100 AGPCNP-BC Practice Questions with
Answers & Rationales WITH PATIENT
ASSESSMENT PROCESS COVERED ALREADY
GRADED A+
1. A 72-year-old female presents with a 3-month history of progressive memory loss, difficulty
finding words, and personality changes. Her family reports she has become withdrawn and
apathetic. Which screening tool is most appropriate for initial cognitive assessment?
A. PHQ-9
B. Montreal Cognitive Assessment (MoCA)
C. CAGE questionnaire
D. AUDIT
Answer: B
Rationale: The Montreal Cognitive Assessment (MoCA) is a sensitive screening tool for mild
cognitive impairment and dementia, assessing multiple cognitive domains including memory,
language, and executive function. The PHQ-9 (A) screens for depression. The CAGE (C) and
AUDIT (D) screen for alcohol use disorders.
2. A 65-year-old male presents with a 2-week history of progressively worsening shortness of
breath, orthopnea, and bilateral lower extremity edema. He has a history of hypertension and
coronary artery disease. On exam, he has jugular venous distension and crackles at the lung
bases. Which diagnostic test is most appropriate INITIALLY?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Echocardiogram
D. B-type natriuretic peptide (BNP)
1
, Answer: C
Rationale: The presentation is consistent with heart failure. An echocardiogram is the most
appropriate initial diagnostic test to assess ejection fraction, valvular function, and structural
abnormalities. BNP (D) is a useful biomarker but does not provide structural information.
3. A 45-year-old male presents with chest pain that worsens with deep inspiration and
improves when leaning forward. He reports a low-grade fever and malaise. On auscultation, a
pericardial friction rub is heard. Which of the following is the most likely diagnosis?
A. Myocardial infarction
B. Pericarditis
C. Pulmonary embolism
D. Pneumothorax
Answer: B
Rationale: Pleuritic chest pain that worsens with inspiration and improves with leaning forward
is classic for pericarditis. A pericardial friction rub is a hallmark finding. Myocardial infarction (A)
typically presents with pressure-like pain. Pulmonary embolism (C) presents with acute
dyspnea.
4. A 68-year-old female presents with a several-month history of fatigue, weight gain, cold
intolerance, and constipation. On exam, she has a delayed relaxation phase of deep tendon
reflexes. Which laboratory finding is most consistent with her presentation?
A. Elevated TSH, low free T4
B. Low TSH, elevated free T4
C. Normal TSH, low free T4
D. Elevated TSH, elevated free T4
Answer: A
Rationale: The presentation is classic for hypothyroidism. The most consistent laboratory
finding is an elevated TSH with a low free T4 (primary hypothyroidism). Low TSH with elevated
free T4 (B) is consistent with hyperthyroidism.
5. A 55-year-old male with a 30-pack-year smoking history presents with a new-onset cough,
hemoptysis, and unintentional weight loss of 15 pounds over 3 months. Which diagnostic test
is most appropriate as the INITIAL imaging study?
2
, A. Chest X-ray
B. CT scan of the chest
C. MRI of the chest
D. PET scan
Answer: A
Rationale: A chest X-ray is the initial imaging study of choice for a patient presenting with
cough, hemoptysis, and weight loss with a significant smoking history. If the chest X-ray is
abnormal, a CT scan (B) may be ordered for further evaluation.
6. A 72-year-old female presents with a 2-day history of acute confusion, fever, and urinary
urgency. She has a history of dementia. Urinalysis shows positive leukocyte esterase and
nitrites. Which of the following is the most likely diagnosis?
A. Alzheimer's disease exacerbation
B. Urinary tract infection (UTI) with delirium
C. Stroke
D. Dehydration
Answer: B
Rationale: Acute confusion (delirium) with fever and urinary symptoms in an older adult is
most likely a urinary tract infection (UTI) causing delirium. Dementia (A) is chronic. Stroke (C)
typically presents with focal neurologic deficits.
