APEA FNP Predictor Exam ACTUAL
EXAM 2026/2027 | FNP Predictor | Verified
Q&A | Pass Guaranteed - A+ Graded
Section 1: Assessment & Diagnostic Reasoning (25 questions)
Q1: A 65-year-old female with a history of hypertension and type 2 diabetes presents for a routine
follow-up. Her blood pressure is 142/88 mmHg. She is currently taking lisinopril 10 mg daily and
metformin 1000 mg twice daily. Her most recent HbA1c is 7.2%. What is the most appropriate next step
in managing her hypertension?
A. Add amlodipine 5 mg daily. [CORRECT]
B. Increase lisinopril to 20 mg daily
C. Add hydrochlorothiazide 25 mg daily
D. Continue current regimen and recheck in 6 months
Correct Answer: A
Rationale: For diabetic patients with blood pressure ≥140/90 mmHg, the target is <130/80 per ADA
guidelines. Adding a calcium channel blocker (amlodipine) is appropriate as second-line therapy. ACE
inhibitors like lisinopril are first-line for diabetics due to renal protection; adding rather than maximizing
may better achieve dual targets.
Q2: A 4-year-old child is brought in with fever, sore throat, and refusal to eat. Physical examination
reveals a "hot potato" voice, drooling, and trismus. The child appears toxic. What is the priority action?
A. Rapid strep test
B. Throat culture
C. Immediate airway evaluation and ENT consultation. [CORRECT]
D. Start oral antibiotics
Correct Answer: C
Rationale: The presentation suggests peritonsillar abscess or epiglottitis with potential airway
compromise. Drooling, tripod positioning, and toxic appearance indicate imminent airway obstruction
requiring immediate specialist evaluation, possible imaging, and controlled airway management, not
outpatient testing.
,Q3: A 28-year-old female presents with acute onset of unilateral facial droop, inability to close the eye,
and loss of forehead wrinkling. Taste sensation is intact. What is the most likely diagnosis?
A. Central stroke
B. Bell palsy (peripheral facial nerve palsy). [CORRECT]
C. Ramsay Hunt syndrome
D. Trigeminal neuralgia
Correct Answer: B
Rationale: Bell palsy presents with acute unilateral lower motor neuron facial paralysis affecting both
upper and lower face (forehead involvement distinguishes peripheral from central causes). Intact taste
and absence of vesicles differentiates from Ramsay Hunt (herpes zoster oticus with taste loss and ear
vesicles).
Q4: A 55-year-old male presents with crushing substernal chest pain radiating to the left arm,
diaphoresis, and nausea. EKG shows ST elevation in leads II, III, and aVF. Which coronary artery is likely
occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery. [CORRECT]
D. Left main coronary artery
Correct Answer: C
Rationale: ST elevation in leads II, III, and aVF indicates inferior wall myocardial infarction, typically
supplied by the right coronary artery (RCA) in 80% of patients (left-dominant circulation in remainder).
This requires immediate reperfusion therapy and right ventricular infarct assessment.
Q5: A 35-year-old female presents with fatigue, weight gain, constipation, and menorrhagia. TSH is 8.5
mIU/L (normal 0.4-4.0), free T4 is 1.0 ng/dL (normal 0.8-1.8). What is the diagnosis?
A. Primary hypothyroidism. [CORRECT]
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Euthyroid sick syndrome
Correct Answer: A
Rationale: Elevated TSH with normal free T4 indicates subclinical (compensated) primary
hypothyroidism—most commonly Hashimoto thyroiditis. The thyroid gland fails to produce sufficient
,hormone, triggering pituitary TSH elevation. Symptoms and TSH >10 or positive antibodies warrant
levothyroxine initiation.
Q6: A 42-year-old male presents with progressive dyspnea on exertion, orthopnea, and bilateral lower
extremity edema. Jugular venous pressure is elevated, and an S3 gallop is heard. Echocardiogram shows
EF 35%. What is the appropriate first-line medication combination?
A. ACE inhibitor, beta-blocker, and loop diuretic. [CORRECT]
B. Calcium channel blocker and thiazide diuretic
C. Alpha-blocker and ACE inhibitor
D. Nitrates and digoxin only
Correct Answer: A
Rationale: Heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medical
therapy: ACE inhibitors (or ARNI), evidence-based beta-blockers (carvedilol, metoprolol succinate,
bisoprolol), and loop diuretics for volume overload. This combination reduces mortality and
hospitalizations.
Q7: A 16-year-old athlete collapses during basketball practice. Witnesses report no trauma. The patient
is unresponsive, pulseless, and not breathing. What is the immediate priority?
A. Establish IV access and give epinephrine
B. Begin high-quality CPR and activate emergency response. [CORRECT]
C. Check blood glucose
D. Perform 12-lead EKG
Correct Answer: B
Rationale: Sudden cardiac arrest in young athletes requires immediate CPR and defibrillation (AED).
