The Ultimate ANCC AGPCNP
Practice Question Bank 2026 With
Verified Answers And Rationales
[GRADED A+]
Question 1: Hypothyroidism Diagnosis
A 68-year-old female patient presents with complaints of fatigue, weight
gain, and cold intolerance. On physical exam, you note bradycardia and
dry, coarse skin. Which of the following is the most appropriate initial
diagnostic test?
A. Complete blood count
B. Thyroid-stimulating hormone (TSH) level
C. Serum cortisol level
D. Fasting blood glucose
Answer: B. Thyroid-stimulating hormone (TSH) level
Rationale: The patient's symptoms are classic for hypothyroidism. TSH is
the most sensitive initial screening test for thyroid dysfunction. A CBC
may show anemia but is not diagnostic, and cortisol or glucose tests are
not the primary tests for this presentation .
Question 2: Geriatric Fall Risk Assessment
A 72-year-old male patient reports a history of falling twice in the past
month. Which of the following is the most important component of the
assessment for falls in the older adult?
A. Orthostatic blood pressure measurement
B. Vision screening
,C. Medication review
D. All of the above
Answer: D. All of the above
Rationale: A comprehensive fall risk assessment includes evaluating for
postural hypotension, visual impairment, and reviewing medications
(especially sedatives and antihypertensives) that increase fall risk .
Question 3: Normal Pressure Hydrocephalus (NPH)
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 (NPH)
B. Alzheimer's disease
C. Parkinson's disease
D. Vascular dementia
Answer: A. Normal pressure hydrocephalus (NPH)
Rationale: NPH presents with the classic triad of gait disturbance,
urinary incontinence, and cognitive decline. Alzheimer's typically
presents with progressive memory loss without the characteristic gait
and urinary symptoms .
Question 4: Chronic Cough Evaluation
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. Observation and reassurance
B. Chest x-ray
C. Antibiotics
D. Antihistamines
,Answer: B. Chest x-ray
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 is appropriate for a cough lasting less than three
weeks .
Question 5: Alzheimer's Disease Pharmacotherapy
An 82-year-old female presents with progressive forgetfulness over the
past 14 months. Her MMSE score is 19/30. Which is the most appropriate
first-line pharmacotherapeutic agent?
A. Memantine
B. Donepezil
C. Haloperidol
D. Sertraline
Answer: B. Donepezil
Rationale: Donepezil, a cholinesterase inhibitor, is a first-line treatment
for mild-to-moderate Alzheimer's disease to temporarily improve or
stabilize cognitive function. Memantine is typically reserved for
moderate-to-severe stages .
Question 6: Acne Treatment
An 18-year-old female has been using OTC topical antibiotic gels and
medicated soap for acne for six months with little improvement. The next
recommended step is:
A. Isotretinoin (Accutane)
B. Tetracycline (Sumycin)
C. Clindamycin topical solution (Cleocin-T)
D. Minoxidil (Rogaine)
Answer: B. Tetracycline (Sumycin)
Rationale: After failing OTC treatments, the next step for moderate acne
is often an oral antibiotic like tetracycline.
, Question 7: Asthma Step-Up Therapy
A young adult with asthma is on an as-needed SABA. They report
daytime symptoms >3 days/week and nighttime awakenings 4-5
times/week. FEV1 is 80% predicted. The appropriate step-up therapy is:
A. Budesonide with formoterol
B. Budesonide with montelukast
C. Cromolyn or nedocromil
D. Fluticasone with salmeterol
Answer: A. Budesonide with formoterol
Rationale: The symptoms indicate a move from step 2 to step 3, where a
low-dose ICS/LABA combination (like budesonide/formoterol) is
recommended.
Question 8: Warfarin Interaction
Which drug can increase bleeding risk in patients on warfarin
(Coumadin)?
A. Trimethoprim-sulfamethoxazole (Bactrim DS)
B. Sucralfate (Carafate)
C. Losartan (Cozaar)
D. Furosemide (Lasix)
Answer: A. Trimethoprim-sulfamethoxazole (Bactrim DS)
Rationale: Bactrim is known to interact with warfarin and significantly
increase the risk of bleeding.
Question 9: First-Line Onychomycosis Treatment
What is a first-line medication for tinea unguium (onychomycosis)?
