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Kaplan AGNP Clinical Management Practice Exam |
100 Clinical Questions and Correct Answers
Kaplan AGNP Clinical Management Practice Exam — 100 Questions
1. A 68-year-old man with a history of hypertension and diabetes presents with
a blood pressure of 148/92 mmHg on three separate occasions. He is currently
on lisinopril 20 mg daily and amlodipine 5 mg daily. According to the 2017
ACC/AHA guidelines, what is the most appropriate next step?
A. Increase lisinopril to 40 mg daily.
B. Add a thiazide diuretic.
C. Add a beta-blocker.
D. No change; recheck in 3 months.
: Correct Answer : B
*Rationale: For Stage 2 hypertension not at goal with two first-line agents, a third
agent from a different class should be added. A thiazide diuretic is recommended
as the third agent for most patients, especially given that this patient is already on
an ACE inhibitor and a calcium channel blocker. Beta-blockers are not first-line
unless there is a specific indication like coronary artery disease or heart failure.*
2. A 72-year-old woman with type 2 diabetes on metformin and glipizide has an
A1c of 8.2% and an eGFR of 35 mL/min. Her BMI is 31. Which medication
adjustment is most appropriate given the need for both glucose control and
cardiovascular risk reduction?
A. Add pioglitazone.
B. Discontinue glipizide and add an SGLT2 inhibitor.
C. Add a DPP-4 inhibitor.
D. Increase glipizide dose.
: Correct Answer : B
*Rationale: SGLT2 inhibitors have proven cardiovascular and renal benefits in
patients with type 2 diabetes and chronic kidney disease with eGFR above 20–25
mL/min. Glipizide increases the risk of hypoglycemia and weight gain. An SGLT2
inhibitor is preferred for cardiovascular and renal protection, and can be used
pg. 1
,2
down to eGFR of 20 (depending on the agent). Pioglitazone can cause fluid
retention and is not first-line for CV risk reduction. DPP-4 inhibitors are neutral
but less robust.*
3. A 75-year-old man with benign prostatic hyperplasia (BPH) reports nocturia,
hesitancy, and a weak urinary stream. Digital rectal exam reveals a smooth,
enlarged prostate; PSA is 2.0 ng/mL. What is the first-line pharmacotherapy?
A. Finasteride
B. Tamsulosin
C. Oxybutynin
D. Saw palmetto
: Correct Answer : B
*Rationale: Alpha-1 adrenergic antagonists (tamsulosin, alfuzosin) provide rapid
symptom relief and are first-line for BPH. 5-alpha-reductase inhibitors
(finasteride) are used for larger prostates (>40 g) and take months to work.
Anticholinergics (oxybutynin) are for overactive bladder, not BPH. Saw palmetto
has limited evidence.*
4. A 62-year-old woman with COPD (FEV1 50% predicted, frequent
exacerbations) on tiotropium and as-needed albuterol presents with increasing
dyspnea and two exacerbations in the past year. What is the most appropriate
next step?
A. Add theophylline.
B. Add an inhaled corticosteroid/long-acting beta-agonist (ICS/LABA)
combination.
C. Start roflumilast.
D. Refer for lung volume reduction surgery.
: Correct Answer : B
Rationale: For GOLD group E (high symptom burden, frequent exacerbations),
escalation to triple therapy (LAMA + LABA + ICS) is recommended. This patient is
already on a LAMA (tiotropium); adding an ICS/LABA combination achieves triple
therapy and reduces exacerbations. Theophylline is third-line due to toxicity;
roflumilast is for severe COPD with chronic bronchitis and frequent exacerbations
despite triple therapy.
pg. 2
,3
5. A 55-year-old man with a 40-pack-year smoking history presents with a new
cough and a 2.5 cm spiculated mass on chest X-ray. He is otherwise
asymptomatic. What is the most appropriate next diagnostic step?
A. Sputum cytology
B. PET scan
C. CT-guided needle biopsy or bronchoscopy
D. Empiric antibiotics and repeat X-ray in 6 weeks
: Correct Answer : C
Rationale: A spiculated mass in a high-risk patient is suspicious for lung cancer and
requires tissue diagnosis. CT-guided biopsy or bronchoscopy is the next step. PET
scan is for staging after diagnosis; sputum cytology has lower yield; delaying with
antibiotics is inappropriate when cancer is likely.
6. A 70-year-old woman with atrial fibrillation (CHA₂DS₂-VASc score 5) has been
on warfarin. Her INR today is 6.2, and she reports no bleeding. What is the most
appropriate management?
A. Administer vitamin K 10 mg IV.
B. Hold warfarin, recheck INR in 1–2 days, and reduce weekly dose.
C. Administer fresh frozen plasma.
D. Continue warfarin at the same dose.
: Correct Answer : B
*Rationale: For an INR >5.0 without bleeding, warfarin should be held for 1–2
doses, the dose reduced, and INR monitored more frequently. IV vitamin K is
reserved for life-threatening bleeding or extremely high INR (>10). FFP is for
active bleeding.*
7. An 80-year-old nursing home resident develops confusion, fever (38.5°C), and
cough with purulent sputum. Chest X-ray shows a right lower lobe infiltrate. Her
CURB-65 score is 3. What is the appropriate disposition?
