NUR 504 3P APEA Exam Masterpiece
2026–2027 | Complete and Verified
Questions, Answers and Rationales
Section 1: Respiratory Assessment (Qs 1–35)
1. Retractions are observed in all the following areas except the:
a) Supraventricular area
b) Hilar area
c) Intercostal area
d) Costal marginal area
Rationale: Retractions occur in compliant chest wall areas (supraventricular,
intercostal, costal marginal). The hilar region is a central lung area not visible on
the chest wall.
2. A 3-year-old with fever 102°F, HR 157, RR 40. Tachypnea is most likely related
to:
a) Paradoxical respirations
b) The child’s febrile state
c) The child’s age
d) An airway obstruction
Rationale: Fever increases metabolic demand and O2 consumption, raising RR
~10 breaths/min per °C fever.
3. When percussing the lower posterior chest, begin by:
a) Standing on the side rather than directly behind the patient
b) Having the patient lie supine
c) Carefully palpating painful areas first
d) Using the ball of the hand
Rationale: Standing to the side allows symmetric visualization and easier access to
both hemithoraces.
4. To assess respiratory expansion, place hands on 8th–10th ribs posteriorly,
thumbs close to vertebrae, then:
,a) Ask patient to cough
b) Ask patient to take a deep breath and note any delay in expansion
c) Have patient hold breath 15 seconds
d) Have patient exhale forcefully
Rationale: Deep inspiration maximizes chest expansion and reveals asymmetry or
delay indicating pathology.
5. Which observation is correct when differentiating hemoptysis from GI bleeding?
a) Hemoptysis is frequent in allergic rhinitis
b) Blood from stomach is brighter
c) Hemoptysis is common in cystic fibrosis
d) Blood-streaked material often originates from the GI tract
Rationale: GI bleeding produces darker, coffee-ground material mixed with food;
hemoptysis is bright red, frothy, mixed with sputum.
6. Percussion note in left-sided heart failure is:
a) Resonant
b) Dull tympany
c) Diffusely hyperresonant
d) Flat
Rationale: Heart failure produces crackles but percussion remains resonant unless
consolidation/effusion develops.
7. The line through the inferior angle of the scapula (arms at sides) is the:
a) Midvertebral line
b) Scapular line
c) Midclavicular line
d) Midspinal line
Rationale: Scapular line runs vertically through the inferior angle of the scapula.
8. Chronic cough with copious purulent sputum is most likely:
a) Tracheobronchitis
b) Chronic bronchitis
c) Bronchiectasis
d) Laryngitis
Rationale: Bronchiectasis features permanently dilated airways with chronic,
copious purulent sputum.
,9. Patient sitting leaning forward, arms supported, pursed-lip breathing. Consistent
with:
a) Pneumonia
b) COPD
c) Asthma
d) Croup
Rationale: Tripod position and pursed-lip breathing are compensatory mechanisms
in COPD.
10. Breath sounds over peripheral lung fields are:
a) Bronchial
b) Abnormal
c) Bronchovesicular
d) Vesicular
Rationale: Vesicular sounds are normal over most peripheral lung fields, with
longer inspiratory phase.
11. Which technique is omitted when percussing posterior chest?
a) Use same technique bilaterally
b) Percuss side to side at each level
c) Percuss areas over the scapulae
d) Apply more pressure for louder note
Rationale: Scapulae are bony and dull regardless of pathology; percuss in
interspaces.
12. Breath sounds in left-sided heart failure:
a) Vesicular with late inspiratory crackles in dependent portions, resonant
percussion
b) Bronchial with crackles, dull percussion
c) Vesicular without adventitious sounds
d) Decreased with wheezes, hyperresonant
Rationale: Heart failure causes basilar crackles but percussion remains resonant.
13. Breath sounds with full inspiratory phase and shortened, softer expiratory
phase, normally over hilar region:
a) Vesicular
b) Bronchial
, c) Bronchovesicular
d) Rhonchi
Rationale: Bronchovesicular sounds are normal over hilar and upper sternal areas.
14. Acute viral illness with burning retrosternal discomfort and dry cough
suggests:
a) Tracheobronchitis
b) Chronic bronchitis
c) Bronchiectasis
d) Laryngitis
Rationale: Acute viral tracheobronchitis presents with retrosternal burning and dry
cough.
15. The costal angle is located:
a) Manubriosternal junction
b) Where right and left costal margins meet at the xiphoid process
c) Suprasternal notch angle
d) 9th–10th rib fusion
Rationale: Costal (subcostal) angle is formed by convergence of costal margins at
xiphoid.
16. Atypical respiratory symptom of GERD includes all EXCEPT:
a) Coughing
b) Wheezing
c) Aspiration pneumonia
d) Rhinitis
Rationale: Rhinitis is not caused by GERD; cough, wheeze, and aspiration
pneumonia are.
17. On auscultation, patient says "ninety-nine" heard clearly. This indicates:
a) Normal chest
b) Lung density
c) Consolidation or compression
d) Inflammation
Rationale: Bronchophony (clear transmission of "ninety-nine") indicates
consolidation.
