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AGPCNP Board Exam ACTUAL EXAM
2026/2027 | Verified Questions and Answers |
ANCC & AANP Style | Lifespan Primary Care
Focus | Exam Pass Target - A+ Graded
DOMAIN 1: ASSESSMENT AND DIAGNOSIS (35 Questions)
Q1: A 68-year-old male presents with progressive dyspnea on exertion, orthopnea, and bilateral
lower extremity edema. Physical exam reveals an S3 gallop, jugular venous distension at 8 cm,
and hepatomegaly. Which additional finding on chest X-ray would be most consistent with his
diagnosis?
A. Right-sided pleural effusion
B. Kerley B lines and cephalization of pulmonary vessels [CORRECT]
C. Pneumothorax
D. Solitary pulmonary nodule
Correct Answer: B
Q2: A 72-year-old female with a history of hypertension and type 2 diabetes presents after a fall.
She reports feeling dizzy before the fall. Her medications include metformin 1000mg BID,
lisinopril 20mg daily, and atorvastatin 40mg daily. Vital signs: BP 118/72 mmHg (supine), 98/60
mmHg (standing after 3 minutes); HR 78 bpm (supine), 96 bpm (standing). What is the most
likely cause of her orthostatic hypotension?
A. Autonomic neuropathy from diabetes
B. Excessive antihypertensive therapy [CORRECT]
C. Hypoglycemia from metformin
D. Orthostatic intolerance syndrome
Correct Answer: B
Q3: [SATA] A 45-year-old male presents with epigastric pain radiating to the back, nausea, and
vomiting. Serum lipase is 1200 U/L (normal <60). Which of the following are risk factors for his
condition? (Select all that apply)
A. Gallstone disease [CORRECT]
B. Chronic alcohol use [CORRECT]
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C. Hypertriglyceridemia [CORRECT]
D. ACE inhibitor use
E. Recent ERCP [CORRECT]
Correct Answers: A, B, C, E
Q4: A 58-year-old female presents with fatigue, weight gain, constipation, and dry skin. Physical
exam reveals delayed deep tendon reflexes and periorbital edema. Laboratory studies show TSH
12.5 mIU/L (normal 0.4-4.0) and free T4 0.6 ng/dL (normal 0.8-1.8). Which additional finding
would be expected?
A. Hypercalcemia
B. Normocytic anemia
C. Elevated creatine kinase [CORRECT]
D. Hypoglycemia
Correct Answer: C
Q5: A 19-year-old college student presents with sore throat, fever of 101.2°F, and tender anterior
cervical lymphadenopathy. Physical exam reveals tonsillar exudates and palatal petechiae. Rapid
strep test is negative. What is the most appropriate next step?
A. Start empiric amoxicillin
B. Order throat culture [CORRECT]
C. Order monospot test
D. Recommend supportive care only
Correct Answer: B
Q6: A 76-year-old male with COPD presents with increased dyspnea and purulent sputum. Vital
signs: Temp 101.8°F, HR 102, RR 24, BP 138/86, SpO2 88% on room air. Chest X-ray shows no
infiltrate. Which additional finding would warrant hospitalization?
A. Age >75
B. SpO2 <90% on room air [CORRECT]
C. Heart rate >100
D. Systolic BP >130
Correct Answer: B
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Q7: [Sequencing] Arrange the following steps in the correct order for evaluating a 55-year-old
with newly diagnosed microscopic hematuria (3 RBCs/hpf on repeat urinalysis, no infection):
A. CT urography
B. Cystoscopy
C. Repeat urinalysis in 6 months
D. Assess for risk factors (smoking, occupational exposures, age) [CORRECT ORDER: D, A,
B, C]
Correct Order: D, A, B, C
Q8: A 62-year-old female presents with right upper quadrant pain after eating fatty meals.
Ultrasound reveals gallstones and a gallbladder wall thickness of 4mm. Which additional finding
would indicate acute cholecystitis rather than biliary colic?
A. Pain lasting 30 minutes
B. Sonographic Murphy's sign [CORRECT]
C. Multiple small gallstones
D. Elevated alkaline phosphatase only
Correct Answer: B
Q9: [SATA] A 50-year-old male with a 30 pack-year smoking history presents for a physical.
