Board Certified Geriatric Pharmacist (BCGP) Exam 2026:
Professional Certification Practice Test — Geriatric Therapeutics,
Medication Safety, Patient Management & Professional Practice —
190 Multiple-Choice Questions with Answers & Detailed Rationales
Question 1
An 82-year-old female with Stage 4 chronic kidney disease (eGFR 24 mL/min/1.73m²), type 2
diabetes, and osteoarthritis presents with worsening knee pain. She currently takes
metformin, lisinopril, and acetaminophen as needed. Which analgesic strategy is most
appropriate?
A. Ibuprofen 400 mg three times daily as needed
B. Naproxen 250 mg twice daily with food
C. Topical diclofenac gel applied to the affected knee
D. Celecoxib 100 mg twice daily
Correct Answer: C
Explanation: Topical NSAIDs have minimal systemic absorption and are preferred in CKD and
older adults for localized osteoarthritis pain. Oral NSAIDs, including COX-2 inhibitors, risk
renal deterioration and GI bleeding.
Question 2
A 78-year-old male with a history of falls and insomnia is currently prescribed zolpidem 10
mg nightly. He reports continued difficulty sleeping and his daughter notes he seems
"confused" in the mornings. What is the most appropriate pharmacist recommendation?
A. Increase zolpidem to 12.5 mg nightly
,B. Switch to lorazepam 1 mg at bedtime
C. Taper zolpidem and initiate cognitive behavioral therapy for insomnia
D. Add diphenhydramine 25 mg at bedtime
Correct Answer: C
Explanation: Zolpidem is a Beers-listed potentially inappropriate medication for older adults
due to fall and delirium risk. Non-pharmacologic therapy is first-line for chronic insomnia.
Question 3
An 85-year-old nursing home resident with advanced dementia and no documented advance
directives develops aspiration pneumonia. The family asks the pharmacist about goals of
care. Which principle best guides medication decision-making in this context?
A. Maximize life expectancy regardless of functional status
B. Prioritize comfort and symptom relief consistent with palliative goals
C. Initiate all available antibiotics to prevent sepsis
D. Transfer to acute care for intravenous therapy
Correct Answer: B
Explanation: In advanced dementia with uncertain prognosis, comfort-focused care aligns
with palliative principles and avoids burdensome interventions. Shared decision-making with
family is essential.
Question 4
,A 72-year-old female is prescribed warfarin for atrial fibrillation. She presents with an INR of
5.8 and no active bleeding. She takes no interacting medications. Which management step is
most appropriate?
A. Administer vitamin K 10 mg IV immediately
B. Hold warfarin and monitor INR without vitamin K
C. Transfuse fresh frozen plasma
D. Continue warfarin at the same dose and recheck in one week
Correct Answer: B
Explanation: For INR 5-9 without bleeding, warfarin should be held and INR monitored.
Vitamin K is reserved for serious bleeding or rapid reversal needs. FFP is unnecessary
without hemorrhage.
Question 5
An 80-year-old male with Parkinson's disease is experiencing visual hallucinations and
confusion. His neurologist considers adding an antipsychotic. Which agent is most
appropriate if pharmacotherapy is deemed necessary?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Olanzapine
Correct Answer: C
, Explanation: Quetiapine has the lowest D2 receptor affinity among atypical antipsychotics
and is least likely to worsen parkinsonism. Typical antipsychotics are contraindicated in
Parkinson's disease.
Question 6
A 76-year-old female is admitted with digoxin toxicity (nausea, visual disturbances,
bradycardia). Her medications include digoxin 0.25 mg daily, furosemide, and lisinopril.
Which factor most likely precipitated her toxicity?
A. Age-related increase in digoxin clearance
B. Hypokalemia from furosemide use
C. Lisinopril-induced hyperkalemia
D. Enhanced digoxin protein binding
Correct Answer: B
Explanation: Loop diuretics cause hypokalemia, which increases digoxin toxicity risk by
enhancing drug binding at Na/K-ATPase. Older adults also have reduced renal digoxin
clearance.
Question 7
An 83-year-old community-dwelling female with mild cognitive impairment asks about
starting a cholinesterase inhibitor. Her MMSE is 26/30. What is the most appropriate
pharmacist response?
