AGNP CERTIFICATION COMPLETE PRACTICE
EXAM 150-QUESTION HIGH-YIELD PRACTICE TEST
WITH RATIONALES Adult-Gerontology Primary Care
Nurse Practitioner - Board Exam Standard
SECTION 1: CARDIOVASCULAR (Questions 1-30)
1. A 62-year-old male with hypertension presents with sudden onset chest pain
radiating to the left arm. ECG shows ST elevation in leads II, III, and aVF.
Which coronary artery is MOST likely involved?
A) Left anterior descending (LAD)
B) Right coronary artery (RCA)
C) Left circumflex artery
D) Left main coronary artery
Answer: B
Rationale: ST elevation in II, III, aVF indicates inferior wall MI, which is most
commonly caused by RCA occlusion. LAD (A) causes anterior MI (leads V1-V4),
circumflex (C) causes lateral MI (leads I, aVL, V5-V6), left main (D) causes
extensive anterior MI.
2. Which medication is FIRST-LINE for hypertension in a patient with
diabetes?
A) Beta-blocker
B) ACE inhibitor or ARB
C) Calcium channel blocker
D) Thiazide diuretic
Answer: B
Rationale: ACE inhibitors (e.g., lisinopril) or ARBs (e.g., losartan) are first-line
for HTN in diabetes due to renal protective effects (reduce proteinuria, slow
nephropathy progression). Beta-blockers (A) are second-line, CCBs (C) and
thiazides (D) are alternatives or add-on therapy.
,3. A 75-year-old female presents with exertional dyspnea, fatigue, and
syncope. Physical exam reveals a harsh, crescendo-decrescendo murmur at
the right 2nd intercostal space radiating to the carotids. What is the MOST
likely diagnosis?
A) Mitral stenosis
B) Aortic stenosis
C) Mitral regurgitation
D) Aortic regurgitation
Answer: B
Rationale: Classic triad of aortic stenosis: dyspnea, fatigue, syncope (SAF). Harsh
crescendo-decrescendo murmur at right 2nd ICS radiating to carotids is diagnostic.
Mitral stenosis (A) = diastolic rumble, mitral regurgitation (C) = holosystolic at
apex, aortic regurgitation (D) = diastolic decrescendo.
4. What is the target LDL for a patient with established coronary artery
disease (CAD)?
A) <100 mg/dL
B) <70 mg/dL
C) <50 mg/dL
D) <130 mg/dL
Answer: B
Rationale: For patients with established CAD (very high risk), ACC/AHA
recommends LDL <70 mg/dL. <100 (A) is for moderate risk, <50 (C) is for
extremely high risk in some guidelines, <130 (D) is for low risk.
5. Which finding is MOST specific for heart failure?
A) JVD
B) Peripheral edema
C) Elevated BNP
D) Hepatomegaly
Answer: C
Rationale: Elevated BNP (>100 pg/mL) or NT-proBNP is highly specific for heart
failure. JVD (A), edema (B), and hepatomegaly (D) can occur in other conditions
(e.g., liver disease, venous insufficiency).
,6. A 58-year-old male presents with palpitations. ECG shows irregularly
irregular rhythm without P waves. What is the MOST appropriate initial
management?
A) Warfarin
B) Beta-blocker
C) Amiodarone
D) Digoxin
Answer: B
Rationale: Irregularly irregular rhythm without P waves = atrial fibrillation. Initial
management: rate control with beta-blocker (e.g., metoprolol) or calcium channel
blocker. Anticoagulation (A) depends on stroke risk (CHA2DS2-VASc).
Amiodarone (C) is for rhythm control if needed, digoxin (D) is second-line.
7. Which antihypertensive is CONTRAINDICATED in pregnancy?
A) Labetalol
B) Lisinopril
C) Amlodipine
D) Methyldopa
Answer: B
Rationale: ACE inhibitors (lisinopril) are contraindicated in pregnancy → fetal
renal damage, oligohydramnios, death. Labetalol (A), amlodipine (C), and
methyldopa (D) are safe in pregnancy.
8. What is the hallmark symptom of peripheral arterial disease (PAD)?
A) Rest pain
B) Intermittent claudication
C) Edema
D) Night cramps
Answer: B
Rationale: Intermittent claudication (pain with walking/exercise, relieved by rest)
is the hallmark of PAD. Rest pain (A) indicates severe disease (critical limb
ischemia), edema (C) = venous disease, night cramps (D) = not specific.
, 9. A 65-year-old female with HTN presents with bilateral leg swelling. Which
medication is MOST likely causing this?
A) Lisinopril
B) Metoprolol
C) Amlodipine
D) Hydrochlorothiazide
Answer: C
Rationale: Amlodipine (calcium channel blocker) commonly causes peripheral
edema due to vasodilation. Lisinopril (A) = angioedema (rare), metoprolol (B) =
no edema, HCTZ (D) = no edema.
10. Which ECG finding indicates HYPERKALEMIA?
A) Peaked T waves
B) ST elevation
C) T wave inversion
D) QT prolongation
Answer: A
Rationale: Hyperkalemia = peaked T waves, widened QRS, loss of P waves,
prolonged PR. ST elevation (B) = MI, T inversion (C) = ischemia, QT
prolongation (D) = hypokalemia or drugs.
11. What is the FIRST diagnostic test for suspected pulmonary embolism
(PE)?
A) CT pulmonary angiogram
B) D-dimer
C) V/Q scan
D) Echocardiogram
Answer: B
Rationale: For low/moderate risk patients, D-dimer is first to rule out PE (if
negative, no PE). If D-dimer positive or high risk, then CT pulmonary angiogram
(A). V/Q scan (C) is alternative, echo (D) assesses hemodynamics.
