APEA 3P High Stakes Exam – Comprehensive Study Guide with
100% Verified Questions and Answers | Advanced Practice Education
Associates (APEA) 3P Exam Preparation Resource for NP Students |
Complete Review of Pathophysiology, Pharmacology, and Physical
Assessment Concepts to Ensure Exam Success
📖 Introduction:
The APEA 3P High Stakes Exam Study Guide ( Edition) is a comprehensive, up-
to-date review resource meticulously designed to help Nurse Practitioner (NP) students prepare
for and pass the Advanced Practice Education Associates (APEA) 3P Exam with confidence.
3P Exam Study APEA
1. What is the recommendation for Warfarin management when a patient misses
a dose?
Answer:
If within 12 hours of the missed dose, take it. If more than 12 hours have passed, skip the dose
and wait until the next scheduled dose. The patient will need an INR redraw to assess
therapeutic range.
Rationale:
Warfarin has a long half-life, so doubling up doses increases bleeding risk. Checking INR
ensures anticoagulation remains therapeutic (2–3 for most indications). Always document missed
doses and recheck coagulation status if multiple are missed.
2. What do we need to know about ACE inhibitors (ACEs) and ARBs?
Answer:
Common side effect: Dry hacking cough (ACE inhibitors).
Indications: Diabetes mellitus (DM), chronic kidney disease (CKD), hypertension
(HTN).
, Not recommended: As first-line agents in African American patients (use thiazide or
CCB first).
Risk: Can cause angioedema (life-threatening).
Rationale:
ACE inhibitors increase bradykinin levels → dry cough. ARBs don’t affect bradykinin, so
they’re alternatives if cough develops. ACEs/ARBs reduce proteinuria and improve cardiac
remodeling, especially beneficial for DM and CKD.
3. Contraindications for Hydrochlorothiazide (HCTZ):
Answer:
Sulfa allergy
Penicillin hypersensitivity
Asthma
Gout
Rationale:
Thiazides are sulfonamide derivatives → contraindicated in patients allergic to sulfa drugs. They
can raise uric acid, worsening gout, and may trigger allergic reactions in sensitive patients.
Caution also with asthma due to hypersensitivity risk.
4. Systolic Murmurs (Benign)
Answer & Mnemonic: “Peyton Manning MR. AS MVP”
MR: Mitral Regurgitation → SOB, fatigue, HF symptoms.
Peyton Manning: Physiologic Murmur → benign, asymptomatic.
AS: Aortic Stenosis → Angina, Syncope, HF.
MVP: Mitral Valve Prolapse → “Click” sound, young women (14–30), palpitations,
chest pain.
Rationale:
Systolic murmurs occur between S1 and S2. MR and AS are pathologic; MVP is often benign
but can progress. Physiologic murmurs have no structural abnormality and resolve with rest.
5. Diastolic Murmurs (Always Pathologic)
Answer:
, AR: Aortic Regurgitation → Angina, HF, dizziness, chest pain.
MS: Mitral Stenosis → Dyspnea, AFib.
Rationale:
Diastolic murmurs indicate regurgitation or stenosis during heart relaxation (S2–S1). Always
abnormal and require echocardiogram evaluation.
6. What does S1 indicate?
Answer:
Closure of the atrioventricular valves (Mitral & Tricuspid).
Rationale:
S1 marks the start of systole when the ventricles contract. Best heard at the apex.
7. What does S2 indicate?
Answer:
Closure of the semilunar valves (Aortic & Pulmonic).
Rationale:
S2 marks the end of systole and beginning of diastole. Best heard at the base of the heart.
8. S3 is often heard in:
Answer:
Congestive Heart Failure (CHF)
May be normal in young athletes or pregnant women
Rationale:
S3 (“ventricular gallop”) indicates increased ventricular filling pressure or volume overload —
classic in systolic HF.
9. S4 is often heard in:
Answer:
100% Verified Questions and Answers | Advanced Practice Education
Associates (APEA) 3P Exam Preparation Resource for NP Students |
Complete Review of Pathophysiology, Pharmacology, and Physical
Assessment Concepts to Ensure Exam Success
📖 Introduction:
The APEA 3P High Stakes Exam Study Guide ( Edition) is a comprehensive, up-
to-date review resource meticulously designed to help Nurse Practitioner (NP) students prepare
for and pass the Advanced Practice Education Associates (APEA) 3P Exam with confidence.
3P Exam Study APEA
1. What is the recommendation for Warfarin management when a patient misses
a dose?
Answer:
If within 12 hours of the missed dose, take it. If more than 12 hours have passed, skip the dose
and wait until the next scheduled dose. The patient will need an INR redraw to assess
therapeutic range.
Rationale:
Warfarin has a long half-life, so doubling up doses increases bleeding risk. Checking INR
ensures anticoagulation remains therapeutic (2–3 for most indications). Always document missed
doses and recheck coagulation status if multiple are missed.
2. What do we need to know about ACE inhibitors (ACEs) and ARBs?
Answer:
Common side effect: Dry hacking cough (ACE inhibitors).
Indications: Diabetes mellitus (DM), chronic kidney disease (CKD), hypertension
(HTN).
, Not recommended: As first-line agents in African American patients (use thiazide or
CCB first).
Risk: Can cause angioedema (life-threatening).
Rationale:
ACE inhibitors increase bradykinin levels → dry cough. ARBs don’t affect bradykinin, so
they’re alternatives if cough develops. ACEs/ARBs reduce proteinuria and improve cardiac
remodeling, especially beneficial for DM and CKD.
3. Contraindications for Hydrochlorothiazide (HCTZ):
Answer:
Sulfa allergy
Penicillin hypersensitivity
Asthma
Gout
Rationale:
Thiazides are sulfonamide derivatives → contraindicated in patients allergic to sulfa drugs. They
can raise uric acid, worsening gout, and may trigger allergic reactions in sensitive patients.
Caution also with asthma due to hypersensitivity risk.
4. Systolic Murmurs (Benign)
Answer & Mnemonic: “Peyton Manning MR. AS MVP”
MR: Mitral Regurgitation → SOB, fatigue, HF symptoms.
Peyton Manning: Physiologic Murmur → benign, asymptomatic.
AS: Aortic Stenosis → Angina, Syncope, HF.
MVP: Mitral Valve Prolapse → “Click” sound, young women (14–30), palpitations,
chest pain.
Rationale:
Systolic murmurs occur between S1 and S2. MR and AS are pathologic; MVP is often benign
but can progress. Physiologic murmurs have no structural abnormality and resolve with rest.
5. Diastolic Murmurs (Always Pathologic)
Answer:
, AR: Aortic Regurgitation → Angina, HF, dizziness, chest pain.
MS: Mitral Stenosis → Dyspnea, AFib.
Rationale:
Diastolic murmurs indicate regurgitation or stenosis during heart relaxation (S2–S1). Always
abnormal and require echocardiogram evaluation.
6. What does S1 indicate?
Answer:
Closure of the atrioventricular valves (Mitral & Tricuspid).
Rationale:
S1 marks the start of systole when the ventricles contract. Best heard at the apex.
7. What does S2 indicate?
Answer:
Closure of the semilunar valves (Aortic & Pulmonic).
Rationale:
S2 marks the end of systole and beginning of diastole. Best heard at the base of the heart.
8. S3 is often heard in:
Answer:
Congestive Heart Failure (CHF)
May be normal in young athletes or pregnant women
Rationale:
S3 (“ventricular gallop”) indicates increased ventricular filling pressure or volume overload —
classic in systolic HF.
9. S4 is often heard in:
Answer:
