MSN 572 APEA 3P Practice Exam 2
Questions and Answers with Rationales
Latest Versions
MSN 572 APEA 3P Practice Exam 2, covering
pathophysiology, pharmacology, and physical assessment
with answers and detailed rationales. These are practice-
style questions, not actual or proprietary APEA exam
questions.
1. 67-year-old patient presents with progressive exertional dyspnea, orthopnea, and
bilateral lower-extremity edema. Examination reveals an S3 gallop and bibasilar
crackles. Which condition best explains these findings?
A. Right-sided heart failure only
B. Left-sided systolic heart failure
C. Acute pericarditis
D. Pulmonary embolism
Answer: B. Left-sided systolic heart failure
Rationale: Left ventricular dysfunction causes pulmonary venous congestion,
producing dyspnea, orthopnea, and crackles. An S3 can reflect volume overload
and impaired ventricular function. Peripheral edema may develop as heart failure
progresses or when right-sided congestion accompanies left-sided disease.
2.
Which laboratory biomarker can support the diagnosis of heart failure in a patient
presenting with unexplained dyspnea?
A. BNP
B. Lipase
C. Amylase
D. ALT
,Answer: A. BNP
Rationale: B-type natriuretic peptide (BNP) and NT-proBNP are released in
response to myocardial wall stress. Elevated levels can support a diagnosis of heart
failure, although values must be interpreted in clinical context because renal
dysfunction, age, obesity, and other conditions can affect levels.
3.
A patient with heart failure is taking furosemide. Which assessment is most
important for detecting a common adverse effect?
A. Serum potassium
B. Serum bilirubin
C. Hemoglobin A1c
D. Platelet count
Answer: A. Serum potassium
Rationale: Furosemide increases urinary sodium and potassium excretion.
Hypokalemia can occur and may predispose the patient to cardiac arrhythmias.
Renal function and volume status should also be monitored.
4.
A patient with hypertension is prescribed amlodipine. Which adverse effect is
relatively common?
A. Peripheral edema
B. Severe hypoglycemia
C. Hyperkalemia
D. Pulmonary fibrosis
Answer: A. Peripheral edema
,Rationale: Dihydropyridine calcium channel blockers such as amlodipine
commonly cause peripheral edema due to arteriolar vasodilation. Other effects can
include flushing and headache.
5.
A patient taking atorvastatin reports unexplained severe muscle pain and weakness.
What is the most appropriate laboratory test to consider?
A. Creatine kinase
B. INR
C. TSH only
D. Serum amylase
Answer: A. Creatine kinase
Rationale: Significant muscle symptoms during statin therapy raise concern for
statin-associated myopathy or, rarely, rhabdomyolysis. Creatine kinase can help
assess the degree of muscle injury.
6.
Which patient is at greatest risk for developing atherosclerotic cardiovascular
disease?
A. A 22-year-old with no risk factors
B. A patient with diabetes, hypertension, and tobacco exposure
C. A patient with seasonal allergies
D. A patient with uncomplicated myopia
Answer: B. A patient with diabetes, hypertension, and tobacco exposure
Rationale: Diabetes, hypertension, and tobacco use are major cardiovascular risk
factors. Risk assessment should also consider age, lipid levels, family history,
kidney disease, and other clinical factors.
, 7.
A patient presents with crushing chest pain, diaphoresis, and nausea. The ECG
demonstrates ST-segment elevation in contiguous leads. What condition is most
concerning?
A. STEMI
B. Stable angina
C. GERD
D. Costochondritis
Answer: A. STEMI
Rationale: ST-segment elevation in an appropriate clinical context is concerning
for ST-elevation myocardial infarction. This requires immediate emergency
management because myocardial salvage is highly time-dependent.
8.
Which cardiac biomarker is most specific for myocardial injury?
A. Troponin
B. BNP
C. D-dimer
D. CK-MB only
Answer: A. Troponin
Rationale: Cardiac troponins are highly sensitive and specific markers of
myocardial injury. An elevated troponin indicates myocardial injury but must be
interpreted with symptoms, ECG findings, and the clinical context to determine
whether acute coronary syndrome is present.
9.
A patient presents with sudden dyspnea, pleuritic chest pain, tachycardia, and
recent immobilization. Which diagnosis should be prioritized?
