AANP AGPCNP PSI TEST 1 & 2 FINAL EXAM
2026 | CORRECT ANSWERS &
COMPREHENSIVE EXAM PREP
AANP AGPCNP PSI TEST 1 & 2 FINAL EXAM 2026 | CORRECT ANSWERS &
COMPREHENSIVE EXAM PREP
DOCUMENT OVERVIEW
• Comprehensive Exam Preparation: This exam contains questions spanning all
major topics tested on the AGPCNP certification, designed to simulate the actual PSI
exam format with detailed rationales for each correct answer.
• Study Strategy: Use this material to identify knowledge gaps across clinical
domains—work through questions by system/topic area, review rationales
thoroughly, and revisit challenging areas multiple times for mastery before your
certification exam.
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-25)
1. A 72-year-old male presents with exertional chest pain that radiates to his
left jaw and shoulder. He has a history of hypertension and hyperlipidemia.
Which diagnostic finding would be most consistent with acute coronary
syndrome?
A) Elevated troponin I and ST-segment elevation in leads II, III, and aVF
B) Normal troponin with diffuse ST-segment depression
C) Elevated BNP with normal troponin levels
D) Decreased hemoglobin with normal troponin
E) Elevated creatinine with peaked T waves
CORRECT ANSWER: A) Elevated troponin I and ST-segment elevation in leads II,
III, and aVF
,RATIONALE: This presentation is classic for acute myocardial infarction (AMI) with
inferior wall involvement. Troponin elevation indicates myocardial necrosis, and ST-
segment elevation in the inferior leads (II, III, aVF) confirms STEMI localization. This
is the most specific and diagnostic finding for acute coronary syndrome. The
inferior leads correspond to right coronary artery territory perfusion. Immediate
intervention with percutaneous coronary intervention (PCI) or fibrinolytic therapy is
indicated.
2. A 65-year-old woman with a 10-year history of hypertension presents with
dyspnea on exertion, fatigue, and orthopnea. Physical examination reveals
crackles in bilateral lung bases and a displaced apical impulse. Which finding
would most likely indicate systolic heart failure?
A) Ejection fraction of 55%
B) Ejection fraction of 35%
C) Left ventricular wall thickness of 15 mm
D) Normal cardiac output with elevated afterload
E) Preserved diastolic function with restrictive pattern
CORRECT ANSWER: B) Ejection fraction of 35%
RATIONALE: Systolic heart failure is defined as reduced ejection fraction (HFrEF),
typically <40%. An ejection fraction of 35% indicates significant systolic dysfunction
where the left ventricle cannot adequately pump blood forward, resulting in
reduced cardiac output and pulmonary/systemic congestion. This patient's
symptoms of orthopnea, dyspnea on exertion, and physical findings of crackles and
displaced apical impulse are classic for HFrEF. Normal or preserved ejection
fraction (≥50%) would suggest diastolic dysfunction or HFpEF.
3. A 78-year-old male is found to have atrial fibrillation with a rapid
ventricular response. He has no history of structural heart disease. His blood
pressure is 145/92 mmHg, heart rate is 118 bpm, and he reports palpitations
,and mild dyspnea. Which medication would be most appropriate as first-line
rate control?
A) Amiodarone IV
B) Diltiazem or verapamil (calcium channel blockers)
C) Digoxin
D) Sotalol
E) Procainamide
CORRECT ANSWER: B) Diltiazem or verapamil (calcium channel blockers)
RATIONALE: Calcium channel blockers (non-dihydropyridines like diltiazem and
verapamil) are first-line agents for rate control in atrial fibrillation without accessory
pathways or hemodynamic instability. They slow AV nodal conduction, reducing
ventricular rate. Diltiazem is preferred because it has less negative inotropic effect.
Amiodarone is reserved for hemodynamically unstable patients or those with
structural heart disease. Digoxin has a narrow therapeutic window and is less
effective. Sotalol and procainamide are rhythm control agents, not rate control.
