Advanced Geriatric Nurse Practitioner (AGNP)
Comprehensive Primary Care Assessment – 150
Questions & Case-Based Scenario
1–25: Cardiovascular & Hypertension
1. A 68-year-old patient presents with blood pressure readings
averaging 162/94 mmHg. Which is the most appropriate first-line
therapy if no contraindications exist?
A. Lisinopril
B. Hydrochlorothiazide
C. Amlodipine
D. Metoprolol
Answer: A. Lisinopril
Rationale: ACE inhibitors, such as lisinopril, are first-line for
hypertension in older adults, especially with diabetes or kidney
disease, due to renal and cardiovascular protective effects.
2. A patient with chronic atrial fibrillation is at risk for
thromboembolism. Which medication is indicated to reduce this
risk?
A. Aspirin
B. Warfarin
C. Clopidogrel
D. Amiodarone
Answer: B. Warfarin
Rationale: Warfarin is an anticoagulant recommended for stroke
prevention in patients with atrial fibrillation.
3. A patient presents with chest pain relieved by rest and
nitroglycerin. What is the most likely diagnosis?
, A. Myocardial infarction
B. Stable angina
C. Unstable angina
D. Pericarditis
Answer: B. Stable angina
Rationale: Stable angina is characterized by predictable chest pain
with exertion relieved by rest or nitroglycerin.
4. Which laboratory marker is most sensitive for myocardial injury?
A. CK-MB
B. Troponin I
C. BNP
D. Myoglobin
Answer: B. Troponin I
Rationale: Troponins are highly sensitive and specific markers for
myocardial injury and are preferred over CK-MB.
5. A 75-year-old patient with systolic heart failure is prescribed a
beta-blocker. Which is the preferred agent?
A. Metoprolol succinate
B. Propranolol
C. Atenolol
D. Carvedilol
Answer: D. Carvedilol
Rationale: Carvedilol is shown to improve survival in systolic heart
failure and is commonly recommended for older adults.
6. In a patient with hypertension and chronic kidney disease, which
antihypertensive is preferred?
A. Thiazide diuretics
B. ACE inhibitors
, C. Beta-blockers
D. Calcium channel blockers
Answer: B. ACE inhibitors
Rationale: ACE inhibitors reduce proteinuria and slow progression of
kidney disease, making them first-line in CKD.
7. Which lipid-lowering agent is preferred for primary prevention in
older adults at high cardiovascular risk?
A. Atorvastatin
B. Gemfibrozil
C. Niacin
D. Cholestyramine
Answer: A. Atorvastatin
Rationale: Statins are first-line for primary and secondary prevention
of cardiovascular disease due to their efficacy in lowering LDL.
8. A patient with peripheral artery disease complains of leg pain
when walking that resolves with rest. What is the most likely
diagnosis?
A. Deep vein thrombosis
B. Claudication
C. Neuropathy
D. Cellulitis
Answer: B. Claudication
Rationale: Intermittent claudication is pain in the legs with exertion
due to arterial insufficiency.
9. Which lifestyle modification most effectively lowers blood
pressure in hypertensive patients?
A. Increase potassium intake
B. Reduce sodium intake
, C. Exercise once weekly
D. Limit alcohol to 3 drinks per day
Answer: B. Reduce sodium intake
Rationale: Sodium restriction significantly lowers blood pressure and
is recommended as a primary non-pharmacologic intervention.
10. A patient has a sudden blood pressure spike with headache
and visual changes. Which condition is most concerning?
A. Hypertensive urgency
B. Hypertensive emergency
C. Chronic hypertension
D. Preeclampsia
Answer: B. Hypertensive emergency
Rationale: Hypertensive emergency involves end-organ damage and
requires immediate IV antihypertensive therapy.
11. Which ECG finding is most commonly associated with left
ventricular hypertrophy?
A. ST elevation in V1-V3
B. Tall R waves in V5-V6
C. Peaked T waves
D. Q waves in II, III, aVF
Answer: B. Tall R waves in V5-V6
Rationale: LVH manifests as high-amplitude R waves in the lateral
leads on ECG.
12. A patient with uncontrolled hypertension develops
proteinuria. Which medication class should be initiated?
