AGNP CERTIFICATION EXAM 2026 LATEST STUDY
GUIDE Practice Questions | Clinical Review | Verified
Answers | Success Preparation Workbook
About This Guide
The questions in this guide are organized by the core content domains tested on the
AGNP certification exam:
• Cardiovascular System (Questions 1-15)
• Endocrine & Metabolic Disorders (Questions 16-25)
• Respiratory System (Questions 26-35)
• Gastrointestinal & Genitourinary Systems (Questions 36-45)
• Neurological & Psychiatric Disorders (Questions 46-55)
• Musculoskeletal & Integumentary Systems (Questions 56-65)
• Infectious Diseases & Immunology (Questions 66-75)
• Hematologic & Oncologic Disorders (Questions 76-85)
• Health Promotion, Screening & Prevention (Questions 86-95)
• Professional Practice, Ethics & Legal Issues (Questions 96-100)
SECTION 1: CARDIOVASCULAR SYSTEM
Questions 1-15
QUESTION 1
A 68-year-old male with a history of hypertension and type 2 diabetes presents
with progressive dyspnea on exertion, orthopnea, and paroxysmal nocturnal
dyspnea. On examination, he has jugular venous distension, bilateral crackles at
the lung bases, and an S3 gallop. His echocardiogram shows an ejection fraction of
,28%. Which of the following medication classes has been shown to reduce
mortality in this patient population?
A. Calcium channel blockers
B. Beta-blockers (e.g., carvedilol, metoprolol succinate)
C. Digoxin
D. Direct vasodilators (e.g., hydralazine)
Rationale:
• Correct Answer: B - The patient has heart failure with reduced ejection
fraction (HFrEF). Beta-blockers (carvedilol, metoprolol succinate,
bisoprolol) have been shown to reduce mortality and hospitalizations in
patients with HFrEF. They are a cornerstone of guideline-directed medical
therapy (GDMT).
• Option A - Calcium channel blockers (with the exception of amlodipine) are
generally avoided in HFrEF due to negative inotropic effects.
• Option C - Digoxin improves symptoms and reduces hospitalizations but
does not reduce mortality.
• Option D - Hydralazine/nitrate combination reduces mortality in African
American patients but is not first-line.
QUESTION 2
A 72-year-old female with a history of atrial fibrillation presents for a routine
follow-up. She is currently on warfarin with a therapeutic INR. She asks about the
risk of stroke associated with her condition. What is the most
appropriate response?
A. "Atrial fibrillation does not increase your risk of stroke"
B. "Atrial fibrillation increases the risk of stroke due to blood pooling in the
atria, which can form clots that travel to the brain"
C. "Your risk of stroke is the same as someone without atrial fibrillation as long as
you take warfarin"
D. "Only patients with valvular atrial fibrillation are at risk for stroke"
,Rationale:
• Correct Answer: B - Atrial fibrillation increases the risk of stroke by
approximately 5-fold due to stasis of blood in the left atrium, which can lead
to thrombus formation. Embolization of these thrombi can cause ischemic
stroke. Anticoagulation significantly reduces this risk.
• Option A - This is incorrect; atrial fibrillation significantly increases stroke
risk.
• Option C - While warfarin reduces stroke risk, the risk is not the same as
someone without atrial fibrillation.
• Option D - Both valvular and non-valvular atrial fibrillation increase stroke
risk.
QUESTION 3
A 65-year-old male presents with acute onset of substernal chest pain that began 45
minutes ago. The pain is described as crushing and radiates to his left arm. He is
diaphoretic and nauseated. His ECG shows ST-segment elevation in leads V1–V4.
What is the most appropriate immediate management?
A. Aspirin 324 mg chewable, oxygen, nitroglycerin, and immediate PCI
evaluation
B. Aspirin 81 mg, morphine sulfate, and admission to telemetry
C. Only aspirin and discharge with cardiology follow-up
D. Nitroglycerin and outpatient stress testing
Rationale:
• Correct Answer: A - The patient has an ST-elevation myocardial infarction
(STEMI) with ST elevation in V1–V4 (anteroseptal MI). Immediate
management includes aspirin 324 mg chewable, oxygen (if SpO2 <90%),
nitroglycerin (if no hypotension), and immediate evaluation for
percutaneous coronary intervention (PCI) . Door-to-balloon time should
be ≤90 minutes.
, • Option B - Morphine may be used but is not the priority; immediate
reperfusion is critical.
• Option C - Discharge is inappropriate for an acute STEMI.
• Option D - Stress testing is contraindicated in acute STEMI.
QUESTION 4
A 58-year-old female with a history of hypertension is noted to have a blood
pressure of 162/94 mmHg on two separate occasions. Her laboratory studies show
creatinine 1.2 mg/dL, potassium 4.2 mEq/L, and urinalysis with trace protein.
Which of the following is the most appropriate initial antihypertensive agent?
A. Lisinopril (ACE inhibitor)
B. Hydrochlorothiazide
C. Amlodipine
D. Metoprolol
Rationale:
• Correct Answer: A - The patient has stage 2 hypertension with evidence of
renal involvement (proteinuria). ACE inhibitors (or ARBs) are preferred in
patients with hypertension and chronic kidney disease or proteinuria due to
their renoprotective effects. They reduce intraglomerular pressure and
proteinuria.
• Option B - Thiazide diuretics are effective but do not have the same
renoprotective effects.
• Option C - Amlodipine is a calcium channel blocker that is effective but not
first-line in patients with proteinuria.
• Option D - Beta-blockers are not first-line for uncomplicated hypertension
unless there is a compelling indication (e.g., heart failure, post-MI).