A. Outpatient oral antibiotics
B. Hospital admission for IV antibiotics
C. ICU admission
D. No antibiotics; likely viral
: Correct Answer : B
*Rationale: A CURB-65 score of 3 indicates severe community-acquired
pg. 3
, 4
pneumonia with a mortality risk of 15–20%, requiring inpatient admission. ICU is
for score ≥4 or mechanical ventilation/vasopressors. Outpatient treatment is for
scores 0–1.*
8. A 64-year-old woman with heart failure with reduced ejection fraction (HFrEF,
EF 30%) is on lisinopril, carvedilol, spironolactone, and furosemide. She has
euvolemic and stable. Which additional therapy has been shown to further
reduce mortality and hospitalizations?
A. Digoxin
B. Sacubitril/valsartan (switch from lisinopril)
C. Amlodipine
D. Isosorbide dinitrate
: Correct Answer : B
Rationale: In stable HFrEF, replacing an ACE inhibitor with an ARNI
(sacubitril/valsartan) further reduces mortality and heart failure hospitalizations
compared to enalapril. Digoxin reduces hospitalizations but not mortality.
Amlodipine is not standard; nitrates are not mortality-reducing.
9. A 58-year-old woman with a history of gastric bypass surgery presents with
fatigue, paresthesias, and a macrocytic anemia (MCV 110 fL). What is the most
likely deficiency?
A. Iron deficiency
B. Vitamin B12 deficiency
C. Folate deficiency
D. Vitamin C deficiency
: Correct Answer : B
Rationale: Gastric bypass reduces intrinsic factor production and B12 absorption.
Macrocytic anemia with neurological symptoms (paresthesias) is classic for B12
deficiency. Iron deficiency causes microcytic anemia. Folate deficiency also causes
macrocytosis but without neurological symptoms.
10. A 50-year-old woman with a history of recurrent deep vein thrombosis and a
family history of thrombosis is found to have factor V Leiden mutation. She is
currently not pregnant. What is the most appropriate long-term management?
A. Lifelong warfarin
B. Prophylactic LMWH during high-risk situations and no routine anticoagulation
pg. 4
Kaplan AGNP Clinical Management Practice Exam |
100 Clinical Questions and Correct Answers
Kaplan AGNP Clinical Management Practice Exam — 100 Questions
1. A 68-year-old man with a history of hypertension and diabetes presents with
a blood pressure of 148/92 mmHg on three separate occasions. He is currently
on lisinopril 20 mg daily and amlodipine 5 mg daily. According to the 2017
ACC/AHA guidelines, what is the most appropriate next step?
A. Increase lisinopril to 40 mg daily.
B. Add a thiazide diuretic.
C. Add a beta-blocker.
D. No change; recheck in 3 months.
: Correct Answer : B
*Rationale: For Stage 2 hypertension not at goal with two first-line agents, a third
agent from a different class should be added. A thiazide diuretic is recommended
as the third agent for most patients, especially given that this patient is already on
an ACE inhibitor and a calcium channel blocker. Beta-blockers are not first-line
unless there is a specific indication like coronary artery disease or heart failure.*
2. A 72-year-old woman with type 2 diabetes on metformin and glipizide has an
A1c of 8.2% and an eGFR of 35 mL/min. Her BMI is 31. Which medication
adjustment is most appropriate given the need for both glucose control and
cardiovascular risk reduction?
A. Add pioglitazone.
B. Discontinue glipizide and add an SGLT2 inhibitor.
C. Add a DPP-4 inhibitor.
D. Increase glipizide dose.
: Correct Answer : B
*Rationale: SGLT2 inhibitors have proven cardiovascular and renal benefits in
patients with type 2 diabetes and chronic kidney disease with eGFR above 20–25
mL/min. Glipizide increases the risk of hypoglycemia and weight gain. An SGLT2
inhibitor is preferred for cardiovascular and renal protection, and can be used
pg. 1
,2
down to eGFR of 20 (depending on the agent). Pioglitazone can cause fluid
retention and is not first-line for CV risk reduction. DPP-4 inhibitors are neutral
but less robust.*
3. A 75-year-old man with benign prostatic hyperplasia (BPH) reports nocturia,
hesitancy, and a weak urinary stream. Digital rectal exam reveals a smooth,
enlarged prostate; PSA is 2.0 ng/mL. What is the first-line pharmacotherapy?
A. Finasteride
B. Tamsulosin
C. Oxybutynin
D. Saw palmetto
: Correct Answer : B
*Rationale: Alpha-1 adrenergic antagonists (tamsulosin, alfuzosin) provide rapid
symptom relief and are first-line for BPH. 5-alpha-reductase inhibitors
(finasteride) are used for larger prostates (>40 g) and take months to work.
