ANCC AGNP Exam Questions and Answers with
Rationales 2026/2027 Update
1. A 68-year-old patient with hypertension has repeated office blood
pressures around 154/92 mmHg. Which finding most strongly supports
a diagnosis of hypertension?
A. One elevated reading during an acute illness
B. Persistent elevation documented on separate occasions
C. Elevated blood pressure after exercise
D. A single home reading of 150/90
Answer: B
Rationale: Hypertension is diagnosed from persistent blood-pressure
elevation rather than an isolated abnormal measurement.
2. Which lifestyle intervention generally has the greatest impact on
reducing cardiovascular risk in an overweight patient with
hypertension?
A. Increasing dietary sodium
B. Weight reduction
C. Avoiding all carbohydrates
D. Increasing saturated-fat intake
Answer: B
Rationale: Appropriate weight reduction can improve blood pressure,
glycemic control, lipid levels, and overall cardiovascular risk.
3. A patient taking lisinopril develops facial swelling and difficulty
breathing. What is the priority action?
A. Continue the medication and reassess tomorrow
B. Administer the next dose with food
C. Discontinue the drug and obtain emergency evaluation
D. Substitute hydrochlorothiazide without further evaluation
,Answer: C
Rationale: Angioedema associated with an ACE inhibitor can rapidly
become life-threatening and requires immediate discontinuation and
emergency assessment.
4. Which adverse effect is particularly associated with ACE inhibitors?
A. Persistent dry cough
B. Severe constipation
C. Hypoglycemia
D. Hearing loss
Answer: A
Rationale: Bradykinin accumulation can cause the characteristic dry
cough associated with ACE inhibitors.
5. A patient with hypertension and chronic kidney disease has
persistent albuminuria. Which medication class is particularly useful
when tolerated?
A. ACE inhibitor or ARB
B. Nitrate
C. Loop antidiarrheal
D. Anticholinergic
Answer: A
Rationale: Renin-angiotensin system blockade can reduce albuminuria
and provide renal and cardiovascular protection in appropriate
patients.
6. Which laboratory finding is most consistent with primary
hyperparathyroidism?
A. Low calcium and high phosphate
B. High calcium and elevated or inappropriately normal PTH
,C. Low calcium and suppressed PTH
D. High phosphate and suppressed PTH
Answer: B
Rationale: Primary hyperparathyroidism typically produces
hypercalcemia with elevated or inadequately suppressed PTH.
7. A patient reports fatigue, weight gain, constipation, and cold
intolerance. Which test is the most appropriate initial laboratory
evaluation?
A. TSH
B. Troponin
C. D-dimer
D. Amylase
Answer: A
Rationale: TSH is the standard initial screening test for suspected
primary hypothyroidism.
8. Which finding is most suggestive of hyperthyroidism?
A. Bradycardia
B. Weight gain
C. Heat intolerance and tremor
D. Delayed relaxation of reflexes
Answer: C
Rationale: Hyperthyroidism commonly causes heat intolerance, tremor,
tachycardia, anxiety, and weight loss.
9. A patient taking levothyroxine asks when it should generally be
taken. Which instruction is appropriate?
A. Take it consistently, preferably on an empty stomach
B. Take it only when symptoms occur
, C. Take it with an iron supplement
D. Double the dose whenever fatigue occurs
Answer: A
Rationale: Consistent administration on an empty stomach improves
predictable absorption. Calcium and iron can interfere with absorption.
10. Which symptom in a patient with diabetes should raise concern for
hypoglycemia?
A. Polyuria
B. Tremor and diaphoresis
C. Gradual weight gain
D. Increased thirst only
Answer: B
Rationale: Adrenergic symptoms of hypoglycemia include sweating,
tremor, palpitations, hunger, and anxiety.
11. Which test is commonly used to assess average glycemic control
over approximately the preceding 2–3 months?
A. Serum sodium
B. Hemoglobin A1c
C. Urine ketones alone
D. Serum amylase
Answer: B
Rationale: HbA1c reflects average blood glucose exposure over the
lifespan of circulating erythrocytes.
12. A patient with diabetes presents with polyuria, polydipsia, and
unexplained weight loss. Which condition should be considered?
