ANCC AGPCNP-BC Practice Exam Version 2 – 260
Questions with Rationales | Adult-Gerontology Primary
Care Nurse Practitioner Certification | Updated 2026
TABLE OF CONTENTS
Domain 1: Patient Assessment Process Questions 1 to 65
Domain 2: Plan of Care Questions 66 to 130
Domain 3: Professional Practice Questions 131 to 195
Domain 4: Mixed Review and High-Yield Scenarios Questions 196 to 260
DOMAIN 1: PATIENT ASSESSMENT PROCESS QUESTIONS 1 TO 65
Question 1
A 72-year-old male patient presents with complaints of progressive difficulty
walking, urinary incontinence, and memory decline over the past six months.
Which of the following is the most likely diagnosis?
A. Normal pressure hydrocephalus
B. Alzheimer's disease
C. Parkinson's disease
D. Vascular dementia
Correct Answer: A
Rationale: Normal pressure hydrocephalus presents with the classic triad of gait
disturbance, urinary incontinence, and cognitive decline. Alzheimer's disease
typically presents with progressive memory loss without the characteristic gait and
urinary symptoms. Parkinson's disease presents with resting tremor, bradykinesia,
and rigidity but not the classic triad. Vascular dementia presents with stepwise
cognitive decline related to cerebrovascular events.
Question 2
A 68-year-old female patient reports a dry cough that has persisted for six weeks
following a viral respiratory infection. She is a non-smoker and has no other
symptoms. Which of the following is the most appropriate initial management?
A. Chest x-ray
,B. Observation and reassurance
C. Antibiotics
D. Antihistamines
Correct Answer: A
Rationale: A cough persisting for more than three weeks warrants further
evaluation with a chest x-ray, especially in a patient over 50 years of age.
Observation and reassurance would be appropriate for a cough lasting less than
three weeks. Antibiotics are not indicated without evidence of infection.
Antihistamines may help if post-nasal drip is suspected but are not the initial
management.
Question 3
A 65-year-old male patient presents with a complaint of difficulty starting
urination and a weak urinary stream. His digital rectal exam reveals an enlarged,
smooth prostate. Which of the following is the most likely diagnosis?
A. Benign prostatic hyperplasia
B. Prostate cancer
C. Prostatitis
D. Urethral stricture
Correct Answer: A
Rationale: Benign prostatic hyperplasia presents with obstructive urinary
symptoms including hesitancy, weak stream, and nocturia. The prostate is typically
enlarged and smooth on digital rectal exam. Prostate cancer may present with
similar symptoms but the prostate is often hard and nodular. Prostatitis presents
with perineal pain and a tender prostate. Urethral stricture presents with a weak
stream but the prostate is normal.
Question 4
A 58-year-old female patient reports difficulty with memory and concentration.
She also reports depressed mood and sleep disturbance. Which of the following is
the most appropriate initial assessment?
A. Cognitive screening with MoCA or Mini-Cog
B. Depression screening with PHQ-9
C. Medication review
D. All of the above
,Correct Answer: D
Rationale: Cognitive complaints in older adults require a comprehensive
assessment including cognitive screening, depression screening, and medication
review. Depression can mimic dementia and is common in older adults.
Medications such as anticholinergics and benzodiazepines can cause cognitive
impairment.
Question 5
A 70-year-old male patient presents with a painful, swollen right knee. He has a
history of osteoarthritis. On exam, you note a warm, erythematous joint with
significant effusion. Which of the following is the most appropriate next step?
A. Joint aspiration
B. X-ray
C. MRI
D. Antibiotics
Correct Answer: A
Rationale: Joint aspiration is indicated to differentiate between gout, pseudogout,
and septic arthritis in a patient with an acutely swollen joint. X-ray may be ordered
to evaluate for joint damage but is not the initial test. MRI is not the initial test.
Antibiotics are indicated if septic arthritis is confirmed.
Question 6
A 68-year-old male patient with a history of diabetes presents with a non-healing
ulcer on his right foot. On exam, you note a 2 centimeter ulcer on the plantar
surface with surrounding erythema and purulent drainage. Which of the following
is the most appropriate next step?
A. Wound culture
B. X-ray of the foot
C. MRI of the foot
D. Arterial doppler studies
Correct Answer: A
Rationale: Wound culture should be obtained to identify the causative organism
and guide antibiotic therapy in a patient with a purulent wound. X-ray of the foot
is indicated if osteomyelitis is suspected. MRI of the foot is more sensitive for
, osteomyelitis but is not the initial test. Arterial doppler studies are indicated if
peripheral artery disease is suspected.
Question 7
A 55-year-old female patient reports chest pain that occurs with exertion and is
relieved by rest. Her electrocardiogram shows ST depression in leads V4 through
V6. Which of the following is the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Myocardial infarction
D. Pericarditis
Correct Answer: A
Rationale: Stable angina is characterized by chest pain with exertion and ST
depression on electrocardiogram. Unstable angina presents with chest pain at rest.
Myocardial infarction presents with ST elevation or elevation of cardiac enzymes.
Pericarditis presents with positional chest pain.
Question 8
A 72-year-old female patient is admitted with shortness of breath and leg swelling.
On exam, you note jugular venous distension, crackles in both lung bases, and 3
plus pitting edema in both legs. Which of the following is the most likely
diagnosis?
A. Heart failure
B. Chronic obstructive pulmonary disease
C. Pneumonia
D. Pulmonary embolism
Correct Answer: A
Rationale: Heart failure presents with dyspnea, crackles on lung auscultation,
peripheral edema, and jugular venous distension. Chronic obstructive pulmonary
disease presents with chronic cough and wheezing. Pneumonia presents with fever
and productive cough. Pulmonary embolism presents with acute dyspnea and
pleuritic chest pain.
