AANP AGPCNP FINAL BOARD EXAM 2024 150
Questions with Verified Answers & Detailed
Rationales ALREDY GRADED A+ LATTEST
VERSION
EXAM INSTRUCTIONS
This comprehensive practice examination is designed to simulate the actual AANP Adult-
Gerontology Primary Care Nurse Practitioner (AGPCNP) certification exam. The exam contains
150 questions (135 scored, 15 pretest) with a 3-hour time limit.
Exam Domains:
• Patient Assessment Process (Approximately 40%)
• Plan of Care (Approximately 40%)
• Professional Practice (Approximately 20%)
Patient Population Distribution:
• Older Adults (65+ years): 30%
• Middle Adults (45-64 years): 26%
• Young Adults (18-44 years): 22%
• Adolescents (13-17 years): 9%
• Children (0-12 years): ~13%
SECTION 1: PATIENT ASSESSMENT (Questions 1-50)
Question 1
An 88-year-old male presents with right-side weakness after being unable to rise unassisted
following a fall to the bathroom floor. History includes aphasia and noncompliance with
hypertension medication regimen. What is the most likely diagnosis?
A) Right-sided CVA
B) Left-sided CVA
C) Transient ischemic attack
D) Subdural hematoma
,Correct Answer: B) Left-sided CVA
Rationale: A left-sided cerebrovascular accident (CVA) typically presents with right-sided
weakness and aphasia, as the left hemisphere controls language function and right-sided motor
function. The patient's noncompliance with hypertension medication is a significant risk factor.
Question 2
Which of the following signs/symptoms are often associated with headaches due to intracranial
tumor?
A) Acute onset: hours to days
B) Hyperflexia, personality change
C) Pain worse laying down, focal neurological signs
D) Pupillary constriction; stupor
Correct Answer: C) Pain worse laying down, focal neurological signs
Rationale: Intracranial tumors typically cause headaches that are worse when lying down due to
increased intracranial pressure, along with focal neurological deficits. Headaches are often
worse in the morning and may awaken the patient from sleep.
Question 3
An 85-year-old male relates that on the way to his annual physical examination, he suffered a
sudden loss of vision in his right eye characterized by "a bunch of lights" and a feeling that "a
curtain came down." All of the following would be included in the differential diagnosis EXCEPT:
A) Ophthalmologic migraine
B) Retinal detachment
C) Diabetic retinopathy
D) TIA
Correct Answer: C) Diabetic retinopathy
Rationale: The acute onset of "curtain coming down" with flashes of light is classic for retinal
detachment. Diabetic retinopathy is a chronic, progressive condition and would not present with
this acute symptomatology. This is a medical emergency requiring immediate ophthalmology
referral.
Question 4
An 88-year-old female presents with a 3-day history of vertigo. The patient has a past medical
history of hypertension controlled with metoprolol, 50 mg daily. She reports that the presenting
symptoms are constant, severe, and accompanied by nausea and vomiting. She denies
,experiencing diplopia, slurring of speech, chest pain, dyspnea, or diaphoresis. She exhibits mild
anxiety and reluctance to change position or turn the head. BP = 126/76; P = 78; R = 16/min;
and T = 98.2°F (36.8°C). HEENT examination reveals 17 beats of horizontal nystagmus on right
lateral gaze; the nystagmus stops after several repetitions of the maneuver. Funduscopic,
cardiac, pulmonary, abdominal, and neurologic examination results are normal. The most likely
diagnosis is:
A) Acoustic neuroma
B) Vestibular neuritis
C) Vertebrobasilar insufficiency
D) TIA
Correct Answer: B) Vestibular neuritis
Rationale: Vestibular neuritis presents with acute, severe, constant vertigo, nausea, vomiting,
and horizontal nystagmus that fatigues with repeated positioning. The absence of other
neurological symptoms helps differentiate it from central causes such as vertebrobasilar
insufficiency or TIA.
Question 5
A patient with diabetes mellitus who is on NPH and regular insulin split-dosing presents with
complaints of early morning rise in fingerstick blood glucose. A review of self blood glucose
monitoring reveals increased morning levels. After an increase in the evening insulin dose, the
problem worsens. This is most likely an example of:
A) Insulin resistance
B) The Somogyi effect
C) Needing more insulin in the mornings
D) Dawn phenomenon
Correct Answer: B) The Somogyi effect
Rationale: The Somogyi effect is characterized by rebound hyperglycemia following nocturnal
hypoglycemia. Increasing the evening insulin dose paradoxically worsens morning
hyperglycemia. The dawn phenomenon, in contrast, is caused by early morning release of
counter-regulatory hormones without preceding hypoglycemia.
