NUR 504 3P APEA Exam Masterpiece 2026–2027 | Complete & Verified
Questions, Answers and Detailed Rationales | Comprehensive Review &
Study Guide | Latest Updated Premium PDF Edition Available
1. Retractions are observed in all the following areas except the:
a) Supraventricular area
b) Hilar area
c) Intercostal area
d) Costal marginal area
➢ CORRECT ANSWER Hilar area is correct because retractions occur in compliant areas of
the chest wall such as supraventricular, intercostal, and costal marginal regions, but the
hilar region is a central lung area not visible on the chest wall.
2. A 3-year-old presents with a history of fever and cough over the past 24 hours. Findings on
exam reveal temperature of 102°F, apical heart rate of 157 beats/minute, and respiratory
rate of 40 breaths/minute. Tachypnea in this child is most likely related to:
a) Paradoxical respirations
b) The child's febrile state
c) The child's age
d) An airway obstruction
➢ CORRECT ANSWER The child's febrile state is correct because fever increases metabolic
demand and oxygen consumption, leading to tachypnea as a physiologic response, with
respiratory rate increasing approximately 10 breaths per minute per degree Celsius of fever.
3. When percussing the lower posterior chest, begin by:
a) Standing on the side rather than directly behind the patient
b) Having the patient lie supine on the examining table
c) Carefully palpating any area the patient has reported pain
d) Using the ball or the ulnar surface of the hand
➢ CORRECT ANSWER Standing on the side rather than directly behind the patient is correct
because standing on the side allows better visualization of symmetric percussion and
easier access to both hemithoraces without straining.
4. The palpation technique used to assess respiratory expansion of the chest is placing the
hands on the eighth or tenth ribs posteriorly with the thumbs close to the vertebrae, sliding
the hand medially and grasping a small fold of skin between the thumbs. Then:
a) Ask the patient to cough and note chest expansion
b) Ask the patient to take a deep breath and note any delay in expansion during inhalation
c) Have the patient hold his breath for 15 seconds then note chest expansion
d) Have the patient exhale forcefully noting expansion on expiration
,➢ CORRECT ANSWER Ask the patient to take a deep breath and note any delay in expansion
during inhalation is correct because deep inspiration maximizes chest expansion and
reveals any asymmetrical movement or delay indicating underlying pathology.
5. When trying to differentiate between hemoptysis or blood streaked material, which one of
the following observations is correct?
a) Hemoptysis is seen frequently in infants, children, and adolescents with allergic rhinitis
b) Blood originating in the stomach is usually brighter than blood originating from the
respiratory tract
c) Hemoptysis is common in children with cystic fibrosis
d) Blood streaked material often originates from the gastrointestinal tract
➢ CORRECT ANSWER Blood streaked material often originates from the gastrointestinal
tract is correct because blood from the GI tract is typically darker (coffee-ground) and mixed
with food contents, while hemoptysis is bright red, frothy, and mixed with sputum.
6. When percussing the chest in a patient who has left sided heart failure, the sound
emanated would be:
a) Resonant
b) Dull tympany
c) Diffusely hyperresonant
d) Flat
➢ CORRECT ANSWER Resonant is correct because left-sided heart failure typically produces
crackles on auscultation, but percussion remains resonant unless there is consolidation or
pleural effusion.
7. The line that extends through the inferior angle of the scapula when the arms are at the
sides of the body is the:
a) Midvertebral line
b) Scapular line
c) Midclavicular line
d) Midspinal line
➢ CORRECT ANSWER Scapular line is correct because the scapular line runs vertically
through the inferior angle of the scapula when the arms are positioned at the sides of the
body.
8. A condition associated with a chronic cough that produces copious amounts of purulent
sputum is most likely:
a) Tracheobronchitis
b) Chronic bronchitis
c) Bronchiectasis
d) Laryngitis
➢ CORRECT ANSWER Bronchiectasis is correct because bronchiectasis is characterized by
permanently dilated airways leading to chronic cough with copious amounts of purulent,
foul-smelling sputum.
