APEA Predictor Exam – Questions, Correct
Answers, and Rationale
Pre-Predictor 2026 LATEST VERSION
1) A 15-year-old high school student presents with a mild sore throat and low-
grade fever that has persisted for about 3 weeks. She reports general malaise,
fatigue, and loss of appetite. The NP suspects mononucleosis. Which of the
following is the LEAST appropriate intervention?
a. Palpate the lymph nodes and spleen.
b. Examine the posterior oropharynx for petechiae.
c. Obtain a CBC, throat culture, and heterophile antibody test.
d. Obtain an urinalysis and serum for LPAs and amylase.
Explanation: Mononucleosis is a symptomatic infection caused by the Epstein-Barr
virus (EBV). It is common in people aged 15–24 years. Common signs and
symptoms include incubation periods of 1-2 months, fatigue, chills, malaise,
anorexia, while non-typical findings include lymphadenopathy or posterior cervical
region. Splenomegaly can be present. A maculopapular rash occurs in less than
15% of patients. A diagnosis is usually made using the Monospot. In addition,
neutropenia and lymphocytosis are usually detected in the CBC. Obtaining lipases
and amylase (LPAs) is not indicated as this is not consistent with pancreatitis;
therefore, option D is the least relevant.
2) A 32-year-old male patient complains of urinary frequency and burning on
urination for 3 days. Urinalysis reveals bacteriuria and positive nitrites. A
diagnosis for urinary tract infections. The initial treatment should be:
a. Trimethoprim-sulfamethoxazole (Bactrim, Sulafurim) For 7-10 day
b. Ciprofloxacin (Cipro) for 3-5 days.
c. Trimethoprim-Sulfamethoxazole for 3 days.
d. 750 mg ciprofloxacin as a one-time dose.
,Explanation: Trimethoprim-sulfamethoxazole (TMP/SMZ) is usually the
appropriate medication for treating urinary tract infections (UTIs) in most
patients. In case of community resistance to TMP/SMZ >20%, another medication
should be substituted. In men, the appropriate length of time is 7–10 days.
Women may be treated for 3 days for uncomplicated UTI. Note: Options involving
shorter courses (3 days) or one-time doses are generally reserved for acute cystitis
in women, not men.
3) Which agent is most effective for the treatment of nodulocystic acne?
a. Benzoyl peroxide (Benzac)
b. Retinoic acid (Retin-A)
c. Topical tetracycline
d. Isotretinoin (Accutane)
Explanation: Isotretinoin (Accutane) is a systemic agent indicated for the
treatment of severe inflammatory acne. Guidelines for its use must be clearly
understood by the patient. A woman of childbearing age must use an effective
method of contraception because isotretinoin is teratogenic. There are many
restrictions in prescribing this medication because of the teratogenic effects given
during pregnancy. Therefore, it is a pregnancy category X drug. While topicals
help, Isotretinoin is the gold standard for nodulocystic (severe) acne.
4) An 18 y/o woman is taking a combined hormonal oral contraceptive. She
should be instructed to use a backup method for the prevention of pregnancy:
a. Throughout the week of placebo pills.
b. If prescribed Topiramate (Topamax) for the treatment of migraines.
c. If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection.
d. If she forgets to take a single dose of the contraceptive.
Explanation: Antiepileptics including phenytoin (Dilantin), carbamazepine
(Tegretol), primidone (Mysoline), topiramate (Topamax), and oxcarbazepine
(Trileptal) reduce the effectiveness of contraceptives. Depo-medroxyprogesterone
,acetate injections or levonorgestrel-releasing intrauterine devices will be a better
method of contraception for patients taking anticonvulsants. Most commonly used
antibiotics have not been proven to reduce the effectiveness of contraceptives.
Rifampin is an exception and additional... [be used by women taking this drug and
using oral contraceptives, transdermal, or vaginal ring preparations]. Additional
backup contraception should be used if taking antifungal agents. No additional
protection is needed throughout the week of placebo pills. Missing one single dose
of contraceptive does not require additional protection; missing more than two
does.
