AGPCNP Exam Review —Questions
AANP AGPCNP PSI Certification Exam Questions
with Answers
Question 1
A 62-year-old man presents with new-onset exertional substernal chest pressure
relieved by rest. Resting ECG is normal. Which is the most appropriate next step?
A. Reassure and follow up in 3 months
B. Order an exercise stress test
C. Start sublingual nitroglycerin only as needed and reassess in 6 months
D. Refer directly for cardiac catheterization
Answer: B
Rationale: Stable angina with a normal resting ECG warrants further risk
stratification with a stress test before invasive testing. Catheterization is reserved
for high-risk features or a positive noninvasive test.
Question 2
Which finding is most consistent with aortic stenosis on physical exam?
A. Holosystolic murmur at the apex radiating to the axilla
B. Mid-systolic crescendo-decrescendo murmur at the right upper sternal
border radiating to the carotids
C. Diastolic murmur best heard at the left sternal border
D. Continuous machinery murmur at the left upper sternal border
Answer: B
Page 1 of 61
, AGPCNP Exam Review —Questions
Rationale: Aortic stenosis produces a harsh systolic ejection (crescendo-
decrescendo) murmur heard best at the right second intercostal space with
radiation to the carotids. Option A describes mitral regurgitation.
Question 3
A patient with atrial fibrillation has a CHA2DS2-VASc score of 3. What is the
recommended management?
A. Aspirin alone
B. No antithrombotic therapy needed
C. Oral anticoagulation
D. Antiplatelet dual therapy
Answer: C
Rationale: A CHA2DS2-VASc score of ≥2 in men (or ≥3 in women) indicates a
benefit from oral anticoagulation to reduce stroke risk; aspirin alone is not
recommended for stroke prevention in AF.
Question 4
Which lab abnormality is most likely to precipitate digoxin toxicity?
A. Hypercalcemia
B. Hyperkalemia
C. Hypokalemia
D. Hypernatremia
Answer: C
Rationale: Hypokalemia increases myocardial sensitivity to digoxin and increases
the risk of toxicity because digoxin and potassium compete for the same binding
site on the Na-K-ATPase pump.
Question 5
A 55-year-old woman has an LDL of 165 mg/dL, no diabetes, and a 10-year ASCVD
risk of 9%. What is the most appropriate initial pharmacologic step?
A. High-intensity statin
B. Moderate-intensity statin
Page 2 of 61
, AGPCNP Exam Review —Questions
C. Fibrate therapy
D. Ezetimibe monotherapy
Answer: B
Rationale: For primary prevention with an intermediate risk (7.5–19.9%) and LDL
≥70, a moderate-intensity statin is the appropriate initial therapy per ACC/AHA
guidelines; high-intensity is reserved for very high risk or established ASCVD.
Question 6
Which of the following best describes the mechanism of action of ACE inhibitors
in heart failure?
A. Block beta-1 adrenergic receptors
B. Prevent conversion of angiotensin I to angiotensin II
C. Block aldosterone receptors
D. Inhibit the sodium-glucose cotransporter
Answer: B
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II,
reducing vasoconstriction and aldosterone secretion, which decreases afterload
and preload in heart failure.
Question 7
A patient on warfarin presents with an INR of 8 and no bleeding. What is the most
appropriate action?
A. Continue current dose
B. Hold warfarin and give oral vitamin K
C. Increase warfarin dose
D. Give fresh frozen plasma immediately
Answer: B
Rationale: For an INR >4.5 without significant bleeding, warfarin should be held
and low-dose oral vitamin K given; FFP is reserved for serious active bleeding.
Question 8
Page 3 of 61
, AGPCNP Exam Review —Questions
Which physical exam finding suggests right-sided heart failure rather than left-
sided?
A. Pulmonary crackles
B. Jugular venous distension and peripheral edema
C. Orthopnea
D. Paroxysmal nocturnal dyspnea
Answer: B
Rationale: Right-sided heart failure causes systemic venous congestion,
manifesting as JVD, hepatomegaly, and peripheral edema, while left-sided failure
causes pulmonary congestion (crackles, orthopnea, PND).
Question 9 [Pulmonology]
A patient with COPD has an FEV1/FVC ratio of 0.65 post-bronchodilator and
moderate symptoms with one exacerbation last year not requiring hospitalization.
According to GOLD criteria, which group is this patient?
A. Group A
B. Group B
C. Group E
D. Group D
Answer: B
Rationale: GOLD Group B is defined by more symptoms (mMRC ≥2 or CAT ≥10)
with 0–1 moderate exacerbations not leading to hospitalization; Group E is
reserved for ≥2 exacerbations or ≥1 leading to hospitalization.
Question 10 [Pulmonology]
Which medication class is first-line for long-term control of persistent asthma?
