APEA PRE-PREDICTOR 2024-2025 ACTUAL EXAM
TEST BANK 850+ QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+
A 6 yo had an acute onset of fever, pharyngitis, and headache 2 days ago. Today, he presents with
cervical lymphadenopathy and sandpaper textured rash everywhere except on his face. A rapid
streptococcal antigen test is positive. The remainder of the assessment in unremarkable. What is the
most likely diagnosis and the most appropriate action? - answer-Scarlet fever; treat with antibiotics.
This disease is due to infection with Group A Beta-hemolytic streptococcus. The rash is thought to be
due to a systemic reaction to the toxin produced by the microorganism. The rash fades with pressure
and ultimately desquamates. A deep, nonblanching rash on the flexor surfaces of the skin is referred to
as pastia lines.
A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is
prescribed. When should the nurse practitioner check the patient's TSH? - answer-6 weeks.
The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7 days. The earliest
that meaningful changes will be observed is at 4-6 weeks. Therefore, the NP should wait a minimum of
4-6 weeks before checking the patient's TSH.
A 15 yo malue has a history of cryptorchidism which was surgically repaired. Because of this
information, it is essential for the nurse practitioner to teach him about: - answer-testicular self-
examination.
Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer.
The treatment of choice for chronic bacterial prostatitis (CBP) is: - answer-a flouroquinolone twice daily
for 3 weeks to 4 months.
The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months. The cure rate with
Bactrim-DS is only about 30-40%.
A 25 yo female has a history of frequent candidal vaginal infections in the past year. She is in a
monogamous sexual relationship and uses and IUD for contraception. Of the following, which is the
most likely underlying conidition predisposing her to recurring candidal vaginitis? - answer-Diabetes.
A common underlying cause of frequent infections is diabetes mellitus. Pregnancy increases the
incidence of candidiasis, but is unlikely a factor with this patient.
,Which of the following is NOT a characteristic of the S3 heart sound? - answer-The sound is high-pitched
and occurs just prior to the S1 heart sound.
The S3 heart sound is low-pitched and occurs just after the S2 heart sound. It is produced by rapid
ventricular filling and is best auscultated in the mitral area. It is a common finding with right-sided heart
failure, rapid growth, and the last trimester of pregnancy.
Following the finding of prostate gland abnormalities on DRE, the NP orders the appropriate labs. Whem
preparing to review lab reports with the patient, the nurse practitioner knows all of the following are
true EXCEPT: - answer-normal PSA is 10ng/ml or less.
Normal PSA is 4ng/ml or less. PSA levels greater the 4 and less than 10 are associated with BPH. A 10 or
greater PSA level suggests prostate cancer. Positive serum acid phosphatase is associated with
malignancy of the prostate gland with bone metasasis.
A 66 yo female presents to your clinic. She states that yesterday evening she had chest pain for 20-30
minutes. Which finding most strongly correlates with myocardial infarction? - answer-Elevated Troponin
I levels
An elevated creatinine kinase (CK) is not diagnostic of a myocardial infarction (MI). CK may be elevated
from an IM injection, surgery, ot any type of extensive skeletal muscle trauma or prolonged, strenuous
physical exertion. ST segment depression on EKG usually indicates an ischemic myocardium, but, not
necessarily, one post-MI. Elevated ST seghments reflect mycardial damage. MB bands are specific for
myocardial smooth muscle. If these are elevated, the patient MAY HAVE had a very recent MI. The most
accurate marker of cardiac damage, because it is more specific and sensitive than CK MB, is a troponin
measurement.
What is a secondary cause of hyperlipidemia? - answer-hypothyroidism
Hypothyroidism is a common secondary cause of hyperlipidemia. In the evaluation of a patient with
hyperlipidemia, a TSH should always be checked and corrected before attempting treatment for
hyperlipidemia. Other possible causes of seconday hyperlipidemia include pregnancy, excessive weight
gain, excessive alcohol intake, insulin resistance or deficiency, obstructive liver disease, and uremia.
Some medications can produce secondary hypothyroidism too: thiazide diuretics, some beta-blockers,
oral contraceptives, and corticosteroids.
A 35-yo male presents with a complaint of low pelvic pain, dysuria, hesitancy, urgency, and reduced for
of stream. The nurse practitioner suspects acute bacterial prostatitis. The NP would appropriately collect
all of the following specimens EXCEPT a: sterile in-and-out catheter urine specimen. - answer-A sterile
in-and-out catheter specimen would identify only organisms in the bladder and would not differentiate
,between bladder, kidney, or prostate site infection. The sequence for obtaining specimens when prostat
infection is suspected is: 1. voided urethral urine, 2. Voided mid-stream bladder urine, and 3. voided
post-prostate massage urine.