5) A 44-year-old female patient has diabetes. Her total cholesterol (TC) is 250
mg/dL (6.5 mmol/L), LDL = 190 mg/dL (4.94 mmol/L), HDL = 25 mg/dL (0.65
mmol/L), and triglycerides = 344 mg/dL (3.94 mmol/L). What agent will have the
greatest effect on improving her lipid profile and reducing morbidity and
mortality associated with dyslipidemia?
a. Niacin (Niaspan)
b. Atorvastatin
c. Omega-3 fatty acids
d. Fenofibrate
Explanation: First and foremost, it is essential to educate individuals on a heart-
healthy lifestyle. LDL-C is one of the major subunits in the development of
atherosclerotic heart disease. The target level of LDL-C is between 50 to 70mg/dL
to prevent plaque formation in the blood vessels. Guidelines strongly recommend
statins therapy because they primarily lower LDL-C levels, but they also have
secondary effects of lowering triglyceride and increasing HDL-C levels. Statins are
the only drugs proven to reduce cardiovascular mortality in this context.
6) A 30-year-old female comes into a clinic with classic signs and symptoms of
appendicitis. The NP fails to refer the patient to a surgeon. The appendix
ruptures and the woman dies. This is an example of:
, a. Failure of diligence
b. Professional liability
c. Negligence
d. Malpractice
Explanation: Malpractice, a negligence tort, occurs when a health care
professional’s actions fall below the appropriate standard of care and hurts the
patient. In this case, the patient came with signs and symptoms indicating
appendicitis, and the NP failed to refer the patient, resulting in death.
7) A nurse practitioner was recently hired to work in a fast track facility. The NP
employs asked if she has a problem prescribing medications for emergency
contraception. The NP replies that:
8) A strawberry tongue and sandpaper rash suggest:
a. Roseola
b. Fifth disease
c. Scarlet fever
d. Hand-foot-mouth disease
9) First-line therapy for group A strep pharyngitis is:
a. Azithromycin
b. Penicillin or amoxicillin
c. Ciprofloxacin
d. Oseltamivir
10) Untreated strep throat may lead to:
a. Diabetes
b. Rheumatic fever
c. Appendicitis
d. Asthma
11) A patient with nasal congestion, facial pressure, and symptoms for 4 days
likely has:
a. Bacterial sinusitis
Answers, and Rationale
Pre-Predictor 2026 LATEST VERSION
1) A 15-year-old high school student presents with a mild sore throat and low-
grade fever that has persisted for about 3 weeks. She reports general malaise,
fatigue, and loss of appetite. The NP suspects mononucleosis. Which of the
following is the LEAST appropriate intervention?
a. Palpate the lymph nodes and spleen.
b. Examine the posterior oropharynx for petechiae.
c. Obtain a CBC, throat culture, and heterophile antibody test.
d. Obtain an urinalysis and serum for LPAs and amylase.
Explanation: Mononucleosis is a symptomatic infection caused by the Epstein-Barr
virus (EBV). It is common in people aged 15–24 years. Common signs and
symptoms include incubation periods of 1-2 months, fatigue, chills, malaise,
anorexia, while non-typical findings include lymphadenopathy or posterior cervical
region. Splenomegaly can be present. A maculopapular rash occurs in less than
15% of patients. A diagnosis is usually made using the Monospot. In addition,
neutropenia and lymphocytosis are usually detected in the CBC. Obtaining lipases
and amylase (LPAs) is not indicated as this is not consistent with pancreatitis;
therefore, option D is the least relevant.
2) A 32-year-old male patient complains of urinary frequency and burning on
urination for 3 days. Urinalysis reveals bacteriuria and positive nitrites. A
diagnosis for urinary tract infections. The initial treatment should be:
a. Trimethoprim-sulfamethoxazole (Bactrim, Sulafurim) For 7-10 day
b. Ciprofloxacin (Cipro) for 3-5 days.
c. Trimethoprim-Sulfamethoxazole for 3 days.
d. 750 mg ciprofloxacin as a one-time dose.
,Explanation: Trimethoprim-sulfamethoxazole (TMP/SMZ) is usually the
appropriate medication for treating urinary tract infections (UTIs) in most
patients. In case of community resistance to TMP/SMZ >20%, another medication
should be substituted. In men, the appropriate length of time is 7–10 days.