According to USPSTF guidelines, which screening tests are indicated? (Select all that apply)
A. Low-dose CT chest for lung cancer [CORRECT]
B. Abdominal ultrasound for AAA [CORRECT]
C. Colonoscopy for colorectal cancer [CORRECT]
D. PSA for prostate cancer
E. Chest X-ray for lung cancer
Correct Answers: A, B, C
Q10: A 35-year-old female presents with intermittent palpitations, heat intolerance, and 10-
pound weight loss over 2 months. Physical exam reveals a fine tremor and brisk reflexes. TSH is
0.1 mIU/L. Which test is most appropriate to establish the etiology?
A. Thyroid ultrasound
B. Radioactive iodine uptake scan
C. Thyroid-stimulating immunoglobulins (TSI) [CORRECT]
D. Fine needle aspiration
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Correct Answer: C
Q11: A 70-year-old female with osteoporosis presents after a fall onto her outstretched hand. She
has wrist pain and deformity. X-ray shows a Colles' fracture. Which additional assessment is
most important given her age?
A. Bone density scan
B. Fall risk evaluation [CORRECT]
C. Vitamin D level
D. Parathyroid hormone level
Correct Answer: B
Q12: A 48-year-old male presents with hemoptysis, weight loss, and night sweats. Chest X-ray
shows a cavitary lesion in the right upper lobe. Sputum AFB smear is positive. Which finding on
additional workup would indicate the highest priority for public health intervention?
A. Cavitation on chest X-ray
B. Positive nucleic acid amplification test (NAAT) for M. tuberculosis [CORRECT]
C. Elevated erythrocyte sedimentation rate
D. Anemia
Correct Answer: B
Q13: A 28-year-old female presents with pelvic pain, dysmenorrhea, and dyspareunia. Physical
exam reveals a fixed, retroverted uterus and tender adnexal masses. Transvaginal ultrasound
shows endometriomas. Which additional finding would support the diagnosis of endometriosis?
A. Elevated CA-125 [CORRECT]
B. Elevated alpha-fetoprotein
C. Elevated inhibin B
D. Elevated beta-hCG
Correct Answer: A
Q14: [SATA] An 82-year-old male presents with confusion, lethargy, and constipation. His
medications include furosemide, digoxin, and warfarin. Laboratory studies reveal: Sodium 128
mEq/L, Potassium 5.8 mEq/L, BUN 45 mg/dL, Creatinine 2.1 mg/dL (baseline 1.0), Calcium
AGPCNP Board Exam ACTUAL EXAM
2026/2027 | Verified Questions and Answers |
ANCC & AANP Style | Lifespan Primary Care
Focus | Exam Pass Target - A+ Graded
DOMAIN 1: ASSESSMENT AND DIAGNOSIS (35 Questions)
Q1: A 68-year-old male presents with progressive dyspnea on exertion, orthopnea, and bilateral
lower extremity edema. Physical exam reveals an S3 gallop, jugular venous distension at 8 cm,
and hepatomegaly. Which additional finding on chest X-ray would be most consistent with his
diagnosis?
A. Right-sided pleural effusion
B. Kerley B lines and cephalization of pulmonary vessels [CORRECT]
C. Pneumothorax
D. Solitary pulmonary nodule
Correct Answer: B
Q2: A 72-year-old female with a history of hypertension and type 2 diabetes presents after a fall.
She reports feeling dizzy before the fall. Her medications include metformin 1000mg BID,
lisinopril 20mg daily, and atorvastatin 40mg daily. Vital signs: BP 118/72 mmHg (supine), 98/60
mmHg (standing after 3 minutes); HR 78 bpm (supine), 96 bpm (standing). What is the most
likely cause of her orthostatic hypotension?
A. Autonomic neuropathy from diabetes
B. Excessive antihypertensive therapy [CORRECT]
C. Hypoglycemia from metformin
D. Orthostatic intolerance syndrome
Correct Answer: B
Q3: [SATA] A 45-year-old male presents with epigastric pain radiating to the back, nausea, and
vomiting. Serum lipase is 1200 U/L (normal <60). Which of the following are risk factors for his
condition? (Select all that apply)
A. Gallstone disease [CORRECT]
B. Chronic alcohol use [CORRECT]
,S
C. Hypertriglyceridemia [CORRECT]
D. ACE inhibitor use
E. Recent ERCP [CORRECT]
Correct Answers: A, B, C, E
Q4: A 58-year-old female presents with fatigue, weight gain, constipation, and dry skin. Physical
exam reveals delayed deep tendon reflexes and periorbital edema. Laboratory studies show TSH
12.5 mIU/L (normal 0.4-4.0) and free T4 0.6 ng/dL (normal 0.8-1.8). Which additional finding
would be expected?
