1
APEA Predictor Exam | 2025/2026 Latest
Edition – Questions, Correct Answers, and
Rationales
• Advanced Physical Assessment – 25%
• Pharmacotherapeutics – 25%
• Pathophysiology – 20%
• Differential Diagnosis – 20%
• Professional & Legal Issues – 10%
SECTION 1: CARDIOVASCULAR DISORDERS
1. A 68-year-old male with hypertension reports episodic chest pain at rest,
relieved within 10 minutes by nitroglycerin. ECG shows ST-segment depression
during pain. Most likely diagnosis?
A. Stable angina
B. Prinzmetal angina
C. NSTEMI
D. Pericarditis
Correct Answer: B. Prinzmetal angina
Rationale: Prinzmetal (variant) angina occurs at rest due to coronary artery vasospasm,
responds to nitrates or calcium channel blockers, and typically shows transient ST
elevation though ST depression can occur .
2. A patient presents with JVD, hypotension, and muffled heart sounds. What is
the most likely diagnosis?
A. Tension pneumothorax
B. Cardiac tamponade
,2
C. Massive pulmonary embolism
D. Aortic dissection
Correct Answer: B. Cardiac tamponade
Rationale: Beck's triad (JVD, hypotension, muffled heart sounds) is classic for cardiac
tamponade. Pulsus paradoxus >10 mmHg is also commonly present .
3. Which murmur is best heard at the left lower sternal border with increased
intensity during inspiration?
A. Aortic stenosis
B. Tricuspid regurgitation
C. Mitral stenosis
D. Aortic regurgitation
Correct Answer: B. Tricuspid regurgitation
Rationale: Inspiration increases right heart filling (Carvallo's sign), which intensifies
right-sided murmurs such as tricuspid regurgitation. Left-sided murmurs do not change
significantly with inspiration .
4. A 55-year-old female with palpitations shows irregularly irregular rhythm, no P
waves, ventricular rate 140 bpm. CHA₂DS₂-VASc score is 3. Next best step?
A. Immediate cardioversion
B. Start apixaban plus rate control
C. Aspirin 325 mg daily
D. Electrophysiology study
Correct Answer: B. Start apixaban plus rate control
Rationale: Atrial fibrillation with a CHA₂DS₂-VASc score ≥2 in men or ≥3 in women
warrants oral anticoagulation to reduce stroke risk. Rate control is also indicated unless
the patient is hemodynamically unstable .
,3
5. A 75-year-old with hypertension and osteoporosis needs a new
antihypertensive. Which agent provides a secondary benefit for bone health?
A. Amlodipine
B. Lisinopril
C. Hydrochlorothiazide
D. Metoprolol
Correct Answer: C. Hydrochlorothiazide
Rationale: Thiazide diuretics reduce urinary calcium excretion and have been shown to
improve bone mineral density, reducing fracture risk in older adults .
6. A patient with sudden severe ripping chest pain radiating to the back. BP
150/90 in right arm, 90/60 in left arm. Most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B. Aortic dissection
Rationale: Aortic dissection presents with sudden, severe "tearing" chest pain and
asymmetric blood pressures between arms .
7. Which BP medication is contraindicated in pregnancy?
A. Labetalol
B. Nifedipine
C. Methyldopa
D. Lisinopril
Correct Answer: D. Lisinopril
, 4
Rationale: ACE inhibitors (lisinopril) are contraindicated in pregnancy due to risk of fetal
renal agenesis, oligohydramnios, and neonatal death. Safe alternatives in pregnancy
include labetalol, nifedipine, and methyldopa .
8. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3. What is the
appropriate management?
A. Aspirin 81 mg daily
B. No anticoagulation
C. Oral anticoagulation
D. Dual antiplatelet therapy
Correct Answer: C. Oral anticoagulation
Rationale: A CHA₂DS₂-VASc score of ≥2 in men or ≥3 in women warrants oral
anticoagulation (warfarin or DOAC) to significantly reduce stroke risk. Aspirin is no
longer recommended for stroke prevention in AF .
9. A patient with newly diagnosed hypertension has a persistent dry cough on
lisinopril. What should the NP teach?
A. Discontinue medication immediately
B. Report to provider; cough is a common ACE inhibitor side effect
C. Increase dose for effectiveness
D. Take medication only during symptoms
Correct Answer: B. Report to provider; cough is a common ACE inhibitor side
effect
Rationale: Persistent dry cough is a common side effect of ACE inhibitors due to
bradykinin accumulation. Patients should notify their provider; alternatives such as ARBs
do not cause cough .