4. A 68-year-old woman with diabetes and chronic kidney disease (Stage 3b)
presents with hypertension (BP 156/94 mmHg). She has microalbuminuria and
an eGFR of 38 mL/min/1.73m². Which antihypertensive medication class is
most appropriate as first-line therapy?
A) Thiazide diuretics
B) ACE inhibitors or ARBs
C) Beta-blockers
D) Calcium channel blockers
E) Alpha-1 adrenergic antagonists
CORRECT ANSWER: B) ACE inhibitors or ARBs
, RATIONALE: In patients with diabetes and chronic kidney disease, ACE inhibitors
(ACEIs) or angiotensin II receptor blockers (ARBs) are first-line agents because they
provide renal protection by reducing glomerular filtration pressure and reducing
proteinuria. Both classes reduce albuminuria and slow progression of renal
disease. ARBs are particularly useful if ACEIs cause hyperkalemia or persistent
cough. Thiazide diuretics may worsen glucose control and are less renoprotective.
Beta-blockers and calcium channel blockers don't provide the same renal
protection benefits.
5. A 70-year-old male with a history of myocardial infarction 2 years ago
presents with stable angina. He is currently on aspirin, atorvastatin, lisinopril,
and metoprolol. What is the target LDL cholesterol level for secondary
prevention in this patient?
A) <100 mg/dL
B) <70 mg/dL
C) <50 mg/dL
D) <130 mg/dL
E) <160 mg/dL
CORRECT ANSWER: B) <70 mg/dL
RATIONALE: For secondary prevention in patients with established coronary artery
disease (CAD), current guidelines recommend an LDL cholesterol target of <70
mg/dL. This patient's history of prior MI classifies him as very high-risk. Intensive
lipid-lowering therapy with high-dose statins is indicated. Studies like the HPS and
4S trial demonstrated that achieving LDL <70 mg/dL reduces cardiovascular events
and mortality. Some very high-risk patients may benefit from even lower targets
(<50 mg/dL). The target for primary prevention or lower-risk patients would be
higher.
2026 | CORRECT ANSWERS &
COMPREHENSIVE EXAM PREP
AANP AGPCNP PSI TEST 1 & 2 FINAL EXAM 2026 | CORRECT ANSWERS &
COMPREHENSIVE EXAM PREP
DOCUMENT OVERVIEW
• Comprehensive Exam Preparation: This exam contains questions spanning all
major topics tested on the AGPCNP certification, designed to simulate the actual PSI
exam format with detailed rationales for each correct answer.
• Study Strategy: Use this material to identify knowledge gaps across clinical
domains—work through questions by system/topic area, review rationales
thoroughly, and revisit challenging areas multiple times for mastery before your
certification exam.
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-25)
1. A 72-year-old male presents with exertional chest pain that radiates to his
left jaw and shoulder. He has a history of hypertension and hyperlipidemia.
Which diagnostic finding would be most consistent with acute coronary
syndrome?
A) Elevated troponin I and ST-segment elevation in leads II, III, and aVF
B) Normal troponin with diffuse ST-segment depression
C) Elevated BNP with normal troponin levels
D) Decreased hemoglobin with normal troponin
E) Elevated creatinine with peaked T waves
CORRECT ANSWER: A) Elevated troponin I and ST-segment elevation in leads II,
III, and aVF
,RATIONALE: This presentation is classic for acute myocardial infarction (AMI) with
inferior wall involvement. Troponin elevation indicates myocardial necrosis, and ST-
segment elevation in the inferior leads (II, III, aVF) confirms STEMI localization. This
is the most specific and diagnostic finding for acute coronary syndrome. The
inferior leads correspond to right coronary artery territory perfusion. Immediate
intervention with percutaneous coronary intervention (PCI) or fibrinolytic therapy is
indicated.
2. A 65-year-old woman with a 10-year history of hypertension presents with
dyspnea on exertion, fatigue, and orthopnea. Physical examination reveals
crackles in bilateral lung bases and a displaced apical impulse. Which finding
would most likely indicate systolic heart failure?
