S
AGPCNP Board Exam ACTUAL EXAM
2026/2027 | Verified Questions and Answers |
ANCC & AANP Style | Lifespan Primary Care
Focus | Exam Pass Target - A+ Graded
Q1: A 68-year-old male presents with progressive fatigue, weight loss, and early satiety. Physical
exam reveals splenomegaly (4 cm below costal margin) and hepatomegaly. CBC shows: WBC
45,000/μL with left shift, hemoglobin 9.2 g/dL, platelets 850,000/μL. Peripheral smear shows
basophilia and myelocytes. What is the most likely diagnosis?
A. Acute lymphoblastic leukemia
B. Chronic myeloid leukemia [CORRECT]
C. Essential thrombocythemia
D. Myelodysplastic syndrome
Correct Answer: B
Q2: A 72-year-old female with a history of hypertension and diabetes presents after a fall. She is
on metformin, lisinopril, and hydrochlorothiazide. Her blood pressure is 142/88 mmHg while
seated, but drops to 98/62 mmHg after standing for 3 minutes. She reports dizziness upon
standing. Which medication is most likely contributing to her orthostatic hypotension?
A. Metformin
B. Lisinopril
C. Hydrochlorothiazide [CORRECT]
D. None; this is diabetic autonomic neuropathy only
Correct Answer: C
Q3: A 58-year-old male presents with crushing substernal chest pain radiating to his left arm,
diaphoresis, and nausea. Vital signs: HR 92, BP 148/96, RR 18, O2 sat 94% on room air. ECG
shows ST-segment elevation in leads V1-V4. Which is the priority intervention?
A. Administer aspirin 325 mg and establish IV access [CORRECT]
B. Obtain CT angiography to rule out pulmonary embolism
C. Administer sublingual nitroglycerin every 5 minutes × 3
D. Perform immediate pericardiocentesis
,S
Correct Answer: A
Q4: [SATA] A 45-year-old female presents with fatigue, joint pain, and a malar rash. ANA is
positive at 1:640. Which additional findings support a diagnosis of systemic lupus
erythematosus? (Select all that apply)
A. Anti-dsDNA antibodies positive [CORRECT]
B. Complement C3 and C4 levels elevated
C. Leukopenia (WBC 3,200/μL) [CORRECT]
D. Proteinuria >500 mg/24 hours [CORRECT]
E. Anti-Smith antibodies positive [CORRECT]
Correct Answers: A, C, D, E
Q5: A 19-year-old college student presents with sore throat, fever of 101.2°F, and tender anterior
cervical lymphadenopathy. Rapid strep test is negative. What is the next best step in
management?
A. Start empiric amoxicillin immediately
B. Obtain throat culture and treat if positive [CORRECT]
C. Order monospot test for infectious mononucleosis
D. Prescribe corticosteroids for symptom relief
Correct Answer: B
Q6: A 76-year-old nursing home resident presents with confusion, fever 101.8°F, and dysuria.
Urinalysis shows pyuria and bacteriuria. Which organism is most commonly responsible for
complicated urinary tract infections in this population?
A. Enterococcus faecalis
B. Pseudomonas aeruginosa
C. Escherichia coli [CORRECT]
D. Klebsiella pneumoniae
Correct Answer: C
Q7: A 62-year-old male with COPD presents with worsening dyspnea, increased sputum
production, and fever. Chest X-ray shows right lower lobe consolidation. Which clinical finding
best differentiates bacterial pneumonia from viral pneumonia?
,S
A. Presence of fever
B. Productive cough with purulent sputum [CORRECT]
C. Tachypnea
D. Pleuritic chest pain
Correct Answer: B
Q8: [Drag-and-Drop Prioritization] A 55-year-old female presents with acute onset severe
headache, "worst headache of my life," photophobia, and nuchal rigidity. Vital signs are stable.
Place the following diagnostic and management steps in the correct priority order:
A. Perform lumbar puncture
B. Obtain non-contrast head CT [CORRECT - First]
C. Start empiric antibiotics [CORRECT - Third]
D. Consult neurosurgery if CT shows hemorrhage [CORRECT - Fourth]
E. Obtain blood cultures [CORRECT - Second]
Correct Order: B, E, A, C, D
Q9: A 35-year-old female presents with palpitations, heat intolerance, and weight loss. Physical
exam shows tremor, lid lag, and diffuse thyroid enlargement. TSH is 0.01 mIU/L (low), free T4
is 2.8 ng/dL (high). Which test is most specific for confirming Graves' disease?