High-quality chest compressions (100-120/min, 2 inches depth) and early defibrillation for shockable
rhythms are survival-critical. Delay for procedures or diagnostics reduces survival probability
dramatically.
Q8: A 50-year-old female presents with joint pain in hands and feet, morning stiffness lasting 2 hours,
and swan-neck deformities. Rheumatoid factor is positive. X-rays show marginal erosions. What is the
appropriate initial DMARD?
A. Hydroxychloroquine
B. Methotrexate. [CORRECT]
, C. Sulfasalazine
D. NSAIDs only
Correct Answer: B
Rationale: Methotrexate is first-line DMARD for rheumatoid arthritis, either as monotherapy or anchor
for combination therapy. Early aggressive treatment prevents irreversible joint damage. Monotherapy
with NSAIDs or less effective DMARDs delays appropriate treatment and worsens long-term outcomes.
Q9: A 6-month-old infant presents with poor weight gain, chronic diarrhea, and a pruritic vesicular rash
on the extensor surfaces. The rash worsens with wheat introduction. What is the most likely diagnosis?
A. Atopic dermatitis
B. Celiac disease
C. Dermatitis herpetiformis with celiac disease. [CORRECT]
D. Psoriasis
Correct Answer: C
Rationale: Celiac disease in infants presents with failure to thrive, chronic diarrhea, and malabsorption.
Dermatitis herpetiformis (pruritic papulovesicular rash on extensor surfaces) is the cutaneous
manifestation of gluten sensitivity, with IgA deposition at dermal papillae tips.
Q10: A 38-year-old female presents with episodic vertigo lasting hours, associated with tinnitus and
aural fullness. She reports hearing fluctuation during attacks. What is the diagnosis?
A. Benign paroxysmal positional vertigo
B. Ménière disease. [CORRECT]
C. Vestibular neuritis
D. Acoustic neuroma
Correct Answer: B
Rationale: Ménière disease is characterized by episodic vertigo (20 min-12 hours), fluctuating
sensorineural hearing loss, tinnitus, and aural fullness. The symptom tetrad distinguishes it from BPPV
(brief positional vertigo), vestibular neuritis (sustained vertigo without hearing loss), and acoustic
neuroma (gradual unilateral hearing loss).
Q11: A 45-year-old male presents with acute onset of severe headache, "worst of life," with nuchal
rigidity. CT shows blood in the basal cisterns. What is the most likely etiology?
A. Hypertensive hemorrhage
B. Ruptured saccular aneurysm. [CORRECT]
EXAM 2026/2027 | FNP Predictor | Verified
Q&A | Pass Guaranteed - A+ Graded
Section 1: Assessment & Diagnostic Reasoning (25 questions)
Q1: A 65-year-old female with a history of hypertension and type 2 diabetes presents for a routine
follow-up. Her blood pressure is 142/88 mmHg. She is currently taking lisinopril 10 mg daily and
metformin 1000 mg twice daily. Her most recent HbA1c is 7.2%. What is the most appropriate next step
in managing her hypertension?
A. Add amlodipine 5 mg daily. [CORRECT]
B. Increase lisinopril to 20 mg daily
C. Add hydrochlorothiazide 25 mg daily
D. Continue current regimen and recheck in 6 months
Correct Answer: A
Rationale: For diabetic patients with blood pressure ≥140/90 mmHg, the target is <130/80 per ADA
guidelines. Adding a calcium channel blocker (amlodipine) is appropriate as second-line therapy. ACE
inhibitors like lisinopril are first-line for diabetics due to renal protection; adding rather than maximizing
may better achieve dual targets.
Q2: A 4-year-old child is brought in with fever, sore throat, and refusal to eat. Physical examination
reveals a "hot potato" voice, drooling, and trismus. The child appears toxic. What is the priority action?
A. Rapid strep test
B. Throat culture
C. Immediate airway evaluation and ENT consultation. [CORRECT]
D. Start oral antibiotics
Correct Answer: C
Rationale: The presentation suggests peritonsillar abscess or epiglottitis with potential airway
compromise. Drooling, tripod positioning, and toxic appearance indicate imminent airway obstruction
requiring immediate specialist evaluation, possible imaging, and controlled airway management, not
outpatient testing.
,Q3: A 28-year-old female presents with acute onset of unilateral facial droop, inability to close the eye,
and loss of forehead wrinkling. Taste sensation is intact. What is the most likely diagnosis?
A. Central stroke
B. Bell palsy (peripheral facial nerve palsy). [CORRECT]
C. Ramsay Hunt syndrome
D. Trigeminal neuralgia
Correct Answer: B
Rationale: Bell palsy presents with acute unilateral lower motor neuron facial paralysis affecting both
upper and lower face (forehead involvement distinguishes peripheral from central causes). Intact taste
and absence of vesicles differentiates from Ramsay Hunt (herpes zoster oticus with taste loss and ear
vesicles).
