to refer the patient..
A NP has recently been hired to work in a fast-track facility. The NP employer asked ifshe has “a problem prescribing medications for
emergency contraception.” The NP replies affirmatively.This is:
Groundsfordismissal
An ethical dilemma for the NP Illegalaccordingtothestandardsofnursing
3
2
, Patient abandonment.
Explanation: In this instance, thee NP has a different opinion with her employer based on her religious or moral belief about providing
emergency contraception. This situation is an example of an ethical dilemma. Failure to participate in the provision of care to the patient based on
theNP’sbeliefsisneither against the lawn or a violation of the standards of practice
A patient presents with pruritic lesions on both knees. There are visible silver scales. HowShouldthis condition be managed?
Topicalantifungalcreamorointment Oral antibiotics Topicalcorticosteroidscream
Topical anti-fungal/steroid cream
Explanation: Psoriasis is characterized by erythematous papules, as well as itchy, red, precisely- defined plaques with silvery scales. Auspitz sings
it is another common finding. Topical agents containing tar and salicylic acid may be used. Topical steroids, such as betamethasone, may also be
ordered.
Antidepressant discontinuation syndrome is less likely if the patient Ismael
Islessthan35y/o
Has taken an SSRI with a short half-life d.GraduallytapersSSRIuse
Explanation: Antidepressant discontinuation syndrome is most often seen in the primary care office in association with SSRI discontinuation
because SSRIs are the most commonly prescribed class of antidepressant medications. Interruption of treatment with an anti-depressant medication
is sometimes associated with an antidepressant discontinuation syndrome; in early reports, it was referred to as a “withdrawal reaction. Symptoms
of antidepressant discontinuation syndrome can include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal.
Experts recommend tapering.
Patientwithbenignprostatichyperplasia (BPH)should be taught to avoid which one of the following drug classes?
Alphaadrenergicantagonist Anti-androgenagents Tricyclicantidepressant(TCA)
Sulfonamides
Explanation: tricyclic antidepressants should not be used by men with benign
prostatichyperplasiabecauseoftheincreasedriskofurinaryretentionsecondarytotheanticholigergiceff ectsofTCAs.
Which of the following is the best response to a woman who has just admitted she is a victim of spousal abusee?
What if you did to make him angry?
Youmustseekrefugeimmediately
c. I am concerned about your
4
3
, safety
I am going to call a shelter for you
Explanation: The first step is to establish trust in the therapeutic relationship. Without trust, future collaboration, intervention, and client
outcomes cannot be accomplished to facilitate appropriatee and safe behavior. The experience of abuse is a traumatic psychological crisis that
must be addressed; healthcare providers must emphasize the fact that the victim has not done anything wrong, and they must also emphasize the
fact that the victim's life and the lives of their children can be in danger if the abuse is not addressed. It will not disappear with vav lack of action.
Anorder of protection against the perpetrator is often recommended.
ForwhichpatientgroupdoestheUSPreventiveServicesTaskForcerecommendroutinescreeni ngfor asymptomatic bacteriuria
pregnant woman Children
Patients with diabetes patients over the age of 70
Explanation: increased incidence of bacteriuria is found in all the populations listed. However, bacteriuria in pregnant women increases the
mother…..Also increased is the risk of pre-term delivery, increasing perinatal and fetal morbidity and mortality. The recommended….
13) Whatdiabeticcomplicationsresultfromhyperglycemia? Retinopathy
Hypertensionresistanttotreatment Peripheral neuropathy Acceleratedatherosclerosis
1,2,3
2,3,4
1,3,4
1,2,4
explanation:Complicationsofuntreatedoruncontrolledhyperglycemiaoveraprolongedperiodoftim einclude:
Microvascular complications: Retinopathy, Nephropathy, Neuropathy Macrovascular complications: Coronary artery disease,
Cerebrovascular disease, Peripheral vascular disease
A 6 y/o presents w/ complaints of sore throat and fever for two days. He has multiple vesiculated ulcerations on his tonsils and
uvula.Therearenootherremarkablefindings.What is the most likely diagnosis?
Viral pharyngitis Herpangina Epiglottitis Tonsillitis
5
4
2024/3030 LATEST VERSION
FINAL EXAM
A 15 years old high school student with a mild sore throat and the low-grade fever has been haspersistedforabout3weeks. She reports
general malaise, fatigue, and loss of appetite. The NP suspects mono nucleosides. Which of the following is the LEAST appropriate
intervention?
