AGNP Program Comprehensive ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Section 1: Health Assessment & Diagnostic Reasoning (Questions 1-25)
Question 1
A 68-year-old male with a 45-pack-year smoking history presents with a new onset of
hoarseness that has persisted for 6 weeks. He denies sore throat or URI symptoms. What is the
most appropriate initial diagnostic action?
A) Prescribe a course of oral antibiotics for suspected laryngitis
B) Order a chest x-ray to evaluate for mediastinal mass
C) Refer the patient for direct or indirect laryngoscopy
D) Recommend voice rest and reassess in 4 weeks
Answer: C) Refer the patient for direct or indirect laryngoscopy
Rationale: Hoarseness persisting for more than 3 weeks in a patient with a significant smoking
history is a "red flag" symptom that requires visualization of the vocal cords to rule out laryngeal
cancer. Laryngoscopy is the gold standard for evaluating persistent hoarseness. While a chest x-
ray may be part of the workup, it does not replace direct visualization of the larynx.
Question 2
During a physical exam, you note a non-blanchable, well-demarcated area of erythema over a
patient's sacrum. The skin is intact. This is characteristic of which stage of pressure injury?
A) Stage 1 pressure injury
B) Stage 2 pressure injury
C) Deep tissue pressure injury
D) Unstageable pressure injury
,Answer: A) Stage 1 pressure injury
Rationale: A Stage 1 pressure injury is defined as intact skin with non-blanchable erythema of a
localized area, usually over a bony prominence. The area may be painful, firm, soft, warmer, or
cooler compared to adjacent tissue. This finding indicates early pressure damage and requires
immediate intervention to prevent progression.
Question 3
A 75-year-old female presents with complaints of progressive bilateral knee pain that is worse
with activity and improves with rest. She reports morning stiffness lasting less than 15 minutes.
Physical exam reveals bony enlargement and crepitus with movement. What is the most likely
diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Septic arthritis
Answer: B) Osteoarthritis
Rationale: This presentation is classic for osteoarthritis, the most common joint disorder in older
adults. Key features include: progressive pain with use, relief with rest, brief morning stiffness
(<30 minutes), bony enlargement (Heberden's nodes for DIP joints, Bouchard's nodes for PIP
joints), and crepitus. Rheumatoid arthritis typically causes prolonged morning stiffness (>60
minutes) and symmetric joint inflammation.
Question 4
A 72-year-old male with a history of hypertension and diabetes presents with acute onset of
right-sided weakness, facial droop, and aphasia. His symptoms began 2 hours ago. What is the
most appropriate immediate action?
A) Administer aspirin 325 mg
B) Order a stat non-contrast head CT
C) Initiate thrombolytic therapy immediately
D) Check blood glucose and obtain stat non-contrast head CT
Answer: D) Check blood glucose and obtain stat non-contrast head CT
Rationale: For a suspected acute stroke, the initial workup must include a stat non-contrast head
CT to differentiate between ischemic and hemorrhagic stroke. Blood glucose should be checked
,to rule out hypoglycemia as a cause of focal neurologic symptoms. Thrombolytic therapy (tPA) is
time-sensitive (within 3-4.5 hours) but requires CT confirmation of ischemic stroke and exclusion
of hemorrhage.
Question 5
A 55-year-old female reports experiencing a persistent, non-productive cough for the past 8
weeks. She is a non-smoker and has no history of asthma. She also reports a sensation of
postnasal drip. Which medication class is most likely to be effective as initial treatment?
A) Systemic corticosteroids
B) Antibiotics
C) Intranasal corticosteroids
D) Antitussive agents
Answer: C) Intranasal corticosteroids
Rationale: The patient's presentation is consistent with upper airway cough syndrome (postnasal
drip), the most common cause of chronic cough. Intranasal corticosteroids are effective in
reducing postnasal drip and associated cough. Antibiotics are not indicated without signs of
infection. Systemic corticosteroids are not first-line. Antitussives treat symptoms but not the
underlying cause.
Question 6
A 67-year-old patient with a history of GERD presents with dysphagia to solid foods. Which
complication should be suspected?
