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APEA PREDICTOR EXAM PRE-PREDICTOR 2026/2027
| Newest Version | Questions, Correct Answers &
Rationale | Highest Score | NP Certification Prep |
Pass Guaranteed - A+ Graded
Section 1: Advanced Health Assessment & Diagnostic Reasoning (Questions 1-40)
Q1. A 68-year-old male presents with exertional chest pressure. On cardiac
auscultation, you hear a harsh crescendo-decrescendo systolic murmur at the right
upper sternal border that radiates to the carotid arteries. What is the most likely
diagnosis?
A. Mitral regurgitation B. Aortic stenosis C. Mitral stenosis D. Aortic regurgitation
Correct Answer: B. Aortic stenosis [CORRECT] Rationale: A harsh crescendo-
decrescendo systolic murmur at the RUSB radiating to the carotids is classic for aortic
stenosis. MR radiates to the axilla, MS is a diastolic rumble at the apex, and AR is a
diastolic decrescendo murmur at the LUSB.
Q2. During cardiac examination of a 45-year-old female, you hear a mid-systolic click
followed by a late systolic murmur at the apex. The murmur intensifies with standing
and Valsalva. What is the diagnosis?
A. Aortic stenosis B. Mitral valve prolapse C. Tricuspid regurgitation D. Hypertrophic
cardiomyopathy
Correct Answer: B. Mitral valve prolapse [CORRECT] Rationale: Mid-systolic click
with late systolic murmur at the apex is pathognomonic for MVP. Standing/Valsalva
(decreased preload) intensifies the murmur. HCM also intensifies with standing but
produces a harsh systolic murmur without a click.
,2
Q3. A 72-year-old with heart failure has a displaced PMI to the left of the
midclavicular line at the 6th intercostal space. What does this finding indicate?
A. Left ventricular hypertrophy B. Right ventricular hypertrophy C. Left atrial
enlargement D. Pericardial effusion
Correct Answer: A. Left ventricular hypertrophy [CORRECT] Rationale: A
displaced, sustained PMI laterally and inferiorly indicates left ventricular
enlargement/hypertrophy. RVH causes a heave at the left lower sternal border.
Pericardial effusion causes muffled heart sounds and distant PMI.
Q4. You observe JVP elevation with a prominent Y descent in a patient with
constrictive pericarditis. Which additional finding supports this diagnosis?
A. Pulsus paradoxus >20 mmHg B. Kussmaul sign (JVP rises with inspiration) C.
Cannon A waves D. Absent Y descent
Correct Answer: B. Kussmaul sign (JVP rises with inspiration) [CORRECT]
Rationale: Kussmaul sign (paradoxical JVP rise with inspiration) is characteristic of
constrictive pericarditis and restrictive cardiomyopathy due to impaired RV filling.
Pulsus paradoxus >20 mmHg is seen in cardiac tamponade.
Q5. A patient with acute decompensated heart failure has an S3 gallop. What is the
pathophysiology of this finding?
A. Atrial contraction against a noncompliant ventricle B. Sudden deceleration of
blood filling a volume-overloaded ventricle C. Pericardial inflammation D. Papillary
muscle dysfunction
Correct Answer: B. Sudden deceleration of blood filling a volume-overloaded
ventricle [CORRECT] Rationale: S3 occurs in early diastole due to abrupt cessation
of rapid ventricular filling in a dilated, volume-overloaded ventricle (HF). S4 is caused
by atrial contraction against a stiff, noncompliant ventricle (hypertrophy).
,3
Q6. You auscultate a scratchy, triphasic sound best heard with the patient leaning
forward and holding breath in expiration. What is this finding?
A. Pleural friction rub B. Pericardial friction rub C. S4 gallop D. Opening snap
Correct Answer: B. Pericardial friction rub [CORRECT] Rationale: Pericardial
friction rub is scratchy, triphasic (atrial systole, ventricular systole, ventricular
diastole), and best heard at the LLSB with the patient leaning forward and holding
expiration. Pleural rub is heard over the chest wall and varies with respiration.
Q7. You detect a carotid bruit in a 75-year-old with coronary artery disease. What is
the next appropriate action?
A. Palpate the carotid artery firmly to assess thrill B. Auscultate with the bell and
avoid palpation C. Order immediate carotid endarterectomy D. Perform carotid
massage
Correct Answer: B. Auscultate with the bell and avoid palpation [CORRECT]
Rationale: Carotid bruits suggest stenosis and should be auscultated with the bell.
Palpation should be avoided due to risk of dislodging emboli. Duplex ultrasound is
the diagnostic next step, not immediate surgery.
Q8. A patient with COPD presents with acute shortness of breath. On lung
auscultation, you hear diffuse polyphonic wheezes that are more prominent at end-
expiration. What does this indicate?
