APEA PMHNP 3P Exam Prep –
Comprehensive Study Guide (2025/2026)
— Verified Content (150 Questions &
Answers | Psychiatric-Mental Health NP
Certification | Predictor Exam)
Section 1: Physical Assessment (Questions 1-50)
Q1. During a physical assessment of a 45-year-old female with right upper quadrant pain, the NP asks
the patient to take a deep breath while palpating under the right costal margin. The patient abruptly
stops mid-inspiration due to pain. What is this sign called?
A) Rovsing sign
B) Murphy sign
C) Psoas sign
D) Grey Turner sign
Answer: B) Murphy sign
Rationale: A positive Murphy sign occurs when the inflamed gallbladder descends and hits the
examiner's fingers during inspiration, causing the patient to catch their breath. This is classic for acute
cholecystitis .
Q2. While assessing a patient with a suspected knee injury, you perform the McMurray test. A palpable
click during this maneuver suggests:
A) ACL tear
B) Meniscus tear
C) Collateral ligament strain
D) Patellar tendonitis
Answer: B) Meniscus tear
Rationale: The McMurray test involves rotating the lower leg while extending the knee. A click or pain
localized to the joint line suggests a meniscal injury .
Q3. During cardiac auscultation, you hear an extra heart sound just before S1. What is the most likely
interpretation?
A) S3 gallop (fluid overload)
B) S4 gallop (decreased ventricular compliance)
C) Mid-systolic click (mitral valve prolapse)
D) Pericardial friction rub
,Answer: B) S4 gallop
Rationale: S4 occurs during atrial contraction when blood is forced into a stiff, non-compliant ventricle—
commonly seen in long-standing hypertension or left ventricular hypertrophy .
Q4. A 79-year-old with appendicitis is unlikely to exhibit which finding?
A) Generalized abdominal pain
B) Initial WBC elevation
C) UTI symptoms
D) Low-grade fever
Answer: B) Initial WBC elevation
Rationale: Elderly adults are less likely to have initial WBC elevations with appendicitis, making diagnosis
easily missed in this population .
Q5. An 84-year-old complains of fecal incontinence. A likely underlying cause is:
A) Inactivity
B) Constipation
C) Poor fluid consumption
D) Medication-related
Answer: B) Constipation
Rationale: Underlying constipation is a common cause of fecal incontinence in older adults. Risk factors
include age >80, impaired mobility, and neurologic disorders .
Q6. A 75-year-old male with poorly controlled hypertension for over 10 years has likely experienced a
shift in his point of maximal impulse (PMI). Where is the most likely new location?
A) 5th ICS, midclavicular line
B) 8th ICS, midclavicular line
C) 5th ICS, left of midclavicular line
D) 6th ICS, right of midclavicular line
Answer: C) 5th ICS, left of MCL
Rationale: Chronic hypertension causes left ventricular hypertrophy (LVH). The hypertrophied left
ventricle shifts the PMI laterally and inferiorly .
Q7. A heart murmur is heard best at the apex with the bell, radiating to the axilla. It is holosystolic. What
is the most likely diagnosis?
A) Aortic stenosis
B) Mitral regurgitation
C) Mitral stenosis
D) Aortic regurgitation
Answer: B) Mitral regurgitation
Rationale: Holosystolic, apical murmur radiating to the axilla is classic for mitral regurgitation. Aortic
stenosis is systolic at 2nd RICS radiating to carotids .
,Q8. A 58-year-old male with hypertension presents with acute onset of tearing chest pain radiating to
the back. BP is 160/100 in right arm, 100/70 in left arm. What is the most likely diagnosis?
A) Acute MI
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Rationale: Tearing chest pain radiating to the back with unequal BP in arms is classic for aortic
dissection .
Q9. A patient with pneumonia has hyponatremia (Na 120) and low serum osmolality. What is the likely
organism?
A) Mycoplasma
B) Legionella
C) Streptococcus pneumoniae
D) Chlamydia psittaci
Answer: B) Legionella
Rationale: Legionella pneumophila causes hyponatremia due to SIADH-like physiology. Other atypical
pneumonias are less commonly associated with this finding .
Q10. A patient has an FEV1/FVC ratio of 55% and FEV1 45% of predicted. What is the GOLD stage of
COPD?
A) Mild
B) Moderate
C) Severe
D) Very severe
Answer: C) Severe
Rationale: GOLD classification: FEV1 30-49% predicted = severe (GOLD stage 3) .