QUESTION 5
GUIDE Practice Questions | Clinical Review | Verified
Answers | Success Preparation Workbook
About This Guide
The questions in this guide are organized by the core content domains tested on the
AGNP certification exam:
• Cardiovascular System (Questions 1-15)
• Endocrine & Metabolic Disorders (Questions 16-25)
• Respiratory System (Questions 26-35)
• Gastrointestinal & Genitourinary Systems (Questions 36-45)
• Neurological & Psychiatric Disorders (Questions 46-55)
• Musculoskeletal & Integumentary Systems (Questions 56-65)
• Infectious Diseases & Immunology (Questions 66-75)
• Hematologic & Oncologic Disorders (Questions 76-85)
• Health Promotion, Screening & Prevention (Questions 86-95)
• Professional Practice, Ethics & Legal Issues (Questions 96-100)
SECTION 1: CARDIOVASCULAR SYSTEM
Questions 1-15
QUESTION 1
A 68-year-old male with a history of hypertension and type 2 diabetes presents
with progressive dyspnea on exertion, orthopnea, and paroxysmal nocturnal
dyspnea. On examination, he has jugular venous distension, bilateral crackles at
the lung bases, and an S3 gallop. His echocardiogram shows an ejection fraction of
,28%. Which of the following medication classes has been shown to reduce
mortality in this patient population?
A. Calcium channel blockers
B. Beta-blockers (e.g., carvedilol, metoprolol succinate)
C. Digoxin
D. Direct vasodilators (e.g., hydralazine)
Rationale:
• Correct Answer: B - The patient has heart failure with reduced ejection
fraction (HFrEF). Beta-blockers (carvedilol, metoprolol succinate,
bisoprolol) have been shown to reduce mortality and hospitalizations in
patients with HFrEF. They are a cornerstone of guideline-directed medical
therapy (GDMT).
• Option A - Calcium channel blockers (with the exception of amlodipine) are
generally avoided in HFrEF due to negative inotropic effects.
• Option C - Digoxin improves symptoms and reduces hospitalizations but
does not reduce mortality.
• Option D - Hydralazine/nitrate combination reduces mortality in African
American patients but is not first-line.
QUESTION 2
A 72-year-old female with a history of atrial fibrillation presents for a routine
follow-up. She is currently on warfarin with a therapeutic INR. She asks about the
risk of stroke associated with her condition. What is the most
appropriate response?
A. "Atrial fibrillation does not increase your risk of stroke"
B. "Atrial fibrillation increases the risk of stroke due to blood pooling in the
atria, which can form clots that travel to the brain"
C. "Your risk of stroke is the same as someone without atrial fibrillation as long as
you take warfarin"
D. "Only patients with valvular atrial fibrillation are at risk for stroke"
,Rationale:
• Correct Answer: B - Atrial fibrillation increases the risk of stroke by
approximately 5-fold due to stasis of blood in the left atrium, which can lead
to thrombus formation. Embolization of these thrombi can cause ischemic
stroke. Anticoagulation significantly reduces this risk.
• Option A - This is incorrect; atrial fibrillation significantly increases stroke
risk.
• Option C - While warfarin reduces stroke risk, the risk is not the same as
someone without atrial fibrillation.
• Option D - Both valvular and non-valvular atrial fibrillation increase stroke
risk.
QUESTION 3
A 65-year-old male presents with acute onset of substernal chest pain that began 45
minutes ago. The pain is described as crushing and radiates to his left arm. He is
diaphoretic and nauseated. His ECG shows ST-segment elevation in leads V1–V4.
What is the most appropriate immediate management?
A. Aspirin 324 mg chewable, oxygen, nitroglycerin, and immediate PCI
evaluation
B. Aspirin 81 mg, morphine sulfate, and admission to telemetry
C. Only aspirin and discharge with cardiology follow-up
D. Nitroglycerin and outpatient stress testing
Rationale:
• Correct Answer: A - The patient has an ST-elevation myocardial infarction
(STEMI) with ST elevation in V1–V4 (anteroseptal MI). Immediate
management includes aspirin 324 mg chewable, oxygen (if SpO2 <90%),
nitroglycerin (if no hypotension), and immediate evaluation for
percutaneous coronary intervention (PCI) . Door-to-balloon time should
be ≤90 minutes.
, • Option B - Morphine may be used but is not the priority; immediate
reperfusion is critical.
• Option C - Discharge is inappropriate for an acute STEMI.
• Option D - Stress testing is contraindicated in acute STEMI.
QUESTION 4
A 58-year-old female with a history of hypertension is noted to have a blood
pressure of 162/94 mmHg on two separate occasions. Her laboratory studies show
creatinine 1.2 mg/dL, potassium 4.2 mEq/L, and urinalysis with trace protein.
Which of the following is the most appropriate initial antihypertensive agent?
A. Lisinopril (ACE inhibitor)
B. Hydrochlorothiazide
C. Amlodipine
D. Metoprolol
Rationale:
• Correct Answer: A - The patient has stage 2 hypertension with evidence of
renal involvement (proteinuria). ACE inhibitors (or ARBs) are preferred in
patients with hypertension and chronic kidney disease or proteinuria due to
their renoprotective effects. They reduce intraglomerular pressure and
proteinuria.
• Option B - Thiazide diuretics are effective but do not have the same
renoprotective effects.
• Option C - Amlodipine is a calcium channel blocker that is effective but not
first-line in patients with proteinuria.
• Option D - Beta-blockers are not first-line for uncomplicated hypertension
unless there is a compelling indication (e.g., heart failure, post-MI).
QUESTION 5
