MSN 572 APEA 3P EXAM / LATEST MSN 572 3P EXAM 2026
AND STUDY GUIDE COMPLETE ACCURATE TEST
APPROVED QUESTIONS AND CORRECT VERIFIED
ANSWERSWITH RATIONALES (DETAILED ANWERS) A NEW
UPDATED VERSION 2026 EDITION |ALREADY GRADED A+
(BRAND NEW!)
1. A 68-year-old male presents with a several-month history of progressively
worsening bilateral hand numbness, clumsiness, and a sensation of "walking on
sponges." On examination, you note hyperreflexia in the lower extremities,
bilateral Babinski signs, and atrophy of the tenor eminences. What is the most
likely diagnosis?
A. Peripheral neuropathy
B. Cervical spondylitis myelopathy
C. Carpal tunnel syndrome
D. Multiple sclerosis
Correct Answer: B. Cervical spondylitis myelopathy
Rationale: The combination of upper motor neuron signs (hyperreflexia, Babinski)
in the legs with lower motor neuron signs (atrophy, weakness) in the upper
extremities is classic for cervical myelopathy. This results from spinal cord
compression in the cervical spine.
2. A patient with a history of heart failure with reduced ejection fraction (Here) is
on a maximally tolerated dose of Lisinopril, carvedilol, and furosemide. The
patient’s ejection fraction is 35% and they remain symptomatic with NYHA class III
symptoms. Which medication is most appropriate to add next?
A. Spironolactone
B. Digoxin
C. Hydralazine and isosorbide denigrate
,D. Dapagliflozin
Correct Answer: D. Dapagliflozin
Rationale: Current guidelines recommend an SGLT2 inhibitor (dapagliflozin or
empagliflozin) as foundational therapy for Here, regardless of diabetes status, to
reduce cardiovascular death and heart failure hospitalizations, added to an
ARNI/Ace, beta-blocker, and MRA.
3. During a cardiac assessment, you palpate the point of maximal impulse (PMI) in
the left 6th intercostal space, anterior axillary line. Which of the following is the
most likely underlying condition?
A. Pericardial effusion
B. Left ventricular hypertrophy
C. Right ventricular hypertrophy
D. Chronic obstructive pulmonary disease (COPD)
Correct Answer: B. Left ventricular hypertrophy
Rationale: A displaced PMI that is lateral and inferior to the midclavicular line
suggests cardiomegaly, most commonly from left ventricular hypertrophy or
dilation, often due to chronic hypertension or aortic stenosis.
4. A 72-year-old female is prescribed a new medication for osteoporosis. She
reports a history of GERD managed with omeprazole. Which medication requires
specific instructions to avoid esophageal irritation?
A. Denosumab
B. Raloxifene
C. Alendronate
D. Teriparatide
Correct Answer: C. Alendronate
,Rationale: Alendronate, a bisphosphonate, is notorious for causing esophageal
irritation and ulcers. It must be taken with a full glass of water upon arising, and
the patient must remain upright for at least 30 minutes afterward.
5. A 45-year-old male presents with acute onset of severe, sharp chest pain that is
worse when lying supine and improves when sitting forward. He reports a recent
upper respiratory infection. On auscultation, you hear a friction rub. What is the
most likely diagnosis?
A. Acute coronary syndrome
B. Pericarditis
C. Aortic dissection
D. Pulmonary embolism
Correct Answer: B. Pericarditis
Rationale: The clinical trial of pleuritic chest pain that is positional (worse supine,
better leaning forward), a pericardial friction rubs, and a recent viral illness is
classic for acute pericarditis.
6. A patient with type 2 diabetes has an eGFI of 38 mL/min/1.73m² and a urinary
albumin-to-creatinine ratio of 300 mg/g. They are already on metformin and
Lisinopril. Which class of medication has been shown to provide the most
significant kidney and cardiovascular protection in this specific scenario?
A. GLP-1 receptor agonist
B. SGLT2 inhibitor
C. Thiazolidinedione
D. Sulfonylurea
Correct Answer: B. SGLT2 inhibitor
Rationale: SGLT2 inhibitors have robust data showing a reduction in the
progression of chronic kidney disease and major adverse cardiovascular events in
, patients with type 2 diabetes and established diabetic kidney disease, even at
lower egress (though initiation is often at eGFI >20-25).
7. On fundoscopic examination, you observe a 65-year-old male with a sharp,
well-defined optic disc but notice small, glistening, yellow deposits scattered in
the macula. There are no signs of neovascularization. What is the most
appropriate next step?
A. Immediate referral to ophthalmology for laser photocoagulation
B. Reassurance and recommendation for antioxidant vitamins (AREDS2 formula)
C. Initiation of intravitreal anti-VEGF injections
D. Screening for carotid artery stenosis
Correct Answer: B. Reassurance and recommendation for antioxidant vitamins
(AREDS2 formula)
Rationale: The findings describe dry (no exudative) age-related macular
degeneration with druse. The AREDS2 vitamin formulation is recommended for
intermediate or advanced dry AMD to reduce the risk of progression to the wet
(endovascular) form.
8. A patient is started on warfarin for atrial fibrillation. One week later, their INR is
1.2. They report no missed doses. Which medication in their home regimen is
most likely interfering with warfarin's anticoagulant effect?
