[ADULT-GERONTOLOGY NURSE PRACTITIONER CERTIFICATION EXAM] – EXAM-
STYLE QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS |
PLUS RATIONALES | GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST
1. A 72-year-old male with a history of hypertension and type 2 diabetes
presents for a routine examination. His current medications include lisinopril 20
mg daily and metformin 1000 mg twice daily. His blood pressure today is
142/88 mmHg, and his most recent HbA1c is 7.2%. Which of the following
represents the most appropriate next step in his management?
A. Increase lisinopril to 40 mg daily and recheck in 4 weeks.
B. Add amlodipine 5 mg daily and continue metformin.
C. Add a low-dose thiazide diuretic and order a basic metabolic panel.
D. Maintain current medications and schedule a follow-up in 3 months.
Correct Answer: C. Add a low-dose thiazide diuretic and order a basic
metabolic panel.
Rationale: The patient’s blood pressure is above the target of <130/80 mmHg for
those with diabetes. The current ACE inhibitor dose is at a moderate level; adding a
low-dose thiazide diuretic is an appropriate second-line agent for additional blood
pressure control. Before initiating a thiazide, a basic metabolic panel is prudent to
assess renal function and baseline electrolytes. Increasing lisinopril to the maximum
dose may be an option but is not the most appropriate first step given the patient's
current level. Adding amlodipine is also a valid option, but thiazides are often
preferred for additive effects in this population. Maintaining current therapy is not
appropriate given the elevated blood pressure.
,2. Which of the following clinical findings is most suggestive of a chronic
condition rather than an acute process in an older adult?
A. Acute onset of confusion and hallucinations.
B. A rapid decline in serum creatinine from 2.0 to 1.2 mg/dL.
C. Progressive difficulty with word-finding over the past 18 months.
D. Sudden, severe headache accompanied by photophobia.
Correct Answer: C. Progressive difficulty with word-finding over the past 18
months.
Rationale: The insidious onset and progression of cognitive or language difficulties
over a period of years is a hallmark of a chronic neurodegenerative process such as
Alzheimer’s disease or primary progressive aphasia. Acute onset of confusion
(delirium), rapid changes in lab values, and sudden severe headache are more
characteristic of acute or subacute medical issues.
3. A 67-year-old female presents with a 6-month history of bilateral hand pain,
stiffness, and swelling that is worse in the mornings and lasts for over an hour.
She also reports fatigue and a low-grade fever. On examination, you note
symmetric swelling of the metacarpophalangeal and proximal interphalangeal
joints. Which of the following is the most appropriate next step in her workup?
A. Order serum uric acid and C-reactive protein.
B. Order rheumatoid factor and anti-cyclic citrullinated peptide antibodies.
C. Prescribe a trial of prednisone and schedule a follow-up in 2 weeks.
D. Order plain radiographs of the hands and wrists.
Correct Answer: B. Order rheumatoid factor and anti-cyclic citrullinated peptide
antibodies.
,Rationale: This presentation is classic for rheumatoid arthritis (RA), characterized
by symmetric polyarthritis of the small joints of the hands, prolonged morning
stiffness, and systemic symptoms. The most appropriate initial serologic workup is
to order rheumatoid factor (RF) and anti-CCP antibodies, which are the most
specific serologic markers for RA. While radiographs are part of the workup,
serologic confirmation is a priority. Serum uric acid is for gout, which typically
presents with monoarticular involvement. While a trial of corticosteroids might be
used later, it is not the first diagnostic step.
4. According to the USPSTF guidelines, which of the following screening
recommendations is correctly paired with the appropriate population?
A. Abdominal aortic aneurysm (AAA) screening: One-time ultrasonography for
men aged 65 to 75 who have ever smoked.
B. Colorectal cancer screening: Colonoscopy every 5 years for adults aged 50 to
75.
C. Osteoporosis screening: Dual-energy x-ray absorptiometry (DXA) for all women
beginning at age 50.
D. Lung cancer screening: Annual low-dose computed tomography for adults
aged 55 to 80 with a 10 pack-year smoking history.
Correct Answer: A. Abdominal aortic aneurysm (AAA) screening: One-time
ultrasonography for men aged 65 to 75 who have ever smoked.
Rationale: The USPSTF recommends one-time screening for AAA with
ultrasonography in men aged 65 to 75 who have ever smoked. For colorectal
cancer, colonoscopy is recommended every 10 years, not 5. Osteoporosis screening
with DXA is recommended for women aged 65 and older, not all women at age 50.
, Lung cancer screening is recommended for adults aged 50 to 80 with a 20 pack-
year smoking history, not 10.
5. A 78-year-old male is prescribed warfarin for atrial fibrillation. He is started
on a new antibiotic for a urinary tract infection. Which of the following
antibiotics is most likely to significantly increase his international normalized
ratio (INR) and risk of bleeding?
A. Amoxicillin
B. Ciprofloxacin
C. Doxycycline
D. Nitrofurantoin
Correct Answer: B. Ciprofloxacin.
Rationale: Ciprofloxacin, a fluoroquinolone, is a known inhibitor of the CYP2C9
enzyme system, which metabolizes warfarin. This inhibition leads to decreased
warfarin clearance and a significantly elevated INR, increasing the risk of major
bleeding. Amoxicillin and doxycycline have a weaker potential for this interaction.
Nitrofurantoin is generally not associated with significant INR increases when used
concurrently with warfarin.
6. A 65-year-old female is newly diagnosed with stage 2 chronic kidney disease
(CKD) with an eGFR of 65 mL/min/1.73m². She has a history of hypertension
and hyperlipidemia. Which of the following medications should be reviewed
and potentially held or reduced based on her current eGFR?
