APEA 3P EXAM PREDICTIVE TESTS 2026/2027 | Questions &
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[Section 1: Health Assessment & Diagnostic Reasoning (Q1-40)]
[Subsection 1A: History Taking & Physical Exam (Q1-25)]
Q1. A 58-year-old male presents for a routine physical examination. During the cardiac
exam, the nurse practitioner auscultates a crescendo-decrescendo systolic murmur at
the right upper sternal border that radiates to the carotid arteries. The patient has a
weak and delayed carotid upstroke. Which valvular disorder is most consistent with
these findings?
A. Mitral regurgitation
B. Tricuspid regurgitation
C. Aortic stenosis [CORRECT]
D. Hypertrophic cardiomyopathy
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic murmur at the
right upper sternal border radiating to the carotids with pulsus parvus et tardus (weak
delayed pulse). MR radiates to the axilla, TR is at the left lower sternal border and
increases with inspiration, and HCM increases with Valsalva.
Correct Answer: C
Q2. A 45-year-old female with asthma reports increased shortness of breath. On
pulmonary function testing, her FEV1 improves by 18% and 320 mL after bronchodilator
administration. How should this result be interpreted?
A. Fixed obstruction consistent with COPD
B. Minimal reversibility consistent with COPD
C. Significant reversibility consistent with asthma [CORRECT]
D. Normal pulmonary function
,Rationale: Asthma is characterized by reversibility defined as ≥12% and ≥200 mL
increase in FEV1 after bronchodilator; COPD shows minimal reversibility (<12% or <200
mL). This patient's significant improvement supports asthma.
Correct Answer: C
Q3. During the abdominal examination of a 62-year-old male, the nurse practitioner
palpates a pulsatile midline mass above the umbilicus. Which is the most appropriate
next step?
A. Immediate surgical referral
B. Abdominal ultrasound [CORRECT]
C. CT abdomen with contrast
D. Observation and repeat exam in 6 months
Rationale: A pulsatile midline abdominal mass suggests abdominal aortic aneurysm
(AAA); ultrasound is the recommended initial screening and diagnostic imaging
modality per USPSTF guidelines for men 65-75 who have ever smoked.
Correct Answer: B
Q4. A 28-year-old female presents with a mid-systolic click followed by a late systolic
murmur at the apex. Her symptoms worsen when moving from squatting to standing.
Which condition is most likely?
A. Aortic stenosis
B. Mitral valve prolapse [CORRECT]
C. Mitral regurgitation
D. Tricuspid stenosis
Rationale: MVP is characterized by a mid-systolic click and late systolic murmur; the
click moves earlier and the murmur prolongs with standing (decreased preload),
whereas squatting delays the click. AS has a crescendo-decrescendo murmur without a
click.
Correct Answer: B
Q5. A 72-year-old male presents with palpitations. The ECG shows an irregularly
irregular rhythm with no discernible P waves and a ventricular rate of 110 bpm. Which
rhythm is present?
A. Atrial flutter
B. Sinus tachycardia with PACs
C. Atrial fibrillation [CORRECT]
,D. Ventricular tachycardia
Rationale: Atrial fibrillation is identified by an irregularly irregular ventricular response,
absent P waves with fibrillatory waves, and a rapid ventricular response. Atrial flutter
shows sawtooth flutter waves, and VT is typically regular with wide QRS complexes.
Correct Answer: C
Q6. A 55-year-old smoker presents with chronic cough and dyspnea. On chest
auscultation, breath sounds are distant and hyperresonance to percussion is noted
bilaterally. The patient's chest X-ray shows flattened diaphragms and increased
retrosternal air space. Which physical finding is most consistent with the patient's likely
diagnosis?
A. Bronchial breath sounds and dullness to percussion
B. Crackles at the lung bases
C. Prolonged expiratory phase and pursed-lip breathing [CORRECT]
D. Pleural friction rub
Rationale: The presentation describes emphysema (pink puffer) with classic findings of
hyperresonance, distant breath sounds, flattened diaphragms, and barrel chest on CXR.
Prolonged expiration and pursed-lip breathing are compensatory mechanisms. Crackles
and dullness suggest other pathologies.
Correct Answer: C
Q7. When performing a thyroid examination, which finding is most suggestive of Graves
disease?