Question 9
Questions with Rationales | Adult-Gerontology Primary
Care Nurse Practitioner Certification | Updated 2026
TABLE OF CONTENTS
Domain 1: Patient Assessment Process Questions 1 to 65
Domain 2: Plan of Care Questions 66 to 130
Domain 3: Professional Practice Questions 131 to 195
Domain 4: Mixed Review and High-Yield Scenarios Questions 196 to 260
DOMAIN 1: PATIENT ASSESSMENT PROCESS QUESTIONS 1 TO 65
Question 1
A 72-year-old male patient presents with complaints of progressive difficulty
walking, urinary incontinence, and memory decline over the past six months.
Which of the following is the most likely diagnosis?
A. Normal pressure hydrocephalus
B. Alzheimer's disease
C. Parkinson's disease
D. Vascular dementia
Correct Answer: A
Rationale: Normal pressure hydrocephalus presents with the classic triad of gait
disturbance, urinary incontinence, and cognitive decline. Alzheimer's disease
typically presents with progressive memory loss without the characteristic gait and
urinary symptoms. Parkinson's disease presents with resting tremor, bradykinesia,
and rigidity but not the classic triad. Vascular dementia presents with stepwise
cognitive decline related to cerebrovascular events.
Question 2
A 68-year-old female patient reports a dry cough that has persisted for six weeks
following a viral respiratory infection. She is a non-smoker and has no other
symptoms. Which of the following is the most appropriate initial management?
A. Chest x-ray
,B. Observation and reassurance
C. Antibiotics
D. Antihistamines
Correct Answer: A
Rationale: A cough persisting for more than three weeks warrants further
evaluation with a chest x-ray, especially in a patient over 50 years of age.
Observation and reassurance would be appropriate for a cough lasting less than
three weeks. Antibiotics are not indicated without evidence of infection.
Antihistamines may help if post-nasal drip is suspected but are not the initial
management.
Question 3
A 65-year-old male patient presents with a complaint of difficulty starting
urination and a weak urinary stream. His digital rectal exam reveals an enlarged,
smooth prostate. Which of the following is the most likely diagnosis?
A. Benign prostatic hyperplasia
B. Prostate cancer
C. Prostatitis
D. Urethral stricture
Correct Answer: A
Rationale: Benign prostatic hyperplasia presents with obstructive urinary
symptoms including hesitancy, weak stream, and nocturia. The prostate is typically
enlarged and smooth on digital rectal exam. Prostate cancer may present with
similar symptoms but the prostate is often hard and nodular. Prostatitis presents
with perineal pain and a tender prostate. Urethral stricture presents with a weak
stream but the prostate is normal.
Question 4
A 58-year-old female patient reports difficulty with memory and concentration.
She also reports depressed mood and sleep disturbance. Which of the following is
the most appropriate initial assessment?
A. Cognitive screening with MoCA or Mini-Cog
B. Depression screening with PHQ-9
C. Medication review
D. All of the above
,Correct Answer: D
Rationale: Cognitive complaints in older adults require a comprehensive
assessment including cognitive screening, depression screening, and medication
review. Depression can mimic dementia and is common in older adults.
Medications such as anticholinergics and benzodiazepines can cause cognitive
impairment.
Question 5
A 70-year-old male patient presents with a painful, swollen right knee. He has a
history of osteoarthritis. On exam, you note a warm, erythematous joint with
significant effusion. Which of the following is the most appropriate next step?
A. Joint aspiration
B. X-ray
C. MRI
D. Antibiotics
Correct Answer: A
Rationale: Joint aspiration is indicated to differentiate between gout, pseudogout,
and septic arthritis in a patient with an acutely swollen joint. X-ray may be ordered
to evaluate for joint damage but is not the initial test. MRI is not the initial test.
Antibiotics are indicated if septic arthritis is confirmed.
Question 6
A 68-year-old male patient with a history of diabetes presents with a non-healing
ulcer on his right foot. On exam, you note a 2 centimeter ulcer on the plantar
surface with surrounding erythema and purulent drainage. Which of the following
is the most appropriate next step?
A. Wound culture
B. X-ray of the foot
C. MRI of the foot
D. Arterial doppler studies
Correct Answer: A
Rationale: Wound culture should be obtained to identify the causative organism
and guide antibiotic therapy in a patient with a purulent wound. X-ray of the foot
is indicated if osteomyelitis is suspected. MRI of the foot is more sensitive for
, osteomyelitis but is not the initial test. Arterial doppler studies are indicated if
peripheral artery disease is suspected.
Question 7
A 55-year-old female patient reports chest pain that occurs with exertion and is
relieved by rest. Her electrocardiogram shows ST depression in leads V4 through
V6. Which of the following is the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Myocardial infarction
D. Pericarditis
Correct Answer: A
Rationale: Stable angina is characterized by chest pain with exertion and ST
depression on electrocardiogram. Unstable angina presents with chest pain at rest.
Myocardial infarction presents with ST elevation or elevation of cardiac enzymes.
Pericarditis presents with positional chest pain.
Question 8
A 72-year-old female patient is admitted with shortness of breath and leg swelling.
On exam, you note jugular venous distension, crackles in both lung bases, and 3
plus pitting edema in both legs. Which of the following is the most likely
diagnosis?
A. Heart failure
B. Chronic obstructive pulmonary disease
C. Pneumonia
D. Pulmonary embolism
Correct Answer: A
Rationale: Heart failure presents with dyspnea, crackles on lung auscultation,
peripheral edema, and jugular venous distension. Chronic obstructive pulmonary
disease presents with chronic cough and wheezing. Pneumonia presents with fever
and productive cough. Pulmonary embolism presents with acute dyspnea and
pleuritic chest pain.
Question 9