7. A 28-year-old female presents with a 3-day history of severe throbbing headache, nausea,
photophobia, and phonophobia. She reports a similar episode 6 months ago. Which of the
following is the most likely diagnosis?
A. Tension-type headache
B. Migraine without aura
C. Cluster headache
D. Sinus headache
Answer: B
Rationale: Recurrent throbbing headache with nausea, photophobia, and phonophobia is
classic for migraine without aura. Tension-type headaches (A) are bilateral and band-like.
Cluster headaches (C) are unilateral, periorbital, and associated with autonomic symptoms.
3
, 8. A 62-year-old female presents with a 6-month history of hot flashes, night sweats, and
irregular menses. She has no other symptoms. Which of the following is the most likely
diagnosis?
A. Hyperthyroidism
B. Perimenopause
C. Premature ovarian failure
D. Pheochromocytoma
Answer: B
Rationale: The symptoms of hot flashes, night sweats, and irregular menses in a woman in her
early 60s are classic for perimenopause (though the typical age range is 45-55, symptoms can
persist). Hyperthyroidism (A) can cause heat intolerance but is less likely with irregular menses.
9. A 58-year-old male presents with a several-month history of progressive difficulty
swallowing solids, followed by liquids. He reports unintentional weight loss of 20 pounds. He
has a 40-pack-year smoking history and drinks alcohol regularly. Which of the following is the
most appropriate INITIAL diagnostic test?
A. Barium swallow
B. Upper endoscopy (EGD)
C. Chest X-ray
D. CT scan of the chest
Answer: B
Rationale: Progressive dysphagia with weight loss in an older adult with a significant smoking
and alcohol history is concerning for esophageal malignancy. The most appropriate initial
diagnostic test is upper endoscopy (EGD) , which allows direct visualization and biopsy.
10. A 52-year-old female presents with a several-week history of a malar rash,
photosensitivity, and joint pain. She also reports fatigue and occasional chest pain with deep
inspiration. Which of the following is the most likely diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus (SLE)
C. Psoriatic arthritis
D. Osteoarthritis
4
Answers & Rationales WITH PATIENT
ASSESSMENT PROCESS COVERED ALREADY
GRADED A+
1. A 72-year-old female presents with a 3-month history of progressive memory loss, difficulty
finding words, and personality changes. Her family reports she has become withdrawn and
apathetic. Which screening tool is most appropriate for initial cognitive assessment?
A. PHQ-9
B. Montreal Cognitive Assessment (MoCA)
C. CAGE questionnaire
D. AUDIT
Answer: B
Rationale: The Montreal Cognitive Assessment (MoCA) is a sensitive screening tool for mild
cognitive impairment and dementia, assessing multiple cognitive domains including memory,
language, and executive function. The PHQ-9 (A) screens for depression. The CAGE (C) and
AUDIT (D) screen for alcohol use disorders.
2. A 65-year-old male presents with a 2-week history of progressively worsening shortness of
breath, orthopnea, and bilateral lower extremity edema. He has a history of hypertension and
coronary artery disease. On exam, he has jugular venous distension and crackles at the lung
bases. Which diagnostic test is most appropriate INITIALLY?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Echocardiogram
D. B-type natriuretic peptide (BNP)
1
, Answer: C
Rationale: The presentation is consistent with heart failure. An echocardiogram is the most
appropriate initial diagnostic test to assess ejection fraction, valvular function, and structural
abnormalities. BNP (D) is a useful biomarker but does not provide structural information.
3. A 45-year-old male presents with chest pain that worsens with deep inspiration and
improves when leaning forward. He reports a low-grade fever and malaise. On auscultation, a
pericardial friction rub is heard. Which of the following is the most likely diagnosis?
A. Myocardial infarction
B. Pericarditis
C. Pulmonary embolism
D. Pneumothorax
Answer: B
Rationale: Pleuritic chest pain that worsens with inspiration and improves with leaning forward
is classic for pericarditis. A pericardial friction rub is a hallmark finding. Myocardial infarction (A)
typically presents with pressure-like pain. Pulmonary embolism (C) presents with acute
dyspnea.
