APEA 3P High Stakes Exam Questions with
Verified Correct Answers for Advanced
Practice Nursing
Section 1: Cardiovascular System
Q1. A 75-year-old male with poorly controlled hypertension for over 10 years
has likely experienced a shift in his point of maximal impulse (PMI). Where is the
most likely new location of his PMI?
• A) 5th intercostal space (ICS), midclavicular line (MCL)
• B) 8th ICS, MCL
• C) 5th ICS, left of MCL
• D) 6th ICS, right of MCL
Correct Answer: C
Rationale: Chronic hypertension causes left ventricular hypertrophy (LVH) as the
heart works against increased afterload. The hypertrophied left ventricle enlarges
and shifts the PMI laterally and inferiorly. A PMI at the 5th ICS, left of the MCL,
indicates LVH .
Q2. A 65-year-old man with a history of smoking and diabetes presents with a 2-
month history of leg pain when walking that resolves with rest. On exam, you
note diminished dorsalis pedis and posterior tibial pulses. What is the most
likely diagnosis?
• A) Venous insufficiency
• B) Peripheral arterial disease (PAD)
, • C) Sciatica
• D) Peripheral neuropathy
Correct Answer: B
Rationale: Intermittent claudication—muscle cramping or pain in the calves,
thighs, or buttocks induced by exercise and relieved by rest—is the classic
symptom of PAD. Diminished pulses are a key physical exam finding .
Q3. A patient with heart failure has auscultation findings consistent with an S3
gallop. An S3 heart sound is often heard in which condition?
• A) Diastolic heart failure only
• B) Congestive heart failure (CHF)
• C) Athletes only
• D) Pericarditis
Correct Answer: B
Rationale: An S3 gallop (ventricular gallop) is often a sign of fluid volume overload
and reduced ventricular compliance, making it a key clinical indicator of heart
failure in adults. It may be normal in some athletic adolescents but is pathologic in
older adults .
Q4. A heart murmur is heard best at the apex with the bell, radiating to the
axilla. It is holosystolic. What is the most likely diagnosis?
• A) Mitral regurgitation
• B) Aortic stenosis
• C) Tricuspid regurgitation
• D) Mitral valve prolapse
Correct Answer: A
,Rationale: Mitral regurgitation produces a holosystolic murmur best heard at the
apex with radiation to the axilla. The bell is used to listen for low-pitched sounds,
and this murmur's characteristics are classic for mitral regurgitation .
Section 2: Respiratory & ENT Systems
Q5. A 58-year-old male with type 2 diabetes reports burning foot pain worse at
night. Exam shows diminished pinprick sensation distal to ankles and absent
Achilles reflexes. What is the most likely diagnosis?
• A) Peripheral artery disease
• B) Lumbar radiculopathy
• C) Diabetic peripheral neuropathy
• D) Vitamin B12 deficiency
Correct Answer: C
Rationale: Distal symmetric polyneuropathy in diabetes presents with burning
pain, nocturnal exacerbation, loss of sensation, and areflexia. PAD causes
claudication, not burning dysesthesia .
Q6. A patient with COPD has worsening dyspnea, increased sputum purulence
and volume. No fever. What is the best initial treatment?
• A) Oral prednisone alone
• B) Azithromycin alone
• C) Bronchodilators + antibiotics
• D) Oxygen only
Correct Answer: C
Rationale: Acute exacerbation of COPD with increased dyspnea, sputum purulence,
and volume (Anthonisen type I) requires antibiotics + bronchodilators .
, Q7. A 3-year-old child with fever, cough, and inspiratory stridor, "barking"
cough. Immunizations are up to date. What is the most likely diagnosis?
• A) Epiglottitis
• B) Croup (laryngotracheobronchitis)
• C) Bacterial tracheitis
• D) Peritonsillar abscess
Correct Answer: B
Rationale: Croup is characterized by a barking cough and inspiratory stridor,
typically caused by parainfluenza virus. Epiglottitis presents with drooling, tripod
positioning, and a toxic appearance .
Section 3: Endocrine & Metabolic
Q8. A 28-year-old woman with palpitations, heat intolerance, and weight loss
despite good appetite. Exam shows fine tremor, brisk reflexes, and lid lag. TSH
<0.01, free T4 elevated. What is the best initial pharmacotherapy?
• A) Propylthiouracil
• B) Methimazole
• C) Levothyroxine
• D) Radioactive iodine
Correct Answer: B
Rationale: Methimazole is first-line for Graves' disease in non-pregnant adults
because of lower hepatotoxicity risk than PTU .
Q9. A 52-year-old man has a firm, painless nodule on the right lobe of the
thyroid. Ultrasound shows microcalcifications and irregular margins. What is the
next best step?
