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Comprehensive 3P Exam Study APEA, Exams of Nursing

University of TorontoNursing

Comprehensive 3P Exam Study APEA for 2025/2026 with correct verified answers graded A+,exams

Typology: Exams

2024/2025

Available from 07/02/2025

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kennedy-wanjiru 🇨🇦

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Comprehensive 3P Exam Study APEA
What would cause decrease in Digoxin levels?
- Antacids
Taking Pyridium for UTI, what can Pyridium cause?
- Hemolytic Anemia
What can PCOS result in?
- Increased insulin levels (Hyperinsulinemia), Androgens, Hirsutism
What are the anti-hypertensives used in pregnancy?
- Methyldopa (Alpha-2-Agonist), Labetalol, Nifedipine, Hydralazine
What is a characteristic of Placenta Previa?
- Painless, red bleeding
What is a chacteristic of Rheumatoid Arthritis?
- Tender, warm, swollen joints
Medications that can cause ototoxicity?
- Aminoglycosides, loop diuretics, NSAIDs, antihistamines, nasal decongestants
What is the treatment time for enterobiasis?
- 2 weeks
What does MCV lab value measure?
- Mean Corpuscular Volume helps diagnose different types of anemia such as B12 &
Folate (Macrocytic) and Fe anemia (Microcytic)
Rhogam is given at how many week gestation?
- 27-28 weeks
What are Janeway lesions and what do they indicate?
- They are irregular, non-tender hemorrhagic macules located on the hands and feet.
Seen in Infective Endocarditis
What are Osler's Nodes and what do they indicate?
- They are split pea-sized, erythematous, tender nodules located on the pads of the
fingers and toes. Seen in Infective Endocarditis
What is the recommendation for Warfarin management when a patient misses a dose?
- If within 12 hours of the dose time, take it. If over 12 hours patient will need a INR
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Comprehensive 3P Exam Study APEA

What would cause decrease in Digoxin levels?

  • Antacids Taking Pyridium for UTI, what can Pyridium cause?
  • Hemolytic Anemia What can PCOS result in?
  • Increased insulin levels (Hyperinsulinemia), Androgens, Hirsutism What are the anti-hypertensives used in pregnancy?
  • Methyldopa (Alpha- 2 - Agonist), Labetalol, Nifedipine, Hydralazine What is a characteristic of Placenta Previa?
  • Painless, red bleeding What is a chacteristic of Rheumatoid Arthritis?
  • Tender, warm, swollen joints Medications that can cause ototoxicity?
  • Aminoglycosides, loop diuretics, NSAIDs, antihistamines, nasal decongestants What is the treatment time for enterobiasis?
  • 2 weeks What does MCV lab value measure?
  • Mean Corpuscular Volume helps diagnose different types of anemia such as B12 & Folate (Macrocytic) and Fe anemia (Microcytic) Rhogam is given at how many week gestation?
  • 27 - 28 weeks What are Janeway lesions and what do they indicate?
  • They are irregular, non-tender hemorrhagic macules located on the hands and feet. Seen in Infective Endocarditis What are Osler's Nodes and what do they indicate?
  • They are split pea-sized, erythematous, tender nodules located on the pads of the fingers and toes. Seen in Infective Endocarditis What is the recommendation for Warfarin management when a patient misses a dose?
  • If within 12 hours of the dose time, take it. If over 12 hours patient will need a INR redraw

What do we need to know about ACEs and ARBs?

