AGPCNP-BC Certification Exam| YEAR
2026–2027 | Comprehensive 150-Question
Practice Test with Answers & Rationales|
Pdf Access ALREADY GRADED A+.
Domain I: Patient Assessment Process (Questions 1–24)
1. A 72-year-old female presents for a wellness visit. She has no complaints. Which screening
is most appropriate based on USPSTF guidelines?
Answer: Colorectal cancer screening (if not up to date)
Rationale: USPSTF recommends colorectal cancer screening for average-risk adults ages 45–75.
At 72, she remains within screening age. Annual wellness visits should include age-appropriate
screenings .
2. An S4 heart sound auscultated in a 68-year-old most commonly indicates:
Answer: Left ventricular hypertrophy
Rationale: An S4 (atrial gallop) results from atrial contraction against a stiff, non-compliant
ventricle, commonly due to LVH from chronic hypertension. It is a common finding in older
adults .
3. A 76-year-old patient reports one fall in the past year. What is the strongest predictor of
future falls?
Answer: History of previous falls
Rationale: A prior fall is the strongest single predictor of future falls. Other risk factors include
gait abnormalities, sedating medications, and cognitive impairment .
4. During a hearing assessment, the NP performs a whisper test and notes bilateral decreased
hearing. The next best step is:
Answer: Perform pneumatic otoscopy and order audiometry
Rationale: Initial evaluation should rule out cerumen impaction or structural causes, then
quantify hearing loss with audiometry. Audiologist referral follows initial workup .
5. Which finding is consistent with normal age-related musculoskeletal changes?
Answer: Mild decreased spinal flexibility
, Rationale: Decreased water content in intervertebral discs causes mild spinal flexibility loss.
Significant deformities or marked atrophy are pathological .
6. A 55-year-old patient with BMI 32 and family history of diabetes has FPG 110 mg/dL. Per
ADA guidelines, how often should she be screened?
Answer: Annually
Rationale: FPG 100–125 indicates prediabetes; annual screening is recommended for high-risk
adults to detect progression early .
7. A 62-year-old presents with fatigue, weight loss, night sweats, Hgb 9.2, MCV 88, elevated
LDH. Most likely diagnosis?
Answer: Lymphoma
Rationale: B symptoms (fever, weight loss, night sweats) with normocytic anemia and elevated
LDH suggest lymphoid malignancy .
8. A 70-year-old with acute dyspnea, pleuritic chest pain, tachycardia, and elevated D-dimer.
Next best step?
Answer: CT pulmonary angiography (CTPA)
Rationale: CTPA is the diagnostic test of choice for suspected PE in hemodynamically stable
patients. Empiric anticoagulation may be considered in high-probability cases .
9. A 45-year-old with polyuria, polydipsia, and random glucose 280 mg/dL. Which confirms
diabetes?
Answer: Any of the above (FPG ≥126, A1c ≥6.5%, OGTT ≥200)
Rationale: ADA allows diagnosis by any one criterion. With classic symptoms and random
glucose ≥200, diagnosis is confirmed, but FPG, A1c, or OGTT can also establish it .
10. A 68-year-old with hypertension and type 2 diabetes. Which nephrotoxic risk is greatest
with NSAIDs?
Answer: Acute kidney injury
Rationale: NSAIDs inhibit prostaglandins that maintain renal blood flow, particularly dangerous
with age-related renal decline and hypertension .
11. A 30-year-old with a firm, painless thyroid nodule and normal thyroid function. Initial
workup?
Answer: Serum TSH and thyroid ultrasound
Rationale: TSH assesses function; ultrasound characterizes nodule features. FNA is based on
ultrasound findings and size criteria .
12. A 68-year-old female with osteoporosis develops acute severe low back pain after
bending. Most likely diagnosis?
Answer: Osteoporotic vertebral compression fracture
2026–2027 | Comprehensive 150-Question
Practice Test with Answers & Rationales|
Pdf Access ALREADY GRADED A+.
Domain I: Patient Assessment Process (Questions 1–24)
1. A 72-year-old female presents for a wellness visit. She has no complaints. Which screening
is most appropriate based on USPSTF guidelines?
Answer: Colorectal cancer screening (if not up to date)
Rationale: USPSTF recommends colorectal cancer screening for average-risk adults ages 45–75.
At 72, she remains within screening age. Annual wellness visits should include age-appropriate
screenings .
2. An S4 heart sound auscultated in a 68-year-old most commonly indicates:
Answer: Left ventricular hypertrophy
Rationale: An S4 (atrial gallop) results from atrial contraction against a stiff, non-compliant
ventricle, commonly due to LVH from chronic hypertension. It is a common finding in older
adults .
3. A 76-year-old patient reports one fall in the past year. What is the strongest predictor of
future falls?
Answer: History of previous falls
Rationale: A prior fall is the strongest single predictor of future falls. Other risk factors include
gait abnormalities, sedating medications, and cognitive impairment .
4. During a hearing assessment, the NP performs a whisper test and notes bilateral decreased
hearing. The next best step is:
Answer: Perform pneumatic otoscopy and order audiometry
Rationale: Initial evaluation should rule out cerumen impaction or structural causes, then
quantify hearing loss with audiometry. Audiologist referral follows initial workup .
5. Which finding is consistent with normal age-related musculoskeletal changes?
Answer: Mild decreased spinal flexibility
, Rationale: Decreased water content in intervertebral discs causes mild spinal flexibility loss.
Significant deformities or marked atrophy are pathological .
6. A 55-year-old patient with BMI 32 and family history of diabetes has FPG 110 mg/dL. Per
ADA guidelines, how often should she be screened?
Answer: Annually
Rationale: FPG 100–125 indicates prediabetes; annual screening is recommended for high-risk
adults to detect progression early .
7. A 62-year-old presents with fatigue, weight loss, night sweats, Hgb 9.2, MCV 88, elevated
LDH. Most likely diagnosis?
Answer: Lymphoma
Rationale: B symptoms (fever, weight loss, night sweats) with normocytic anemia and elevated
LDH suggest lymphoid malignancy .
8. A 70-year-old with acute dyspnea, pleuritic chest pain, tachycardia, and elevated D-dimer.
Next best step?
Answer: CT pulmonary angiography (CTPA)
Rationale: CTPA is the diagnostic test of choice for suspected PE in hemodynamically stable
patients. Empiric anticoagulation may be considered in high-probability cases .
9. A 45-year-old with polyuria, polydipsia, and random glucose 280 mg/dL. Which confirms
diabetes?
Answer: Any of the above (FPG ≥126, A1c ≥6.5%, OGTT ≥200)
Rationale: ADA allows diagnosis by any one criterion. With classic symptoms and random
glucose ≥200, diagnosis is confirmed, but FPG, A1c, or OGTT can also establish it .
10. A 68-year-old with hypertension and type 2 diabetes. Which nephrotoxic risk is greatest
with NSAIDs?
Answer: Acute kidney injury
Rationale: NSAIDs inhibit prostaglandins that maintain renal blood flow, particularly dangerous
with age-related renal decline and hypertension .
11. A 30-year-old with a firm, painless thyroid nodule and normal thyroid function. Initial
workup?
Answer: Serum TSH and thyroid ultrasound
Rationale: TSH assesses function; ultrasound characterizes nodule features. FNA is based on
ultrasound findings and size criteria .
12. A 68-year-old female with osteoporosis develops acute severe low back pain after
bending. Most likely diagnosis?
Answer: Osteoporotic vertebral compression fracture