• A) Repeat ultrasound in 1 year
Verified Correct Answers for Advanced
Practice Nursing
Section 1: Cardiovascular System
Q1. A 75-year-old male with poorly controlled hypertension for over 10 years
has likely experienced a shift in his point of maximal impulse (PMI). Where is the
most likely new location of his PMI?
• A) 5th intercostal space (ICS), midclavicular line (MCL)
• B) 8th ICS, MCL
• C) 5th ICS, left of MCL
• D) 6th ICS, right of MCL
Correct Answer: C
Rationale: Chronic hypertension causes left ventricular hypertrophy (LVH) as the
heart works against increased afterload. The hypertrophied left ventricle enlarges
and shifts the PMI laterally and inferiorly. A PMI at the 5th ICS, left of the MCL,
indicates LVH .
Q2. A 65-year-old man with a history of smoking and diabetes presents with a 2-
month history of leg pain when walking that resolves with rest. On exam, you
note diminished dorsalis pedis and posterior tibial pulses. What is the most
likely diagnosis?
• A) Venous insufficiency
• B) Peripheral arterial disease (PAD)
, • C) Sciatica
• D) Peripheral neuropathy
Correct Answer: B
Rationale: Intermittent claudication—muscle cramping or pain in the calves,
thighs, or buttocks induced by exercise and relieved by rest—is the classic
symptom of PAD. Diminished pulses are a key physical exam finding .
Q3. A patient with heart failure has auscultation findings consistent with an S3
gallop. An S3 heart sound is often heard in which condition?
• A) Diastolic heart failure only
• B) Congestive heart failure (CHF)
• C) Athletes only
• D) Pericarditis
Correct Answer: B
Rationale: An S3 gallop (ventricular gallop) is often a sign of fluid volume overload
and reduced ventricular compliance, making it a key clinical indicator of heart
failure in adults. It may be normal in some athletic adolescents but is pathologic in
older adults .
Q4. A heart murmur is heard best at the apex with the bell, radiating to the
axilla. It is holosystolic. What is the most likely diagnosis?
• A) Mitral regurgitation
• B) Aortic stenosis
• C) Tricuspid regurgitation
• D) Mitral valve prolapse
Correct Answer: A
,Rationale: Mitral regurgitation produces a holosystolic murmur best heard at the
apex with radiation to the axilla. The bell is used to listen for low-pitched sounds,
and this murmur's characteristics are classic for mitral regurgitation .
Section 2: Respiratory & ENT Systems
Q5. A 58-year-old male with type 2 diabetes reports burning foot pain worse at
night. Exam shows diminished pinprick sensation distal to ankles and absent
Achilles reflexes. What is the most likely diagnosis?
• A) Peripheral artery disease
• B) Lumbar radiculopathy
• C) Diabetic peripheral neuropathy
• D) Vitamin B12 deficiency
Correct Answer: C
Rationale: Distal symmetric polyneuropathy in diabetes presents with burning
pain, nocturnal exacerbation, loss of sensation, and areflexia. PAD causes
claudication, not burning dysesthesia .
Q6. A patient with COPD has worsening dyspnea, increased sputum purulence
and volume. No fever. What is the best initial treatment?
• A) Oral prednisone alone
• B) Azithromycin alone
• C) Bronchodilators + antibiotics
• D) Oxygen only
Correct Answer: C
Rationale: Acute exacerbation of COPD with increased dyspnea, sputum purulence,
and volume (Anthonisen type I) requires antibiotics + bronchodilators .
, Q7. A 3-year-old child with fever, cough, and inspiratory stridor, "barking"
cough. Immunizations are up to date. What is the most likely diagnosis?
• A) Epiglottitis
• B) Croup (laryngotracheobronchitis)
• C) Bacterial tracheitis
• D) Peritonsillar abscess
Correct Answer: B
Rationale: Croup is characterized by a barking cough and inspiratory stridor,
typically caused by parainfluenza virus. Epiglottitis presents with drooling, tripod
positioning, and a toxic appearance .
Section 3: Endocrine & Metabolic
Q8. A 28-year-old woman with palpitations, heat intolerance, and weight loss
despite good appetite. Exam shows fine tremor, brisk reflexes, and lid lag. TSH
<0.01, free T4 elevated. What is the best initial pharmacotherapy?
• A) Propylthiouracil
• B) Methimazole
• C) Levothyroxine
• D) Radioactive iodine
Correct Answer: B
Rationale: Methimazole is first-line for Graves' disease in non-pregnant adults
because of lower hepatotoxicity risk than PTU .
Q9. A 52-year-old man has a firm, painless nodule on the right lobe of the
thyroid. Ultrasound shows microcalcifications and irregular margins. What is the
next best step?
• A) Repeat ultrasound in 1 year
