AGPCNP Certification Exam 2026: Adult-Gerontology Primary Care
Nurse Practitioner Board Practice Test — Health Promotion,
Geriatric Care, Chronic Disease Management, Pharmacology,
Diagnostics & Clinical Decision-Making — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
Section 1: Cardiovascular System (Questions 1–24)
Question 1
A 72-year-old patient with hypertension, chronic kidney disease, and osteoarthritis has an
office blood pressure of 168/82 mmHg. Home readings average 146/76 mmHg. Which
intervention is most appropriate initially?
A. Discontinue all antihypertensive therapy
B. Confirm home blood pressure technique and obtain additional out-of-office readings
C. Immediately add three antihypertensive agents
D. Diagnose resistant hypertension
Correct Answer: B
Explanation: Confirm home blood pressure technique before escalating therapy; out-of-
office measurements help distinguish sustained hypertension from white-coat effects.
Clinical Pearl: Proper cuff size and positioning are essential for accurate readings in older
adults.
Question 2
,An 80-year-old patient taking warfarin develops melena and dizziness. Blood pressure is
88/54 mmHg and heart rate is 118/min. Which finding requires the highest priority?
A. INR of 4.8
B. Hemoglobin of 9.8 g/dL
C. Hemodynamic instability from suspected major gastrointestinal bleeding
D. History of atrial fibrillation
Correct Answer: C
Explanation: Hypotension and tachycardia with melena indicate life-threatening blood loss
requiring immediate stabilization. Best Practice: Airway, breathing, and circulation take
priority over laboratory values in acute hemorrhage.
Question 3
A 67-year-old patient reports exertional substernal pressure that resolves after several
minutes of rest. Which diagnosis should be prioritized?
A. Gastroesophageal reflux disease
B. Costochondritis
C. Stable angina due to myocardial ischemia
D. Panic disorder
Correct Answer: C
Explanation: Predictable exertional chest pressure relieved by rest is characteristic of stable
angina. Clinical Pearl: Older adults and women may present with atypical symptoms such as
dyspnea or fatigue rather than classic chest pain.
,Question 4
A 74-year-old patient with type 2 diabetes has an A1C of 8.9%, recurrent falls, and mild
cognitive impairment. Which approach best reflects individualized diabetes management?
A. Automatically target an A1C below 6.5%
B. Individualize the glycemic target based on comorbidities, cognition, functional status, and
hypoglycemia risk
C. Stop all diabetes medications
D. Begin intensive insulin therapy regardless of risk
Correct Answer: B
Explanation: Glycemic targets in older adults must account for overall health, functional
status, and hypoglycemia risk rather than a universal target. Best Practice: The American
Diabetes Association recommends A1C targets of 7.5–8.0% for older adults with multiple
comorbidities.
Question 5
A 69-year-old patient has progressive exertional dyspnea, bilateral ankle edema, orthopnea,
and an elevated BNP. Which diagnosis is most likely?
A. Chronic bronchitis
B. Pulmonary embolism
C. Heart failure
D. Nephrolithiasis
Correct Answer: C
, Explanation: Orthopnea, peripheral edema, exertional dyspnea, and elevated natriuretic
peptide strongly support heart failure. Clinical Pearl: BNP levels can be falsely elevated in
renal insufficiency and falsely low in obesity.
Question 6
A 76-year-old patient taking lisinopril develops persistent potassium of 5.9 mEq/L. Which
action is most appropriate?
A. Increase the lisinopril dose
B. Add potassium supplementation
C. Evaluate the hyperkalemia and review renal function and contributing medications
D. Encourage a high-potassium diet
Correct Answer: C
Explanation: ACE inhibitors can increase serum potassium, particularly in chronic kidney
disease. Significant hyperkalemia requires assessment of renal function, medications, and
treatment urgency. Clinical Pearl: Always check potassium and creatinine within 1–2 weeks
of initiating or titrating ACE inhibitors or ARBs.
Question 7
A 71-year-old patient presents with new unilateral temporal headache, jaw claudication, and
transient visual blurring. Which condition should be suspected?
