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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 (Questions 1-35)
Q1: A 68-year-old male presents with fatigue and dyspnea on exertion. Vital signs: BP 142/88,
HR 92, RR 18, SpO2 94% on room air. Laboratory studies reveal: Hemoglobin 8.2 g/dL, MCV
72 fL, Ferritin 15 ng/mL, Transferrin saturation 12%. Stool guaiac is positive. Which is the most
appropriate next step?
A. Initiate oral ferrous sulfate 325 mg daily
B. Refer for urgent colonoscopy [CORRECT]
C. Repeat stool guaiac in 3 months
D. Start parenteral iron replacement
Correct Answer: B
Q2: A 72-year-old female reports a 3-month history of progressive memory loss, difficulty
finding words, and getting lost in familiar places. Her MMSE score is 22/30. MRI shows mild
cortical atrophy. Which additional finding on history or exam would most strongly suggest
Alzheimer's disease rather than vascular dementia?
A. Stepwise decline in function with focal neurologic deficits
B. Gradual progressive decline with early impairment of episodic memory [CORRECT]
C. History of multiple strokes
D. Prominent early personality changes and disinhibition
Correct Answer: B
Q3: A 45-year-old male with type 2 diabetes presents for follow-up. He reports nocturia 3-4
times nightly. Vital signs: BP 138/82, BMI 31. Laboratory studies: A1C 7.2%, eGFR 45
mL/min/1.73m², UACR 45 mg/g. Which medication should be added to his regimen?
A. Loop diuretic
B. ACE inhibitor or ARB [CORRECT]
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C. Alpha-blocker
D. SGLT2 inhibitor alone (without considering renal threshold)
Correct Answer: B
Q4: A 58-year-old female presents with palpitations and lightheadedness. ECG reveals atrial
fibrillation with ventricular rate 110 bpm. She is hemodynamically stable. Which is the priority
assessment before initiating rate or rhythm control?
A. Thyroid function tests
B. Duration of symptoms to determine anticoagulation strategy [CORRECT]
C. Exercise stress test
D. Cardiac catheterization
Correct Answer: B
Q5: A 76-year-old male presents after a fall. He takes warfarin for atrial fibrillation. Examination
reveals bruising and mild confusion. CT head shows subdural hematoma 8mm with midline
shift. INR is 3.2. Which is the most appropriate immediate intervention?
A. Hold warfarin and observe
B. Administer vitamin K and 4-factor prothrombin complex concentrate [CORRECT]
C. Administer fresh frozen plasma only
D. Continue warfarin with lower dose
Correct Answer: B
Q6: A 34-year-old female presents with fatigue, joint pain, and photosensitive facial rash.
Laboratory studies: ANA positive 1:640, Anti-dsDNA positive, C3 low, C4 low, Urine protein
2+. Which finding would indicate the most severe disease activity?
A. Arthritis
B. Lupus nephritis [CORRECT]
C. Photosensitivity
D. Oral ulcers
Correct Answer: B
Q7: A 62-year-old male with COPD presents with increased dyspnea and sputum production.
Vital signs: Temp 38.2°C, HR 98, RR 24, SpO2 88% on room air. Which finding would indicate
the need for hospitalization?
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A. Increased sputum volume
B. SpO2 88% despite supplemental oxygen and inability to maintain SpO2 >90% [CORRECT]
C. Change in sputum color
D. Mild fever
Correct Answer: B
Q8: A 28-year-old female presents with recurrent headaches described as unilateral, throbbing,
associated with nausea and photophobia, lasting 12-24 hours. Which finding on history would
support a diagnosis of migraine with aura?
A. Bilateral pressure-like pain
B. Visual scintillations preceding headache by 20 minutes [CORRECT]
C. Pain relieved by bending forward
D. Sudden "thunderclap" onset
Correct Answer: B
Q9: An 82-year-old female presents with acute confusion, dysuria, and fever. She has a Foley
catheter placed 5 days ago. Vital signs: Temp 38.8°C, HR 110, BP 98/62. Which is the most
appropriate management?
