ADULT-GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER-CERTIFIED (AGNP-C)
QUESTIONS AND CORRECT ANSWERS WITH DETAILED RATIONALES | LATEST VERSION PDF
SECTION ONE: QUESTIONS 1–100
A 72-year-old patient presents with a new onset of atrial fibrillation. Which diagnostic test is most
essential to evaluate for structural heart disease?
A. Chest X-ray
B. Transthoracic echocardiogram
C. Cardiac stress test
D. Coronary artery calcium scoring
🟢 B. Transthoracic echocardiogram
🔴 RATIONALE: An echocardiogram is the gold standard for evaluating structural heart disease,
such as valve abnormalities or left ventricular hypertrophy, which are critical in the management of
new-onset atrial fibrillation.
Which federal act requires the disclosure of financial relationships between healthcare providers
and pharmaceutical companies?
A. The Affordable Care Act
B. The Health Insurance Portability and Accountability Act
C. The Physician Payments Sunshine Act
D. The Emergency Medical Treatment and Labor Act
🟢 C. The Physician Payments Sunshine Act
🔴 RATIONALE: The Physician Payments Sunshine Act requires manufacturers of drugs, devices,
and biologics to report payments or transfers of value made to physicians and teaching hospitals to
the CMS.
An 80-year-old patient on chronic warfarin therapy has an INR of 4.5 and is asymptomatic. What is
the most appropriate management?
,A. Administer oral Vitamin K
B. Hold warfarin and resume at a lower dose when INR is therapeutic
C. Administer subcutaneous Vitamin K
D. Increase daily dose of warfarin
🟢 B. Hold warfarin and resume at a lower dose when INR is therapeutic
🔴 RATIONALE: For an asymptomatic patient with an INR between 4.5 and 10, the current
recommendation is to temporarily hold warfarin and monitor the INR until it returns to the
therapeutic range.
Which of the following is the most sensitive screening tool for cognitive impairment in the elderly?
A. Mini-Mental State Examination (MMSE)
B. Mini-Cog
C. Montreal Cognitive Assessment (MoCA)
D. Geriatric Depression Scale
🟢 C. Montreal Cognitive Assessment (MoCA)
🔴 RATIONALE: The MoCA is recognized as more sensitive than the MMSE for detecting mild
cognitive impairment (MCI) and early-stage dementia.
A patient with COPD presents with increased dyspnea and yellow sputum. Which antibiotic is first-
line?
A. Azithromycin
B. Ciprofloxacin
C. Amoxicillin-clavulanate
D. Doxycycline
🟢 A. Azithromycin
🔴 RATIONALE: For uncomplicated COPD exacerbations, macrolides like azithromycin are often
the first-line choice unless there are risk factors for Pseudomonas.
,What is the primary goal of palliative care for a patient with end-stage heart failure?
A. Curative treatment of underlying cardiac pathology
B. Symptom management and improvement of quality of life
C. Prolonging life at all costs
D. Initiation of hospice care only
🟢 B. Symptom management and improvement of quality of life
🔴 RATIONALE: Palliative care focuses on relieving symptoms, pain, and stress of serious illness
to improve quality of life, regardless of prognosis or curative status.
A 65-year-old male presents with a firm, painless, non-tender nodule on his prostate during a digital
rectal exam. What is the next step?
A. Recheck in 6 months
B. Order a PSA test
C. Referral for transrectal ultrasound and biopsy
D. Prescribe an alpha-blocker
🟢 C. Referral for transrectal ultrasound and biopsy
🔴 RATIONALE: A firm, nodular prostate is highly suspicious for malignancy and requires
immediate urological evaluation and biopsy regardless of PSA level.
Which class of antihypertensive is contraindicated in patients with bilateral renal artery stenosis?
A. Calcium channel blockers
B. Thiazide diuretics
C. ACE inhibitors
D. Beta-blockers
🟢 C. ACE inhibitors
🔴 RATIONALE: ACE inhibitors can cause a precipitous decline in glomerular filtration rate in
patients with bilateral renal artery stenosis by preventing efferent arteriolar vasoconstriction.
, The "Welcome to Medicare" visit (Initial Preventive Physical Examination) must be completed
within what timeframe of Part B enrollment?
A. 6 months
B. 12 months
C. 18 months
D. 24 months
🟢 B. 12 months
🔴 RATIONALE: Medicare covers an Initial Preventive Physical Examination (IPPE) if it is
performed within the first 12 months of the patient’s Part B effective date.
A 55-year-old female presents with sudden onset of severe headache and visual disturbances. You
suspect giant cell arteritis. What is the immediate diagnostic step?
A. Erythrocyte sedimentation rate (ESR)
B. Temporal artery biopsy
C. CT scan of the head
D. Serum protein electrophoresis
🟢 A. Erythrocyte sedimentation rate (ESR)
🔴 RATIONALE: An elevated ESR is the hallmark screening test for giant cell arteritis, which
should be followed by temporal artery biopsy for definitive diagnosis.
Which ethical principle is defined by the duty to do no harm?