2026–2027 | Complete and Verified
Questions, Answers and Rationales
Section 1: Respiratory Assessment (Qs 1–35)
1. Retractions are observed in all the following areas except the:
a) Supraventricular area
b) Hilar area
c) Intercostal area
d) Costal marginal area
Rationale: Retractions occur in compliant chest wall areas (supraventricular,
intercostal, costal marginal). The hilar region is a central lung area not visible on
the chest wall.
2. A 3-year-old with fever 102°F, HR 157, RR 40. Tachypnea is most likely related
to:
a) Paradoxical respirations
b) The child’s febrile state
c) The child’s age
d) An airway obstruction
Rationale: Fever increases metabolic demand and O2 consumption, raising RR
~10 breaths/min per °C fever.
3. When percussing the lower posterior chest, begin by:
a) Standing on the side rather than directly behind the patient
b) Having the patient lie supine
c) Carefully palpating painful areas first
d) Using the ball of the hand
Rationale: Standing to the side allows symmetric visualization and easier access to
both hemithoraces.
4. To assess respiratory expansion, place hands on 8th–10th ribs posteriorly,
thumbs close to vertebrae, then:
,a) Ask patient to cough
b) Ask patient to take a deep breath and note any delay in expansion
c) Have patient hold breath 15 seconds
d) Have patient exhale forcefully
Rationale: Deep inspiration maximizes chest expansion and reveals asymmetry or
delay indicating pathology.
5. Which observation is correct when differentiating hemoptysis from GI bleeding?
a) Hemoptysis is frequent in allergic rhinitis
b) Blood from stomach is brighter
c) Hemoptysis is common in cystic fibrosis
d) Blood-streaked material often originates from the GI tract
Rationale: GI bleeding produces darker, coffee-ground material mixed with food;
hemoptysis is bright red, frothy, mixed with sputum.
6. Percussion note in left-sided heart failure is:
a) Resonant
b) Dull tympany
c) Diffusely hyperresonant
d) Flat
Rationale: Heart failure produces crackles but percussion remains resonant unless
consolidation/effusion develops.
7. The line through the inferior angle of the scapula (arms at sides) is the:
a) Midvertebral line
b) Scapular line
c) Midclavicular line
d) Midspinal line
Rationale: Scapular line runs vertically through the inferior angle of the scapula.
8. Chronic cough with copious purulent sputum is most likely:
a) Tracheobronchitis
b) Chronic bronchitis
c) Bronchiectasis
d) Laryngitis
Rationale: Bronchiectasis features permanently dilated airways with chronic,
copious purulent sputum.
,9. Patient sitting leaning forward, arms supported, pursed-lip breathing. Consistent
with:
a) Pneumonia
b) COPD
c) Asthma
d) Croup
Rationale: Tripod position and pursed-lip breathing are compensatory mechanisms
in COPD.
10. Breath sounds over peripheral lung fields are:
a) Bronchial
b) Abnormal
c) Bronchovesicular
d) Vesicular
Rationale: Vesicular sounds are normal over most peripheral lung fields, with
longer inspiratory phase.
11. Which technique is omitted when percussing posterior chest?
a) Use same technique bilaterally
b) Percuss side to side at each level
c) Percuss areas over the scapulae
d) Apply more pressure for louder note
Rationale: Scapulae are bony and dull regardless of pathology; percuss in
interspaces.
12. Breath sounds in left-sided heart failure:
a) Vesicular with late inspiratory crackles in dependent portions, resonant
percussion
b) Bronchial with crackles, dull percussion
c) Vesicular without adventitious sounds
d) Decreased with wheezes, hyperresonant
Rationale: Heart failure causes basilar crackles but percussion remains resonant.
13. Breath sounds with full inspiratory phase and shortened, softer expiratory
phase, normally over hilar region:
a) Vesicular
b) Bronchial
, c) Bronchovesicular
d) Rhonchi
Rationale: Bronchovesicular sounds are normal over hilar and upper sternal areas.
14. Acute viral illness with burning retrosternal discomfort and dry cough
suggests:
a) Tracheobronchitis
b) Chronic bronchitis
c) Bronchiectasis
d) Laryngitis
Rationale: Acute viral tracheobronchitis presents with retrosternal burning and dry
cough.
15. The costal angle is located:
a) Manubriosternal junction
b) Where right and left costal margins meet at the xiphoid process
c) Suprasternal notch angle
d) 9th–10th rib fusion
Rationale: Costal (subcostal) angle is formed by convergence of costal margins at
xiphoid.
16. Atypical respiratory symptom of GERD includes all EXCEPT:
a) Coughing
b) Wheezing
c) Aspiration pneumonia
d) Rhinitis
Rationale: Rhinitis is not caused by GERD; cough, wheeze, and aspiration
pneumonia are.
17. On auscultation, patient says "ninety-nine" heard clearly. This indicates:
a) Normal chest
b) Lung density
c) Consolidation or compression
d) Inflammation
Rationale: Bronchophony (clear transmission of "ninety-nine") indicates
consolidation.
