[UTAH AGPCNP] – QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
Advanced Health Assessment and Diagnostic Reasoning
Adult and Geriatric Primary Care Management
Pharmacotherapeutics Across the Lifespan
Professional Role, Ethics, and Legal Standards in Advanced Practice
Health Promotion, Disease Prevention, and Population Health
Chronic Disease Management and Complex Comorbidities
Palliative Care and End-of-Life Decision Making
Introduction
This rigorous assessment evaluates advanced practice nursing competency for adult-
gerontology primary care nurse practitioners. The examination measures clinical
reasoning, diagnostic acumen, and evidence-based management across diverse adult
populations, from young adults to frail elders. Utilizing a comprehensive blend of multiple-
choice items and complex clinical scenarios, the test assesses foundational theory
alongside practical application in primary care settings. Candidates are tested on their
ability to synthesize clinical data, navigate legal and ethical dilemmas, and implement safe,
cost-effective, and patient-centered interventions. Emphasis is placed on real-world
,decision-making, acute and chronic disease stabilization, and health promotion across the
continuum of care.
Section One: Questions 1–100
Question 1
A 68-year-old male presents for a routine wellness exam. He has a 40-pack-year smoking
history and currently smokes one pack per day. According to current USPSTF guidelines,
what is the appropriate lung cancer screening recommendation for this patient?
A. Annual low-dose computed tomography (LDCT) scan until age 80
B. Annual chest radiography and sputum cytology starting at age 70
C. Annual LDCT scan until he has quit smoking for 15 consecutive years
D. Biennial chest magnetic resonance imaging until age 75
🟢 C. Annual LDCT scan until he has quit smoking for 15 consecutive years
🔴 Explanation: USPSTF guidelines recommend annual screening for lung cancer with
low-dose computed tomography in adults aged 50 to 80 years who have a 20 pack-year
smoking history and currently smoke or have quit within the past 15 years. Screening
should be discontinued once a person has not smoked for 15 years or develops a health
problem that substantially limits life expectancy.
Question 2
An 82-year-old female is brought to the clinic by her daughter, who reports progressive
short-term memory loss, apathy, and difficulty managing her finances over the past eight
,months. The patient scores 21/30 on the Mini-Mental State Examination (MMSE).
Laboratory workup reveals a normal TSH, normal vitamin B12, and a normal complete
blood count. Which of the following is the most likely diagnosis?
A. Normal pressure hydrocephalus
B. Major neurocognitive disorder due to Alzheimer's disease
C. Delirium secondary to a urinary tract infection
D. Major depressive disorder with cognitive pseudodementia
🟢 B. Major neurocognitive disorder due to Alzheimer's disease
🔴 Explanation: Gradual, progressive cognitive decline affecting instrumental activities of
daily living in an older adult with normal metabolic and thyroid screening points toward
Alzheimer's disease as the most common etiology of major neurocognitive disorder.
Delirium presents with acute onset and fluctuating course. Depression-related cognitive
impairment often responds to treatment and shows distinct depressive features.
Question 3
A 45-year-old female presents with a three-month history of fatigue, weight gain,
constipation, and cold intolerance. Laboratory findings show a TSH of 9.8 mIU/L
(reference: 0.4–4.0 mIU/L) and a free T4 of 0.7 ng/dL (reference: 0.8–1.8 ng/dL). Which of
the following is the most appropriate initial management?
A. Initiate levothyroxine at 25 to 50 mcg orally daily and recheck TSH in 6 weeks
B. Monitor thyroid function tests every 3 months without medication initiation
, C. Initiate liothyronine (T3) monotherapy at 5 mcg daily
D. Refer immediately to an endocrinologist for radioactive iodine uptake testing
🟢 A. Initiate levothyroxine at 25 to 50 mcg orally daily and recheck TSH in 6 weeks
🔴 Explanation: Overt primary hypothyroidism is characterized by an elevated TSH and
low free T4. Standard initial treatment is levothyroxine, typically started at a lower dose (25
to 50 mcg daily) in otherwise healthy adults, or lower in elderly or cardiac patients. Thyroid-
stimulating hormone should be rechecked in 6 weeks to titrate the dose.
Question 4
A 72-year-old male with a history of hypertension and osteoarthritis presents with acute
onset of severe right first metatarsophalangeal joint pain, swelling, and erythema that
began overnight. He takes hydrochlorothiazide and lisinopril. Which of the following is the
most appropriate next diagnostic step?
A. Serum uric acid level
B. Arthrocentesis with synovial fluid analysis
C. Plain radiography of the right foot
D. Antinuclear antibody (ANA) titer
🟢 B. Arthrocentesis with synovial fluid analysis
🔴 Explanation: The gold standard for diagnosing an acute gout flare is joint aspiration
(arthrocentesis) with polarized light microscopy demonstrating negatively birefringent
monosodium urate crystals. Serum uric acid levels can be normal during an acute attack,
and plain radiographs are typically normal early in the disease course.