,9. A patient who walked into the examination room may be observed to be sitting and leaning
forward in a chair, lips pursed during exhalation, and arms supported on the table. This
position could be consistent with patients who have:
a) Pneumonia
b) Chronic obstructive pulmonary disease (COPD)
c) Asthma
d) Croup
➢ CORRECT ANSWER Chronic obstructive pulmonary disease (COPD) is correct because the
tripod position (leaning forward with arms supported) and pursed-lip breathing are
compensatory mechanisms to improve gas exchange in COPD.
10. Breath sounds heard over the periphery of the lung fields are:
a) Bronchial
b) Abnormal
c) Bronchovesicular
d) Vesicular
➢ CORRECT ANSWER Vesicular is correct because vesicular breath sounds are normally
heard over most of the peripheral lung fields and are characterized by a longer, louder
inspiratory phase.
11. When percussing the posterior chest, which one of the following techniques would be
omitted?
a) When comparing two areas on the chest, use the same percussion technique in both
areas
b) Percuss one side of the chest then the other at each level
c) Percuss the areas over the scapulae
d) If a louder note is needed, apply more pressure with the pleximeter finger
➢ CORRECT ANSWER Percuss the areas over the scapulae is correct because the scapulae
are bony structures that produce a dull sound regardless of underlying lung pathology, so
percussion should be performed in the interspaces to avoid bone.
12. When auscultating breath sounds in a patient who has left sided heart failure, the breath
sounds are:
a) Vesicular with late inspiratory crackles in the dependent portions of the lungs and
resonant on percussion
b) Bronchial with late inspiratory crackles over the involved area and dull on percussion
c) Vesicular without adventitious sounds and resonant on percussion
d) Decreased with some audible wheezes and diffusely hyperresonant on percussion
➢ CORRECT ANSWER Vesicular with late inspiratory crackles in the dependent portions of the
lungs and resonant on percussion is correct because left heart failure causes pulmonary
congestion with crackles at the lung bases while percussion remains resonant.
13. Breath sounds consisting of a full inspiratory phase and a shortened and softer expiratory
phase normally audible over the hilar region of the chest are termed:
, a) Vesicular
b) Bronchial
c) Bronchovesicular
d) Rhonchi
➢ CORRECT ANSWER Bronchovesicular is correct because bronchovesicular breath sounds
have a full inspiratory phase and a shortened, softer expiratory phase and are normally
heard over the hilar region.
14. An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is
suggestive of:
a) Tracheobronchitis
b) Chronic bronchitis
c) Bronchiectasis
d) Laryngitis
➢ CORRECT ANSWER Tracheobronchitis is correct because acute viral tracheobronchitis
classically presents with burning retrosternal chest discomfort and a dry, non-productive
cough.
15. One of the anterior thoracic landmarks is the costal angle. It is located:
a) Where the manubrium and body of the sternum intersect
b) Where the right and left costal margins form an angle where they meet at the xiphoid
process
c) Where the suprasternal notch and the sternum form an angle
d) At the angle where the ninth and tenth ribs are fused
➢ CORRECT ANSWER Where the right and left costal margins form an angle where they meet
at the xiphoid process is correct because the costal angle (subcostal angle) is formed by the
convergence of the right and left costal margins at the xiphoid process.
16. Atypical respiratory symptoms associated with gastroesophageal disease (GERD) may
include all of the following except:
a) Coughing
b) Wheezing
c) Aspiration pneumonia
d) Rhinitis
➢ CORRECT ANSWER Rhinitis is correct because rhinitis is inflammation of the nasal
passages typically caused by allergies or viruses, not GERD, while coughing, wheezing, and
aspiration pneumonia are well-known atypical respiratory manifestations of GERD.
