APEA 3P: PATHOPHYSIOLOGY, PHARMACOLOGY AND PHYSICAL
ASSESSMENT FINAL EXAM 2025.
1. Which finding is associated with early clinical development of diabetic nephropathy?
• An elevation in blood urea nitrogen (BUN)
• An elevation in blood urea nitrogen (BUN) and creatinine (Cr)
• A decreased glomerular filtration rate
• Microalbuminuria
Rationale: Microalbuminuria is an early sign of kidney damage in diabetes due to
protein leakage.
2. Which of the following neurological conditions does NOT cause headaches with nausea
and vomiting?
• Migraine headaches
• Brain tumors
• Subarachnoid hemorrhage
• Tension headaches
Rationale: Tension headaches typically lack nausea and vomiting, unlike the others.
3. Which of the following medications is NOT indicated for the treatment of muscle spasm?
• Baclofen (Lioresal)
• Tizanidine (Zanaflex)
• Cyclobenzaprine (Flexeril)
• Carisoprodol (Soma)
Rationale: Baclofen treats spasticity, not spasms; the others are antispasmodics.
4. Which medication is initially used for patients with benign positional vertigo?
• Hydrochlorothiazide
• Meclizine (Antivert)
• Pseudoephedrine (Sudafed)
• Promethazine (Phenergan)
Rationale: Meclizine suppresses vestibular symptoms, making it first-line for vertigo.
5. Which medication class is contraindicated in a pediatric patient diagnosed with acute
sinusitis?
• Antihistamines
• Expectorant
• Decongestants
• Nasal steroids
Rationale: Nasal steroids are not recommended in acute pediatric sinusitis due to limited
efficacy.
,6. What clinical emergency is associated with findings of papilledema?
• Optic atrophy
• Microaneurysms
• Increased intracranial pressure
• Retinal hemorrhages
Rationale: Papilledema indicates swelling from elevated intracranial pressure, often due
to a brain mass.
7. What is the mechanism of action for prostaglandin E1 (PG1) in a patient with
transposition of the great arteries?
• To maintain equal pressure in the ventricles
• To maintain patency of the great arteries
• To produce vasodilation and adequate oxygen saturation
• To prevent cyanotic episodes by trapping blood in the lower extremities
Rationale: PGE1 keeps the ductus arteriosus open, aiding oxygenation in this congenital
defect.
8. Which of the following complaints best describes lower extremity calf pain associated
with peripheral artery disease?
• A sharp, stabbing pain
• A dull pain or cramp
• An electric shock
• A pulsating pain
Rationale: PAD causes ischemic dull or cramping pain, worsened by activity.
9. Which medication can cause a false positive result for amphetamines in a urine drug
screen?
• Metformin
• Lisinopril
• Glyburide
• Bupropion
Rationale: Bupropion’s chemical structure mimics amphetamines, leading to false
positives.
10. A 24-year-old woman states that she has used lindane (Kwell) for the treatment of
scabies. The nurse practitioner informs her the medication:
• Is safe to use in pregnant women, babies, children, and older adults
• Lotion and/or shampoo is not considered first-line therapy
• Needs to be repeated following 12-hour intervals
• Can be used in patients with a history of seizures
Rationale: Lindane is not first-line due to neurotoxicity risks; permethrin is preferred.
,11. Which finding suggests possible serotonin syndrome in a patient currently taking
nortriptyline?
• Depression
• Anxiety, manic behavior
• Rapid heart rate, high blood pressure
• Decreased levels of serotonin
Rationale: Serotonin syndrome causes autonomic instability (e.g., tachycardia,
hypertension).
12. Which diagnostic test is ordered to measure renal function in a patient with suspected
insufficiency?
• Blood urea nitrogen (BUN)
• Serum creatinine
• A 24-hour creatinine clearance
• Serum uric acid
Rationale: 24-hour creatinine clearance accurately measures glomerular filtration rate.
13. A 42-year-old woman with a past medical history of migraine headaches is requesting
prophylactic medication treatment. Which medication should NOT be prescribed?
• Sumatriptan (Imitrex)
• Amitriptyline (Elavil)
• Verapamil (Verelan)
• Metoprolol (Lopressor)
Rationale: Amitriptyline is not a first-line prophylactic option; others are more suitable.
