APEA 3P Practice Test 2026 | 400 Q&A with
Correct Answers & Rationales for NP Board
Exam Prep
Question 1
A 68-year-old male with a 40-pack-year smoking history presents with progressive
dyspnea, chronic cough, and weight loss. O₂ sat 92%. Lung exam shows diminished
breath sounds and end-expiratory wheezing. CXR: hyperinflation, flat diaphragms.
What is the most appropriate next step?
A. Initiate long-acting bronchodilator and refer to pulmonary rehab
B. Start oral prednisone 60 mg daily
C. Refer for urgent bronchoscopy
D. Prescribe azithromycin
Rationale: This is stable COPD (GOLD group B/E). First-line is LABA/LAMA +
pulmonary rehabilitation. Systemic steroids are not for stable disease. Bronchoscopy
is for masses/hemoptysis. Antibiotics are for acute exacerbations with purulent
sputum.
Question 2
A 72-year-old female with HTN and DM presents with palpitations and dizziness.
ECG: irregularly irregular, no P waves, rate 118. She is stable. What is initial
management?
A. Rate control with metoprolol + anticoagulation evaluation
B. Immediate synchronized cardioversion
C. IV amiodarone 150 mg bolus
D. Oral flecainide 200 mg
Rationale: Atrial fibrillation with RVR in a stable patient. Rate control is first-line
(beta-blocker or CCB). Anticoagulation based on CHA₂DS₂-VASc. Cardioversion is for
unstable or new-onset <48h without anticoagulation.
Question 3
A 55-year-old obese male with GERD presents with acute RUQ pain, nausea,
,vomiting after fatty meal. Fever 101.5°F, positive Murphy's sign. WBC 14,500. Most
definitive diagnostic study?
A. Right upper quadrant ultrasound
B. Abdominal CT with contrast
C. HIDA scan
D. Abdominal X-ray
Rationale: Acute cholecystitis. Ultrasound is first-line and most definitive: shows
stones, wall thickening >4mm, pericholecystic fluid, sonographic Murphy's. CT less
sensitive for stones. HIDA if ultrasound equivocal.
Question 4
A 34-year-old G2P1 at 28 weeks presents with painless, bright red vaginal bleeding.
Vitals stable, FHR reactive. Most likely diagnosis?
A. Placenta previa
B. Placental abruption
C. Preterm labor
D. Vasa previa
Rationale: Painless third-trimester bleeding = placenta previa until proven. DO NOT
perform digital exam. Abruption = painful with uterine rigidity. Vasa previa = rare
with fetal bradycardia.
Question 5
A 60-year-old male with DM and HTN has a non-healing ulcer on right great toe.
Foot warm, DP pulses palpable, monofilament sensation decreased. Most important
initial intervention?
A. Offloading and wound debridement
B. Urgent vascular bypass
C. IV vancomycin
D. Oral ciprofloxacin
Rationale: Neuropathic ulcer (warm, palpable pulses, loss of sensation). Offloading +
debridement is cornerstone. Antibiotics only if infected (purulence, cellulitis). Bypass
for ischemic ulcers (cold, pulseless).
,Question 6
A 45-year-old female with bilateral hand pain/stiffness/swelling >1 hour morning
stiffness, fatigue, dry eyes. Ulnar deviation, swan-neck deformities. Most specific lab?
A. Anti-CCP antibody
B. Rheumatoid factor
C. ANA
D. ESR
Rationale: Rheumatoid arthritis. Anti-CCP is most specific (>95%). RF is sensitive but
less specific. ANA in SLE. ESR/CRP are non-specific inflammatory markers.
Question 7
A 72-year-old male with BPH has acute urinary retention. Foley placed, 1200 mL
drained. What complication to monitor for in next 24-48 hours?
A. Post-obstructive diuresis
B. Pyelonephritis
C. Urosepsis
D. Bladder rupture
Rationale: Post-obstructive diuresis after relief of chronic obstruction >1000mL.
