1
APEA 3P EXAM FINAL VERSION 2026/2027
Complete Predictive Exam Package | Actual
Questions & Verified Answers | Nurse
Practitioner Board Preparation | Pass Guarantee
Section 1: Advanced Pathophysiology
Q1: In heart failure with reduced ejection fraction (HFrEF), the primary pathophysiologic
mechanism is:
A. Impaired ventricular contraction and systolic function
B. Impaired ventricular relaxation and diastolic filling
C. Isolated right ventricular dysfunction
D. Pericardial constriction
Answer: A
Verified Rationale: HFrEF is defined by reduced myocardial contractility leading to a decreased
ejection fraction, distinguishing it from HFpEF which is characterized by diastolic dysfunction.
Q2: Which pathophysiological process underlies the development of neuropathic pain in diabetic
peripheral neuropathy?
A. Inflammatory mediator release
B. Nerve fiber damage and dysfunctional nociceptive signaling
C. Muscle spasm and tension
D. Vascular compression
Answer: B
Verified Rationale: Metabolic injury to peripheral nerves in diabetes causes direct axonal damage
and aberrant sodium-channel expression, resulting in maladaptive pain signaling.
Q3: The central driver of aldosterone hypersecretion in primary hyperaldosteronism is:
A. ACTH overstimulation
B. Autonomous adrenal cortical adenoma secretion
C. Renal artery stenosis
D. Left ventricular stretch
Answer: B
Verified Rationale: An aldosterone-producing adenoma autonomously secretes aldosterone
independent of renin-angiotensin feedback, causing hypertension and hypokalemia.
,2
Q4: Which cellular adaptation best explains left ventricular hypertrophy in chronic aortic
stenosis?
A. Dysplasia
B. Hyperplasia
C. Hypertrophy
D. Metaplasia
Answer: C
Verified Rationale: Pressure overload increases cardiomyocyte size (hypertrophy) without an
increase in cell number, enhancing wall stress compensation.
Q5: In obstructive sleep apnea, intermittent hypoxemia leads to sustained sympathetic activation
primarily through:
A. Carotid body chemoreceptor stimulation
B. Pulmonary stretch receptor inhibition
C. Medullary respiratory center fatigue
D. Cortical desynchronization
Answer: A
Verified Rationale: Repetitive nocturnal desaturations activate carotid body chemoreceptors,
triggering reflex catecholamine surges that perpetuate hypertension.
Q6: Which inflammatory cytokine is most responsible for systemic capillary leak in septic
shock?
A. IL-10
B. TNF-α
C. IL-4
D. TGF-β
Answer: B
Verified Rationale: TNF-α disrupts endothelial tight junctions, increasing vascular permeability
and precipitating distributive shock.
Q7: The pathogenesis of hepatic encephalopathy centers on impaired clearance of:
A. Bilirubin
B. Gamma-aminobutyric acid
C. Ammonia
D. Lactate
Answer: C
Verified Rationale: Cirrhotic livers cannot convert ammonia to urea, allowing neurotoxic levels
that alter astrocyte osmoregulation and neurotransmission.
,3
Q8: Which mechanism precipitates acute gouty arthritis?
A. Calcium pyrophosphate crystal phagocytosis
B. Monosodium urate crystal deposition in synovium
C. Antibody-mediated joint destruction
D. Septic bacterial seeding
Answer: B
Verified Rationale: Supersaturation of urate in joint fluid forms needle-shaped crystals that incite
NLRP3 inflammasome activation and neutrophil influx.
Q9: In chronic kidney disease, secondary hyperparathyroidism arises chiefly because of:
A. Phosphate retention and decreased ionized calcium
B. Excessive vitamin D synthesis
C. Aldosterone excess
D. Magnesium deficiency
Answer: A
Verified Rationale: Hyperphosphatemia complexes with calcium, lowering serum ionized
calcium and stimulating parathyroid hormone secretion.
Q10: Which pathologic finding characterizes ulcerative colitis but not Crohn disease?
A. Transmural fissuring
B. Non-caseating granulomas
C. Continuous mucosal inflammation starting in rectum
D. Skip lesions
Answer: C
Verified Rationale: Ulcerative colitis exhibits diffuse superficial inflammation extending
proximally from the rectum without skip areas or granulomas.
