,APEA 3P Exam – Pathophysiology, Pharmacology & Physical
Assessment (2026) Q&A | Nursing
1. The nurse practitioner is evaluating a 55‑year‑old with hypertension and
notes a sustained, forceful apical impulse displaced to the 6th intercostal space
anterior axillary line. This finding most likely indicates:
A) Left ventricular hypertrophy
B) Right ventricular hypertrophy
C) Aortic stenosis
D) Mitral valve prolapse
Correct Answer: Left ventricular hypertrophy
Rationale: A displaced, sustained, forceful apical impulse suggests left
ventricular enlargement, often due to chronic pressure overload from
hypertension. Aortic stenosis may cause a similar impulse, but the question
context is hypertension.
2. Which mechanism best explains the development of primary essential
hypertension?
A) Increased renin‑angiotensin‑aldosterone system activity combined with
endothelial dysfunction
B) A single gene mutation affecting sodium channels
C) Acute glomerulonephritis
D) Renal artery stenosis
Correct Answer: Increased renin‑angiotensin‑aldosterone system activity
combined with endothelial dysfunction
,Rationale: Essential hypertension is multifactorial, involving increased RAAS
activity, sympathetic overdrive, endothelial dysfunction, and sodium retention.
It is not caused by a single gene mutation or acute renal disease.
3. A 60‑year‑old with type 2 diabetes presents with a painless, punched‑out
ulcer on the plantar surface of the foot surrounded by callus. The nurse
practitioner recognizes this as:
A) Venous stasis ulcer
B) Arterial insufficiency ulcer
C) Neuropathic ulcer
D) Pressure injury
Correct Answer: Neuropathic ulcer
Rationale: Diabetes‑related peripheral neuropathy leads to loss of protective
sensation, causing pressure points to develop painless ulcers with calloused
borders. Arterial ulcers are typically painful; venous ulcers are irregular and
shallow.
4. The NP is auscultating the heart and hears a low‑pitched diastolic rumble at
the apex with the bell. This finding is classic for:
A) Mitral stenosis
B) Aortic regurgitation
C) Mitral regurgitation
D) Aortic stenosis
, Correct Answer: Mitral stenosis
Rationale: Mitral stenosis produces a low‑pitched, rumbling diastolic murmur
best heard at the apex with the bell. Aortic regurgitation is a diastolic blowing
murmur at the left sternal border; mitral regurgitation is systolic.
5. A patient develops sudden, severe chest pain that radiates to the back,
accompanied by a difference in blood pressure between arms. The NP suspects:
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Correct Answer: Aortic dissection
Rationale: Aortic dissection presents with severe, tearing pain radiating to the
back, and a pulse or BP deficit between arms is a key sign. MI pain does not
typically cause BP differences.
6. Which laboratory finding is most consistent with iron deficiency anemia?
A) Microcytic, hypochromic red blood cells
B) Macrocytic, normochromic red blood cells
C) Normocytic, normochromic red blood cells
D) Macrocytic, hyperchromic red blood cells
Correct Answer: Microcytic, hypochromic red blood cells
Assessment (2026) Q&A | Nursing
1. The nurse practitioner is evaluating a 55‑year‑old with hypertension and
notes a sustained, forceful apical impulse displaced to the 6th intercostal space
anterior axillary line. This finding most likely indicates:
A) Left ventricular hypertrophy
B) Right ventricular hypertrophy
C) Aortic stenosis
D) Mitral valve prolapse
Correct Answer: Left ventricular hypertrophy
Rationale: A displaced, sustained, forceful apical impulse suggests left
ventricular enlargement, often due to chronic pressure overload from
hypertension. Aortic stenosis may cause a similar impulse, but the question
context is hypertension.
2. Which mechanism best explains the development of primary essential
hypertension?
A) Increased renin‑angiotensin‑aldosterone system activity combined with
endothelial dysfunction
B) A single gene mutation affecting sodium channels
C) Acute glomerulonephritis
D) Renal artery stenosis
Correct Answer: Increased renin‑angiotensin‑aldosterone system activity
combined with endothelial dysfunction
,Rationale: Essential hypertension is multifactorial, involving increased RAAS
activity, sympathetic overdrive, endothelial dysfunction, and sodium retention.
It is not caused by a single gene mutation or acute renal disease.
3. A 60‑year‑old with type 2 diabetes presents with a painless, punched‑out
ulcer on the plantar surface of the foot surrounded by callus. The nurse
practitioner recognizes this as:
A) Venous stasis ulcer
B) Arterial insufficiency ulcer
C) Neuropathic ulcer
D) Pressure injury
Correct Answer: Neuropathic ulcer
Rationale: Diabetes‑related peripheral neuropathy leads to loss of protective
sensation, causing pressure points to develop painless ulcers with calloused
borders. Arterial ulcers are typically painful; venous ulcers are irregular and
shallow.
4. The NP is auscultating the heart and hears a low‑pitched diastolic rumble at
the apex with the bell. This finding is classic for:
A) Mitral stenosis
B) Aortic regurgitation
C) Mitral regurgitation
D) Aortic stenosis
, Correct Answer: Mitral stenosis
Rationale: Mitral stenosis produces a low‑pitched, rumbling diastolic murmur
best heard at the apex with the bell. Aortic regurgitation is a diastolic blowing
murmur at the left sternal border; mitral regurgitation is systolic.
5. A patient develops sudden, severe chest pain that radiates to the back,
accompanied by a difference in blood pressure between arms. The NP suspects:
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Correct Answer: Aortic dissection
Rationale: Aortic dissection presents with severe, tearing pain radiating to the
back, and a pulse or BP deficit between arms is a key sign. MI pain does not
typically cause BP differences.
6. Which laboratory finding is most consistent with iron deficiency anemia?
A) Microcytic, hypochromic red blood cells
B) Macrocytic, normochromic red blood cells
C) Normocytic, normochromic red blood cells
D) Macrocytic, hyperchromic red blood cells
Correct Answer: Microcytic, hypochromic red blood cells