Monitor for hypotension, electrolyte depletion (Na⁺, K⁺). Replace fluid to match
output only if hemodynamic instability.
Question 8
A 28-year-old female with acute severe unilateral throbbing headache, nausea,
photophobia, phonophobia. Episodes last 4-72 hours. Normal neuro exam. Acute
treatment?
A. Sumatriptan (triptan)
B. Propranolol daily
C. IV morphine
D. Acetaminophen 650mg
Rationale: Migraine without aura. Triptans are first-line for moderate-severe acute
attacks. Propranolol is prophylaxis. Opioids avoided. Acetaminophen for mild attacks.
, Question 9
A 65-year-old female with osteoporosis has acute severe back pain after lifting.
Unable to stand. Midline tenderness T12-L1. No neuro deficits. Next imaging?
A. X-ray thoracolumbar spine
B. MRI spine without contrast
C. CT spine with contrast
D. Bone scan
Rationale: Suspected vertebral compression fracture. Plain X-rays (AP/lateral) are
initial study. MRI for cord compression/neurologic deficits. CT for trauma/surgical
planning.
Question 10
A 50-year-old male smoker with 3-week hoarseness. No fever/mass/odynophagia.
Laryngoscopy: unilateral vocal fold lesion. Strongest risk factor?
A. Tobacco smoking
B. HPV
C. Alcohol use
D. GERD
Rationale: Laryngeal SCC. Tobacco is strongest risk factor. Alcohol is synergistic but
less potent alone. HPV associated with oropharyngeal (not laryngeal) cancer.
Question 11
A 32-year-old male with painful swollen right knee after twisting injury. Cannot bear
weight. Effusion, positive Lachman's. Most likely diagnosis?
A. ACL tear
B. Medial meniscus tear
C. PCL tear
D. Patellar dislocation
Rationale: ACL tear: acute injury, effusion, inability to bear weight, positive Lachman
(most sensitive test). Meniscus = joint line pain/locking. PCL = posterior drawer.
Patellar = apprehension test.
Correct Answers & Rationales for NP Board
Exam Prep
Question 1
A 68-year-old male with a 40-pack-year smoking history presents with progressive
dyspnea, chronic cough, and weight loss. O₂ sat 92%. Lung exam shows diminished
breath sounds and end-expiratory wheezing. CXR: hyperinflation, flat diaphragms.
What is the most appropriate next step?
A. Initiate long-acting bronchodilator and refer to pulmonary rehab
B. Start oral prednisone 60 mg daily
C. Refer for urgent bronchoscopy
D. Prescribe azithromycin
Rationale: This is stable COPD (GOLD group B/E). First-line is LABA/LAMA +
pulmonary rehabilitation. Systemic steroids are not for stable disease. Bronchoscopy
is for masses/hemoptysis. Antibiotics are for acute exacerbations with purulent
sputum.
Question 2
A 72-year-old female with HTN and DM presents with palpitations and dizziness.
ECG: irregularly irregular, no P waves, rate 118. She is stable. What is initial
management?
A. Rate control with metoprolol + anticoagulation evaluation
B. Immediate synchronized cardioversion
C. IV amiodarone 150 mg bolus
D. Oral flecainide 200 mg
Rationale: Atrial fibrillation with RVR in a stable patient. Rate control is first-line
(beta-blocker or CCB). Anticoagulation based on CHA₂DS₂-VASc. Cardioversion is for
unstable or new-onset <48h without anticoagulation.
Question 3
A 55-year-old obese male with GERD presents with acute RUQ pain, nausea,
,vomiting after fatty meal. Fever 101.5°F, positive Murphy's sign. WBC 14,500. Most
definitive diagnostic study?
A. Right upper quadrant ultrasound
B. Abdominal CT with contrast
C. HIDA scan
D. Abdominal X-ray
Rationale: Acute cholecystitis. Ultrasound is first-line and most definitive: shows
stones, wall thickening >4mm, pericholecystic fluid, sonographic Murphy's. CT less
sensitive for stones. HIDA if ultrasound equivocal.