A. Thyroid ultrasound
B. Radioactive iodine uptake scan
C. Thyroid-stimulating immunoglobulin (TSI) [CORRECT]
D. Thyroid peroxidase antibodies
Correct Answer: C
Q10: A 67-year-old male with a 40 pack-year smoking history presents with hemoptysis and
weight loss. Chest CT shows a 3.5 cm spiculated mass in the right upper lobe with mediastinal
lymphadenopathy. What is the next best diagnostic step?
A. Start empiric antibiotics and repeat CT in 6 weeks
B. Positron emission tomography (PET) scan
C. Bronchoscopy with biopsy [CORRECT]
D. Transthoracic needle aspiration
Correct Answer: C
, S
Q11: [SATA] A 28-year-old female presents with cyclic pelvic pain, dyspareunia, and infertility.
Laparoscopy confirms endometriosis. Which findings are consistent with this diagnosis? (Select
all that apply)
A. Fixed, retroverted uterus on bimanual exam [CORRECT]
B. Chocolate cysts on ovarian ultrasound [CORRECT]
C. Elevated CA-125 levels [CORRECT]
D. Purulent cervical discharge
E. Tender nodularity along uterosacral ligaments [CORRECT]
Correct Answers: A, B, C, E
Q12: A 71-year-old female presents after her daughter noticed she "seems different." She has
difficulty with short-term memory, gets lost in familiar places, and has trouble naming objects.
Mini-Mental State Examination (MMSE) score is 18/30. MRI shows cortical atrophy and
hippocampal volume loss. Which finding best differentiates Alzheimer's disease from vascular
dementia?
A. Stepwise deterioration vs. gradual decline [CORRECT]
B. Presence of memory impairment
C. Age of onset
D. Family history of dementia
Correct Answer: A
Q13: A 52-year-old male presents with epigastric pain, early satiety, and unintentional weight
loss of 15 pounds over 2 months. He has a history of H. pylori infection treated 5 years ago.
Which diagnostic test is most appropriate to evaluate for gastric malignancy?
A. Repeat H. pylori stool antigen test
B. Upper endoscopy with biopsy [CORRECT]
C. Abdominal ultrasound
D. Trial of proton pump inhibitor therapy
Correct Answer: B
Q14: A 44-year-old African American female presents with bilateral hand stiffness lasting >1
hour in the mornings, involving the metacarpophalangeal and proximal interphalangeal joints.
AGPCNP Board Exam ACTUAL EXAM
2026/2027 | Verified Questions and Answers |
ANCC & AANP Style | Lifespan Primary Care
Focus | Exam Pass Target - A+ Graded
Q1: A 68-year-old male presents with progressive fatigue, weight loss, and early satiety. Physical
exam reveals splenomegaly (4 cm below costal margin) and hepatomegaly. CBC shows: WBC
45,000/μL with left shift, hemoglobin 9.2 g/dL, platelets 850,000/μL. Peripheral smear shows
basophilia and myelocytes. What is the most likely diagnosis?
A. Acute lymphoblastic leukemia
B. Chronic myeloid leukemia [CORRECT]
C. Essential thrombocythemia
D. Myelodysplastic syndrome
Correct Answer: B
Q2: A 72-year-old female with a history of hypertension and diabetes presents after a fall. She is
on metformin, lisinopril, and hydrochlorothiazide. Her blood pressure is 142/88 mmHg while
seated, but drops to 98/62 mmHg after standing for 3 minutes. She reports dizziness upon
standing. Which medication is most likely contributing to her orthostatic hypotension?
A. Metformin
B. Lisinopril
C. Hydrochlorothiazide [CORRECT]
D. None; this is diabetic autonomic neuropathy only
Correct Answer: C
Q3: A 58-year-old male presents with crushing substernal chest pain radiating to his left arm,
diaphoresis, and nausea. Vital signs: HR 92, BP 148/96, RR 18, O2 sat 94% on room air. ECG
shows ST-segment elevation in leads V1-V4. Which is the priority intervention?
A. Administer aspirin 325 mg and establish IV access [CORRECT]
B. Obtain CT angiography to rule out pulmonary embolism
C. Administer sublingual nitroglycerin every 5 minutes × 3
D. Perform immediate pericardiocentesis
,S
Correct Answer: A
Q4: [SATA] A 45-year-old female presents with fatigue, joint pain, and a malar rash. ANA is
positive at 1:640. Which additional findings support a diagnosis of systemic lupus
erythematosus? (Select all that apply)
A. Anti-dsDNA antibodies positive [CORRECT]
B. Complement C3 and C4 levels elevated
C. Leukopenia (WBC 3,200/μL) [CORRECT]
D. Proteinuria >500 mg/24 hours [CORRECT]
E. Anti-Smith antibodies positive [CORRECT]
Correct Answers: A, C, D, E
Q5: A 19-year-old college student presents with sore throat, fever of 101.2°F, and tender anterior
cervical lymphadenopathy. Rapid strep test is negative. What is the next best step in
management?