A. Fixed upper airway obstruction B. Asthma exacerbation with dynamic airway
collapse C. Bronchial tumor obstruction D. Pulmonary edema
Correct Answer: B. Asthma exacerbation with dynamic airway collapse
[CORRECT] Rationale: Polyphonic wheezes at end-expiration indicate dynamic
airway collapse from bronchospasm (asthma/COPD). Monophonic wheezes suggest
focal obstruction (tumor/foreign body). Stridor indicates upper airway obstruction.
, 4
Q9. You percuss a patient's chest and note hyperresonance over the left lung field
with absent tactile fremitus and deviated trachea to the right. What is the diagnosis?
A. Left-sided pleural effusion B. Left-sided pneumothorax C. Left lower lobe
consolidation D. Left lung atelectasis
Correct Answer: B. Left-sided pneumothorax [CORRECT] Rationale:
Hyperresonance, absent fremitus, and contralateral tracheal deviation are classic for
tension pneumothorax. Pleural effusion causes dullness and decreased fremitus with
ipsilateral tracheal deviation. Consolidation increases fremitus.
Q10. A patient with pneumonia has increased tactile fremitus, dull percussion, and
egophony over the right lower lobe. What explains the egophony?
A. Air trapping in emphysematous blebs B. Consolidated lung transmits sound with
vowel distortion C. Fluid in the pleural space D. Bronchial obstruction with air distal
to the lesion
Correct Answer: B. Consolidated lung transmits sound with vowel distortion
[CORRECT] Rationale: Egophony ("E-to-A" change) occurs when consolidated lung
tissue transmits sound, distorting spoken "E" into "A." Whispered pectoriloquy also
indicates consolidation. These findings are absent in effusion or pneumothorax.
Q11. A 35-year-old female presents with RUQ pain after eating fatty foods. During
palpation of the RUQ, the patient abruptly stops inspiration due to pain. What is this
sign called?
A. McBurney sign B. Murphy sign C. Rovsing sign D. Obturator sign
Correct Answer: B. Murphy sign [CORRECT] Rationale: Murphy sign is inspiratory
arrest during RUQ palpation, indicating cholecystitis. McBurney point tenderness
indicates appendicitis. Rovsing sign is referred RLQ pain with LLQ palpation
(appendicitis).
APEA PREDICTOR EXAM PRE-PREDICTOR 2026/2027
| Newest Version | Questions, Correct Answers &
Rationale | Highest Score | NP Certification Prep |
Pass Guaranteed - A+ Graded
Section 1: Advanced Health Assessment & Diagnostic Reasoning (Questions 1-40)
Q1. A 68-year-old male presents with exertional chest pressure. On cardiac
auscultation, you hear a harsh crescendo-decrescendo systolic murmur at the right
upper sternal border that radiates to the carotid arteries. What is the most likely
diagnosis?
A. Mitral regurgitation B. Aortic stenosis C. Mitral stenosis D. Aortic regurgitation
Correct Answer: B. Aortic stenosis [CORRECT] Rationale: A harsh crescendo-
decrescendo systolic murmur at the RUSB radiating to the carotids is classic for aortic
stenosis. MR radiates to the axilla, MS is a diastolic rumble at the apex, and AR is a
diastolic decrescendo murmur at the LUSB.
Q2. During cardiac examination of a 45-year-old female, you hear a mid-systolic click
followed by a late systolic murmur at the apex. The murmur intensifies with standing
and Valsalva. What is the diagnosis?
A. Aortic stenosis B. Mitral valve prolapse C. Tricuspid regurgitation D. Hypertrophic
cardiomyopathy
Correct Answer: B. Mitral valve prolapse [CORRECT] Rationale: Mid-systolic click
with late systolic murmur at the apex is pathognomonic for MVP. Standing/Valsalva
(decreased preload) intensifies the murmur. HCM also intensifies with standing but
produces a harsh systolic murmur without a click.
,2
Q3. A 72-year-old with heart failure has a displaced PMI to the left of the
midclavicular line at the 6th intercostal space. What does this finding indicate?
A. Left ventricular hypertrophy B. Right ventricular hypertrophy C. Left atrial
enlargement D. Pericardial effusion
Correct Answer: A. Left ventricular hypertrophy [CORRECT] Rationale: A
displaced, sustained PMI laterally and inferiorly indicates left ventricular
enlargement/hypertrophy. RVH causes a heave at the left lower sternal border.
Pericardial effusion causes muffled heart sounds and distant PMI.
Q4. You observe JVP elevation with a prominent Y descent in a patient with
constrictive pericarditis. Which additional finding supports this diagnosis?