A. Single hard nodule
B. Diffuse enlargement with bruit [CORRECT]
C. Tender, firm gland
D. Multiple discrete nodules
Rationale: Graves disease typically presents with a diffusely enlarged thyroid gland and
an audible bruit due to increased vascularity. A single hard nodule raises concern for
malignancy, tenderness suggests thyroiditis, and multiple nodules indicate multinodular
goiter.
Correct Answer: B
Q8. A 68-year-old female complains of unilateral leg swelling and pain. On physical
exam, the affected calf is tender, warm, and 3 cm larger in circumference than the
, unaffected side. Which clinical decision rule should be applied first to determine pretest
probability for deep vein thrombosis?
A. HEART score
B. Wells score [CORRECT]
C. CURB-65
D. Ottawa ankle rules
Rationale: The Wells score for DVT assesses clinical probability using criteria including
calf swelling, tenderness, pitting edema, and alternative diagnosis less likely; scores ≥2
indicate DVT is likely and D-dimer is not needed before imaging. HEART score is for
ACS, CURB-65 for pneumonia severity, and Ottawa rules for ankle/foot fracture.
Correct Answer: B
Q9. A 42-year-old female presents with a facial rash across the cheeks and bridge of the
nose that spares the nasolabial folds. She reports photosensitivity and oral ulcers.
Which physical finding supports the diagnosis of systemic lupus erythematosus?
A. Malar rash [CORRECT]
B. Gottron papules
C. Heliotrope rash
D. Erythema marginatum
Rationale: The malar (butterfly) rash sparing the nasolabial folds, photosensitivity, and
oral ulcers are classic ACR criteria for SLE. Gottron papules and heliotrope rash indicate
dermatomyositis, while erythema marginatum is associated with acute rheumatic fever.
Correct Answer: A
Q10. During the neurologic examination of a 70-year-old male, the nurse practitioner
asks the patient to stand with feet together and eyes closed. The patient sways and
nearly falls. This is a positive:
A. Romberg test [CORRECT]
B. Straight leg raise test
C. Phalen test
D. Tinel sign
Rationale: A positive Romberg test (increased swaying with eyes closed) indicates
proprioceptive or vestibular dysfunction, typically from dorsal column pathology.
Straight leg raise tests for radiculopathy, Phalen for carpal tunnel, and Tinel for nerve
entrapment.
100% Correct Answers | Latest Version PDF Download | Best
Predictive Exams | Pass Guaranteed - A+ Graded
[Section 1: Health Assessment & Diagnostic Reasoning (Q1-40)]
[Subsection 1A: History Taking & Physical Exam (Q1-25)]
Q1. A 58-year-old male presents for a routine physical examination. During the cardiac
exam, the nurse practitioner auscultates a crescendo-decrescendo systolic murmur at
the right upper sternal border that radiates to the carotid arteries. The patient has a
weak and delayed carotid upstroke. Which valvular disorder is most consistent with
these findings?
A. Mitral regurgitation
B. Tricuspid regurgitation
C. Aortic stenosis [CORRECT]
D. Hypertrophic cardiomyopathy
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic murmur at the
right upper sternal border radiating to the carotids with pulsus parvus et tardus (weak
delayed pulse). MR radiates to the axilla, TR is at the left lower sternal border and
increases with inspiration, and HCM increases with Valsalva.
Correct Answer: C
Q2. A 45-year-old female with asthma reports increased shortness of breath. On
pulmonary function testing, her FEV1 improves by 18% and 320 mL after bronchodilator
administration. How should this result be interpreted?
A. Fixed obstruction consistent with COPD
B. Minimal reversibility consistent with COPD
C. Significant reversibility consistent with asthma [CORRECT]
D. Normal pulmonary function
,Rationale: Asthma is characterized by reversibility defined as ≥12% and ≥200 mL
increase in FEV1 after bronchodilator; COPD shows minimal reversibility (<12% or <200
mL). This patient's significant improvement supports asthma.
Correct Answer: C
Q3. During the abdominal examination of a 62-year-old male, the nurse practitioner
palpates a pulsatile midline mass above the umbilicus. Which is the most appropriate
next step?
A. Immediate surgical referral
B. Abdominal ultrasound [CORRECT]
C. CT abdomen with contrast
D. Observation and repeat exam in 6 months
Rationale: A pulsatile midline abdominal mass suggests abdominal aortic aneurysm
(AAA); ultrasound is the recommended initial screening and diagnostic imaging
modality per USPSTF guidelines for men 65-75 who have ever smoked.