Q4: A 55-year-old male presents with crushing substernal chest pain radiating to the left arm,
diaphoresis, and nausea. EKG shows ST elevation in leads II, III, and aVF. Which coronary artery is likely
occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery. [CORRECT]
D. Left main coronary artery
Correct Answer: C
Rationale: ST elevation in leads II, III, and aVF indicates inferior wall myocardial infarction, typically
supplied by the right coronary artery (RCA) in 80% of patients (left-dominant circulation in remainder).
This requires immediate reperfusion therapy and right ventricular infarct assessment.
Q5: A 35-year-old female presents with fatigue, weight gain, constipation, and menorrhagia. TSH is 8.5
mIU/L (normal 0.4-4.0), free T4 is 1.0 ng/dL (normal 0.8-1.8). What is the diagnosis?
A. Primary hypothyroidism. [CORRECT]
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Euthyroid sick syndrome
Correct Answer: A
Rationale: Elevated TSH with normal free T4 indicates subclinical (compensated) primary
hypothyroidism—most commonly Hashimoto thyroiditis. The thyroid gland fails to produce sufficient
,hormone, triggering pituitary TSH elevation. Symptoms and TSH >10 or positive antibodies warrant
levothyroxine initiation.
Q6: A 42-year-old male presents with progressive dyspnea on exertion, orthopnea, and bilateral lower
extremity edema. Jugular venous pressure is elevated, and an S3 gallop is heard. Echocardiogram shows
EF 35%. What is the appropriate first-line medication combination?
A. ACE inhibitor, beta-blocker, and loop diuretic. [CORRECT]
B. Calcium channel blocker and thiazide diuretic
C. Alpha-blocker and ACE inhibitor
D. Nitrates and digoxin only
Correct Answer: A
Rationale: Heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medical
therapy: ACE inhibitors (or ARNI), evidence-based beta-blockers (carvedilol, metoprolol succinate,
bisoprolol), and loop diuretics for volume overload. This combination reduces mortality and
hospitalizations.
Q7: A 16-year-old athlete collapses during basketball practice. Witnesses report no trauma. The patient
is unresponsive, pulseless, and not breathing. What is the immediate priority?
A. Establish IV access and give epinephrine
B. Begin high-quality CPR and activate emergency response. [CORRECT]
C. Check blood glucose
D. Perform 12-lead EKG
Correct Answer: B
Rationale: Sudden cardiac arrest in young athletes requires immediate CPR and defibrillation (AED).
High-quality chest compressions (100-120/min, 2 inches depth) and early defibrillation for shockable
rhythms are survival-critical. Delay for procedures or diagnostics reduces survival probability
dramatically.
Q8: A 50-year-old female presents with joint pain in hands and feet, morning stiffness lasting 2 hours,
and swan-neck deformities. Rheumatoid factor is positive. X-rays show marginal erosions. What is the
appropriate initial DMARD?
A. Hydroxychloroquine
B. Methotrexate. [CORRECT]
, C. Sulfasalazine
D. NSAIDs only
Correct Answer: B
Rationale: Methotrexate is first-line DMARD for rheumatoid arthritis, either as monotherapy or anchor
for combination therapy. Early aggressive treatment prevents irreversible joint damage. Monotherapy
with NSAIDs or less effective DMARDs delays appropriate treatment and worsens long-term outcomes.
Q9: A 6-month-old infant presents with poor weight gain, chronic diarrhea, and a pruritic vesicular rash
on the extensor surfaces. The rash worsens with wheat introduction. What is the most likely diagnosis?
A. Atopic dermatitis
B. Celiac disease
C. Dermatitis herpetiformis with celiac disease. [CORRECT]
D. Psoriasis
Correct Answer: C
Rationale: Celiac disease in infants presents with failure to thrive, chronic diarrhea, and malabsorption.
Dermatitis herpetiformis (pruritic papulovesicular rash on extensor surfaces) is the cutaneous
manifestation of gluten sensitivity, with IgA deposition at dermal papillae tips.
Q10: A 38-year-old female presents with episodic vertigo lasting hours, associated with tinnitus and
aural fullness. She reports hearing fluctuation during attacks. What is the diagnosis?
A. Benign paroxysmal positional vertigo
B. Ménière disease. [CORRECT]
C. Vestibular neuritis
D. Acoustic neuroma
Correct Answer: B
Rationale: Ménière disease is characterized by episodic vertigo (20 min-12 hours), fluctuating
sensorineural hearing loss, tinnitus, and aural fullness. The symptom tetrad distinguishes it from BPPV
(brief positional vertigo), vestibular neuritis (sustained vertigo without hearing loss), and acoustic
neuroma (gradual unilateral hearing loss).
Q11: A 45-year-old male presents with acute onset of severe headache, "worst of life," with nuchal
rigidity. CT shows blood in the basal cisterns. What is the most likely etiology?
A. Hypertensive hemorrhage
B. Ruptured saccular aneurysm. [CORRECT]
