APEA Family NP Exam Prep Guide:
System-Based Practice Test (2026
Edition)|| questions and answers with
rationales/graded A+/2026
update/100% correct /instant
download
Student Name: _________________________
Date: _________________________
Total Questions: 85
Time Limit: 3 hours
Instructions: Select the single best answer for each question. Correct answers are
indicated in bold text with rationale provided.
Section 1: Cardiovascular System (Questions 1–12)
1. A 58-year-old male with hypertension reports new-onset exertional chest
pressure relieved by rest. His ECG is normal at rest. What is the next best
step?
a) Exercise treadmill test
b) Coronary artery calcium (CAC) score
c) Prescribe sublingual nitroglycerin
d) Refer for coronary angiography
Rationale: CAC scoring is non-invasive and guides risk stratification in
asymptomatic/mildly symptomatic patients. Treadmill test is appropriate if
intermediate pre-test probability, but CAC is preferred for initial risk assessment in
2026 guidelines.
2. Which heart sound is best heard at the apex with the patient in left lateral
decubitus position using the bell of the stethoscope?
a) S1 splitting
, b) S3 gallop
c) S4 gallop
d) Opening snap
Rationale: S3 is low-pitched, heard best at apex with bell in left lateral position,
indicating reduced ventricular compliance (e.g., HFpEF, volume overload).
3. A 72-year-old woman with diabetes and CKD stage 3b has a BP of 148/86
mmHg. Her current meds: lisinopril 20 mg daily. What is the guideline-
recommended next step (2026 ACC/AHA)?
a) Add amlodipine 5 mg daily
b) Increase lisinopril to 40 mg daily
c) Add chlorthalidone 12.5 mg daily
d) Refer to nephrology
Rationale: For CKD and diabetes, target BP <130/80. First-line is ACEi/ARB,
then add thiazide-like diuretic (chlorthalidone) before increasing ACEi beyond
max tolerated.
4. A patient presents with sudden severe ripping chest pain radiating to the
back, and a blood pressure difference of 20 mmHg between arms. Most likely
diagnosis?
a) Pulmonary embolism
b) Aortic dissection
c) Acute coronary syndrome
d) Pericarditis
Rationale: Classic presentation of aortic dissection: tearing pain, pulse/blood
pressure differential, mediastinal widening on CXR.
5. Which ECG finding is most specific for acute pericarditis?
a) ST depression in V1-V3
b) Diffuse ST elevation with PR depression
c) Pathologic Q waves
d) Epsilon waves
Rationale: Pericarditis causes diffuse ST elevation (concave up) and PR segment
depression, especially in limb leads.
6. A 45-year-old obese male has a BMI of 38, BP 142/90, fasting glucose 110
mg/dL, triglycerides 210 mg/dL, HDL 32 mg/dL. What is his 10-year ASCVD
System-Based Practice Test (2026
Edition)|| questions and answers with
rationales/graded A+/2026
update/100% correct /instant
download
Student Name: _________________________
Date: _________________________
Total Questions: 85
Time Limit: 3 hours
Instructions: Select the single best answer for each question. Correct answers are
indicated in bold text with rationale provided.
Section 1: Cardiovascular System (Questions 1–12)
1. A 58-year-old male with hypertension reports new-onset exertional chest
pressure relieved by rest. His ECG is normal at rest. What is the next best
step?
a) Exercise treadmill test
b) Coronary artery calcium (CAC) score
c) Prescribe sublingual nitroglycerin
d) Refer for coronary angiography
Rationale: CAC scoring is non-invasive and guides risk stratification in
asymptomatic/mildly symptomatic patients. Treadmill test is appropriate if
intermediate pre-test probability, but CAC is preferred for initial risk assessment in
2026 guidelines.
2. Which heart sound is best heard at the apex with the patient in left lateral
decubitus position using the bell of the stethoscope?
a) S1 splitting
, b) S3 gallop
c) S4 gallop
d) Opening snap
Rationale: S3 is low-pitched, heard best at apex with bell in left lateral position,
indicating reduced ventricular compliance (e.g., HFpEF, volume overload).
3. A 72-year-old woman with diabetes and CKD stage 3b has a BP of 148/86
mmHg. Her current meds: lisinopril 20 mg daily. What is the guideline-
recommended next step (2026 ACC/AHA)?
a) Add amlodipine 5 mg daily
b) Increase lisinopril to 40 mg daily
c) Add chlorthalidone 12.5 mg daily
d) Refer to nephrology
Rationale: For CKD and diabetes, target BP <130/80. First-line is ACEi/ARB,
then add thiazide-like diuretic (chlorthalidone) before increasing ACEi beyond
max tolerated.
4. A patient presents with sudden severe ripping chest pain radiating to the
back, and a blood pressure difference of 20 mmHg between arms. Most likely
diagnosis?
a) Pulmonary embolism
b) Aortic dissection
c) Acute coronary syndrome
d) Pericarditis
Rationale: Classic presentation of aortic dissection: tearing pain, pulse/blood
pressure differential, mediastinal widening on CXR.
5. Which ECG finding is most specific for acute pericarditis?
a) ST depression in V1-V3
b) Diffuse ST elevation with PR depression
c) Pathologic Q waves
d) Epsilon waves
Rationale: Pericarditis causes diffuse ST elevation (concave up) and PR segment
depression, especially in limb leads.
6. A 45-year-old obese male has a BMI of 38, BP 142/90, fasting glucose 110
mg/dL, triglycerides 210 mg/dL, HDL 32 mg/dL. What is his 10-year ASCVD
