Maria Leik AGNP Exam Study Guide
(2026/2027) – 1400+ Questions, Clinical
Terms & Answers for Adult-Gerontology
NP Board Exam Prep (PDF)
SECTION 1: ASSESSMENT & DIAGNOSIS
Question 1
A 72-year-old man presents with a 3-day history of right-sided headache, visual
disturbance, and jaw claudication. His ESR is 110 mm/hr and CRP is 95 mg/L. Which of
the following is the most appropriate next step?
A) Prescribe oral prednisone and schedule a temporal artery biopsy
B) Order an MRI of the brain
C) Prescribe sumatriptan for migraine
D) Refer to ophthalmology for routine eye exam
Correct Answer: A) Prescribe oral prednisone and schedule a temporal artery
biopsy
Rationale: This patient has classic signs of giant cell arteritis (temporal arteritis),
including headache, visual disturbance, jaw claudication, and markedly elevated ESR and
CRP. This is a medical emergency due to the risk of blindness. High-dose corticosteroids
should be started immediately, and a temporal artery biopsy should be scheduled as
soon as possible. Do not wait for biopsy results to start steroids.
Question 2
,A 68-year-old woman with a history of COPD presents with worsening shortness of
breath, lower extremity edema, and jugular venous distention. She has a right ventricular
heave on exam. Which diagnosis is most likely?
A) Left-sided heart failure
B) Cor pulmonale
C) Pulmonary embolism
D) Pneumonia
Correct Answer: B) Cor pulmonale
Rationale: Cor pulmonale is right-sided heart failure caused by pulmonary hypertension
secondary to chronic lung disease (such as COPD). Key findings include lower extremity
edema, JVD, right ventricular heave, and worsening dyspnea. Left-sided heart failure
typically presents with pulmonary crackles. Pulmonary embolism presents acutely with
sudden dyspnea and pleuritic chest pain.
Question 3
A 74-year-old male is newly diagnosed with hypertension. His blood pressure is 145/88
mmHg on two separate occasions. He has no other significant medical history. What is
the most appropriate initial management?
A) Begin lifestyle modifications and reassess in 3-6 months
B) Start hydrochlorothiazide 12.5 mg daily
C) Start lisinopril 10 mg daily
D) Order a renal ultrasound
Correct Answer: A) Begin lifestyle modifications and reassess in 3-6 months
Rationale: For patients with stage 1 hypertension (BP 130-139/80-89) and low
cardiovascular risk, lifestyle modifications are recommended as first-line treatment. If BP
is not controlled after 3-6 months of lifestyle changes, pharmacologic therapy should be
initiated. In patients with stage 2 hypertension (≥140/90) or high cardiovascular risk,
medication should be started immediately.
,Question 4
A 70-year-old woman reports that she has been experiencing "dizziness when she
stands up." Her blood pressure drops from 140/90 to 110/70 mmHg upon standing.
What is the most appropriate initial recommendation?
A) Increase fluid and salt intake
B) Start midodrine
C) Discontinue all antihypertensives
D) Refer to cardiology for pacemaker evaluation
Correct Answer: A) Increase fluid and salt intake
Rationale: Orthostatic hypotension in older adults often responds to non-
pharmacologic interventions first. Increasing fluid and salt intake, avoiding sudden
position changes, and wearing compression stockings are first-line recommendations.
Midodrine is a pharmacologic option for refractory cases. Antihypertensives should be
adjusted, not necessarily discontinued completely. Pacemakers are for bradyarrhythmias.
Question 5
An 82-year-old woman with no significant medical history reports that she has been
feeling "down" for the past few weeks. Her appetite is decreased, she has difficulty
sleeping, and she no longer enjoys activities she once loved. She is able to perform her
activities of daily living. What is the most appropriate initial screen?
A) PHQ-9
B) MMSE
C) GAD-7
D) CAGE questionnaire
Correct Answer: A) PHQ-9
Rationale: The PHQ-9 is a validated screening tool for depression that can be
administered in primary care. The patient's symptoms of depressed mood, anhedonia,
sleep disturbance, and appetite changes are consistent with major depressive disorder.
The MMSE is for cognitive impairment, GAD-7 is for anxiety, and CAGE is for alcohol use.
, Question 6
A 67-year-old man presents with acute onset of severe left lower quadrant abdominal
pain, fever, and constipation. On exam, he has left lower quadrant tenderness and a
palpable mass. What is the most likely diagnosis?
A) Diverticulitis
B) Appendicitis
C) Irritable bowel syndrome
D) Ovarian torsion
Correct Answer: A) Diverticulitis
Rationale: Diverticulitis typically presents with left lower quadrant abdominal pain,
fever, nausea, and change in bowel habits (constipation or diarrhea). The left lower
quadrant is the most common location for diverticulitis. Appendicitis presents with right
lower quadrant pain. IBS does not cause fever or a palpable mass. Ovarian torsion is not
applicable in a male.
Question 7
A 75-year-old woman with a history of Alzheimer's disease is started on donepezil.
Which side effect is most common and often dose-related?
A) Bradycardia
B) Nausea, diarrhea, and insomnia
C) Hepatotoxicity
D) Weight gain
Correct Answer: B) Nausea, diarrhea, and insomnia
Rationale: Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) commonly
cause gastrointestinal upset (nausea, vomiting, diarrhea) and insomnia. These symptoms
are often dose-related and may improve with time or dose reduction. Bradycardia can
occur but is less common. Weight gain and hepatotoxicity are not typical side effects of
donepezil .