A 24 yo female taking an oral contraceptive has missed her last 2 pills. What should the nurse
practitioner advise her to do to minimize her risk of pregnancy? - answer-Double today's dose and
tomorrow's dose and use a barrier method for the rest of the month.
If 2 mills are missed on consecutive days, the next 2 days' doseages should be doubled and a barrier
method recommended for the remainder of the cycle.
A 50yo, non-smoker, with no co-morbidity presents to the clinica and is diagnosed with pna. His vital
signs are normal except for temperature of 101.6 degrees. A sputum specimen is collected and sent for
culture and sensitivity. What action should the nurse practitioner take today? - answer-Start
Clarithromycin (Biaxin) 500mg 2 times a day for 10 to 14 days.
Most treatment guidelines for outpatient pna in non-smokers without co-morbidity and 60 years of age
or younger, recommend erythromycin or another macrolide like Biaxin. Pcn s indicated for patient swith
pneumococcal pna and ciprofloxacin is recommended for Legionella species.
A 38 year old patient is being treated the by the NP for heavy vaginal bleeding secondary to multiple
uterine leiomyomas. Her uterus is greater than 12 weeks gestational size, her hematocrit is 28%, and
she has not responded to hormonal therapy. Which of the following would be the most appropriate
intervention at this time? - answer-Obtain a gynecological consultation
Gynecological consultation is recommended for a patient with a uterus greater that 12 weeks
gestational size, significant anemia (hct <30),. o a normal endometrial biopsy with failure to respond to
hormonal therapy.
What maternal situation is considered an absolute contraindication to breastfeeding? - answer-Early HIV
detection
There are few absolute contraindications to breastfeeding. HIV infection and IV drug abuse are 2
contraindications.
A 21 yo college student presents to the sudent health center with copious, markedly purulent discharge
from her left eye. The nurse practitioner should suspect: - answer-gonococcal conjunctivitis.
A purulent and copious discharge should alert the nurse practitioner to the likely possibility of
gonococcal or chlamydial conjunctivitis. Noth require systemic anitbiotic treatment and immediate
referral to an opthalmologist for evaluation.
, Babies should begin oral iron supplementation: - answer-4-6 months of age.
Generally, full term infants who are breadt-fed have sufficient stores of iron to last through the first 4-6
months of life. Earlier supplementation may be m=necessary for premature infants, infants who are
breastyfed exclusively beyond the first 6 months of age, and infants who begin drinking cow's milk prior
to 1 year of age.
Which item is NOT implicated in erectile dysfunction (ED)? - answer-Urinary tract infection (UTI)
Many systemic disease like diabetes, hypo/hyperthyroidism, Cushing's syndrome can result in ED> Many
medications can cause ED, particularly the antihypertensives (Vasotec) and the antidepressants (Paxil).
Other activities like heavy smoking, drug abuse, and alcoholism can also lead to ED.
Expected spriometry readings when the patient has chronic emphysema include: - answer-Increased
total lung capacity (TLC).
Residual volume is increased, Volume Capacity is decreased, FEV-1 in decreased, and total lung capacity
is increased with emphysema. RV, VC, and FEV-1 spirometry readings are the same whether COPD is due
to chronic emphysema or chronic bronchitis, however, TLC is normal or only slightly increased with
chronic bronchitis.
Physical exam findings consistent with emphysema include all of the following EXCEPT: - answer-pallor
and cyanosis of the mucosa and nailbeds.
Pallor and cyanosis is typical of chronic bronchitis (type B COPD, the "blue boater"_. Emphysema (Type A
COPD, the "pink puffer") is not associated with pallor or cyanosis. Increased AP dianeter produces a
"barrel chest". The normal chest is elliptical whereas the barrel chest is round. The muscles of the thorax
appear thin and wasted while the accessory muscles of respiration are hypertrophied. Breath sounds are
minished and cough is weak and ineffective.
Which laboratory test is useful in the diagnosis of spontaneous abortion? - answer-Serial quantitative
beta-huma chorionic gonadotropin levels.
Serial quantitative beta-human chorionic gonadotropin levels are the most useful for diagnosing
spontaneous abortion. The levels progressively decline.
The most acceoted recommendation regarding skin cancer prevention is: - answer-avoidance of
excessive sun exposure.
