1
Adult-Gerontology Primary Care Nurse
Practitioner Certification Examination
Questions 1–200 | ANCC & AANP Style | 100%
Pass Guaranteed | Graded A+
1. A 72-year-old male with a 50-pack-year smoking history presents for a
routine visit. He reports no symptoms. Screening for abdominal aortic
aneurysm is indicated. Which imaging modality is most appropriate?
A. Abdominal radiography
B. Contrast-enhanced computed tomography
C. Magnetic resonance angiography
D. Abdominal ultrasonography
ANS: D
Explanation: The U.S. Preventive Services Task Force recommends one-time
screening for abdominal aortic aneurysm with ultrasonography in men aged 65
to 75 years who have ever smoked. Ultrasound is noninvasive, does not involve
radiation, and has high sensitivity and specificity. Contrast-enhanced CT and
MRA are reserved for pre-surgical planning or when ultrasound is inconclusive.
Abdominal radiography is not sensitive enough to reliably detect aneurysms .
2. A 68-year-old female with hypertension and chronic kidney disease
(eGFR 32 mL/min/1.73m²) has a blood pressure of 152/88 mmHg. She is
currently taking lisinopril 20 mg daily. Which medication is most
appropriate to add for blood pressure control?
A. Spironolactone
B. Furosemide
C. Chlorthalidone
D. Amlodipine
, 2
ANS: D
Explanation: In patients with CKD and hypertension already on an ACE
inhibitor, adding a calcium channel blocker such as amlodipine is an effective
strategy. Amlodipine is not renally cleared and does not require dose
adjustment. Spironolactone would increase risk of hyperkalemia with an ACE
inhibitor and reduced GFR. Furosemide is a loop diuretic but generally used for
volume overload rather than first-line add-on in CKD hypertension without
edema. Chlorthalidone may be less effective with GFR <30 mL/min .
3. An 81-year-old nursing home resident develops acute confusion, urinary
frequency, and suprapubic tenderness. Temperature is 100.2°F (37.9°C).
Urinalysis shows leukocyte esterase positive, nitrite positive, and >50
WBC/hpf. What is the most likely diagnosis?
A. Asymptomatic bacteriuria
B. Pyelonephritis
C. Acute cystitis
D. Prostatitis
ANS: C
Explanation: Acute cystitis presents with dysuria, frequency, urgency,
suprapubic pain, and pyuria/bacteriuria in the setting of acute mental status
change in older adults. Asymptomatic bacteriuria lacks localized symptoms
and acute confusion; guidelines recommend against treatment in non-pregnant
adults. Pyelonephritis would typically present with fever >100.4°F, flank pain,
and possibly systemic symptoms. Prostatitis would cause perineal pain and
prostatic tenderness, not primarily suprapubic .
4. A 75-year-old female with osteoporosis is started on alendronate 70 mg
weekly. What important counseling point must be included regarding
administration?
A. Take with a full glass of milk to enhance absorption
B. Crush the tablet if difficulty swallowing
, 3
C. Remain upright for at least 30 minutes after taking
D. Take at bedtime to minimize gastrointestinal upset
ANS: C
Explanation: To prevent esophageal irritation and ensure adequate
absorption, patients must remain upright for at least 30 minutes after taking
an oral bisphosphonate. The medication should be taken first thing in the
morning with plain water only, at least 30 minutes before any food, drink, or
other medications. Milk, calcium, and other cations impair absorption.
Crushing alendronate is contraindicated due to risk of oropharyngeal
ulceration. Bedtime administration would lead to recumbency and increased
esophageal injury risk .
5. A 68-year-old male presents to the clinic with a 2-week history of
progressive dyspnea on exertion and orthopnea. Physical exam reveals
bilateral crackles at lung bases, elevated JVP at 6 cm, and 2+ pitting
edema in bilateral lower extremities. ECG shows sinus rhythm with left
ventricular hypertrophy. Which diagnostic test is MOST appropriate to
confirm the suspected diagnosis?
