2026 AGPCNP-BC Exam Prep: Adult-
Gerontology Primary Care Practice
Questions with Answer Rationales for Adult
Health Assessment, Diagnosis, Treatment,
Pharmacology, Clinical Management, and
Study Guide
Domain 1: Patient Assessment Process (24% of Scored Exam)
Q1. A 68-year-old male presents for his annual wellness visit. He has a history of
hypertension and type 2 diabetes. Which screening test is most appropriate to
recommend at this visit?
A. Chest X-ray
B. Low-dose CT scan for lung cancer
C. Carotid artery ultrasound
D. Cardiac stress test
Answer: B
Rationale: Low-dose CT scan for lung cancer screening is recommended annually
for adults aged 50–80 with a 20 pack-year smoking history who currently smoke or
quit within the past 15 years. The USPSTF recommends this as a Grade B
screening. Chest X-ray is not recommended for lung cancer screening, and carotid
ultrasound and cardiac stress test are not routine screening tests for asymptomatic
patients without specific indications .
Q2. During the cardiovascular examination of a 72-year-old female, the NP
auscultates an S4 heart sound. This finding most commonly indicates:
A. Mitral valve regurgitation
B. Left ventricular hypertrophy
,C. Aortic stenosis
D. Atrial fibrillation
Answer: B
Rationale: An S4 heart sound (atrial gallop) is caused by atrial contraction against
a stiff, non-compliant left ventricle. It is most commonly associated with left
ventricular hypertrophy due to hypertension, which is prevalent in older adults.
Mitral regurgitation typically causes a holosystolic murmur, aortic stenosis causes
a crescendo-decrescendo systolic murmur, and atrial fibrillation is characterized by
an irregularly irregular rhythm .
Q3. A 55-year-old patient reports progressive hearing loss in both ears over the
past year. The NP performs the whisper test and notes decreased hearing
bilaterally. The next most appropriate step is:
A. Immediate referral to an audiologist
B. Prescribe hearing aids
C. Perform pneumatic otoscopy and order audiometry
D. Order CT scan of the temporal bones
Answer: C
Rationale: For suspected hearing loss, the NP should first perform a complete ear
examination including pneumatic otoscopy to assess for cerumen impaction,
infection, or tympanic membrane abnormalities, followed by audiometry for
formal testing. Immediate audiologist referral without basic evaluation is
premature .
Q4. A 70-year-old female presents with sudden onset of severe headache, neck
stiffness, and photophobia. What is the most likely diagnosis?
A. Migraine
B. Subarachnoid hemorrhage
C. Tension headache
D. Meningitis
Answer: B
,Rationale: The "thunderclap" headache with meningismus is classic for
subarachnoid hemorrhage. Meningitis also presents with neck stiffness and
photophobia but typically has fever and a more gradual onset. Migraine and
tension headache do not present with neck stiffness.
Q5. A 72-year-old patient presents with a Mini-Cog score of 2/5. What is the most
appropriate next step?
A. Diagnose dementia and start donepezil
B. Perform a comprehensive cognitive assessment and workup
C. Reassure the patient that this is normal aging
D. Order a head CT only
Answer: B
Rationale: A Mini-Cog score of ≤3 suggests cognitive impairment and warrants a
comprehensive assessment to identify reversible causes and determine the
underlying etiology. Diagnosis of dementia requires more than a screening test,
and a score of 2/5 is not normal aging.
Q6. A 65-year-old patient has a CHA₂DS₂-VASc score of 4 with new atrial
fibrillation. Which is the most appropriate stroke prevention strategy?
A. Aspirin 81 mg daily
B. Anticoagulation with a direct oral anticoagulant (DOAC) or warfarin
C. No antithrombotic therapy
D. Clopidogrel 75 mg daily
Answer: B
Rationale: A CHA₂DS₂-VASc score of ≥2 in men (or ≥3 in women) warrants oral
anticoagulation. DOACs are preferred over warfarin in most patients without
mechanical valves or severe mitral stenosis. Aspirin and clopidogrel are not
adequate for stroke prevention in high-risk AF.
Q7. Which laboratory value is most indicative of early renal impairment in an
older adult?
, A. Serum sodium 138 mmol/L
B. Blood urea nitrogen 28 mg/dL
C. Creatinine clearance 70 mL/min
D. Glomerular filtration rate 55 mL/min/1.73 m²
Answer: D
Rationale: GFR accounts for age-related muscle mass loss; a value <60
mL/min/1.73 m² signals chronic kidney disease. Serum sodium is within normal
limits, BUN is nonspecific, and creatinine clearance overestimates renal function
in older adults due to reduced muscle mass.
Q8. A 78-year-old patient has a creatinine of 2.0 mg/dL. Which factor most affects
the interpretation of this value?
A. The patient's age
B. The patient's muscle mass
C. The patient's hydration status
D. All of the above
Answer: D
Rationale: Serum creatinine is affected by age (reduced renal function), muscle
mass (reduced in frail elderly), and hydration status. All must be considered when
interpreting creatinine values in older adults.
Q9. Which screening tool is recommended for depression in older adults?
A. PHQ-9
B. MMSE
C. CAM
D. MoCA
Answer: A
Rationale: The PHQ-9 is a validated screening tool for depression in older adults.
MMSE and MoCA assess cognition, and CAM assesses delirium.