A. Amiodarone
B. Metronidazole
C. Rifampin
D. Trimethoprim-sulfamethoxazole
Correct Answer: C. Rifampin
AND STUDY GUIDE COMPLETE ACCURATE TEST
APPROVED QUESTIONS AND CORRECT VERIFIED
ANSWERSWITH RATIONALES (DETAILED ANWERS) A NEW
UPDATED VERSION 2026 EDITION |ALREADY GRADED A+
(BRAND NEW!)
1. A 68-year-old male presents with a several-month history of progressively
worsening bilateral hand numbness, clumsiness, and a sensation of "walking on
sponges." On examination, you note hyperreflexia in the lower extremities,
bilateral Babinski signs, and atrophy of the tenor eminences. What is the most
likely diagnosis?
A. Peripheral neuropathy
B. Cervical spondylitis myelopathy
C. Carpal tunnel syndrome
D. Multiple sclerosis
Correct Answer: B. Cervical spondylitis myelopathy
Rationale: The combination of upper motor neuron signs (hyperreflexia, Babinski)
in the legs with lower motor neuron signs (atrophy, weakness) in the upper
extremities is classic for cervical myelopathy. This results from spinal cord
compression in the cervical spine.
2. A patient with a history of heart failure with reduced ejection fraction (Here) is
on a maximally tolerated dose of Lisinopril, carvedilol, and furosemide. The
patient’s ejection fraction is 35% and they remain symptomatic with NYHA class III
symptoms. Which medication is most appropriate to add next?
A. Spironolactone
B. Digoxin
C. Hydralazine and isosorbide denigrate
,D. Dapagliflozin
Correct Answer: D. Dapagliflozin
Rationale: Current guidelines recommend an SGLT2 inhibitor (dapagliflozin or
empagliflozin) as foundational therapy for Here, regardless of diabetes status, to
reduce cardiovascular death and heart failure hospitalizations, added to an
ARNI/Ace, beta-blocker, and MRA.
3. During a cardiac assessment, you palpate the point of maximal impulse (PMI) in
the left 6th intercostal space, anterior axillary line. Which of the following is the
most likely underlying condition?
A. Pericardial effusion
B. Left ventricular hypertrophy
C. Right ventricular hypertrophy
D. Chronic obstructive pulmonary disease (COPD)
Correct Answer: B. Left ventricular hypertrophy
Rationale: A displaced PMI that is lateral and inferior to the midclavicular line
suggests cardiomegaly, most commonly from left ventricular hypertrophy or
dilation, often due to chronic hypertension or aortic stenosis.
4. A 72-year-old female is prescribed a new medication for osteoporosis. She
reports a history of GERD managed with omeprazole. Which medication requires
specific instructions to avoid esophageal irritation?
A. Denosumab
B. Raloxifene
C. Alendronate
D. Teriparatide
Correct Answer: C. Alendronate
,Rationale: Alendronate, a bisphosphonate, is notorious for causing esophageal
irritation and ulcers. It must be taken with a full glass of water upon arising, and
the patient must remain upright for at least 30 minutes afterward.
5. A 45-year-old male presents with acute onset of severe, sharp chest pain that is
worse when lying supine and improves when sitting forward. He reports a recent
upper respiratory infection. On auscultation, you hear a friction rub. What is the
most likely diagnosis?
A. Acute coronary syndrome
B. Pericarditis
C. Aortic dissection
D. Pulmonary embolism
Correct Answer: B. Pericarditis
Rationale: The clinical trial of pleuritic chest pain that is positional (worse supine,
better leaning forward), a pericardial friction rubs, and a recent viral illness is
classic for acute pericarditis.
6. A patient with type 2 diabetes has an eGFI of 38 mL/min/1.73m² and a urinary
albumin-to-creatinine ratio of 300 mg/g. They are already on metformin and
Lisinopril. Which class of medication has been shown to provide the most
significant kidney and cardiovascular protection in this specific scenario?
A. GLP-1 receptor agonist
B. SGLT2 inhibitor
C. Thiazolidinedione
D. Sulfonylurea
Correct Answer: B. SGLT2 inhibitor
Rationale: SGLT2 inhibitors have robust data showing a reduction in the
progression of chronic kidney disease and major adverse cardiovascular events in
, patients with type 2 diabetes and established diabetic kidney disease, even at
lower egress (though initiation is often at eGFI >20-25).
7. On fundoscopic examination, you observe a 65-year-old male with a sharp,
well-defined optic disc but notice small, glistening, yellow deposits scattered in
the macula. There are no signs of neovascularization. What is the most
appropriate next step?
A. Immediate referral to ophthalmology for laser photocoagulation
B. Reassurance and recommendation for antioxidant vitamins (AREDS2 formula)
C. Initiation of intravitreal anti-VEGF injections
D. Screening for carotid artery stenosis
Correct Answer: B. Reassurance and recommendation for antioxidant vitamins
(AREDS2 formula)
Rationale: The findings describe dry (no exudative) age-related macular
degeneration with druse. The AREDS2 vitamin formulation is recommended for
intermediate or advanced dry AMD to reduce the risk of progression to the wet
(endovascular) form.
8. A patient is started on warfarin for atrial fibrillation. One week later, their INR is
1.2. They report no missed doses. Which medication in their home regimen is
most likely interfering with warfarin's anticoagulant effect?
A. Amiodarone
B. Metronidazole
C. Rifampin
D. Trimethoprim-sulfamethoxazole
Correct Answer: C. Rifampin