A. Start empiric amoxicillin immediately
B. Obtain throat culture and treat if positive [CORRECT]
C. Order monospot test for infectious mononucleosis
D. Prescribe corticosteroids for symptom relief
Correct Answer: B
Q6: A 76-year-old nursing home resident presents with confusion, fever 101.8°F, and dysuria.
Urinalysis shows pyuria and bacteriuria. Which organism is most commonly responsible for
complicated urinary tract infections in this population?
A. Enterococcus faecalis
B. Pseudomonas aeruginosa
C. Escherichia coli [CORRECT]
D. Klebsiella pneumoniae
Correct Answer: C
Q7: A 62-year-old male with COPD presents with worsening dyspnea, increased sputum
production, and fever. Chest X-ray shows right lower lobe consolidation. Which clinical finding
best differentiates bacterial pneumonia from viral pneumonia?
,S
A. Presence of fever
B. Productive cough with purulent sputum [CORRECT]
C. Tachypnea
D. Pleuritic chest pain
Correct Answer: B
Q8: [Drag-and-Drop Prioritization] A 55-year-old female presents with acute onset severe
headache, "worst headache of my life," photophobia, and nuchal rigidity. Vital signs are stable.
Place the following diagnostic and management steps in the correct priority order:
A. Perform lumbar puncture
B. Obtain non-contrast head CT [CORRECT - First]
C. Start empiric antibiotics [CORRECT - Third]
D. Consult neurosurgery if CT shows hemorrhage [CORRECT - Fourth]
E. Obtain blood cultures [CORRECT - Second]
Correct Order: B, E, A, C, D
Q9: A 35-year-old female presents with palpitations, heat intolerance, and weight loss. Physical
exam shows tremor, lid lag, and diffuse thyroid enlargement. TSH is 0.01 mIU/L (low), free T4
is 2.8 ng/dL (high). Which test is most specific for confirming Graves' disease?
A. Thyroid ultrasound
B. Radioactive iodine uptake scan
C. Thyroid-stimulating immunoglobulin (TSI) [CORRECT]
D. Thyroid peroxidase antibodies
Correct Answer: C
Q10: A 67-year-old male with a 40 pack-year smoking history presents with hemoptysis and
weight loss. Chest CT shows a 3.5 cm spiculated mass in the right upper lobe with mediastinal
lymphadenopathy. What is the next best diagnostic step?
A. Start empiric antibiotics and repeat CT in 6 weeks
B. Positron emission tomography (PET) scan
C. Bronchoscopy with biopsy [CORRECT]
D. Transthoracic needle aspiration
Correct Answer: C
, S
Q11: [SATA] A 28-year-old female presents with cyclic pelvic pain, dyspareunia, and infertility.
Laparoscopy confirms endometriosis. Which findings are consistent with this diagnosis? (Select
all that apply)
A. Fixed, retroverted uterus on bimanual exam [CORRECT]
B. Chocolate cysts on ovarian ultrasound [CORRECT]
C. Elevated CA-125 levels [CORRECT]
D. Purulent cervical discharge
E. Tender nodularity along uterosacral ligaments [CORRECT]
Correct Answers: A, B, C, E
Q12: A 71-year-old female presents after her daughter noticed she "seems different." She has
difficulty with short-term memory, gets lost in familiar places, and has trouble naming objects.
Mini-Mental State Examination (MMSE) score is 18/30. MRI shows cortical atrophy and
hippocampal volume loss. Which finding best differentiates Alzheimer's disease from vascular
dementia?
A. Stepwise deterioration vs. gradual decline [CORRECT]
B. Presence of memory impairment
C. Age of onset
D. Family history of dementia
Correct Answer: A
Q13: A 52-year-old male presents with epigastric pain, early satiety, and unintentional weight
loss of 15 pounds over 2 months. He has a history of H. pylori infection treated 5 years ago.
Which diagnostic test is most appropriate to evaluate for gastric malignancy?
A. Repeat H. pylori stool antigen test
B. Upper endoscopy with biopsy [CORRECT]
C. Abdominal ultrasound
D. Trial of proton pump inhibitor therapy
Correct Answer: B
Q14: A 44-year-old African American female presents with bilateral hand stiffness lasting >1
hour in the mornings, involving the metacarpophalangeal and proximal interphalangeal joints.