A. Hypercalcemia
B. Normocytic anemia
C. Elevated creatine kinase [CORRECT]
D. Hypoglycemia
Correct Answer: C
Q5: A 19-year-old college student presents with sore throat, fever of 101.2°F, and tender anterior
cervical lymphadenopathy. Physical exam reveals tonsillar exudates and palatal petechiae. Rapid
strep test is negative. What is the most appropriate next step?
A. Start empiric amoxicillin
B. Order throat culture [CORRECT]
C. Order monospot test
D. Recommend supportive care only
Correct Answer: B
Q6: A 76-year-old male with COPD presents with increased dyspnea and purulent sputum. Vital
signs: Temp 101.8°F, HR 102, RR 24, BP 138/86, SpO2 88% on room air. Chest X-ray shows no
infiltrate. Which additional finding would warrant hospitalization?
A. Age >75
B. SpO2 <90% on room air [CORRECT]
C. Heart rate >100
D. Systolic BP >130
Correct Answer: B
,S
Q7: [Sequencing] Arrange the following steps in the correct order for evaluating a 55-year-old
with newly diagnosed microscopic hematuria (3 RBCs/hpf on repeat urinalysis, no infection):
A. CT urography
B. Cystoscopy
C. Repeat urinalysis in 6 months
D. Assess for risk factors (smoking, occupational exposures, age) [CORRECT ORDER: D, A,
B, C]
Correct Order: D, A, B, C
Q8: A 62-year-old female presents with right upper quadrant pain after eating fatty meals.
Ultrasound reveals gallstones and a gallbladder wall thickness of 4mm. Which additional finding
would indicate acute cholecystitis rather than biliary colic?
A. Pain lasting 30 minutes
B. Sonographic Murphy's sign [CORRECT]
C. Multiple small gallstones
D. Elevated alkaline phosphatase only
Correct Answer: B
Q9: [SATA] A 50-year-old male with a 30 pack-year smoking history presents for a physical.
According to USPSTF guidelines, which screening tests are indicated? (Select all that apply)
A. Low-dose CT chest for lung cancer [CORRECT]
B. Abdominal ultrasound for AAA [CORRECT]
C. Colonoscopy for colorectal cancer [CORRECT]
D. PSA for prostate cancer
E. Chest X-ray for lung cancer
Correct Answers: A, B, C
Q10: A 35-year-old female presents with intermittent palpitations, heat intolerance, and 10-
pound weight loss over 2 months. Physical exam reveals a fine tremor and brisk reflexes. TSH is
0.1 mIU/L. Which test is most appropriate to establish the etiology?
A. Thyroid ultrasound
B. Radioactive iodine uptake scan
C. Thyroid-stimulating immunoglobulins (TSI) [CORRECT]
D. Fine needle aspiration
, S
Correct Answer: C
Q11: A 70-year-old female with osteoporosis presents after a fall onto her outstretched hand. She
has wrist pain and deformity. X-ray shows a Colles' fracture. Which additional assessment is
most important given her age?
A. Bone density scan
B. Fall risk evaluation [CORRECT]
C. Vitamin D level
D. Parathyroid hormone level
Correct Answer: B
Q12: A 48-year-old male presents with hemoptysis, weight loss, and night sweats. Chest X-ray
shows a cavitary lesion in the right upper lobe. Sputum AFB smear is positive. Which finding on
additional workup would indicate the highest priority for public health intervention?
A. Cavitation on chest X-ray
B. Positive nucleic acid amplification test (NAAT) for M. tuberculosis [CORRECT]
C. Elevated erythrocyte sedimentation rate
D. Anemia
Correct Answer: B
Q13: A 28-year-old female presents with pelvic pain, dysmenorrhea, and dyspareunia. Physical
exam reveals a fixed, retroverted uterus and tender adnexal masses. Transvaginal ultrasound
shows endometriomas. Which additional finding would support the diagnosis of endometriosis?
A. Elevated CA-125 [CORRECT]
B. Elevated alpha-fetoprotein
C. Elevated inhibin B
D. Elevated beta-hCG
Correct Answer: A
Q14: [SATA] An 82-year-old male presents with confusion, lethargy, and constipation. His
medications include furosemide, digoxin, and warfarin. Laboratory studies reveal: Sodium 128
mEq/L, Potassium 5.8 mEq/L, BUN 45 mg/dL, Creatinine 2.1 mg/dL (baseline 1.0), Calcium
