NSG 6998 APEA PREDICTOR EXAM 1 | QUESTIONS
AND 100% CORRECT ANSWERS WITH RATIONALES |
LATEST UPDATE GRADED A+
1. A 65-year-old patient presents with sudden onset shortness of breath and chest pain.
Which is the most appropriate initial diagnostic test?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. D-dimer
D. Pulmonary function test
Answer: B – ECG is the most immediate test to assess for cardiac causes such as myocardial
infarction, which can present with sudden chest pain and dyspnea.
2. A patient with type 2 diabetes has an A1C of 9%. Which medication adjustment is
most appropriate?
A. Continue current therapy
B. Add a GLP-1 receptor agonist
C. Switch to metformin monotherapy
D. Stop all oral hypoglycemics
Answer: B – GLP-1 receptor agonists improve glycemic control and offer cardiovascular
benefits in patients with uncontrolled diabetes.
3. Which pediatric vaccine is contraindicated in an immunocompromised child?
A. Hepatitis B
B. Inactivated polio vaccine
C. MMR
D. Tdap
Answer: C – MMR is a live attenuated vaccine and may cause infection in
immunocompromised children.
4. A patient presents with fatigue, pallor, and spoon-shaped nails. What is the most likely
diagnosis?
A. Iron-deficiency anemia
B. Vitamin B12 deficiency
C. Sickle cell anemia
D. Thalassemia
Answer: A – Fatigue, pallor, and koilonychia (spoon-shaped nails) are classic signs of iron-
deficiency anemia.
5. A 55-year-old patient has persistent hypertension despite three antihypertensive
medications. Which is the next best step?
, A. Increase current doses
B. Add a fourth antihypertensive
C. Screen for secondary causes
D. Discontinue therapy
Answer: C – Resistant hypertension warrants evaluation for secondary causes such as renal
artery stenosis or endocrine disorders.
6. Which is the first-line treatment for an acute gout attack?
A. Allopurinol
B. Colchicine
C. Febuxostat
D. Probenecid
Answer: B – Colchicine is effective in reducing inflammation during an acute gout attack;
urate-lowering therapies like allopurinol are for chronic management.
7. A patient presents with sudden confusion, slurred speech, and right-sided weakness.
What is the most likely cause?
A. Hypoglycemia
B. Ischemic stroke
C. Seizure
D. Migraine
Answer: B – Sudden focal neurological deficits suggest an acute ischemic stroke, requiring
immediate evaluation.
8. Which antibiotic is contraindicated in children under 8 years old due to risk of teeth
discoloration?
A. Amoxicillin
B. Ciprofloxacin
C. Tetracycline
D. Azithromycin
Answer: C – Tetracyclines can cause permanent teeth discoloration in children.
9. Which of the following is the most common cause of community-acquired pneumonia
in adults?
A. Staphylococcus aureus
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Mycoplasma pneumoniae
Answer: B – Streptococcus pneumoniae is the leading cause of community-acquired
pneumonia in adults.
10. A patient presents with polyuria, polydipsia, and polyphagia. Which lab test is most
diagnostic?
, A. Serum potassium
B. Fasting blood glucose
C. CBC
D. Serum calcium
Answer: B – Elevated fasting blood glucose confirms diabetes mellitus in a patient with
classic symptoms.
11. A 30-year-old woman has sudden-onset right lower quadrant pain, nausea, and
vomiting. Which is the most likely diagnosis?
A. Ectopic pregnancy
B. Appendicitis
C. Ovarian cyst rupture
D. Gastroenteritis
Answer: B – Acute appendicitis often presents with RLQ pain, nausea, and vomiting; ectopic
pregnancy must also be ruled out with a pregnancy test.
12. Which medication class is first-line for treating chronic heart failure with reduced
ejection fraction?
A. Beta-blockers
B. Calcium channel blockers
C. Loop diuretics
D. Nitrates
Answer: A – Beta-blockers improve survival and reduce hospitalizations in HFrEF.
13. A patient presents with jaundice, dark urine, and pale stools. Which lab test is most
useful?
