APEA 3P Exam Complete Study Guide – 186 Questions
Multiple Choice, Full Rationales – NP Board Review| 2026
WITH VERIFFIED ANSWERS
Section 1: Cardiovascular (Questions 1–20)
1. A 58-year-old male with HTN, DM type 2, and hyperlipidemia presents with
substernal chest pressure radiating to the jaw, occurring with exertion and
relieved by rest. What is the most likely diagnosis?
A) Unstable angina
B) Stable angina
C) NSTEMI
D) Pericarditis
Correct Answer: B) Stable angina
Rationale: Stable angina is predictable, triggered by exertion/stress, and relieved
by rest or nitroglycerin. Unstable angina occurs at rest or increases in frequency.
NSTEMI has prolonged pain with elevated cardiac markers. Pericarditis pain is
pleuritic, relieved by leaning forward.
2. On auscultation, you hear a high-pitched, blowing, early-diastolic decrescendo
murmur best heard at the left sternal border. Which valve is most likely involved?
A) Mitral stenosis
B) Aortic stenosis
,C) Aortic regurgitation
D) Mitral regurgitation
Correct Answer: C) Aortic regurgitation
Rationale: Aortic regurgitation murmur is early diastolic, decrescendo, high-
pitched, left sternal border. Mitral stenosis is mid-diastolic with opening snap.
Aortic stenosis is systolic crescendo-decrescendo. Mitral regurgitation is
pansystolic at apex.
3. A 72-year-old with HTN reports occasional dizziness and syncope. ECG shows a
heart rate of 48 bpm with regular rhythm and a P wave before each QRS. What is
the rhythm?
A) Second-degree AV block type I
B) Second-degree AV block type II
C) Third-degree AV block
D) Sinus bradycardia
Correct Answer: D) Sinus bradycardia
Rationale: Sinus bradycardia has rate <60, normal P wave before each QRS,
regular rhythm. Type I Wenckebach has progressive PR lengthening. Type II has
dropped beats without PR change. Third-degree has complete AV dissociation.
4. A 68-year-old with chronic HFrEF (EF 35%) presents with worsening dyspnea, 3+
pitting edema, and JVD. Which medication is most likely to reduce mortality?
A) Furosemide
,B) Metoprolol succinate
C) Hydralazine
D) Digoxin
Correct Answer: B) Metoprolol succinate
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce
mortality in HFrEF. Furosemide controls symptoms but no mortality benefit.
Hydralazine/nitrates add-on in African Americans. Digoxin reduces
hospitalizations but not mortality.
5. A 55-year-old with sudden onset of severe, tearing chest pain radiating to the
back. BP 100/60 in right arm, 140/90 in left arm. Most likely diagnosis?
A) Acute MI
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C) Aortic dissection
Rationale: Tearing chest pain radiating to back + pulse differential = aortic
dissection until proven otherwise. MI pain not typically tearing. PE has hypoxia,
sudden dyspnea. Pericarditis is pleuritic, relieved leaning forward.
6. Which ECG finding is most specific for pericarditis?
A) ST elevation in all leads except aVR and V1
B) ST depression in V2-V4
, C) Pathologic Q waves
D) Peaked T waves
Correct Answer: A) ST elevation in all leads except aVR and V1
Rationale: Pericarditis causes diffuse ST elevation with PR depression. ST
depression in V2-V4 suggests ischemia. Pathologic Q waves = prior MI. Peaked T
waves = hyperkalemia.
7. A 65-year-old with HTN and DM has a BP of 150/90 in clinic. Home readings
average 135/85. What is the most appropriate next step?
A) Start amlodipine
B) Start lisinopril
C) Continue lifestyle modification and recheck in 3-6 months
D) Order renal artery duplex
Correct Answer: C) Continue lifestyle modification and recheck in 3-6
months
Rationale: Home BP <135/85 indicates controlled hypertension. No need to start
or change meds. Confirm with repeat visits. Renal artery duplex if resistant
hypertension.
8. A 70-year-old with sudden-onset severe headache, nausea, and altered mental
status. BP 210/120. Fundoscopy shows flame hemorrhages and papilledema.
Diagnosis?
