AGNP Certification Exam Prep – Clinical
Management, Diagnostics & Advanced
Practice (ANCC / AANPCB)
1. A 68-year-old man with long-standing hypertension presents with
dyspnea on exertion and lower extremity edema. On exam you
hear an S3 gallop. Which is the most likely diagnosis?
A. Chronic obstructive pulmonary disease
B. Heart failure with reduced ejection fraction (HFrEF)
C. Pericarditis
D. Pulmonary embolism
Rationale: S3 gallop in an older patient with dyspnea and edema
suggests volume overload from systolic heart failure (HFrEF).
2. First-line therapy for newly diagnosed type 2 diabetes mellitus in
an adult with eGFR >45 and no contraindications is:
A. Insulin
B. Metformin
C. Glyburide
D. Pioglitazone
Rationale: Metformin is first-line unless contraindicated by renal
dysfunction or other issues.
3. A 55-year-old with COPD presents with acute increase in sputum
purulence, dyspnea, and cough. Which treatment is indicated if
moderate exacerbation?
A. Intravenous corticosteroids only
B. Immediate intubation
, C. Short course oral corticosteroids and a course of antibiotics if
bacterial infection is suspected
D. Inhaled bronchodilators are contraindicated
Rationale: Moderate COPD exacerbations are treated with
bronchodilators, short-course oral steroids, and antibiotics when
bacterial infection is likely.
4. Which lipid change is most strongly associated with increased
atherosclerotic cardiovascular disease (ASCVD) risk?
A. Elevated HDL
B. Elevated LDL cholesterol
C. Low triglycerides
D. Elevated apolipoprotein A1
Rationale: LDL cholesterol is the primary lipid target for ASCVD
risk reduction.
5. A 72-year-old with suspected community-acquired pneumonia:
which empirical outpatient antibiotic is appropriate for a patient
without comorbidities?
A. Levofloxacin
B. Amoxicillin or doxycycline or macrolide (if local pneumococcal
resistance is low)
C. Ceftriaxone IV at home
D. Vancomycin
Rationale: For outpatients without comorbidities, amoxicillin,
doxycycline, or macrolide (if resistance low) is typical empiric
therapy.
6. Best initial test for suspected iron-deficiency anemia in an adult?
A. Bone marrow biopsy
, B. CBC with peripheral smear and ferritin level
C. Serum B12 only
D. Direct antiglobulin test
Rationale: CBC and iron studies (ferritin, iron, TIBC) evaluate
iron-deficiency; ferritin is the best single test.
7. A 45-year-old woman with hypothyroid symptoms and TSH
elevated, free T4 low. Best initial management:
A. Methimazole
B. Initiate levothyroxine replacement
C. Radioactive iodine
D. Propranolol monotherapy
Rationale: Primary hypothyroidism is treated with levothyroxine
replacement.
8. For a 60-year-old with atrial fibrillation and CHA₂DS₂-VASc score of
3, recommended therapy to reduce stroke risk is:
A. Aspirin alone
B. No antithrombotic therapy
C. Oral anticoagulation (DOAC preferred unless contraindicated)
D. Dual antiplatelet therapy
Rationale: A CHA₂DS₂-VASc ≥2 in men (≥3 overall depending on
scoring) warrants anticoagulation; DOACs preferred absent
contraindication.
9. A 30-year-old presents with acute onset unilateral swollen, painful
knee after minor trauma. Best next test:
A. MRI knee immediately
B. Aspiration of the joint for synovial fluid analysis
C. Start NSAIDs and observe
D. Plain abdominal X-ray
, Rationale: Acute monoarthritis requires arthrocentesis to rule
out septic arthritis and crystal arthropathy.
10. Which vaccine is recommended annually for adults,
especially those with chronic illness?
A. Tdap only once
B. Varicella every year
C. Influenza vaccine yearly
D. HPV vaccine yearly
Rationale: Annual influenza vaccination is recommended for
almost all adults, particularly those with chronic conditions.
11. A patient with chronic kidney disease stage 3 has a
potassium of 5.8 mEq/L but is asymptomatic and EKG normal.
Next best step:
A. Urgent dialysis immediately
B. Repeat potassium, review medications, dietary counseling,
consider temporizing measures if persistent or EKG changes
develop
C. Discharge without changes
D. Give oral potassium supplement
Rationale: Mild hyperkalemia without EKG changes prompts
reassessment, medication review (e.g., ACEi), dietary counseling,
and outpatient management unless severe or ECG changes.
12. Screening for abdominal aortic aneurysm (AAA) with
onetime ultrasound is recommended in which group?