4. A 68-year-old female presents with a several-month history of fatigue, weight gain, cold
intolerance, and constipation. On exam, she has a delayed relaxation phase of deep tendon
reflexes. Which laboratory finding is most consistent with her presentation?
A. Elevated TSH, low free T4
B. Low TSH, elevated free T4
C. Normal TSH, low free T4
D. Elevated TSH, elevated free T4
Answer: A
Rationale: The presentation is classic for hypothyroidism. The most consistent laboratory
finding is an elevated TSH with a low free T4 (primary hypothyroidism). Low TSH with elevated
free T4 (B) is consistent with hyperthyroidism.
5. A 55-year-old male with a 30-pack-year smoking history presents with a new-onset cough,
hemoptysis, and unintentional weight loss of 15 pounds over 3 months. Which diagnostic test
is most appropriate as the INITIAL imaging study?
2
, A. Chest X-ray
B. CT scan of the chest
C. MRI of the chest
D. PET scan
Answer: A
Rationale: A chest X-ray is the initial imaging study of choice for a patient presenting with
cough, hemoptysis, and weight loss with a significant smoking history. If the chest X-ray is
abnormal, a CT scan (B) may be ordered for further evaluation.
6. A 72-year-old female presents with a 2-day history of acute confusion, fever, and urinary
urgency. She has a history of dementia. Urinalysis shows positive leukocyte esterase and
nitrites. Which of the following is the most likely diagnosis?
A. Alzheimer's disease exacerbation
B. Urinary tract infection (UTI) with delirium
C. Stroke
D. Dehydration
Answer: B
Rationale: Acute confusion (delirium) with fever and urinary symptoms in an older adult is
most likely a urinary tract infection (UTI) causing delirium. Dementia (A) is chronic. Stroke (C)
typically presents with focal neurologic deficits.
7. A 28-year-old female presents with a 3-day history of severe throbbing headache, nausea,
photophobia, and phonophobia. She reports a similar episode 6 months ago. Which of the
following is the most likely diagnosis?
A. Tension-type headache
B. Migraine without aura
C. Cluster headache
D. Sinus headache
Answer: B
Rationale: Recurrent throbbing headache with nausea, photophobia, and phonophobia is
classic for migraine without aura. Tension-type headaches (A) are bilateral and band-like.
Cluster headaches (C) are unilateral, periorbital, and associated with autonomic symptoms.
3
, 8. A 62-year-old female presents with a 6-month history of hot flashes, night sweats, and
irregular menses. She has no other symptoms. Which of the following is the most likely
diagnosis?
A. Hyperthyroidism
B. Perimenopause
C. Premature ovarian failure
D. Pheochromocytoma
Answer: B
Rationale: The symptoms of hot flashes, night sweats, and irregular menses in a woman in her
early 60s are classic for perimenopause (though the typical age range is 45-55, symptoms can
persist). Hyperthyroidism (A) can cause heat intolerance but is less likely with irregular menses.
9. A 58-year-old male presents with a several-month history of progressive difficulty
swallowing solids, followed by liquids. He reports unintentional weight loss of 20 pounds. He
has a 40-pack-year smoking history and drinks alcohol regularly. Which of the following is the
most appropriate INITIAL diagnostic test?
A. Barium swallow
B. Upper endoscopy (EGD)
C. Chest X-ray
D. CT scan of the chest
Answer: B
Rationale: Progressive dysphagia with weight loss in an older adult with a significant smoking
and alcohol history is concerning for esophageal malignancy. The most appropriate initial
diagnostic test is upper endoscopy (EGD) , which allows direct visualization and biopsy.
10. A 52-year-old female presents with a several-week history of a malar rash,
photosensitivity, and joint pain. She also reports fatigue and occasional chest pain with deep
inspiration. Which of the following is the most likely diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus (SLE)
C. Psoriatic arthritis
D. Osteoarthritis
4