14. A patient has a left pulmonary embolism (PE). Which medication inhibits blood
coagulation by selectively blocking the active Factor Xa?
• Enoxaparin (Lovenox)
• Apixaban (Eliquis)
• Warfarin (Coumadin)
• Dabigatran etexilate (Pradaxa)
Rationale: Apixaban directly targets Factor Xa, unlike the others with broader
mechanisms.
15. Which answer best describes a presentation that is common in men with cancer?
• A group of small scattered vesicles
• A chancre
• Papules with a variety of shapes
• A nontender indurated penile nodule
Rationale: A painless, hard nodule is a classic sign of penile cancer.
, 16. Which of the following is considered a synovial joint?
• Vertebral bodies of the spine
• Skull
• Shoulder
• Pubic symphysis of the pelvis
Rationale: The shoulder is a synovial joint with a fluid-filled cavity for movement.
17. Which of the following skin assessment is NOT a normal finding associated with the
aging process?
• Xerosis (dry skin)
• Cherry angiomas and senile purpura
• Senile keratoses and senile lentigines
• Dermatophytosis
Rationale: Dermatophytosis (ringworm) is an infection, not a normal aging change.
18. Which medication is used as an anticoagulant reversal agent for dabigatran etexilate
(Pradaxa)?
• Idarucizumab (Praxbind)
• Vitamin K
• Protamine sulfate
• Fondaparinux (Arixtra)
Rationale: Idarucizumab specifically reverses dabigatran by binding to it.
19. Which of the following is NOT a common symptom of Vitamin B12 deficiency?
• Sore tongue
• Fatigue
• Constipation
• Vomiting
Rationale: Vomiting is less typical; neurological and GI symptoms like soreness
predominate.
20. During an abdominal examination, the nurse practitioner percusses the bulging area of
the abdomen. Which sound suggests the presence of ascitic fluid (ascites)?
• Tympany
• Dullness
• Hyperresonant sounds
• Normal resonance
Rationale: Dullness indicates fluid or solid mass beneath, consistent with ascites.
21. Which medication prescribed is appropriate for a woman with a history of sphincter
incompetence and stress incontinence?
ASSESSMENT FINAL EXAM 2025.
1. Which finding is associated with early clinical development of diabetic nephropathy?
• An elevation in blood urea nitrogen (BUN)
• An elevation in blood urea nitrogen (BUN) and creatinine (Cr)
• A decreased glomerular filtration rate
• Microalbuminuria
Rationale: Microalbuminuria is an early sign of kidney damage in diabetes due to
protein leakage.
2. Which of the following neurological conditions does NOT cause headaches with nausea
and vomiting?
• Migraine headaches
• Brain tumors
• Subarachnoid hemorrhage
• Tension headaches
Rationale: Tension headaches typically lack nausea and vomiting, unlike the others.
3. Which of the following medications is NOT indicated for the treatment of muscle spasm?
• Baclofen (Lioresal)
• Tizanidine (Zanaflex)
• Cyclobenzaprine (Flexeril)
• Carisoprodol (Soma)
Rationale: Baclofen treats spasticity, not spasms; the others are antispasmodics.
4. Which medication is initially used for patients with benign positional vertigo?
• Hydrochlorothiazide
• Meclizine (Antivert)
• Pseudoephedrine (Sudafed)
• Promethazine (Phenergan)
Rationale: Meclizine suppresses vestibular symptoms, making it first-line for vertigo.
5. Which medication class is contraindicated in a pediatric patient diagnosed with acute
sinusitis?
• Antihistamines
• Expectorant
• Decongestants
• Nasal steroids
Rationale: Nasal steroids are not recommended in acute pediatric sinusitis due to limited
efficacy.
,6. What clinical emergency is associated with findings of papilledema?
• Optic atrophy
• Microaneurysms
• Increased intracranial pressure
• Retinal hemorrhages
Rationale: Papilledema indicates swelling from elevated intracranial pressure, often due
to a brain mass.
7. What is the mechanism of action for prostaglandin E1 (PG1) in a patient with
transposition of the great arteries?