17. On auscultation of the chest, if the patient says "ninety-nine" and it is clearly heard, this is
indicative of:
a) A normal sounding chest
b) Lung density in the area
c) Consolidation or compression in the area
d) Inflammation in the area
Questions, Answers and Detailed Rationales | Comprehensive Review &
Study Guide | Latest Updated Premium PDF Edition Available
1. Retractions are observed in all the following areas except the:
a) Supraventricular area
b) Hilar area
c) Intercostal area
d) Costal marginal area
➢ CORRECT ANSWER Hilar area is correct because retractions occur in compliant areas of
the chest wall such as supraventricular, intercostal, and costal marginal regions, but the
hilar region is a central lung area not visible on the chest wall.
2. A 3-year-old presents with a history of fever and cough over the past 24 hours. Findings on
exam reveal temperature of 102°F, apical heart rate of 157 beats/minute, and respiratory
rate of 40 breaths/minute. Tachypnea in this child is most likely related to:
a) Paradoxical respirations
b) The child's febrile state
c) The child's age
d) An airway obstruction
➢ CORRECT ANSWER The child's febrile state is correct because fever increases metabolic
demand and oxygen consumption, leading to tachypnea as a physiologic response, with
respiratory rate increasing approximately 10 breaths per minute per degree Celsius of fever.
3. When percussing the lower posterior chest, begin by:
a) Standing on the side rather than directly behind the patient
b) Having the patient lie supine on the examining table
c) Carefully palpating any area the patient has reported pain
d) Using the ball or the ulnar surface of the hand
➢ CORRECT ANSWER Standing on the side rather than directly behind the patient is correct
because standing on the side allows better visualization of symmetric percussion and
easier access to both hemithoraces without straining.
4. The palpation technique used to assess respiratory expansion of the chest is placing the
hands on the eighth or tenth ribs posteriorly with the thumbs close to the vertebrae, sliding
the hand medially and grasping a small fold of skin between the thumbs. Then:
a) Ask the patient to cough and note chest expansion
b) Ask the patient to take a deep breath and note any delay in expansion during inhalation
c) Have the patient hold his breath for 15 seconds then note chest expansion
d) Have the patient exhale forcefully noting expansion on expiration
,➢ CORRECT ANSWER Ask the patient to take a deep breath and note any delay in expansion
during inhalation is correct because deep inspiration maximizes chest expansion and
reveals any asymmetrical movement or delay indicating underlying pathology.
5. When trying to differentiate between hemoptysis or blood streaked material, which one of
the following observations is correct?
a) Hemoptysis is seen frequently in infants, children, and adolescents with allergic rhinitis
b) Blood originating in the stomach is usually brighter than blood originating from the
respiratory tract
c) Hemoptysis is common in children with cystic fibrosis
d) Blood streaked material often originates from the gastrointestinal tract
➢ CORRECT ANSWER Blood streaked material often originates from the gastrointestinal
tract is correct because blood from the GI tract is typically darker (coffee-ground) and mixed
with food contents, while hemoptysis is bright red, frothy, and mixed with sputum.
6. When percussing the chest in a patient who has left sided heart failure, the sound
emanated would be:
a) Resonant
b) Dull tympany
c) Diffusely hyperresonant
d) Flat
➢ CORRECT ANSWER Resonant is correct because left-sided heart failure typically produces
crackles on auscultation, but percussion remains resonant unless there is consolidation or
pleural effusion.
7. The line that extends through the inferior angle of the scapula when the arms are at the
sides of the body is the:
a) Midvertebral line
b) Scapular line
c) Midclavicular line
d) Midspinal line
➢ CORRECT ANSWER Scapular line is correct because the scapular line runs vertically
through the inferior angle of the scapula when the arms are positioned at the sides of the
body.
8. A condition associated with a chronic cough that produces copious amounts of purulent
sputum is most likely:
a) Tracheobronchitis
b) Chronic bronchitis
c) Bronchiectasis
d) Laryngitis
➢ CORRECT ANSWER Bronchiectasis is correct because bronchiectasis is characterized by
permanently dilated airways leading to chronic cough with copious amounts of purulent,
foul-smelling sputum.