A) Migraine with aura
Multiple Choice, Full Rationales – NP Board Review| 2026
WITH VERIFFIED ANSWERS
Section 1: Cardiovascular (Questions 1–20)
1. A 58-year-old male with HTN, DM type 2, and hyperlipidemia presents with
substernal chest pressure radiating to the jaw, occurring with exertion and
relieved by rest. What is the most likely diagnosis?
A) Unstable angina
B) Stable angina
C) NSTEMI
D) Pericarditis
Correct Answer: B) Stable angina
Rationale: Stable angina is predictable, triggered by exertion/stress, and relieved
by rest or nitroglycerin. Unstable angina occurs at rest or increases in frequency.
NSTEMI has prolonged pain with elevated cardiac markers. Pericarditis pain is
pleuritic, relieved by leaning forward.
2. On auscultation, you hear a high-pitched, blowing, early-diastolic decrescendo
murmur best heard at the left sternal border. Which valve is most likely involved?
A) Mitral stenosis
B) Aortic stenosis
,C) Aortic regurgitation
D) Mitral regurgitation
Correct Answer: C) Aortic regurgitation
Rationale: Aortic regurgitation murmur is early diastolic, decrescendo, high-
pitched, left sternal border. Mitral stenosis is mid-diastolic with opening snap.
Aortic stenosis is systolic crescendo-decrescendo. Mitral regurgitation is
pansystolic at apex.
3. A 72-year-old with HTN reports occasional dizziness and syncope. ECG shows a
heart rate of 48 bpm with regular rhythm and a P wave before each QRS. What is
the rhythm?
A) Second-degree AV block type I
B) Second-degree AV block type II
C) Third-degree AV block
D) Sinus bradycardia
Correct Answer: D) Sinus bradycardia
Rationale: Sinus bradycardia has rate <60, normal P wave before each QRS,
regular rhythm. Type I Wenckebach has progressive PR lengthening. Type II has
dropped beats without PR change. Third-degree has complete AV dissociation.
4. A 68-year-old with chronic HFrEF (EF 35%) presents with worsening dyspnea, 3+
pitting edema, and JVD. Which medication is most likely to reduce mortality?
A) Furosemide
,B) Metoprolol succinate
C) Hydralazine
D) Digoxin
Correct Answer: B) Metoprolol succinate
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce
mortality in HFrEF. Furosemide controls symptoms but no mortality benefit.
Hydralazine/nitrates add-on in African Americans. Digoxin reduces
hospitalizations but not mortality.
5. A 55-year-old with sudden onset of severe, tearing chest pain radiating to the
back. BP 100/60 in right arm, 140/90 in left arm. Most likely diagnosis?
A) Acute MI
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C) Aortic dissection
Rationale: Tearing chest pain radiating to back + pulse differential = aortic
dissection until proven otherwise. MI pain not typically tearing. PE has hypoxia,
sudden dyspnea. Pericarditis is pleuritic, relieved leaning forward.
6. Which ECG finding is most specific for pericarditis?
A) ST elevation in all leads except aVR and V1
B) ST depression in V2-V4
, C) Pathologic Q waves
D) Peaked T waves
Correct Answer: A) ST elevation in all leads except aVR and V1
Rationale: Pericarditis causes diffuse ST elevation with PR depression. ST
depression in V2-V4 suggests ischemia. Pathologic Q waves = prior MI. Peaked T
waves = hyperkalemia.
7. A 65-year-old with HTN and DM has a BP of 150/90 in clinic. Home readings
average 135/85. What is the most appropriate next step?
A) Start amlodipine
B) Start lisinopril
C) Continue lifestyle modification and recheck in 3-6 months
D) Order renal artery duplex
Correct Answer: C) Continue lifestyle modification and recheck in 3-6
months
Rationale: Home BP <135/85 indicates controlled hypertension. No need to start
or change meds. Confirm with repeat visits. Renal artery duplex if resistant
hypertension.
8. A 70-year-old with sudden-onset severe headache, nausea, and altered mental
status. BP 210/120. Fundoscopy shows flame hemorrhages and papilledema.
Diagnosis?
A) Migraine with aura