Question 4
A 34-year-old G2P1 at 28 weeks presents with painless, bright red vaginal bleeding.
Vitals stable, FHR reactive. Most likely diagnosis?
A. Placenta previa
B. Placental abruption
C. Preterm labor
D. Vasa previa
Rationale: Painless third-trimester bleeding = placenta previa until proven. DO NOT
perform digital exam. Abruption = painful with uterine rigidity. Vasa previa = rare
with fetal bradycardia.
Question 5
A 60-year-old male with DM and HTN has a non-healing ulcer on right great toe.
Foot warm, DP pulses palpable, monofilament sensation decreased. Most important
initial intervention?
A. Offloading and wound debridement
B. Urgent vascular bypass
C. IV vancomycin
D. Oral ciprofloxacin
Rationale: Neuropathic ulcer (warm, palpable pulses, loss of sensation). Offloading +
debridement is cornerstone. Antibiotics only if infected (purulence, cellulitis). Bypass
for ischemic ulcers (cold, pulseless).
,Question 6
A 45-year-old female with bilateral hand pain/stiffness/swelling >1 hour morning
stiffness, fatigue, dry eyes. Ulnar deviation, swan-neck deformities. Most specific lab?
A. Anti-CCP antibody
B. Rheumatoid factor
C. ANA
D. ESR
Rationale: Rheumatoid arthritis. Anti-CCP is most specific (>95%). RF is sensitive but
less specific. ANA in SLE. ESR/CRP are non-specific inflammatory markers.
Question 7
A 72-year-old male with BPH has acute urinary retention. Foley placed, 1200 mL
drained. What complication to monitor for in next 24-48 hours?
A. Post-obstructive diuresis
B. Pyelonephritis
C. Urosepsis
D. Bladder rupture
Rationale: Post-obstructive diuresis after relief of chronic obstruction >1000mL.
Monitor for hypotension, electrolyte depletion (Na⁺, K⁺). Replace fluid to match
output only if hemodynamic instability.
Question 8
A 28-year-old female with acute severe unilateral throbbing headache, nausea,
photophobia, phonophobia. Episodes last 4-72 hours. Normal neuro exam. Acute
treatment?
A. Sumatriptan (triptan)
B. Propranolol daily
C. IV morphine
D. Acetaminophen 650mg
Rationale: Migraine without aura. Triptans are first-line for moderate-severe acute
attacks. Propranolol is prophylaxis. Opioids avoided. Acetaminophen for mild attacks.
, Question 9
A 65-year-old female with osteoporosis has acute severe back pain after lifting.
Unable to stand. Midline tenderness T12-L1. No neuro deficits. Next imaging?
A. X-ray thoracolumbar spine
B. MRI spine without contrast
C. CT spine with contrast
D. Bone scan
Rationale: Suspected vertebral compression fracture. Plain X-rays (AP/lateral) are
initial study. MRI for cord compression/neurologic deficits. CT for trauma/surgical
planning.
Question 10
A 50-year-old male smoker with 3-week hoarseness. No fever/mass/odynophagia.
Laryngoscopy: unilateral vocal fold lesion. Strongest risk factor?
A. Tobacco smoking
B. HPV
C. Alcohol use
D. GERD
Rationale: Laryngeal SCC. Tobacco is strongest risk factor. Alcohol is synergistic but
less potent alone. HPV associated with oropharyngeal (not laryngeal) cancer.
Question 11
A 32-year-old male with painful swollen right knee after twisting injury. Cannot bear
weight. Effusion, positive Lachman's. Most likely diagnosis?
A. ACL tear
B. Medial meniscus tear
C. PCL tear
D. Patellar dislocation
Rationale: ACL tear: acute injury, effusion, inability to bear weight, positive Lachman
(most sensitive test). Meniscus = joint line pain/locking. PCL = posterior drawer.
Patellar = apprehension test.
