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APEA 3P EXAM QUESTIONS AND
ANSWERS UPDATED (202 5 /202 6 )
(VERIFIED ANSWERS)
A patient has poorly controlled hypertension for more than 10 years. Indicate the most likely position of his point of maximal impulse (PMI) 5th ICS, left of MCL A 43 year old Hispanic male has an audible diastolic murmur best heard in the mitral listening point. There is no audible click. His status has been monitored for the past two years. This murmur is probably mitral stenosis A patient who has diabetes presents with pain in his lower legs when he walks and pain resolution with rest. When specifically asked about his pain in his lower leg, he likely will report pain in the calf muscle
A patient with hypertension describes a previous allergic reaction to a sulfa antibiotic as "sloughing of skin" and hospitalization. Which medication is contraindicated in this patient? hydrochlorothiazide A 75 year old patient who has aortic stenosis wants to know what symptoms indicate worsening of his stenosis. the NP replies: shortness of breath and syncope A 74 year old patient has PAD. Which item listed below is an important nonmodifiable risk factor for PAD? diabetes Benazepril should be d/c immediately if pregnancy occurs
Medication that can exacerbate HF naproxen Patient taking ACE inhibitors should avoid? potassium supplements Grade 3 murmur indication for a referral a fixed split Group of meds used to treat HF fosinopril, HCTZ, verapamil Mr. Smith is a 72 - year-old patient who takes warfarin for chronic A-fib. INR today is 4.0. the NP should: stop the warfarin today and repeat INR tomorrow
According to the NHLBI, which characteristic is a coronary heart disease risk equivalent, that is, which risk factor places the pt. as a CHD risk similar to a hx of CHD diabetes mellitus good drug to reduce morbidity and mortality in mild HF metoprolol A pt. taking atorvastatin newly diagnosed with dyslipidemia complaints of fatigue, weakness, and muscle aches in his lower back, arms, legs for the past 3 days. it is not improved with rest How should this be evaluated? Stop the atorvastatin immediately symptom not indicative of HF headache
a 74 - year-old patient has had an increase in b/p since the last exam. his b/p has increased from 144/90 to reading in the upper 160's/upper 80's. If medication is to be started on this patient, what would be a good first choice? Calcium channel blocker Factor contributing to the development of AAA cigarette smoking A 40 - year-old African-American pt. has a b/p of 175/100 and 170/102. What is a reasonable plan of care for this pt today? initiate amlodipine 5mg daily Usual course of treatment for mitral valve prolapse is benign
A 50 - year-old patient with hypertension has taken HCTZ 25mg daily for the past 4 weeks. Her b/p has decreased from 155/95 to 145/90. How should the NP proceed? add another drug from another class to the daily 25mg HCTZ A patient with mitral valve prolapse reports chest pain and frequent arrhythmias. In the absence of other cardiac anomalies, the drug of choice to treat her symptoms is: metoprolol which hypertensive pt. is most likely to have adverse b/p effects from excessive sodium consumption? a 70 - year-old African American where would the murmur associated w/mitral regurgitation best be auscultated? mitral listening point
A 15-year-old male has worked this summer as a lifeguard at a local swimming pool. He complains of itching in the groin area. He is dx with tinea cruris. The NP is likely to identify well marginated half moon shape macules on the inner thigh A pt. exhibits petechiae on both lower legs w/o other complaints. How should the NP proceed? order a CBC A pt. has been dx w/scabies. What is the medication of choice to treat this? permethrin and good hand hygiene A pt. has been in the sun for the past few weeks and has developed darkened skin and numerous 3 - 6 mm light-colored, flat lesions on his trunk. What is the likely etiology? tinea vesicolor Which vehicle is least appropriate in a pt. w/atopic dermatitis?
lotions a pt. presents w/small vesicles on the lateral edges of his fingers and intense itching. there are small vesicles on the palmar surface of the hand. What is this called? dyshidrotic dermatitis a low-potency topical hydrocortisone cream would be most appropriate in a pt. who has been dx with? atopic dermatitis most common form of skin cancer basal cell carcinoma greatest percutaneous absorption areas in the body genitalia
an example of a premalignant lesion that develops on sun-damaged skin is: actinic keratosis A patient w/Diabetes has right anterior shin edema, erythema, warmth, and tenderness to touch. This developed over the past 3 past. There is no visible pus. What is the most likely diagnosis to consider? cellulitis A pt. was burned w/hot water. He has several 2 - 3 cm fluid-filled lesions. What are theses termed? bullae A wound has the following characteristics; partial thickness loss of dermis, a shallow open ulcer w/red/pink bed, and no evidence of sloughing. What stage of pressure ulcer does this describe? stage II
A pt. present w/plaques on the extensor surface of the elbows, knees, and back. The plaques are erythematous and thick, silvery scale are present. This is likely: Plaque psoriasis An adolescent has acne. The NP prescribed a benzoyl peroxide product for him. What important teaching point should be given to this adolescent regarding the benzoyl peroxide. photosensitivity of the skin can occur A 76-year-old obese pt. has fatigue, thirst, and frequent urination. She was asked to measure AM fasting glucose values for 1 week. The values range from 142-175 this pt: can be dx w/DMT The most appropriate time to begin screening for renal nephropathy in a pt w/ T2DM at diagnosis
should have an Hgb A1C performed a diabetic pt. w/albuminuria has been placed on an ACE inhibitor. How soon can the antiproteinuric effect of the ACEi be realized for this pt. 6 - 8 weeks how does hyperthyroidism affect b/p by producing an increase in systolic and diastolic readings Symptoms least likely associated with DMT fatigue, constipation, athletes foot, impetigo constipation What is the relationship between Hgb A1C and lipid values? As Hgb A1C decreases, triglycerides decrease
when the serum free T4 falls: the TSH rises earliest detectable glycemic abnormality in a pt. w/t2DM postprandial glucose elevation acanthosis nigricans in a teen suggest? insulin resistant risk factor for T2DM? History of gestational diabetes a 40 - year-old pt. with newly dx of T2DM asks what his target b/p should be. the most correct answer is: less than 140/
A pt. has a TSH value of 13.1 today. The NP has decided to initiate replacement with levothyroxine 88mcg daily. When should the NP recheck pt's TSH levels 6 weeks A pt. presents with consistently elevated blood glucose before his evening meal. What choice below represents an insulin change that would improve his evening glucose? current AM regimen 22u NPH, 12u short-acting insulin Current PM regimen 10u NPH, 8u short-acting insulin 24u NPH insulin in AM A 30 - year-old female pt. with complaints of fatigue undergoes a screening TSH. Her TSH is 8 what should be done next? repeat the TSH and add T A 65 - year-old diabetic has been on oral antihyperglycemic agents and is still having poor glycemic control. His AM fasting glucose range from 140 - 160. You decide to add insulin. He weighs 127 kg. What should the NP order as an initial starting dose?
10u of long-acting insulin at bedtime the most appropriate time to screen for renal nephropathy in a pt. with type 1 diabetes is 5 years after diagnosis what is the most sensitive lab assay for screening and identifying the vast majority of ambulatory pt.'s w/ primary hypothyroidism TSH only A 52 - year-old presents w/thirst and frequent urination today. His glucose is 352. How should this be managed today? start insulin +what is the significance of AV nicking? this is indicative of longstanding hypertension