A. Atorvastatin 20 mg daily
B. Amlodipine 5 mg daily
STYLE QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS |
PLUS RATIONALES | GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST
1. A 72-year-old male with a history of hypertension and type 2 diabetes
presents for a routine examination. His current medications include lisinopril 20
mg daily and metformin 1000 mg twice daily. His blood pressure today is
142/88 mmHg, and his most recent HbA1c is 7.2%. Which of the following
represents the most appropriate next step in his management?
A. Increase lisinopril to 40 mg daily and recheck in 4 weeks.
B. Add amlodipine 5 mg daily and continue metformin.
C. Add a low-dose thiazide diuretic and order a basic metabolic panel.
D. Maintain current medications and schedule a follow-up in 3 months.
Correct Answer: C. Add a low-dose thiazide diuretic and order a basic
metabolic panel.
Rationale: The patient’s blood pressure is above the target of <130/80 mmHg for
those with diabetes. The current ACE inhibitor dose is at a moderate level; adding a
low-dose thiazide diuretic is an appropriate second-line agent for additional blood
pressure control. Before initiating a thiazide, a basic metabolic panel is prudent to
assess renal function and baseline electrolytes. Increasing lisinopril to the maximum
dose may be an option but is not the most appropriate first step given the patient's
current level. Adding amlodipine is also a valid option, but thiazides are often
preferred for additive effects in this population. Maintaining current therapy is not
appropriate given the elevated blood pressure.
,2. Which of the following clinical findings is most suggestive of a chronic
condition rather than an acute process in an older adult?
A. Acute onset of confusion and hallucinations.
B. A rapid decline in serum creatinine from 2.0 to 1.2 mg/dL.
C. Progressive difficulty with word-finding over the past 18 months.
D. Sudden, severe headache accompanied by photophobia.
Correct Answer: C. Progressive difficulty with word-finding over the past 18
months.
Rationale: The insidious onset and progression of cognitive or language difficulties
over a period of years is a hallmark of a chronic neurodegenerative process such as
Alzheimer’s disease or primary progressive aphasia. Acute onset of confusion
(delirium), rapid changes in lab values, and sudden severe headache are more
characteristic of acute or subacute medical issues.
3. A 67-year-old female presents with a 6-month history of bilateral hand pain,
stiffness, and swelling that is worse in the mornings and lasts for over an hour.
She also reports fatigue and a low-grade fever. On examination, you note
symmetric swelling of the metacarpophalangeal and proximal interphalangeal
joints. Which of the following is the most appropriate next step in her workup?
A. Order serum uric acid and C-reactive protein.
B. Order rheumatoid factor and anti-cyclic citrullinated peptide antibodies.
C. Prescribe a trial of prednisone and schedule a follow-up in 2 weeks.
D. Order plain radiographs of the hands and wrists.
Correct Answer: B. Order rheumatoid factor and anti-cyclic citrullinated peptide
antibodies.
,Rationale: This presentation is classic for rheumatoid arthritis (RA), characterized
by symmetric polyarthritis of the small joints of the hands, prolonged morning
stiffness, and systemic symptoms. The most appropriate initial serologic workup is
to order rheumatoid factor (RF) and anti-CCP antibodies, which are the most
specific serologic markers for RA. While radiographs are part of the workup,
serologic confirmation is a priority. Serum uric acid is for gout, which typically
presents with monoarticular involvement. While a trial of corticosteroids might be
used later, it is not the first diagnostic step.
4. According to the USPSTF guidelines, which of the following screening
recommendations is correctly paired with the appropriate population?
A. Abdominal aortic aneurysm (AAA) screening: One-time ultrasonography for
men aged 65 to 75 who have ever smoked.
B. Colorectal cancer screening: Colonoscopy every 5 years for adults aged 50 to
75.
C. Osteoporosis screening: Dual-energy x-ray absorptiometry (DXA) for all women
beginning at age 50.
D. Lung cancer screening: Annual low-dose computed tomography for adults
aged 55 to 80 with a 10 pack-year smoking history.
Correct Answer: A. Abdominal aortic aneurysm (AAA) screening: One-time
ultrasonography for men aged 65 to 75 who have ever smoked.
Rationale: The USPSTF recommends one-time screening for AAA with
ultrasonography in men aged 65 to 75 who have ever smoked. For colorectal
cancer, colonoscopy is recommended every 10 years, not 5. Osteoporosis screening
with DXA is recommended for women aged 65 and older, not all women at age 50.
, Lung cancer screening is recommended for adults aged 50 to 80 with a 20 pack-
year smoking history, not 10.
5. A 78-year-old male is prescribed warfarin for atrial fibrillation. He is started
on a new antibiotic for a urinary tract infection. Which of the following
antibiotics is most likely to significantly increase his international normalized
ratio (INR) and risk of bleeding?
A. Amoxicillin
B. Ciprofloxacin
C. Doxycycline
D. Nitrofurantoin
Correct Answer: B. Ciprofloxacin.
Rationale: Ciprofloxacin, a fluoroquinolone, is a known inhibitor of the CYP2C9
enzyme system, which metabolizes warfarin. This inhibition leads to decreased
warfarin clearance and a significantly elevated INR, increasing the risk of major
bleeding. Amoxicillin and doxycycline have a weaker potential for this interaction.
Nitrofurantoin is generally not associated with significant INR increases when used
concurrently with warfarin.
6. A 65-year-old female is newly diagnosed with stage 2 chronic kidney disease
(CKD) with an eGFR of 65 mL/min/1.73m². She has a history of hypertension
and hyperlipidemia. Which of the following medications should be reviewed
and potentially held or reduced based on her current eGFR?
A. Atorvastatin 20 mg daily
B. Amlodipine 5 mg daily
