1
APEA FNP CARDIO EXAM 2026/2027 | Questions and
Answers | Top Score | Free Cardiology Certification
Focus | Pass Guaranteed - A+ Graded
Section 1: Cardiac Assessment & Physical Examination (Q1-25)
Subsection 1A: History & Symptoms (Chest Pain, Dyspnea, Palpitations, Syncope)
(Q1-10)
Q1. A 58-year-old male presents with substernal chest pressure radiating to his left
jaw and shoulder, occurring with exertion and relieved by rest and sublingual
nitroglycerin. Which differential diagnosis best fits this presentation?
A. Musculoskeletal chest pain
B. Gastroesophageal reflux disease
C. Stable angina pectoris
D. Pericarditis
Correct Answer: C. Stable angina pectoris [CORRECT]
Rationale: Cardiac chest pain is typically substernal, pressure-like, radiates to the
jaw/left arm/shoulder/back, is exertional, and relieved by rest or nitroglycerin.
Musculoskeletal pain is sharp and reproducible with palpation; GERD is burning and
postprandial; pericarditis is sharp, positional, and worse supine.
Correct Answer: C
Q2. A 42-year-old female reports sharp, localized left chest pain that is reproducible
with palpation and worsens with deep inspiration and arm movement. Which
etiology is most likely?
A. Acute coronary syndrome
B. Costochondritis
C. Pulmonary embolism
D. Myocardial infarction
,2
Correct Answer: B. Costochondritis [CORRECT]
Rationale: Musculoskeletal chest pain is sharp, localized, and reproducible with
palpation or movement. ACS/MI presents as pressure-like and not reproducible with
palpation; PE causes pleuritic pain but is not typically reproducible with chest wall
palpation.
Correct Answer: B
Q3. A 65-year-old male with a history of GERD presents with epigastric burning pain
occurring 30 minutes after meals and radiating to the throat, relieved by antacids.
Which etiology is most consistent?
A. Acute myocardial infarction
B. Peptic ulcer disease
C. Gastroesophageal reflux disease
D. Biliary colic
Correct Answer: C. Gastroesophageal reflux disease [CORRECT]
Rationale: GI-related chest pain is often epigastric, burning, postprandial, and
relieved by antacids. ACS/MI may present as epigastric discomfort but is not typically
relieved by antacids or linked to meal timing.
Correct Answer: C
Q4. A 35-year-old female presents with sudden-onset sharp chest pain that worsens
with inspiration and is accompanied by dyspnea and tachycardia. Which etiology
should be prioritized?
A. Stable angina
B. Pleuritic chest pain from pulmonary embolism
C. Esophageal spasm
D. Hypertrophic cardiomyopathy
Correct Answer: B. Pleuritic chest pain from pulmonary embolism [CORRECT]
Rationale: Pleuritic chest pain is sharp and worsens with inspiration, characteristic of
,3
pulmonary embolism, pneumonia, or pleuritis. Stable angina is exertional and
pressure-like; esophageal spasm is squeezing and related to swallowing.
Correct Answer: B
Q5. A 28-year-old male reports sharp chest pain that improves when leaning forward
and worsens when lying supine. He recently had a viral upper respiratory infection.
Which diagnosis is most likely?
A. Acute pericarditis
B. Acute myocardial infarction
C. Aortic dissection
D. Pneumothorax
Correct Answer: A. Acute pericarditis [CORRECT]
Rationale: Pericarditic pain is sharp, positional (improved leaning forward, worse
supine), and often follows a viral prodrome. MI pain is not positional; aortic
dissection is tearing and radiates to the back.
Correct Answer: A
Q6. A 72-year-old female with a history of heart failure reports waking up breathless
after 2 hours of sleep and needing to sit upright to breathe. Which term best
describes this symptom?
A. Orthopnea
B. Paroxysmal nocturnal dyspnea
C. Exertional dyspnea
D. Trepopnea
Correct Answer: B. Paroxysmal nocturnal dyspnea [CORRECT]
Rationale: PND is acute dyspnea occurring during sleep, causing the patient to
awaken and sit upright for relief. Orthopnea is dyspnea when lying flat; exertional
dyspnea occurs with activity.
Correct Answer: B
, 4
Q7. A 45-year-old male with a 30-pack-year smoking history presents with dyspnea,
wheezing, and productive cough with purulent sputum. Which etiology is most
likely?
A. Heart failure exacerbation
B. Chronic obstructive pulmonary disease exacerbation
C. Pulmonary embolism
D. Anxiety disorder
Correct Answer: B. Chronic obstructive pulmonary disease exacerbation
[CORRECT]
Rationale: Pulmonary dyspnea is associated with wheezing, cough, sputum
production, and smoking history. HF dyspnea typically presents with orthopnea, JVD,
and peripheral edema without productive cough.
Correct Answer: B
Q8. A 62-year-old female presents with an irregularly irregular pulse, absent P waves
on ECG, and reports intermittent fluttering sensations in her chest. Which arrhythmia
best explains her palpitations?
A. Supraventricular tachycardia
B. Atrial fibrillation
C. Ventricular tachycardia
D. Sinus arrhythmia
Correct Answer: B. Atrial fibrillation [CORRECT]
Rationale: Atrial fibrillation presents with an irregularly irregular rhythm, absent P
waves, and palpitations. SVT is regular with narrow QRS; VT is wide-complex and
regular; sinus arrhythmia is physiologic and varies with respiration.