A. ACE inhibitors
B. Loop diuretics
Comprehensive Primary Care Assessment – 150
Questions & Case-Based Scenario
1–25: Cardiovascular & Hypertension
1. A 68-year-old patient presents with blood pressure readings
averaging 162/94 mmHg. Which is the most appropriate first-line
therapy if no contraindications exist?
A. Lisinopril
B. Hydrochlorothiazide
C. Amlodipine
D. Metoprolol
Answer: A. Lisinopril
Rationale: ACE inhibitors, such as lisinopril, are first-line for
hypertension in older adults, especially with diabetes or kidney
disease, due to renal and cardiovascular protective effects.
2. A patient with chronic atrial fibrillation is at risk for
thromboembolism. Which medication is indicated to reduce this
risk?
A. Aspirin
B. Warfarin
C. Clopidogrel
D. Amiodarone
Answer: B. Warfarin
Rationale: Warfarin is an anticoagulant recommended for stroke
prevention in patients with atrial fibrillation.
3. A patient presents with chest pain relieved by rest and
nitroglycerin. What is the most likely diagnosis?
, A. Myocardial infarction
B. Stable angina
C. Unstable angina
D. Pericarditis
Answer: B. Stable angina
Rationale: Stable angina is characterized by predictable chest pain
with exertion relieved by rest or nitroglycerin.
4. Which laboratory marker is most sensitive for myocardial injury?
A. CK-MB
B. Troponin I
C. BNP
D. Myoglobin
Answer: B. Troponin I
Rationale: Troponins are highly sensitive and specific markers for
myocardial injury and are preferred over CK-MB.
5. A 75-year-old patient with systolic heart failure is prescribed a
beta-blocker. Which is the preferred agent?
A. Metoprolol succinate
B. Propranolol
C. Atenolol
D. Carvedilol
Answer: D. Carvedilol
Rationale: Carvedilol is shown to improve survival in systolic heart
failure and is commonly recommended for older adults.
6. In a patient with hypertension and chronic kidney disease, which
antihypertensive is preferred?
A. Thiazide diuretics
B. ACE inhibitors
, C. Beta-blockers
D. Calcium channel blockers
Answer: B. ACE inhibitors
Rationale: ACE inhibitors reduce proteinuria and slow progression of
kidney disease, making them first-line in CKD.
7. Which lipid-lowering agent is preferred for primary prevention in
older adults at high cardiovascular risk?
A. Atorvastatin
B. Gemfibrozil
C. Niacin
D. Cholestyramine
Answer: A. Atorvastatin
Rationale: Statins are first-line for primary and secondary prevention
of cardiovascular disease due to their efficacy in lowering LDL.
8. A patient with peripheral artery disease complains of leg pain
when walking that resolves with rest. What is the most likely
diagnosis?
A. Deep vein thrombosis
B. Claudication
C. Neuropathy
D. Cellulitis
Answer: B. Claudication
Rationale: Intermittent claudication is pain in the legs with exertion
due to arterial insufficiency.
9. Which lifestyle modification most effectively lowers blood
pressure in hypertensive patients?
A. Increase potassium intake
B. Reduce sodium intake
, C. Exercise once weekly
D. Limit alcohol to 3 drinks per day
Answer: B. Reduce sodium intake
Rationale: Sodium restriction significantly lowers blood pressure and
is recommended as a primary non-pharmacologic intervention.
10. A patient has a sudden blood pressure spike with headache
and visual changes. Which condition is most concerning?
A. Hypertensive urgency
B. Hypertensive emergency
C. Chronic hypertension
D. Preeclampsia
Answer: B. Hypertensive emergency
Rationale: Hypertensive emergency involves end-organ damage and
requires immediate IV antihypertensive therapy.
11. Which ECG finding is most commonly associated with left
ventricular hypertrophy?
A. ST elevation in V1-V3
B. Tall R waves in V5-V6
C. Peaked T waves
D. Q waves in II, III, aVF
Answer: B. Tall R waves in V5-V6
Rationale: LVH manifests as high-amplitude R waves in the lateral
leads on ECG.
12. A patient with uncontrolled hypertension develops
proteinuria. Which medication class should be initiated?
A. ACE inhibitors
B. Loop diuretics