A. All women aged 65–75
B. Men aged 65–75 who have ever smoked
C. All adults over 50 regardless of history
D. Teenagers with family history
Management, Diagnostics & Advanced
Practice (ANCC / AANPCB)
1. A 68-year-old man with long-standing hypertension presents with
dyspnea on exertion and lower extremity edema. On exam you
hear an S3 gallop. Which is the most likely diagnosis?
A. Chronic obstructive pulmonary disease
B. Heart failure with reduced ejection fraction (HFrEF)
C. Pericarditis
D. Pulmonary embolism
Rationale: S3 gallop in an older patient with dyspnea and edema
suggests volume overload from systolic heart failure (HFrEF).
2. First-line therapy for newly diagnosed type 2 diabetes mellitus in
an adult with eGFR >45 and no contraindications is:
A. Insulin
B. Metformin
C. Glyburide
D. Pioglitazone
Rationale: Metformin is first-line unless contraindicated by renal
dysfunction or other issues.
3. A 55-year-old with COPD presents with acute increase in sputum
purulence, dyspnea, and cough. Which treatment is indicated if
moderate exacerbation?
A. Intravenous corticosteroids only
B. Immediate intubation
, C. Short course oral corticosteroids and a course of antibiotics if
bacterial infection is suspected
D. Inhaled bronchodilators are contraindicated
Rationale: Moderate COPD exacerbations are treated with
bronchodilators, short-course oral steroids, and antibiotics when
bacterial infection is likely.
4. Which lipid change is most strongly associated with increased
atherosclerotic cardiovascular disease (ASCVD) risk?
A. Elevated HDL
B. Elevated LDL cholesterol
C. Low triglycerides
D. Elevated apolipoprotein A1
Rationale: LDL cholesterol is the primary lipid target for ASCVD
risk reduction.
5. A 72-year-old with suspected community-acquired pneumonia:
which empirical outpatient antibiotic is appropriate for a patient
without comorbidities?
A. Levofloxacin
B. Amoxicillin or doxycycline or macrolide (if local pneumococcal
resistance is low)
C. Ceftriaxone IV at home
D. Vancomycin
Rationale: For outpatients without comorbidities, amoxicillin,
doxycycline, or macrolide (if resistance low) is typical empiric
therapy.
6. Best initial test for suspected iron-deficiency anemia in an adult?
A. Bone marrow biopsy
, B. CBC with peripheral smear and ferritin level
C. Serum B12 only
D. Direct antiglobulin test
Rationale: CBC and iron studies (ferritin, iron, TIBC) evaluate
iron-deficiency; ferritin is the best single test.
7. A 45-year-old woman with hypothyroid symptoms and TSH
elevated, free T4 low. Best initial management:
A. Methimazole
B. Initiate levothyroxine replacement
C. Radioactive iodine
D. Propranolol monotherapy
Rationale: Primary hypothyroidism is treated with levothyroxine
replacement.
8. For a 60-year-old with atrial fibrillation and CHA₂DS₂-VASc score of
3, recommended therapy to reduce stroke risk is:
A. Aspirin alone
B. No antithrombotic therapy
C. Oral anticoagulation (DOAC preferred unless contraindicated)
D. Dual antiplatelet therapy
Rationale: A CHA₂DS₂-VASc ≥2 in men (≥3 overall depending on
scoring) warrants anticoagulation; DOACs preferred absent
contraindication.
9. A 30-year-old presents with acute onset unilateral swollen, painful
knee after minor trauma. Best next test:
A. MRI knee immediately
B. Aspiration of the joint for synovial fluid analysis
C. Start NSAIDs and observe
D. Plain abdominal X-ray
, Rationale: Acute monoarthritis requires arthrocentesis to rule
out septic arthritis and crystal arthropathy.
10. Which vaccine is recommended annually for adults,
especially those with chronic illness?
A. Tdap only once
B. Varicella every year
C. Influenza vaccine yearly
D. HPV vaccine yearly
Rationale: Annual influenza vaccination is recommended for
almost all adults, particularly those with chronic conditions.
11. A patient with chronic kidney disease stage 3 has a
potassium of 5.8 mEq/L but is asymptomatic and EKG normal.
Next best step:
A. Urgent dialysis immediately
B. Repeat potassium, review medications, dietary counseling,
consider temporizing measures if persistent or EKG changes
develop
C. Discharge without changes
D. Give oral potassium supplement
Rationale: Mild hyperkalemia without EKG changes prompts
reassessment, medication review (e.g., ACEi), dietary counseling,
and outpatient management unless severe or ECG changes.
12. Screening for abdominal aortic aneurysm (AAA) with
onetime ultrasound is recommended in which group?
A. All women aged 65–75
B. Men aged 65–75 who have ever smoked
C. All adults over 50 regardless of history
D. Teenagers with family history