A) Peptic ulcer disease
B) Esophageal stricture
C) Barrett's esophagus
D) Hiatal hernia
Answer: B) Esophageal stricture
Rationale: Long-standing GERD can lead to chronic inflammation and scarring of the esophageal
mucosa, resulting in peptic strictures. Dysphagia to solid foods is a classic sign. Barrett's
esophagus is a premalignant condition but does not typically cause dysphagia. Hiatal hernia is
associated with GERD but is less likely to cause progressive dysphagia without stricture.
, Question 7
A 62-year-old patient with a history of type 2 diabetes presents with a painless ulcer on the
plantar surface of the left foot. The ulcer is well-demarcated, with a punched-out appearance,
but there is no erythema or warmth. What is the most concerning complication?
A) Peripheral neuropathy
B) Osteomyelitis
C) Charcot arthropathy
D) Peripheral vascular disease
Answer: B) Osteomyelitis
Rationale: A painless, punched-out ulcer on the plantar surface of the foot in a patient with
diabetes is a classic sign of neuropathic ulceration. The lack of erythema/warmth can be
misleading due to neuropathy masking infection. The most significant complication is
osteomyelitis of the underlying bone. Deep probing to bone is a key diagnostic indicator that
should be evaluated.
Question 8
A 70-year-old female reports symptoms of urge incontinence, including a sudden, intense need
to void. Which of the following medications is first-line treatment?
A) Oxytocin
B) Oxybutynin
C) Doxazosin
D) Finasteride
Answer: B) Oxybutynin
Rationale: Urge incontinence is caused by involuntary detrusor muscle contractions. First-line
therapy includes bladder training and anticholinergic/antimuscarinic medications such as
oxybutynin. Doxazosin (alpha-blocker) and finasteride (5-alpha reductase inhibitor) are used for
voiding symptoms related to benign prostatic hyperplasia. Lifestyle modifications, such as
caffeine reduction, are also key components of treatment.
Question 9
An 82-year-old patient with a history of benign prostatic hyperplasia presents with acute urinary
retention. What is the initial step in management?
QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Section 1: Health Assessment & Diagnostic Reasoning (Questions 1-25)
Question 1
A 68-year-old male with a 45-pack-year smoking history presents with a new onset of
hoarseness that has persisted for 6 weeks. He denies sore throat or URI symptoms. What is the
most appropriate initial diagnostic action?
A) Prescribe a course of oral antibiotics for suspected laryngitis
B) Order a chest x-ray to evaluate for mediastinal mass
C) Refer the patient for direct or indirect laryngoscopy
D) Recommend voice rest and reassess in 4 weeks
Answer: C) Refer the patient for direct or indirect laryngoscopy
Rationale: Hoarseness persisting for more than 3 weeks in a patient with a significant smoking
history is a "red flag" symptom that requires visualization of the vocal cords to rule out laryngeal
cancer. Laryngoscopy is the gold standard for evaluating persistent hoarseness. While a chest x-
ray may be part of the workup, it does not replace direct visualization of the larynx.
Question 2
During a physical exam, you note a non-blanchable, well-demarcated area of erythema over a
patient's sacrum. The skin is intact. This is characteristic of which stage of pressure injury?
A) Stage 1 pressure injury
B) Stage 2 pressure injury
C) Deep tissue pressure injury
D) Unstageable pressure injury
,Answer: A) Stage 1 pressure injury
Rationale: A Stage 1 pressure injury is defined as intact skin with non-blanchable erythema of a
localized area, usually over a bony prominence. The area may be painful, firm, soft, warmer, or
cooler compared to adjacent tissue. This finding indicates early pressure damage and requires
immediate intervention to prevent progression.
Question 3
A 75-year-old female presents with complaints of progressive bilateral knee pain that is worse
with activity and improves with rest. She reports morning stiffness lasting less than 15 minutes.