A. D-dimer
B. Brain natriuretic peptide (BNP) or NT-proBNP
C. Troponin I
D. Pulmonary function tests
ANS: B
Explanation: The clinical presentation is consistent with heart failure. BNP or
NT-proBNP is the most appropriate diagnostic test to confirm the diagnosis. D-
dimer is used for pulmonary embolism. Troponin I is used for myocardial
infarction. Pulmonary function tests are used for obstructive or restrictive lung
diseases .
6. A 72-year-old female with a history of osteoporosis reports two falls in
the past month at home. She takes amlodipine 5 mg daily and
, 4
alprazolam 0.5 mg at bedtime. Her Timed Up and Go (TUG) test takes 14
seconds. Which intervention should be prioritized FIRST?
A. Start vitamin D 50,000 IU weekly
B. Discontinue alprazolam and conduct a comprehensive medication review
C. Recommend a cane for ambulation
D. Order lumbar spine X-ray
ANS: B
Explanation: Alprazolam is a benzodiazepine that significantly increases fall
risk in older adults due to sedation, cognitive impairment, and balance issues.
Discontinuing alprazolam and conducting a comprehensive medication review
is the priority intervention. Vitamin D supplementation, cane recommendation,
and X-ray are important but secondary to addressing the primary reversible
risk factor .
7. A 45-year-old male with type 2 diabetes presents for routine follow-up.
He reports no symptoms. Physical exam is unremarkable. His last
comprehensive metabolic panel was 6 months ago. According to current
guidelines, which screening test should be performed at this visit?
A. Annual urine microalbumin-to-creatinine ratio
B. Quarterly HbA1c only
C. Fasting lipid panel every 2 years
D. Dilated eye exam every 2 years
ANS: A
Explanation: Annual urine microalbumin-to-creatinine ratio is recommended
for all patients with type 2 diabetes to screen for diabetic nephropathy. HbA1c
should be checked at least twice yearly if at goal. Lipid panels are typically
checked annually. Dilated eye exams are recommended annually for patients
with diabetes .
Adult-Gerontology Primary Care Nurse
Practitioner Certification Examination
Questions 1–200 | ANCC & AANP Style | 100%
Pass Guaranteed | Graded A+
1. A 72-year-old male with a 50-pack-year smoking history presents for a
routine visit. He reports no symptoms. Screening for abdominal aortic
aneurysm is indicated. Which imaging modality is most appropriate?
A. Abdominal radiography
B. Contrast-enhanced computed tomography
C. Magnetic resonance angiography
D. Abdominal ultrasonography
ANS: D
Explanation: The U.S. Preventive Services Task Force recommends one-time
screening for abdominal aortic aneurysm with ultrasonography in men aged 65
to 75 years who have ever smoked. Ultrasound is noninvasive, does not involve
radiation, and has high sensitivity and specificity. Contrast-enhanced CT and
MRA are reserved for pre-surgical planning or when ultrasound is inconclusive.
Abdominal radiography is not sensitive enough to reliably detect aneurysms .
2. A 68-year-old female with hypertension and chronic kidney disease
(eGFR 32 mL/min/1.73m²) has a blood pressure of 152/88 mmHg. She is
currently taking lisinopril 20 mg daily. Which medication is most
appropriate to add for blood pressure control?
A. Spironolactone
B. Furosemide
C. Chlorthalidone
D. Amlodipine
, 2
ANS: D
Explanation: In patients with CKD and hypertension already on an ACE
inhibitor, adding a calcium channel blocker such as amlodipine is an effective
strategy. Amlodipine is not renally cleared and does not require dose
adjustment. Spironolactone would increase risk of hyperkalemia with an ACE
inhibitor and reduced GFR. Furosemide is a loop diuretic but generally used for
volume overload rather than first-line add-on in CKD hypertension without
edema. Chlorthalidone may be less effective with GFR <30 mL/min .
3. An 81-year-old nursing home resident develops acute confusion, urinary
frequency, and suprapubic tenderness. Temperature is 100.2°F (37.9°C).