  • A dry hacking cough is a common side effect of ACEs and will go away within a week after discontinuing. ACEs & ARBs are indicated for patients with DM, CKD, and HTN. Not recommended as 1st line agent with African Americans & can cause angioedema. Contraindications for Hydrochlorothiazide
  • Sulfa allergy, PCN hypersensitivity, Asthma, Gout Systolic Murmurs (Benign)
  • MR = Mitral Regurge (SOB/Fatigue HF) Peyton Manning = Physiologic Murmur (Asymptomatic) AS = Aortic Stenosis (Angina, Syncope HF) MVP = Mitral Valve Prolapse ("Click", Women 14-30, Palpitations, Chest Pain Diastolic Murmurs (Abnormal)
  • AR = Aortic Regurgitation (Angina, HF, Dizziness, Chest Pain) MS = Mitral Stenosis (Dyspnea, AFib) What does S1 indicate?
  • S1 Closure of the Atrioventricular Valves (Mitral & Tricuspid Valves) What does S2 indicate?
  • S2 Closure of the Semilunar Valves (Aortic & Pulmonic Valves) S3 is often heard in?
  • CHF, possibly normal for athletic adolescents S4 is often heard in?
  • Diastolic HF, Left Ventricular Hypertrophy (LVH), Poorly controlled HTN, MI Treatment of Peripheral Artery Disease (PAD)
  • Antiplatelets (Plavix, ASA), Pentoxifylline (Decreases blood viscosity) Diagnosing Peripheral Artery Disease (PAD)
  • Gold Standard = Angiography Ankle Brachial Index (ABI) Coronary Artery Disease (CAD) treatment
  • Aotrvastatin/Rosuvastatin = If LDL>150 use high doses. Watch for LFTs & arthralgia. Change type & dose if issues. Helps stabilize plaques. What medications are indicated for HF treatment?
  • ACEs, ARBs, ARNI w/BBs, Aldosterone Recepter Antagonists What is the treatment for Sarcopter Scabiei (Scabies)?
  • Treatment consists of Corticosteroids, Antihistamines, Calcineurin Inhibitors (Tacrolimus) Facts about Acne Vulgaris
      • Inflammatory skin disorder where androgen-dependent sebaceous glands produce excess sebum.
  • Usually affects face, anterior & posterior chest, Upper Back, Shoulders, and Arms
  • Treatment consists of Erythromycin/Benzoyl Peroxide (Benzamycin)
  • Education r/t Erythromycin/Benzoyl Peroxide includes limit exposure to sunlight and can decrease resistance to erythromycin Facts about Atopic Dermatitis
      • Patchy plaque-like rash
  • Can occur in people with other atopic conditions such as Asthma and Allergic Rhinitis (Hay Fever) Eye exam findings in DM & HTN
      • AV Nicking = Arteries indent and displace veins
  • Cotton Wool Spots = White or grayish fluffy lesions on the retina
  • Flame Hemorrhages = Flame-like hemorrhages along the retinal nerve fiber layer
  • Dot & Blot Hemorrhages = Small hemorrhages caused by rupture of weakened blood vessels - Hallmark sign of diabetic retinopathy Acute Sinusitis Tx for Adults & Pediatrics
      • Viral is symptomatic treatment only
  • Bacterial tx is Amoxicillin 1st line if symptoms >10 days and include purulent nasal discharge, fever, unilateral face/tooth pain Snellen Test
    • Test of CN II (Optic Nerve) Which medications can cause ototoxicity?
    • Aminoglycosides Loop Diuretics Quinine ASA Allergic Rhinitis
    • Eosinophils elevated in Allergies, Wheezes, Parasites Tx is Fluticasone (Flonase) Acute Bacterial Rhinosinusitis treatment
    • If patient is allergic to PCN, then Doxycycline is the best alternative Which Immunoglobuliin is responsible for symptoms of Allergies & Allergic Rhinitis?
    • IgE

Assessment of a 4yr old visual acuity results in 20/30 in L eye and 20/40 in R eye

  • Means vision is normal for his age. Children at 6 years can normally achieve 20/ vision. Medication given for Benign Paroxysmal Positional Vertigo
  • Meclizine (Antivert) Pterygium
  • A growth of fleshy tissue on the conjunctiva that can extend onto the cornea.
  • Sx include redness, irritation, and a gritty or foreign body sensation in the eye Eye Emergencies
  • Papilledema - r/t Increased ICP, Swollen Optic Disc, and Engorged Tortuous Vein Acute Closed-Angle Glaucoma - Sudden onset severe eye pain and Rapid loss of vision Foreign Object in Eye
  • Only attempt to remove with wet cotton swab and if not able send to ophthamologist stat Meniere's Disease
  • Vertigo, Tinitus, and Pressure in the Right Ear Hyperopia (Farsightedness)
  • Light that is focused behind the retina causes the visual disturbance Mononucleosis
  • condition caused by the Epstein-Barr virus and characterized by an increase in mononuclear cells (monocytes and lymphocytes) in the blood along with enlarged lymph nodes (lymphadenopathy), fatigue, and sore throat (pharyngitis) Which medication is most commonly associated with hypoglycemia?
  • Sulfonylureas i.e. Glyburide, Glipizide, Glimepiride What does myxedema indicate and what is the clinical presentation?
  • Myxedema indicates hypothyroidism. S&S include hypothermia, thickening of the tongue, disorientation, and swelling of the face, hands, feet. Hyperthyroidism S&S
  • Tachycardia, AFib, weight loss, hyperactiivity, heat insensitivity, moist skin, exophthalmos. Hyperprolactinemia
  • Menstrual Dysfunction Erectile Dysfunction Breast Pain

