APEA 3P Exam | Key Concepts and 200 Questions and Answers
Comprehensive Review for Nurse Practitioner Students
Pathophysiology | Pharmacotherapeutics | Physical
Assessment 2026 Updated Edition
Q1. When performing a visual acuity test, the nurse practitioner notes 20/30 in the left eye and
20/40 in the right eye using the Snellen eye chart. This means:
A. Have the patient returning in two weeks for a follow-up vision screen
B. Dilate the eye and retest
C. Refer the patient to an ophthalmologist
D. Document this as a normal finding
ANSWER: C) Refer the patient to an ophthalmologist
EXPLANATION: A visual acuity of 20/40 or worse in either eye warrants ophthalmology referral
for further evaluation. While 20/30 is within normal limits, 20/40 indicates decreased vision
that requires investigation .
---
Q2. When auscultating heart sounds arising from the aortic valve in an adult patient, where
should the stethoscope be placed?
A. Near the apex of the heart between the 5th and 6th intercostal space in the mid-clavicular
line
B. Between the 2nd and 3rd intercostal spaces at the right upper sternal border
C. At the 4th intercostal space, left sternal border
D. At the 2nd intercostal space, left sternal border
,ANSWER: B) Between the 2nd and 3rd intercostal spaces at the right upper sternal border
EXPLANATION: The aortic valve is best auscultated in the 2nd intercostal space at the right
upper sternal border. The pulmonic valve is auscultated at the 2nd intercostal space at the left
sternal border, and the mitral valve is best heard at the apex .
---
Q3. On auscultation of the abdomen, rushes of high-pitched sounds are audible and coincide
with abdominal cramps. These findings are most consistent with:
A. Paralytic ileus
B. Gastroenteritis
C. Intestinal obstruction
D. Peritonitis
ANSWER: C) Intestinal obstruction
EXPLANATION: High-pitched rushes that coincide with abdominal cramping are characteristic of
intestinal obstruction. These sounds represent increased peristalsis as the bowel attempts to
overcome the obstruction .
---
Q4. A patient presents with dull puffiness of the eyes with pronounced non-pitting periorbital
edema. This finding is suggestive of:
A. Nephrotic syndrome
B. Myxedema
C. Cushing syndrome
D. Sinusitis
,ANSWER: B) Myxedema
EXPLANATION: Myxedema is a deposition of mucopolysaccharides in the dermis, commonly
found in patients with advanced hypothyroidism. The classic skin changes include swelling of
the face, lips, eyelids, and tongue. It is the hallmark of both Graves' disease and Hashimoto's
thyroiditis .
---
Q5. Ophthalmoscopic examination reveals dark specks noted between the fundus and the lens.
These specks are most likely:
A. Microaneurysms
B. Vitreous floaters
C. Cotton wool spots
D. Drusen bodies
ANSWER: B) Vitreous floaters
EXPLANATION: Dark specks noted between the fundus and the lens are characteristic of
vitreous floaters. These are common and often benign, but a sudden increase may indicate
retinal detachment .
---
Q6. When performing the first Leopold maneuver on a pregnant woman, if the buttocks and
head are not easily palpated at the fundus, the fetus is said to be in:
A. Cephalic presentation
B. Breech presentation
C. Transverse lie
, D. Oblique presentation
ANSWER: C) Transverse lie
EXPLANATION: In the first Leopold maneuver, the examiner palpates the fundus to determine
the fetal part occupying the fundus. If neither the buttocks nor the head is easily palpated at the
fundus, the fetus is likely in a transverse lie .
---
Q7. During the breast examination of a perimenopausal woman, the NP detects a bloody
spontaneous discharge from the right nipple. This indicates further evaluation for:
A. Fibroadenoma
B. Polycystic breast disease
C. An intraductal papilloma
D. Pituitary prolactinoma
ANSWER: C) An intraductal papilloma
EXPLANATION: Intraductal papillomas are usually solitary and smaller than 1 cm. They are
located in large lactiferous sinuses or ducts and have a tendency to bleed. Spontaneous bloody
nipple discharge warrants evaluation for intraductal papilloma .