Physical exam reveals bony enlargement and crepitus with movement. What is the most likely
diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Septic arthritis
Answer: B) Osteoarthritis
Rationale: This presentation is classic for osteoarthritis, the most common joint disorder in older
adults. Key features include: progressive pain with use, relief with rest, brief morning stiffness
(<30 minutes), bony enlargement (Heberden's nodes for DIP joints, Bouchard's nodes for PIP
joints), and crepitus. Rheumatoid arthritis typically causes prolonged morning stiffness (>60
minutes) and symmetric joint inflammation.
Question 4
A 72-year-old male with a history of hypertension and diabetes presents with acute onset of
right-sided weakness, facial droop, and aphasia. His symptoms began 2 hours ago. What is the
most appropriate immediate action?
A) Administer aspirin 325 mg
B) Order a stat non-contrast head CT
C) Initiate thrombolytic therapy immediately
D) Check blood glucose and obtain stat non-contrast head CT
Answer: D) Check blood glucose and obtain stat non-contrast head CT
Rationale: For a suspected acute stroke, the initial workup must include a stat non-contrast head
CT to differentiate between ischemic and hemorrhagic stroke. Blood glucose should be checked
,to rule out hypoglycemia as a cause of focal neurologic symptoms. Thrombolytic therapy (tPA) is
time-sensitive (within 3-4.5 hours) but requires CT confirmation of ischemic stroke and exclusion
of hemorrhage.
Question 5
A 55-year-old female reports experiencing a persistent, non-productive cough for the past 8
weeks. She is a non-smoker and has no history of asthma. She also reports a sensation of
postnasal drip. Which medication class is most likely to be effective as initial treatment?
A) Systemic corticosteroids
B) Antibiotics
C) Intranasal corticosteroids
D) Antitussive agents
Answer: C) Intranasal corticosteroids
Rationale: The patient's presentation is consistent with upper airway cough syndrome (postnasal
drip), the most common cause of chronic cough. Intranasal corticosteroids are effective in
reducing postnasal drip and associated cough. Antibiotics are not indicated without signs of
infection. Systemic corticosteroids are not first-line. Antitussives treat symptoms but not the
underlying cause.
Question 6
A 67-year-old patient with a history of GERD presents with dysphagia to solid foods. Which
complication should be suspected?
A) Peptic ulcer disease
B) Esophageal stricture
C) Barrett's esophagus
D) Hiatal hernia
Answer: B) Esophageal stricture
Rationale: Long-standing GERD can lead to chronic inflammation and scarring of the esophageal
mucosa, resulting in peptic strictures. Dysphagia to solid foods is a classic sign. Barrett's
esophagus is a premalignant condition but does not typically cause dysphagia. Hiatal hernia is
associated with GERD but is less likely to cause progressive dysphagia without stricture.
, Question 7
A 62-year-old patient with a history of type 2 diabetes presents with a painless ulcer on the
plantar surface of the left foot. The ulcer is well-demarcated, with a punched-out appearance,
but there is no erythema or warmth. What is the most concerning complication?
A) Peripheral neuropathy
B) Osteomyelitis
C) Charcot arthropathy
D) Peripheral vascular disease
Answer: B) Osteomyelitis
Rationale: A painless, punched-out ulcer on the plantar surface of the foot in a patient with
diabetes is a classic sign of neuropathic ulceration. The lack of erythema/warmth can be
misleading due to neuropathy masking infection. The most significant complication is
osteomyelitis of the underlying bone. Deep probing to bone is a key diagnostic indicator that
should be evaluated.
Question 8
A 70-year-old female reports symptoms of urge incontinence, including a sudden, intense need
to void. Which of the following medications is first-line treatment?
A) Oxytocin
B) Oxybutynin
C) Doxazosin
D) Finasteride
Answer: B) Oxybutynin
Rationale: Urge incontinence is caused by involuntary detrusor muscle contractions. First-line
therapy includes bladder training and anticholinergic/antimuscarinic medications such as
oxybutynin. Doxazosin (alpha-blocker) and finasteride (5-alpha reductase inhibitor) are used for
voiding symptoms related to benign prostatic hyperplasia. Lifestyle modifications, such as
caffeine reduction, are also key components of treatment.
Question 9
An 82-year-old patient with a history of benign prostatic hyperplasia presents with acute urinary
retention. What is the initial step in management?