Q11: The primary acid–base abnormality in acute aspirin overdose is:
A. Metabolic alkalosis
B. Respiratory alkalosis followed by metabolic acidosis
C. Metabolic acidosis with respiratory acidosis
D. Isolated respiratory acidosis
Answer: B
Verified Rationale: Salicylate directly stimulates medullary respiratory centers causing
hyperventilation, then uncouples oxidative phosphorylation producing lactic acid.
Q12: Which vascular change underlies the formation of a granuloma in pulmonary sarcoidosis?
A. Fibrinoid necrosis of arterioles
B. Non-caseating epithelioid cell aggregation around CD4+ T cells
, 4
C. Lipid-laden macrophage infiltration
D. Transmural eosinophilic vasculitis
Answer: B
Verified Rationale: Sarcoidosis is driven by TH1-mediated inflammation forming tight
collections of epithelioid histiocytes without central necrosis.
Q13: In multiple sclerosis, demyelination is primarily mediated by:
A. Autoantibodies against myelin basic protein
B. CD8+ cytotoxic T-cell attack on oligodendrocytes
C. Microglial phagocytosis of axons
D. Complement membrane attack complex
Answer: B
Verified Rationale: Autoreactive cytotoxic T lymphocytes cross the blood–brain barrier and
destroy myelin-producing oligodendrocytes.
Q14: Which hemodynamic parameter is most elevated in cor pulmonale?
A. Left atrial pressure
B. Pulmonary artery pressure
C. Central venous pressure
D. Aortic pulse pressure
Answer: B
Verified Rationale: Chronic hypoxic pulmonary vasoconstriction increases pulmonary vascular
resistance, leading to right ventricular afterload.
Q15: The biochemical hallmark of pheochromocytoma is excessive secretion of:
A. Cortisol
B. Catecholamines
C. Aldosterone
D. Vasopressin
Answer: B
Verified Rationale: Chromaffin cells of the adrenal medulla autonomously release epinephrine
and norepinephrine, causing episodic hypertension.
Section 2: Pharmacology for Nurse Practitioners
Q16: When initiating metformin for a newly diagnosed type 2 diabetic with eGFR 52
mL/min/1.73 m², the NP should:
A. Start 1000 mg ER nightly and reassess in one week
B. Limit total daily dose to 1000 mg and monitor renal function every 3–4 months
C. Avoid metformin completely
D. Combine with dapagliflozin at full dose
APEA 3P EXAM FINAL VERSION 2026/2027
Complete Predictive Exam Package | Actual
Questions & Verified Answers | Nurse
Practitioner Board Preparation | Pass Guarantee
Section 1: Advanced Pathophysiology
Q1: In heart failure with reduced ejection fraction (HFrEF), the primary pathophysiologic
mechanism is:
A. Impaired ventricular contraction and systolic function
B. Impaired ventricular relaxation and diastolic filling
C. Isolated right ventricular dysfunction
D. Pericardial constriction
Answer: A
Verified Rationale: HFrEF is defined by reduced myocardial contractility leading to a decreased
ejection fraction, distinguishing it from HFpEF which is characterized by diastolic dysfunction.
Q2: Which pathophysiological process underlies the development of neuropathic pain in diabetic
peripheral neuropathy?
A. Inflammatory mediator release
B. Nerve fiber damage and dysfunctional nociceptive signaling
C. Muscle spasm and tension
D. Vascular compression
Answer: B
Verified Rationale: Metabolic injury to peripheral nerves in diabetes causes direct axonal damage
and aberrant sodium-channel expression, resulting in maladaptive pain signaling.
Q3: The central driver of aldosterone hypersecretion in primary hyperaldosteronism is:
A. ACTH overstimulation
B. Autonomous adrenal cortical adenoma secretion
C. Renal artery stenosis
D. Left ventricular stretch
Answer: B
Verified Rationale: An aldosterone-producing adenoma autonomously secretes aldosterone
independent of renin-angiotensin feedback, causing hypertension and hypokalemia.
,2
Q4: Which cellular adaptation best explains left ventricular hypertrophy in chronic aortic
stenosis?
A. Dysplasia
B. Hyperplasia
C. Hypertrophy
D. Metaplasia
Answer: C
Verified Rationale: Pressure overload increases cardiomyocyte size (hypertrophy) without an
increase in cell number, enhancing wall stress compensation.
Q5: In obstructive sleep apnea, intermittent hypoxemia leads to sustained sympathetic activation
primarily through:
A. Carotid body chemoreceptor stimulation
B. Pulmonary stretch receptor inhibition
C. Medullary respiratory center fatigue
D. Cortical desynchronization
Answer: A
Verified Rationale: Repetitive nocturnal desaturations activate carotid body chemoreceptors,
triggering reflex catecholamine surges that perpetuate hypertension.
