ADULT-GERONTOLOGY PRIMARY CARE NURSE
PRACTITIONER (AGPCNP-BC) PRACTICE
EXAMINATION | COMPREHENSIVE TEST BANK
WITH VERIFIED ANSWERS & DETAILED
RATIONALES | IDEAL FOR MSN, DNP & ADULT-
GERONTOLOGY PRIMARY CARE NP STUDENTS
PREPARING FOR BOARD CERTIFICATION (2026–2027
EDITION) NEWEST A+ GRADED.
1. A 72-year-old man with hypertension and type 2 diabetes presents for a
routine follow-up. He is currently taking lisinopril 20 mg daily and
metformin 1,000 mg twice daily. His blood pressure today is 134/78 mmHg,
and his hemoglobin A1C is 7.4%. He is asymptomatic. Which of the
following is the most appropriate next step in management to reduce
cardiovascular and renal risk?
a) Add amlodipine 5 mg daily
b) Increase lisinopril to 40 mg daily
c) Add an SGLT2 inhibitor such as empagliflozin
d) Discontinue metformin and start insulin glargine
c) Add an SGLT2 inhibitor such as empagliflozin
Rationale: SGLT2 inhibitors provide cardiovascular and renal protective
benefits in patients with type 2 diabetes and hypertension, independent of
glycemic control. Empagliflozin, canagliflozin, or dapagliflozin are
recommended as add-on therapy in this population.
2. A 68-year-old man with a 50-pack-year smoking history presents with
progressive dyspnea on exertion, chronic cough with scant white sputum,
and a 10-pound weight loss over the past 6 months. Physical exam reveals
decreased breath sounds bilaterally, hyperresonance on percussion, and
, prolonged expiration. Spirometry shows FEV1/FVC ratio <0.70 with
significantly reduced FEV1. Which diagnosis is most likely?
a) Chronic obstructive pulmonary disease (COPD)
b) Asthma
c) Bronchiectasis
d) Idiopathic pulmonary fibrosis
a) Chronic obstructive pulmonary disease (COPD)
Rationale: The combination of smoking history, progressive dyspnea,
hyperresonance, decreased breath sounds, and fixed airflow obstruction on
spirometry confirms COPD. Asthma would typically show reversible
obstruction.
3. A 75-year-old woman with osteoporosis has been taking alendronate 70 mg
weekly for 5 years. Her bone mineral density has remained stable, and she
has had no fractures. She reports no new symptoms. What is the most
appropriate management?
a) Continue alendronate indefinitely
b) Consider a bisphosphonate drug holiday and reassess in 2–3 years
c) Switch to denosumab 60 mg subcutaneously every 6 months
d) Add teriparatide 20 mcg daily
b) Consider a bisphosphonate drug holiday and reassess in 2–3 years
Rationale: After 5 years of oral bisphosphonate therapy in patients with
stable bone density and no history of fractures, a drug holiday can be
considered to reduce the risk of atypical femur fractures and osteonecrosis
of the jaw. Bone density and risk should be reassessed periodically.
4. A 70-year-old man with a history of benign prostatic hyperplasia (BPH)
presents with acute inability to urinate for 10 hours. He reports severe
suprapubic pain. Bladder scan reveals 900 mL of urine. What is the most
appropriate initial intervention?
a) Oral tamsulosin 0.4 mg daily
b) Immediate transurethral resection of the prostate (TURP)
c) Placement of a Foley catheter
d) Suprapubic catheter insertion
, c) Placement of a Foley catheter
Rationale: Acute urinary retention is an emergency relieved by immediate
bladder decompression via urethral catheterization. Tamsulosin may be
started after drainage, and surgery is considered later.
5. A 65-year-old woman with a history of diabetes and hypertension presents
with acute onset of painless vision loss in the right eye. She describes a
"curtain coming down." Funduscopic exam reveals a pale retina with a
cherry-red macula. What is the most likely diagnosis?
a) Central retinal vein occlusion
b) Central retinal artery occlusion
c) Retinal detachment
d) Vitreous hemorrhage
b) Central retinal artery occlusion
Rationale: Central retinal artery occlusion (CRAO) presents with sudden,
painless, severe vision loss and a classic cherry-red macula on a pale retina.
It is an ocular emergency, often embolic from carotid or cardiac sources.