A. Serum bilirubin
B. Serum creatinine
C. CBC
D. Amylase
Answer: A – Elevated bilirubin indicates hepatobiliary dysfunction causing jaundice.
14. A 7-year-old child has a barking cough, stridor, and mild fever. What is the most
likely diagnosis?
A. Asthma exacerbation
B. Croup (laryngotracheitis)
C. Bronchiolitis
D. Epiglottitis
Answer: B – Barking cough and stridor are classic signs of croup in children.
15. A patient presents with resting tremor, rigidity, and bradykinesia. What is the most
likely diagnosis?
A. Multiple sclerosis
, B. Parkinson’s disease
C. Huntington’s disease
D. Amyotrophic lateral sclerosis
Answer: B – Parkinson’s disease is characterized by the triad of tremor, rigidity, and
bradykinesia.
16. Which lab value is most indicative of acute kidney injury?
A. Elevated serum creatinine
B. Low hemoglobin
C. Elevated ALT
D. Low potassium
Answer: A – Serum creatinine rises in acute kidney injury, reflecting impaired renal function.
17. A patient presents with sudden severe headache, nausea, and neck stiffness. Which is
the most likely diagnosis?
A. Migraine
B. Subarachnoid hemorrhage
C. Tension headache
D. Sinusitis
Answer: B – Sudden severe headache (“thunderclap headache”) with neck stiffness suggests
subarachnoid hemorrhage.
18. Which electrolyte imbalance is most likely with chronic diarrhea?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Answer: B – Chronic diarrhea causes potassium loss leading to hypokalemia.
19. A 25-year-old patient presents with fever, dysuria, and flank pain. What is the most
likely diagnosis?
A. Cystitis
B. Pyelonephritis
C. Kidney stones
D. Prostatitis
Answer: B – Fever, dysuria, and flank pain indicate upper urinary tract infection
(pyelonephritis).
20. Which class of antihypertensive is preferred in a patient with diabetes and
proteinuria?
A. Beta-blocker
B. ACE inhibitor
AND 100% CORRECT ANSWERS WITH RATIONALES |
LATEST UPDATE GRADED A+
1. A 65-year-old patient presents with sudden onset shortness of breath and chest pain.
Which is the most appropriate initial diagnostic test?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. D-dimer
D. Pulmonary function test
Answer: B – ECG is the most immediate test to assess for cardiac causes such as myocardial
infarction, which can present with sudden chest pain and dyspnea.
2. A patient with type 2 diabetes has an A1C of 9%. Which medication adjustment is
most appropriate?
A. Continue current therapy
B. Add a GLP-1 receptor agonist
C. Switch to metformin monotherapy
D. Stop all oral hypoglycemics
Answer: B – GLP-1 receptor agonists improve glycemic control and offer cardiovascular
benefits in patients with uncontrolled diabetes.
3. Which pediatric vaccine is contraindicated in an immunocompromised child?
A. Hepatitis B
B. Inactivated polio vaccine
C. MMR
D. Tdap
Answer: C – MMR is a live attenuated vaccine and may cause infection in
immunocompromised children.
4. A patient presents with fatigue, pallor, and spoon-shaped nails. What is the most likely
diagnosis?
A. Iron-deficiency anemia
B. Vitamin B12 deficiency
C. Sickle cell anemia
D. Thalassemia
Answer: A – Fatigue, pallor, and koilonychia (spoon-shaped nails) are classic signs of iron-
deficiency anemia.
5. A 55-year-old patient has persistent hypertension despite three antihypertensive
medications. Which is the next best step?
, A. Increase current doses
B. Add a fourth antihypertensive
C. Screen for secondary causes
D. Discontinue therapy
Answer: C – Resistant hypertension warrants evaluation for secondary causes such as renal
artery stenosis or endocrine disorders.
6. Which is the first-line treatment for an acute gout attack?
A. Allopurinol
B. Colchicine
C. Febuxostat
D. Probenecid
Answer: B – Colchicine is effective in reducing inflammation during an acute gout attack;
urate-lowering therapies like allopurinol are for chronic management.
