A-GNP ADULT-GERONTOLOGY
PRIMARY CARE NURSE PRACTITIONER
CERTIFICATION EXAM 2026/2027: 135
VERIFIED PRACTICE QUESTIONS &
ANSWERS WITH DETAILED
RATIONALES — AANPCB EXAM PREP
SECTION I: CARDIOVASCULAR SYSTEM (Questions 1–25)
Question 1. A 68-year-old male with hypertension and type 2 diabetes presents with
exertional dyspnea, orthopnea, bibasilar crackles, an S3 gallop, and JVD. BNP is 850
pg/mL. What is the MOST appropriate initial pharmacologic management?
A) Furosemide 40 mg IV B) Metoprolol succinate 50 mg PO daily C) Lisinopril 10 mg
PO daily D) Carvedilol 6.25 mg PO BID
Answer: A) Furosemide 40 mg IV
Rationale: This patient has acute decompensated heart failure with fluid overload. IV
loop diuretics are the first-line treatment for acute decompensation to reduce preload
and relieve congestion. Beta-blockers and ACE inhibitors are chronic management
agents, not initial acute therapy.
Question 2. A 58-year-old male presents with acute-onset severe substernal chest
pressure radiating to the jaw, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V2–V4. What is the MOST appropriate immediate action?
A) Administer sublingual nitroglycerin and wait 10 minutes B) Administer aspirin
324 mg chewable and activate EMS C) Order a chest x-ray D) Perform an
echocardiogram
Answer: B) Administer aspirin 324 mg chewable and activate EMS
Rationale: This patient is having an STEMI. The priority is aspirin (antiplatelet therapy)
and immediate EMS activation for transport to a PCI-capable hospital. Time is
myocardium. Nitroglycerin may be given but not before aspirin, and EMS activation is
the priority.
,Question 3. A 65-year-old African American patient with newly diagnosed
hypertension and no other comorbidities. What is the most appropriate initial
antihypertensive agent?
A) ACE inhibitor B) Beta-blocker C) Thiazide diuretic D) Alpha-blocker
Answer: C) Thiazide diuretic
Rationale: For African American patients without comorbidities, thiazide diuretics or
calcium channel blockers are first-line therapy due to evidence of greater efficacy in
this population. ACE inhibitors are less effective as monotherapy in African American
patients.
Question 4. A 72-year-old female with atrial fibrillation has a CHA₂DS₂-VASc score of
4. What is the most appropriate anticoagulation strategy?
A) Apixaban 5 mg PO BID B) Aspirin 81 mg daily C) Clopidogrel 75 mg daily D) No
anticoagulation
Answer: A) Apixaban 5 mg PO BID
Rationale: A CHA₂DS₂-VASc score of 4 indicates high stroke risk. Direct oral
anticoagulants (DOACs) like apixaban are preferred over warfarin for nonvalvular AF.
Aspirin is insufficient for stroke prevention in high-risk patients.
Question 5. A 70-year-old male presents with stable angina. His symptoms occur
predictably with exertion and are relieved by rest. What is the first-line antianginal
medication?
A) Ranolazine B) Nitroglycerin PRN C) Metoprolol succinate D) Amlodipine
Answer: C) Metoprolol succinate
Rationale: Beta-blockers are first-line therapy for stable angina. They reduce
myocardial oxygen demand by decreasing heart rate and contractility. Nitroglycerin is
used for acute symptom relief, not chronic prevention.
Question 6. A 78-year-old with heart failure and reduced ejection fraction (HFrEF) is
on lisinopril and metoprolol. Which additional medication has mortality benefit?
A) Amlodipine B) Sacubitril/valsartan C) Digoxin D) Furosemide
Answer: B) Sacubitril/valsartan
Rationale: ARNI (sacubitril/valsartan) replaced ACEI/ARB in the PARADIGM-HF trial,
showing significant mortality reduction in HFrEF when substituted for enalapril. It
should replace the ACE inhibitor, not be added to it.
