Page 1 of 72
APEA 3P NURSING EXAM PRACTICE 2026
COMPLETE (125) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
APEA
Maximize your success with this APEA 3P Nursing Exam practice exam
designed to reinforce essential assessment, pharmacology, and
pathophysiology concepts critical for advanced nursing practice. The
exam-style questions help strengthen clinical reasoning, identify
knowledge gaps, and build confidence for exam day. A valuable resource
for focused review and effective preparation. Suitable for nurse
practitioner students preparing for the APEA 3P examination.
MULTIPLE CHOICE.
Section 1: Advanced Pathophysiology (Questions 1–42)
1. A 45-year-old patient presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory findings reveal
elevated TSH and low free T4. Which of the following is the most
likely diagnosis?
A. Graves' disease
B. Hashimoto's thyroiditis
C. Thyroid storm
D. Subclinical hyperthyroidism
Correct answer: B. Hashimoto's thyroiditis
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Rationale: Hashimoto's thyroiditis is an autoimmune disorder
characterized by elevated TSH and low free T4, resulting in primary
hypothyroidism. Clinical manifestations include fatigue, weight
gain, cold intolerance, and constipation. Graves' disease causes
hyperthyroidism. Thyroid storm is a severe hyperthyroid state.
Subclinical hyperthyroidism would present with low TSH.
2. A 65-year-old male with a history of hypertension and smoking
presents with sudden onset of severe, tearing chest pain
radiating to the back. Blood pressure is 190/110 mmHg. Which of
the following conditions should be suspected first?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct answer: C. Aortic dissection
Rationale: Aortic dissection presents with sudden, severe, tearing
chest pain that may radiate to the back. Risk factors include
hypertension and smoking. The classic presentation includes a
blood pressure differential between arms. Acute MI pain is typically
crushing or pressure-like. Pulmonary embolism presents with
sudden dyspnea and pleuritic chest pain. Pericarditis pain is sharp
and positional.
3. A 28-year-old woman presents with amenorrhea,
galactorrhea, and visual field defects. A pituitary adenoma is
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suspected. Which of the following laboratory findings would
support this diagnosis?
A. Elevated prolactin
B. Elevated TSH
C. Elevated cortisol
D. Elevated ACTH
Correct answer: A. Elevated prolactin
Rationale: Prolactin-secreting pituitary adenomas (prolactinomas)
cause elevated prolactin levels, leading to amenorrhea and
galactorrhea in women. Large adenomas can compress the optic
chiasm, causing visual field defects (bitemporal hemianopsia).
Elevated TSH is seen in primary hypothyroidism. Elevated cortisol
suggests Cushing's syndrome. Elevated ACTH may indicate
Cushing's disease.
4. Which of the following is a hallmark laboratory finding in
diabetic ketoacidosis (DKA)?
A. Serum bicarbonate > 22 mEq/L
B. Serum pH > 7.35
C. Anion gap > 12 mEq/L
D. Serum osmolality < 280 mOsm/kg
Correct answer: C. Anion gap > 12 mEq/L
Rationale: DKA is characterized by an elevated anion gap metabolic
acidosis (anion gap > 12 mEq/L) due to increased production of
ketone bodies. Serum bicarbonate is typically low (< 18 mEq/L), pH
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is acidic (< 7.35), and serum osmolality is elevated (> 290 mOsm/kg)
due to hyperglycemia.
5. A 55-year-old male with a 30-pack-year smoking history
presents with a new-onset cough, hemoptysis, and weight loss.
Chest X-ray reveals a right hilar mass. Which of the following is
the most likely diagnosis?
A. Tuberculosis
B. Sarcoidosis
C. Bronchogenic carcinoma
D. Pneumonia
Correct answer: C. Bronchogenic carcinoma
Rationale: Bronchogenic carcinoma (lung cancer) is strongly
associated with smoking history. Classic presenting symptoms
include new-onset cough, hemoptysis, weight loss, and a hilar mass
on chest X-ray. Tuberculosis would present with fever, night sweats,
and upper lobe infiltrates. Sarcoidosis typically presents with
bilateral hilar adenopathy. Pneumonia would present with fever and
acute symptoms.
6. A 32-year-old woman presents with palpitations, heat
intolerance, weight loss, and tremor. Physical examination
reveals a diffuse, painless goiter and exophthalmos. Which of
the following is the most likely diagnosis?