Q6: Which inflammatory cytokine is most responsible for systemic capillary leak in septic
shock?
A. IL-10
B. TNF-α
C. IL-4
D. TGF-β
Answer: B
Verified Rationale: TNF-α disrupts endothelial tight junctions, increasing vascular permeability
and precipitating distributive shock.
Q7: The pathogenesis of hepatic encephalopathy centers on impaired clearance of:
A. Bilirubin
B. Gamma-aminobutyric acid
C. Ammonia
D. Lactate
Answer: C
Verified Rationale: Cirrhotic livers cannot convert ammonia to urea, allowing neurotoxic levels
that alter astrocyte osmoregulation and neurotransmission.
,3
Q8: Which mechanism precipitates acute gouty arthritis?
A. Calcium pyrophosphate crystal phagocytosis
B. Monosodium urate crystal deposition in synovium
C. Antibody-mediated joint destruction
D. Septic bacterial seeding
Answer: B
Verified Rationale: Supersaturation of urate in joint fluid forms needle-shaped crystals that incite
NLRP3 inflammasome activation and neutrophil influx.
Q9: In chronic kidney disease, secondary hyperparathyroidism arises chiefly because of:
A. Phosphate retention and decreased ionized calcium
B. Excessive vitamin D synthesis
C. Aldosterone excess
D. Magnesium deficiency
Answer: A
Verified Rationale: Hyperphosphatemia complexes with calcium, lowering serum ionized
calcium and stimulating parathyroid hormone secretion.
Q10: Which pathologic finding characterizes ulcerative colitis but not Crohn disease?
A. Transmural fissuring
B. Non-caseating granulomas
C. Continuous mucosal inflammation starting in rectum
D. Skip lesions
Answer: C
Verified Rationale: Ulcerative colitis exhibits diffuse superficial inflammation extending
proximally from the rectum without skip areas or granulomas.
Q11: The primary acid–base abnormality in acute aspirin overdose is:
A. Metabolic alkalosis
B. Respiratory alkalosis followed by metabolic acidosis
C. Metabolic acidosis with respiratory acidosis
D. Isolated respiratory acidosis
Answer: B
Verified Rationale: Salicylate directly stimulates medullary respiratory centers causing
hyperventilation, then uncouples oxidative phosphorylation producing lactic acid.
Q12: Which vascular change underlies the formation of a granuloma in pulmonary sarcoidosis?
A. Fibrinoid necrosis of arterioles
B. Non-caseating epithelioid cell aggregation around CD4+ T cells
, 4
C. Lipid-laden macrophage infiltration
D. Transmural eosinophilic vasculitis
Answer: B
Verified Rationale: Sarcoidosis is driven by TH1-mediated inflammation forming tight
collections of epithelioid histiocytes without central necrosis.
Q13: In multiple sclerosis, demyelination is primarily mediated by:
A. Autoantibodies against myelin basic protein
B. CD8+ cytotoxic T-cell attack on oligodendrocytes
C. Microglial phagocytosis of axons
D. Complement membrane attack complex
Answer: B
Verified Rationale: Autoreactive cytotoxic T lymphocytes cross the blood–brain barrier and
destroy myelin-producing oligodendrocytes.
Q14: Which hemodynamic parameter is most elevated in cor pulmonale?
A. Left atrial pressure
B. Pulmonary artery pressure
C. Central venous pressure
D. Aortic pulse pressure
Answer: B
Verified Rationale: Chronic hypoxic pulmonary vasoconstriction increases pulmonary vascular
resistance, leading to right ventricular afterload.
Q15: The biochemical hallmark of pheochromocytoma is excessive secretion of:
A. Cortisol
B. Catecholamines
C. Aldosterone
D. Vasopressin
Answer: B
Verified Rationale: Chromaffin cells of the adrenal medulla autonomously release epinephrine
and norepinephrine, causing episodic hypertension.
Section 2: Pharmacology for Nurse Practitioners
Q16: When initiating metformin for a newly diagnosed type 2 diabetic with eGFR 52
mL/min/1.73 m², the NP should:
A. Start 1000 mg ER nightly and reassess in one week
B. Limit total daily dose to 1000 mg and monitor renal function every 3–4 months
C. Avoid metformin completely
D. Combine with dapagliflozin at full dose
