MSN 572 APEA 3P-style Practice Exam
Questions and Answers with Rationales
Latest Versions
1. A 68-year-old patient presents with fatigue, dizziness, and
palpitations. The ECG demonstrates atrial fibrillation with a ventricular
rate of 138/min. Which physiologic mechanism most directly explains
the patient's symptoms?
A. Increased ventricular filling time
B. Decreased cardiac output caused by loss of atrial contraction
C. Increased coronary perfusion
D. Increased stroke volume
Answer: B. Decreased cardiac output caused by loss of atrial
contraction
Rationale: Atrial fibrillation eliminates effective atrial contraction,
reducing ventricular filling and potentially decreasing cardiac output.
Rapid ventricular response further shortens diastolic filling time and can
produce fatigue, dizziness, and palpitations.
2. A patient taking lisinopril for hypertension should have which
laboratory value monitored most closely?
A. Calcium
B. Potassium
C. Hemoglobin
D. Platelets
Answer: B. Potassium
,Rationale: ACE inhibitors decrease aldosterone activity, which can
increase serum potassium. Renal function should also be monitored
because ACE inhibitors can increase creatinine, particularly in patients
with renal artery stenosis or underlying kidney disease.
3. A patient reports unilateral calf pain and swelling after a long-haul
flight. Which finding most strongly increases suspicion for deep-vein
thrombosis?
A. Bilateral ankle edema
B. Unilateral calf swelling and tenderness
C. Cool feet bilaterally
D. Bounding pedal pulses
Answer: B. Unilateral calf swelling and tenderness
Rationale: Acute unilateral swelling, warmth, tenderness, and erythema
are concerning for DVT. Bilateral edema is more commonly associated
with systemic causes such as heart failure or venous insufficiency.
4. During an abdominal examination, the NP hears high-pitched,
frequent bowel sounds accompanied by intermittent abdominal
cramping. Which condition should be suspected?
A. Paralytic ileus
B. Intestinal obstruction
C. Acute pancreatitis
D. Hepatitis
Answer: B. Intestinal obstruction
Rationale: Early mechanical bowel obstruction can produce high-
pitched, hyperactive bowel sounds as intestinal contents attempt to pass
,the obstruction. A prolonged obstruction may eventually result in
decreased or absent bowel sounds.
5. Which physical examination finding is most characteristic of left-
sided heart failure?
A. Ascites
B. Jugular venous distention
C. Pulmonary crackles
D. Peripheral cyanosis only
Answer: C. Pulmonary crackles
Rationale: Left ventricular failure causes pulmonary venous congestion
and fluid accumulation in the lungs, producing dyspnea and crackles,
particularly at the lung bases. Right-sided failure more commonly causes
peripheral edema, JVD, and hepatomegaly.
6. A patient with type 1 diabetes develops nausea, vomiting, abdominal
pain, and deep, rapid respirations. Which acid-base disturbance is most
likely?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. High-anion-gap metabolic acidosis
Answer: D. High-anion-gap metabolic acidosis
Rationale: Diabetic ketoacidosis results from severe insulin deficiency,
leading to ketone production and metabolic acidosis. Kussmaul
respirations represent respiratory compensation for the metabolic
acidosis.
, 7. A patient taking warfarin requires routine monitoring of which
laboratory test?
A. aPTT
B. INR
C. Troponin
D. Serum amylase
Answer: B. INR
Rationale: The INR is used to monitor the anticoagulant effect of
warfarin and guide dosing. Unusually elevated values increase bleeding
risk.
8. Which finding is most consistent with hypothyroidism?
A. Heat intolerance
B. Weight loss
C. Tachycardia
D. Cold intolerance
Answer: D. Cold intolerance
Rationale: Hypothyroidism produces decreased metabolic activity.
Common findings include fatigue, weight gain, constipation, dry skin,
bradycardia, and cold intolerance.
9. A 54-year-old patient has persistent blood pressure readings of 158/96
mm Hg. Which initial assessment is most appropriate?
