2026/2027
3P APEA Exam Comprehensive
Review and Practice Questions Study
Guide for Success 2026/2027 Version
Question 1
A nurse performs a visual acuity test using the Snellen chart. The patient reads 20/30
in the left eye and 20/40 in the right eye. What is the most appropriate nursing
interpretation?
A. Normal vision in both eyes
B. Immediate ophthalmic emergency
C. Mild visual impairment requiring further evaluation
D. Complete blindness in the right eye
Correct Answer: C. Mild visual impairment requiring further evaluation
Rationale: Visual acuity of 20/20 is considered normal. A result of 20/30 and 20/40
indicates reduced visual acuity, meaning the patient sees at 20 feet what a normal eye
sees at 30–40 feet. While not an emergency, these findings require further evaluation
to determine underlying causes such as refractive errors or early ocular disease.
Complete blindness would be far worse (e.g., no light perception).
Question 2
A nurse suspects Munchausen syndrome by proxy in a hospitalized child. Which
finding supports this diagnosis?
A. Child refuses school attendance
B. Caregiver repeatedly induces or fabricates illness in the child
C. Child has confirmed genetic disorder
D. Child shows normal growth and development
Correct Answer: B. Caregiver repeatedly induces or fabricates illness in the
child
Rationale: Munchausen syndrome by proxy is a form of abuse in which a caregiver
deliberately causes or exaggerates illness in a dependent to gain attention. The child’s
symptoms are often inconsistent or unexplained. The other options do not describe
caregiver-induced illness.
Question 3
,2026/2027
A patient reports fatigue and low mood after starting a new antidepressant affecting
serotonin and norepinephrine. What is the most appropriate interpretation?
A. Expected therapeutic improvement
B. Medication-related side effect contributing to depressive symptoms
C. Allergic reaction
D. Antipsychotic toxicity
Correct Answer: B. Medication-related side effect contributing to depressive
symptoms
Rationale: Antidepressants affecting serotonin and norepinephrine can initially cause
side effects such as fatigue, mood changes, or worsening depressive symptoms before
therapeutic effects occur. These are not allergic reactions or toxicity unless severe
systemic symptoms appear.
Question 4
A nurse observes a dark, raised lesion with irregular borders and asymmetry on a
patient’s skin. What condition is most likely?
A. Basal cell carcinoma
B. Melanoma
C. Seborrheic keratosis
D. Lipoma
Correct Answer: B. Melanoma
Rationale: Melanoma typically presents as an asymmetrical, irregularly bordered, and
variably pigmented lesion. It is more dangerous than basal cell carcinoma or benign
lesions like lipomas or seborrheic keratosis.
Question 5
A patient presents with puffy, non-pitting periorbital edema. Which condition is most
strongly associated with this finding?
A. Liver cirrhosis
B. Nephrotic syndrome
C. Heart failure
D. Hyperthyroidism
Correct Answer: B. Nephrotic syndrome
Rationale: Nephrotic syndrome causes protein loss in urine leading to
hypoalbuminemia and fluid shifts, resulting in periorbital edema. Cardiac and hepatic
causes typically produce dependent or generalized edema rather than isolated
periorbital swelling.
,2026/2027
Question 6
Which medication is commonly used off-label for migraine prophylaxis?
A. Amitriptyline
B. Morphine
C. Ibuprofen
D. Furosemide
Correct Answer: A. Amitriptyline
Rationale: Amitriptyline, a tricyclic antidepressant, is commonly used off-label to
prevent migraines by modulating neurotransmitters involved in pain pathways.
Opioids and diuretics are not used for prophylaxis.
Question 7
A patient has round patches of alopecia with scaling on the scalp. Which condition is
most likely?
A. Psoriasis
B. Tinea capitis
C. Alopecia areata
D. Contact dermatitis
Correct Answer: B. Tinea capitis
Rationale: Tinea capitis is a fungal infection causing scaly patches and hair loss,
especially in children. Alopecia areata is non-scarring and non-scaly.
Question 8
Which patient should be advised against using combined hormonal contraceptives?
A. Healthy 25-year-old nonsmoker
B. Woman over 45 who smokes
C. Woman with mild acne
D. Woman with seasonal allergies
Correct Answer: B. Woman over 45 who smokes
Rationale: Combined hormonal contraceptives increase thromboembolic risk,
especially in smokers over 35–40 years. Other conditions listed are not absolute
contraindications.
, 2026/2027
Question 9
A pregnant woman is Rh-negative. When should Rho(D) immunoglobulin be
administered?
A. At delivery only
B. At 12 weeks gestation
C. At 28 weeks gestation
D. After every ultrasound
Correct Answer: C. At 28 weeks gestation
Rationale: Rh-negative mothers receive Rho(D) immunoglobulin at 28 weeks and
again postpartum if the newborn is Rh-positive to prevent hemolytic disease of the
newborn.
Question 10
What does mean corpuscular volume (MCV) measure?
A. Hemoglobin concentration
B. White blood cell count
C. Size of red blood cells
D. Platelet function
Correct Answer: C. Size of red blood cells
Rationale: MCV reflects RBC size. Low MCV indicates microcytic anemia (e.g., iron
deficiency), while high MCV indicates macrocytic anemia (e.g., B12 deficiency).
Question 11
Which medication should be avoided for migraine prophylaxis due to adverse effects?
A. Venlafaxine
B. Propranolol
C. Amitriptyline
D. Topiramate
Correct Answer: A. Venlafaxine
Rationale: Venlafaxine can increase risk of serotonin-related adverse effects and is
not preferred for migraine prophylaxis in many patients. Other listed drugs are
commonly used preventive agents.