Anticholinergics (oxybutynin) are for overactive bladder, not BPH. Saw palmetto
has limited evidence.*
4. A 62-year-old woman with COPD (FEV1 50% predicted, frequent
exacerbations) on tiotropium and as-needed albuterol presents with increasing
dyspnea and two exacerbations in the past year. What is the most appropriate
next step?
A. Add theophylline.
B. Add an inhaled corticosteroid/long-acting beta-agonist (ICS/LABA)
combination.
C. Start roflumilast.
D. Refer for lung volume reduction surgery.
: Correct Answer : B
Rationale: For GOLD group E (high symptom burden, frequent exacerbations),
escalation to triple therapy (LAMA + LABA + ICS) is recommended. This patient is
already on a LAMA (tiotropium); adding an ICS/LABA combination achieves triple
therapy and reduces exacerbations. Theophylline is third-line due to toxicity;
roflumilast is for severe COPD with chronic bronchitis and frequent exacerbations
despite triple therapy.
pg. 2
,3
5. A 55-year-old man with a 40-pack-year smoking history presents with a new
cough and a 2.5 cm spiculated mass on chest X-ray. He is otherwise
asymptomatic. What is the most appropriate next diagnostic step?
A. Sputum cytology
B. PET scan
C. CT-guided needle biopsy or bronchoscopy
D. Empiric antibiotics and repeat X-ray in 6 weeks
: Correct Answer : C
Rationale: A spiculated mass in a high-risk patient is suspicious for lung cancer and
requires tissue diagnosis. CT-guided biopsy or bronchoscopy is the next step. PET
scan is for staging after diagnosis; sputum cytology has lower yield; delaying with
antibiotics is inappropriate when cancer is likely.
6. A 70-year-old woman with atrial fibrillation (CHA₂DS₂-VASc score 5) has been
on warfarin. Her INR today is 6.2, and she reports no bleeding. What is the most
appropriate management?
A. Administer vitamin K 10 mg IV.
B. Hold warfarin, recheck INR in 1–2 days, and reduce weekly dose.
C. Administer fresh frozen plasma.
D. Continue warfarin at the same dose.
: Correct Answer : B
*Rationale: For an INR >5.0 without bleeding, warfarin should be held for 1–2
doses, the dose reduced, and INR monitored more frequently. IV vitamin K is
reserved for life-threatening bleeding or extremely high INR (>10). FFP is for
active bleeding.*
7. An 80-year-old nursing home resident develops confusion, fever (38.5°C), and
cough with purulent sputum. Chest X-ray shows a right lower lobe infiltrate. Her
CURB-65 score is 3. What is the appropriate disposition?
A. Outpatient oral antibiotics
B. Hospital admission for IV antibiotics
C. ICU admission
D. No antibiotics; likely viral
: Correct Answer : B
*Rationale: A CURB-65 score of 3 indicates severe community-acquired
pg. 3
, 4
pneumonia with a mortality risk of 15–20%, requiring inpatient admission. ICU is
for score ≥4 or mechanical ventilation/vasopressors. Outpatient treatment is for
scores 0–1.*
8. A 64-year-old woman with heart failure with reduced ejection fraction (HFrEF,
EF 30%) is on lisinopril, carvedilol, spironolactone, and furosemide. She has
euvolemic and stable. Which additional therapy has been shown to further
reduce mortality and hospitalizations?
A. Digoxin
B. Sacubitril/valsartan (switch from lisinopril)
C. Amlodipine
D. Isosorbide dinitrate
: Correct Answer : B
Rationale: In stable HFrEF, replacing an ACE inhibitor with an ARNI
(sacubitril/valsartan) further reduces mortality and heart failure hospitalizations
compared to enalapril. Digoxin reduces hospitalizations but not mortality.
Amlodipine is not standard; nitrates are not mortality-reducing.
9. A 58-year-old woman with a history of gastric bypass surgery presents with
fatigue, paresthesias, and a macrocytic anemia (MCV 110 fL). What is the most
likely deficiency?
A. Iron deficiency
B. Vitamin B12 deficiency
C. Folate deficiency
D. Vitamin C deficiency
: Correct Answer : B
Rationale: Gastric bypass reduces intrinsic factor production and B12 absorption.
Macrocytic anemia with neurological symptoms (paresthesias) is classic for B12
deficiency. Iron deficiency causes microcytic anemia. Folate deficiency also causes
macrocytosis but without neurological symptoms.
10. A 50-year-old woman with a history of recurrent deep vein thrombosis and a
family history of thrombosis is found to have factor V Leiden mutation. She is
currently not pregnant. What is the most appropriate long-term management?
A. Lifelong warfarin
B. Prophylactic LMWH during high-risk situations and no routine anticoagulation
pg. 4
