APEA 3P Exam Complete Study Guide –
Questions, Multiple Choice, & Full
Rationales (NP Board Review), 100%
Guaranteed Pass || Complete A+ Guide
Q1
A 65-year-old patient presents with sudden-onset dyspnea, pleuritic chest
pain, and hemoptysis. Heart rate is 110 bpm, BP 130/80 mmHg, O2 sat
89% on room air. Which diagnostic test is most appropriate initially?
A. Chest X-ray
B. D-dimer assay
C. CT pulmonary angiography
D. ECG
Answer: C
Rationale:
• Sudden dyspnea, pleuritic pain, hemoptysis + hypoxemia suggests
pulmonary embolism.
• CT pulmonary angiography (CTA) is the gold standard for diagnosis.
• D-dimer is sensitive but not specific; useful in low-risk patients.
• Chest X-ray may rule out alternative causes but often normal in PE.
, • ECG can show sinus tachycardia or S1Q3T3 pattern but is not
diagnostic.
Q2
A patient with type 2 diabetes presents with polyuria, polydipsia, and
fatigue. Labs show glucose 560 mg/dL, pH 7.25, serum bicarbonate 18
mEq/L, and ketones present. What is the most likely diagnosis?
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemia
D. Lactic acidosis
Answer: B
Rationale:
• DKA: hyperglycemia, metabolic acidosis (pH <7.3), low bicarb,
ketonemia.
• HHS usually occurs in older patients, glucose >600 mg/dL, no
significant ketosis, and minimal acidosis.
• Hypoglycemia presents with low glucose.
• Lactic acidosis has high lactate, often in sepsis/shock.
Q3
Which medication is first-line for rate control in atrial fibrillation with
rapid ventricular response in a patient with preserved left ventricular
function?
,A. Amiodarone
B. Digoxin
C. Metoprolol
D. Verapamil
Answer: C
Rationale:
• Beta-blockers (metoprolol) are first-line for rate control.
• Calcium channel blockers (verapamil/diltiazem) also effective but
used cautiously if LV dysfunction.
• Digoxin is less effective in acute settings.
• Amiodarone is for rhythm control, not first-line rate control.
Q4
A 50-year-old man presents with sudden, severe epigastric pain radiating
to the back. Lipase is elevated, vitals stable. Best initial management
includes:
A. Emergent laparotomy
B. IV fluids, NPO, analgesia
C. Oral pancreatic enzymes
D. Immediate ERCP
Answer: B
Rationale:
• Acute pancreatitis (epigastric pain, radiation to back, elevated
lipase) requires supportive care: aggressive IV hydration, analgesia,
NPO initially.
• Surgery only if complications develop.
• ERCP is reserved for biliary pancreatitis with obstruction.
, • Pancreatic enzymes are not indicated acutely.
Q5
Which electrolyte abnormality is most associated with chronic kidney
disease?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: A
Rationale:
• CKD leads to decreased renal potassium excretion →
hyperkalemia.
• Hypokalemia is rare without diuretics.
• Hypernatremia and hypocalcemia can occur but hyperkalemia is a
more immediate, dangerous risk.
Q6
A 70-year-old patient presents with acute confusion and urinary retention.
On exam: distended bladder. Which is the most likely cause?
A. Acute stroke
B. Benign prostatic hyperplasia (BPH)
C. Sepsis
D. Diabetic neuropathy
Questions, Multiple Choice, & Full
Rationales (NP Board Review), 100%
Guaranteed Pass || Complete A+ Guide
Q1
A 65-year-old patient presents with sudden-onset dyspnea, pleuritic chest
pain, and hemoptysis. Heart rate is 110 bpm, BP 130/80 mmHg, O2 sat
89% on room air. Which diagnostic test is most appropriate initially?
A. Chest X-ray
B. D-dimer assay
C. CT pulmonary angiography
D. ECG
Answer: C
Rationale:
• Sudden dyspnea, pleuritic pain, hemoptysis + hypoxemia suggests
pulmonary embolism.
• CT pulmonary angiography (CTA) is the gold standard for diagnosis.
• D-dimer is sensitive but not specific; useful in low-risk patients.
• Chest X-ray may rule out alternative causes but often normal in PE.
, • ECG can show sinus tachycardia or S1Q3T3 pattern but is not
diagnostic.
Q2
A patient with type 2 diabetes presents with polyuria, polydipsia, and
fatigue. Labs show glucose 560 mg/dL, pH 7.25, serum bicarbonate 18
mEq/L, and ketones present. What is the most likely diagnosis?
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemia
D. Lactic acidosis
Answer: B
Rationale:
• DKA: hyperglycemia, metabolic acidosis (pH <7.3), low bicarb,
ketonemia.
• HHS usually occurs in older patients, glucose >600 mg/dL, no
significant ketosis, and minimal acidosis.
• Hypoglycemia presents with low glucose.
• Lactic acidosis has high lactate, often in sepsis/shock.
Q3
Which medication is first-line for rate control in atrial fibrillation with
rapid ventricular response in a patient with preserved left ventricular
function?
,A. Amiodarone
B. Digoxin
C. Metoprolol
D. Verapamil
Answer: C
Rationale:
• Beta-blockers (metoprolol) are first-line for rate control.
• Calcium channel blockers (verapamil/diltiazem) also effective but
used cautiously if LV dysfunction.
• Digoxin is less effective in acute settings.
• Amiodarone is for rhythm control, not first-line rate control.
Q4
A 50-year-old man presents with sudden, severe epigastric pain radiating
to the back. Lipase is elevated, vitals stable. Best initial management
includes:
A. Emergent laparotomy
B. IV fluids, NPO, analgesia
C. Oral pancreatic enzymes
D. Immediate ERCP
Answer: B
Rationale:
• Acute pancreatitis (epigastric pain, radiation to back, elevated
lipase) requires supportive care: aggressive IV hydration, analgesia,
NPO initially.
• Surgery only if complications develop.
• ERCP is reserved for biliary pancreatitis with obstruction.
, • Pancreatic enzymes are not indicated acutely.
Q5
Which electrolyte abnormality is most associated with chronic kidney
disease?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: A
Rationale:
• CKD leads to decreased renal potassium excretion →
hyperkalemia.
• Hypokalemia is rare without diuretics.
• Hypernatremia and hypocalcemia can occur but hyperkalemia is a
more immediate, dangerous risk.
Q6
A 70-year-old patient presents with acute confusion and urinary retention.
On exam: distended bladder. Which is the most likely cause?
A. Acute stroke
B. Benign prostatic hyperplasia (BPH)
C. Sepsis
D. Diabetic neuropathy
