Adult-Gerontology Primary Care Nurse
Practitioner Board Certification Examination |
200 Advanced Practice Questions with Verified
Answers & Detailed Rationales | ANCC &
AANPCB Blueprint Aligned | 2026 Edition
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1–25)
1. A 68-year-old male with a history of hypertension and diabetes presents with exertional
dyspnea and orthopnea. On examination, you note jugular venous distension, bilateral
crackles, and 2+ pitting edema. What is the most likely diagnosis?
A. Right-sided heart failure
B. Left-sided heart failure
C. Biventricular heart failure
D. Cardiac tamponade
Correct Answer: C
Rationale: The presence of both left-sided (crackles, orthopnea) and right-sided (JVD, edema)
heart failure findings indicates biventricular involvement. This is common in patients with
longstanding hypertension and diabetes who have progressed to advanced heart failure.
Cardiac tamponade would present with Beck's triad (hypotension, muffled heart sounds, JVD).
2. A 72-year-old female presents with palpitations and fatigue. ECG shows atrial fibrillation
with a rapid ventricular response. Which medication is most appropriate for rate control in
this patient?
A. Amiodarone
B. Metoprolol
C. Digoxin
D. Flecainide
Correct Answer: B
,Rationale: Beta-blockers such as metoprolol are first-line for rate control in atrial fibrillation.
They are particularly effective during exertion. Amiodarone is used for rhythm control. Digoxin is
less effective during exertion and has a narrow therapeutic window. Flecainide is a rhythm
control agent with proarrhythmic risk.
3. A 65-year-old male with known coronary artery disease reports new-onset chest pain at
rest. Which finding on ECG is most concerning for acute coronary syndrome?
A. ST elevation in leads V1-V4
B. ST depression in leads II, III, aVF
C. T wave inversion in leads V5-V6
D. New left bundle branch block
Correct Answer: A
Rationale: ST elevation indicates acute transmural ischemia (STEMI) requiring immediate
reperfusion. ST depression and T wave inversion suggest subendocardial ischemia
(NSTEMI/unstable angina). New LBBB is concerning but requires clinical correlation.
4. A 70-year-old male with heart failure is prescribed furosemide. Which electrolyte
abnormality should be monitored most closely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Correct Answer: B
Rationale: Loop diuretics such as furosemide cause significant potassium excretion, leading to
hypokalemia. This can precipitate cardiac arrhythmias, particularly in patients with underlying
heart disease. Potassium levels should be monitored closely and supplemented as needed.
5. A 58-year-old female presents with a blood pressure of 158/94 mmHg on three separate
occasions. Which medication class is most appropriate as first-line therapy?
A. Alpha-blockers
B. Thiazide diuretics
,C. Beta-blockers
D. Central alpha-2 agonists
Correct Answer: B
Rationale: Thiazide diuretics are first-line therapy for hypertension in older adults. They are
effective, well-tolerated, and have proven cardiovascular benefit. Beta-blockers are not first-line
unless there is a compelling indication (e.g., heart failure, post-MI).
6. A 75-year-old male with aortic stenosis presents with syncope and angina. Which finding on
examination is most characteristic?
A. Diastolic murmur at the apex
B. Systolic ejection murmur radiating to the carotids
C. Continuous murmur at the left sternal border
D. Holosystolic murmur at the apex
Correct Answer: B
Rationale: Aortic stenosis produces a systolic ejection murmur that radiates to the carotid
arteries. The classic triad is angina, syncope, and heart failure. Diastolic murmurs suggest
regurgitation. Continuous murmurs suggest PDA.
7. A 62-year-old female on warfarin for atrial fibrillation has an INR of 5.2. Which action is
most appropriate?
A. Continue current dose and recheck in 1 week
B. Hold warfarin and administer vitamin K
C. Increase warfarin dose
D. Administer fresh frozen plasma
Correct Answer: B
Rationale: An INR of 5.2 is significantly elevated (therapeutic range 2.0-3.0 for AF). The patient
is at high risk for bleeding. Warfarin should be held, and vitamin K administered if there is active
bleeding or if the INR is markedly elevated. FFP is reserved for major bleeding.
, 8. A 55-year-old male presents with sudden-onset severe chest pain radiating to the back.
Blood pressure is 180/100 mmHg in the right arm and 150/90 mmHg in the left arm. What is
the most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Rationale: Aortic dissection classically presents with sudden, severe tearing chest pain radiating
to the back, with a blood pressure differential between arms. This is a life-threatening
emergency requiring immediate imaging and surgical consultation.
9. A 70-year-old female with heart failure has an ejection fraction of 35%. Which medication
has been shown to reduce mortality?
A. Digoxin
B. Furosemide
C. Carvedilol
D. Amlodipine
Correct Answer: C
Rationale: Carvedilol is a beta-blocker with proven mortality benefit in heart failure with
reduced ejection fraction (HFrEF). Digoxin reduces hospitalizations but not mortality.
Furosemide provides symptomatic relief. Amlodipine is not indicated for HFrEF.
10. A 68-year-old male with diabetes and hypertension has a creatinine of 2.8 mg/dL and
proteinuria. Which medication is most appropriate?
