Page 1 of 150
Adult-Gerontology Primary Care Nurse
Practitioner (AGPCNP) Exam | 2026 Edition
100 questions with correct answers Focus:
Chronic disease management • Geriatric
syndromes • Pharmacology in older adults •
Preventive care •
1. A 72-year-old with hypertension, diabetes, and stage 3 CKD
(eGFR 45) has BP 148/86 mmHg on lisinopril 20 mg daily. What
is the next best step?
A. Add hydrochlorothiazide 12.5 mg
B. Increase lisinopril to 40 mg daily
C. Add amlodipine 5 mg daily
D. Switch to losartan 50 mg daily
,Page 2 of 150
Answer: C. Add amlodipine 5 mg daily
*Rationale: In CKD, target BP <130/80. ACE inhibitor is already
at moderate dose. Add a dihydropyridine CCB (amlodipine) as
second-line. Thiazides less effective at eGFR <45.*
2. A 68-year-old with heart failure with preserved ejection
fraction (HFpEF) complains of dyspnea on exertion and leg
edema. Which medication has been shown to reduce
hospitalizations in HFpEF?
A. Spironolactone
B. Metoprolol succinate
C. Empagliflozin
D. Digoxin
Answer: C. Empagliflozin
*Rationale: EMPEROR-Preserved trial showed SGLT2 inhibitors
(empagliflozin) reduce HF hospitalization in HFpEF.
,Page 3 of 150
Spironolactone (TOPCAT) showed benefit in some subgroups but
not overall.*
3. A 75-year-old with atrial fibrillation (paroxysmal) has
CHA₂DS₂-VASc score of 4 (hypertension, diabetes, prior stroke,
age 75). Which anticoagulant is preferred in older adults with
stable CAD?
A. Apixaban
B. Warfarin
C. Rivaroxaban 20 mg daily
D. Aspirin 325 mg
Answer: A. Apixaban
Rationale: DOACs preferred over warfarin in elderly due to fewer
drug interactions and no INR monitoring. Apixaban has lower
bleeding risk than rivaroxaban in older adults.
4. A 70-year-old with a new diagnosis of hypertension has a BP
of 162/94 mmHg. He has no other comorbidities. According to
, Page 4 of 150
the 2024 hypertension guidelines, what is the initial treatment?
A. Lifestyle modification alone for 6 months
B. Start amlodipine 5 mg daily
C. Start chlorthalidone 12.5 mg daily
D. Start lisinopril 10 mg daily
Answer: C. Start chlorthalidone 12.5 mg daily
Rationale: For primary hypertension in older adults without
compelling indications, thiazide-like diuretics (chlorthalidone) are
first-line based on ALLHAT and latest guidelines.
5. A 78-year-old with HFrEF (LVEF 35%) is on carvedilol 25 mg
BID, lisinopril 20 mg daily, and furosemide 40 mg daily. He
reports a chronic dry cough. What should the ACNP do next?
A. Switch lisinopril to losartan
B. Add a calcium channel blocker
C. Discontinue furosemide
D. Reduce carvedilol dose
Adult-Gerontology Primary Care Nurse
Practitioner (AGPCNP) Exam | 2026 Edition
100 questions with correct answers Focus:
Chronic disease management • Geriatric
syndromes • Pharmacology in older adults •
Preventive care •
1. A 72-year-old with hypertension, diabetes, and stage 3 CKD
(eGFR 45) has BP 148/86 mmHg on lisinopril 20 mg daily. What
is the next best step?
A. Add hydrochlorothiazide 12.5 mg
B. Increase lisinopril to 40 mg daily
C. Add amlodipine 5 mg daily
D. Switch to losartan 50 mg daily
,Page 2 of 150
Answer: C. Add amlodipine 5 mg daily
*Rationale: In CKD, target BP <130/80. ACE inhibitor is already
at moderate dose. Add a dihydropyridine CCB (amlodipine) as
second-line. Thiazides less effective at eGFR <45.*
2. A 68-year-old with heart failure with preserved ejection
fraction (HFpEF) complains of dyspnea on exertion and leg
edema. Which medication has been shown to reduce
hospitalizations in HFpEF?
A. Spironolactone
B. Metoprolol succinate
C. Empagliflozin
D. Digoxin
Answer: C. Empagliflozin
*Rationale: EMPEROR-Preserved trial showed SGLT2 inhibitors
(empagliflozin) reduce HF hospitalization in HFpEF.
,Page 3 of 150
Spironolactone (TOPCAT) showed benefit in some subgroups but
not overall.*
3. A 75-year-old with atrial fibrillation (paroxysmal) has
CHA₂DS₂-VASc score of 4 (hypertension, diabetes, prior stroke,
age 75). Which anticoagulant is preferred in older adults with
stable CAD?
A. Apixaban
B. Warfarin
C. Rivaroxaban 20 mg daily
D. Aspirin 325 mg
Answer: A. Apixaban
Rationale: DOACs preferred over warfarin in elderly due to fewer
drug interactions and no INR monitoring. Apixaban has lower
bleeding risk than rivaroxaban in older adults.
4. A 70-year-old with a new diagnosis of hypertension has a BP
of 162/94 mmHg. He has no other comorbidities. According to
, Page 4 of 150
the 2024 hypertension guidelines, what is the initial treatment?
A. Lifestyle modification alone for 6 months
B. Start amlodipine 5 mg daily
C. Start chlorthalidone 12.5 mg daily
D. Start lisinopril 10 mg daily
Answer: C. Start chlorthalidone 12.5 mg daily
Rationale: For primary hypertension in older adults without
compelling indications, thiazide-like diuretics (chlorthalidone) are
first-line based on ALLHAT and latest guidelines.
5. A 78-year-old with HFrEF (LVEF 35%) is on carvedilol 25 mg
BID, lisinopril 20 mg daily, and furosemide 40 mg daily. He
reports a chronic dry cough. What should the ACNP do next?
A. Switch lisinopril to losartan
B. Add a calcium channel blocker
C. Discontinue furosemide
D. Reduce carvedilol dose
