AGNP BOARD CERTIFICATION
EXAM 2026-2027 QUESTIONS
AND ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
COMPREHENSIVE PRACTICE TEST
(90 QUESTIONS)
STYLE: AANP / ANCC BOARD
FORMAT
Domain 1: Assessment & Diagnosis (History & Physical)
1. A 72-year-old male with a history of hypertension presents with a blood
pressure of 150/90 mmHg despite adherence to Lisinopril 20 mg daily. His
serum creatinine is 1.4 mg/dL (eGFR 55 mL/min) and potassium is 4.2 mEq/L.
What is the most appropriate next step in managing his hypertension?
A) Increase Lisinopril to 40 mg daily
B) Add Amlodipine 5 mg daily
C) Add Amlodipine 5 mg daily
D) Switch Lisinopril to Losartan 50 mg daily
Rationale: The patient has Stage 2 hypertension with CKD (eGFR 55). According to
the 2017 ACC/AHA guideline, adding a long-acting dihydropyridine CCB
(amlodipine) is preferred over increasing the ACE inhibitor dose, which risks
hyperkalemia/AKI without additional BP benefit. Thiazides are less effective when
eGFR is below 60 .
,2. A 28-year-old female presents with dysuria, frequency, and suprapubic
discomfort for 2 days. She has no fever, flank pain, or vaginal discharge.
Urinalysis shows 50-100 WBCs, positive nitrites, and trace leukocyte esterase.
What is the first-line antibiotic for uncomplicated cystitis?
A) Ciprofloxacin 250 mg BID for 3 days
B) Nitrofurantoin monohydrate 100 mg BID for 5 days
C) Trimethoprim-sulfamethoxazole 160/800 mg BID for 3 days
D) Amoxicillin-clavulanate 500 mg BID for 7 days
Rationale: IDSA guidelines recommend Nitrofurantoin as first-line for uncomplicated
cystitis due to low resistance and minimal impact on gut flora. TMP-SMX is no longer
first-line if resistance exceeds 20%. Fluoroquinolones are reserved for complicated
cases .
3. Which test is the most sensitive for diagnosing an Anterior Cruciate Ligament
(ACL) tear?
A) McMurray test
B) Anterior Drawer test
C) Lachman test
D) Phalen’s maneuver
Rationale: The Lachman test is considered the most sensitive and accurate clinical
maneuver for assessing ACL integrity, especially in acute injuries, compared to the
Anterior Drawer test .
4. A 68-year-old with COPD presents with new-onset confusion. What is the
priority assessment?
A) Blood glucose
B) Oxygen saturation
C) Mini-Mental State Exam
D) Chest X-ray
Rationale: In patients with chronic lung disease, new confusion is a primary
symptom of hypoxia until proven otherwise. Always assess oxygenation first before
assuming dementia or delirium .
5. A "herald patch" followed by a "Christmas tree" rash distribution on the back
indicates:
A) Tinea corporis
B) Pityriasis rosea
C) Psoriasis
D) Scabies
, Rationale: Pityriasis rosea is a self-limiting viral exanthem. The herald patch (solitary
scaly plaque) appears 1-2 weeks before the secondary rash, which follows Langer's
lines (cleavage lines) resembling a Christmas tree .
6. A patient presents with acute onset of right lower quadrant abdominal pain,
nausea, and anorexia. Temperature 38.5°C (101.3°F). On exam, she has
tenderness at McBurney's point with guarding and rebound. WBC is 14,000/µL.
What is the most appropriate next step?
A) CT Abdomen and Pelvis with contrast
B) Abdominal ultrasound
C) Immediate surgical consultation for appendectomy
D) MRI abdomen
Rationale: This patient presents with classic signs of acute appendicitis (fever,
anorexia, RLQ pain, leukocytosis, peritoneal signs). In a patient with high clinical
probability, immediate surgical consultation is indicated without need for
confirmatory imaging .
7. A patient has a TSH of 15 µIU/mL and Low Free T4. What is the appropriate
management?
A) Methimazole
B) Levothyroxine
C) Propylthiouracil (PTU)
D) Iodine solution
Rationale: These labs confirm primary hypothyroidism (high TSH, low T4).
Levothyroxine is the standard of care replacement therapy. Methimazole and PTU are
for hyperthyroidism .
8. Epigastric pain that is relieved by eating suggests:
A) Gastric ulcer
B) Duodenal ulcer
C) GERD
D) Pancreatitis
Rationale: Food buffers stomach acid. In duodenal ulcers, acid irritates the ulcer site,
so food provides relief. In gastric ulcers, food often worsens the pain due to gastric
distention and stretching of the ulcer .
9. What is the characteristic finding in the stool of an infant with
Intussusception?