Correct Answer: B
APEA FNP CARDIO EXAM 2026/2027 | Questions and
Answers | Top Score | Free Cardiology Certification
Focus | Pass Guaranteed - A+ Graded
Section 1: Cardiac Assessment & Physical Examination (Q1-25)
Subsection 1A: History & Symptoms (Chest Pain, Dyspnea, Palpitations, Syncope)
(Q1-10)
Q1. A 58-year-old male presents with substernal chest pressure radiating to his left
jaw and shoulder, occurring with exertion and relieved by rest and sublingual
nitroglycerin. Which differential diagnosis best fits this presentation?
A. Musculoskeletal chest pain
B. Gastroesophageal reflux disease
C. Stable angina pectoris
D. Pericarditis
Correct Answer: C. Stable angina pectoris [CORRECT]
Rationale: Cardiac chest pain is typically substernal, pressure-like, radiates to the
jaw/left arm/shoulder/back, is exertional, and relieved by rest or nitroglycerin.
Musculoskeletal pain is sharp and reproducible with palpation; GERD is burning and
postprandial; pericarditis is sharp, positional, and worse supine.
Correct Answer: C
Q2. A 42-year-old female reports sharp, localized left chest pain that is reproducible
with palpation and worsens with deep inspiration and arm movement. Which
etiology is most likely?
A. Acute coronary syndrome
B. Costochondritis
C. Pulmonary embolism
D. Myocardial infarction
,2
Correct Answer: B. Costochondritis [CORRECT]
Rationale: Musculoskeletal chest pain is sharp, localized, and reproducible with
palpation or movement. ACS/MI presents as pressure-like and not reproducible with
palpation; PE causes pleuritic pain but is not typically reproducible with chest wall
palpation.
Correct Answer: B
Q3. A 65-year-old male with a history of GERD presents with epigastric burning pain
occurring 30 minutes after meals and radiating to the throat, relieved by antacids.
Which etiology is most consistent?
A. Acute myocardial infarction
B. Peptic ulcer disease
C. Gastroesophageal reflux disease
D. Biliary colic
Correct Answer: C. Gastroesophageal reflux disease [CORRECT]
Rationale: GI-related chest pain is often epigastric, burning, postprandial, and
relieved by antacids. ACS/MI may present as epigastric discomfort but is not typically
relieved by antacids or linked to meal timing.
Correct Answer: C
Q4. A 35-year-old female presents with sudden-onset sharp chest pain that worsens
with inspiration and is accompanied by dyspnea and tachycardia. Which etiology
should be prioritized?
A. Stable angina
B. Pleuritic chest pain from pulmonary embolism
C. Esophageal spasm
D. Hypertrophic cardiomyopathy
Correct Answer: B. Pleuritic chest pain from pulmonary embolism [CORRECT]
Rationale: Pleuritic chest pain is sharp and worsens with inspiration, characteristic of
,3
pulmonary embolism, pneumonia, or pleuritis. Stable angina is exertional and
pressure-like; esophageal spasm is squeezing and related to swallowing.
Correct Answer: B
Q5. A 28-year-old male reports sharp chest pain that improves when leaning forward
and worsens when lying supine. He recently had a viral upper respiratory infection.
Which diagnosis is most likely?
A. Acute pericarditis
B. Acute myocardial infarction
C. Aortic dissection
D. Pneumothorax
Correct Answer: A. Acute pericarditis [CORRECT]
Rationale: Pericarditic pain is sharp, positional (improved leaning forward, worse
supine), and often follows a viral prodrome. MI pain is not positional; aortic
dissection is tearing and radiates to the back.
Correct Answer: A
Q6. A 72-year-old female with a history of heart failure reports waking up breathless
after 2 hours of sleep and needing to sit upright to breathe. Which term best
describes this symptom?
A. Orthopnea
B. Paroxysmal nocturnal dyspnea
C. Exertional dyspnea
D. Trepopnea
Correct Answer: B. Paroxysmal nocturnal dyspnea [CORRECT]
Rationale: PND is acute dyspnea occurring during sleep, causing the patient to
awaken and sit upright for relief. Orthopnea is dyspnea when lying flat; exertional
dyspnea occurs with activity.
Correct Answer: B
, 4
Q7. A 45-year-old male with a 30-pack-year smoking history presents with dyspnea,
wheezing, and productive cough with purulent sputum. Which etiology is most
likely?
A. Heart failure exacerbation
B. Chronic obstructive pulmonary disease exacerbation
C. Pulmonary embolism
D. Anxiety disorder
Correct Answer: B. Chronic obstructive pulmonary disease exacerbation
[CORRECT]
Rationale: Pulmonary dyspnea is associated with wheezing, cough, sputum
production, and smoking history. HF dyspnea typically presents with orthopnea, JVD,
and peripheral edema without productive cough.
Correct Answer: B
Q8. A 62-year-old female presents with an irregularly irregular pulse, absent P waves
on ECG, and reports intermittent fluttering sensations in her chest. Which arrhythmia
best explains her palpitations?
A. Supraventricular tachycardia
B. Atrial fibrillation
C. Ventricular tachycardia
D. Sinus arrhythmia
Correct Answer: B. Atrial fibrillation [CORRECT]
Rationale: Atrial fibrillation presents with an irregularly irregular rhythm, absent P
waves, and palpitations. SVT is regular with narrow QRS; VT is wide-complex and
regular; sinus arrhythmia is physiologic and varies with respiration.
Correct Answer: B