Hepatitis S&S

  • Low-grade fever Malaise Jaundice Weight Loss Joint Pain Dark Urine RUQ Pain Pancytopenia Enlarged Liver Elevated ALT/AST, Bilirubin, and Alkaline Phosphate GERD S&S
  • Pyrosis (heartburn) Regurgitation Post-Nasal Drip Chronic Cough Chronic Sore Throat Hoarseness Tx PPI BIDx14 days H Pylori Algorrithm
  • Amoxicillin BID & Clarithromycin BID PPIO BIDx14 days IF PCN Allergies then: Metronidazole & Clarithromycin BID PPIx14 days What GERD symptom is alarming?
  • Odynophagia (Pain with swallowing) Chron's Disease S&S
  • Chronic Bloody Diarrhea Fatigue, Abdomnial Pain Weight Loss/Fever Skip Lesions, Cobblestone appearance Fistulas are common Slow progressive inflammation of small/large intestine Tx is Budesonide 5-aminosalicylates Gastroenteritis Common Pathogens
  • Adults: Norovirus, Enteric Adenovirus, Astrovirus Salmonella - Most Common Foodborne Illness Giardia Lambia - Most Common Parasitic Infants:

Norovirus, Enteric Adenovirus, Astrovirus Campylobacter jejuni Pyloric Stenosis presentation

  • Occurs in first few weeks of life: Projectile Vomiting Non-bileous Vomiting Visible Peristalsis after feeding Hungry/Irritable/Dehydration/Electrolyte Imbalance Hepatitis B & C
  • Bloodborne/Body fluids highly infectious Patient's who test positive should be testedd for HIV r/t common transmission routes Enterobiasis vermicularis (Pinworm) Infection
  • Helminths can be transmitted by the bite of blood sucking insects Tx: Pyrantel Pamoate - One dose initially, then another dose in 2 weeks. Re-Test after 2 weeks of last dose Ulcerative Colitis
  • chronic inflammation of the colon with ulcerations Which enzyme is not produced in the pancreas?
  • Pepsin Small Bowel Obstruction
  • Crampy & Intermittent Abdominal Pain Nausea/Vomiting inability to pass gas Acute Lymphoblastic Leukemia (ALL)
  • Most common Leukemia in children S&S: Fever, Thrombocytopenia, Anemia, Gingival Hyperplasia (swelling), Bone pain Beta Thalassemia
  • Genetic disorder where there is decreased or absent production of hemoglobin. Common amongst Mediterranea descent Causes microcytic hypochromic anemia Tx: Desferal which removes excess iron Iron Deficiency Anemia
  • Microcytic Hypochromic r/t iron loss exceeds iron intake S&S: Pica, Atrophic Glossitis

BPH Treatment

  • *Gold standard TURP Medications Alpha 1 adrenergic antagonist (tamsulosin) - relaxes smooth muscle in the prostate - immediate relief 5 Alpha Reductase inhibitor (finasteride) - inhibits conversion of testosterone to DHT - Long term and takes 6-12months to start working Hydrocele
  • Peritoneal fluid collection in the scrotum. Painless swelling in scrotum, feels heavy, and transillumination of the scrotum will light up brightly Penile Cancer
  • Squamous cell carcinoma - Thick white plaques, large scaly growths. Bleeding is late sign. Risk Factors: HPV, AIDs, uncircumcised, smoking, psoriasis, cryptochordism Erectile Dysfunction
  • Treatment PDE-5 inhibitor - contraindicated with nitrates Causes - Anti-HTN meds, antidepressants, antiandrogens, recreational drugs #1 Risk Factor for Testicular & Penile Cancer
  • Cryptochordism Prostatitis
  • Inflammation of the prostate & usually bacterial S&S: Frequency, urgency, fever, enlarged boggy warm prostate Prostatitis Treatment
  • Chronic Prostatitis: Ciprofloxacin or Flouroquinolones (Levofloxacin) for 4-12 wks or Bactrim 4-6 wks. Treatment guided by Culture & Sensitivity No Keflex (cephalexin) Testicular Torsion
  • Acute onset testicular pain and loss of cremasteric reflex on affected side. Most common in prepubertal boys Epididymitis
  • Testicular pain onset over a few days (gradual) and cremasteric reflex is present. Gonorrhea & Chlamydia treatment
  • Doxycycline 100mg BIDx14 days & Ceftriaxone x1 IM Migraine Treatment
  • Rescue: Triptans

