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Verified APEA FNP Practice Exam 2025 (Q160) –
Real Questions, Expert Rationales, 100% Pass
Guarantee
Question 1
A 56-year-old male with a 10-year history of Type 2 Diabetes presents for a
routine visit. He denies any current symptoms. On examination, you note
diminished vibratory sensation in both feet and reduced ankle reflexes.
Which of the following is the most appropriate next step in managing this
patient?
A. Begin treatment with pregabalin
B. Refer to a neurologist for EMG
C. Initiate strict glycemic control and foot care education
D. Order an MRI of the lumbar spine
Correct Answer: C. Initiate strict glycemic control and foot care
education
Rationale:
This patient presents with classic findings of diabetic peripheral
neuropathy (DPN)—a common complication of long-standing Type 2
, 2
diabetes characterized by sensory deficits and diminished reflexes. Although
symptomatic treatment (like pregabalin) is useful for neuropathic pain, this
patient is asymptomatic, so the focus should be on prevention of further
nerve damage and complications like foot ulcers and amputations.
Therefore, tight glycemic control is the mainstay of treatment.
Additionally, educating the patient on proper foot care is crucial to
prevent complications. EMG or MRI are not indicated unless there are
atypical findings or diagnostic uncertainty.
Question 2
A 32-year-old female presents with lower abdominal pain, fever (101.8°F),
and vaginal discharge. On bimanual exam, cervical motion tenderness is
noted. What is the most appropriate empiric outpatient treatment?
A. Azithromycin 1 g orally x1
B. Metronidazole 500 mg BID x7 days
C. Ceftriaxone IM + doxycycline ± metronidazole
D. Ciprofloxacin 500 mg BID x3 days
Correct Answer: C. Ceftriaxone IM + doxycycline ± metronidazole
Rationale:
This patient has classic signs of pelvic inflammatory disease (PID): fever,
vaginal discharge, and cervical motion tenderness. The recommended
CDC outpatient regimen for PID includes Ceftriaxone 500 mg IM once,
Doxycycline 100 mg BID x14 days, and Metronidazole 500 mg BID x14
days (to cover anaerobes like B. fragilis). Azithromycin is used for
, 3
chlamydia, but not for PID monotherapy. Metronidazole alone would not be
sufficient. Ciprofloxacin does not cover the most likely organisms (GC/CT
and anaerobes) effectively.
Question 3
An 82-year-old male presents with progressive confusion over the past two
days. He is disoriented, mildly agitated, and pulling at his IV line. His
daughter reports he was normal three days ago. Vitals: T 100.9°F, HR 94,
BP 132/78. Which of the following is the most appropriate initial diagnostic
test?
A. CT head without contrast
B. Urinalysis with culture
C. Serum B12 and folate
D. EEG
Correct Answer: B. Urinalysis with culture
Rationale:
In elderly patients, acute confusion (delirium) is often due to a reversible
medical cause, most commonly infection. In men over 80, urinary tract
infection (UTI) is a leading culprit, even in the absence of urinary
symptoms. Thus, the initial workup should include a urinalysis with
urine culture to assess for UTI. While a CT head might be necessary later if
neurological deficits or trauma are suspected, it is not first-line. EEG is used
for seizure activity, and B12/folate are for chronic cognitive issues—not for
acute confusion.
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Question 4
A 25-year-old female on oral contraceptive pills presents with a 2-day
history of right calf pain and swelling. You note unilateral edema and
tenderness. What is the most appropriate next step?
A. Start anticoagulation immediately
B. Order a venous duplex ultrasound
C. Measure D-dimer levels
D. Apply warm compresses and reassess in 2 days
Correct Answer: B. Order a venous duplex ultrasound
Rationale:
The clinical presentation is suspicious for deep vein thrombosis (DVT),
especially considering the risk factor of oral contraceptive use. The first
diagnostic step in evaluating suspected DVT is a venous duplex
ultrasound of the affected limb. Although D-dimer can be used to rule out
DVT in low-risk patients, this patient is not low risk. Empiric
anticoagulation is only started if imaging is not immediately available and
suspicion is very high. Warm compresses and delayed reassessment are
inappropriate and unsafe.
Question 5
Which of the following best describes the primary mechanism of action of
metformin in patients with Type 2 Diabetes?
