AANP AGPCNP PRACTICE EXAM 2026/2027 –
UPDATED QUESTIONS & VERIFIED
ANSWERS | A+ EXAM PREP
AANP AGPCNP PRACTICE EXAM 2026/2027 – UPDATED QUESTIONS & VERIFIED
ANSWERS | A+ EXAM PREP
DOCUMENT OVERVIEW
• This comprehensive practice exam contains 200 verified multiple-choice questions
designed to mirror the actual AANP/AGPCNP certification examination, complete
with detailed rationales for each answer to reinforce learning and identify
knowledge gaps.
• Use this material for self-assessment, targeted review of weak areas, and
confidence building before your certification exam by studying systematically
through each question and understanding the clinical reasoning behind correct
answers.
QUESTIONS
QUESTION 1
A 68-year-old male with COPD presents with acute exacerbation. Which
finding would most likely indicate acute cor pulmonale?
A) Increased jugular venous pressure
B) Decreased pulmonary artery pressure
C) Decreased right ventricular workload
D) Increased left ventricular ejection fraction
E) Decreased cardiac output with hypertension
CORRECT ANSWER: A) Increased jugular venous pressure
,RATIONALE: Acute cor pulmonale develops when the right ventricle acutely fails
due to severe pulmonary hypertension (commonly from acute COPD exacerbation).
This causes right ventricular dysfunction, leading to increased right atrial pressure,
which is reflected as elevated jugular venous pressure. Options B, C, D, and E are
incorrect because they describe either normal physiology or findings inconsistent
with acute cor pulmonale pathophysiology.
QUESTION 2
Which antihypertensive medication is contraindicated in a patient with acute
myocardial infarction complicated by cardiogenic shock?
A) Metoprolol
B) Lisinopril
C) Nitroglycerin
D) Calcium channel blockers
E) Hydralazine
CORRECT ANSWER: D) Calcium channel blockers
RATIONALE: Calcium channel blockers, particularly non-dihydropyridines
(diltiazem, verapamil), are contraindicated in cardiogenic shock as they have
negative inotropic effects and reduce cardiac contractility further, worsening shock.
Beta-blockers, ACE inhibitors, nitrates, and hydralazine are either beneficial or can
be used cautiously with appropriate monitoring in this setting.
QUESTION 3
A 55-year-old woman presents with sudden-onset diplopia and facial droop.
CT head is negative. Which medication should be administered immediately?
A) Aspirin 81 mg daily
B) Alteplase IV bolus
,C) Clopidogrel 300 mg loading dose
D) Enoxaparin subcutaneous
E) Warfarin loading dose
CORRECT ANSWER: B) Alteplase IV bolus
RATIONALE: The patient presents with acute stroke symptoms (diplopia, facial
droop) within the thrombolytic window. Alteplase (tPA) IV is the gold standard for
acute ischemic stroke within 3-4.5 hours of symptom onset, as shown by NINDS
and ECASS III trials. Aspirin, clopidogrel, anticoagulation, and warfarin are not first-
line interventions in the acute phase.
QUESTION 4
Which patient is at highest risk for developing aspiration pneumonia?
A) A 70-year-old with seasonal allergies
B) A 75-year-old with Parkinson's disease and dysphagia
C) A 65-year-old with well-controlled hypertension
D) A 68-year-old with treated hypothyroidism
E) A 72-year-old on statins for hyperlipidemia
CORRECT ANSWER: B) A 75-year-old with Parkinson's disease and dysphagia
RATIONALE: Parkinson's disease impairs protective airway reflexes and causes
dysphagia, significantly increasing aspiration risk. Dysphagia and swallowing
dysfunction are the primary risk factors for aspiration pneumonia. The other
options represent conditions without significant swallowing or airway protection
impairment.
QUESTION 5
A 62-year-old male with newly diagnosed atrial fibrillation and CHADS2-VASc
score of 4 should receive which anticoagulation strategy?
, A) No anticoagulation (aspirin monotherapy)
B) Warfarin with INR 2-3
C) Apixaban 5 mg twice daily
D) Aspirin 325 mg daily with clopidogrel
E) Dabigatran only when symptomatic
CORRECT ANSWER: B) Warfarin with INR 2-3
RATIONALE: A CHADS2-VASc score of 4 indicates moderate-to-high stroke risk,
requiring anticoagulation. Both warfarin (INR 2-3) and DOACs (apixaban,
dabigatran) are acceptable options. While apixaban is also correct, warfarin with
INR 2-3 is the traditional gold standard and most studied. Aspirin monotherapy and
combination antiplatelet therapy are insufficient for this risk stratification.
QUESTION 6
Which finding on physical examination would most suggest acute
cholecystitis rather than biliary colic?
A) Right upper quadrant pain
B) Murphy's sign positive with fever
C) Pain radiating to right shoulder
D) Intermittent pain pattern
E) Pain worse with fatty meals
CORRECT ANSWER: B) Murphy's sign positive with fever
RATIONALE: Murphy's sign (cessation of inspiration during palpation of RUQ due to
pain) combined with fever indicates inflammation (cholecystitis) rather than simple
colic. Biliary colic presents with pain without Murphy's sign or fever. The other
findings are common to both conditions.