A. Remove catheter, obtain urine culture, and start empiric antibiotics [CORRECT]
B. Change catheter and continue current management
C. Treat with antipyretics only
D. Obtain blood culture only
Correct Answer: A
Q10: A 55-year-old male presents with epigastric pain radiating to the back, nausea, and
vomiting. Vital signs: BP 90/60, HR 120. Laboratory studies: Lipase 3,500 U/L, Calcium 7.2
mg/dL, Glucose 220 mg/dL, BUN 45 mg/dL. Which finding indicates severe acute pancreatitis?
A. Lipase elevation alone
B. Hypocalcemia, hyperglycemia, and elevated BUN indicating organ failure [CORRECT]
C. Epigastric pain location
D. Nausea and vomiting
Correct Answer: B
, S
Q11: A 48-year-old female presents with fatigue, constipation, and dry skin. Laboratory studies:
TSH 12.5 mIU/L, Free T4 0.8 ng/dL, Anti-TPO antibodies positive. Which symptom would most
specifically indicate severe hypothyroidism requiring urgent treatment?
A. Constipation
B. Dry skin
C. Altered mental status and hypothermia (myxedema coma features) [CORRECT]
D. Mild fatigue
Correct Answer: C
Q12: A 65-year-old male with hypertension and hyperlipidemia presents with acute onset right-
sided weakness and aphasia. Symptoms started 45 minutes ago. CT head shows no hemorrhage.
Which is the priority intervention?
A. Immediate anticoagulation with heparin
B. Assessment for thrombolytic therapy (tPA) within time window [CORRECT]
C. Observation for 24 hours
D. Start aspirin 325 mg only
Correct Answer: B
Q13: A 38-year-old male presents with low back pain radiating down the left leg, worse with
sitting and Valsalva. Straight leg raise test is positive at 30 degrees on the left. Which finding
would indicate the need for urgent surgical evaluation?
A. Positive straight leg raise
B. Saddle anesthesia and urinary incontinence (cauda equina syndrome) [CORRECT]
C. Pain worse with sitting
D. Radicular symptoms
Correct Answer: B
Q14: A 71-year-old female presents with tremor at rest, rigidity, bradykinesia, and postural
instability. Which additional finding would support a diagnosis of Parkinson's disease rather than
essential tremor?
A. Tremor improves with action
B. Asymmetric onset of symptoms [CORRECT]
C. Family history of tremor
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 (Questions 1-35)
Q1: A 68-year-old male presents with fatigue and dyspnea on exertion. Vital signs: BP 142/88,
HR 92, RR 18, SpO2 94% on room air. Laboratory studies reveal: Hemoglobin 8.2 g/dL, MCV
72 fL, Ferritin 15 ng/mL, Transferrin saturation 12%. Stool guaiac is positive. Which is the most
appropriate next step?
A. Initiate oral ferrous sulfate 325 mg daily
B. Refer for urgent colonoscopy [CORRECT]
C. Repeat stool guaiac in 3 months
D. Start parenteral iron replacement
Correct Answer: B
Q2: A 72-year-old female reports a 3-month history of progressive memory loss, difficulty
finding words, and getting lost in familiar places. Her MMSE score is 22/30. MRI shows mild
cortical atrophy. Which additional finding on history or exam would most strongly suggest
Alzheimer's disease rather than vascular dementia?
A. Stepwise decline in function with focal neurologic deficits
B. Gradual progressive decline with early impairment of episodic memory [CORRECT]
C. History of multiple strokes
D. Prominent early personality changes and disinhibition
Correct Answer: B
Q3: A 45-year-old male with type 2 diabetes presents for follow-up. He reports nocturia 3-4
times nightly. Vital signs: BP 138/82, BMI 31. Laboratory studies: A1C 7.2%, eGFR 45
mL/min/1.73m², UACR 45 mg/g. Which medication should be added to his regimen?
A. Loop diuretic
B. ACE inhibitor or ARB [CORRECT]
,S
C. Alpha-blocker
D. SGLT2 inhibitor alone (without considering renal threshold)
Correct Answer: B
Q4: A 58-year-old female presents with palpitations and lightheadedness. ECG reveals atrial
fibrillation with ventricular rate 110 bpm. She is hemodynamically stable. Which is the priority
assessment before initiating rate or rhythm control?
A. Thyroid function tests
B. Duration of symptoms to determine anticoagulation strategy [CORRECT]
C. Exercise stress test
D. Cardiac catheterization
Correct Answer: B
Q5: A 76-year-old male presents after a fall. He takes warfarin for atrial fibrillation. Examination
reveals bruising and mild confusion. CT head shows subdural hematoma 8mm with midline
shift. INR is 3.2. Which is the most appropriate immediate intervention?
