A 49-year-old man is diagnosed with type 2 diabetes after an A1C of 7.4% and a fasting glucose of 148 mg/dL on separate days. He has no visual symptoms. In addition to a foot examination and a urine albumin-to-creatinine ratio, when should a dilated retinal examination be performed?

At diagnosis, then every 1-2 years if normal

Within 5 years of diagnosis, then annually thereafter

When the A1C first exceeds 9%, then annually

Only after visual symptoms develop

A 58-year-old woman stopped paroxetine 40 mg daily on her own 3 days ago because she felt better. She now has dizziness, nausea, irritability, vivid dreams, flu-like aches and brief electric shock-like sensations when she moves her eyes. Temperature is 37.0 C, and she has no tremor, clonus or hyperreflexia. Which is the most likely diagnosis?

Antidepressant discontinuation syndrome

Relapse of major depressive disorder

A 54-year-old woman with type 2 diabetes has an average blood pressure of 142/88 mm Hg on office and home readings over 1 month despite lifestyle changes. Her urine albumin-to-creatinine ratio is 12 mg/g and eGFR is 84 mL/min/1.73 m2. Which of the following is the most appropriate initial antihypertensive therapy?

Amlodipine-losartan single-pill combination daily

Metoprolol succinate 50 mg daily

A 44-year-old woman notices a painless lump in her neck. Exam shows a firm 2-cm nodule in the right thyroid lobe without cervical lymphadenopathy. TSH is 1.8 mIU/L. Which step is most appropriate?

Fine-needle aspiration without imaging

A 77-year-old woman started sertraline 3 weeks ago for depression and now has fatigue and mild confusion. She appears euvolemic, without edema or orthostatic changes, and takes no diuretics. TSH and morning cortisol are normal. Her results are shown. Test Result Reference range Serum sodium 124 mEq/L 135-145 mEq/L Serum osmolality 258 mOsm/kg 275-295 mOsm/kg Urine osmolality 430 mOsm/kg Not applicable Urine sodium 52 mEq/L Not applicable Glucose 96 mg/dL 70-99 mg/dL Which diagnosis is most likely?

Hypovolemic hyponatremia from poor intake

Pseudohyponatremia from hyperlipidemia

A 79-year-old man has 2 months of forgetfulness, fatigue, early morning awakening and a 4-kg weight loss. He complains loudly about his poor memory. On the MoCA he answers many items with "I don't know" and scores 22, and his effort is poor. He is alert and attentive, and labs including TSH and B12 are normal. Which is the most likely diagnosis?

Amnestic mild cognitive impairment

Adult-Gerontology Primary Care Nurse Practitioner Exam

Free AGPCNP Practice Questions

10 sample questions for the Adult-Gerontology Primary Care Nurse Practitioner Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Professional Practice, Health Promotion and Disease Prevention, Geriatric Assessment, Pharmacology and Palliative Care, Endocrine and Metabolic Disorders, Respiratory Disorders, Renal and Genitourinary Disorders, Reproductive and Sexual Health, Neurological, Musculoskeletal and Rheumatologic Disorders, HEENT and Integumentary Disorders.