,Question 7. A 60-year-old female has LDL of 190 mg/dL and no other risk factors.
What is the most appropriate lipid-lowering therapy?
A) Diet and exercise alone B) High-intensity statin C) Fibrate D) Niacin
Answer: B) High-intensity statin
Rationale: An LDL ≥190 mg/dL indicates possible familial hypercholesterolemia and
warrants high-intensity statin therapy regardless of other risk factors. Lifestyle
modification alone is insufficient.
Question 8. A 75-year-old male on warfarin for AF has an INR of 6.5 without
bleeding. What is the most appropriate management?
A) Continue warfarin at same dose B) Give vitamin K 10 mg IV C) Hold warfarin and
give vitamin K 2.5 mg PO D) Transfuse FFP
Answer: C) Hold warfarin and give vitamin K 2.5 mg PO
Rationale: For INR 6.5 without bleeding, hold warfarin and give low-dose oral vitamin
K (2.5 mg). High-dose IV vitamin K and FFP are reserved for major bleeding or life-
threatening situations.
Question 9. A 55-year-old male presents with tearing chest pain radiating to the
back. BP is 180/100, and there is a diastolic murmur. What is the most likely
diagnosis?
A) STEMI B) Aortic dissection C) Pericarditis D) Pulmonary embolism
Answer: B) Aortic dissection
Rationale: Tearing chest pain radiating to the back, severe hypertension, and a diastolic
murmur (aortic regurgitation) are classic for aortic dissection. Immediate CT
angiography is required.
Question 10. A 68-year-old with HFrEF is on maximally tolerated beta-blocker and
ACE inhibitor. He remains symptomatic (NYHA Class III). What should be added?
A) Amlodipine B) Spironolactone C) Digoxin D) Hydralazine
Answer: B) Spironolactone
Rationale: Aldosterone receptor antagonists (spironolactone, eplerenone) have
mortality benefit in NYHA Class II–IV HFrEF. They should be added when patients
remain symptomatic despite optimal beta-blocker and ACE inhibitor/ARB therapy.
, Question 11. A 62-year-old male with a 40-pack-year smoking history has a new
cough, hemoptysis, and 15-lb weight loss. Chest x-ray shows a 3-cm spiculated
nodule in the right upper lobe. What is the most appropriate next step?
A) Repeat x-ray in 6 months B) CT-guided biopsy C) Bronchoscopy with biopsy D)
Pulmonary function testing
Answer: C) Bronchoscopy with biopsy
Rationale: A solitary pulmonary nodule with spiculated margins and constitutional
symptoms in a high-risk smoker is highly suspicious for lung cancer. Bronchoscopy is
indicated for central lesions. CT-guided biopsy is for peripheral lesions. Observation is
inappropriate.
Question 12. A 45-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. She has dry skin, bradycardia, and delayed DTR
relaxation. Which lab finding confirms the diagnosis?
A) Elevated free T4 B) Elevated TSH C) Low TSH D) Elevated T3 uptake
Answer: B) Elevated TSH
Rationale: This is classic hypothyroidism. Primary hypothyroidism is confirmed by
elevated TSH with low free T4. The pituitary compensates for low thyroid hormone by
increasing TSH secretion.
Question 13. A 34-year-old female presents with palpitations, heat intolerance,
tremor, and weight loss. Thyroid exam reveals a diffuse, nontender goiter with a
bruit. Which test is most specific for the diagnosis?
A) Anti-thyroglobulin antibody B) Anti-TPO antibody C) Thyroid-stimulating
immunoglobulin (TSI) D) Thyroxine-binding globulin
Answer: C) TSI
Rationale: This presentation is consistent with Graves' disease. TSI is the most specific
test for Graves' disease, as it stimulates the TSH receptor, causing hyperthyroidism.
Question 14. A 52-year-old male with type 2 diabetes on metformin has an HbA1c
of 8.5%. What is the most appropriate addition to his regimen?