A. Migraine
B. Tension headache
C. Giant cell arteritis
D. Trigeminal neuralgia
Nurse Practitioner Board Practice Test — Health Promotion,
Geriatric Care, Chronic Disease Management, Pharmacology,
Diagnostics & Clinical Decision-Making — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
Section 1: Cardiovascular System (Questions 1–24)
Question 1
A 72-year-old patient with hypertension, chronic kidney disease, and osteoarthritis has an
office blood pressure of 168/82 mmHg. Home readings average 146/76 mmHg. Which
intervention is most appropriate initially?
A. Discontinue all antihypertensive therapy
B. Confirm home blood pressure technique and obtain additional out-of-office readings
C. Immediately add three antihypertensive agents
D. Diagnose resistant hypertension
Correct Answer: B
Explanation: Confirm home blood pressure technique before escalating therapy; out-of-
office measurements help distinguish sustained hypertension from white-coat effects.
Clinical Pearl: Proper cuff size and positioning are essential for accurate readings in older
adults.
Question 2
,An 80-year-old patient taking warfarin develops melena and dizziness. Blood pressure is
88/54 mmHg and heart rate is 118/min. Which finding requires the highest priority?
A. INR of 4.8
B. Hemoglobin of 9.8 g/dL
C. Hemodynamic instability from suspected major gastrointestinal bleeding
D. History of atrial fibrillation
Correct Answer: C
Explanation: Hypotension and tachycardia with melena indicate life-threatening blood loss
requiring immediate stabilization. Best Practice: Airway, breathing, and circulation take
priority over laboratory values in acute hemorrhage.
Question 3
A 67-year-old patient reports exertional substernal pressure that resolves after several
minutes of rest. Which diagnosis should be prioritized?
A. Gastroesophageal reflux disease
B. Costochondritis
C. Stable angina due to myocardial ischemia
D. Panic disorder
Correct Answer: C
Explanation: Predictable exertional chest pressure relieved by rest is characteristic of stable
angina. Clinical Pearl: Older adults and women may present with atypical symptoms such as
dyspnea or fatigue rather than classic chest pain.
,Question 4
A 74-year-old patient with type 2 diabetes has an A1C of 8.9%, recurrent falls, and mild
cognitive impairment. Which approach best reflects individualized diabetes management?
A. Automatically target an A1C below 6.5%
B. Individualize the glycemic target based on comorbidities, cognition, functional status, and
hypoglycemia risk
C. Stop all diabetes medications
D. Begin intensive insulin therapy regardless of risk
Correct Answer: B
Explanation: Glycemic targets in older adults must account for overall health, functional
status, and hypoglycemia risk rather than a universal target. Best Practice: The American
Diabetes Association recommends A1C targets of 7.5–8.0% for older adults with multiple
comorbidities.
Question 5
A 69-year-old patient has progressive exertional dyspnea, bilateral ankle edema, orthopnea,
and an elevated BNP. Which diagnosis is most likely?
A. Chronic bronchitis
B. Pulmonary embolism
C. Heart failure
D. Nephrolithiasis
Correct Answer: C
, Explanation: Orthopnea, peripheral edema, exertional dyspnea, and elevated natriuretic
peptide strongly support heart failure. Clinical Pearl: BNP levels can be falsely elevated in
renal insufficiency and falsely low in obesity.
Question 6
A 76-year-old patient taking lisinopril develops persistent potassium of 5.9 mEq/L. Which
action is most appropriate?
A. Increase the lisinopril dose
B. Add potassium supplementation
C. Evaluate the hyperkalemia and review renal function and contributing medications
D. Encourage a high-potassium diet
Correct Answer: C
Explanation: ACE inhibitors can increase serum potassium, particularly in chronic kidney
disease. Significant hyperkalemia requires assessment of renal function, medications, and
treatment urgency. Clinical Pearl: Always check potassium and creatinine within 1–2 weeks
of initiating or titrating ACE inhibitors or ARBs.
Question 7
A 71-year-old patient presents with new unilateral temporal headache, jaw claudication, and
transient visual blurring. Which condition should be suspected?
A. Migraine
B. Tension headache
C. Giant cell arteritis
D. Trigeminal neuralgia
