APEA 3P Test
Set 2 Questions and Answers| Latest Update| Guaranteed Pass
,Question 1. During a cardiac exam, the nurse practitioner auscultates a
murmur that is loudest at the second right intercostal space, radiates to
the carotids, and increases with passive leg raise. This is most
consistent with:
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral valve prolapse
D. Tricuspid regurgitation
Correct Answer: B. Aortic stenosis
Rationale: Aortic stenosis produces a harsh, crescendo-decrescendo systolic
murmur best heard at the right upper sternal border (2nd right ICS) with
radiation to the carotids. Increased preload (leg raise) increases stroke
volume across the stenotic valve, intensifying the murmur. Mitral regurgitation
is holosystolic at the apex radiating to the axilla; MVP has a midsystolic click;
tricuspid regurgitation is best heard at the lower left sternal border and
increases with inspiration.
Question 2. A patient presents with unilateral facial weakness involving
the forehead (inability to raise the eyebrow on the affected side). This
finding localizes the lesion to:
A. Contralateral cerebral cortex (upper motor neuron)
B. Ipsilateral facial nerve (lower motor neuron)
C. Ipsilateral trigeminal nerve
D. Contralateral internal capsule
Correct Answer: B. Ipsilateral facial nerve (lower motor neuron)
Rationale: Because the forehead receives bilateral cortical innervation, an
upper motor neuron (central) lesion spares the forehead and only affects the
lower face contralaterally. Involvement of the forehead indicates a lower
motor neuron lesion of the facial nerve (CN VII) itself, ipsilateral to the
weakness, as in Bell's palsy.
,Question 3. On abdominal exam, the examiner elicits pain in the right
lower quadrant when pressing on the left lower quadrant. This is known
as:
A. Murphy's sign
B. Psoas sign
C. Rovsing's sign
D. Obturator sign
Correct Answer: C. Rovsing's sign
Rationale: Rovsing's sign is right lower quadrant pain elicited by palpation of
the left lower quadrant, suggesting peritoneal irritation from appendicitis.
Murphy's sign involves inspiratory arrest with right upper quadrant palpation
(cholecystitis); the psoas and obturator signs involve pain with hip
flexion/rotation against resistance.
Question 4. A patient's deep tendon reflexes are graded 4+ with
sustained clonus. This finding is most consistent with:
A. Peripheral neuropathy
B. Upper motor neuron lesion
C. Normal variant
D. Cerebellar dysfunction
Correct Answer: B. Upper motor neuron lesion
Rationale: Hyperreflexia (4+) with clonus reflects loss of descending
inhibitory control from an upper motor neuron lesion (e.g., stroke, spinal cord
injury above the level tested). Peripheral neuropathy and lower motor neuron
lesions typically cause diminished or absent reflexes.
, Question 5. During funduscopic examination, the NP observes
flame-shaped hemorrhages, cotton-wool spots, and arteriovenous
nicking. These findings are most consistent with:
A. Diabetic retinopathy, nonproliferative
B. Chronic hypertensive retinopathy
C. Papilledema
D. Central retinal vein occlusion
Correct Answer: B. Chronic hypertensive retinopathy
Rationale: AV nicking, flame hemorrhages, and cotton-wool spots
(microinfarcts) are classic hypertensive retinopathy findings from chronic
arteriolar narrowing and vessel wall changes. Diabetic retinopathy more
typically shows microaneurysms and dot-blot hemorrhages; papilledema
shows disc swelling with blurred margins.
Question 6. A patient has a positive McMurray test. This test is used to
assess for injury to the:
A. Anterior cruciate ligament
B. Meniscus
C. Medial collateral ligament
D. Patellar tendon
Correct Answer: B. Meniscus
Rationale: The McMurray test involves flexing the knee and rotating the tibia
while extending it; a palpable/audible click with pain indicates meniscal tear.
The Lachman and anterior drawer tests assess ACL integrity; valgus stress
tests the MCL.
