Page 1 of 132
NSG 6998 APEA Predictor Final Exam – ACTUAL EXAM
COMPLETE QUESTIONS AND VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR
NSG 6998 APEA Predictor Final Exam –
Exam Coverage Areas:
• Adult & Geriatric Primary Care
• Pediatric Primary Care
• Women’s Health and Reproductive Care
• Psychiatric and Mental Health Management
• Acute & Chronic Disease Management
• Preventive Care & Screening Guidelines
• Pharmacology and Medication Management
• Laboratory Interpretation and Diagnostic Testing
• Patient Education & Health Promotion
• Emergency & Urgent Care Scenarios
BATCH 1 – Questions 1–50
Question 1
A 28-year-old woman presents with amenorrhea for 3 months. She has galactorrhea and mild
headaches. Serum prolactin is elevated. What is the next best step?
A) Start combined oral contraceptive
B) Order MRI of the pituitary
C) Prescribe bromocriptine empirically
D) Reassure patient; repeat labs in 3 months
Answer: B) Order MRI of the pituitary
Rationale: Hyperprolactinemia with galactorrhea and amenorrhea raises suspicion for a
prolactinoma. Imaging is necessary before initiating dopamine agonists.
,Page 2 of 132
Question 2
A 52-year-old postmenopausal woman presents with vulvar pruritus and a raised, white, well-
demarcated plaque on the labia majora for 6 months. Previous antifungal treatment failed.
What is the most appropriate next step?
A) Prescribe a 2-week course of high-potency topical corticosteroid
B) Perform a punch biopsy of the lesion
C) Reassure and recommend emollient hygiene only
D) Start oral fluconazole 150 mg weekly for 4 weeks
Answer: B) Perform a punch biopsy of the lesion
Rationale: Persistent white plaques in postmenopausal women may indicate vulvar
intraepithelial neoplasia or lichen sclerosus. Biopsy is required for histologic confirmation
before therapy. Topical treatments alone could mask malignancy.
Question 3
A 6-year-old boy presents with new-onset enuresis, snoring, and daytime fatigue. BMI is above
the 95th percentile. What is the most likely underlying condition?
A) Urinary tract infection
B) Obstructive sleep apnea
,Page 3 of 132
C) Diabetes insipidus
D) Behavioral regression
Answer: B) Obstructive sleep apnea
Rationale: Obese children with snoring and daytime fatigue often have OSA. Sleep-disordered
breathing can also cause secondary enuresis. Evaluation may include sleep study and ENT
referral.
Question 4
A 65-year-old man presents with sudden onset of severe left eye pain, halos around lights,
headache, nausea, and vomiting. Intraocular pressure is elevated. What is the immediate
intervention?
A) Oral acetazolamide and referral to ophthalmology
B) Prescribe topical antibiotics
C) Advise warm compresses and observation
D) Schedule routine eye exam in 1 week
Answer: A) Oral acetazolamide and referral to ophthalmology
Rationale: Acute angle-closure glaucoma is an ocular emergency. Immediate pressure
reduction and urgent ophthalmology referral are essential to prevent permanent vision loss.
, Page 4 of 132
Question 5
A 40-year-old patient with type 2 diabetes presents with A1c of 9.2% despite metformin 1000
mg BID. What is the best next pharmacologic step?
A) Increase metformin to 2000 mg BID
B) Add GLP-1 receptor agonist
C) Start insulin pump immediately
D) Add sulfonylurea without lifestyle counseling
Answer: B) Add GLP-1 receptor agonist
Rationale: GLP-1 receptor agonists provide glycemic control, cardiovascular benefit, and weight
loss. Metformin alone is insufficient for A1c >9%, and lifestyle intervention should continue
concurrently.
Question 6
A 70-year-old woman presents with mild memory loss and confusion over 6 months. Mini-
Mental State Exam score is 23/30. What is the most appropriate initial test?
