APEA 3P PRACTICE EXAM 2026
Section 1: Advanced Cardiovascular & Hemodynamics
1. A 70-year-old man walks 20 minutes most days of the week. He has begun to complain of pain in his
left calf when he is walking. The problem has gotten gradually worse and now he is unable to
complete his 20-minute walks without stopping to rest. What choice best describes the pain
associated with peripheral artery disease (PAD)?
A. A sharp, stabbing pain
B. A dull pain and cramp
C. An electric shock
D. A pulsating pain
Answer: B
Rationale: Peripheral artery disease (PAD) typically presents as intermittent claudication, which is
characterized by a dull, aching, cramping pain or sensation of fatigue in the affected muscle group (e.g.,
calf, thigh, buttock) during exercise. This pain is caused by ischemia from inadequate blood flow and is
relieved by rest. The description of a dull pain and cramp is classic for PAD .
2. Which hypertensive patient is most likely to have adverse blood pressure effects from excessive
sodium consumption?
A. 21-year-old Asian American male
B. 35-year-old menstruating female
C. 55-year-old postmenopausal female
D. 70-year-old African American male
Answer: D
Rationale: Two groups of patients are particularly sodium-sensitive and typically experience adverse
blood pressure effects from sodium consumption greater than 2,000 mg daily: elderly patients and
African American patients. This is due to physiological differences in the renin-angiotensin-aldosterone
system (RAAS) and renal handling of sodium .
3. Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug does NOT need
to be stopped prior to her catheterization?
,A. Naproxen
B. Furosemide
C. Metformin
D. Losartan
Answer: D
Rationale: While several medications need to be held before a procedure involving contrast dye, an ARB
like losartan does not typically require cessation specifically for the contrast. Naproxen (NSAID) is often
withheld due to its impact on renal prostaglandin production. Furosemide is stopped because it
contributes to volume depletion. Metformin should be stopped 48 hours prior to catheterization due to
the rare but serious risk of lactic acidosis when combined with contrast dye in the setting of potential
acute kidney injury .
4. A 75-year-old patient with longstanding hypertension takes an ACE inhibitor and a thiazide diuretic
daily. He has developed dyspnea on exertion and peripheral edema over the past several days. This
probably indicates:
A. Worsening hypertension
B. Development of heart failure (HF)
C. Noncompliance with medication
D. Acute myocardial infarction
Answer: B
Rationale: The symptoms of dyspnea on exertion and peripheral edema are classic symptoms of heart
failure. Longstanding hypertension is a major risk factor for the development of heart failure with
preserved ejection fraction (HFpEF). The fluid retention and backward failure from a failing heart lead to
these specific findings .
5. A patient with a history of hypertension presents with chest pain. The nurse practitioner observes
jugular venous distention. This finding is consistent with:
A. Hypertension
B. Heart failure
C. Asthma
D. Pneumonia
Answer: B
Rationale: Jugular venous distention (JVD) is a physical exam finding indicative of elevated central
venous pressure. This occurs when the right side of the heart is unable to efficiently pump blood
forward, causing blood to back up into the venous system. This is a classic sign of right-sided heart
failure .
6. The usual clinical course of mitral valve prolapse (MVP) is:
, A. Benign
B. Results in sudden cardiac death
C. Results in chronic heart failure
D. Is associated with multiple episodes of emboli
Answer: A
Rationale: The usual course of mitral valve prolapse (MVP) is benign, and most patients who have MVP
are asymptomatic. A mid-systolic click and/or murmur may be present. In a minority of patients,
symptoms of heart failure (from mitral regurgitation) or, rarely, sudden death may occur, but this is not
the usual course .
7. Which of the following statements is correct regarding orthostatic hypotension in older adults?
A. It is diagnosed if systolic BP drops 20 mmHg or more within 1 minute of rising
B. It is diagnosed if systolic BP drops 20 mmHg or more within 3 minutes of rising
C. It is a normal finding and does not require intervention
D. It is diagnosed only if the patient becomes symptomatic
Answer: B
Rationale: Orthostatic hypotension, also called postural hypotension, is diagnosed in older adults when
the systolic blood pressure drops 20 mm Hg or more (or diastolic drops by 10 mm Hg) within 3 minutes
of moving from a lying to a standing position. Patients may report lightheadedness, weakness, or
dizziness, but symptoms are not required for the diagnosis .
8. A patient asks how a beta blocker helps with his angina. What is the best explanation?
A. It dilates the coronary arteries to increase blood flow
B. It slows the heart rate and decreases the force of contraction, reducing oxygen demand
C. It prevents platelets from sticking together and forming clots
D. It reduces the amount of fluid in the bloodstream, decreasing workload on the heart
Answer: B
Rationale: Beta blockers are effective for angina because they block the effects of epinephrine on the
heart. This results in a slower heart rate (negative chronotropy), depressed myocardial contractility
(negative inotropy), and decreased sympathetic stimulation. These actions decrease myocardial oxygen
demand, which helps prevent angina during exertion or stress .