Set 2 Questions and Answers| Latest Update| Guaranteed Pass
,Question 1. During a cardiac exam, the nurse practitioner auscultates a
murmur that is loudest at the second right intercostal space, radiates to
the carotids, and increases with passive leg raise. This is most
consistent with:
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral valve prolapse
D. Tricuspid regurgitation
Correct Answer: B. Aortic stenosis
Rationale: Aortic stenosis produces a harsh, crescendo-decrescendo systolic
murmur best heard at the right upper sternal border (2nd right ICS) with
radiation to the carotids. Increased preload (leg raise) increases stroke
volume across the stenotic valve, intensifying the murmur. Mitral regurgitation
is holosystolic at the apex radiating to the axilla; MVP has a midsystolic click;
tricuspid regurgitation is best heard at the lower left sternal border and
increases with inspiration.
Question 2. A patient presents with unilateral facial weakness involving
the forehead (inability to raise the eyebrow on the affected side). This
finding localizes the lesion to:
A. Contralateral cerebral cortex (upper motor neuron)
B. Ipsilateral facial nerve (lower motor neuron)
C. Ipsilateral trigeminal nerve
D. Contralateral internal capsule
Correct Answer: B. Ipsilateral facial nerve (lower motor neuron)
Rationale: Because the forehead receives bilateral cortical innervation, an
upper motor neuron (central) lesion spares the forehead and only affects the
lower face contralaterally. Involvement of the forehead indicates a lower
motor neuron lesion of the facial nerve (CN VII) itself, ipsilateral to the
weakness, as in Bell's palsy.
,Question 3. On abdominal exam, the examiner elicits pain in the right
lower quadrant when pressing on the left lower quadrant. This is known
as:
A. Murphy's sign
B. Psoas sign
C. Rovsing's sign
D. Obturator sign
Correct Answer: C. Rovsing's sign
Rationale: Rovsing's sign is right lower quadrant pain elicited by palpation of
the left lower quadrant, suggesting peritoneal irritation from appendicitis.
Murphy's sign involves inspiratory arrest with right upper quadrant palpation
(cholecystitis); the psoas and obturator signs involve pain with hip
flexion/rotation against resistance.
Question 4. A patient's deep tendon reflexes are graded 4+ with
sustained clonus. This finding is most consistent with:
A. Peripheral neuropathy
B. Upper motor neuron lesion
C. Normal variant
D. Cerebellar dysfunction
Correct Answer: B. Upper motor neuron lesion
Rationale: Hyperreflexia (4+) with clonus reflects loss of descending
inhibitory control from an upper motor neuron lesion (e.g., stroke, spinal cord
injury above the level tested). Peripheral neuropathy and lower motor neuron
lesions typically cause diminished or absent reflexes.
, Question 5. During funduscopic examination, the NP observes
flame-shaped hemorrhages, cotton-wool spots, and arteriovenous
nicking. These findings are most consistent with:
A. Diabetic retinopathy, nonproliferative
B. Chronic hypertensive retinopathy
C. Papilledema
D. Central retinal vein occlusion
Correct Answer: B. Chronic hypertensive retinopathy
Rationale: AV nicking, flame hemorrhages, and cotton-wool spots
(microinfarcts) are classic hypertensive retinopathy findings from chronic
arteriolar narrowing and vessel wall changes. Diabetic retinopathy more
typically shows microaneurysms and dot-blot hemorrhages; papilledema
shows disc swelling with blurred margins.
Question 6. A patient has a positive McMurray test. This test is used to
assess for injury to the:
A. Anterior cruciate ligament
B. Meniscus
C. Medial collateral ligament
D. Patellar tendon
Correct Answer: B. Meniscus
Rationale: The McMurray test involves flexing the knee and rotating the tibia
while extending it; a palpable/audible click with pain indicates meniscal tear.
The Lachman and anterior drawer tests assess ACL integrity; valgus stress
tests the MCL.