A) MRI brain
B) Thyroid function tests and B12 levels
C) Prescribe donepezil
D) EEG
NSG 6998 APEA Predictor Final Exam – ACTUAL EXAM
COMPLETE QUESTIONS AND VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR
NSG 6998 APEA Predictor Final Exam –
Exam Coverage Areas:
• Adult & Geriatric Primary Care
• Pediatric Primary Care
• Women’s Health and Reproductive Care
• Psychiatric and Mental Health Management
• Acute & Chronic Disease Management
• Preventive Care & Screening Guidelines
• Pharmacology and Medication Management
• Laboratory Interpretation and Diagnostic Testing
• Patient Education & Health Promotion
• Emergency & Urgent Care Scenarios
BATCH 1 – Questions 1–50
Question 1
A 28-year-old woman presents with amenorrhea for 3 months. She has galactorrhea and mild
headaches. Serum prolactin is elevated. What is the next best step?
A) Start combined oral contraceptive
B) Order MRI of the pituitary
C) Prescribe bromocriptine empirically
D) Reassure patient; repeat labs in 3 months
Answer: B) Order MRI of the pituitary
Rationale: Hyperprolactinemia with galactorrhea and amenorrhea raises suspicion for a
prolactinoma. Imaging is necessary before initiating dopamine agonists.
,Page 2 of 132
Question 2
A 52-year-old postmenopausal woman presents with vulvar pruritus and a raised, white, well-
demarcated plaque on the labia majora for 6 months. Previous antifungal treatment failed.
What is the most appropriate next step?
A) Prescribe a 2-week course of high-potency topical corticosteroid
B) Perform a punch biopsy of the lesion
C) Reassure and recommend emollient hygiene only
D) Start oral fluconazole 150 mg weekly for 4 weeks
Answer: B) Perform a punch biopsy of the lesion
Rationale: Persistent white plaques in postmenopausal women may indicate vulvar
intraepithelial neoplasia or lichen sclerosus. Biopsy is required for histologic confirmation
before therapy. Topical treatments alone could mask malignancy.
Question 3
A 6-year-old boy presents with new-onset enuresis, snoring, and daytime fatigue. BMI is above
the 95th percentile. What is the most likely underlying condition?
A) Urinary tract infection
B) Obstructive sleep apnea
,Page 3 of 132
C) Diabetes insipidus
D) Behavioral regression
Answer: B) Obstructive sleep apnea
Rationale: Obese children with snoring and daytime fatigue often have OSA. Sleep-disordered
breathing can also cause secondary enuresis. Evaluation may include sleep study and ENT
referral.
Question 4
A 65-year-old man presents with sudden onset of severe left eye pain, halos around lights,
headache, nausea, and vomiting. Intraocular pressure is elevated. What is the immediate
intervention?
A) Oral acetazolamide and referral to ophthalmology
B) Prescribe topical antibiotics
C) Advise warm compresses and observation
D) Schedule routine eye exam in 1 week
Answer: A) Oral acetazolamide and referral to ophthalmology
Rationale: Acute angle-closure glaucoma is an ocular emergency. Immediate pressure
reduction and urgent ophthalmology referral are essential to prevent permanent vision loss.
, Page 4 of 132
Question 5
A 40-year-old patient with type 2 diabetes presents with A1c of 9.2% despite metformin 1000
mg BID. What is the best next pharmacologic step?
A) Increase metformin to 2000 mg BID
B) Add GLP-1 receptor agonist
C) Start insulin pump immediately
D) Add sulfonylurea without lifestyle counseling
Answer: B) Add GLP-1 receptor agonist
Rationale: GLP-1 receptor agonists provide glycemic control, cardiovascular benefit, and weight
loss. Metformin alone is insufficient for A1c >9%, and lifestyle intervention should continue
concurrently.
Question 6
A 70-year-old woman presents with mild memory loss and confusion over 6 months. Mini-
Mental State Exam score is 23/30. What is the most appropriate initial test?
A) MRI brain
B) Thyroid function tests and B12 levels
C) Prescribe donepezil
D) EEG
