APEA 3P Exam STUDY GUIDE 2026
150+ must know Practice Questions with Detailed
Rationales
NEW 2025/2026 UPDATE
1. A 68-year-old male with a 15-year history of hypertension and type 2 diabetes
presents for a follow-up. His current medications are metformin 1000 mg BID
and lisinopril 20 mg daily. His blood pressure is 136/88 mmHg. His urine
albumin-to-creatinine ratio (UACR) is 85 mg/g. According to the latest
guidelines, what is the most appropriate next step in management?
A. Increase lisinopril to 40 mg daily.
B. Discontinue lisinopril and start amlodipine 5 mg daily.
C. Add a low-dose thiazide diuretic.
D. Add an SGLT2 inhibitor (e.g., empagliflozin).
Correct Answer: D
Rationale: This patient has diabetic kidney disease as evidenced by persistent
albuminuria (UACR >30 mg/g) despite being on an ACE inhibitor (lisinopril). The
latest evidence and guidelines (including ADA and updated heart failure
protocols) recommend adding an SGLT2 inhibitor in patients with type 2 diabetes
and established cardiovascular disease or diabetic kidney disease to slow
progression of nephropathy and reduce cardiovascular risk, independent of
glycemic control . While increasing the ACE inhibitor (A) might be considered, the
addition of an SGLT2 inhibitor provides additive organ protection. Amlodipine (B)
,is not first-line for diabetic nephropathy. A thiazide (C) could be added for BP
control but does not offer the same renal protective benefits in this context.
2. Which patient is most likely to have the highest systolic blood pressure?
A. A 21-year-old male.
B. A 35-year-old perimenopausal female.
C. A 50-year-old patient with Type 2 diabetes.
D. A 75-year-old male.
Correct Answer: D
Rationale: The greatest incidence of hypertension is in older adults due to age-
related changes in the vascular intima, including thickening and calcium
deposition. Males of any age are more likely to be hypertensive than females of
the same age .
3. A 75-year-old patient with a history of hypertension presents with new-onset
dyspnea on exertion and 2+ pitting edema in the lower extremities. He takes
lisinopril and hydrochlorothiazide daily. What is the most likely cause of his
symptoms?
A. Worsening hypertension.
B. Development of heart failure.
C. Noncompliance with his medication regimen.
D. Acute myocardial infarction.
Correct Answer: B
Rationale: Dyspnea on exertion and peripheral edema are classic symptoms of
heart failure (HF). Long-standing hypertension is a major risk factor for the
, development of HF, as the heart works against chronically elevated pressure,
leading to ventricular hypertrophy and eventual diastolic or systolic dysfunction .
4. A patient with a history of coronary artery disease and angina is being started
on a new medication to decrease the likelihood of anginal episodes. Which
medication works by decreasing myocardial oxygen demand?
A. ACE inhibitor.
B. Beta-blocker.
C. Thiazide diuretic.
D. Angiotensin receptor blocker.
Correct Answer: B
Rationale: Beta-blockers reduce myocardial oxygen demand by slowing the heart
rate, decreasing myocardial contractility, and reducing sympathetic stimulation.
This mechanism makes them first-line agents for preventing angina symptoms in
patients with underlying coronary artery disease .
5. Mrs. Brandy is scheduled for a heart catheterization with contrast dye next
week. Which of her home medications does NOT need to be held prior to the
procedure?
A. Naproxen.
B. Furosemide.
C. Metformin.
D. Losartan.
Correct Answer: D
Rationale: Naproxen (NSAID) should be held 24 hours prior due to its effect on
renal prostaglandins and risk of acute kidney injury. Furosemide is often held to
150+ must know Practice Questions with Detailed
Rationales
NEW 2025/2026 UPDATE
1. A 68-year-old male with a 15-year history of hypertension and type 2 diabetes
presents for a follow-up. His current medications are metformin 1000 mg BID
and lisinopril 20 mg daily. His blood pressure is 136/88 mmHg. His urine
albumin-to-creatinine ratio (UACR) is 85 mg/g. According to the latest
guidelines, what is the most appropriate next step in management?
A. Increase lisinopril to 40 mg daily.
B. Discontinue lisinopril and start amlodipine 5 mg daily.
C. Add a low-dose thiazide diuretic.
D. Add an SGLT2 inhibitor (e.g., empagliflozin).
Correct Answer: D
Rationale: This patient has diabetic kidney disease as evidenced by persistent
albuminuria (UACR >30 mg/g) despite being on an ACE inhibitor (lisinopril). The
latest evidence and guidelines (including ADA and updated heart failure
protocols) recommend adding an SGLT2 inhibitor in patients with type 2 diabetes
and established cardiovascular disease or diabetic kidney disease to slow
progression of nephropathy and reduce cardiovascular risk, independent of
glycemic control . While increasing the ACE inhibitor (A) might be considered, the
addition of an SGLT2 inhibitor provides additive organ protection. Amlodipine (B)
,is not first-line for diabetic nephropathy. A thiazide (C) could be added for BP
control but does not offer the same renal protective benefits in this context.
2. Which patient is most likely to have the highest systolic blood pressure?
A. A 21-year-old male.
B. A 35-year-old perimenopausal female.
C. A 50-year-old patient with Type 2 diabetes.
D. A 75-year-old male.
Correct Answer: D
Rationale: The greatest incidence of hypertension is in older adults due to age-
related changes in the vascular intima, including thickening and calcium
deposition. Males of any age are more likely to be hypertensive than females of
the same age .
3. A 75-year-old patient with a history of hypertension presents with new-onset
dyspnea on exertion and 2+ pitting edema in the lower extremities. He takes
lisinopril and hydrochlorothiazide daily. What is the most likely cause of his
symptoms?
A. Worsening hypertension.
B. Development of heart failure.
C. Noncompliance with his medication regimen.
D. Acute myocardial infarction.
Correct Answer: B
Rationale: Dyspnea on exertion and peripheral edema are classic symptoms of
heart failure (HF). Long-standing hypertension is a major risk factor for the
, development of HF, as the heart works against chronically elevated pressure,
leading to ventricular hypertrophy and eventual diastolic or systolic dysfunction .
4. A patient with a history of coronary artery disease and angina is being started
on a new medication to decrease the likelihood of anginal episodes. Which
medication works by decreasing myocardial oxygen demand?
A. ACE inhibitor.
B. Beta-blocker.
C. Thiazide diuretic.
D. Angiotensin receptor blocker.
Correct Answer: B
Rationale: Beta-blockers reduce myocardial oxygen demand by slowing the heart
rate, decreasing myocardial contractility, and reducing sympathetic stimulation.
This mechanism makes them first-line agents for preventing angina symptoms in
patients with underlying coronary artery disease .
5. Mrs. Brandy is scheduled for a heart catheterization with contrast dye next
week. Which of her home medications does NOT need to be held prior to the
procedure?
A. Naproxen.
B. Furosemide.
C. Metformin.
D. Losartan.
Correct Answer: D
Rationale: Naproxen (NSAID) should be held 24 hours prior due to its effect on
renal prostaglandins and risk of acute kidney injury. Furosemide is often held to
