adult gerontology acute care nurse practitioner agacnpancc certification exam board review 20222023detailed questions and answers
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ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER
(AGACNP)/ANCC CERTIFICATION EXAM BOARD REVIEW
2022/2023
1. A 35 yo male presents with a 3-month history of constipation, blood-streaked stools, and decreasing
stool caliber. Barium enema reveals a lesion in the descending colon (classic applecore lesion). Which
aspect of the patient's history is MOST likely to be helpful in understanding the cause of the patient's
colon cancer?
a. Travel history
b. Dietary history
c. Family history
d. Sexual history (correct answers)c. Family history
Rationale: The risk of colon cancer increases with age, with peak incidence between 70 and 80. Colon
cancer is rare in persons under age 50, unless they have a predisposing risk factors. Strongest risk factor
for the development of colon cancer is one of the hereditary polyposis syndromes (familial
adenomatous polyposis, or hereditary non-polyposis colorectal cancer). In patients with familial
adenomatous polyposis, the risk for colon cancer is nearly 100% by age 40. Thus, inquiry about family
history of premature colon cancer or familial polyposis would be the most helpful historical information
in understanding why this young man has colon cancer, a disease usually seen at a much older age.
Patients on a high-fat, low fiber diet are also at increased risk for colon cancer, but the excess risk is
small. Foreign travel might put him at risk for parasitic diseases of the colon such as amebiasis, but this
does not increase the risk for colon cancer. Persons who practice anal sex are at risk for infectious
diseases of the colon such as gonorrhea and for anal carcinoma related to HPV, but these illnesses do
not cause apple core lesions of the colon.
2. A 60-year-old male complains of cough, increasing shortness of breath, and headache for the past 3
weeks. He has mild hypertension for which he takes hydrochlorothiazide; he has smoked 1 pack of
cigarettes a day for 40 years. On examination you notice facial fullness and jugular venous distention to
the angle of the jaw. He has prominent veins over the anterior chest and a firm to hard right
supraclavicular lymph node. Cardiac examination is normal, and lungs are without rales. Peripheral
edema is absent. What is the most likely cause of his condition?
a. Gastric carcinoma
b. Emphysema
c. Lung cancer
d. Congestive heart failure (correct answers)c. Lung cancer
, Rationale: The patient is presenting with superior vena cava (SVC) syndrome. Such patients have jugular
venous distension but no other signs of right sided heart failure. They have prominent facial (especially
periorbital) puffiness and may complain of headache, dizziness, or lethargy. SVC syndrome is caused by a
malignant tumor 90% of the time. Lung cancer and lymphoma, both of which are often associated with
bulky mediastinal lymphadenopathy, predominate. Gastric cancer often metastasizes to the
supraclavicular nodes (most often on the left, the so-called Virchow node) but does not usually affect
the mediastinal nodes to this degree. Prompt diagnosis is necessary to prevent CNS complications or
laryngeal edema. Sensitive tumors (lymphoma, small cell lung cancer) may be treated with
chemotherapy, while most other cell types are treated with radiation therapy. Emphysema does not
cause SVC syndrome.
3. A 35 yo female is evaluated by her primary care physician for an annual health exam. During her visit,
she expresses concern regarding her risk of ovarian cancer, as one of her close friends was recently
diagnosed with advanced ovarian cancer. She works as a software engineer in a securities firm, smokes
half a pack of cigarettes a day and has no family history of breast, ovarian or colon cancer. She appears
healthy and her physical examination is unremarkable. What is the best screening option for the
patient?
a. CA-125
b. Transvaginal pelvic ultrasound
c. BRAC-1 and BRCA-2 mutation analysis
d. No screening is required (correct answers)d. No screening is required
Rationale: Although ovarian cancer is the leading cause of death from gynecologic malignancy in the
U.S., currently no screening test for early detection in the general population is recommended.
Screening with annual CA-125 levels, transvaginal ultrasound, or pelvic CT scan has not shown reduction
in mortality. BRAC-1 and BRAC 2 mutations are associated with familial breast-ovarian cancer syndrome,
but screening of BRCA-1 and BRCA-2 are recommended for women with 2 or more relatives with breast
or ovarian cancer.
4. A 46 yo female complains of fatigue and night sweats associated with itching for 2 months. On PE,
there is diffuse non-tender lymphadenopathy, including small supraclavicular, epitrochlear and scalene
nodes. CBC and chemistry studies (including liver enzymes) are normal. Chest X-ray shows hilar
lymphadenopathy. Which of the following is the best next step in evaluation?
a. Excisional lymph node biopsy
b. Percutaneous aspiration biopsy of the largest lymph node
c. Monospot test
d. Toxoplasmosis IgG serology (correct answers)a. Excisional lymph node biopsy
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