6. A 70-year-old man with a history of hypertension and diabetes presents
with acute onset of severe lower back pain that radiates to both legs. He
has difficulty voiding and perineal numbness. What is the most appropriate
initial diagnostic test?
a) Lumbar X-ray
b) MRI of the lumbar spine
c) CT myelography
d) Electromyography
b) MRI of the lumbar spine
Rationale: Cauda equina syndrome is a neurosurgical emergency. MRI is the
imaging modality of choice to confirm compression and guide urgent
decompression.
7. A 74-year-old woman with atrial fibrillation (CHA2DS2-VASc score 5) has
been on warfarin for several years. She presents with an acute ischemic
stroke within 4.5 hours of symptom onset. CT shows no hemorrhage. She
, has no other contraindications. What is the most appropriate acute
treatment?
a) Aspirin 325 mg
b) Intravenous tPA (alteplase)
c) Mechanical thrombectomy only
d) Low-molecular-weight heparin
b) Intravenous tPA (alteplase)
Rationale: IV alteplase is indicated for acute ischemic stroke within 4.5 hours
of symptom onset in eligible patients, including those on warfarin if INR
≤1.7. The patient has no hemorrhage on CT, so thrombolysis should be
considered.
8. A 65-year-old man with COPD on home oxygen 2 L/min presents with
worsening dyspnea, increased sputum purulence, and confusion. ABG
shows pH 7.25, PaCO2 80 mmHg, PaO2 55 mmHg. What is the most
appropriate initial ventilatory support?
a) High-flow nasal cannula
b) Noninvasive positive pressure ventilation (NIPPV/BiPAP)
c) Endotracheal intubation
d) Oxygen via non-rebreather mask
b) Noninvasive positive pressure ventilation (NIPPV/BiPAP)
Rationale: Acute hypercapnic respiratory failure in COPD with acidosis (pH
≤7.30) is an indication for noninvasive positive pressure ventilation, which
reduces the need for intubation and improves outcomes.
9. A 68-year-old woman with a history of hypertension and dyslipidemia
presents with acute onset of chest pain, nausea, and diaphoresis. ECG
shows ST elevations in leads II, III, and aVF. What is the most appropriate
immediate management?
a) Aspirin 325 mg chewed and transfer for primary percutaneous coronary
intervention (PCI)
b) Thrombolytic therapy
c) High-dose statin and beta-blocker
d) Sublingual nitroglycerin only
PRACTITIONER (AGPCNP-BC) PRACTICE
EXAMINATION | COMPREHENSIVE TEST BANK
WITH VERIFIED ANSWERS & DETAILED
RATIONALES | IDEAL FOR MSN, DNP & ADULT-
GERONTOLOGY PRIMARY CARE NP STUDENTS
PREPARING FOR BOARD CERTIFICATION (2026–2027
EDITION) NEWEST A+ GRADED.
1. A 72-year-old man with hypertension and type 2 diabetes presents for a
routine follow-up. He is currently taking lisinopril 20 mg daily and
metformin 1,000 mg twice daily. His blood pressure today is 134/78 mmHg,
and his hemoglobin A1C is 7.4%. He is asymptomatic. Which of the
following is the most appropriate next step in management to reduce
cardiovascular and renal risk?
a) Add amlodipine 5 mg daily
b) Increase lisinopril to 40 mg daily
c) Add an SGLT2 inhibitor such as empagliflozin
d) Discontinue metformin and start insulin glargine
c) Add an SGLT2 inhibitor such as empagliflozin
Rationale: SGLT2 inhibitors provide cardiovascular and renal protective
benefits in patients with type 2 diabetes and hypertension, independent of
glycemic control. Empagliflozin, canagliflozin, or dapagliflozin are
recommended as add-on therapy in this population.
2. A 68-year-old man with a 50-pack-year smoking history presents with
progressive dyspnea on exertion, chronic cough with scant white sputum,
and a 10-pound weight loss over the past 6 months. Physical exam reveals
decreased breath sounds bilaterally, hyperresonance on percussion, and
, prolonged expiration. Spirometry shows FEV1/FVC ratio <0.70 with
significantly reduced FEV1. Which diagnosis is most likely?
a) Chronic obstructive pulmonary disease (COPD)
b) Asthma
c) Bronchiectasis
d) Idiopathic pulmonary fibrosis
a) Chronic obstructive pulmonary disease (COPD)
Rationale: The combination of smoking history, progressive dyspnea,
hyperresonance, decreased breath sounds, and fixed airflow obstruction on
spirometry confirms COPD. Asthma would typically show reversible
obstruction.