EXAM 150-QUESTION HIGH-YIELD PRACTICE TEST
WITH RATIONALES Adult-Gerontology Primary Care
Nurse Practitioner - Board Exam Standard
SECTION 1: CARDIOVASCULAR (Questions 1-30)
1. A 62-year-old male with hypertension presents with sudden onset chest pain
radiating to the left arm. ECG shows ST elevation in leads II, III, and aVF.
Which coronary artery is MOST likely involved?
A) Left anterior descending (LAD)
B) Right coronary artery (RCA)
C) Left circumflex artery
D) Left main coronary artery
Answer: B
Rationale: ST elevation in II, III, aVF indicates inferior wall MI, which is most
commonly caused by RCA occlusion. LAD (A) causes anterior MI (leads V1-V4),
circumflex (C) causes lateral MI (leads I, aVL, V5-V6), left main (D) causes
extensive anterior MI.
2. Which medication is FIRST-LINE for hypertension in a patient with
diabetes?
A) Beta-blocker
B) ACE inhibitor or ARB
C) Calcium channel blocker
D) Thiazide diuretic
Answer: B
Rationale: ACE inhibitors (e.g., lisinopril) or ARBs (e.g., losartan) are first-line
for HTN in diabetes due to renal protective effects (reduce proteinuria, slow
nephropathy progression). Beta-blockers (A) are second-line, CCBs (C) and
thiazides (D) are alternatives or add-on therapy.
,3. A 75-year-old female presents with exertional dyspnea, fatigue, and
syncope. Physical exam reveals a harsh, crescendo-decrescendo murmur at
the right 2nd intercostal space radiating to the carotids. What is the MOST
likely diagnosis?
A) Mitral stenosis
B) Aortic stenosis
C) Mitral regurgitation
D) Aortic regurgitation
Answer: B
Rationale: Classic triad of aortic stenosis: dyspnea, fatigue, syncope (SAF). Harsh
crescendo-decrescendo murmur at right 2nd ICS radiating to carotids is diagnostic.
Mitral stenosis (A) = diastolic rumble, mitral regurgitation (C) = holosystolic at
apex, aortic regurgitation (D) = diastolic decrescendo.
4. What is the target LDL for a patient with established coronary artery
disease (CAD)?
A) <100 mg/dL
B) <70 mg/dL
C) <50 mg/dL
D) <130 mg/dL
Answer: B
Rationale: For patients with established CAD (very high risk), ACC/AHA
recommends LDL <70 mg/dL. <100 (A) is for moderate risk, <50 (C) is for
extremely high risk in some guidelines, <130 (D) is for low risk.
5. Which finding is MOST specific for heart failure?
A) JVD
B) Peripheral edema
C) Elevated BNP
D) Hepatomegaly
Answer: C
Rationale: Elevated BNP (>100 pg/mL) or NT-proBNP is highly specific for heart
failure. JVD (A), edema (B), and hepatomegaly (D) can occur in other conditions
(e.g., liver disease, venous insufficiency).
,6. A 58-year-old male presents with palpitations. ECG shows irregularly
irregular rhythm without P waves. What is the MOST appropriate initial
management?
A) Warfarin
B) Beta-blocker
C) Amiodarone
D) Digoxin
Answer: B
Rationale: Irregularly irregular rhythm without P waves = atrial fibrillation. Initial
management: rate control with beta-blocker (e.g., metoprolol) or calcium channel
blocker. Anticoagulation (A) depends on stroke risk (CHA2DS2-VASc).
Amiodarone (C) is for rhythm control if needed, digoxin (D) is second-line.
7. Which antihypertensive is CONTRAINDICATED in pregnancy?
A) Labetalol
B) Lisinopril
C) Amlodipine
D) Methyldopa
Answer: B
Rationale: ACE inhibitors (lisinopril) are contraindicated in pregnancy → fetal
renal damage, oligohydramnios, death. Labetalol (A), amlodipine (C), and
methyldopa (D) are safe in pregnancy.
8. What is the hallmark symptom of peripheral arterial disease (PAD)?
A) Rest pain
B) Intermittent claudication
C) Edema
D) Night cramps
Answer: B
Rationale: Intermittent claudication (pain with walking/exercise, relieved by rest)
is the hallmark of PAD. Rest pain (A) indicates severe disease (critical limb
ischemia), edema (C) = venous disease, night cramps (D) = not specific.
, 9. A 65-year-old female with HTN presents with bilateral leg swelling. Which
medication is MOST likely causing this?
A) Lisinopril
B) Metoprolol
C) Amlodipine
D) Hydrochlorothiazide
Answer: C
Rationale: Amlodipine (calcium channel blocker) commonly causes peripheral
edema due to vasodilation. Lisinopril (A) = angioedema (rare), metoprolol (B) =
no edema, HCTZ (D) = no edema.
10. Which ECG finding indicates HYPERKALEMIA?
A) Peaked T waves
B) ST elevation
C) T wave inversion
D) QT prolongation
Answer: A
Rationale: Hyperkalemia = peaked T waves, widened QRS, loss of P waves,
prolonged PR. ST elevation (B) = MI, T inversion (C) = ischemia, QT
prolongation (D) = hypokalemia or drugs.
11. What is the FIRST diagnostic test for suspected pulmonary embolism
(PE)?
A) CT pulmonary angiogram
B) D-dimer
C) V/Q scan
D) Echocardiogram
Answer: B
Rationale: For low/moderate risk patients, D-dimer is first to rule out PE (if
negative, no PE). If D-dimer positive or high risk, then CT pulmonary angiogram
(A). V/Q scan (C) is alternative, echo (D) assesses hemodynamics.