Gerontology Primary Care Practice
Questions with Answer Rationales for Adult
Health Assessment, Diagnosis, Treatment,
Pharmacology, Clinical Management, and
Study Guide
Domain 1: Patient Assessment Process (24% of Scored Exam)
Q1. A 68-year-old male presents for his annual wellness visit. He has a history of
hypertension and type 2 diabetes. Which screening test is most appropriate to
recommend at this visit?
A. Chest X-ray
B. Low-dose CT scan for lung cancer
C. Carotid artery ultrasound
D. Cardiac stress test
Answer: B
Rationale: Low-dose CT scan for lung cancer screening is recommended annually
for adults aged 50–80 with a 20 pack-year smoking history who currently smoke or
quit within the past 15 years. The USPSTF recommends this as a Grade B
screening. Chest X-ray is not recommended for lung cancer screening, and carotid
ultrasound and cardiac stress test are not routine screening tests for asymptomatic
patients without specific indications .
Q2. During the cardiovascular examination of a 72-year-old female, the NP
auscultates an S4 heart sound. This finding most commonly indicates:
A. Mitral valve regurgitation
B. Left ventricular hypertrophy
,C. Aortic stenosis
D. Atrial fibrillation
Answer: B
Rationale: An S4 heart sound (atrial gallop) is caused by atrial contraction against
a stiff, non-compliant left ventricle. It is most commonly associated with left
ventricular hypertrophy due to hypertension, which is prevalent in older adults.
Mitral regurgitation typically causes a holosystolic murmur, aortic stenosis causes
a crescendo-decrescendo systolic murmur, and atrial fibrillation is characterized by
an irregularly irregular rhythm .
Q3. A 55-year-old patient reports progressive hearing loss in both ears over the
past year. The NP performs the whisper test and notes decreased hearing
bilaterally. The next most appropriate step is:
A. Immediate referral to an audiologist
B. Prescribe hearing aids
C. Perform pneumatic otoscopy and order audiometry
D. Order CT scan of the temporal bones
Answer: C
Rationale: For suspected hearing loss, the NP should first perform a complete ear
examination including pneumatic otoscopy to assess for cerumen impaction,
infection, or tympanic membrane abnormalities, followed by audiometry for
formal testing. Immediate audiologist referral without basic evaluation is
premature .
Q4. A 70-year-old female presents with sudden onset of severe headache, neck
stiffness, and photophobia. What is the most likely diagnosis?
A. Migraine
B. Subarachnoid hemorrhage
C. Tension headache
D. Meningitis
Answer: B
,Rationale: The "thunderclap" headache with meningismus is classic for
subarachnoid hemorrhage. Meningitis also presents with neck stiffness and
photophobia but typically has fever and a more gradual onset. Migraine and
tension headache do not present with neck stiffness.
Q5. A 72-year-old patient presents with a Mini-Cog score of 2/5. What is the most
appropriate next step?
A. Diagnose dementia and start donepezil
B. Perform a comprehensive cognitive assessment and workup
C. Reassure the patient that this is normal aging
D. Order a head CT only
Answer: B
Rationale: A Mini-Cog score of ≤3 suggests cognitive impairment and warrants a
comprehensive assessment to identify reversible causes and determine the
underlying etiology. Diagnosis of dementia requires more than a screening test,
and a score of 2/5 is not normal aging.
Q6. A 65-year-old patient has a CHA₂DS₂-VASc score of 4 with new atrial
fibrillation. Which is the most appropriate stroke prevention strategy?
A. Aspirin 81 mg daily
B. Anticoagulation with a direct oral anticoagulant (DOAC) or warfarin
C. No antithrombotic therapy
D. Clopidogrel 75 mg daily
Answer: B
Rationale: A CHA₂DS₂-VASc score of ≥2 in men (or ≥3 in women) warrants oral
anticoagulation. DOACs are preferred over warfarin in most patients without
mechanical valves or severe mitral stenosis. Aspirin and clopidogrel are not
adequate for stroke prevention in high-risk AF.
Q7. Which laboratory value is most indicative of early renal impairment in an
older adult?
, A. Serum sodium 138 mmol/L
B. Blood urea nitrogen 28 mg/dL
C. Creatinine clearance 70 mL/min
D. Glomerular filtration rate 55 mL/min/1.73 m²
Answer: D
Rationale: GFR accounts for age-related muscle mass loss; a value <60
mL/min/1.73 m² signals chronic kidney disease. Serum sodium is within normal
limits, BUN is nonspecific, and creatinine clearance overestimates renal function
in older adults due to reduced muscle mass.
Q8. A 78-year-old patient has a creatinine of 2.0 mg/dL. Which factor most affects
the interpretation of this value?
A. The patient's age
B. The patient's muscle mass
C. The patient's hydration status
D. All of the above
Answer: D
Rationale: Serum creatinine is affected by age (reduced renal function), muscle
mass (reduced in frail elderly), and hydration status. All must be considered when
interpreting creatinine values in older adults.
Q9. Which screening tool is recommended for depression in older adults?
A. PHQ-9
B. MMSE
C. CAM
D. MoCA
Answer: A
Rationale: The PHQ-9 is a validated screening tool for depression in older adults.
MMSE and MoCA assess cognition, and CAM assesses delirium.