A. Hold warfarin and observe
B. Administer vitamin K and 4-factor prothrombin complex concentrate [CORRECT]
C. Administer fresh frozen plasma only
D. Continue warfarin with lower dose
Correct Answer: B
Q6: A 34-year-old female presents with fatigue, joint pain, and photosensitive facial rash.
Laboratory studies: ANA positive 1:640, Anti-dsDNA positive, C3 low, C4 low, Urine protein
2+. Which finding would indicate the most severe disease activity?
A. Arthritis
B. Lupus nephritis [CORRECT]
C. Photosensitivity
D. Oral ulcers
Correct Answer: B
Q7: A 62-year-old male with COPD presents with increased dyspnea and sputum production.
Vital signs: Temp 38.2°C, HR 98, RR 24, SpO2 88% on room air. Which finding would indicate
the need for hospitalization?
,S
A. Increased sputum volume
B. SpO2 88% despite supplemental oxygen and inability to maintain SpO2 >90% [CORRECT]
C. Change in sputum color
D. Mild fever
Correct Answer: B
Q8: A 28-year-old female presents with recurrent headaches described as unilateral, throbbing,
associated with nausea and photophobia, lasting 12-24 hours. Which finding on history would
support a diagnosis of migraine with aura?
A. Bilateral pressure-like pain
B. Visual scintillations preceding headache by 20 minutes [CORRECT]
C. Pain relieved by bending forward
D. Sudden "thunderclap" onset
Correct Answer: B
Q9: An 82-year-old female presents with acute confusion, dysuria, and fever. She has a Foley
catheter placed 5 days ago. Vital signs: Temp 38.8°C, HR 110, BP 98/62. Which is the most
appropriate management?
A. Remove catheter, obtain urine culture, and start empiric antibiotics [CORRECT]
B. Change catheter and continue current management
C. Treat with antipyretics only
D. Obtain blood culture only
Correct Answer: A
Q10: A 55-year-old male presents with epigastric pain radiating to the back, nausea, and
vomiting. Vital signs: BP 90/60, HR 120. Laboratory studies: Lipase 3,500 U/L, Calcium 7.2
mg/dL, Glucose 220 mg/dL, BUN 45 mg/dL. Which finding indicates severe acute pancreatitis?
A. Lipase elevation alone
B. Hypocalcemia, hyperglycemia, and elevated BUN indicating organ failure [CORRECT]
C. Epigastric pain location
D. Nausea and vomiting
Correct Answer: B
, S
Q11: A 48-year-old female presents with fatigue, constipation, and dry skin. Laboratory studies:
TSH 12.5 mIU/L, Free T4 0.8 ng/dL, Anti-TPO antibodies positive. Which symptom would most
specifically indicate severe hypothyroidism requiring urgent treatment?
A. Constipation
B. Dry skin
C. Altered mental status and hypothermia (myxedema coma features) [CORRECT]
D. Mild fatigue
Correct Answer: C
Q12: A 65-year-old male with hypertension and hyperlipidemia presents with acute onset right-
sided weakness and aphasia. Symptoms started 45 minutes ago. CT head shows no hemorrhage.
Which is the priority intervention?
A. Immediate anticoagulation with heparin
B. Assessment for thrombolytic therapy (tPA) within time window [CORRECT]
C. Observation for 24 hours
D. Start aspirin 325 mg only
Correct Answer: B
Q13: A 38-year-old male presents with low back pain radiating down the left leg, worse with
sitting and Valsalva. Straight leg raise test is positive at 30 degrees on the left. Which finding
would indicate the need for urgent surgical evaluation?
A. Positive straight leg raise
B. Saddle anesthesia and urinary incontinence (cauda equina syndrome) [CORRECT]
C. Pain worse with sitting
D. Radicular symptoms
Correct Answer: B
Q14: A 71-year-old female presents with tremor at rest, rigidity, bradykinesia, and postural
instability. Which additional finding would support a diagnosis of Parkinson's disease rather than
essential tremor?
A. Tremor improves with action
B. Asymmetric onset of symptoms [CORRECT]
C. Family history of tremor
