NR 509 APEA 3P FINAL EXAM 2025 LATEST
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES ALREADY GRADED A+.
A 73-YRS-old retired salesman presents to the Emergency Department complaining of
chest pain that started about 2 hours ago. Electrocardiogram, cardiac enzymes, and
chest x-ray are normal. The nurse notes that his blood pressures in the right arm are
significantly lower than of blood pressures in his left arm. Based on history and physical
examination, which of the following will most likely explain his signs and symptoms? -
--SOLUTION-- a. Dissecting aortic aneurysm
Rationale: Patients with dissecting aortic aneurysms typically present with chest pain,
many times described as a "tearing" type pain. They are usually elderly, and, due to the
dissection of the aorta, asymmetric pulses in blood pressures in the extremities may be
present. Coarctation of the aorta can also cause similar symptoms; however, it would be
unlikely due to the patient's age as this is a congenital defect. MI, PE, and pericarditis
are also common causes of concerning chest pain; however, neither typically will cause
asymmetric blood pressures or pulses in the extremities.
A 19-YRS-old carwash attendant sustained a laceration to the ulnar aspect of his mid-
forearm while at work last week. He did not have it evaluated at that time and is now
noticing purulent discharge and increasing pain from the wound along with fever and
chills. Where would the clinician expect to find the first signs of lymphadenopathy? -
--SOLUTION-- a. Epitrochlear nodes
,Rationale: The epitrochlear nodes are the first nodes in the drainage region from the
ulnar surface of the forearm and hand, little and ring fingers, and adjacent surface of the
middle finger. Axillary nodes, infraclavicular nodes, and cervical chain nodes are all
distal to this area and may show evidence of lymphadenopathy as well; however, that
would be secondary after the epitrochlear nodes.
When assessing for the femoral pulse, where should the clinician begin deeply
palpating? - --SOLUTION-- C. Below the inguinal ligament, midway between the anterior
superior iliac spine and symphysis pubis
Rationale: The clinician would begin deeply palpating below the inguinal ligament,
midway between the anterior superior iliac spine in the symphysis pubis. The external
iliac artery transitions into the femoral artery at the level of the inguinal ligament.
Therefore, palpating above the inguinal ligament would be assessing the external iliac
artery. The femoral artery is typically located midway between the anterior superior iliac
spine in the symphysis pubis in most patients.
The clinician is palpating pulses in the foot of a diabetic patient while in the clinic. A
strong pulse is felt located on the dorsum of the foot, just lateral to the extensor tendon
of the big toe. Which artery is being assessed? - --SOLUTION-- C. Dorsalis pedis
Rationale: The dorsalis pedis artery is usually palpable on the dorsum of the foot just
lateral to the extensor tendon of the big toe. The arterial arch of the foot is more distal
and runs transversely and is not usually palpable. The posterior tibial artery is found
,behind the medial malleolus of the ankle. The popliteal and femoral pulses are found
more proximally at the knee and near the groin, respectively.
A 68-YRS-old retired administrative assistant complains of a 3-month history of
recurring pain after ambulating that radiates from her back in the upper lumbar region
into both buttocks, bilateral thighs, and mid-calf regions. Her pain is typically improved
by sitting or by leaning forward. The origin of her pain is likely secondary to which of the
following? - --SOLUTION-- d. Neurogenic claudication
Rationale: Neurogenic claudication can mimic PAD by causing pain related to walking;
however, it is typically relieved simply by sitting or by leaning forward. Many patients
with spinal stenosis of the lumbar spine have pain that originates in the spinal region
and radiates into the areas noted. PAD is not typically relieved just by sitting alone and
usually will take some time. PAD also does not typically improve with bending over.
Acute arterial occlusion does not cause recurring symptoms and is not usually bilateral.
Abdominal aortic aneurysms may cause similar pain as well; however, they typically do
not have the same palliating factors.
A patient that has a known history of cardiovascular disease including a myocardial
infarction and positive ankle-brachial index indicating peripheral arterial disease in his
left leg is now having some issues with erectile dysfunction (ED). The clinician suspects
it may be due to medications or further vascular disease. He does not complain of any
other symptoms. If his symptoms are related to vascular disease, where would the
lesion likely be located? - --SOLUTION-- b. Iliac pudendal
, A 61-YRS-old retired librarian was recently diagnosed with ovarian cancer. She was
otherwise healthy until her recent cancer diagnosis. She has not been feeling well lately
and has had a cough and some mild shortness of breath for the past couple of days.
She now presents to the clinic complaining of pain and swelling in her right groin and
leg, which she says is been there for about a week but is worsening. On physical
examination, 2+ edema of the right leg up to the thigh; 1+ femoral, popliteal, dorsalis
pedis, and posterior tibial pulses; and no significant erythema are noted. What is the
chief concern with this patient? - --SOLUTION-- d. Pulmonary embolism (PE)
Rationale: Cancer patients are at high risk of deep venous thrombosis (DVT), and, with
the presenting symptoms of swelling and pain in her groin, along with recent history of
cough and shortness of breath, this patient's presentation is suspicious for PE. Patients
with DVT in the proximal leg veins are at high risk of thromboembolism. Acute arterial
occlusion should not cause significant edema, and pulses would likely be absent. The
constellation of symptoms and history in this patient also does not suggest an acute
arterial occlusion. Superficial thrombophlebitis typically only causes mild local swelling,
redness, and warmth along with a subcutaneous cord. Acute lymphangitis typically
presents with red streaks from an infection passing through lymph channels.
A 32-YRS-old cabdriver complains of pain in his left leg. He has a history of type 2
diabetes, is a smoker, and recently was diagnosed with hypertension. He does not
remember injuring his leg; however, he notes that there is a small wound on the lateral
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES ALREADY GRADED A+.