A. Lisinopril
B. Hydrochlorothiazide
C. Metoprolol
D. Diltiazem
Correct Answer: A
Practitioner Board Certification Examination |
200 Advanced Practice Questions with Verified
Answers & Detailed Rationales | ANCC &
AANPCB Blueprint Aligned | 2026 Edition
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1–25)
1. A 68-year-old male with a history of hypertension and diabetes presents with exertional
dyspnea and orthopnea. On examination, you note jugular venous distension, bilateral
crackles, and 2+ pitting edema. What is the most likely diagnosis?
A. Right-sided heart failure
B. Left-sided heart failure
C. Biventricular heart failure
D. Cardiac tamponade
Correct Answer: C
Rationale: The presence of both left-sided (crackles, orthopnea) and right-sided (JVD, edema)
heart failure findings indicates biventricular involvement. This is common in patients with
longstanding hypertension and diabetes who have progressed to advanced heart failure.
Cardiac tamponade would present with Beck's triad (hypotension, muffled heart sounds, JVD).
2. A 72-year-old female presents with palpitations and fatigue. ECG shows atrial fibrillation
with a rapid ventricular response. Which medication is most appropriate for rate control in
this patient?
A. Amiodarone
B. Metoprolol
C. Digoxin
D. Flecainide
Correct Answer: B
,Rationale: Beta-blockers such as metoprolol are first-line for rate control in atrial fibrillation.
They are particularly effective during exertion. Amiodarone is used for rhythm control. Digoxin is
less effective during exertion and has a narrow therapeutic window. Flecainide is a rhythm
control agent with proarrhythmic risk.
3. A 65-year-old male with known coronary artery disease reports new-onset chest pain at
rest. Which finding on ECG is most concerning for acute coronary syndrome?
A. ST elevation in leads V1-V4
B. ST depression in leads II, III, aVF
C. T wave inversion in leads V5-V6
D. New left bundle branch block
Correct Answer: A
Rationale: ST elevation indicates acute transmural ischemia (STEMI) requiring immediate
reperfusion. ST depression and T wave inversion suggest subendocardial ischemia
(NSTEMI/unstable angina). New LBBB is concerning but requires clinical correlation.
4. A 70-year-old male with heart failure is prescribed furosemide. Which electrolyte
abnormality should be monitored most closely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Correct Answer: B
Rationale: Loop diuretics such as furosemide cause significant potassium excretion, leading to
hypokalemia. This can precipitate cardiac arrhythmias, particularly in patients with underlying
heart disease. Potassium levels should be monitored closely and supplemented as needed.
5. A 58-year-old female presents with a blood pressure of 158/94 mmHg on three separate
occasions. Which medication class is most appropriate as first-line therapy?
A. Alpha-blockers
B. Thiazide diuretics
,C. Beta-blockers
D. Central alpha-2 agonists
Correct Answer: B
Rationale: Thiazide diuretics are first-line therapy for hypertension in older adults. They are
effective, well-tolerated, and have proven cardiovascular benefit. Beta-blockers are not first-line
unless there is a compelling indication (e.g., heart failure, post-MI).
6. A 75-year-old male with aortic stenosis presents with syncope and angina. Which finding on
examination is most characteristic?
A. Diastolic murmur at the apex
B. Systolic ejection murmur radiating to the carotids
C. Continuous murmur at the left sternal border
D. Holosystolic murmur at the apex
Correct Answer: B
Rationale: Aortic stenosis produces a systolic ejection murmur that radiates to the carotid
arteries. The classic triad is angina, syncope, and heart failure. Diastolic murmurs suggest
regurgitation. Continuous murmurs suggest PDA.
7. A 62-year-old female on warfarin for atrial fibrillation has an INR of 5.2. Which action is
most appropriate?
A. Continue current dose and recheck in 1 week
B. Hold warfarin and administer vitamin K
C. Increase warfarin dose
D. Administer fresh frozen plasma
Correct Answer: B
Rationale: An INR of 5.2 is significantly elevated (therapeutic range 2.0-3.0 for AF). The patient
is at high risk for bleeding. Warfarin should be held, and vitamin K administered if there is active
bleeding or if the INR is markedly elevated. FFP is reserved for major bleeding.
, 8. A 55-year-old male presents with sudden-onset severe chest pain radiating to the back.
Blood pressure is 180/100 mmHg in the right arm and 150/90 mmHg in the left arm. What is
the most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Rationale: Aortic dissection classically presents with sudden, severe tearing chest pain radiating
to the back, with a blood pressure differential between arms. This is a life-threatening
emergency requiring immediate imaging and surgical consultation.
9. A 70-year-old female with heart failure has an ejection fraction of 35%. Which medication
has been shown to reduce mortality?
A. Digoxin
B. Furosemide
C. Carvedilol
D. Amlodipine
Correct Answer: C
Rationale: Carvedilol is a beta-blocker with proven mortality benefit in heart failure with
reduced ejection fraction (HFrEF). Digoxin reduces hospitalizations but not mortality.
Furosemide provides symptomatic relief. Amlodipine is not indicated for HFrEF.
10. A 68-year-old male with diabetes and hypertension has a creatinine of 2.8 mg/dL and
proteinuria. Which medication is most appropriate?
A. Lisinopril
B. Hydrochlorothiazide
C. Metoprolol
D. Diltiazem
Correct Answer: A