Question 12
3P APEA Exam Comprehensive
Review and Practice Questions Study
Guide for Success 2026/2027 Version
Question 1
A nurse performs a visual acuity test using the Snellen chart. The patient reads 20/30
in the left eye and 20/40 in the right eye. What is the most appropriate nursing
interpretation?
A. Normal vision in both eyes
B. Immediate ophthalmic emergency
C. Mild visual impairment requiring further evaluation
D. Complete blindness in the right eye
Correct Answer: C. Mild visual impairment requiring further evaluation
Rationale: Visual acuity of 20/20 is considered normal. A result of 20/30 and 20/40
indicates reduced visual acuity, meaning the patient sees at 20 feet what a normal eye
sees at 30–40 feet. While not an emergency, these findings require further evaluation
to determine underlying causes such as refractive errors or early ocular disease.
Complete blindness would be far worse (e.g., no light perception).
Question 2
A nurse suspects Munchausen syndrome by proxy in a hospitalized child. Which
finding supports this diagnosis?
A. Child refuses school attendance
B. Caregiver repeatedly induces or fabricates illness in the child
C. Child has confirmed genetic disorder
D. Child shows normal growth and development
Correct Answer: B. Caregiver repeatedly induces or fabricates illness in the
child
Rationale: Munchausen syndrome by proxy is a form of abuse in which a caregiver
deliberately causes or exaggerates illness in a dependent to gain attention. The child’s
symptoms are often inconsistent or unexplained. The other options do not describe
caregiver-induced illness.
Question 3
,2026/2027
A patient reports fatigue and low mood after starting a new antidepressant affecting
serotonin and norepinephrine. What is the most appropriate interpretation?
A. Expected therapeutic improvement
B. Medication-related side effect contributing to depressive symptoms
C. Allergic reaction
D. Antipsychotic toxicity
Correct Answer: B. Medication-related side effect contributing to depressive
symptoms
Rationale: Antidepressants affecting serotonin and norepinephrine can initially cause
side effects such as fatigue, mood changes, or worsening depressive symptoms before
therapeutic effects occur. These are not allergic reactions or toxicity unless severe
systemic symptoms appear.
Question 4
A nurse observes a dark, raised lesion with irregular borders and asymmetry on a
patient’s skin. What condition is most likely?
A. Basal cell carcinoma
B. Melanoma
C. Seborrheic keratosis
D. Lipoma
Correct Answer: B. Melanoma
Rationale: Melanoma typically presents as an asymmetrical, irregularly bordered, and
variably pigmented lesion. It is more dangerous than basal cell carcinoma or benign
lesions like lipomas or seborrheic keratosis.
Question 5
A patient presents with puffy, non-pitting periorbital edema. Which condition is most
strongly associated with this finding?
A. Liver cirrhosis
B. Nephrotic syndrome
C. Heart failure
D. Hyperthyroidism
Correct Answer: B. Nephrotic syndrome
Rationale: Nephrotic syndrome causes protein loss in urine leading to
hypoalbuminemia and fluid shifts, resulting in periorbital edema. Cardiac and hepatic
causes typically produce dependent or generalized edema rather than isolated
periorbital swelling.
,2026/2027
Question 6
Which medication is commonly used off-label for migraine prophylaxis?
A. Amitriptyline
B. Morphine
C. Ibuprofen
D. Furosemide
Correct Answer: A. Amitriptyline
Rationale: Amitriptyline, a tricyclic antidepressant, is commonly used off-label to
prevent migraines by modulating neurotransmitters involved in pain pathways.
Opioids and diuretics are not used for prophylaxis.
Question 7
A patient has round patches of alopecia with scaling on the scalp. Which condition is
most likely?
A. Psoriasis
B. Tinea capitis
C. Alopecia areata
D. Contact dermatitis
Correct Answer: B. Tinea capitis
Rationale: Tinea capitis is a fungal infection causing scaly patches and hair loss,
especially in children. Alopecia areata is non-scarring and non-scaly.
Question 8
Which patient should be advised against using combined hormonal contraceptives?
A. Healthy 25-year-old nonsmoker
B. Woman over 45 who smokes
C. Woman with mild acne
D. Woman with seasonal allergies
Correct Answer: B. Woman over 45 who smokes
Rationale: Combined hormonal contraceptives increase thromboembolic risk,
especially in smokers over 35–40 years. Other conditions listed are not absolute
contraindications.
, 2026/2027
Question 9
A pregnant woman is Rh-negative. When should Rho(D) immunoglobulin be
administered?
A. At delivery only
B. At 12 weeks gestation
C. At 28 weeks gestation
D. After every ultrasound
Correct Answer: C. At 28 weeks gestation
Rationale: Rh-negative mothers receive Rho(D) immunoglobulin at 28 weeks and
again postpartum if the newborn is Rh-positive to prevent hemolytic disease of the
newborn.
Question 10
What does mean corpuscular volume (MCV) measure?
A. Hemoglobin concentration
B. White blood cell count
C. Size of red blood cells
D. Platelet function
Correct Answer: C. Size of red blood cells
Rationale: MCV reflects RBC size. Low MCV indicates microcytic anemia (e.g., iron
deficiency), while high MCV indicates macrocytic anemia (e.g., B12 deficiency).
Question 11
Which medication should be avoided for migraine prophylaxis due to adverse effects?
A. Venlafaxine
B. Propranolol
C. Amitriptyline
D. Topiramate
Correct Answer: A. Venlafaxine
Rationale: Venlafaxine can increase risk of serotonin-related adverse effects and is
not preferred for migraine prophylaxis in many patients. Other listed drugs are
commonly used preventive agents.
Question 12