A. Assume the patient has secondary hypertension
B. Assess cardiovascular risk factors and confirm persistent
Questions and Answers with Rationales
Latest Versions
1. A 68-year-old patient presents with fatigue, dizziness, and
palpitations. The ECG demonstrates atrial fibrillation with a ventricular
rate of 138/min. Which physiologic mechanism most directly explains
the patient's symptoms?
A. Increased ventricular filling time
B. Decreased cardiac output caused by loss of atrial contraction
C. Increased coronary perfusion
D. Increased stroke volume
Answer: B. Decreased cardiac output caused by loss of atrial
contraction
Rationale: Atrial fibrillation eliminates effective atrial contraction,
reducing ventricular filling and potentially decreasing cardiac output.
Rapid ventricular response further shortens diastolic filling time and can
produce fatigue, dizziness, and palpitations.
2. A patient taking lisinopril for hypertension should have which
laboratory value monitored most closely?
A. Calcium
B. Potassium
C. Hemoglobin
D. Platelets
Answer: B. Potassium
,Rationale: ACE inhibitors decrease aldosterone activity, which can
increase serum potassium. Renal function should also be monitored
because ACE inhibitors can increase creatinine, particularly in patients
with renal artery stenosis or underlying kidney disease.
3. A patient reports unilateral calf pain and swelling after a long-haul
flight. Which finding most strongly increases suspicion for deep-vein
thrombosis?
A. Bilateral ankle edema
B. Unilateral calf swelling and tenderness
C. Cool feet bilaterally
D. Bounding pedal pulses
Answer: B. Unilateral calf swelling and tenderness
Rationale: Acute unilateral swelling, warmth, tenderness, and erythema
are concerning for DVT. Bilateral edema is more commonly associated
with systemic causes such as heart failure or venous insufficiency.
4. During an abdominal examination, the NP hears high-pitched,
frequent bowel sounds accompanied by intermittent abdominal
cramping. Which condition should be suspected?
A. Paralytic ileus
B. Intestinal obstruction
C. Acute pancreatitis
D. Hepatitis
Answer: B. Intestinal obstruction
Rationale: Early mechanical bowel obstruction can produce high-
pitched, hyperactive bowel sounds as intestinal contents attempt to pass
,the obstruction. A prolonged obstruction may eventually result in
decreased or absent bowel sounds.
5. Which physical examination finding is most characteristic of left-
sided heart failure?
A. Ascites
B. Jugular venous distention
C. Pulmonary crackles
D. Peripheral cyanosis only
Answer: C. Pulmonary crackles
Rationale: Left ventricular failure causes pulmonary venous congestion
and fluid accumulation in the lungs, producing dyspnea and crackles,
particularly at the lung bases. Right-sided failure more commonly causes
peripheral edema, JVD, and hepatomegaly.
6. A patient with type 1 diabetes develops nausea, vomiting, abdominal
pain, and deep, rapid respirations. Which acid-base disturbance is most
likely?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. High-anion-gap metabolic acidosis
Answer: D. High-anion-gap metabolic acidosis
Rationale: Diabetic ketoacidosis results from severe insulin deficiency,
leading to ketone production and metabolic acidosis. Kussmaul
respirations represent respiratory compensation for the metabolic
acidosis.
, 7. A patient taking warfarin requires routine monitoring of which
laboratory test?
A. aPTT
B. INR
C. Troponin
D. Serum amylase
Answer: B. INR
Rationale: The INR is used to monitor the anticoagulant effect of
warfarin and guide dosing. Unusually elevated values increase bleeding
risk.
8. Which finding is most consistent with hypothyroidism?
A. Heat intolerance
B. Weight loss
C. Tachycardia
D. Cold intolerance
Answer: D. Cold intolerance
Rationale: Hypothyroidism produces decreased metabolic activity.
Common findings include fatigue, weight gain, constipation, dry skin,
bradycardia, and cold intolerance.
9. A 54-year-old patient has persistent blood pressure readings of 158/96
mm Hg. Which initial assessment is most appropriate?
A. Assume the patient has secondary hypertension
B. Assess cardiovascular risk factors and confirm persistent