7. A patient presents with sudden confusion, slurred speech, and right-sided weakness.
What is the most likely cause?
A. Hypoglycemia
B. Ischemic stroke
C. Seizure
D. Migraine
Answer: B – Sudden focal neurological deficits suggest an acute ischemic stroke, requiring
immediate evaluation.
8. Which antibiotic is contraindicated in children under 8 years old due to risk of teeth
discoloration?
A. Amoxicillin
B. Ciprofloxacin
C. Tetracycline
D. Azithromycin
Answer: C – Tetracyclines can cause permanent teeth discoloration in children.
9. Which of the following is the most common cause of community-acquired pneumonia
in adults?
A. Staphylococcus aureus
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Mycoplasma pneumoniae
Answer: B – Streptococcus pneumoniae is the leading cause of community-acquired
pneumonia in adults.
10. A patient presents with polyuria, polydipsia, and polyphagia. Which lab test is most
diagnostic?
, A. Serum potassium
B. Fasting blood glucose
C. CBC
D. Serum calcium
Answer: B – Elevated fasting blood glucose confirms diabetes mellitus in a patient with
classic symptoms.
11. A 30-year-old woman has sudden-onset right lower quadrant pain, nausea, and
vomiting. Which is the most likely diagnosis?
A. Ectopic pregnancy
B. Appendicitis
C. Ovarian cyst rupture
D. Gastroenteritis
Answer: B – Acute appendicitis often presents with RLQ pain, nausea, and vomiting; ectopic
pregnancy must also be ruled out with a pregnancy test.
12. Which medication class is first-line for treating chronic heart failure with reduced
ejection fraction?
A. Beta-blockers
B. Calcium channel blockers
C. Loop diuretics
D. Nitrates
Answer: A – Beta-blockers improve survival and reduce hospitalizations in HFrEF.
13. A patient presents with jaundice, dark urine, and pale stools. Which lab test is most
useful?
A. Serum bilirubin
B. Serum creatinine
C. CBC
D. Amylase
Answer: A – Elevated bilirubin indicates hepatobiliary dysfunction causing jaundice.
14. A 7-year-old child has a barking cough, stridor, and mild fever. What is the most
likely diagnosis?
A. Asthma exacerbation
B. Croup (laryngotracheitis)
C. Bronchiolitis
D. Epiglottitis
Answer: B – Barking cough and stridor are classic signs of croup in children.
15. A patient presents with resting tremor, rigidity, and bradykinesia. What is the most
likely diagnosis?
A. Multiple sclerosis
, B. Parkinson’s disease
C. Huntington’s disease
D. Amyotrophic lateral sclerosis
Answer: B – Parkinson’s disease is characterized by the triad of tremor, rigidity, and
bradykinesia.
16. Which lab value is most indicative of acute kidney injury?
A. Elevated serum creatinine
B. Low hemoglobin
C. Elevated ALT
D. Low potassium
Answer: A – Serum creatinine rises in acute kidney injury, reflecting impaired renal function.
17. A patient presents with sudden severe headache, nausea, and neck stiffness. Which is
the most likely diagnosis?
A. Migraine
B. Subarachnoid hemorrhage
C. Tension headache
D. Sinusitis
Answer: B – Sudden severe headache (“thunderclap headache”) with neck stiffness suggests
subarachnoid hemorrhage.
18. Which electrolyte imbalance is most likely with chronic diarrhea?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Answer: B – Chronic diarrhea causes potassium loss leading to hypokalemia.
19. A 25-year-old patient presents with fever, dysuria, and flank pain. What is the most
likely diagnosis?
A. Cystitis
B. Pyelonephritis
C. Kidney stones
D. Prostatitis
Answer: B – Fever, dysuria, and flank pain indicate upper urinary tract infection
(pyelonephritis).
20. Which class of antihypertensive is preferred in a patient with diabetes and
proteinuria?
A. Beta-blocker
B. ACE inhibitor