Q11. The "drawer sign" during knee exam assesses:
A) Meniscal integrity
B) Cruciate ligament integrity
C) Collateral ligament integrity
D) Patellar tracking
Answer: B) Cruciate ligament integrity
Rationale: The anterior/posterior drawer test assesses the ACL and PCL .
Q12. A patient presents with periorbital erythema and edema, fever, and nasal drainage. What is the
priority action?
A) Oral antihistamines
B) CT scan of sinuses
, C) Aggressive antibiotic therapy
D) Warm compresses
Answer: C) Aggressive antibiotic therapy
Rationale: Periorbital (preseptal) cellulitis requires prompt antibiotic treatment to prevent spread to the
orbit and intracranial complications .
Q13. A patient presents with periorbital edema that is worse in the morning, frothy urine, and fatigue.
What is the most likely diagnosis?
A) Allergic conjunctivitis
B) Nephrotic syndrome
C) Orbital cellulitis
D) Sinusitis
Answer: B) Nephrotic syndrome
Rationale: Periorbital edema upon awakening with frothy urine suggests proteinuria and nephrotic
syndrome .
Q14. A patient has a history of stage 3 chronic kidney disease. Anemia in this patient is most likely
caused by:
A) Iron deficiency
B) Vitamin B12 deficiency
C) Reduced erythropoietin production
D) Hemolysis
Answer: C) Reduced erythropoietin production
Rationale: As kidney function declines, erythropoietin production decreases, leading to normocytic,
normochromic anemia .
Q15. A 43-year-old male presents with a large and painful furuncle, the third one in 6 months. What
should the NP do?
A) Incision and drainage
B) Prescribe prophylactic antibiotics
C) Evaluate for diabetes or immune deficiency
D) Prescribe antibiotic based on culture
Answer: B) Prescribe prophylactic antibiotics (EXCEPTION - this is the one NOT to do)
Rationale: Routine prophylactic antibiotics are not indicated for recurrent furunculosis. Focus on
treating acute lesions and identifying underlying causes .
Q16. A 16-year-old athlete complains of pain under his heel. Exam reveals a verrucous lesion level with
the skin. What intervention is appropriate?
A) Oral antifungal
B) Systemic antibiotic
C) Corticosteroid injection
D) Salicylic acid plasters
Comprehensive Study Guide (2025/2026)
— Verified Content (150 Questions &
Answers | Psychiatric-Mental Health NP
Certification | Predictor Exam)
Section 1: Physical Assessment (Questions 1-50)
Q1. During a physical assessment of a 45-year-old female with right upper quadrant pain, the NP asks
the patient to take a deep breath while palpating under the right costal margin. The patient abruptly
stops mid-inspiration due to pain. What is this sign called?
A) Rovsing sign
B) Murphy sign
C) Psoas sign
D) Grey Turner sign
Answer: B) Murphy sign
Rationale: A positive Murphy sign occurs when the inflamed gallbladder descends and hits the
examiner's fingers during inspiration, causing the patient to catch their breath. This is classic for acute
cholecystitis .
Q2. While assessing a patient with a suspected knee injury, you perform the McMurray test. A palpable
click during this maneuver suggests:
A) ACL tear
B) Meniscus tear
C) Collateral ligament strain
D) Patellar tendonitis
Answer: B) Meniscus tear
Rationale: The McMurray test involves rotating the lower leg while extending the knee. A click or pain
localized to the joint line suggests a meniscal injury .
Q3. During cardiac auscultation, you hear an extra heart sound just before S1. What is the most likely
interpretation?
A) S3 gallop (fluid overload)
B) S4 gallop (decreased ventricular compliance)
C) Mid-systolic click (mitral valve prolapse)
D) Pericardial friction rub
,Answer: B) S4 gallop
Rationale: S4 occurs during atrial contraction when blood is forced into a stiff, non-compliant ventricle—
commonly seen in long-standing hypertension or left ventricular hypertrophy .
Q4. A 79-year-old with appendicitis is unlikely to exhibit which finding?
A) Generalized abdominal pain
B) Initial WBC elevation
C) UTI symptoms
D) Low-grade fever
Answer: B) Initial WBC elevation
Rationale: Elderly adults are less likely to have initial WBC elevations with appendicitis, making diagnosis
easily missed in this population .
Q5. An 84-year-old complains of fecal incontinence. A likely underlying cause is:
A) Inactivity
B) Constipation
C) Poor fluid consumption
D) Medication-related
Answer: B) Constipation
Rationale: Underlying constipation is a common cause of fecal incontinence in older adults. Risk factors
include age >80, impaired mobility, and neurologic disorders .