A. Pulsus paradoxus >20 mmHg B. Kussmaul sign (JVP rises with inspiration) C.
Cannon A waves D. Absent Y descent
Correct Answer: B. Kussmaul sign (JVP rises with inspiration) [CORRECT]
Rationale: Kussmaul sign (paradoxical JVP rise with inspiration) is characteristic of
constrictive pericarditis and restrictive cardiomyopathy due to impaired RV filling.
Pulsus paradoxus >20 mmHg is seen in cardiac tamponade.
Q5. A patient with acute decompensated heart failure has an S3 gallop. What is the
pathophysiology of this finding?
A. Atrial contraction against a noncompliant ventricle B. Sudden deceleration of
blood filling a volume-overloaded ventricle C. Pericardial inflammation D. Papillary
muscle dysfunction
Correct Answer: B. Sudden deceleration of blood filling a volume-overloaded
ventricle [CORRECT] Rationale: S3 occurs in early diastole due to abrupt cessation
of rapid ventricular filling in a dilated, volume-overloaded ventricle (HF). S4 is caused
by atrial contraction against a stiff, noncompliant ventricle (hypertrophy).
,3
Q6. You auscultate a scratchy, triphasic sound best heard with the patient leaning
forward and holding breath in expiration. What is this finding?
A. Pleural friction rub B. Pericardial friction rub C. S4 gallop D. Opening snap
Correct Answer: B. Pericardial friction rub [CORRECT] Rationale: Pericardial
friction rub is scratchy, triphasic (atrial systole, ventricular systole, ventricular
diastole), and best heard at the LLSB with the patient leaning forward and holding
expiration. Pleural rub is heard over the chest wall and varies with respiration.
Q7. You detect a carotid bruit in a 75-year-old with coronary artery disease. What is
the next appropriate action?
A. Palpate the carotid artery firmly to assess thrill B. Auscultate with the bell and
avoid palpation C. Order immediate carotid endarterectomy D. Perform carotid
massage
Correct Answer: B. Auscultate with the bell and avoid palpation [CORRECT]
Rationale: Carotid bruits suggest stenosis and should be auscultated with the bell.
Palpation should be avoided due to risk of dislodging emboli. Duplex ultrasound is
the diagnostic next step, not immediate surgery.
Q8. A patient with COPD presents with acute shortness of breath. On lung
auscultation, you hear diffuse polyphonic wheezes that are more prominent at end-
expiration. What does this indicate?
A. Fixed upper airway obstruction B. Asthma exacerbation with dynamic airway
collapse C. Bronchial tumor obstruction D. Pulmonary edema
Correct Answer: B. Asthma exacerbation with dynamic airway collapse
[CORRECT] Rationale: Polyphonic wheezes at end-expiration indicate dynamic
airway collapse from bronchospasm (asthma/COPD). Monophonic wheezes suggest
focal obstruction (tumor/foreign body). Stridor indicates upper airway obstruction.
, 4
Q9. You percuss a patient's chest and note hyperresonance over the left lung field
with absent tactile fremitus and deviated trachea to the right. What is the diagnosis?
A. Left-sided pleural effusion B. Left-sided pneumothorax C. Left lower lobe
consolidation D. Left lung atelectasis
Correct Answer: B. Left-sided pneumothorax [CORRECT] Rationale:
Hyperresonance, absent fremitus, and contralateral tracheal deviation are classic for
tension pneumothorax. Pleural effusion causes dullness and decreased fremitus with
ipsilateral tracheal deviation. Consolidation increases fremitus.
Q10. A patient with pneumonia has increased tactile fremitus, dull percussion, and
egophony over the right lower lobe. What explains the egophony?
A. Air trapping in emphysematous blebs B. Consolidated lung transmits sound with
vowel distortion C. Fluid in the pleural space D. Bronchial obstruction with air distal
to the lesion
Correct Answer: B. Consolidated lung transmits sound with vowel distortion
[CORRECT] Rationale: Egophony ("E-to-A" change) occurs when consolidated lung
tissue transmits sound, distorting spoken "E" into "A." Whispered pectoriloquy also
indicates consolidation. These findings are absent in effusion or pneumothorax.
Q11. A 35-year-old female presents with RUQ pain after eating fatty foods. During
palpation of the RUQ, the patient abruptly stops inspiration due to pain. What is this
sign called?
A. McBurney sign B. Murphy sign C. Rovsing sign D. Obturator sign
Correct Answer: B. Murphy sign [CORRECT] Rationale: Murphy sign is inspiratory
arrest during RUQ palpation, indicating cholecystitis. McBurney point tenderness
indicates appendicitis. Rovsing sign is referred RLQ pain with LLQ palpation
(appendicitis).
