APEA 3P ACTUAL EXAM TEST BANK | 2026 UPDATE VERSION
COMPREHENSIVE 150+ QUESTION PRACTICE EXAM WITH
MULTIPLE CHOICES, CORRECT ANSWERS WELL ELABORATED
RATIONALES.
SECTION 1: CARDIOVASCULAR SYSTEM
1. A 67-year-old woman with a history of A-fib and an ejection fraction of 48% has had normal digoxin
levels. Which can cause a decrease of digoxin level?
a) Decreased creatinine clearance
b) Weight loss
c) Increased exercise
d) Regular use of antacids
ANSWER: d) Regular use of antacids
Rationale: Antacids can decrease digoxin absorption, lowering serum levels by binding to the medication
in the GI tract.
2. A 55-year-old male with hypertension presents with a new onset of chest pain. Which finding is most
concerning for acute coronary syndrome?
a) Pain that worsens with deep inspiration
,b) Pain that is reproducible with palpation
c) Pain radiating to the left arm with diaphoresis
d) Pain that improves with sitting forward
ANSWER: c) Pain radiating to the left arm with diaphoresis
Rationale: Chest pain radiating to the left arm with diaphoresis is classic for acute coronary syndrome/
myocardial infarction.
3. Which medication is first-line therapy for heart failure with reduced ejection fraction (HFrEF)?
a) Digoxin
b) Metoprolol succinate
c) Amiodarone
d) Diltiazem
ANSWER: b) Metoprolol succinate
Rationale: Beta-blockers (metoprolol succinate, carvedilol, bisoprolol) are first-line therapy for HFrEF
along with ACE inhibitors/ARBs.
4. A patient presents with a blood pressure of 180/110 mmHg. The patient denies symptoms. What is
the most appropriate initial management?
a) Admit to hospital for IV antihypertensive therapy
,b) Start oral antihypertensive and follow up in 1 week
c) Recheck blood pressure in 30 minutes
d) Start two antihypertensive medications immediately
ANSWER: c) Recheck blood pressure in 30 minutes
Rationale: Asymptomatic severe hypertension should be confirmed with repeat measurement before
initiating treatment.
5. Which ECG finding is most indicative of prior myocardial infarction?
a) ST-segment elevation
b) Pathologic Q waves
c) Peaked T waves
d) Prolonged PR interval
ANSWER: b) Pathologic Q waves
Rationale: Pathologic Q waves indicate previous myocardial infarction with transmural necrosis.
6. A 72-year-old with peripheral artery disease complains of leg pain that occurs with walking and
resolves with rest. This is known as:
, a) Rest pain
b) Intermittent claudication
c) Venous insufficiency
d) Neuropathic pain
ANSWER: b) Intermittent claudication
Rationale: Intermittent claudication is exertional muscle pain that resolves with rest, classic for
peripheral artery disease.
7. Which finding is associated with right-sided heart failure?
a) Pulmonary crackles
b) Jugular venous distention
c) Orthopnea
d) Paroxysmal nocturnal dyspnea
ANSWER: b) Jugular venous distention
Rationale: Right-sided heart failure presents with JVD, peripheral edema, and hepatomegaly due to fluid
backup.
8. A patient with atrial fibrillation is at highest risk for which complication?
COMPREHENSIVE 150+ QUESTION PRACTICE EXAM WITH
MULTIPLE CHOICES, CORRECT ANSWERS WELL ELABORATED
RATIONALES.
SECTION 1: CARDIOVASCULAR SYSTEM
1. A 67-year-old woman with a history of A-fib and an ejection fraction of 48% has had normal digoxin
levels. Which can cause a decrease of digoxin level?
a) Decreased creatinine clearance
b) Weight loss
c) Increased exercise
d) Regular use of antacids
ANSWER: d) Regular use of antacids
Rationale: Antacids can decrease digoxin absorption, lowering serum levels by binding to the medication
in the GI tract.
2. A 55-year-old male with hypertension presents with a new onset of chest pain. Which finding is most
concerning for acute coronary syndrome?
a) Pain that worsens with deep inspiration
,b) Pain that is reproducible with palpation
c) Pain radiating to the left arm with diaphoresis
d) Pain that improves with sitting forward
ANSWER: c) Pain radiating to the left arm with diaphoresis
Rationale: Chest pain radiating to the left arm with diaphoresis is classic for acute coronary syndrome/
myocardial infarction.
3. Which medication is first-line therapy for heart failure with reduced ejection fraction (HFrEF)?
a) Digoxin
b) Metoprolol succinate
c) Amiodarone
d) Diltiazem
ANSWER: b) Metoprolol succinate
Rationale: Beta-blockers (metoprolol succinate, carvedilol, bisoprolol) are first-line therapy for HFrEF
along with ACE inhibitors/ARBs.
4. A patient presents with a blood pressure of 180/110 mmHg. The patient denies symptoms. What is
the most appropriate initial management?
a) Admit to hospital for IV antihypertensive therapy
,b) Start oral antihypertensive and follow up in 1 week
c) Recheck blood pressure in 30 minutes
d) Start two antihypertensive medications immediately
ANSWER: c) Recheck blood pressure in 30 minutes
Rationale: Asymptomatic severe hypertension should be confirmed with repeat measurement before
initiating treatment.
5. Which ECG finding is most indicative of prior myocardial infarction?
a) ST-segment elevation
b) Pathologic Q waves
c) Peaked T waves
d) Prolonged PR interval
ANSWER: b) Pathologic Q waves
Rationale: Pathologic Q waves indicate previous myocardial infarction with transmural necrosis.
6. A 72-year-old with peripheral artery disease complains of leg pain that occurs with walking and
resolves with rest. This is known as:
, a) Rest pain
b) Intermittent claudication
c) Venous insufficiency
d) Neuropathic pain
ANSWER: b) Intermittent claudication
Rationale: Intermittent claudication is exertional muscle pain that resolves with rest, classic for
peripheral artery disease.
7. Which finding is associated with right-sided heart failure?
a) Pulmonary crackles
b) Jugular venous distention
c) Orthopnea
d) Paroxysmal nocturnal dyspnea
ANSWER: b) Jugular venous distention
Rationale: Right-sided heart failure presents with JVD, peripheral edema, and hepatomegaly due to fluid
backup.
8. A patient with atrial fibrillation is at highest risk for which complication?
