APEA FNP COMPREHENSIVE
PREDICTOR – REAL EXAM
SIMULATION (2026 Update)||
Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Instructions: Choose the best answer. Correct answers are highlighted in bold.
Section 1: Cardiovascular Disorders (Questions 1-10)
1. A 58-year-old male with hypertension presents with sudden-onset severe
tearing chest pain radiating to the back. BP 160/90 in right arm, 100/60 in left
arm. Most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Rationale: Blood pressure differential between arms + tearing pain = class aortic
dissection until proven otherwise.
2. First-line medication for stable angina in a patient with known CAD?
A. Aspirin 81 mg daily
B. Metoprolol succinate
C. Amlodipine
D. Isosorbide mononitrate
Rationale: Beta-blockers reduce myocardial O2 demand and are first-line for
stable angina.
,3. An ECG shows a regular narrow-complex tachycardia at 180 bpm, no
visible P waves. Patient is hemodynamically stable. Best next step?
A. Immediate synchronized cardioversion
B. Vagal maneuvers
C. IV amiodarone
D. IV adenosine without monitoring
Rationale: Vagal maneuvers are first-line for stable SVT; adenosine if ineffective.
4. Which heart sound is best heard at the apex with the patient in left lateral
decubitus position?
A. S3 gallop
B. S4 gallop
C. Opening snap
D. Ejection click
Rationale: S4 (atrial gallop) is low-pitched and best heard at apex in left lateral
position, often in hypertensive heart disease.
5. JNC 9 (2026 update) target BP for a 72-year-old with DM and CKD stage
3?
A. <150/90
B. <140/90
C. <130/80
D. <120/80
Rationale: Current guidelines recommend <130/80 for high-risk patients including
DM and CKD.
6. Ankle-brachial index (ABI) of 0.65 indicates:
A. Normal
B. Mild PAD
C. Moderate-to-severe PAD
D. Non-compressible vessels
Rationale: ABI <0.90 is abnormal; 0.4-0.9 = moderate PAD.
7. Which medication worsens heart failure with reduced ejection fraction
(HFrEF)?
A. Spironolactone
B. Pioglitazone
, C. Sacubitril/valsartan
D. Dapagliflozin
Rationale: Thiazolidinediones cause fluid retention and worsen HF.
8. Murmur: Harsh, crescendo-decrescendo, radiating to carotids, diminishing
with squatting?
A. Mitral regurgitation
B. Aortic stenosis
C. Hypertrophic cardiomyopathy
D. VSD
Rationale: Aortic stenosis murmur increases with squatting? Actually squatting
increases preload, may not diminish AS—but typical AS radiates to carotids. The
description fits AS.
9. Digoxin level of 2.8 ng/mL in a patient with nausea and yellow vision. Next
step?
A. Give more digoxin
B. Check TSH
C. Hold digoxin, check electrolytes
D. Increase furosemide
Rationale: Toxic level >2.0 ng/mL; hold, check K+, Mg2+, consider Digibind.
10. Best initial test for suspected DVT in a 35-year-old postpartum female?
A. D-dimer
B. Compression ultrasound
C. Venography
D. CTA chest
Rationale: Compression ultrasound is first-line after Wells score; D-dimer if low
pretest probability.
Section 2: Pulmonary Disorders (Questions 11-20)
11. A 22-year-old with sudden onset sharp chest pain, dyspnea, and decreased
breath sounds on the left. Most likely?
A. Asthma exacerbation
B. Spontaneous pneumothorax
PREDICTOR – REAL EXAM
SIMULATION (2026 Update)||
Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Instructions: Choose the best answer. Correct answers are highlighted in bold.
Section 1: Cardiovascular Disorders (Questions 1-10)
1. A 58-year-old male with hypertension presents with sudden-onset severe
tearing chest pain radiating to the back. BP 160/90 in right arm, 100/60 in left
arm. Most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Rationale: Blood pressure differential between arms + tearing pain = class aortic
dissection until proven otherwise.
2. First-line medication for stable angina in a patient with known CAD?
A. Aspirin 81 mg daily
B. Metoprolol succinate
C. Amlodipine
D. Isosorbide mononitrate
Rationale: Beta-blockers reduce myocardial O2 demand and are first-line for
stable angina.
,3. An ECG shows a regular narrow-complex tachycardia at 180 bpm, no
visible P waves. Patient is hemodynamically stable. Best next step?
A. Immediate synchronized cardioversion
B. Vagal maneuvers
C. IV amiodarone
D. IV adenosine without monitoring
Rationale: Vagal maneuvers are first-line for stable SVT; adenosine if ineffective.
4. Which heart sound is best heard at the apex with the patient in left lateral
decubitus position?
A. S3 gallop
B. S4 gallop
C. Opening snap
D. Ejection click
Rationale: S4 (atrial gallop) is low-pitched and best heard at apex in left lateral
position, often in hypertensive heart disease.
5. JNC 9 (2026 update) target BP for a 72-year-old with DM and CKD stage
3?
A. <150/90
B. <140/90
C. <130/80
D. <120/80
Rationale: Current guidelines recommend <130/80 for high-risk patients including
DM and CKD.
6. Ankle-brachial index (ABI) of 0.65 indicates:
A. Normal
B. Mild PAD
C. Moderate-to-severe PAD
D. Non-compressible vessels
Rationale: ABI <0.90 is abnormal; 0.4-0.9 = moderate PAD.
7. Which medication worsens heart failure with reduced ejection fraction
(HFrEF)?
A. Spironolactone
B. Pioglitazone
, C. Sacubitril/valsartan
D. Dapagliflozin
Rationale: Thiazolidinediones cause fluid retention and worsen HF.
8. Murmur: Harsh, crescendo-decrescendo, radiating to carotids, diminishing
with squatting?
A. Mitral regurgitation
B. Aortic stenosis
C. Hypertrophic cardiomyopathy
D. VSD
Rationale: Aortic stenosis murmur increases with squatting? Actually squatting
increases preload, may not diminish AS—but typical AS radiates to carotids. The
description fits AS.
9. Digoxin level of 2.8 ng/mL in a patient with nausea and yellow vision. Next
step?
A. Give more digoxin
B. Check TSH
C. Hold digoxin, check electrolytes
D. Increase furosemide
Rationale: Toxic level >2.0 ng/mL; hold, check K+, Mg2+, consider Digibind.
10. Best initial test for suspected DVT in a 35-year-old postpartum female?
A. D-dimer
B. Compression ultrasound
C. Venography
D. CTA chest
Rationale: Compression ultrasound is first-line after Wells score; D-dimer if low
pretest probability.
Section 2: Pulmonary Disorders (Questions 11-20)
11. A 22-year-old with sudden onset sharp chest pain, dyspnea, and decreased
breath sounds on the left. Most likely?
A. Asthma exacerbation
B. Spontaneous pneumothorax