A. Short-acting beta agonist
B. Inhaled corticosteroid
C. Oral corticosteroid
D. Leukotriene receptor antagonist
Answer: B
Page 4 of 61
AANP AGPCNP PSI Certification Exam Questions
with Answers
Question 1
A 62-year-old man presents with new-onset exertional substernal chest pressure
relieved by rest. Resting ECG is normal. Which is the most appropriate next step?
A. Reassure and follow up in 3 months
B. Order an exercise stress test
C. Start sublingual nitroglycerin only as needed and reassess in 6 months
D. Refer directly for cardiac catheterization
Answer: B
Rationale: Stable angina with a normal resting ECG warrants further risk
stratification with a stress test before invasive testing. Catheterization is reserved
for high-risk features or a positive noninvasive test.
Question 2
Which finding is most consistent with aortic stenosis on physical exam?
A. Holosystolic murmur at the apex radiating to the axilla
B. Mid-systolic crescendo-decrescendo murmur at the right upper sternal
border radiating to the carotids
C. Diastolic murmur best heard at the left sternal border
D. Continuous machinery murmur at the left upper sternal border
Answer: B
Page 1 of 61
, AGPCNP Exam Review —Questions
Rationale: Aortic stenosis produces a harsh systolic ejection (crescendo-
decrescendo) murmur heard best at the right second intercostal space with
radiation to the carotids. Option A describes mitral regurgitation.
Question 3
A patient with atrial fibrillation has a CHA2DS2-VASc score of 3. What is the
recommended management?
A. Aspirin alone
B. No antithrombotic therapy needed
C. Oral anticoagulation
D. Antiplatelet dual therapy
Answer: C
Rationale: A CHA2DS2-VASc score of ≥2 in men (or ≥3 in women) indicates a
benefit from oral anticoagulation to reduce stroke risk; aspirin alone is not
recommended for stroke prevention in AF.
Question 4
Which lab abnormality is most likely to precipitate digoxin toxicity?
A. Hypercalcemia
B. Hyperkalemia
C. Hypokalemia
D. Hypernatremia
Answer: C
Rationale: Hypokalemia increases myocardial sensitivity to digoxin and increases
the risk of toxicity because digoxin and potassium compete for the same binding
site on the Na-K-ATPase pump.
Question 5
A 55-year-old woman has an LDL of 165 mg/dL, no diabetes, and a 10-year ASCVD
risk of 9%. What is the most appropriate initial pharmacologic step?
A. High-intensity statin
B. Moderate-intensity statin
Page 2 of 61
, AGPCNP Exam Review —Questions
C. Fibrate therapy
D. Ezetimibe monotherapy
Answer: B
Rationale: For primary prevention with an intermediate risk (7.5–19.9%) and LDL
≥70, a moderate-intensity statin is the appropriate initial therapy per ACC/AHA
guidelines; high-intensity is reserved for very high risk or established ASCVD.
Question 6
Which of the following best describes the mechanism of action of ACE inhibitors
in heart failure?
A. Block beta-1 adrenergic receptors
B. Prevent conversion of angiotensin I to angiotensin II
C. Block aldosterone receptors
D. Inhibit the sodium-glucose cotransporter
Answer: B
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II,
reducing vasoconstriction and aldosterone secretion, which decreases afterload
and preload in heart failure.
Question 7
A patient on warfarin presents with an INR of 8 and no bleeding. What is the most
appropriate action?
A. Continue current dose
B. Hold warfarin and give oral vitamin K
C. Increase warfarin dose
D. Give fresh frozen plasma immediately
Answer: B
Rationale: For an INR >4.5 without significant bleeding, warfarin should be held
and low-dose oral vitamin K given; FFP is reserved for serious active bleeding.
Question 8
Page 3 of 61
, AGPCNP Exam Review —Questions
Which physical exam finding suggests right-sided heart failure rather than left-
sided?
A. Pulmonary crackles
B. Jugular venous distension and peripheral edema
C. Orthopnea
D. Paroxysmal nocturnal dyspnea
Answer: B
Rationale: Right-sided heart failure causes systemic venous congestion,
manifesting as JVD, hepatomegaly, and peripheral edema, while left-sided failure
causes pulmonary congestion (crackles, orthopnea, PND).
Question 9 [Pulmonology]
A patient with COPD has an FEV1/FVC ratio of 0.65 post-bronchodilator and
moderate symptoms with one exacerbation last year not requiring hospitalization.
According to GOLD criteria, which group is this patient?
A. Group A
B. Group B
C. Group E
D. Group D
Answer: B
Rationale: GOLD Group B is defined by more symptoms (mMRC ≥2 or CAT ≥10)
with 0–1 moderate exacerbations not leading to hospitalization; Group E is
reserved for ≥2 exacerbations or ≥1 leading to hospitalization.
Question 10 [Pulmonology]
Which medication class is first-line for long-term control of persistent asthma?
A. Short-acting beta agonist
B. Inhaled corticosteroid
C. Oral corticosteroid
D. Leukotriene receptor antagonist
Answer: B
Page 4 of 61