Correct Answer: B
Q4. A 28-year-old female presents with a mid-systolic click followed by a late systolic
murmur at the apex. Her symptoms worsen when moving from squatting to standing.
Which condition is most likely?
A. Aortic stenosis
B. Mitral valve prolapse [CORRECT]
C. Mitral regurgitation
D. Tricuspid stenosis
Rationale: MVP is characterized by a mid-systolic click and late systolic murmur; the
click moves earlier and the murmur prolongs with standing (decreased preload),
whereas squatting delays the click. AS has a crescendo-decrescendo murmur without a
click.
Correct Answer: B
Q5. A 72-year-old male presents with palpitations. The ECG shows an irregularly
irregular rhythm with no discernible P waves and a ventricular rate of 110 bpm. Which
rhythm is present?
A. Atrial flutter
B. Sinus tachycardia with PACs
C. Atrial fibrillation [CORRECT]
,D. Ventricular tachycardia
Rationale: Atrial fibrillation is identified by an irregularly irregular ventricular response,
absent P waves with fibrillatory waves, and a rapid ventricular response. Atrial flutter
shows sawtooth flutter waves, and VT is typically regular with wide QRS complexes.
Correct Answer: C
Q6. A 55-year-old smoker presents with chronic cough and dyspnea. On chest
auscultation, breath sounds are distant and hyperresonance to percussion is noted
bilaterally. The patient's chest X-ray shows flattened diaphragms and increased
retrosternal air space. Which physical finding is most consistent with the patient's likely
diagnosis?
A. Bronchial breath sounds and dullness to percussion
B. Crackles at the lung bases
C. Prolonged expiratory phase and pursed-lip breathing [CORRECT]
D. Pleural friction rub
Rationale: The presentation describes emphysema (pink puffer) with classic findings of
hyperresonance, distant breath sounds, flattened diaphragms, and barrel chest on CXR.
Prolonged expiration and pursed-lip breathing are compensatory mechanisms. Crackles
and dullness suggest other pathologies.
Correct Answer: C
Q7. When performing a thyroid examination, which finding is most suggestive of Graves
disease?
A. Single hard nodule
B. Diffuse enlargement with bruit [CORRECT]
C. Tender, firm gland
D. Multiple discrete nodules
Rationale: Graves disease typically presents with a diffusely enlarged thyroid gland and
an audible bruit due to increased vascularity. A single hard nodule raises concern for
malignancy, tenderness suggests thyroiditis, and multiple nodules indicate multinodular
goiter.
Correct Answer: B
Q8. A 68-year-old female complains of unilateral leg swelling and pain. On physical
exam, the affected calf is tender, warm, and 3 cm larger in circumference than the
, unaffected side. Which clinical decision rule should be applied first to determine pretest
probability for deep vein thrombosis?
A. HEART score
B. Wells score [CORRECT]
C. CURB-65
D. Ottawa ankle rules
Rationale: The Wells score for DVT assesses clinical probability using criteria including
calf swelling, tenderness, pitting edema, and alternative diagnosis less likely; scores ≥2
indicate DVT is likely and D-dimer is not needed before imaging. HEART score is for
ACS, CURB-65 for pneumonia severity, and Ottawa rules for ankle/foot fracture.
Correct Answer: B
Q9. A 42-year-old female presents with a facial rash across the cheeks and bridge of the
nose that spares the nasolabial folds. She reports photosensitivity and oral ulcers.
Which physical finding supports the diagnosis of systemic lupus erythematosus?
A. Malar rash [CORRECT]
B. Gottron papules
C. Heliotrope rash
D. Erythema marginatum
Rationale: The malar (butterfly) rash sparing the nasolabial folds, photosensitivity, and
oral ulcers are classic ACR criteria for SLE. Gottron papules and heliotrope rash indicate
dermatomyositis, while erythema marginatum is associated with acute rheumatic fever.
Correct Answer: A
Q10. During the neurologic examination of a 70-year-old male, the nurse practitioner
asks the patient to stand with feet together and eyes closed. The patient sways and
nearly falls. This is a positive:
A. Romberg test [CORRECT]
B. Straight leg raise test
C. Phalen test
D. Tinel sign
Rationale: A positive Romberg test (increased swaying with eyes closed) indicates
proprioceptive or vestibular dysfunction, typically from dorsal column pathology.
Straight leg raise tests for radiculopathy, Phalen for carpal tunnel, and Tinel for nerve
entrapment.