A) Insulin glargine B) Empagliflozin C) Pioglitazone D) Glyburide
Answer: B) Empagliflozin
PRIMARY CARE NURSE PRACTITIONER
CERTIFICATION EXAM 2026/2027: 135
VERIFIED PRACTICE QUESTIONS &
ANSWERS WITH DETAILED
RATIONALES — AANPCB EXAM PREP
SECTION I: CARDIOVASCULAR SYSTEM (Questions 1–25)
Question 1. A 68-year-old male with hypertension and type 2 diabetes presents with
exertional dyspnea, orthopnea, bibasilar crackles, an S3 gallop, and JVD. BNP is 850
pg/mL. What is the MOST appropriate initial pharmacologic management?
A) Furosemide 40 mg IV B) Metoprolol succinate 50 mg PO daily C) Lisinopril 10 mg
PO daily D) Carvedilol 6.25 mg PO BID
Answer: A) Furosemide 40 mg IV
Rationale: This patient has acute decompensated heart failure with fluid overload. IV
loop diuretics are the first-line treatment for acute decompensation to reduce preload
and relieve congestion. Beta-blockers and ACE inhibitors are chronic management
agents, not initial acute therapy.
Question 2. A 58-year-old male presents with acute-onset severe substernal chest
pressure radiating to the jaw, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V2–V4. What is the MOST appropriate immediate action?
A) Administer sublingual nitroglycerin and wait 10 minutes B) Administer aspirin
324 mg chewable and activate EMS C) Order a chest x-ray D) Perform an
echocardiogram
Answer: B) Administer aspirin 324 mg chewable and activate EMS
Rationale: This patient is having an STEMI. The priority is aspirin (antiplatelet therapy)
and immediate EMS activation for transport to a PCI-capable hospital. Time is
myocardium. Nitroglycerin may be given but not before aspirin, and EMS activation is
the priority.
,Question 3. A 65-year-old African American patient with newly diagnosed
hypertension and no other comorbidities. What is the most appropriate initial
antihypertensive agent?
A) ACE inhibitor B) Beta-blocker C) Thiazide diuretic D) Alpha-blocker
Answer: C) Thiazide diuretic
Rationale: For African American patients without comorbidities, thiazide diuretics or
calcium channel blockers are first-line therapy due to evidence of greater efficacy in
this population. ACE inhibitors are less effective as monotherapy in African American
patients.
Question 4. A 72-year-old female with atrial fibrillation has a CHA₂DS₂-VASc score of
4. What is the most appropriate anticoagulation strategy?
A) Apixaban 5 mg PO BID B) Aspirin 81 mg daily C) Clopidogrel 75 mg daily D) No
anticoagulation
Answer: A) Apixaban 5 mg PO BID
Rationale: A CHA₂DS₂-VASc score of 4 indicates high stroke risk. Direct oral
anticoagulants (DOACs) like apixaban are preferred over warfarin for nonvalvular AF.
Aspirin is insufficient for stroke prevention in high-risk patients.
Question 5. A 70-year-old male presents with stable angina. His symptoms occur
predictably with exertion and are relieved by rest. What is the first-line antianginal
medication?
A) Ranolazine B) Nitroglycerin PRN C) Metoprolol succinate D) Amlodipine
Answer: C) Metoprolol succinate
Rationale: Beta-blockers are first-line therapy for stable angina. They reduce
myocardial oxygen demand by decreasing heart rate and contractility. Nitroglycerin is
used for acute symptom relief, not chronic prevention.
Question 6. A 78-year-old with heart failure and reduced ejection fraction (HFrEF) is
on lisinopril and metoprolol. Which additional medication has mortality benefit?
A) Amlodipine B) Sacubitril/valsartan C) Digoxin D) Furosemide
Answer: B) Sacubitril/valsartan
Rationale: ARNI (sacubitril/valsartan) replaced ACEI/ARB in the PARADIGM-HF trial,
showing significant mortality reduction in HFrEF when substituted for enalapril. It
should replace the ACE inhibitor, not be added to it.
,Question 7. A 60-year-old female has LDL of 190 mg/dL and no other risk factors.