3. A 75-year-old woman with osteoporosis has been taking alendronate 70 mg
weekly for 5 years. Her bone mineral density has remained stable, and she
has had no fractures. She reports no new symptoms. What is the most
appropriate management?
a) Continue alendronate indefinitely
b) Consider a bisphosphonate drug holiday and reassess in 2–3 years
c) Switch to denosumab 60 mg subcutaneously every 6 months
d) Add teriparatide 20 mcg daily
b) Consider a bisphosphonate drug holiday and reassess in 2–3 years
Rationale: After 5 years of oral bisphosphonate therapy in patients with
stable bone density and no history of fractures, a drug holiday can be
considered to reduce the risk of atypical femur fractures and osteonecrosis
of the jaw. Bone density and risk should be reassessed periodically.
4. A 70-year-old man with a history of benign prostatic hyperplasia (BPH)
presents with acute inability to urinate for 10 hours. He reports severe
suprapubic pain. Bladder scan reveals 900 mL of urine. What is the most
appropriate initial intervention?
a) Oral tamsulosin 0.4 mg daily
b) Immediate transurethral resection of the prostate (TURP)
c) Placement of a Foley catheter
d) Suprapubic catheter insertion
, c) Placement of a Foley catheter
Rationale: Acute urinary retention is an emergency relieved by immediate
bladder decompression via urethral catheterization. Tamsulosin may be
started after drainage, and surgery is considered later.
5. A 65-year-old woman with a history of diabetes and hypertension presents
with acute onset of painless vision loss in the right eye. She describes a
"curtain coming down." Funduscopic exam reveals a pale retina with a
cherry-red macula. What is the most likely diagnosis?
a) Central retinal vein occlusion
b) Central retinal artery occlusion
c) Retinal detachment
d) Vitreous hemorrhage
b) Central retinal artery occlusion
Rationale: Central retinal artery occlusion (CRAO) presents with sudden,
painless, severe vision loss and a classic cherry-red macula on a pale retina.
It is an ocular emergency, often embolic from carotid or cardiac sources.
6. A 70-year-old man with a history of hypertension and diabetes presents
with acute onset of severe lower back pain that radiates to both legs. He
has difficulty voiding and perineal numbness. What is the most appropriate
initial diagnostic test?
a) Lumbar X-ray
b) MRI of the lumbar spine
c) CT myelography
d) Electromyography
b) MRI of the lumbar spine
Rationale: Cauda equina syndrome is a neurosurgical emergency. MRI is the
imaging modality of choice to confirm compression and guide urgent
decompression.
7. A 74-year-old woman with atrial fibrillation (CHA2DS2-VASc score 5) has
been on warfarin for several years. She presents with an acute ischemic
stroke within 4.5 hours of symptom onset. CT shows no hemorrhage. She
, has no other contraindications. What is the most appropriate acute
treatment?
a) Aspirin 325 mg
b) Intravenous tPA (alteplase)
c) Mechanical thrombectomy only
d) Low-molecular-weight heparin
b) Intravenous tPA (alteplase)
Rationale: IV alteplase is indicated for acute ischemic stroke within 4.5 hours
of symptom onset in eligible patients, including those on warfarin if INR
≤1.7. The patient has no hemorrhage on CT, so thrombolysis should be
considered.
8. A 65-year-old man with COPD on home oxygen 2 L/min presents with
worsening dyspnea, increased sputum purulence, and confusion. ABG
shows pH 7.25, PaCO2 80 mmHg, PaO2 55 mmHg. What is the most
appropriate initial ventilatory support?
a) High-flow nasal cannula
b) Noninvasive positive pressure ventilation (NIPPV/BiPAP)
c) Endotracheal intubation
d) Oxygen via non-rebreather mask
b) Noninvasive positive pressure ventilation (NIPPV/BiPAP)
Rationale: Acute hypercapnic respiratory failure in COPD with acidosis (pH
≤7.30) is an indication for noninvasive positive pressure ventilation, which
reduces the need for intubation and improves outcomes.
9. A 68-year-old woman with a history of hypertension and dyslipidemia
presents with acute onset of chest pain, nausea, and diaphoresis. ECG
shows ST elevations in leads II, III, and aVF. What is the most appropriate
immediate management?
a) Aspirin 325 mg chewed and transfer for primary percutaneous coronary
intervention (PCI)
b) Thrombolytic therapy
c) High-dose statin and beta-blocker
d) Sublingual nitroglycerin only