Question 1 · Professional Practice, Health Promotion and Disease Prevention
A primary care network evaluated a new point-of-care test in 1,000 adults. A reference standard identified 100 adults who had the condition. The results are summarized as follows.
Group Test positive Test negative
Condition present 90 10
Condition absent 180 720
An NP plans to use this test in a clinic population with the same prevalence. Based on the data, what is the probability that a patient with a positive result truly has the condition?
- A.99%
- B.90%
- C.80%
- D.33%
Show answer and explanation
Answer: D. 33%
Sensitivity (90/100) and specificity (720/900) describe the test itself, and negative predictive value (720/730) describes negative results, so none of them answers this question. At a 10% prevalence even a fairly accurate test yields more false positives than true positives. The question asks for positive predictive value: true positives divided by all positives, 90 / (90 + 180) = 90/270, or 33%.
Question 2 · Endocrine and Metabolic Disorders
A 46-year-old woman has office blood pressures of 146/92 and 148/90 mm Hg at two visits a month apart. After her technique was checked, her 7-day home average with a validated upper-arm cuff is 124/76 mm Hg. She has no diabetes or kidney disease. Which of the following is the most likely diagnosis?
- A.Masked hypertension
- B.White coat hypertension
- C.Stage 1 hypertension
- D.Stage 2 hypertension
Show answer and explanation
Answer: B. White coat hypertension
Elevated office readings with normal out-of-office readings (home average below 130/80) define white coat hypertension, which needs periodic out-of-office monitoring rather than drug therapy. Diagnosing stage 1 or stage 2 hypertension requires that out-of-office readings confirm elevation. Masked hypertension is the opposite pattern, with normal office readings and elevated home or ambulatory readings.
Question 3 · Endocrine and Metabolic Disorders
A 49-year-old man is diagnosed with type 2 diabetes after an A1C of 7.4% and a fasting glucose of 148 mg/dL on separate days. He has no visual symptoms. In addition to a foot examination and a urine albumin-to-creatinine ratio, when should a dilated retinal examination be performed?
- A.Within 5 years of diagnosis, then annually thereafter
- B.At diagnosis, then every 1-2 years if normal
- C.When the A1C first exceeds 9%, then annually
- D.Only after visual symptoms develop
Show answer and explanation
Answer: B. At diagnosis, then every 1-2 years if normal
Because type 2 diabetes often goes undiagnosed for years, ADA recommends a dilated, comprehensive eye examination (or validated retinal imaging) at the time of diagnosis; if no retinopathy is found and glycemia is controlled, the interval can be extended to every 1-2 years. The 5-year delay applies to type 1 diabetes, and retinopathy screening does not depend on symptoms or A1C thresholds.
Question 4 · Renal and Genitourinary Disorders
A 15-year-old boy wakes with sudden severe left testicular pain and vomiting. The left testis is high-riding with a horizontal lie, the left cremasteric reflex is absent, and elevating the testis does not relieve the pain. Urinalysis is normal. Which diagnosis is most likely?
- A.Incarcerated inguinal hernia
- B.Testicular torsion
- C.Acute epididymitis
- D.Torsion of the appendix testis
Show answer and explanation
Answer: B. Testicular torsion
Sudden onset, vomiting, a high-riding testis with horizontal lie, an absent cremasteric reflex and a negative Prehn sign point to testicular torsion, a surgical emergency in which salvage falls sharply after about 6 hours; urgent urology evaluation should not wait for imaging when suspicion is high. Epididymitis develops gradually, often with pyuria, a preserved cremasteric reflex and relief with elevation. Torsion of the appendix testis causes a tender upper-pole nodule, sometimes with a blue dot sign.
Question 5 · Professional Practice, Health Promotion and Disease Prevention
A 58-year-old woman stopped paroxetine 40 mg daily on her own 3 days ago because she felt better. She now has dizziness, nausea, irritability, vivid dreams, flu-like aches and brief electric shock-like sensations when she moves her eyes. Temperature is 37.0 C, and she has no tremor, clonus or hyperreflexia. Which is the most likely diagnosis?
- A.Antidepressant discontinuation syndrome
- B.Serotonin syndrome
- C.Acute vestibular neuritis
- D.Relapse of major depressive disorder
Show answer and explanation
Answer: A. Antidepressant discontinuation syndrome
Abrupt cessation of a short-half-life SSRI such as paroxetine causes discontinuation syndrome within 1 to 3 days, with dizziness, nausea, flu-like symptoms, irritability, sleep disturbance and sensory brain zaps; restarting the drug and tapering slowly resolves it. Depressive relapse develops more gradually and does not cause sensory shocks. Serotonin syndrome follows an added serotonergic drug and causes hyperthermia, clonus and hyperreflexia, which are absent.
Question 6 · Professional Practice, Health Promotion and Disease Prevention
A randomized trial enrolled adults aged 50 to 69 with hypertension and followed them for 5 years. The proportion of patients who had a stroke in each group is shown as follows.
Group Stroke over 5 years
Usual care 10%
New treatment 6%
Based on the data, how many patients must receive the new treatment for 5 years to prevent one stroke?
- A.40
- B.25
- C.10
- D.17
Show answer and explanation
Answer: B. 25
The relative risk reduction (4 out of 10) is a percentage, not a patient count, and dividing 1 by the treated group's 6% event rate is not an NNT calculation. The absolute risk reduction is 10% - 6% = 4%, so the number needed to treat is 1 / 0.04 = 25 patients treated for 5 years.
Question 7 · Endocrine and Metabolic Disorders
A 54-year-old woman with type 2 diabetes has an average blood pressure of 142/88 mm Hg on office and home readings over 1 month despite lifestyle changes. Her urine albumin-to-creatinine ratio is 12 mg/g and eGFR is 84 mL/min/1.73 m2. Which of the following is the most appropriate initial antihypertensive therapy?
- A.Metoprolol succinate 50 mg daily
- B.Losartan 50 mg daily alone
- C.Amlodipine-losartan single-pill combination daily
- D.Lisinopril plus losartan daily
Show answer and explanation
Answer: C. Amlodipine-losartan single-pill combination daily
An average of 142/88 mm Hg is stage 2 hypertension, and the current ACC/AHA guideline recommends starting two first-line drugs from different classes, preferably as a single-pill combination, to reach a goal below 130/80. Without albuminuria, a thiazide, ACEI, ARB or CCB is acceptable, but one drug alone is unlikely to reach goal. An ACE inhibitor must never be combined with an ARB (hyperkalemia and kidney injury without added benefit), and beta blockers are not first line for uncomplicated hypertension.
Question 8 · Endocrine and Metabolic Disorders
A 44-year-old woman notices a painless lump in her neck. Exam shows a firm 2-cm nodule in the right thyroid lobe without cervical lymphadenopathy. TSH is 1.8 mIU/L. Which step is most appropriate?
- A.CT of the neck with contrast
- B.Radioactive iodine uptake scan
- C.Fine-needle aspiration without imaging
- D.Thyroid ultrasound
Show answer and explanation
Answer: D. Thyroid ultrasound
After TSH, every palpable thyroid nodule should be evaluated with diagnostic thyroid ultrasound, which characterizes size and sonographic features to decide on fine-needle aspiration and examines the cervical lymph nodes. A radioactive iodine scan is indicated only when TSH is low, to look for a hyperfunctioning nodule that rarely needs biopsy. FNA is guided by ultrasound findings rather than done blind, and CT is not a first-line thyroid imaging test.

