1
APEA 3P PRACTICE TEST SET 2 2026/2027 | Recently
Updated | Best NP Certification Revision Material |
Questions & Verified Answers | Pass Guaranteed - A+
Graded
Section 1: Assessment & Diagnosis (History, Physical Exam, Diagnostic Reasoning)
(Q1-20)
Q1. A 62-year-old male presents with substernal chest pressure radiating to the left
arm, occurring with exertion and relieved by rest within 5 minutes. Physical exam
reveals a blood pressure of 148/92 mmHg, heart rate 88 bpm, and no murmurs. The
ECG shows normal sinus rhythm with no ST changes. Which is the most likely
diagnosis?
A. Acute myocardial infarction
B. Stable angina pectoris
C. Pericarditis
D. Gastroesophageal reflux disease
B. Stable angina pectoris [CORRECT]
Rationale: Exertional chest pressure relieved by rest is classic for stable angina. MI (A)
causes persistent pain with ECG changes, pericarditis (C) produces pleuritic pain
worsened by inspiration and relieved by leaning forward, and GERD (D) causes
burning substernal pain unrelated to exertion.
Correct Answer: B
Q2. A 68-year-old with a 40 pack-year smoking history presents with progressive
dyspnea. Lung examination reveals diminished breath sounds, hyperresonance to
percussion, and a prolonged expiratory phase. Which condition do these findings
most strongly suggest?
,2
A. Consolidated lobar pneumonia
B. Chronic obstructive pulmonary disease
C. Pneumothorax
D. Pulmonary edema
B. Chronic obstructive pulmonary disease [CORRECT]
Rationale: Hyperresonance, diminished breath sounds, and prolonged expiration are
classic obstructive findings in COPD. Pneumonia (A) causes dullness and bronchial
breath sounds, pneumothorax (C) causes absent breath sounds and tympany, and
pulmonary edema (D) causes crackles and dullness.
Correct Answer: B
Q3. A 28-year-old male sustained a humeral fracture after a fall. He now presents
with wrist drop, inability to extend the thumb, and decreased sensation over the
dorsum of the hand. Which nerve is most likely injured?
A. Median nerve
B. Ulnar nerve
C. Radial nerve
D. Axillary nerve
C. Radial nerve [CORRECT]
Rationale: Wrist drop and inability to extend the thumb are pathognomonic for radial
nerve injury, often associated with mid-shaft humeral fractures. Median nerve (A)
affects wrist flexion and thumb opposition, ulnar nerve (B) affects finger
abduction/adduction, and axillary nerve (D) affects deltoid function.
Correct Answer: C
Q4. A 19-year-old college student presents with 18 hours of worsening right lower
quadrant pain, nausea, and anorexia. Physical exam reveals tenderness at McBurney's
,3
point, rebound tenderness, and a positive obturator sign. Which diagnosis is most
likely?
A. Acute appendicitis
B. Crohn's disease
C. Ectopic pregnancy
D. Nephrolithiasis
A. Acute appendicitis [CORRECT]
Rationale: McBurney's point tenderness, rebound, and obturator sign are classic for
acute appendicitis. Crohn's (B) typically presents with chronic diarrhea, ectopic
pregnancy (C) causes pelvic pain and amenorrhea, and nephrolithiasis (D) causes
flank pain radiating to the groin.
Correct Answer: A
Q5. A 72-year-old with hypertension presents with palpitations and mild dyspnea.
The ECG reveals an irregularly irregular rhythm with no discernible P waves and
fibrillatory waves between QRS complexes. The ventricular rate is 110 bpm. Which
rhythm is present?
A. Atrial flutter
B. Atrial fibrillation
C. Ventricular tachycardia
D. Sinus tachycardia with frequent PACs
B. Atrial fibrillation [CORRECT]
Rationale: An irregularly irregular rhythm with absent P waves and fibrillatory waves
is diagnostic of atrial fibrillation. Atrial flutter (A) demonstrates sawtooth flutter
waves, ventricular tachycardia (C) shows wide QRS complexes, and sinus tachycardia
with PACs (D) would have visible P waves.
Correct Answer: B
, 4
Q6. A 75-year-old reports exertional syncope and dyspnea. Cardiac auscultation
reveals a harsh crescendo-decrescendo systolic murmur heard best at the right upper
sternal border with radiation to the carotid arteries. Which valvular disorder is most
likely?
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral stenosis
D. Tricuspid regurgitation
B. Aortic stenosis [CORRECT]
Rationale: A harsh systolic crescendo-decrescendo murmur at the RUSB radiating to
the carotids is classic for aortic stenosis, which causes exertional syncope due to fixed
outflow obstruction. Mitral regurgitation (A) causes a holosystolic murmur at the
apex, mitral stenosis (C) causes a diastolic rumble, and tricuspid regurgitation (D)
causes a holosystolic murmur at the LLSB.
Correct Answer: B
Q7. A 50-year-old presents with a changing mole on the back. Examination reveals
an 8 mm asymmetric lesion with irregular borders, variegated color (brown, black,
and red), and slight elevation. Which feature is most predictive of malignancy?
A. Diameter >6 mm
B. Asymmetry and border irregularity
C. Elevation above the skin surface
D. Location on the back
B. Asymmetry and border irregularity [CORRECT]
Rationale: The ABCDE criteria identify melanoma risk, with asymmetry and border
irregularity being the most sensitive early indicators of malignancy. While diameter
>6 mm (A) is a criterion, many benign nevi are larger, and elevation (C) can occur in
benign lesions.