APEA Predictor Exam | 2025/2026 Latest
Edition – Questions, Correct Answers, and
Rationales
• Advanced Physical Assessment – 25%
• Pharmacotherapeutics – 25%
• Pathophysiology – 20%
• Differential Diagnosis – 20%
• Professional & Legal Issues – 10%
SECTION 1: CARDIOVASCULAR DISORDERS
1. A 68-year-old male with hypertension reports episodic chest pain at rest,
relieved within 10 minutes by nitroglycerin. ECG shows ST-segment depression
during pain. Most likely diagnosis?
A. Stable angina
B. Prinzmetal angina
C. NSTEMI
D. Pericarditis
Correct Answer: B. Prinzmetal angina
Rationale: Prinzmetal (variant) angina occurs at rest due to coronary artery vasospasm,
responds to nitrates or calcium channel blockers, and typically shows transient ST
elevation though ST depression can occur .
2. A patient presents with JVD, hypotension, and muffled heart sounds. What is
the most likely diagnosis?
A. Tension pneumothorax
B. Cardiac tamponade
,2
C. Massive pulmonary embolism
D. Aortic dissection
Correct Answer: B. Cardiac tamponade
Rationale: Beck's triad (JVD, hypotension, muffled heart sounds) is classic for cardiac
tamponade. Pulsus paradoxus >10 mmHg is also commonly present .
3. Which murmur is best heard at the left lower sternal border with increased
intensity during inspiration?
A. Aortic stenosis
B. Tricuspid regurgitation
C. Mitral stenosis
D. Aortic regurgitation
Correct Answer: B. Tricuspid regurgitation
Rationale: Inspiration increases right heart filling (Carvallo's sign), which intensifies
right-sided murmurs such as tricuspid regurgitation. Left-sided murmurs do not change
significantly with inspiration .
4. A 55-year-old female with palpitations shows irregularly irregular rhythm, no P
waves, ventricular rate 140 bpm. CHA₂DS₂-VASc score is 3. Next best step?
A. Immediate cardioversion
B. Start apixaban plus rate control
C. Aspirin 325 mg daily
D. Electrophysiology study
Correct Answer: B. Start apixaban plus rate control
Rationale: Atrial fibrillation with a CHA₂DS₂-VASc score ≥2 in men or ≥3 in women
warrants oral anticoagulation to reduce stroke risk. Rate control is also indicated unless
the patient is hemodynamically unstable .
,3
5. A 75-year-old with hypertension and osteoporosis needs a new
antihypertensive. Which agent provides a secondary benefit for bone health?
A. Amlodipine
B. Lisinopril
C. Hydrochlorothiazide
D. Metoprolol
Correct Answer: C. Hydrochlorothiazide
Rationale: Thiazide diuretics reduce urinary calcium excretion and have been shown to
improve bone mineral density, reducing fracture risk in older adults .
6. A patient with sudden severe ripping chest pain radiating to the back. BP
150/90 in right arm, 90/60 in left arm. Most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B. Aortic dissection
Rationale: Aortic dissection presents with sudden, severe "tearing" chest pain and
asymmetric blood pressures between arms .
7. Which BP medication is contraindicated in pregnancy?
A. Labetalol
B. Nifedipine
C. Methyldopa
D. Lisinopril
Correct Answer: D. Lisinopril
, 4
Rationale: ACE inhibitors (lisinopril) are contraindicated in pregnancy due to risk of fetal
renal agenesis, oligohydramnios, and neonatal death. Safe alternatives in pregnancy
include labetalol, nifedipine, and methyldopa .
8. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3. What is the
appropriate management?
A. Aspirin 81 mg daily
B. No anticoagulation
C. Oral anticoagulation
D. Dual antiplatelet therapy
Correct Answer: C. Oral anticoagulation
Rationale: A CHA₂DS₂-VASc score of ≥2 in men or ≥3 in women warrants oral
anticoagulation (warfarin or DOAC) to significantly reduce stroke risk. Aspirin is no
longer recommended for stroke prevention in AF .
9. A patient with newly diagnosed hypertension has a persistent dry cough on
lisinopril. What should the NP teach?
A. Discontinue medication immediately
B. Report to provider; cough is a common ACE inhibitor side effect
C. Increase dose for effectiveness
D. Take medication only during symptoms
Correct Answer: B. Report to provider; cough is a common ACE inhibitor side
effect
Rationale: Persistent dry cough is a common side effect of ACE inhibitors due to
bradykinin accumulation. Patients should notify their provider; alternatives such as ARBs
do not cause cough .