,9. A patient who walked into the examination room may be observed to be sitting and leaning
forward in a chair, lips pursed during exhalation, and arms supported on the table. This
position could be consistent with patients who have:
a) Pneumonia
b) Chronic obstructive pulmonary disease (COPD)
c) Asthma
d) Croup
➢ CORRECT ANSWER Chronic obstructive pulmonary disease (COPD) is correct because the
tripod position (leaning forward with arms supported) and pursed-lip breathing are
compensatory mechanisms to improve gas exchange in COPD.
10. Breath sounds heard over the periphery of the lung fields are:
a) Bronchial
b) Abnormal
c) Bronchovesicular
d) Vesicular
➢ CORRECT ANSWER Vesicular is correct because vesicular breath sounds are normally
heard over most of the peripheral lung fields and are characterized by a longer, louder
inspiratory phase.
11. When percussing the posterior chest, which one of the following techniques would be
omitted?
a) When comparing two areas on the chest, use the same percussion technique in both
areas
b) Percuss one side of the chest then the other at each level
c) Percuss the areas over the scapulae
d) If a louder note is needed, apply more pressure with the pleximeter finger
➢ CORRECT ANSWER Percuss the areas over the scapulae is correct because the scapulae
are bony structures that produce a dull sound regardless of underlying lung pathology, so
percussion should be performed in the interspaces to avoid bone.
12. When auscultating breath sounds in a patient who has left sided heart failure, the breath
sounds are:
a) Vesicular with late inspiratory crackles in the dependent portions of the lungs and
resonant on percussion
b) Bronchial with late inspiratory crackles over the involved area and dull on percussion
c) Vesicular without adventitious sounds and resonant on percussion
d) Decreased with some audible wheezes and diffusely hyperresonant on percussion
➢ CORRECT ANSWER Vesicular with late inspiratory crackles in the dependent portions of the
lungs and resonant on percussion is correct because left heart failure causes pulmonary
congestion with crackles at the lung bases while percussion remains resonant.
13. Breath sounds consisting of a full inspiratory phase and a shortened and softer expiratory
phase normally audible over the hilar region of the chest are termed:
, a) Vesicular
b) Bronchial
c) Bronchovesicular
d) Rhonchi
➢ CORRECT ANSWER Bronchovesicular is correct because bronchovesicular breath sounds
have a full inspiratory phase and a shortened, softer expiratory phase and are normally
heard over the hilar region.
14. An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is
suggestive of:
a) Tracheobronchitis
b) Chronic bronchitis
c) Bronchiectasis
d) Laryngitis
➢ CORRECT ANSWER Tracheobronchitis is correct because acute viral tracheobronchitis
classically presents with burning retrosternal chest discomfort and a dry, non-productive
cough.
15. One of the anterior thoracic landmarks is the costal angle. It is located:
a) Where the manubrium and body of the sternum intersect
b) Where the right and left costal margins form an angle where they meet at the xiphoid
process
c) Where the suprasternal notch and the sternum form an angle
d) At the angle where the ninth and tenth ribs are fused
➢ CORRECT ANSWER Where the right and left costal margins form an angle where they meet
at the xiphoid process is correct because the costal angle (subcostal angle) is formed by the
convergence of the right and left costal margins at the xiphoid process.
16. Atypical respiratory symptoms associated with gastroesophageal disease (GERD) may
include all of the following except:
a) Coughing
b) Wheezing
c) Aspiration pneumonia
d) Rhinitis
➢ CORRECT ANSWER Rhinitis is correct because rhinitis is inflammation of the nasal
passages typically caused by allergies or viruses, not GERD, while coughing, wheezing, and
aspiration pneumonia are well-known atypical respiratory manifestations of GERD.
17. On auscultation of the chest, if the patient says "ninety-nine" and it is clearly heard, this is
indicative of:
a) A normal sounding chest
b) Lung density in the area
c) Consolidation or compression in the area
d) Inflammation in the area
