APEA PRE-PREDICTOR 2024 – 2025 ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED
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A 12-year-old presents with ear pain of 36 hours duration. The
nurse practitioner diagnoses acute otitis media because
the: ...ANSWER... bony landmarks are obscured and the
tympanic membrane is mildly erythematous, dull, and immobile.
Rationale: Serous otitis media typically presents with a flat or
bulging and tympanic membrane with a fluid line and/or tiny
bubbles visible posteriorly. The tympanic membrane may be
immobile and retracted against the bony landmarks when the
eustachian tube is swollen or congested as with the common
cold or allergies. Narrowing of the external canal with erythema
and extreme tenderness of the canal wall is indicative of otitis
externa.
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
nurse practitioner suspects mononucleosis. Which of the
following is the LEAST appropriate
,2 intervention? ...ANSWER... Obtain a urinalysis and serum for
LFTs and amylase.
Rationale: The clinical presentation of this patient is typical of
mononucleosis. Lymphadenopathy, splenomegaly, pharyngeal
petechiae, and leukocytosis are common additional findings.
Urinalysis, serum amylase, and LFTs would not yield
information regarding the diagnosis. The confirmatory tests are
throat culture and the heterophil antibody test.
A 16 year old sexually active student presents with complaints
of a greenish-gray frothy vaginal discharge and vaginal itching.
The nurse practitioner should suspect: ...ANSWER...
trichomoniasis.
Rationale: The cardinal symptoms of infection with
Trichomonas vaginalis (a flagellated protozoan) is a frothy,
greenish-gray discharge with a fishy odor. The vagina may be
very edematous and red. The cervix may be friable with
petechiae ("strawberry cervix").
A 16 year-old has been diagnosed with Lyme disease. Which
drug should be used to treat him? ...ANSWER... Doxycycline
,3 Rationale: Doxycycline is frequently chosen first line to treat
Lyme Disease. However, numerous studies have demonstrated
that amoxicillin and cefuroxime have equal efficacy as
doxycycline in treatment of early Lyme Disease. These drugs are
recommended in patients who exhibit erythema migrans.
Doxycycline is not recommended in children less than 9 years of
age.
A 17-year-old female presents with painful vesicular lesions on
her vulva. Which of the following would be the most definitive
diagnostic test? ...ANSWER... Tzanck prep
Rationale: Tzanck prep is the only test in this list which is
diagnostic for herpes simplex. KOH prep is used to diagnose
candidal and bacterial vaginosis. Gram stain is used to help
distinguish Gram positive and Gram negative organisms. The
Papanicolaou (Pap) smear is used to screen for cervical
dysplasia and cancer.
A 2-year-old female presents with a 3 day history of high fever,
followed by abrupt resolution and development of a pink,
maculopapular rash today. What pharmacological intervention(s)
should the nurse practitioner consider? ...ANSWER... No
pharmacologic intervention is needed, but fluids should be
encouraged
, 4 Rationale: This 2 year old has roseola, a human herpes virus.
Since the fever has resolved and the rash will last another day
or 2, no pharmacologic intervention is needed. Fluids should be
encouraged because there may be some residual dehydration
from the 3 days of fever.
A 28 year-old has a Grade 3 murmur. Which characteristic
indicates a need for referral? ...ANSWER... A fixed split
Rationale: A split is created because of closure of valves. For
example, an S2 is created by closure of the aortic and pulmonic
valves. Normally these split with inspiration and almost never
with expiration. Splits should never be fixed. This indicates
some pathology like an atrial septal defect, pulmonic stenosis,
or possibly mitral regurgitation. In any event, this patient needs
initial evaluation with an echocardiogram because fixed splits
are always considered abnormal.
A 3 year-old female had a fever of 102 degrees F for 3 days.
Today she woke up from a nap and is afebrile. She has a
maculopapular rash. Which statement is true? ...ANSWER...
The rash will blanch.
Rationale: This describes a patient with roseola or exanthem
subitum. This is a common viral exanthem found in young
children caused by the Human Herpes Virus 6B. It is
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