Section 2: Respiratory & Pulmonary Integration
9. Which assessment finding would be unusual in a patient with bacterial pneumonia?
A. Egophony ("E" to "A" changes)
B. Increased tactile fremitus
C. Dullness to percussion
D. Hyperresonance to percussion
Section 1: Advanced Cardiovascular & Hemodynamics
1. A 70-year-old man walks 20 minutes most days of the week. He has begun to complain of pain in his
left calf when he is walking. The problem has gotten gradually worse and now he is unable to
complete his 20-minute walks without stopping to rest. What choice best describes the pain
associated with peripheral artery disease (PAD)?
A. A sharp, stabbing pain
B. A dull pain and cramp
C. An electric shock
D. A pulsating pain
Answer: B
Rationale: Peripheral artery disease (PAD) typically presents as intermittent claudication, which is
characterized by a dull, aching, cramping pain or sensation of fatigue in the affected muscle group (e.g.,
calf, thigh, buttock) during exercise. This pain is caused by ischemia from inadequate blood flow and is
relieved by rest. The description of a dull pain and cramp is classic for PAD .
2. Which hypertensive patient is most likely to have adverse blood pressure effects from excessive
sodium consumption?
A. 21-year-old Asian American male
B. 35-year-old menstruating female
C. 55-year-old postmenopausal female
D. 70-year-old African American male
Answer: D
Rationale: Two groups of patients are particularly sodium-sensitive and typically experience adverse
blood pressure effects from sodium consumption greater than 2,000 mg daily: elderly patients and
African American patients. This is due to physiological differences in the renin-angiotensin-aldosterone
system (RAAS) and renal handling of sodium .
3. Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug does NOT need
to be stopped prior to her catheterization?
,A. Naproxen
B. Furosemide
C. Metformin
D. Losartan
Answer: D
Rationale: While several medications need to be held before a procedure involving contrast dye, an ARB
like losartan does not typically require cessation specifically for the contrast. Naproxen (NSAID) is often
withheld due to its impact on renal prostaglandin production. Furosemide is stopped because it
contributes to volume depletion. Metformin should be stopped 48 hours prior to catheterization due to
the rare but serious risk of lactic acidosis when combined with contrast dye in the setting of potential
acute kidney injury .
4. A 75-year-old patient with longstanding hypertension takes an ACE inhibitor and a thiazide diuretic
daily. He has developed dyspnea on exertion and peripheral edema over the past several days. This
probably indicates:
A. Worsening hypertension
B. Development of heart failure (HF)
C. Noncompliance with medication
D. Acute myocardial infarction
Answer: B
Rationale: The symptoms of dyspnea on exertion and peripheral edema are classic symptoms of heart
failure. Longstanding hypertension is a major risk factor for the development of heart failure with
preserved ejection fraction (HFpEF). The fluid retention and backward failure from a failing heart lead to
these specific findings .
5. A patient with a history of hypertension presents with chest pain. The nurse practitioner observes
jugular venous distention. This finding is consistent with:
A. Hypertension
B. Heart failure
C. Asthma
D. Pneumonia
Answer: B
Rationale: Jugular venous distention (JVD) is a physical exam finding indicative of elevated central
venous pressure. This occurs when the right side of the heart is unable to efficiently pump blood
forward, causing blood to back up into the venous system. This is a classic sign of right-sided heart
failure .
6. The usual clinical course of mitral valve prolapse (MVP) is:
, A. Benign
B. Results in sudden cardiac death
C. Results in chronic heart failure
D. Is associated with multiple episodes of emboli
Answer: A
Rationale: The usual course of mitral valve prolapse (MVP) is benign, and most patients who have MVP
are asymptomatic. A mid-systolic click and/or murmur may be present. In a minority of patients,
symptoms of heart failure (from mitral regurgitation) or, rarely, sudden death may occur, but this is not
the usual course .
7. Which of the following statements is correct regarding orthostatic hypotension in older adults?
A. It is diagnosed if systolic BP drops 20 mmHg or more within 1 minute of rising
B. It is diagnosed if systolic BP drops 20 mmHg or more within 3 minutes of rising
C. It is a normal finding and does not require intervention
D. It is diagnosed only if the patient becomes symptomatic
Answer: B
Rationale: Orthostatic hypotension, also called postural hypotension, is diagnosed in older adults when
the systolic blood pressure drops 20 mm Hg or more (or diastolic drops by 10 mm Hg) within 3 minutes
of moving from a lying to a standing position. Patients may report lightheadedness, weakness, or
dizziness, but symptoms are not required for the diagnosis .
8. A patient asks how a beta blocker helps with his angina. What is the best explanation?
A. It dilates the coronary arteries to increase blood flow
B. It slows the heart rate and decreases the force of contraction, reducing oxygen demand
C. It prevents platelets from sticking together and forming clots
D. It reduces the amount of fluid in the bloodstream, decreasing workload on the heart
Answer: B
Rationale: Beta blockers are effective for angina because they block the effects of epinephrine on the
heart. This results in a slower heart rate (negative chronotropy), depressed myocardial contractility
(negative inotropy), and decreased sympathetic stimulation. These actions decrease myocardial oxygen
demand, which helps prevent angina during exertion or stress .
Section 2: Respiratory & Pulmonary Integration
9. Which assessment finding would be unusual in a patient with bacterial pneumonia?
A. Egophony ("E" to "A" changes)
B. Increased tactile fremitus
C. Dullness to percussion
D. Hyperresonance to percussion