Palpate the lymph nodes and spleen Examinetheposteriororopharynxforpetechiae
Obtain a CBC, throat culture, and heterophil antibody test. Obtain urinalyses and serum for LFTs and amylase
Explanation: mononucleosis is a symptomatic infection caused by the Epstein-Bar virus. Common is people 15-24 years of age. Following the
incubation period (1-2 months), common signs and symptoms include fatigue, chills, malaise, anorexia, white tonsillar exudates, and
lymphadenopathy or posterior cervical region. Splenomegaly can be present. A maculopapular or occasionally petechial rash occurs in less than
15% of patients. A diagnosis is usually made using the Monospot.In addition,neutropeniaandlymphocytosisareusuallydetectedintheCBC.
A 32-year-old male patient complaint of urinary frequency and burning on urination for three days. Urinalyses reveal bacteriuria and positive
nitrites. He denies any past hx. Of urinary tract infections. The initial treatment should be:
a. trimethoprim-sulfamethoxazole(Bactrim,Sulfatrim)for7-10day ciprofloxacin(Cipro)for3-5days
Trimethoprim-Sulfamethoxazolefor3days 750mg ciprofloxacinasa one-timedose
Explanation: trimethoprim-sulfamethoxazole(TMPS)is usually n appropriate medication for most patients' urinary tract infections.In the case of
community resistancetoTMPS
>20%^, another medication should be substituted. In men, the appropriate length of time is 7-10 days.Womenmaybetreatedfor3 days for
uncomplicated UTI
Which agent is most effective for the treatment of nodulocystic acne? Benzoyl peroxide(Benzac)
Retinoic acid(RetinA)
Topical tetracycline
Isotretinoin)
Explanation: Isotretinoin (Accutane) is a systemic agent indicated for treating severe inflammatory acne. The patient must clearly understand
the guidelines for its use. A woman of childbearing age must use an effective method of contraception because isotretinoin is teratogenic.
Many restrictions are in prescribing this medication because of the teratogenic effects given during pregnancy. Therefore, it is a pregnancy
category X.
An 18 y/o woman is taking a combined hormonal oral contraceptive. She should be instructed to use a backup method for the
prevention of pregnancy
Throughouttheweekofplacebopills
If prescribed to piramate(Topamax)for the treatment of migraines.
, Ifprescribedamoxicillin/clavulanate(Augmentin)for sinus infection if she forgets totakeasingledoseofthecontraceptive
Explanation: Anticonvulsants, including phenytoin (Dilantin), carbamazepine (Tegretol), primidone (Mysoline), topiramate (Topamax) and
oxcarbazepine (Trileptal)reduce the effectiveness of contraceptives. Depo-medroxyprogesterone acetate injections or levonorgestrel-releasing
intrauterine devices would be a better method of contraception for patients taking anticonvulsants. Most commonly used antibiotics have not been proven
to reduce the effectiveness of contraceptives.
Rifampin is an exception, and additional…. Be used by women
taking this drug and using oral contraceptives, transdermal, or vaginal ring preparations. Additional backup contraception should be used if
taking antifungal agents. No additional protection is needed thought the week of placebo pills. Missing one contraceptive dose does not require
additional protection; missing more than one dose does.
A 44 years old female patient has diabetes. Her total cholesterol (TC) is 250 mg/dl (6.5mmol/L), LDL= 190 mg/dL (4.94 mmol/L), HDL= 25
mg/dL (65 mmol/L), and triglycerides=344mg/dL(8.94mmol/L).What agent significantly improves her lipid profile and reduces morbidity and
mortality associated with dyslipidemia?
a.
Niacin(Niaspan) Atorvastatin Omega3fattyacids Fenofibrates
Explanation: First and foremost, educating individuals on a heart-healthy lifestyle is essential. LDL-C is one of the major culprits in the development
of atherosclerotic heart disease. The target level of LDL-C is between 50 to 70mg/dl to prevent plaque formation in the blood vessels.
Guidelines strongly recommend statin therapy because they primarily lower LDL-C levels but also has the secondary effects of lowering triglyceride and
increasing HDL-C levels.
A 30 years old female comes into a clinic with classic signs and symptoms of appendicitis. The NP fails to refer the patient to a surgeon.