Urinalysis shows leukocyte esterase positive, nitrite positive, and >50
WBC/hpf. What is the most likely diagnosis?
A. Asymptomatic bacteriuria
B. Pyelonephritis
C. Acute cystitis
D. Prostatitis
ANS: C
Explanation: Acute cystitis presents with dysuria, frequency, urgency,
suprapubic pain, and pyuria/bacteriuria in the setting of acute mental status
change in older adults. Asymptomatic bacteriuria lacks localized symptoms
and acute confusion; guidelines recommend against treatment in non-pregnant
adults. Pyelonephritis would typically present with fever >100.4°F, flank pain,
and possibly systemic symptoms. Prostatitis would cause perineal pain and
prostatic tenderness, not primarily suprapubic .
4. A 75-year-old female with osteoporosis is started on alendronate 70 mg
weekly. What important counseling point must be included regarding
administration?
A. Take with a full glass of milk to enhance absorption
B. Crush the tablet if difficulty swallowing
, 3
C. Remain upright for at least 30 minutes after taking
D. Take at bedtime to minimize gastrointestinal upset
ANS: C
Explanation: To prevent esophageal irritation and ensure adequate
absorption, patients must remain upright for at least 30 minutes after taking
an oral bisphosphonate. The medication should be taken first thing in the
morning with plain water only, at least 30 minutes before any food, drink, or
other medications. Milk, calcium, and other cations impair absorption.
Crushing alendronate is contraindicated due to risk of oropharyngeal
ulceration. Bedtime administration would lead to recumbency and increased
esophageal injury risk .
5. A 68-year-old male presents to the clinic with a 2-week history of
progressive dyspnea on exertion and orthopnea. Physical exam reveals
bilateral crackles at lung bases, elevated JVP at 6 cm, and 2+ pitting
edema in bilateral lower extremities. ECG shows sinus rhythm with left
ventricular hypertrophy. Which diagnostic test is MOST appropriate to
confirm the suspected diagnosis?
A. D-dimer
B. Brain natriuretic peptide (BNP) or NT-proBNP
C. Troponin I
D. Pulmonary function tests
ANS: B
Explanation: The clinical presentation is consistent with heart failure. BNP or
NT-proBNP is the most appropriate diagnostic test to confirm the diagnosis. D-
dimer is used for pulmonary embolism. Troponin I is used for myocardial
infarction. Pulmonary function tests are used for obstructive or restrictive lung
diseases .
6. A 72-year-old female with a history of osteoporosis reports two falls in
the past month at home. She takes amlodipine 5 mg daily and
, 4
alprazolam 0.5 mg at bedtime. Her Timed Up and Go (TUG) test takes 14
seconds. Which intervention should be prioritized FIRST?
A. Start vitamin D 50,000 IU weekly
B. Discontinue alprazolam and conduct a comprehensive medication review
C. Recommend a cane for ambulation
D. Order lumbar spine X-ray
ANS: B
Explanation: Alprazolam is a benzodiazepine that significantly increases fall
risk in older adults due to sedation, cognitive impairment, and balance issues.
Discontinuing alprazolam and conducting a comprehensive medication review
is the priority intervention. Vitamin D supplementation, cane recommendation,
and X-ray are important but secondary to addressing the primary reversible
risk factor .
7. A 45-year-old male with type 2 diabetes presents for routine follow-up.
He reports no symptoms. Physical exam is unremarkable. His last
comprehensive metabolic panel was 6 months ago. According to current
guidelines, which screening test should be performed at this visit?
A. Annual urine microalbumin-to-creatinine ratio
B. Quarterly HbA1c only
C. Fasting lipid panel every 2 years
D. Dilated eye exam every 2 years
ANS: A
Explanation: Annual urine microalbumin-to-creatinine ratio is recommended
for all patients with type 2 diabetes to screen for diabetic nephropathy. HbA1c
should be checked at least twice yearly if at goal. Lipid panels are typically
checked annually. Dilated eye exams are recommended annually for patients
with diabetes .