A. Autonomy
B. Justice
C. Beneficence
D. Nonmaleficence
🟢 D. Nonmaleficence
QUESTIONS AND CORRECT ANSWERS WITH DETAILED RATIONALES | LATEST VERSION PDF
SECTION ONE: QUESTIONS 1–100
A 72-year-old patient presents with a new onset of atrial fibrillation. Which diagnostic test is most
essential to evaluate for structural heart disease?
A. Chest X-ray
B. Transthoracic echocardiogram
C. Cardiac stress test
D. Coronary artery calcium scoring
🟢 B. Transthoracic echocardiogram
🔴 RATIONALE: An echocardiogram is the gold standard for evaluating structural heart disease,
such as valve abnormalities or left ventricular hypertrophy, which are critical in the management of
new-onset atrial fibrillation.
Which federal act requires the disclosure of financial relationships between healthcare providers
and pharmaceutical companies?
A. The Affordable Care Act
B. The Health Insurance Portability and Accountability Act
C. The Physician Payments Sunshine Act
D. The Emergency Medical Treatment and Labor Act
🟢 C. The Physician Payments Sunshine Act
🔴 RATIONALE: The Physician Payments Sunshine Act requires manufacturers of drugs, devices,
and biologics to report payments or transfers of value made to physicians and teaching hospitals to
the CMS.
An 80-year-old patient on chronic warfarin therapy has an INR of 4.5 and is asymptomatic. What is
the most appropriate management?
,A. Administer oral Vitamin K
B. Hold warfarin and resume at a lower dose when INR is therapeutic
C. Administer subcutaneous Vitamin K
D. Increase daily dose of warfarin
🟢 B. Hold warfarin and resume at a lower dose when INR is therapeutic
🔴 RATIONALE: For an asymptomatic patient with an INR between 4.5 and 10, the current
recommendation is to temporarily hold warfarin and monitor the INR until it returns to the
therapeutic range.
Which of the following is the most sensitive screening tool for cognitive impairment in the elderly?
A. Mini-Mental State Examination (MMSE)
B. Mini-Cog
C. Montreal Cognitive Assessment (MoCA)
D. Geriatric Depression Scale
🟢 C. Montreal Cognitive Assessment (MoCA)
🔴 RATIONALE: The MoCA is recognized as more sensitive than the MMSE for detecting mild
cognitive impairment (MCI) and early-stage dementia.
A patient with COPD presents with increased dyspnea and yellow sputum. Which antibiotic is first-
line?
A. Azithromycin
B. Ciprofloxacin
C. Amoxicillin-clavulanate
D. Doxycycline
🟢 A. Azithromycin
🔴 RATIONALE: For uncomplicated COPD exacerbations, macrolides like azithromycin are often
the first-line choice unless there are risk factors for Pseudomonas.
,What is the primary goal of palliative care for a patient with end-stage heart failure?
A. Curative treatment of underlying cardiac pathology
B. Symptom management and improvement of quality of life
C. Prolonging life at all costs
D. Initiation of hospice care only
🟢 B. Symptom management and improvement of quality of life
🔴 RATIONALE: Palliative care focuses on relieving symptoms, pain, and stress of serious illness
to improve quality of life, regardless of prognosis or curative status.
A 65-year-old male presents with a firm, painless, non-tender nodule on his prostate during a digital
rectal exam. What is the next step?
A. Recheck in 6 months
B. Order a PSA test
C. Referral for transrectal ultrasound and biopsy
D. Prescribe an alpha-blocker
🟢 C. Referral for transrectal ultrasound and biopsy
🔴 RATIONALE: A firm, nodular prostate is highly suspicious for malignancy and requires
immediate urological evaluation and biopsy regardless of PSA level.
Which class of antihypertensive is contraindicated in patients with bilateral renal artery stenosis?
A. Calcium channel blockers
B. Thiazide diuretics
C. ACE inhibitors
D. Beta-blockers
🟢 C. ACE inhibitors
🔴 RATIONALE: ACE inhibitors can cause a precipitous decline in glomerular filtration rate in
patients with bilateral renal artery stenosis by preventing efferent arteriolar vasoconstriction.
, The "Welcome to Medicare" visit (Initial Preventive Physical Examination) must be completed
within what timeframe of Part B enrollment?
A. 6 months
B. 12 months
C. 18 months
D. 24 months
🟢 B. 12 months
🔴 RATIONALE: Medicare covers an Initial Preventive Physical Examination (IPPE) if it is
performed within the first 12 months of the patient’s Part B effective date.
A 55-year-old female presents with sudden onset of severe headache and visual disturbances. You
suspect giant cell arteritis. What is the immediate diagnostic step?
A. Erythrocyte sedimentation rate (ESR)
B. Temporal artery biopsy
C. CT scan of the head
D. Serum protein electrophoresis
🟢 A. Erythrocyte sedimentation rate (ESR)
🔴 RATIONALE: An elevated ESR is the hallmark screening test for giant cell arteritis, which
should be followed by temporal artery biopsy for definitive diagnosis.
Which ethical principle is defined by the duty to do no harm?
A. Autonomy
B. Justice
C. Beneficence
D. Nonmaleficence
🟢 D. Nonmaleficence