(2026/2027) – 1400+ Questions, Clinical
Terms & Answers for Adult-Gerontology
NP Board Exam Prep (PDF)
SECTION 1: ASSESSMENT & DIAGNOSIS
Question 1
A 72-year-old man presents with a 3-day history of right-sided headache, visual
disturbance, and jaw claudication. His ESR is 110 mm/hr and CRP is 95 mg/L. Which of
the following is the most appropriate next step?
A) Prescribe oral prednisone and schedule a temporal artery biopsy
B) Order an MRI of the brain
C) Prescribe sumatriptan for migraine
D) Refer to ophthalmology for routine eye exam
Correct Answer: A) Prescribe oral prednisone and schedule a temporal artery
biopsy
Rationale: This patient has classic signs of giant cell arteritis (temporal arteritis),
including headache, visual disturbance, jaw claudication, and markedly elevated ESR and
CRP. This is a medical emergency due to the risk of blindness. High-dose corticosteroids
should be started immediately, and a temporal artery biopsy should be scheduled as
soon as possible. Do not wait for biopsy results to start steroids.
Question 2
,A 68-year-old woman with a history of COPD presents with worsening shortness of
breath, lower extremity edema, and jugular venous distention. She has a right ventricular
heave on exam. Which diagnosis is most likely?
A) Left-sided heart failure
B) Cor pulmonale
C) Pulmonary embolism
D) Pneumonia
Correct Answer: B) Cor pulmonale
Rationale: Cor pulmonale is right-sided heart failure caused by pulmonary hypertension
secondary to chronic lung disease (such as COPD). Key findings include lower extremity
edema, JVD, right ventricular heave, and worsening dyspnea. Left-sided heart failure
typically presents with pulmonary crackles. Pulmonary embolism presents acutely with
sudden dyspnea and pleuritic chest pain.
Question 3
A 74-year-old male is newly diagnosed with hypertension. His blood pressure is 145/88
mmHg on two separate occasions. He has no other significant medical history. What is
the most appropriate initial management?
A) Begin lifestyle modifications and reassess in 3-6 months
B) Start hydrochlorothiazide 12.5 mg daily
C) Start lisinopril 10 mg daily
D) Order a renal ultrasound
Correct Answer: A) Begin lifestyle modifications and reassess in 3-6 months
Rationale: For patients with stage 1 hypertension (BP 130-139/80-89) and low
cardiovascular risk, lifestyle modifications are recommended as first-line treatment. If BP
is not controlled after 3-6 months of lifestyle changes, pharmacologic therapy should be
initiated. In patients with stage 2 hypertension (≥140/90) or high cardiovascular risk,
medication should be started immediately.
,Question 4
A 70-year-old woman reports that she has been experiencing "dizziness when she
stands up." Her blood pressure drops from 140/90 to 110/70 mmHg upon standing.
What is the most appropriate initial recommendation?
A) Increase fluid and salt intake
B) Start midodrine
C) Discontinue all antihypertensives
D) Refer to cardiology for pacemaker evaluation
Correct Answer: A) Increase fluid and salt intake
Rationale: Orthostatic hypotension in older adults often responds to non-
pharmacologic interventions first. Increasing fluid and salt intake, avoiding sudden
position changes, and wearing compression stockings are first-line recommendations.
Midodrine is a pharmacologic option for refractory cases. Antihypertensives should be
adjusted, not necessarily discontinued completely. Pacemakers are for bradyarrhythmias.
Question 5
An 82-year-old woman with no significant medical history reports that she has been
feeling "down" for the past few weeks. Her appetite is decreased, she has difficulty
sleeping, and she no longer enjoys activities she once loved. She is able to perform her
activities of daily living. What is the most appropriate initial screen?
A) PHQ-9
B) MMSE
C) GAD-7
D) CAGE questionnaire
Correct Answer: A) PHQ-9
Rationale: The PHQ-9 is a validated screening tool for depression that can be
administered in primary care. The patient's symptoms of depressed mood, anhedonia,
sleep disturbance, and appetite changes are consistent with major depressive disorder.
The MMSE is for cognitive impairment, GAD-7 is for anxiety, and CAGE is for alcohol use.
, Question 6
A 67-year-old man presents with acute onset of severe left lower quadrant abdominal
pain, fever, and constipation. On exam, he has left lower quadrant tenderness and a
palpable mass. What is the most likely diagnosis?
A) Diverticulitis
B) Appendicitis
C) Irritable bowel syndrome
D) Ovarian torsion
Correct Answer: A) Diverticulitis
Rationale: Diverticulitis typically presents with left lower quadrant abdominal pain,
fever, nausea, and change in bowel habits (constipation or diarrhea). The left lower
quadrant is the most common location for diverticulitis. Appendicitis presents with right
lower quadrant pain. IBS does not cause fever or a palpable mass. Ovarian torsion is not
applicable in a male.
Question 7
A 75-year-old woman with a history of Alzheimer's disease is started on donepezil.
Which side effect is most common and often dose-related?
A) Bradycardia
B) Nausea, diarrhea, and insomnia
C) Hepatotoxicity
D) Weight gain
Correct Answer: B) Nausea, diarrhea, and insomnia
Rationale: Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) commonly
cause gastrointestinal upset (nausea, vomiting, diarrhea) and insomnia. These symptoms
are often dose-related and may improve with time or dose reduction. Bradycardia can
occur but is less common. Weight gain and hepatotoxicity are not typical side effects of
donepezil .