Question 6
Which of the following is a common presenting feature of hyperthyroidism in the elderly?
A) Elevated TSH
B) Thyroid enlargement
C) Atrial fibrillation
D) Abnormal T3 suppression
, Correct Answer: C) Atrial fibrillation
Rationale: In elderly patients, hyperthyroidism often presents with "apathetic" symptoms
including atrial fibrillation, weight loss, depression, and fatigue rather than classic symptoms
such as heat intolerance, tachycardia, and tremor. Atrial fibrillation is a common cardiac
manifestation.
Question 7
A patient is referred with DM, HTN and CAD. He is on insulin and a beta blocker. How would you
educate this patient on recognizing the signs and symptoms of hypoglycemia?
A) "You will experience tremors and palpitations"
B) "Monitor for diaphoresis and tachycardia"
C) "Beta blockers may mask symptoms; monitor blood glucose regularly"
D) "Symptoms will be more severe with beta blocker use"
Correct Answer: C) "Beta blockers may mask symptoms; monitor blood glucose regularly"
Rationale: Beta blockers can mask the adrenergic symptoms of hypoglycemia such as
tachycardia and tremors, making regular blood glucose monitoring essential. Patients should be
educated to recognize diaphoresis, which may still occur, and to check blood glucose with any
concerning symptoms.
Question 8
A 12-lead EKG shows an undulating baseline with no visible P waves and an irregularly irregular
R-R interval. This arrhythmia is:
A) Atrial flutter
B) Atrial fibrillation
C) Second degree heart block
D) Wolff-Parkinson-White Syndrome
Correct Answer: B) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by an undulating baseline (fibrillatory waves),
absence of P waves, and irregularly irregular ventricular response. It is the most common
sustained arrhythmia in older adults and a major risk factor for stroke.
Question 9
In the elderly, one pathophysiologic mechanism of isolated systolic hypertension involves:
Questions with Verified Answers & Detailed
Rationales ALREDY GRADED A+ LATTEST
VERSION
EXAM INSTRUCTIONS
This comprehensive practice examination is designed to simulate the actual AANP Adult-
Gerontology Primary Care Nurse Practitioner (AGPCNP) certification exam. The exam contains
150 questions (135 scored, 15 pretest) with a 3-hour time limit.
Exam Domains:
• Patient Assessment Process (Approximately 40%)
• Plan of Care (Approximately 40%)
• Professional Practice (Approximately 20%)
Patient Population Distribution:
• Older Adults (65+ years): 30%
• Middle Adults (45-64 years): 26%
• Young Adults (18-44 years): 22%
• Adolescents (13-17 years): 9%
• Children (0-12 years): ~13%
SECTION 1: PATIENT ASSESSMENT (Questions 1-50)
Question 1
An 88-year-old male presents with right-side weakness after being unable to rise unassisted
following a fall to the bathroom floor. History includes aphasia and noncompliance with
hypertension medication regimen. What is the most likely diagnosis?
A) Right-sided CVA
B) Left-sided CVA
C) Transient ischemic attack
D) Subdural hematoma
,Correct Answer: B) Left-sided CVA
Rationale: A left-sided cerebrovascular accident (CVA) typically presents with right-sided
weakness and aphasia, as the left hemisphere controls language function and right-sided motor
function. The patient's noncompliance with hypertension medication is a significant risk factor.
Question 2
Which of the following signs/symptoms are often associated with headaches due to intracranial
tumor?
A) Acute onset: hours to days
B) Hyperflexia, personality change
C) Pain worse laying down, focal neurological signs
D) Pupillary constriction; stupor
Correct Answer: C) Pain worse laying down, focal neurological signs
Rationale: Intracranial tumors typically cause headaches that are worse when lying down due to
increased intracranial pressure, along with focal neurological deficits. Headaches are often
worse in the morning and may awaken the patient from sleep.