A. Oral terbinafine (Lamisil)
B. Efinaconazole 10% solution (Jublia)
C. Azelaic acid (Azelex)
D. Metronidazole topical gel (Metrogel)
Practice Question Bank 2026 With
Verified Answers And Rationales
[GRADED A+]
Question 1: Hypothyroidism Diagnosis
A 68-year-old female patient presents with complaints of fatigue, weight
gain, and cold intolerance. On physical exam, you note bradycardia and
dry, coarse skin. Which of the following is the most appropriate initial
diagnostic test?
A. Complete blood count
B. Thyroid-stimulating hormone (TSH) level
C. Serum cortisol level
D. Fasting blood glucose
Answer: B. Thyroid-stimulating hormone (TSH) level
Rationale: The patient's symptoms are classic for hypothyroidism. TSH is
the most sensitive initial screening test for thyroid dysfunction. A CBC
may show anemia but is not diagnostic, and cortisol or glucose tests are
not the primary tests for this presentation .
Question 2: Geriatric Fall Risk Assessment
A 72-year-old male patient reports a history of falling twice in the past
month. Which of the following is the most important component of the
assessment for falls in the older adult?
A. Orthostatic blood pressure measurement
B. Vision screening
,C. Medication review
D. All of the above
Answer: D. All of the above
Rationale: A comprehensive fall risk assessment includes evaluating for
postural hypotension, visual impairment, and reviewing medications
(especially sedatives and antihypertensives) that increase fall risk .
Question 3: Normal Pressure Hydrocephalus (NPH)
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 (NPH)
B. Alzheimer's disease
C. Parkinson's disease
D. Vascular dementia
Answer: A. Normal pressure hydrocephalus (NPH)
Rationale: NPH presents with the classic triad of gait disturbance,
urinary incontinence, and cognitive decline. Alzheimer's typically
presents with progressive memory loss without the characteristic gait
and urinary symptoms .
Question 4: Chronic Cough Evaluation
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. Observation and reassurance
B. Chest x-ray
C. Antibiotics
D. Antihistamines
,Answer: B. Chest x-ray
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 is appropriate for a cough lasting less than three
weeks .
Question 5: Alzheimer's Disease Pharmacotherapy
An 82-year-old female presents with progressive forgetfulness over the
past 14 months. Her MMSE score is 19/30. Which is the most appropriate
first-line pharmacotherapeutic agent?
A. Memantine
B. Donepezil
C. Haloperidol
D. Sertraline
Answer: B. Donepezil
Rationale: Donepezil, a cholinesterase inhibitor, is a first-line treatment
for mild-to-moderate Alzheimer's disease to temporarily improve or
stabilize cognitive function. Memantine is typically reserved for
moderate-to-severe stages .
Question 6: Acne Treatment
An 18-year-old female has been using OTC topical antibiotic gels and
medicated soap for acne for six months with little improvement. The next
recommended step is:
A. Isotretinoin (Accutane)
B. Tetracycline (Sumycin)
C. Clindamycin topical solution (Cleocin-T)
D. Minoxidil (Rogaine)
Answer: B. Tetracycline (Sumycin)
Rationale: After failing OTC treatments, the next step for moderate acne
is often an oral antibiotic like tetracycline.
, Question 7: Asthma Step-Up Therapy
A young adult with asthma is on an as-needed SABA. They report
daytime symptoms >3 days/week and nighttime awakenings 4-5
times/week. FEV1 is 80% predicted. The appropriate step-up therapy is:
A. Budesonide with formoterol
B. Budesonide with montelukast
C. Cromolyn or nedocromil
D. Fluticasone with salmeterol
Answer: A. Budesonide with formoterol
Rationale: The symptoms indicate a move from step 2 to step 3, where a
low-dose ICS/LABA combination (like budesonide/formoterol) is
recommended.
Question 8: Warfarin Interaction
Which drug can increase bleeding risk in patients on warfarin
(Coumadin)?
A. Trimethoprim-sulfamethoxazole (Bactrim DS)
B. Sucralfate (Carafate)
C. Losartan (Cozaar)
D. Furosemide (Lasix)
Answer: A. Trimethoprim-sulfamethoxazole (Bactrim DS)
Rationale: Bactrim is known to interact with warfarin and significantly
increase the risk of bleeding.
Question 9: First-Line Onychomycosis Treatment
What is a first-line medication for tinea unguium (onychomycosis)?
A. Oral terbinafine (Lamisil)
B. Efinaconazole 10% solution (Jublia)
C. Azelaic acid (Azelex)
D. Metronidazole topical gel (Metrogel)