What is the most appropriate lipid-lowering therapy?
A) Diet and exercise alone B) High-intensity statin C) Fibrate D) Niacin
Answer: B) High-intensity statin
Rationale: An LDL ≥190 mg/dL indicates possible familial hypercholesterolemia and
warrants high-intensity statin therapy regardless of other risk factors. Lifestyle
modification alone is insufficient.
Question 8. A 75-year-old male on warfarin for AF has an INR of 6.5 without
bleeding. What is the most appropriate management?
A) Continue warfarin at same dose B) Give vitamin K 10 mg IV C) Hold warfarin and
give vitamin K 2.5 mg PO D) Transfuse FFP
Answer: C) Hold warfarin and give vitamin K 2.5 mg PO
Rationale: For INR 6.5 without bleeding, hold warfarin and give low-dose oral vitamin
K (2.5 mg). High-dose IV vitamin K and FFP are reserved for major bleeding or life-
threatening situations.
Question 9. A 55-year-old male presents with tearing chest pain radiating to the
back. BP is 180/100, and there is a diastolic murmur. What is the most likely
diagnosis?
A) STEMI B) Aortic dissection C) Pericarditis D) Pulmonary embolism
Answer: B) Aortic dissection
Rationale: Tearing chest pain radiating to the back, severe hypertension, and a diastolic
murmur (aortic regurgitation) are classic for aortic dissection. Immediate CT
angiography is required.
Question 10. A 68-year-old with HFrEF is on maximally tolerated beta-blocker and
ACE inhibitor. He remains symptomatic (NYHA Class III). What should be added?
A) Amlodipine B) Spironolactone C) Digoxin D) Hydralazine
Answer: B) Spironolactone
Rationale: Aldosterone receptor antagonists (spironolactone, eplerenone) have
mortality benefit in NYHA Class II–IV HFrEF. They should be added when patients
remain symptomatic despite optimal beta-blocker and ACE inhibitor/ARB therapy.
, Question 11. A 62-year-old male with a 40-pack-year smoking history has a new
cough, hemoptysis, and 15-lb weight loss. Chest x-ray shows a 3-cm spiculated
nodule in the right upper lobe. What is the most appropriate next step?
A) Repeat x-ray in 6 months B) CT-guided biopsy C) Bronchoscopy with biopsy D)
Pulmonary function testing
Answer: C) Bronchoscopy with biopsy
Rationale: A solitary pulmonary nodule with spiculated margins and constitutional
symptoms in a high-risk smoker is highly suspicious for lung cancer. Bronchoscopy is
indicated for central lesions. CT-guided biopsy is for peripheral lesions. Observation is
inappropriate.
Question 12. A 45-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. She has dry skin, bradycardia, and delayed DTR
relaxation. Which lab finding confirms the diagnosis?
A) Elevated free T4 B) Elevated TSH C) Low TSH D) Elevated T3 uptake
Answer: B) Elevated TSH
Rationale: This is classic hypothyroidism. Primary hypothyroidism is confirmed by
elevated TSH with low free T4. The pituitary compensates for low thyroid hormone by
increasing TSH secretion.
Question 13. A 34-year-old female presents with palpitations, heat intolerance,
tremor, and weight loss. Thyroid exam reveals a diffuse, nontender goiter with a
bruit. Which test is most specific for the diagnosis?
A) Anti-thyroglobulin antibody B) Anti-TPO antibody C) Thyroid-stimulating
immunoglobulin (TSI) D) Thyroxine-binding globulin
Answer: C) TSI
Rationale: This presentation is consistent with Graves' disease. TSI is the most specific
test for Graves' disease, as it stimulates the TSH receptor, causing hyperthyroidism.
Question 14. A 52-year-old male with type 2 diabetes on metformin has an HbA1c
of 8.5%. What is the most appropriate addition to his regimen?
A) Insulin glargine B) Empagliflozin C) Pioglitazone D) Glyburide
Answer: B) Empagliflozin