A) Ejection fraction of 55%
B) Ejection fraction of 35%
C) Left ventricular wall thickness of 15 mm
D) Normal cardiac output with elevated afterload
E) Preserved diastolic function with restrictive pattern
CORRECT ANSWER: B) Ejection fraction of 35%
RATIONALE: Systolic heart failure is defined as reduced ejection fraction (HFrEF),
typically <40%. An ejection fraction of 35% indicates significant systolic dysfunction
where the left ventricle cannot adequately pump blood forward, resulting in
reduced cardiac output and pulmonary/systemic congestion. This patient's
symptoms of orthopnea, dyspnea on exertion, and physical findings of crackles and
displaced apical impulse are classic for HFrEF. Normal or preserved ejection
fraction (≥50%) would suggest diastolic dysfunction or HFpEF.
3. A 78-year-old male is found to have atrial fibrillation with a rapid
ventricular response. He has no history of structural heart disease. His blood
pressure is 145/92 mmHg, heart rate is 118 bpm, and he reports palpitations
,and mild dyspnea. Which medication would be most appropriate as first-line
rate control?
A) Amiodarone IV
B) Diltiazem or verapamil (calcium channel blockers)
C) Digoxin
D) Sotalol
E) Procainamide
CORRECT ANSWER: B) Diltiazem or verapamil (calcium channel blockers)
RATIONALE: Calcium channel blockers (non-dihydropyridines like diltiazem and
verapamil) are first-line agents for rate control in atrial fibrillation without accessory
pathways or hemodynamic instability. They slow AV nodal conduction, reducing
ventricular rate. Diltiazem is preferred because it has less negative inotropic effect.
Amiodarone is reserved for hemodynamically unstable patients or those with
structural heart disease. Digoxin has a narrow therapeutic window and is less
effective. Sotalol and procainamide are rhythm control agents, not rate control.
4. A 68-year-old woman with diabetes and chronic kidney disease (Stage 3b)
presents with hypertension (BP 156/94 mmHg). She has microalbuminuria and
an eGFR of 38 mL/min/1.73m². Which antihypertensive medication class is
most appropriate as first-line therapy?
A) Thiazide diuretics
B) ACE inhibitors or ARBs
C) Beta-blockers
D) Calcium channel blockers
E) Alpha-1 adrenergic antagonists
CORRECT ANSWER: B) ACE inhibitors or ARBs
, RATIONALE: In patients with diabetes and chronic kidney disease, ACE inhibitors
(ACEIs) or angiotensin II receptor blockers (ARBs) are first-line agents because they
provide renal protection by reducing glomerular filtration pressure and reducing
proteinuria. Both classes reduce albuminuria and slow progression of renal
disease. ARBs are particularly useful if ACEIs cause hyperkalemia or persistent
cough. Thiazide diuretics may worsen glucose control and are less renoprotective.
Beta-blockers and calcium channel blockers don't provide the same renal
protection benefits.
5. A 70-year-old male with a history of myocardial infarction 2 years ago
presents with stable angina. He is currently on aspirin, atorvastatin, lisinopril,
and metoprolol. What is the target LDL cholesterol level for secondary
prevention in this patient?
A) <100 mg/dL
B) <70 mg/dL
C) <50 mg/dL
D) <130 mg/dL
E) <160 mg/dL
CORRECT ANSWER: B) <70 mg/dL
RATIONALE: For secondary prevention in patients with established coronary artery
disease (CAD), current guidelines recommend an LDL cholesterol target of <70
mg/dL. This patient's history of prior MI classifies him as very high-risk. Intensive
lipid-lowering therapy with high-dose statins is indicated. Studies like the HPS and
4S trial demonstrated that achieving LDL <70 mg/dL reduces cardiovascular events
and mortality. Some very high-risk patients may benefit from even lower targets
(<50 mg/dL). The target for primary prevention or lower-risk patients would be
higher.