Group	Test positive	Test negative
Condition present	90	10
Condition absent	180	720

Group	Stroke over 5 years
Usual care	10%
New treatment	6%

Question 9 · Renal and Genitourinary Disorders

A 77-year-old woman started sertraline 3 weeks ago for depression and now has fatigue and mild confusion. She appears euvolemic, without edema or orthostatic changes, and takes no diuretics. TSH and morning cortisol are normal. Her results are shown.

Test	Result	Reference range
Serum sodium	124 mEq/L	135-145 mEq/L
Serum osmolality	258 mOsm/kg	275-295 mOsm/kg
Urine osmolality	430 mOsm/kg	Not applicable
Urine sodium	52 mEq/L	Not applicable
Glucose	96 mg/dL	70-99 mg/dL

Which diagnosis is most likely?

A.Primary polydipsia
B.SIADH related to sertraline
C.Hypovolemic hyponatremia from poor intake
D.Pseudohyponatremia from hyperlipidemia

Show answer and explanation

Answer: B. SIADH related to sertraline

Hypotonic hyponatremia (serum osmolality 258 mOsm/kg) with inappropriately concentrated urine (over 100 mOsm/kg), urine sodium above 30 mEq/L, clinical euvolemia, no diuretic use and normal thyroid and adrenal function meets criteria for SIADH; SSRIs are a common cause in older adults. Hypovolemia would produce a low urine sodium, primary polydipsia produces maximally dilute urine under 100 mOsm/kg, and pseudohyponatremia has a normal serum osmolality. Management is stopping or switching the drug and fluid restriction.

Question 10 · Professional Practice, Health Promotion and Disease Prevention
A 79-year-old man has 2 months of forgetfulness, fatigue, early morning awakening and a 4-kg weight loss. He complains loudly about his poor memory. On the MoCA he answers many items with "I don't know" and scores 22, and his effort is poor. He is alert and attentive, and labs including TSH and B12 are normal. Which is the most likely diagnosis?
- A.Hypoactive delirium
- B.Early-stage Alzheimer disease
- C.Late-life major depression
- D.Amnestic mild cognitive impairment
Show answer and explanation
Answer: C. Late-life major depression
Subacute onset, prominent neurovegetative symptoms, emphasis on cognitive failure and poor effort with "I don't know" answers suggest depression with cognitive impairment, sometimes called pseudodementia. Patients with Alzheimer disease typically minimize deficits and attempt answers, giving near-miss responses. Delirium is excluded by his normal attention and alertness, and treating the depression often improves cognition.

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