UPDATED QUESTIONS & VERIFIED
ANSWERS | A+ EXAM PREP
AANP AGPCNP PRACTICE EXAM 2026/2027 – UPDATED QUESTIONS & VERIFIED
ANSWERS | A+ EXAM PREP
DOCUMENT OVERVIEW
• This comprehensive practice exam contains 200 verified multiple-choice questions
designed to mirror the actual AANP/AGPCNP certification examination, complete
with detailed rationales for each answer to reinforce learning and identify
knowledge gaps.
• Use this material for self-assessment, targeted review of weak areas, and
confidence building before your certification exam by studying systematically
through each question and understanding the clinical reasoning behind correct
answers.
QUESTIONS
QUESTION 1
A 68-year-old male with COPD presents with acute exacerbation. Which
finding would most likely indicate acute cor pulmonale?
A) Increased jugular venous pressure
B) Decreased pulmonary artery pressure
C) Decreased right ventricular workload
D) Increased left ventricular ejection fraction
E) Decreased cardiac output with hypertension
CORRECT ANSWER: A) Increased jugular venous pressure
,RATIONALE: Acute cor pulmonale develops when the right ventricle acutely fails
due to severe pulmonary hypertension (commonly from acute COPD exacerbation).
This causes right ventricular dysfunction, leading to increased right atrial pressure,
which is reflected as elevated jugular venous pressure. Options B, C, D, and E are
incorrect because they describe either normal physiology or findings inconsistent
with acute cor pulmonale pathophysiology.
QUESTION 2
Which antihypertensive medication is contraindicated in a patient with acute
myocardial infarction complicated by cardiogenic shock?
A) Metoprolol
B) Lisinopril
C) Nitroglycerin
D) Calcium channel blockers
E) Hydralazine
CORRECT ANSWER: D) Calcium channel blockers
RATIONALE: Calcium channel blockers, particularly non-dihydropyridines
(diltiazem, verapamil), are contraindicated in cardiogenic shock as they have
negative inotropic effects and reduce cardiac contractility further, worsening shock.
Beta-blockers, ACE inhibitors, nitrates, and hydralazine are either beneficial or can
be used cautiously with appropriate monitoring in this setting.
QUESTION 3
A 55-year-old woman presents with sudden-onset diplopia and facial droop.
CT head is negative. Which medication should be administered immediately?
A) Aspirin 81 mg daily
B) Alteplase IV bolus
,C) Clopidogrel 300 mg loading dose
D) Enoxaparin subcutaneous
E) Warfarin loading dose
CORRECT ANSWER: B) Alteplase IV bolus
RATIONALE: The patient presents with acute stroke symptoms (diplopia, facial
droop) within the thrombolytic window. Alteplase (tPA) IV is the gold standard for
acute ischemic stroke within 3-4.5 hours of symptom onset, as shown by NINDS
and ECASS III trials. Aspirin, clopidogrel, anticoagulation, and warfarin are not first-
line interventions in the acute phase.
QUESTION 4
Which patient is at highest risk for developing aspiration pneumonia?
A) A 70-year-old with seasonal allergies
B) A 75-year-old with Parkinson's disease and dysphagia
C) A 65-year-old with well-controlled hypertension
D) A 68-year-old with treated hypothyroidism
E) A 72-year-old on statins for hyperlipidemia
CORRECT ANSWER: B) A 75-year-old with Parkinson's disease and dysphagia
RATIONALE: Parkinson's disease impairs protective airway reflexes and causes
dysphagia, significantly increasing aspiration risk. Dysphagia and swallowing
dysfunction are the primary risk factors for aspiration pneumonia. The other
options represent conditions without significant swallowing or airway protection
impairment.
QUESTION 5
A 62-year-old male with newly diagnosed atrial fibrillation and CHADS2-VASc
score of 4 should receive which anticoagulation strategy?
, A) No anticoagulation (aspirin monotherapy)
B) Warfarin with INR 2-3
C) Apixaban 5 mg twice daily
D) Aspirin 325 mg daily with clopidogrel
E) Dabigatran only when symptomatic
CORRECT ANSWER: B) Warfarin with INR 2-3
RATIONALE: A CHADS2-VASc score of 4 indicates moderate-to-high stroke risk,
requiring anticoagulation. Both warfarin (INR 2-3) and DOACs (apixaban,
dabigatran) are acceptable options. While apixaban is also correct, warfarin with
INR 2-3 is the traditional gold standard and most studied. Aspirin monotherapy and
combination antiplatelet therapy are insufficient for this risk stratification.
QUESTION 6
Which finding on physical examination would most suggest acute
cholecystitis rather than biliary colic?
A) Right upper quadrant pain
B) Murphy's sign positive with fever
C) Pain radiating to right shoulder
D) Intermittent pain pattern
E) Pain worse with fatty meals
CORRECT ANSWER: B) Murphy's sign positive with fever
RATIONALE: Murphy's sign (cessation of inspiration during palpation of RUQ due to
pain) combined with fever indicates inflammation (cholecystitis) rather than simple
colic. Biliary colic presents with pain without Murphy's sign or fever. The other
findings are common to both conditions.