A) Steatorrhea
B) Ribbon-like stools
C) Currant-jelly stools
D) Clay-colored stools
EXAM 2026-2027 QUESTIONS
AND ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
COMPREHENSIVE PRACTICE TEST
(90 QUESTIONS)
STYLE: AANP / ANCC BOARD
FORMAT
Domain 1: Assessment & Diagnosis (History & Physical)
1. A 72-year-old male with a history of hypertension presents with a blood
pressure of 150/90 mmHg despite adherence to Lisinopril 20 mg daily. His
serum creatinine is 1.4 mg/dL (eGFR 55 mL/min) and potassium is 4.2 mEq/L.
What is the most appropriate next step in managing his hypertension?
A) Increase Lisinopril to 40 mg daily
B) Add Amlodipine 5 mg daily
C) Add Amlodipine 5 mg daily
D) Switch Lisinopril to Losartan 50 mg daily
Rationale: The patient has Stage 2 hypertension with CKD (eGFR 55). According to
the 2017 ACC/AHA guideline, adding a long-acting dihydropyridine CCB
(amlodipine) is preferred over increasing the ACE inhibitor dose, which risks
hyperkalemia/AKI without additional BP benefit. Thiazides are less effective when
eGFR is below 60 .
,2. A 28-year-old female presents with dysuria, frequency, and suprapubic
discomfort for 2 days. She has no fever, flank pain, or vaginal discharge.
Urinalysis shows 50-100 WBCs, positive nitrites, and trace leukocyte esterase.
What is the first-line antibiotic for uncomplicated cystitis?
A) Ciprofloxacin 250 mg BID for 3 days
B) Nitrofurantoin monohydrate 100 mg BID for 5 days
C) Trimethoprim-sulfamethoxazole 160/800 mg BID for 3 days
D) Amoxicillin-clavulanate 500 mg BID for 7 days
Rationale: IDSA guidelines recommend Nitrofurantoin as first-line for uncomplicated
cystitis due to low resistance and minimal impact on gut flora. TMP-SMX is no longer
first-line if resistance exceeds 20%. Fluoroquinolones are reserved for complicated
cases .
3. Which test is the most sensitive for diagnosing an Anterior Cruciate Ligament
(ACL) tear?
A) McMurray test
B) Anterior Drawer test
C) Lachman test
D) Phalen’s maneuver
Rationale: The Lachman test is considered the most sensitive and accurate clinical
maneuver for assessing ACL integrity, especially in acute injuries, compared to the
Anterior Drawer test .
4. A 68-year-old with COPD presents with new-onset confusion. What is the
priority assessment?
A) Blood glucose
B) Oxygen saturation
C) Mini-Mental State Exam
D) Chest X-ray
Rationale: In patients with chronic lung disease, new confusion is a primary
symptom of hypoxia until proven otherwise. Always assess oxygenation first before
assuming dementia or delirium .
5. A "herald patch" followed by a "Christmas tree" rash distribution on the back
indicates:
A) Tinea corporis
B) Pityriasis rosea
C) Psoriasis
D) Scabies
, Rationale: Pityriasis rosea is a self-limiting viral exanthem. The herald patch (solitary
scaly plaque) appears 1-2 weeks before the secondary rash, which follows Langer's
lines (cleavage lines) resembling a Christmas tree .
6. A patient presents with acute onset of right lower quadrant abdominal pain,
nausea, and anorexia. Temperature 38.5°C (101.3°F). On exam, she has
tenderness at McBurney's point with guarding and rebound. WBC is 14,000/µL.
What is the most appropriate next step?
A) CT Abdomen and Pelvis with contrast
B) Abdominal ultrasound
C) Immediate surgical consultation for appendectomy
D) MRI abdomen
Rationale: This patient presents with classic signs of acute appendicitis (fever,
anorexia, RLQ pain, leukocytosis, peritoneal signs). In a patient with high clinical
probability, immediate surgical consultation is indicated without need for
confirmatory imaging .
7. A patient has a TSH of 15 µIU/mL and Low Free T4. What is the appropriate
management?
A) Methimazole
B) Levothyroxine
C) Propylthiouracil (PTU)
D) Iodine solution
Rationale: These labs confirm primary hypothyroidism (high TSH, low T4).
Levothyroxine is the standard of care replacement therapy. Methimazole and PTU are
for hyperthyroidism .
8. Epigastric pain that is relieved by eating suggests:
A) Gastric ulcer
B) Duodenal ulcer
C) GERD
D) Pancreatitis
Rationale: Food buffers stomach acid. In duodenal ulcers, acid irritates the ulcer site,
so food provides relief. In gastric ulcers, food often worsens the pain due to gastric
distention and stretching of the ulcer .
9. What is the characteristic finding in the stool of an infant with
Intussusception?
A) Steatorrhea
B) Ribbon-like stools
C) Currant-jelly stools
D) Clay-colored stools