Questions and Answers with Rationales
Latest Versions
MSN 572 APEA 3P Practice Exam 2, covering
pathophysiology, pharmacology, and physical assessment
with answers and detailed rationales. These are practice-
style questions, not actual or proprietary APEA exam
questions.
1. 67-year-old patient presents with progressive exertional dyspnea, orthopnea, and
bilateral lower-extremity edema. Examination reveals an S3 gallop and bibasilar
crackles. Which condition best explains these findings?
A. Right-sided heart failure only
B. Left-sided systolic heart failure
C. Acute pericarditis
D. Pulmonary embolism
Answer: B. Left-sided systolic heart failure
Rationale: Left ventricular dysfunction causes pulmonary venous congestion,
producing dyspnea, orthopnea, and crackles. An S3 can reflect volume overload
and impaired ventricular function. Peripheral edema may develop as heart failure
progresses or when right-sided congestion accompanies left-sided disease.
2.
Which laboratory biomarker can support the diagnosis of heart failure in a patient
presenting with unexplained dyspnea?
A. BNP
B. Lipase
C. Amylase
D. ALT
,Answer: A. BNP
Rationale: B-type natriuretic peptide (BNP) and NT-proBNP are released in
response to myocardial wall stress. Elevated levels can support a diagnosis of heart
failure, although values must be interpreted in clinical context because renal
dysfunction, age, obesity, and other conditions can affect levels.
3.
A patient with heart failure is taking furosemide. Which assessment is most
important for detecting a common adverse effect?
A. Serum potassium
B. Serum bilirubin
C. Hemoglobin A1c
D. Platelet count
Answer: A. Serum potassium
Rationale: Furosemide increases urinary sodium and potassium excretion.
Hypokalemia can occur and may predispose the patient to cardiac arrhythmias.
Renal function and volume status should also be monitored.
4.
A patient with hypertension is prescribed amlodipine. Which adverse effect is
relatively common?
A. Peripheral edema
B. Severe hypoglycemia
C. Hyperkalemia
D. Pulmonary fibrosis
Answer: A. Peripheral edema
,Rationale: Dihydropyridine calcium channel blockers such as amlodipine
commonly cause peripheral edema due to arteriolar vasodilation. Other effects can
include flushing and headache.
5.
A patient taking atorvastatin reports unexplained severe muscle pain and weakness.
What is the most appropriate laboratory test to consider?
A. Creatine kinase
B. INR
C. TSH only
D. Serum amylase
Answer: A. Creatine kinase
Rationale: Significant muscle symptoms during statin therapy raise concern for
statin-associated myopathy or, rarely, rhabdomyolysis. Creatine kinase can help
assess the degree of muscle injury.
6.
Which patient is at greatest risk for developing atherosclerotic cardiovascular
disease?
A. A 22-year-old with no risk factors
B. A patient with diabetes, hypertension, and tobacco exposure
C. A patient with seasonal allergies
D. A patient with uncomplicated myopia
Answer: B. A patient with diabetes, hypertension, and tobacco exposure
Rationale: Diabetes, hypertension, and tobacco use are major cardiovascular risk
factors. Risk assessment should also consider age, lipid levels, family history,
kidney disease, and other clinical factors.
, 7.
A patient presents with crushing chest pain, diaphoresis, and nausea. The ECG
demonstrates ST-segment elevation in contiguous leads. What condition is most
concerning?
A. STEMI
B. Stable angina
C. GERD
D. Costochondritis
Answer: A. STEMI
Rationale: ST-segment elevation in an appropriate clinical context is concerning
for ST-elevation myocardial infarction. This requires immediate emergency
management because myocardial salvage is highly time-dependent.
8.
Which cardiac biomarker is most specific for myocardial injury?
A. Troponin
B. BNP
C. D-dimer
D. CK-MB only
Answer: A. Troponin
Rationale: Cardiac troponins are highly sensitive and specific markers of
myocardial injury. An elevated troponin indicates myocardial injury but must be
interpreted with symptoms, ECG findings, and the clinical context to determine
whether acute coronary syndrome is present.
9.
A patient presents with sudden dyspnea, pleuritic chest pain, tachycardia, and
recent immobilization. Which diagnosis should be prioritized?