Women may be treated for 3 days for uncomplicated UTI. Note: Options involving
shorter courses (3 days) or one-time doses are generally reserved for acute cystitis
in women, not men.
3) Which agent is most effective for the treatment of nodulocystic acne?
a. Benzoyl peroxide (Benzac)
b. Retinoic acid (Retin-A)
c. Topical tetracycline
d. Isotretinoin (Accutane)
Explanation: Isotretinoin (Accutane) is a systemic agent indicated for the
treatment of severe inflammatory acne. Guidelines for its use must be clearly
understood by the patient. A woman of childbearing age must use an effective
method of contraception because isotretinoin is teratogenic. There are many
restrictions in prescribing this medication because of the teratogenic effects given
during pregnancy. Therefore, it is a pregnancy category X drug. While topicals
help, Isotretinoin is the gold standard for nodulocystic (severe) acne.
4) An 18 y/o woman is taking a combined hormonal oral contraceptive. She
should be instructed to use a backup method for the prevention of pregnancy:
a. Throughout the week of placebo pills.
b. If prescribed Topiramate (Topamax) for the treatment of migraines.
c. If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection.
d. If she forgets to take a single dose of the contraceptive.
Explanation: Antiepileptics including phenytoin (Dilantin), carbamazepine
(Tegretol), primidone (Mysoline), topiramate (Topamax), and oxcarbazepine
(Trileptal) reduce the effectiveness of contraceptives. Depo-medroxyprogesterone
,acetate injections or levonorgestrel-releasing intrauterine devices will be a better
method of contraception for patients taking anticonvulsants. Most commonly used
antibiotics have not been proven to reduce the effectiveness of contraceptives.
Rifampin is an exception and additional... [be used by women taking this drug and
using oral contraceptives, transdermal, or vaginal ring preparations]. Additional
backup contraception should be used if taking antifungal agents. No additional
protection is needed throughout the week of placebo pills. Missing one single dose
of contraceptive does not require additional protection; missing more than two
does.
5) A 44-year-old female patient has diabetes. Her total cholesterol (TC) is 250
mg/dL (6.5 mmol/L), LDL = 190 mg/dL (4.94 mmol/L), HDL = 25 mg/dL (0.65
mmol/L), and triglycerides = 344 mg/dL (3.94 mmol/L). What agent will have the
greatest effect on improving her lipid profile and reducing morbidity and
mortality associated with dyslipidemia?
a. Niacin (Niaspan)
b. Atorvastatin
c. Omega-3 fatty acids
d. Fenofibrate
Explanation: First and foremost, it is essential to educate individuals on a heart-
healthy lifestyle. LDL-C is one of the major subunits in the development of
atherosclerotic heart disease. The target level of LDL-C is between 50 to 70mg/dL
to prevent plaque formation in the blood vessels. Guidelines strongly recommend
statins therapy because they primarily lower LDL-C levels, but they also have
secondary effects of lowering triglyceride and increasing HDL-C levels. Statins are
the only drugs proven to reduce cardiovascular mortality in this context.
6) A 30-year-old female comes into a clinic with classic signs and symptoms of
appendicitis. The NP fails to refer the patient to a surgeon. The appendix
ruptures and the woman dies. This is an example of:
, a. Failure of diligence
b. Professional liability
c. Negligence
d. Malpractice
Explanation: Malpractice, a negligence tort, occurs when a health care
professional’s actions fall below the appropriate standard of care and hurts the
patient. In this case, the patient came with signs and symptoms indicating
appendicitis, and the NP failed to refer the patient, resulting in death.
7) A nurse practitioner was recently hired to work in a fast track facility. The NP
employs asked if she has a problem prescribing medications for emergency
contraception. The NP replies that:
8) A strawberry tongue and sandpaper rash suggest:
a. Roseola
b. Fifth disease
c. Scarlet fever
d. Hand-foot-mouth disease
9) First-line therapy for group A strep pharyngitis is:
a. Azithromycin
b. Penicillin or amoxicillin
c. Ciprofloxacin
d. Oseltamivir
10) Untreated strep throat may lead to:
a. Diabetes
b. Rheumatic fever
c. Appendicitis
d. Asthma
11) A patient with nasal congestion, facial pressure, and symptoms for 4 days
likely has:
a. Bacterial sinusitis