Correct Answer: B
APEA 3P PRACTICE TEST SET 2 2026/2027 | Recently
Updated | Best NP Certification Revision Material |
Questions & Verified Answers | Pass Guaranteed - A+
Graded
Section 1: Assessment & Diagnosis (History, Physical Exam, Diagnostic Reasoning)
(Q1-20)
Q1. A 62-year-old male presents with substernal chest pressure radiating to the left
arm, occurring with exertion and relieved by rest within 5 minutes. Physical exam
reveals a blood pressure of 148/92 mmHg, heart rate 88 bpm, and no murmurs. The
ECG shows normal sinus rhythm with no ST changes. Which is the most likely
diagnosis?
A. Acute myocardial infarction
B. Stable angina pectoris
C. Pericarditis
D. Gastroesophageal reflux disease
B. Stable angina pectoris [CORRECT]
Rationale: Exertional chest pressure relieved by rest is classic for stable angina. MI (A)
causes persistent pain with ECG changes, pericarditis (C) produces pleuritic pain
worsened by inspiration and relieved by leaning forward, and GERD (D) causes
burning substernal pain unrelated to exertion.
Correct Answer: B
Q2. A 68-year-old with a 40 pack-year smoking history presents with progressive
dyspnea. Lung examination reveals diminished breath sounds, hyperresonance to
percussion, and a prolonged expiratory phase. Which condition do these findings
most strongly suggest?
,2
A. Consolidated lobar pneumonia
B. Chronic obstructive pulmonary disease
C. Pneumothorax
D. Pulmonary edema
B. Chronic obstructive pulmonary disease [CORRECT]
Rationale: Hyperresonance, diminished breath sounds, and prolonged expiration are
classic obstructive findings in COPD. Pneumonia (A) causes dullness and bronchial
breath sounds, pneumothorax (C) causes absent breath sounds and tympany, and
pulmonary edema (D) causes crackles and dullness.
Correct Answer: B
Q3. A 28-year-old male sustained a humeral fracture after a fall. He now presents
with wrist drop, inability to extend the thumb, and decreased sensation over the
dorsum of the hand. Which nerve is most likely injured?
A. Median nerve
B. Ulnar nerve
C. Radial nerve
D. Axillary nerve
C. Radial nerve [CORRECT]
Rationale: Wrist drop and inability to extend the thumb are pathognomonic for radial
nerve injury, often associated with mid-shaft humeral fractures. Median nerve (A)
affects wrist flexion and thumb opposition, ulnar nerve (B) affects finger
abduction/adduction, and axillary nerve (D) affects deltoid function.
Correct Answer: C
Q4. A 19-year-old college student presents with 18 hours of worsening right lower
quadrant pain, nausea, and anorexia. Physical exam reveals tenderness at McBurney's
,3
point, rebound tenderness, and a positive obturator sign. Which diagnosis is most
likely?
A. Acute appendicitis
B. Crohn's disease
C. Ectopic pregnancy
D. Nephrolithiasis
A. Acute appendicitis [CORRECT]
Rationale: McBurney's point tenderness, rebound, and obturator sign are classic for
acute appendicitis. Crohn's (B) typically presents with chronic diarrhea, ectopic
pregnancy (C) causes pelvic pain and amenorrhea, and nephrolithiasis (D) causes
flank pain radiating to the groin.
Correct Answer: A
Q5. A 72-year-old with hypertension presents with palpitations and mild dyspnea.
The ECG reveals an irregularly irregular rhythm with no discernible P waves and
fibrillatory waves between QRS complexes. The ventricular rate is 110 bpm. Which
rhythm is present?
A. Atrial flutter
B. Atrial fibrillation
C. Ventricular tachycardia
D. Sinus tachycardia with frequent PACs
B. Atrial fibrillation [CORRECT]
Rationale: An irregularly irregular rhythm with absent P waves and fibrillatory waves
is diagnostic of atrial fibrillation. Atrial flutter (A) demonstrates sawtooth flutter
waves, ventricular tachycardia (C) shows wide QRS complexes, and sinus tachycardia
with PACs (D) would have visible P waves.
Correct Answer: B
, 4
Q6. A 75-year-old reports exertional syncope and dyspnea. Cardiac auscultation
reveals a harsh crescendo-decrescendo systolic murmur heard best at the right upper
sternal border with radiation to the carotid arteries. Which valvular disorder is most
likely?
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral stenosis
D. Tricuspid regurgitation
B. Aortic stenosis [CORRECT]
Rationale: A harsh systolic crescendo-decrescendo murmur at the RUSB radiating to
the carotids is classic for aortic stenosis, which causes exertional syncope due to fixed
outflow obstruction. Mitral regurgitation (A) causes a holosystolic murmur at the
apex, mitral stenosis (C) causes a diastolic rumble, and tricuspid regurgitation (D)
causes a holosystolic murmur at the LLSB.
Correct Answer: B
Q7. A 50-year-old presents with a changing mole on the back. Examination reveals
an 8 mm asymmetric lesion with irregular borders, variegated color (brown, black,
and red), and slight elevation. Which feature is most predictive of malignancy?
A. Diameter >6 mm
B. Asymmetry and border irregularity
C. Elevation above the skin surface
D. Location on the back
B. Asymmetry and border irregularity [CORRECT]
Rationale: The ABCDE criteria identify melanoma risk, with asymmetry and border
irregularity being the most sensitive early indicators of malignancy. While diameter
>6 mm (A) is a criterion, many benign nevi are larger, and elevation (C) can occur in
benign lesions.
Correct Answer: B