• To maintain equal pressure in the ventricles
• To maintain patency of the great arteries
• To produce vasodilation and adequate oxygen saturation
• To prevent cyanotic episodes by trapping blood in the lower extremities
Rationale: PGE1 keeps the ductus arteriosus open, aiding oxygenation in this congenital
defect.
8. Which of the following complaints best describes lower extremity calf pain associated
with peripheral artery disease?
• A sharp, stabbing pain
• A dull pain or cramp
• An electric shock
• A pulsating pain
Rationale: PAD causes ischemic dull or cramping pain, worsened by activity.
9. Which medication can cause a false positive result for amphetamines in a urine drug
screen?
• Metformin
• Lisinopril
• Glyburide
• Bupropion
Rationale: Bupropion’s chemical structure mimics amphetamines, leading to false
positives.
10. A 24-year-old woman states that she has used lindane (Kwell) for the treatment of
scabies. The nurse practitioner informs her the medication:
• Is safe to use in pregnant women, babies, children, and older adults
• Lotion and/or shampoo is not considered first-line therapy
• Needs to be repeated following 12-hour intervals
• Can be used in patients with a history of seizures
Rationale: Lindane is not first-line due to neurotoxicity risks; permethrin is preferred.
,11. Which finding suggests possible serotonin syndrome in a patient currently taking
nortriptyline?
• Depression
• Anxiety, manic behavior
• Rapid heart rate, high blood pressure
• Decreased levels of serotonin
Rationale: Serotonin syndrome causes autonomic instability (e.g., tachycardia,
hypertension).
12. Which diagnostic test is ordered to measure renal function in a patient with suspected
insufficiency?
• Blood urea nitrogen (BUN)
• Serum creatinine
• A 24-hour creatinine clearance
• Serum uric acid
Rationale: 24-hour creatinine clearance accurately measures glomerular filtration rate.
13. A 42-year-old woman with a past medical history of migraine headaches is requesting
prophylactic medication treatment. Which medication should NOT be prescribed?
• Sumatriptan (Imitrex)
• Amitriptyline (Elavil)
• Verapamil (Verelan)
• Metoprolol (Lopressor)
Rationale: Amitriptyline is not a first-line prophylactic option; others are more suitable.
14. A patient has a left pulmonary embolism (PE). Which medication inhibits blood
coagulation by selectively blocking the active Factor Xa?
• Enoxaparin (Lovenox)
• Apixaban (Eliquis)
• Warfarin (Coumadin)
• Dabigatran etexilate (Pradaxa)
Rationale: Apixaban directly targets Factor Xa, unlike the others with broader
mechanisms.
15. Which answer best describes a presentation that is common in men with cancer?
• A group of small scattered vesicles
• A chancre
• Papules with a variety of shapes
• A nontender indurated penile nodule
Rationale: A painless, hard nodule is a classic sign of penile cancer.
, 16. Which of the following is considered a synovial joint?
• Vertebral bodies of the spine
• Skull
• Shoulder
• Pubic symphysis of the pelvis
Rationale: The shoulder is a synovial joint with a fluid-filled cavity for movement.
17. Which of the following skin assessment is NOT a normal finding associated with the
aging process?
• Xerosis (dry skin)
• Cherry angiomas and senile purpura
• Senile keratoses and senile lentigines
• Dermatophytosis
Rationale: Dermatophytosis (ringworm) is an infection, not a normal aging change.
18. Which medication is used as an anticoagulant reversal agent for dabigatran etexilate
(Pradaxa)?
• Idarucizumab (Praxbind)
• Vitamin K
• Protamine sulfate
• Fondaparinux (Arixtra)
Rationale: Idarucizumab specifically reverses dabigatran by binding to it.
19. Which of the following is NOT a common symptom of Vitamin B12 deficiency?
• Sore tongue
• Fatigue
• Constipation
• Vomiting
Rationale: Vomiting is less typical; neurological and GI symptoms like soreness
predominate.
20. During an abdominal examination, the nurse practitioner percusses the bulging area of
the abdomen. Which sound suggests the presence of ascitic fluid (ascites)?
• Tympany
• Dullness
• Hyperresonant sounds
• Normal resonance
Rationale: Dullness indicates fluid or solid mass beneath, consistent with ascites.
21. Which medication prescribed is appropriate for a woman with a history of sphincter
incompetence and stress incontinence?
