Adult-Gerontology NP Certification Exam –
Complete 150-Item Practice Test (Answer Key
Included)
2025/2026
1. A 72-year-old male presents with isolated systolic hypertension.
Which medication class is preferred as first-line therapy?
A. Beta-blocker
B. Alpha-blocker
C. Thiazide diuretic
D. ACE inhibitor
Rationale: Thiazides have strong evidence for reducing cardiovascular
events in older adults with isolated systolic hypertension.
2. A 68-year-old woman has new-onset atrial fibrillation. Which tool
helps assess stroke risk?
A. Wells Score
B. CHA₂DS₂-VASc
C. TIMI Score
D. APACHE II
Rationale: CHA₂DS₂-VASc is the standard tool for stroke risk
stratification in atrial fibrillation.
3. An older adult complains of nocturnal leg cramps. Which
intervention is recommended first?
A. Magnesium supplements
B. Potassium supplements
,C. Stretching exercises
D. Quinine
Rationale: Stretching is first-line; supplements are not routinely
recommended, and quinine is unsafe.
4. A 70-year-old man with COPD has increased sputum and dyspnea
for 3 days. Which medication should be initiated?
A. Long-term oxygen therapy
B. Short course of oral steroids
C. Leukotriene inhibitor
D. Antihistamine
Rationale: COPD exacerbations require short systemic corticosteroids
to reduce inflammation and improve airflow.
5. A 66-year-old woman with hypothyroidism has been stable for
years. Her TSH is slightly low. What is the best action?
A. Increase levothyroxine
B. Decrease levothyroxine dose
C. Switch to T3 therapy
D. No change
Rationale: Low TSH suggests overtreatment; dose should be reduced.
6. A 79-year-old male has macrocytic anemia with elevated MCV and
normal B12. What is the next evaluation?
A. Ferritin
B. Hemoglobin electrophoresis
C. Folate level
,D. TIBC
Rationale: Macrocytosis with normal B12 warrants evaluation of
folate deficiency.
7. Older adult with Parkinson’s disease develops hallucinations.
Which medication is preferred?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Lithium
Rationale: Quetiapine is safer in Parkinson’s due to minimal
extrapyramidal effects.
8. A 65-year-old man complains of urinary hesitancy. Which class
improves symptoms of BPH quickly?
A. 5-alpha-reductase inhibitor
B. Alpha-blocker
C. Anticholinergic
D. PDE-5 inhibitor
Rationale: Alpha-blockers provide rapid symptom relief by relaxing
smooth muscle.
9. Which vaccine is recommended for all adults ≥65?
A. Live zoster vaccine
B. Tdap
C. Pneumococcal vaccine
D. HPV
, Rationale: Adults ≥65 should receive pneumococcal vaccination based
on ACIP guidelines.
10. A 75-year-old woman has acute confusion and foul-smelling urine.
What is best next step?
A. Treat empirically
B. Order urinalysis and urine culture
C. Start antipsychotic
D. Observe only
Rationale: Diagnosis requires UA and culture before antibiotics in
older adults.
11. An older man has resting tremor, bradykinesia, and shuffling gait.
The most likely diagnosis?
A. ALS
B. Parkinson’s disease
C. Lewy body dementia
D. MS
Rationale: Classic triad of Parkinson’s: tremor, rigidity, bradykinesia.
12. Which lab should be monitored regularly in a patient on ACE
inhibitors?
A. CBC
B. Potassium
C. INR
D. LFTs
Complete 150-Item Practice Test (Answer Key
Included)
2025/2026
1. A 72-year-old male presents with isolated systolic hypertension.
Which medication class is preferred as first-line therapy?
A. Beta-blocker
B. Alpha-blocker
C. Thiazide diuretic
D. ACE inhibitor
Rationale: Thiazides have strong evidence for reducing cardiovascular
events in older adults with isolated systolic hypertension.
2. A 68-year-old woman has new-onset atrial fibrillation. Which tool
helps assess stroke risk?
A. Wells Score
B. CHA₂DS₂-VASc
C. TIMI Score
D. APACHE II
Rationale: CHA₂DS₂-VASc is the standard tool for stroke risk
stratification in atrial fibrillation.
3. An older adult complains of nocturnal leg cramps. Which
intervention is recommended first?
A. Magnesium supplements
B. Potassium supplements
,C. Stretching exercises
D. Quinine
Rationale: Stretching is first-line; supplements are not routinely
recommended, and quinine is unsafe.
4. A 70-year-old man with COPD has increased sputum and dyspnea
for 3 days. Which medication should be initiated?
A. Long-term oxygen therapy
B. Short course of oral steroids
C. Leukotriene inhibitor
D. Antihistamine
Rationale: COPD exacerbations require short systemic corticosteroids
to reduce inflammation and improve airflow.
5. A 66-year-old woman with hypothyroidism has been stable for
years. Her TSH is slightly low. What is the best action?
A. Increase levothyroxine
B. Decrease levothyroxine dose
C. Switch to T3 therapy
D. No change
Rationale: Low TSH suggests overtreatment; dose should be reduced.
6. A 79-year-old male has macrocytic anemia with elevated MCV and
normal B12. What is the next evaluation?
A. Ferritin
B. Hemoglobin electrophoresis
C. Folate level
,D. TIBC
Rationale: Macrocytosis with normal B12 warrants evaluation of
folate deficiency.
7. Older adult with Parkinson’s disease develops hallucinations.
Which medication is preferred?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Lithium
Rationale: Quetiapine is safer in Parkinson’s due to minimal
extrapyramidal effects.
8. A 65-year-old man complains of urinary hesitancy. Which class
improves symptoms of BPH quickly?
A. 5-alpha-reductase inhibitor
B. Alpha-blocker
C. Anticholinergic
D. PDE-5 inhibitor
Rationale: Alpha-blockers provide rapid symptom relief by relaxing
smooth muscle.
9. Which vaccine is recommended for all adults ≥65?
A. Live zoster vaccine
B. Tdap
C. Pneumococcal vaccine
D. HPV
, Rationale: Adults ≥65 should receive pneumococcal vaccination based
on ACIP guidelines.
10. A 75-year-old woman has acute confusion and foul-smelling urine.
What is best next step?
A. Treat empirically
B. Order urinalysis and urine culture
C. Start antipsychotic
D. Observe only
Rationale: Diagnosis requires UA and culture before antibiotics in
older adults.
11. An older man has resting tremor, bradykinesia, and shuffling gait.
The most likely diagnosis?
A. ALS
B. Parkinson’s disease
C. Lewy body dementia
D. MS
Rationale: Classic triad of Parkinson’s: tremor, rigidity, bradykinesia.
12. Which lab should be monitored regularly in a patient on ACE
inhibitors?
A. CBC
B. Potassium
C. INR
D. LFTs