Prophylactic: Beta Blockers, antidepressants, anticonvulsants (Topamax, Propranolol, Inderal) Migraine Presentation

  • S&S: Unilateral 70% of time, Crescendo, Nausea/Vomiting, Photophobia, and Auras, Duration: 4-72hrs Patient Appearance: Pt desires a cool, quiet, dark room Cluster Headache Presentation
  • Always unilateral, begins around temple/eye, pain peaks within minutes; excruciating/explosive, rhinorrhea, tears, eye becomes red ETOH can be a trigger Tension Headache Presentation
  • Bilateral, pressure, tightness, band-like, waxes and wanes Parkinson's Disease
  • Deficiency of Dopamine and destruction of cells in the substantia nigra Parkinson's Disease Presentation
  • Bradykinesia, rigidity, resting tremor ("pill rolling"), postural instability Parkinson's Disease Treatment
  • Dopaminergic agents, Carbidopa/levadopa (Do not give to patients with narrow angle glaucoma) Beer's List
  • a list of drugs for which you should not give or monitoring is especially important in elderly patients Anti-cholinergics, anti-spasmotics, scopolamine, meclizine, promethazine High risk of confusion, dry mouth, constipation. Meningitis
  • Inflammation of the brain and spinal cord meninges result from bacteria, virus, or fungi. Headache is caused by meningeal irritation. Tx is cephalosporins (Ceftriaxone). Transient Ischemic Attack (TIA)
  • brief episode of loss of blood flow to the brain, usually caused by a partial occlusion that results in temporary neurologic deficit (impairment). Typically resolves within hours; often precedes a CVA Seizures
  • Uncontrolled electrical activity within the brain Scoliosis
  • Lateral curvature of the spine greater than 10 degrees

Chronic Gout (2 or more attacks/year) - Allopurinol - decreases production of uric acid GTPAL

  • Gravidia - # of times a woman has been pregnant multiples = 1 Term - Number of children at >37 weeks Preterm - Number of children at 20-37 weeks Abortion - Abortions/Miscarriages Living - living children, twins count individually Fundal Height
  • Distance from the pubic bone to the top of the uterus in centimeters. After 24 weeks fundal height should equal the number of weeks the patient has been pregnant. i.e. 24cm = 24wks Preeclampsia
  • BP > 140/90 & Proteinuria (300mg/24hr urine sample) or edema, pulmonary edema, visual impairments, impaired renal or hepatic function. Preeclampsia Treatment
  • Magnesium Sulfate Anti-Hypertensives i.e. methyldopa, labetalol, nifedipine Corticosteroids for fetus lung development if preterm birth expected Naegeles Rule
  • First day of LMP, subtract 3 months, add 7 days Placenta Previa
  • Painless, bright red bleeding in a woman >20 weeks gestation. Abnormal placement of the placenta near or covering the internal cervical os 1st line Treatment of UTI in pregnancy
  • Nitrofurantoin (Macrobid) Rhogam
  • Given at 28wks gestation, within 72hrs of delivery and any maternal hemorrhage, ectopic pregnancy, and abortion Vaccines that are safe in pregnancy
  • Flu vaccine, Tdap, COVID Abruptio Placentae (Placental Abruption)
  • Absent/Profuse vaginal bleeding, abnormal painful uterine contractions, uterine tenderness, rigid & board-like uterus on palpatation Bulimia Presentation
  • Recurrent episodes of eating, binging, and purging.
  • Russell's Sign - knuckle scarring from induced vomiting Bulimia Treatment
  • SSRIs i.e. fluoxetine (Prozac) & sertraline (Zoloft) Depression Treatment
  • Unipolar Depression - sertraline (Zoloft) & escitalopram (Lexapro)
  • Start with 4wks of treatment then re-evaluate for dose adjustment for a minimum of 6 months Anxiety Treatment
  • busparone (Buspar) *Anxiety & Depression coexist - use GAD 7 scale to dx Major Depressive Disorder symptoms
  • S: Sleep Disturbances I: Interest/Pleasure loss in activities once enjoyed (anhedonia) G: Guilt or Worthlessness feelings E: Decreased Energy or Fatigue C: Difficulty concentrating or making decisions A: Changes in appetite or weight (Increase/Decrease) P: Psychomotor agitation or retardation (slow movements) S: Suicidal thoughts/behaviors Neurotransmitters in Depression
  • Serotonin - Regulate mood, sleep, appetite, social behavior Norepinephrine - Mood, Arousal, Attention Dopamine - Pleasure, reward, motivation, movement GABA - Inhibitory - Calmness, Relaxation, Sedation NMDA (Glutamate) - Excitatory - Learning, Memory Munchausen syndrome by proxy
  • A factitious disorder in which parents make up or produce illnesses in their loved one. Also known as factitious disorder by proxy. Suicide Screening
  • Are you thinking of hurting yourself? If yes, do you have a plan? Do you have means to make the plan happen? Risk Factors: Prior attempts, adolescents, Males, Elderly males Asthma - Mild Intermittent
  • Symptoms present < 2 days/week, or < 2 nights/month Asthma - Mild Persistent
  • Symptoms present > 2days/week but not everyday, 3-4 nighttime awakenings/month