Verified APEA FNP Practice Exam 2025 (Q160) –
Real Questions, Expert Rationales, 100% Pass
Guarantee
Question 1
A 56-year-old male with a 10-year history of Type 2 Diabetes presents for a
routine visit. He denies any current symptoms. On examination, you note
diminished vibratory sensation in both feet and reduced ankle reflexes.
Which of the following is the most appropriate next step in managing this
patient?
A. Begin treatment with pregabalin
B. Refer to a neurologist for EMG
C. Initiate strict glycemic control and foot care education
D. Order an MRI of the lumbar spine
Correct Answer: C. Initiate strict glycemic control and foot care
education
Rationale:
This patient presents with classic findings of diabetic peripheral
neuropathy (DPN)—a common complication of long-standing Type 2
, 2
diabetes characterized by sensory deficits and diminished reflexes. Although
symptomatic treatment (like pregabalin) is useful for neuropathic pain, this
patient is asymptomatic, so the focus should be on prevention of further
nerve damage and complications like foot ulcers and amputations.
Therefore, tight glycemic control is the mainstay of treatment.
Additionally, educating the patient on proper foot care is crucial to
prevent complications. EMG or MRI are not indicated unless there are
atypical findings or diagnostic uncertainty.
Question 2
A 32-year-old female presents with lower abdominal pain, fever (101.8°F),
and vaginal discharge. On bimanual exam, cervical motion tenderness is
noted. What is the most appropriate empiric outpatient treatment?
A. Azithromycin 1 g orally x1
B. Metronidazole 500 mg BID x7 days
C. Ceftriaxone IM + doxycycline ± metronidazole
D. Ciprofloxacin 500 mg BID x3 days
Correct Answer: C. Ceftriaxone IM + doxycycline ± metronidazole
Rationale:
This patient has classic signs of pelvic inflammatory disease (PID): fever,
vaginal discharge, and cervical motion tenderness. The recommended
CDC outpatient regimen for PID includes Ceftriaxone 500 mg IM once,
Doxycycline 100 mg BID x14 days, and Metronidazole 500 mg BID x14
days (to cover anaerobes like B. fragilis). Azithromycin is used for
, 3
chlamydia, but not for PID monotherapy. Metronidazole alone would not be
sufficient. Ciprofloxacin does not cover the most likely organisms (GC/CT
and anaerobes) effectively.
Question 3
An 82-year-old male presents with progressive confusion over the past two
days. He is disoriented, mildly agitated, and pulling at his IV line. His
daughter reports he was normal three days ago. Vitals: T 100.9°F, HR 94,
BP 132/78. Which of the following is the most appropriate initial diagnostic
test?
A. CT head without contrast
B. Urinalysis with culture
C. Serum B12 and folate
D. EEG
Correct Answer: B. Urinalysis with culture
Rationale:
In elderly patients, acute confusion (delirium) is often due to a reversible
medical cause, most commonly infection. In men over 80, urinary tract
infection (UTI) is a leading culprit, even in the absence of urinary
symptoms. Thus, the initial workup should include a urinalysis with
urine culture to assess for UTI. While a CT head might be necessary later if
neurological deficits or trauma are suspected, it is not first-line. EEG is used
for seizure activity, and B12/folate are for chronic cognitive issues—not for
acute confusion.
, 4
Question 4
A 25-year-old female on oral contraceptive pills presents with a 2-day
history of right calf pain and swelling. You note unilateral edema and
tenderness. What is the most appropriate next step?
A. Start anticoagulation immediately
B. Order a venous duplex ultrasound
C. Measure D-dimer levels
D. Apply warm compresses and reassess in 2 days
Correct Answer: B. Order a venous duplex ultrasound
Rationale:
The clinical presentation is suspicious for deep vein thrombosis (DVT),
especially considering the risk factor of oral contraceptive use. The first
diagnostic step in evaluating suspected DVT is a venous duplex
ultrasound of the affected limb. Although D-dimer can be used to rule out
DVT in low-risk patients, this patient is not low risk. Empiric
anticoagulation is only started if imaging is not immediately available and
suspicion is very high. Warm compresses and delayed reassessment are
inappropriate and unsafe.
Question 5
Which of the following best describes the primary mechanism of action of
metformin in patients with Type 2 Diabetes?