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
Advanced Health Assessment and Diagnostic Reasoning
Adult and Geriatric Primary Care Management
Pharmacotherapeutics Across the Lifespan
Professional Role, Ethics, and Legal Standards in Advanced Practice
Health Promotion, Disease Prevention, and Population Health
Chronic Disease Management and Complex Comorbidities
Palliative Care and End-of-Life Decision Making
Introduction
This rigorous assessment evaluates advanced practice nursing competency for adult-
gerontology primary care nurse practitioners. The examination measures clinical
reasoning, diagnostic acumen, and evidence-based management across diverse adult
populations, from young adults to frail elders. Utilizing a comprehensive blend of multiple-
choice items and complex clinical scenarios, the test assesses foundational theory
alongside practical application in primary care settings. Candidates are tested on their
ability to synthesize clinical data, navigate legal and ethical dilemmas, and implement safe,
cost-effective, and patient-centered interventions. Emphasis is placed on real-world
,decision-making, acute and chronic disease stabilization, and health promotion across the
continuum of care.
Section One: Questions 1–100
Question 1
A 68-year-old male presents for a routine wellness exam. He has a 40-pack-year smoking
history and currently smokes one pack per day. According to current USPSTF guidelines,
what is the appropriate lung cancer screening recommendation for this patient?
A. Annual low-dose computed tomography (LDCT) scan until age 80
B. Annual chest radiography and sputum cytology starting at age 70
C. Annual LDCT scan until he has quit smoking for 15 consecutive years
D. Biennial chest magnetic resonance imaging until age 75
🟢 C. Annual LDCT scan until he has quit smoking for 15 consecutive years
🔴 Explanation: USPSTF guidelines recommend annual screening for lung cancer with
low-dose computed tomography in adults aged 50 to 80 years who have a 20 pack-year
smoking history and currently smoke or have quit within the past 15 years. Screening
should be discontinued once a person has not smoked for 15 years or develops a health
problem that substantially limits life expectancy.
Question 2
An 82-year-old female is brought to the clinic by her daughter, who reports progressive
short-term memory loss, apathy, and difficulty managing her finances over the past eight
,months. The patient scores 21/30 on the Mini-Mental State Examination (MMSE).
Laboratory workup reveals a normal TSH, normal vitamin B12, and a normal complete
blood count. Which of the following is the most likely diagnosis?
A. Normal pressure hydrocephalus
B. Major neurocognitive disorder due to Alzheimer's disease
C. Delirium secondary to a urinary tract infection
D. Major depressive disorder with cognitive pseudodementia
🟢 B. Major neurocognitive disorder due to Alzheimer's disease
🔴 Explanation: Gradual, progressive cognitive decline affecting instrumental activities of
daily living in an older adult with normal metabolic and thyroid screening points toward
Alzheimer's disease as the most common etiology of major neurocognitive disorder.
Delirium presents with acute onset and fluctuating course. Depression-related cognitive
impairment often responds to treatment and shows distinct depressive features.
Question 3
A 45-year-old female presents with a three-month history of fatigue, weight gain,
constipation, and cold intolerance. Laboratory findings show a TSH of 9.8 mIU/L
(reference: 0.4–4.0 mIU/L) and a free T4 of 0.7 ng/dL (reference: 0.8–1.8 ng/dL). Which of
the following is the most appropriate initial management?
A. Initiate levothyroxine at 25 to 50 mcg orally daily and recheck TSH in 6 weeks
B. Monitor thyroid function tests every 3 months without medication initiation
, C. Initiate liothyronine (T3) monotherapy at 5 mcg daily
D. Refer immediately to an endocrinologist for radioactive iodine uptake testing
🟢 A. Initiate levothyroxine at 25 to 50 mcg orally daily and recheck TSH in 6 weeks
🔴 Explanation: Overt primary hypothyroidism is characterized by an elevated TSH and
low free T4. Standard initial treatment is levothyroxine, typically started at a lower dose (25
to 50 mcg daily) in otherwise healthy adults, or lower in elderly or cardiac patients. Thyroid-
stimulating hormone should be rechecked in 6 weeks to titrate the dose.
Question 4
A 72-year-old male with a history of hypertension and osteoarthritis presents with acute
onset of severe right first metatarsophalangeal joint pain, swelling, and erythema that
began overnight. He takes hydrochlorothiazide and lisinopril. Which of the following is the
most appropriate next diagnostic step?
A. Serum uric acid level
B. Arthrocentesis with synovial fluid analysis
C. Plain radiography of the right foot
D. Antinuclear antibody (ANA) titer
🟢 B. Arthrocentesis with synovial fluid analysis
🔴 Explanation: The gold standard for diagnosing an acute gout flare is joint aspiration
(arthrocentesis) with polarized light microscopy demonstrating negatively birefringent
monosodium urate crystals. Serum uric acid levels can be normal during an acute attack,
and plain radiographs are typically normal early in the disease course.