A. Hyperglycemia
B. Hypothyroidism
Rationales 2026/2027 Update
1. A 68-year-old patient with hypertension has repeated office blood
pressures around 154/92 mmHg. Which finding most strongly supports
a diagnosis of hypertension?
A. One elevated reading during an acute illness
B. Persistent elevation documented on separate occasions
C. Elevated blood pressure after exercise
D. A single home reading of 150/90
Answer: B
Rationale: Hypertension is diagnosed from persistent blood-pressure
elevation rather than an isolated abnormal measurement.
2. Which lifestyle intervention generally has the greatest impact on
reducing cardiovascular risk in an overweight patient with
hypertension?
A. Increasing dietary sodium
B. Weight reduction
C. Avoiding all carbohydrates
D. Increasing saturated-fat intake
Answer: B
Rationale: Appropriate weight reduction can improve blood pressure,
glycemic control, lipid levels, and overall cardiovascular risk.
3. A patient taking lisinopril develops facial swelling and difficulty
breathing. What is the priority action?
A. Continue the medication and reassess tomorrow
B. Administer the next dose with food
C. Discontinue the drug and obtain emergency evaluation
D. Substitute hydrochlorothiazide without further evaluation
,Answer: C
Rationale: Angioedema associated with an ACE inhibitor can rapidly
become life-threatening and requires immediate discontinuation and
emergency assessment.
4. Which adverse effect is particularly associated with ACE inhibitors?
A. Persistent dry cough
B. Severe constipation
C. Hypoglycemia
D. Hearing loss
Answer: A
Rationale: Bradykinin accumulation can cause the characteristic dry
cough associated with ACE inhibitors.
5. A patient with hypertension and chronic kidney disease has
persistent albuminuria. Which medication class is particularly useful
when tolerated?
A. ACE inhibitor or ARB
B. Nitrate
C. Loop antidiarrheal
D. Anticholinergic
Answer: A
Rationale: Renin-angiotensin system blockade can reduce albuminuria
and provide renal and cardiovascular protection in appropriate
patients.
6. Which laboratory finding is most consistent with primary
hyperparathyroidism?
A. Low calcium and high phosphate
B. High calcium and elevated or inappropriately normal PTH
,C. Low calcium and suppressed PTH
D. High phosphate and suppressed PTH
Answer: B
Rationale: Primary hyperparathyroidism typically produces
hypercalcemia with elevated or inadequately suppressed PTH.
7. A patient reports fatigue, weight gain, constipation, and cold
intolerance. Which test is the most appropriate initial laboratory
evaluation?
A. TSH
B. Troponin
C. D-dimer
D. Amylase
Answer: A
Rationale: TSH is the standard initial screening test for suspected
primary hypothyroidism.
8. Which finding is most suggestive of hyperthyroidism?
A. Bradycardia
B. Weight gain
C. Heat intolerance and tremor
D. Delayed relaxation of reflexes
Answer: C
Rationale: Hyperthyroidism commonly causes heat intolerance, tremor,
tachycardia, anxiety, and weight loss.
9. A patient taking levothyroxine asks when it should generally be
taken. Which instruction is appropriate?
A. Take it consistently, preferably on an empty stomach
B. Take it only when symptoms occur
, C. Take it with an iron supplement
D. Double the dose whenever fatigue occurs
Answer: A
Rationale: Consistent administration on an empty stomach improves
predictable absorption. Calcium and iron can interfere with absorption.
10. Which symptom in a patient with diabetes should raise concern for
hypoglycemia?
A. Polyuria
B. Tremor and diaphoresis
C. Gradual weight gain
D. Increased thirst only
Answer: B
Rationale: Adrenergic symptoms of hypoglycemia include sweating,
tremor, palpitations, hunger, and anxiety.
11. Which test is commonly used to assess average glycemic control
over approximately the preceding 2–3 months?
A. Serum sodium
B. Hemoglobin A1c
C. Urine ketones alone
D. Serum amylase
Answer: B
Rationale: HbA1c reflects average blood glucose exposure over the
lifespan of circulating erythrocytes.
12. A patient with diabetes presents with polyuria, polydipsia, and
unexplained weight loss. Which condition should be considered?
A. Hyperglycemia
B. Hypothyroidism