Tuberculosis (TB) Diagnostics

  • Gold Standard - sputum sample. Other - Quantiferon Gold, T spot, TB Skin Test S&S - Hemoptysis, weight loss, night sweats, Fever, Cough TB Treatment
  • Isoniazid, Rifampin - Both very liver toxic. Do treat latent, but not infectious Croup
  • Acute viral illness S&S - Barking Cough, Stridor, Sub-glottal swelling, Hoarseness. Croup Treatment
  • Racemic Epinephrine, Corticosteroids, Cool-Mist Humidification ** DO NOT USE TONGUE DEPRESSORS, CAN CAUSE SPASM!! Chlamydia
  • Most Common STI in US. S&S - Genital Ulceration, Lymphadenopathy, Occular Trachoma, Proctitis, Cervical Motion Tenderness, Assymptomatic. Can cause PID Chlamydia Diagnostic & Treatment
  • Gold Standard - Nuclieic Acid Amplification Test (NAAT) & Gen-Probe Assay Tx: Azithromycin in pregnant patients, Amoxicillin if allergic. Gonorrhea
  • Common with Chlamydia. S&S - Purulent discharge, blood-tinged discharge, prostatitis Tx: Ceftriazone 500mg IMx1... if Chlamydia also suspected give Doxycycline 100mg BIDx7 days Bacterial Vaginosis
  • Not an STI. Common sexually active females. S&S - Fishy smell, watery discharge, clue cells, increased alkalosis Tx: metronidazole (Flagyl), Lactobacillus Probiotics Genital Herpes
  • Herpes Simplex Virus Type 1 or 2, transmitted with direct contact with active lesions or with virus containing fluid. Tx: Antivirals - Acyclovir, Valacyclovir, Famciclovir. Pt can be infectious while shedding virus. HPV
  • Soft painless, flesh colored warts. Can be cauliflower like if perianal. 16 & 18 - Cervical Cancer 6 & 11 causes genital warts

Syphilis

  • Treponema Pallidum Primary - Chancre at site of infection Secondary - Systemic Rash Latent - Asymptomatic Tertiary - Can occur MANY years after infection and affect multiple organs i.e. neuro, cardiovascular, soft tissue Trichomoniasis
  • Trichomonas Vaginalis - Protozoan S&S - Copious pale yellow-to-grey/green discharge, petechiae on cervix. Dx: NAAT Tx: metronidazole (Flagyl) Pediculosis Pubis
  • Tx: Permethrin (Nix) HIV early signs
  • Fever, fatigue, swollen lymphnodes, sore throat HIV late signs
  • Rapid weight loss, recurring fever, night sweats, fatigue, chronic diarrhea, swollen glands When does HIV progress to AIDs?
  • When the number of CD4 cells fall below 200 Overflow Incontinence
  • The bladder cannot empty properly r/t bladder dysfunction, urinary tract blockage, or underactive bladder muscles. Tx: Behavior Training i.e. Kegels, Bethanechol, Foley, Alpha-Blockers Urge Incontinence
  • Sudden and strong urge to urinate which is hard to control and can lead to leakage. Tx: Anticholinergics i.e. Oxybutynin Stress Incontinence
  • Involuntary leakage of urine during physical activities or movements that put pressure on the bladder... i.e. coughing, sneezing, laughing. Tx: Psuedophedrine can help UTI
  • Positive leukocytes and nitrates on UA S&S - pain, burning, urgency, frequency, fever, chills

Aortic Regurgitation presentation

  • Angina & Dyspnea Endocarditis Treatment
  • Zosyn/Vancomycin Prostaglandins in patients with Transposition of the great vessels
  • Provide vasodilation & adequate oxygenation