Q6. A 75-year-old male with poorly controlled hypertension for over 10 years has likely experienced a
shift in his point of maximal impulse (PMI). Where is the most likely new location?
A) 5th ICS, midclavicular line
B) 8th ICS, midclavicular line
C) 5th ICS, left of midclavicular line
D) 6th ICS, right of midclavicular line
Answer: C) 5th ICS, left of MCL
Rationale: Chronic hypertension causes left ventricular hypertrophy (LVH). The hypertrophied left
ventricle shifts the PMI laterally and inferiorly .
Q7. A heart murmur is heard best at the apex with the bell, radiating to the axilla. It is holosystolic. What
is the most likely diagnosis?
A) Aortic stenosis
B) Mitral regurgitation
C) Mitral stenosis
D) Aortic regurgitation
Answer: B) Mitral regurgitation
Rationale: Holosystolic, apical murmur radiating to the axilla is classic for mitral regurgitation. Aortic
stenosis is systolic at 2nd RICS radiating to carotids .
,Q8. A 58-year-old male with hypertension presents with acute onset of tearing chest pain radiating to
the back. BP is 160/100 in right arm, 100/70 in left arm. What is the most likely diagnosis?
A) Acute MI
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Rationale: Tearing chest pain radiating to the back with unequal BP in arms is classic for aortic
dissection .
Q9. A patient with pneumonia has hyponatremia (Na 120) and low serum osmolality. What is the likely
organism?
A) Mycoplasma
B) Legionella
C) Streptococcus pneumoniae
D) Chlamydia psittaci
Answer: B) Legionella
Rationale: Legionella pneumophila causes hyponatremia due to SIADH-like physiology. Other atypical
pneumonias are less commonly associated with this finding .
Q10. A patient has an FEV1/FVC ratio of 55% and FEV1 45% of predicted. What is the GOLD stage of
COPD?
A) Mild
B) Moderate
C) Severe
D) Very severe
Answer: C) Severe
Rationale: GOLD classification: FEV1 30-49% predicted = severe (GOLD stage 3) .
Q11. The "drawer sign" during knee exam assesses:
A) Meniscal integrity
B) Cruciate ligament integrity
C) Collateral ligament integrity
D) Patellar tracking
Answer: B) Cruciate ligament integrity
Rationale: The anterior/posterior drawer test assesses the ACL and PCL .
Q12. A patient presents with periorbital erythema and edema, fever, and nasal drainage. What is the
priority action?
A) Oral antihistamines
B) CT scan of sinuses
, C) Aggressive antibiotic therapy
D) Warm compresses
Answer: C) Aggressive antibiotic therapy
Rationale: Periorbital (preseptal) cellulitis requires prompt antibiotic treatment to prevent spread to the
orbit and intracranial complications .
Q13. A patient presents with periorbital edema that is worse in the morning, frothy urine, and fatigue.
What is the most likely diagnosis?
A) Allergic conjunctivitis
B) Nephrotic syndrome
C) Orbital cellulitis
D) Sinusitis
Answer: B) Nephrotic syndrome
Rationale: Periorbital edema upon awakening with frothy urine suggests proteinuria and nephrotic
syndrome .
Q14. A patient has a history of stage 3 chronic kidney disease. Anemia in this patient is most likely
caused by:
A) Iron deficiency
B) Vitamin B12 deficiency
C) Reduced erythropoietin production
D) Hemolysis
Answer: C) Reduced erythropoietin production
Rationale: As kidney function declines, erythropoietin production decreases, leading to normocytic,
normochromic anemia .
Q15. A 43-year-old male presents with a large and painful furuncle, the third one in 6 months. What
should the NP do?
A) Incision and drainage
B) Prescribe prophylactic antibiotics
C) Evaluate for diabetes or immune deficiency
D) Prescribe antibiotic based on culture
Answer: B) Prescribe prophylactic antibiotics (EXCEPTION - this is the one NOT to do)
Rationale: Routine prophylactic antibiotics are not indicated for recurrent furunculosis. Focus on
treating acute lesions and identifying underlying causes .
Q16. A 16-year-old athlete complains of pain under his heel. Exam reveals a verrucous lesion level with
the skin. What intervention is appropriate?
A) Oral antifungal
B) Systemic antibiotic
C) Corticosteroid injection
D) Salicylic acid plasters