A. Cholinesterase inhibitors are contraindicated in mild cognitive impairment
B. Benefits are modest and should be weighed against GI and cardiac side effects
C. Initiate donepezil 10 mg immediately for neuroprotection
Professional Certification Practice Test — Geriatric Therapeutics,
Medication Safety, Patient Management & Professional Practice —
190 Multiple-Choice Questions with Answers & Detailed Rationales
Question 1
An 82-year-old female with Stage 4 chronic kidney disease (eGFR 24 mL/min/1.73m²), type 2
diabetes, and osteoarthritis presents with worsening knee pain. She currently takes
metformin, lisinopril, and acetaminophen as needed. Which analgesic strategy is most
appropriate?
A. Ibuprofen 400 mg three times daily as needed
B. Naproxen 250 mg twice daily with food
C. Topical diclofenac gel applied to the affected knee
D. Celecoxib 100 mg twice daily
Correct Answer: C
Explanation: Topical NSAIDs have minimal systemic absorption and are preferred in CKD and
older adults for localized osteoarthritis pain. Oral NSAIDs, including COX-2 inhibitors, risk
renal deterioration and GI bleeding.
Question 2
A 78-year-old male with a history of falls and insomnia is currently prescribed zolpidem 10
mg nightly. He reports continued difficulty sleeping and his daughter notes he seems
"confused" in the mornings. What is the most appropriate pharmacist recommendation?
A. Increase zolpidem to 12.5 mg nightly
,B. Switch to lorazepam 1 mg at bedtime
C. Taper zolpidem and initiate cognitive behavioral therapy for insomnia
D. Add diphenhydramine 25 mg at bedtime
Correct Answer: C
Explanation: Zolpidem is a Beers-listed potentially inappropriate medication for older adults
due to fall and delirium risk. Non-pharmacologic therapy is first-line for chronic insomnia.
Question 3
An 85-year-old nursing home resident with advanced dementia and no documented advance
directives develops aspiration pneumonia. The family asks the pharmacist about goals of
care. Which principle best guides medication decision-making in this context?
A. Maximize life expectancy regardless of functional status
B. Prioritize comfort and symptom relief consistent with palliative goals
C. Initiate all available antibiotics to prevent sepsis
D. Transfer to acute care for intravenous therapy
Correct Answer: B
Explanation: In advanced dementia with uncertain prognosis, comfort-focused care aligns
with palliative principles and avoids burdensome interventions. Shared decision-making with
family is essential.
Question 4
,A 72-year-old female is prescribed warfarin for atrial fibrillation. She presents with an INR of
5.8 and no active bleeding. She takes no interacting medications. Which management step is
most appropriate?
A. Administer vitamin K 10 mg IV immediately
B. Hold warfarin and monitor INR without vitamin K
C. Transfuse fresh frozen plasma
D. Continue warfarin at the same dose and recheck in one week
Correct Answer: B
Explanation: For INR 5-9 without bleeding, warfarin should be held and INR monitored.
Vitamin K is reserved for serious bleeding or rapid reversal needs. FFP is unnecessary
without hemorrhage.
Question 5
An 80-year-old male with Parkinson's disease is experiencing visual hallucinations and
confusion. His neurologist considers adding an antipsychotic. Which agent is most
appropriate if pharmacotherapy is deemed necessary?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Olanzapine
Correct Answer: C
, Explanation: Quetiapine has the lowest D2 receptor affinity among atypical antipsychotics
and is least likely to worsen parkinsonism. Typical antipsychotics are contraindicated in
Parkinson's disease.
Question 6
A 76-year-old female is admitted with digoxin toxicity (nausea, visual disturbances,
bradycardia). Her medications include digoxin 0.25 mg daily, furosemide, and lisinopril.
Which factor most likely precipitated her toxicity?
A. Age-related increase in digoxin clearance
B. Hypokalemia from furosemide use
C. Lisinopril-induced hyperkalemia
D. Enhanced digoxin protein binding
Correct Answer: B
Explanation: Loop diuretics cause hypokalemia, which increases digoxin toxicity risk by
enhancing drug binding at Na/K-ATPase. Older adults also have reduced renal digoxin
clearance.
Question 7
An 83-year-old community-dwelling female with mild cognitive impairment asks about
starting a cholinesterase inhibitor. Her MMSE is 26/30. What is the most appropriate
pharmacist response?
A. Cholinesterase inhibitors are contraindicated in mild cognitive impairment
B. Benefits are modest and should be weighed against GI and cardiac side effects
C. Initiate donepezil 10 mg immediately for neuroprotection
