APEA 3P Exam Test Bank 2025 Final Version –
100 Questions with Verified Answers for
Advanced Practice Nursing
This exam consists of 100 questions across three modules: Pathophysiology, Pharmacology, and
Physical Assessment, designed for advanced practice nursing. Each question includes the correct
answer and a brief rationale, formatted without multiple-choice options for clarity.
Module 1: Pathophysiology (Questions 1-34)
1. What is the primary pathophysiological mechanism causing ST-segment elevation in
inferior leads (II, III, aVF) in a patient with acute chest pain, diaphoresis, and
nausea?
Answer: Complete occlusion of the right coronary artery
Rationale: ST-elevation in inferior leads indicates acute inferior myocardial infarction
due to right coronary artery occlusion, causing ischemia and necrosis.
2. What pathophysiological process primarily drives diabetic retinopathy in chronic
hyperglycemia?
Answer: Non-enzymatic glycosylation of basement membranes
Rationale: Glycosylation thickens retinal capillary basement membranes, leading to
microaneurysms, hemorrhages, and neovascularization.
3. What pathophysiological event causes sudden severe headache and altered mental
status with a hyperdense area in the right basal ganglia on CT scan in a
hypertensive patient?
Answer: Rupture of a lenticulostriate artery due to chronic hypertension
Rationale: Hypertension weakens small penetrating arteries, causing intracerebral
hemorrhage in deep brain structures.
4. What is the primary pathophysiological alteration causing air trapping and
hyperinflation in COPD?
Answer: Loss of alveolar attachments and airway collapse during expiration
Rationale: Alveolar wall destruction reduces radial traction, causing dynamic airway
collapse and air trapping.
5. What autoimmune pathophysiological process drives synovial inflammation in
rheumatoid arthritis with morning stiffness?
Answer: T-cell mediated cytokine release (e.g., TNF-alpha)
Rationale: CD4+ T-cell activation produces cytokines like TNF-alpha, promoting
synovial hyperplasia and joint destruction.
6. What key pathophysiological factor allows acid reflux into the esophagus in GERD?
Answer: Transient LES relaxations and hiatal hernia
, Rationale: Impaired LES barrier function allows gastric acid reflux, causing mucosal
injury.
7. What is the primary pathophysiological defect in Hashimoto's thyroiditis causing
hypothyroidism?
Answer: Autoantibody-mediated destruction of thyroid follicular cells
Rationale: Anti-TPO and anti-thyroglobulin antibodies cause lymphocytic infiltration
and thyroid destruction.
8. What compensatory pathophysiological mechanism maintains GFR initially in
prerenal AKI?
Answer: Activation of the renin-angiotensin-aldosterone system
Rationale: RAAS causes efferent arteriolar vasoconstriction, increasing intraglomerular
pressure to preserve GFR.
9. What molecular pathophysiological change causes red blood cell sickling in sickle
cell anemia?
Answer: Polymerization of hemoglobin S under deoxygenation
Rationale: Valine substitution in HbS leads to deoxy-HbS polymerization, distorting
RBCs and obstructing microvasculature.
10. What is the primary pathophysiological hallmark contributing to neuronal loss in
Alzheimer's disease?
Answer: Extracellular beta-amyloid plaques and intracellular tau tangles
Rationale: Amyloid plaques disrupt synapses, and tau tangles impair axonal transport,
causing cortical atrophy.
11. What pathophysiological process underlies lupus nephritis in a patient with SLE,
proteinuria, and hematuria?
Answer: Immune complex deposition in glomeruli
Rationale: Immune complexes activate complement, causing glomerular inflammation
and renal damage.
12. What triggers the autoimmune pathophysiological destruction of pancreatic beta
cells in type 1 diabetes?
Answer: Viral infection presenting self-antigens
Rationale: Viruses initiate T-cell attack on beta cells expressing GAD or insulin
autoantibodies, causing insulin deficiency.
13. What pathophysiological mechanism drives ascites in cirrhosis?
Answer: Portal hypertension and hypoalbuminemia
Rationale: Increased hydrostatic pressure and reduced oncotic pressure promote
transudative fluid accumulation per Starling's forces.
14. What pathophysiological loss in the substantia nigra causes bradykinesia in
Parkinson's disease?
Answer: Dopaminergic neuron loss and Lewy body formation
Rationale: Reduced striatal dopamine disrupts basal ganglia circuits, causing motor
symptoms.
15. What pathophysiological change in cartilage is central to osteoarthritis?
Answer: Degradation of proteoglycans and collagen by matrix metalloproteinases
Rationale: Mechanical stress induces MMPs, breaking down cartilage matrix and
causing joint damage.