A. Hashimoto's thyroiditis
B. Graves' disease
APEA 3P NURSING EXAM PRACTICE 2026
COMPLETE (125) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
APEA
Maximize your success with this APEA 3P Nursing Exam practice exam
designed to reinforce essential assessment, pharmacology, and
pathophysiology concepts critical for advanced nursing practice. The
exam-style questions help strengthen clinical reasoning, identify
knowledge gaps, and build confidence for exam day. A valuable resource
for focused review and effective preparation. Suitable for nurse
practitioner students preparing for the APEA 3P examination.
MULTIPLE CHOICE.
Section 1: Advanced Pathophysiology (Questions 1–42)
1. A 45-year-old patient presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory findings reveal
elevated TSH and low free T4. Which of the following is the most
likely diagnosis?
A. Graves' disease
B. Hashimoto's thyroiditis
C. Thyroid storm
D. Subclinical hyperthyroidism
Correct answer: B. Hashimoto's thyroiditis
, Page 2 of 72
Rationale: Hashimoto's thyroiditis is an autoimmune disorder
characterized by elevated TSH and low free T4, resulting in primary
hypothyroidism. Clinical manifestations include fatigue, weight
gain, cold intolerance, and constipation. Graves' disease causes
hyperthyroidism. Thyroid storm is a severe hyperthyroid state.
Subclinical hyperthyroidism would present with low TSH.
2. A 65-year-old male with a history of hypertension and smoking
presents with sudden onset of severe, tearing chest pain
radiating to the back. Blood pressure is 190/110 mmHg. Which of
the following conditions should be suspected first?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct answer: C. Aortic dissection
Rationale: Aortic dissection presents with sudden, severe, tearing
chest pain that may radiate to the back. Risk factors include
hypertension and smoking. The classic presentation includes a
blood pressure differential between arms. Acute MI pain is typically
crushing or pressure-like. Pulmonary embolism presents with
sudden dyspnea and pleuritic chest pain. Pericarditis pain is sharp
and positional.
3. A 28-year-old woman presents with amenorrhea,
galactorrhea, and visual field defects. A pituitary adenoma is
, Page 3 of 72
suspected. Which of the following laboratory findings would
support this diagnosis?
A. Elevated prolactin
B. Elevated TSH
C. Elevated cortisol
D. Elevated ACTH
Correct answer: A. Elevated prolactin
Rationale: Prolactin-secreting pituitary adenomas (prolactinomas)
cause elevated prolactin levels, leading to amenorrhea and
galactorrhea in women. Large adenomas can compress the optic
chiasm, causing visual field defects (bitemporal hemianopsia).
Elevated TSH is seen in primary hypothyroidism. Elevated cortisol
suggests Cushing's syndrome. Elevated ACTH may indicate
Cushing's disease.
4. Which of the following is a hallmark laboratory finding in
diabetic ketoacidosis (DKA)?
A. Serum bicarbonate > 22 mEq/L
B. Serum pH > 7.35
C. Anion gap > 12 mEq/L
D. Serum osmolality < 280 mOsm/kg
Correct answer: C. Anion gap > 12 mEq/L
Rationale: DKA is characterized by an elevated anion gap metabolic
acidosis (anion gap > 12 mEq/L) due to increased production of
ketone bodies. Serum bicarbonate is typically low (< 18 mEq/L), pH
, Page 4 of 72
is acidic (< 7.35), and serum osmolality is elevated (> 290 mOsm/kg)
due to hyperglycemia.
5. A 55-year-old male with a 30-pack-year smoking history
presents with a new-onset cough, hemoptysis, and weight loss.
Chest X-ray reveals a right hilar mass. Which of the following is
the most likely diagnosis?
A. Tuberculosis
B. Sarcoidosis
C. Bronchogenic carcinoma
D. Pneumonia
Correct answer: C. Bronchogenic carcinoma
Rationale: Bronchogenic carcinoma (lung cancer) is strongly
associated with smoking history. Classic presenting symptoms
include new-onset cough, hemoptysis, weight loss, and a hilar mass
on chest X-ray. Tuberculosis would present with fever, night sweats,
and upper lobe infiltrates. Sarcoidosis typically presents with
bilateral hilar adenopathy. Pneumonia would present with fever and
acute symptoms.
6. A 32-year-old woman presents with palpitations, heat
intolerance, weight loss, and tremor. Physical examination
reveals a diffuse, painless goiter and exophthalmos. Which of
the following is the most likely diagnosis?
A. Hashimoto's thyroiditis
B. Graves' disease
