APEA 3P EXAM STUDY GUIDE 2026
150+ ACTUAL QUESTIONS WITH DETAILED RATIONALES
NEW 2025/2026 UPDATE
CARDIOVASCULAR
1. Which patient could be expected to have the highest systolic blood pressure?
A. A 21-year-old male
B. A 50-year-old perimenopausal female
C. A 35-year-old patient with Type 2 diabetes
D. A 75-year-old male
Rationale: The greatest incidence of hypertension is in older adults because of
changes in the intima of vessels as aging and calcium deposition occur. Males of
any age are more likely to be hypertensive than females of the same age .
2. Mrs. Brandy is having contrast dye next week for a heart catheterization.
What drug does NOT need to be stopped prior to her catheterization?
A. Naproxen
,B. Furosemide
C. Metformin
D. Losartan
Rationale: Naproxen and furosemide should be stopped for 24 hours prior.
Metformin should be stopped 48 hours prior due to risk of lactic acidosis. ACE
inhibitors and ARBs like losartan are often continued or held based on facility
protocol, but of the options listed, losartan is the one that may not require
routine discontinuation .
3. A patient presents with chest pain and the nurse practitioner observes jugular
venous distention. This finding is consistent with:
A. Hypertension
B. Heart failure
C. Asthma
D. Pneumonia
Rationale: Heart failure causes decreased cardiac output when the heart fails as a
pump and the circulation becomes backed up and congested. Jugular vein
distention is a classic sign of right-sided heart failure .
,4. What is the usual clinical course of mitral valve prolapse (MVP)?
A. It is benign
B. Results in sudden cardiac death
C. Results in chronic heart failure
D. Is associated with multiple episodes of emboli
Rationale: The usual course of MVP is benign, and most patients are
asymptomatic. A murmur may be present and is best auscultated with the
diaphragm over the cardiac apex .
5. An ACE inhibitor is specifically indicated in patients who have:
A. Hypertension, diabetes with proteinuria, and heart failure
B. Diabetes, hypertension, hyperlipidemia
C. Asthma, hypertension, diabetes
D. Renal nephropathy, heart failure, hyperlipidemia
Rationale: ACE inhibitors have numerous indications including hypertension,
heart failure, and diabetic nephropathy (proteinuria). Diabetes without
proteinuria is not a specific indication .
6. An older adult with hypertension and angina takes multiple medications.
Which one decreases the likelihood of his having angina?
, A. ACE inhibitor
B. Beta blocker
C. Diuretic
D. Angiotensin receptor blocker
Rationale: Beta blockers slow heart rate, depress myocardial contractility, and
decrease sympathetic stimulation. These decrease myocardial oxygen demand
and improve angina symptoms .
7. Orthostatic hypotension can be diagnosed in an older adult if the systolic
blood pressure decreases:
A. More than 20 points anytime after rising
B. More than 20 points within 3 minutes after rising
C. More than 20 points within 1 minute after rising
D. Any degree drop if the patient becomes weak or dizzy
Rationale: Orthostatic hypotension is diagnosed in older adults when systolic BP
drops ≥20 mm Hg or diastolic drops ≥10 mm Hg within 3 minutes of moving to a
more upright position .
8. Which hypertensive patient is most likely to have adverse blood pressure
effects from excessive sodium consumption?
150+ ACTUAL QUESTIONS WITH DETAILED RATIONALES
NEW 2025/2026 UPDATE
CARDIOVASCULAR
1. Which patient could be expected to have the highest systolic blood pressure?
A. A 21-year-old male
B. A 50-year-old perimenopausal female
C. A 35-year-old patient with Type 2 diabetes
D. A 75-year-old male
Rationale: The greatest incidence of hypertension is in older adults because of
changes in the intima of vessels as aging and calcium deposition occur. Males of
any age are more likely to be hypertensive than females of the same age .
2. Mrs. Brandy is having contrast dye next week for a heart catheterization.
What drug does NOT need to be stopped prior to her catheterization?
A. Naproxen
,B. Furosemide
C. Metformin
D. Losartan
Rationale: Naproxen and furosemide should be stopped for 24 hours prior.
Metformin should be stopped 48 hours prior due to risk of lactic acidosis. ACE
inhibitors and ARBs like losartan are often continued or held based on facility
protocol, but of the options listed, losartan is the one that may not require
routine discontinuation .
3. A patient presents with chest pain and the nurse practitioner observes jugular
venous distention. This finding is consistent with:
A. Hypertension
B. Heart failure
C. Asthma
D. Pneumonia
Rationale: Heart failure causes decreased cardiac output when the heart fails as a
pump and the circulation becomes backed up and congested. Jugular vein
distention is a classic sign of right-sided heart failure .
,4. What is the usual clinical course of mitral valve prolapse (MVP)?
A. It is benign
B. Results in sudden cardiac death
C. Results in chronic heart failure
D. Is associated with multiple episodes of emboli
Rationale: The usual course of MVP is benign, and most patients are
asymptomatic. A murmur may be present and is best auscultated with the
diaphragm over the cardiac apex .
5. An ACE inhibitor is specifically indicated in patients who have:
A. Hypertension, diabetes with proteinuria, and heart failure
B. Diabetes, hypertension, hyperlipidemia
C. Asthma, hypertension, diabetes
D. Renal nephropathy, heart failure, hyperlipidemia
Rationale: ACE inhibitors have numerous indications including hypertension,
heart failure, and diabetic nephropathy (proteinuria). Diabetes without
proteinuria is not a specific indication .
6. An older adult with hypertension and angina takes multiple medications.
Which one decreases the likelihood of his having angina?
, A. ACE inhibitor
B. Beta blocker
C. Diuretic
D. Angiotensin receptor blocker
Rationale: Beta blockers slow heart rate, depress myocardial contractility, and
decrease sympathetic stimulation. These decrease myocardial oxygen demand
and improve angina symptoms .
7. Orthostatic hypotension can be diagnosed in an older adult if the systolic
blood pressure decreases:
A. More than 20 points anytime after rising
B. More than 20 points within 3 minutes after rising
C. More than 20 points within 1 minute after rising
D. Any degree drop if the patient becomes weak or dizzy
Rationale: Orthostatic hypotension is diagnosed in older adults when systolic BP
drops ≥20 mm Hg or diastolic drops ≥10 mm Hg within 3 minutes of moving to a
more upright position .
8. Which hypertensive patient is most likely to have adverse blood pressure
effects from excessive sodium consumption?