100 Questions with Verified Answers for
Advanced Practice Nursing
This exam consists of 100 questions across three modules: Pathophysiology, Pharmacology, and
Physical Assessment, designed for advanced practice nursing. Each question includes the correct
answer and a brief rationale, formatted without multiple-choice options for clarity.
Module 1: Pathophysiology (Questions 1-34)
1. What is the primary pathophysiological mechanism causing ST-segment elevation in
inferior leads (II, III, aVF) in a patient with acute chest pain, diaphoresis, and
nausea?
Answer: Complete occlusion of the right coronary artery
Rationale: ST-elevation in inferior leads indicates acute inferior myocardial infarction
due to right coronary artery occlusion, causing ischemia and necrosis.
2. What pathophysiological process primarily drives diabetic retinopathy in chronic
hyperglycemia?
Answer: Non-enzymatic glycosylation of basement membranes
Rationale: Glycosylation thickens retinal capillary basement membranes, leading to
microaneurysms, hemorrhages, and neovascularization.
3. What pathophysiological event causes sudden severe headache and altered mental
status with a hyperdense area in the right basal ganglia on CT scan in a
hypertensive patient?
Answer: Rupture of a lenticulostriate artery due to chronic hypertension
Rationale: Hypertension weakens small penetrating arteries, causing intracerebral
hemorrhage in deep brain structures.
4. What is the primary pathophysiological alteration causing air trapping and
hyperinflation in COPD?
Answer: Loss of alveolar attachments and airway collapse during expiration
Rationale: Alveolar wall destruction reduces radial traction, causing dynamic airway
collapse and air trapping.
5. What autoimmune pathophysiological process drives synovial inflammation in
rheumatoid arthritis with morning stiffness?
Answer: T-cell mediated cytokine release (e.g., TNF-alpha)
Rationale: CD4+ T-cell activation produces cytokines like TNF-alpha, promoting
synovial hyperplasia and joint destruction.
6. What key pathophysiological factor allows acid reflux into the esophagus in GERD?
Answer: Transient LES relaxations and hiatal hernia
, Rationale: Impaired LES barrier function allows gastric acid reflux, causing mucosal
injury.
7. What is the primary pathophysiological defect in Hashimoto's thyroiditis causing
hypothyroidism?
Answer: Autoantibody-mediated destruction of thyroid follicular cells
Rationale: Anti-TPO and anti-thyroglobulin antibodies cause lymphocytic infiltration
and thyroid destruction.
8. What compensatory pathophysiological mechanism maintains GFR initially in
prerenal AKI?
Answer: Activation of the renin-angiotensin-aldosterone system
Rationale: RAAS causes efferent arteriolar vasoconstriction, increasing intraglomerular
pressure to preserve GFR.
9. What molecular pathophysiological change causes red blood cell sickling in sickle
cell anemia?
Answer: Polymerization of hemoglobin S under deoxygenation
Rationale: Valine substitution in HbS leads to deoxy-HbS polymerization, distorting
RBCs and obstructing microvasculature.
10. What is the primary pathophysiological hallmark contributing to neuronal loss in
Alzheimer's disease?
Answer: Extracellular beta-amyloid plaques and intracellular tau tangles
Rationale: Amyloid plaques disrupt synapses, and tau tangles impair axonal transport,
causing cortical atrophy.
11. What pathophysiological process underlies lupus nephritis in a patient with SLE,
proteinuria, and hematuria?
Answer: Immune complex deposition in glomeruli
Rationale: Immune complexes activate complement, causing glomerular inflammation
and renal damage.
12. What triggers the autoimmune pathophysiological destruction of pancreatic beta
cells in type 1 diabetes?
Answer: Viral infection presenting self-antigens
Rationale: Viruses initiate T-cell attack on beta cells expressing GAD or insulin
autoantibodies, causing insulin deficiency.
13. What pathophysiological mechanism drives ascites in cirrhosis?
Answer: Portal hypertension and hypoalbuminemia
Rationale: Increased hydrostatic pressure and reduced oncotic pressure promote
transudative fluid accumulation per Starling's forces.
14. What pathophysiological loss in the substantia nigra causes bradykinesia in
Parkinson's disease?
Answer: Dopaminergic neuron loss and Lewy body formation
Rationale: Reduced striatal dopamine disrupts basal ganglia circuits, causing motor
symptoms.
15. What pathophysiological change in cartilage is central to osteoarthritis?
Answer: Degradation of proteoglycans and collagen by matrix metalloproteinases
Rationale: Mechanical stress induces MMPs, breaking down cartilage matrix and
causing joint damage.