A 73-YRS-old retired salesman presents to the Emergency Department complaining of
chest pain that started about 2 hours ago. Electrocardiogram, cardiac enzymes, and
chest x-ray are normal. The nurse notes that his blood pressures in the right arm are
significantly lower than of blood pressures in his left arm. Based on history and physical
examination, which of the following will most likely explain his signs and symptoms? -
--SOLUTION-- a. Dissecting aortic aneurysm
Rationale: Patients with dissecting aortic aneurysms typically present with chest pain,
many times described as a "tearing" type pain. They are usually elderly, and, due to the
dissection of the aorta, asymmetric pulses in blood pressures in the extremities may be
present. Coarctation of the aorta can also cause similar symptoms; however, it would be
unlikely due to the patient's age as this is a congenital defect. MI, PE, and pericarditis
are also common causes of concerning chest pain; however, neither typically will cause
asymmetric blood pressures or pulses in the extremities.
A 19-YRS-old carwash attendant sustained a laceration to the ulnar aspect of his mid-
forearm while at work last week. He did not have it evaluated at that time and is now
noticing purulent discharge and increasing pain from the wound along with fever and
chills. Where would the clinician expect to find the first signs of lymphadenopathy? -
--SOLUTION-- a. Epitrochlear nodes
,Rationale: The epitrochlear nodes are the first nodes in the drainage region from the
ulnar surface of the forearm and hand, little and ring fingers, and adjacent surface of the
middle finger. Axillary nodes, infraclavicular nodes, and cervical chain nodes are all
distal to this area and may show evidence of lymphadenopathy as well; however, that
would be secondary after the epitrochlear nodes.
When assessing for the femoral pulse, where should the clinician begin deeply
palpating? - --SOLUTION-- C. Below the inguinal ligament, midway between the anterior
superior iliac spine and symphysis pubis
Rationale: The clinician would begin deeply palpating below the inguinal ligament,
midway between the anterior superior iliac spine in the symphysis pubis. The external
iliac artery transitions into the femoral artery at the level of the inguinal ligament.
Therefore, palpating above the inguinal ligament would be assessing the external iliac
artery. The femoral artery is typically located midway between the anterior superior iliac
spine in the symphysis pubis in most patients.
The clinician is palpating pulses in the foot of a diabetic patient while in the clinic. A
strong pulse is felt located on the dorsum of the foot, just lateral to the extensor tendon
of the big toe. Which artery is being assessed? - --SOLUTION-- C. Dorsalis pedis
Rationale: The dorsalis pedis artery is usually palpable on the dorsum of the foot just
lateral to the extensor tendon of the big toe. The arterial arch of the foot is more distal
and runs transversely and is not usually palpable. The posterior tibial artery is found
,behind the medial malleolus of the ankle. The popliteal and femoral pulses are found
more proximally at the knee and near the groin, respectively.
A 68-YRS-old retired administrative assistant complains of a 3-month history of
recurring pain after ambulating that radiates from her back in the upper lumbar region
into both buttocks, bilateral thighs, and mid-calf regions. Her pain is typically improved
by sitting or by leaning forward. The origin of her pain is likely secondary to which of the
following? - --SOLUTION-- d. Neurogenic claudication
Rationale: Neurogenic claudication can mimic PAD by causing pain related to walking;
however, it is typically relieved simply by sitting or by leaning forward. Many patients
with spinal stenosis of the lumbar spine have pain that originates in the spinal region
and radiates into the areas noted. PAD is not typically relieved just by sitting alone and
usually will take some time. PAD also does not typically improve with bending over.
Acute arterial occlusion does not cause recurring symptoms and is not usually bilateral.
Abdominal aortic aneurysms may cause similar pain as well; however, they typically do
not have the same palliating factors.
A patient that has a known history of cardiovascular disease including a myocardial
infarction and positive ankle-brachial index indicating peripheral arterial disease in his
left leg is now having some issues with erectile dysfunction (ED). The clinician suspects
it may be due to medications or further vascular disease. He does not complain of any
other symptoms. If his symptoms are related to vascular disease, where would the
lesion likely be located? - --SOLUTION-- b. Iliac pudendal
, A 61-YRS-old retired librarian was recently diagnosed with ovarian cancer. She was
otherwise healthy until her recent cancer diagnosis. She has not been feeling well lately
and has had a cough and some mild shortness of breath for the past couple of days.
She now presents to the clinic complaining of pain and swelling in her right groin and
leg, which she says is been there for about a week but is worsening. On physical
examination, 2+ edema of the right leg up to the thigh; 1+ femoral, popliteal, dorsalis
pedis, and posterior tibial pulses; and no significant erythema are noted. What is the
chief concern with this patient? - --SOLUTION-- d. Pulmonary embolism (PE)
Rationale: Cancer patients are at high risk of deep venous thrombosis (DVT), and, with
the presenting symptoms of swelling and pain in her groin, along with recent history of
cough and shortness of breath, this patient's presentation is suspicious for PE. Patients
with DVT in the proximal leg veins are at high risk of thromboembolism. Acute arterial
occlusion should not cause significant edema, and pulses would likely be absent. The
constellation of symptoms and history in this patient also does not suggest an acute
arterial occlusion. Superficial thrombophlebitis typically only causes mild local swelling,
redness, and warmth along with a subcutaneous cord. Acute lymphangitis typically
presents with red streaks from an infection passing through lymph channels.
A 32-YRS-old cabdriver complains of pain in his left leg. He has a history of type 2
diabetes, is a smoker, and recently was diagnosed with hypertension. He does not
remember injuring his leg; however, he notes that there is a small wound on the lateral