---
Q8. Resting tremors refer to those tremors that disappear:
A. With voluntary movement
B. During sleep
C. With intention
Comprehensive Review for Nurse Practitioner Students
Pathophysiology | Pharmacotherapeutics | Physical
Assessment 2026 Updated Edition
Q1. When performing a visual acuity test, the nurse practitioner notes 20/30 in the left eye and
20/40 in the right eye using the Snellen eye chart. This means:
A. Have the patient returning in two weeks for a follow-up vision screen
B. Dilate the eye and retest
C. Refer the patient to an ophthalmologist
D. Document this as a normal finding
ANSWER: C) Refer the patient to an ophthalmologist
EXPLANATION: A visual acuity of 20/40 or worse in either eye warrants ophthalmology referral
for further evaluation. While 20/30 is within normal limits, 20/40 indicates decreased vision
that requires investigation .
---
Q2. When auscultating heart sounds arising from the aortic valve in an adult patient, where
should the stethoscope be placed?
A. Near the apex of the heart between the 5th and 6th intercostal space in the mid-clavicular
line
B. Between the 2nd and 3rd intercostal spaces at the right upper sternal border
C. At the 4th intercostal space, left sternal border
D. At the 2nd intercostal space, left sternal border
,ANSWER: B) Between the 2nd and 3rd intercostal spaces at the right upper sternal border
EXPLANATION: The aortic valve is best auscultated in the 2nd intercostal space at the right
upper sternal border. The pulmonic valve is auscultated at the 2nd intercostal space at the left
sternal border, and the mitral valve is best heard at the apex .
---
Q3. On auscultation of the abdomen, rushes of high-pitched sounds are audible and coincide
with abdominal cramps. These findings are most consistent with:
A. Paralytic ileus
B. Gastroenteritis
C. Intestinal obstruction
D. Peritonitis
ANSWER: C) Intestinal obstruction
EXPLANATION: High-pitched rushes that coincide with abdominal cramping are characteristic of
intestinal obstruction. These sounds represent increased peristalsis as the bowel attempts to
overcome the obstruction .
---
Q4. A patient presents with dull puffiness of the eyes with pronounced non-pitting periorbital
edema. This finding is suggestive of:
A. Nephrotic syndrome
B. Myxedema
C. Cushing syndrome
D. Sinusitis
,ANSWER: B) Myxedema
EXPLANATION: Myxedema is a deposition of mucopolysaccharides in the dermis, commonly
found in patients with advanced hypothyroidism. The classic skin changes include swelling of
the face, lips, eyelids, and tongue. It is the hallmark of both Graves' disease and Hashimoto's
thyroiditis .
---
Q5. Ophthalmoscopic examination reveals dark specks noted between the fundus and the lens.
These specks are most likely:
A. Microaneurysms
B. Vitreous floaters
C. Cotton wool spots
D. Drusen bodies
ANSWER: B) Vitreous floaters
EXPLANATION: Dark specks noted between the fundus and the lens are characteristic of
vitreous floaters. These are common and often benign, but a sudden increase may indicate
retinal detachment .
---
Q6. When performing the first Leopold maneuver on a pregnant woman, if the buttocks and
head are not easily palpated at the fundus, the fetus is said to be in:
A. Cephalic presentation
B. Breech presentation
C. Transverse lie
, D. Oblique presentation
ANSWER: C) Transverse lie
EXPLANATION: In the first Leopold maneuver, the examiner palpates the fundus to determine
the fetal part occupying the fundus. If neither the buttocks nor the head is easily palpated at the
fundus, the fetus is likely in a transverse lie .
---
Q7. During the breast examination of a perimenopausal woman, the NP detects a bloody
spontaneous discharge from the right nipple. This indicates further evaluation for:
A. Fibroadenoma
B. Polycystic breast disease
C. An intraductal papilloma
D. Pituitary prolactinoma
ANSWER: C) An intraductal papilloma
EXPLANATION: Intraductal papillomas are usually solitary and smaller than 1 cm. They are
located in large lactiferous sinuses or ducts and have a tendency to bleed. Spontaneous bloody
nipple discharge warrants evaluation for intraductal papilloma .
---
Q8. Resting tremors refer to those tremors that disappear:
A. With voluntary movement
B. During sleep
C. With intention