The appendix ruptures and the woman dies. This is an example of
Failureofdiligence Professional liability Negligence
. Malpractice
Explanation: malpractice, a negligence tort, occurs when a healthcare professional’s actions fall Bellow the appropriate standard of care and
hurts the patient. In this case, the patient came with signs and symptoms indicating appendicitis and the NP failed to refer the patient..
A NP has recently been hired to work in a fast-track facility. The NP employer asked ifshe has “a problem prescribing medications for
emergency contraception.” The NP replies affirmatively.This is:
Groundsfordismissal
An ethical dilemma for the NP Illegalaccordingtothestandardsofnursing
3
2
, Patient abandonment.
Explanation: In this instance, thee NP has a different opinion with her employer based on her religious or moral belief about providing
emergency contraception. This situation is an example of an ethical dilemma. Failure to participate in the provision of care to the patient based on
theNP’sbeliefsisneither against the lawn or a violation of the standards of practice
A patient presents with pruritic lesions on both knees. There are visible silver scales. HowShouldthis condition be managed?
Topicalantifungalcreamorointment Oral antibiotics Topicalcorticosteroidscream
Topical anti-fungal/steroid cream
Explanation: Psoriasis is characterized by erythematous papules, as well as itchy, red, precisely- defined plaques with silvery scales. Auspitz sings
it is another common finding. Topical agents containing tar and salicylic acid may be used. Topical steroids, such as betamethasone, may also be
ordered.
Antidepressant discontinuation syndrome is less likely if the patient Ismael
Islessthan35y/o
Has taken an SSRI with a short half-life d.GraduallytapersSSRIuse
Explanation: Antidepressant discontinuation syndrome is most often seen in the primary care office in association with SSRI discontinuation
because SSRIs are the most commonly prescribed class of antidepressant medications. Interruption of treatment with an anti-depressant medication
is sometimes associated with an antidepressant discontinuation syndrome; in early reports, it was referred to as a “withdrawal reaction. Symptoms
of antidepressant discontinuation syndrome can include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal.
Experts recommend tapering.
Patientwithbenignprostatichyperplasia (BPH)should be taught to avoid which one of the following drug classes?
Alphaadrenergicantagonist Anti-androgenagents Tricyclicantidepressant(TCA)
Sulfonamides
Explanation: tricyclic antidepressants should not be used by men with benign
prostatichyperplasiabecauseoftheincreasedriskofurinaryretentionsecondarytotheanticholigergiceff ectsofTCAs.
Which of the following is the best response to a woman who has just admitted she is a victim of spousal abusee?
What if you did to make him angry?
Youmustseekrefugeimmediately
c. I am concerned about your
4
3
, safety
I am going to call a shelter for you
Explanation: The first step is to establish trust in the therapeutic relationship. Without trust, future collaboration, intervention, and client
outcomes cannot be accomplished to facilitate appropriatee and safe behavior. The experience of abuse is a traumatic psychological crisis that
must be addressed; healthcare providers must emphasize the fact that the victim has not done anything wrong, and they must also emphasize the
fact that the victim's life and the lives of their children can be in danger if the abuse is not addressed. It will not disappear with vav lack of action.
Anorder of protection against the perpetrator is often recommended.
ForwhichpatientgroupdoestheUSPreventiveServicesTaskForcerecommendroutinescreeni ngfor asymptomatic bacteriuria
pregnant woman Children
Patients with diabetes patients over the age of 70
Explanation: increased incidence of bacteriuria is found in all the populations listed. However, bacteriuria in pregnant women increases the
mother…..Also increased is the risk of pre-term delivery, increasing perinatal and fetal morbidity and mortality. The recommended….
13) Whatdiabeticcomplicationsresultfromhyperglycemia? Retinopathy
Hypertensionresistanttotreatment Peripheral neuropathy Acceleratedatherosclerosis
1,2,3
2,3,4
1,3,4
1,2,4
explanation:Complicationsofuntreatedoruncontrolledhyperglycemiaoveraprolongedperiodoftim einclude:
Microvascular complications: Retinopathy, Nephropathy, Neuropathy Macrovascular complications: Coronary artery disease,
Cerebrovascular disease, Peripheral vascular disease
A 6 y/o presents w/ complaints of sore throat and fever for two days. He has multiple vesiculated ulcerations on his tonsils and
uvula.Therearenootherremarkablefindings.What is the most likely diagnosis?
Viral pharyngitis Herpangina Epiglottitis Tonsillitis
5
4