Question 3
An 85-year-old male relates that on the way to his annual physical examination, he suffered a
sudden loss of vision in his right eye characterized by "a bunch of lights" and a feeling that "a
curtain came down." All of the following would be included in the differential diagnosis EXCEPT:
A) Ophthalmologic migraine
B) Retinal detachment
C) Diabetic retinopathy
D) TIA
Correct Answer: C) Diabetic retinopathy
Rationale: The acute onset of "curtain coming down" with flashes of light is classic for retinal
detachment. Diabetic retinopathy is a chronic, progressive condition and would not present with
this acute symptomatology. This is a medical emergency requiring immediate ophthalmology
referral.
Question 4
An 88-year-old female presents with a 3-day history of vertigo. The patient has a past medical
history of hypertension controlled with metoprolol, 50 mg daily. She reports that the presenting
symptoms are constant, severe, and accompanied by nausea and vomiting. She denies
,experiencing diplopia, slurring of speech, chest pain, dyspnea, or diaphoresis. She exhibits mild
anxiety and reluctance to change position or turn the head. BP = 126/76; P = 78; R = 16/min;
and T = 98.2°F (36.8°C). HEENT examination reveals 17 beats of horizontal nystagmus on right
lateral gaze; the nystagmus stops after several repetitions of the maneuver. Funduscopic,
cardiac, pulmonary, abdominal, and neurologic examination results are normal. The most likely
diagnosis is:
A) Acoustic neuroma
B) Vestibular neuritis
C) Vertebrobasilar insufficiency
D) TIA
Correct Answer: B) Vestibular neuritis
Rationale: Vestibular neuritis presents with acute, severe, constant vertigo, nausea, vomiting,
and horizontal nystagmus that fatigues with repeated positioning. The absence of other
neurological symptoms helps differentiate it from central causes such as vertebrobasilar
insufficiency or TIA.
Question 5
A patient with diabetes mellitus who is on NPH and regular insulin split-dosing presents with
complaints of early morning rise in fingerstick blood glucose. A review of self blood glucose
monitoring reveals increased morning levels. After an increase in the evening insulin dose, the
problem worsens. This is most likely an example of:
A) Insulin resistance
B) The Somogyi effect
C) Needing more insulin in the mornings
D) Dawn phenomenon
Correct Answer: B) The Somogyi effect
Rationale: The Somogyi effect is characterized by rebound hyperglycemia following nocturnal
hypoglycemia. Increasing the evening insulin dose paradoxically worsens morning
hyperglycemia. The dawn phenomenon, in contrast, is caused by early morning release of
counter-regulatory hormones without preceding hypoglycemia.
Question 6
Which of the following is a common presenting feature of hyperthyroidism in the elderly?
A) Elevated TSH
B) Thyroid enlargement
C) Atrial fibrillation
D) Abnormal T3 suppression
, Correct Answer: C) Atrial fibrillation
Rationale: In elderly patients, hyperthyroidism often presents with "apathetic" symptoms
including atrial fibrillation, weight loss, depression, and fatigue rather than classic symptoms
such as heat intolerance, tachycardia, and tremor. Atrial fibrillation is a common cardiac
manifestation.
Question 7
A patient is referred with DM, HTN and CAD. He is on insulin and a beta blocker. How would you
educate this patient on recognizing the signs and symptoms of hypoglycemia?
A) "You will experience tremors and palpitations"
B) "Monitor for diaphoresis and tachycardia"
C) "Beta blockers may mask symptoms; monitor blood glucose regularly"
D) "Symptoms will be more severe with beta blocker use"
Correct Answer: C) "Beta blockers may mask symptoms; monitor blood glucose regularly"
Rationale: Beta blockers can mask the adrenergic symptoms of hypoglycemia such as
tachycardia and tremors, making regular blood glucose monitoring essential. Patients should be
educated to recognize diaphoresis, which may still occur, and to check blood glucose with any
concerning symptoms.
Question 8
A 12-lead EKG shows an undulating baseline with no visible P waves and an irregularly irregular
R-R interval. This arrhythmia is:
A) Atrial flutter
B) Atrial fibrillation
C) Second degree heart block
D) Wolff-Parkinson-White Syndrome
Correct Answer: B) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by an undulating baseline (fibrillatory waves),
absence of P waves, and irregularly irregular ventricular response. It is the most common
sustained arrhythmia in older adults and a major risk factor for stroke.
Question 9
In the elderly, one pathophysiologic mechanism of isolated systolic hypertension involves:
