Advanced Practice Nursing Gerontology &
Primary Care Exam 2026/2027 – 78
Multiple Choice Questions with Rationales |
NP Board Review
Description:
Pass your NP certification with the 2026/2027 Advanced Practice Nursing Examination
in Gerontology and Primary Care. Includes 78 board-style multiple choice questions,
evidence-based answers, clinical rationales, and a complete answer key. Covers diabetes,
hypertension, dementia, delirium, palliative care, urinary incontinence, Parkinson's
disease, elder abuse, and pharmacotherapy. Updated to ACC/AHA 2017, ADA, and
GOLD guidelines.
Download the full 2026/2027 edition now and pass on your first attempt.
, NP Gerontology Board Exam 2026/2027 – 78 Questions with
Answers
Section 1: Cerebrovascular and Neurological Disorders
Question 1
Mr. A experienced a brief onset of right-sided weakness, slurred speech, and confusion
yesterday. The symptoms have resolved, and the CT scan is normal. What is the most
appropriate next step in the management plan?
A. Assure the patient that he will not experience the symptoms again
B. Identify modifiable cardiovascular risk factors
C. Order ASA 81 mg stat
D. Order a stat EEG and administer O₂ by mask
Answer: B
Explanation: Mr. A's presentation describes a transient ischemic attack (TIA), characterized
by temporary neurological deficits without evidence of acute infarction on imaging.
Following symptom resolution and normal CT, the priority is secondary prevention through
identification and management of modifiable risk factors including hypertension, diabetes,
hyperlipidemia, atrial fibrillation, smoking, and obesity. Aspirin therapy is typically indicated
after TIA, but risk factor identification precedes and guides pharmacologic management.
Assuring the patient that symptoms will not recur is false reassurance, as TIA significantly
increases subsequent stroke risk.
Question 2
Which of the following is the most appropriate screening tool for delirium?
A. St. Louis University Mental Status Exam (SLUMS)
B. Montreal Cognitive Assessment (MoCA)
C. Lawton Scale of Instrumental Activities of Daily Living
D. Confusion Assessment Method (CAM)
Answer: D
Explanation: The Confusion Assessment Method is the most widely validated and
recommended tool for delirium identification, demonstrating high sensitivity and specificity
(94-100%). It evaluates four key features: acute onset and fluctuating course, inattention,
disorganized thinking, and altered level of consciousness. SLUMS and MoCA screen for
,general cognitive impairment and dementia, while the Lawton Scale assesses functional
status rather than acute cognitive changes.
Question 3
Which characteristic of delirium helps to distinguish it from dementia?
A. Short-term memory impairment
B. Personality changes
C. Acute onset
D. Impaired attention
Answer: C
Explanation: Acute onset is the hallmark distinguishing feature of delirium, typically
developing over hours to days. Dementia has an insidious onset progressing over months to
years. While short-term memory impairment, personality changes, and impaired attention can
occur in both conditions, the temporal pattern is the most reliable differentiating factor.
Question 4
A 68-year-old woman presents with a complaint of urine leakage whenever she sneezes,
laughs, or strains for the past 4 months. She denies dysuria, frequency, and nocturia.
Urinalysis is negative for RBCs, leukocyte esterase, nitrates, ketones, and urobilinogen. What
is the diagnosis?
A. Stress incontinence
B. Urinary incontinence
C. Urge incontinence
D. Overflow incontinence
Answer: A
Explanation: Stress incontinence is characterized by involuntary leakage of urine upon
increased intra-abdominal pressure from activities such as sneezing, coughing, laughing, or
straining. The absence of irritative voiding symptoms (dysuria, frequency, nocturia) and
normal urinalysis further support this diagnosis. Urge incontinence involves a sudden,
compelling desire to void, while overflow incontinence presents with constant dribbling and
incomplete emptying.
, Question 5
The most common sustained rhythmic disorder characterized by fibrillatory P waves is:
A. AV block
B. Atrial tachycardia
C. Atrial fibrillation
D. Atrial flutter
Answer: C
Explanation: Atrial fibrillation is the most common sustained cardiac arrhythmia,
characterized on electrocardiogram by absent P waves replaced by fibrillatory waves (f
waves) with an irregularly irregular ventricular response. Atrial flutter typically demonstrates
sawtooth flutter waves (F waves) at a regular rate.
Question 6
What is the most common neurological cause of seizures in an older adult?
A. Multiple sclerosis
B. Stroke
C. Alzheimer's disease
D. Peripheral neuropathy
Answer: B
Explanation: Cerebrovascular disease, particularly stroke, is the leading cause of new-onset
seizures in older adults. Post-stroke seizures account for approximately 50% of all late-onset
epilepsy cases in the elderly population. Other causes include brain tumors,
neurodegenerative diseases, and metabolic disturbances.
Section 2: Diabetes Mellitus and Metabolic Disorders
Question 7
A 56-year-old male patient screened for diabetes has a fasting plasma glucose level of 96
mg/dL. The nurse practitioner's management plan includes:
A. Repeat fasting plasma glucose in three years
B. Prescribe metformin 500 mg PO BID
C. Repeat fasting plasma glucose in one year
D. Refer to ophthalmology for eye exam
Answer: A
Primary Care Exam 2026/2027 – 78
Multiple Choice Questions with Rationales |
NP Board Review
Description:
Pass your NP certification with the 2026/2027 Advanced Practice Nursing Examination
in Gerontology and Primary Care. Includes 78 board-style multiple choice questions,
evidence-based answers, clinical rationales, and a complete answer key. Covers diabetes,
hypertension, dementia, delirium, palliative care, urinary incontinence, Parkinson's
disease, elder abuse, and pharmacotherapy. Updated to ACC/AHA 2017, ADA, and
GOLD guidelines.
Download the full 2026/2027 edition now and pass on your first attempt.
, NP Gerontology Board Exam 2026/2027 – 78 Questions with
Answers
Section 1: Cerebrovascular and Neurological Disorders
Question 1
Mr. A experienced a brief onset of right-sided weakness, slurred speech, and confusion
yesterday. The symptoms have resolved, and the CT scan is normal. What is the most
appropriate next step in the management plan?
A. Assure the patient that he will not experience the symptoms again
B. Identify modifiable cardiovascular risk factors
C. Order ASA 81 mg stat
D. Order a stat EEG and administer O₂ by mask
Answer: B
Explanation: Mr. A's presentation describes a transient ischemic attack (TIA), characterized
by temporary neurological deficits without evidence of acute infarction on imaging.
Following symptom resolution and normal CT, the priority is secondary prevention through
identification and management of modifiable risk factors including hypertension, diabetes,
hyperlipidemia, atrial fibrillation, smoking, and obesity. Aspirin therapy is typically indicated
after TIA, but risk factor identification precedes and guides pharmacologic management.
Assuring the patient that symptoms will not recur is false reassurance, as TIA significantly
increases subsequent stroke risk.
Question 2
Which of the following is the most appropriate screening tool for delirium?
A. St. Louis University Mental Status Exam (SLUMS)
B. Montreal Cognitive Assessment (MoCA)
C. Lawton Scale of Instrumental Activities of Daily Living
D. Confusion Assessment Method (CAM)
Answer: D
Explanation: The Confusion Assessment Method is the most widely validated and
recommended tool for delirium identification, demonstrating high sensitivity and specificity
(94-100%). It evaluates four key features: acute onset and fluctuating course, inattention,
disorganized thinking, and altered level of consciousness. SLUMS and MoCA screen for
,general cognitive impairment and dementia, while the Lawton Scale assesses functional
status rather than acute cognitive changes.
Question 3
Which characteristic of delirium helps to distinguish it from dementia?
A. Short-term memory impairment
B. Personality changes
C. Acute onset
D. Impaired attention
Answer: C
Explanation: Acute onset is the hallmark distinguishing feature of delirium, typically
developing over hours to days. Dementia has an insidious onset progressing over months to
years. While short-term memory impairment, personality changes, and impaired attention can
occur in both conditions, the temporal pattern is the most reliable differentiating factor.
Question 4
A 68-year-old woman presents with a complaint of urine leakage whenever she sneezes,
laughs, or strains for the past 4 months. She denies dysuria, frequency, and nocturia.
Urinalysis is negative for RBCs, leukocyte esterase, nitrates, ketones, and urobilinogen. What
is the diagnosis?
A. Stress incontinence
B. Urinary incontinence
C. Urge incontinence
D. Overflow incontinence
Answer: A
Explanation: Stress incontinence is characterized by involuntary leakage of urine upon
increased intra-abdominal pressure from activities such as sneezing, coughing, laughing, or
straining. The absence of irritative voiding symptoms (dysuria, frequency, nocturia) and
normal urinalysis further support this diagnosis. Urge incontinence involves a sudden,
compelling desire to void, while overflow incontinence presents with constant dribbling and
incomplete emptying.
, Question 5
The most common sustained rhythmic disorder characterized by fibrillatory P waves is:
A. AV block
B. Atrial tachycardia
C. Atrial fibrillation
D. Atrial flutter
Answer: C
Explanation: Atrial fibrillation is the most common sustained cardiac arrhythmia,
characterized on electrocardiogram by absent P waves replaced by fibrillatory waves (f
waves) with an irregularly irregular ventricular response. Atrial flutter typically demonstrates
sawtooth flutter waves (F waves) at a regular rate.
Question 6
What is the most common neurological cause of seizures in an older adult?
A. Multiple sclerosis
B. Stroke
C. Alzheimer's disease
D. Peripheral neuropathy
Answer: B
Explanation: Cerebrovascular disease, particularly stroke, is the leading cause of new-onset
seizures in older adults. Post-stroke seizures account for approximately 50% of all late-onset
epilepsy cases in the elderly population. Other causes include brain tumors,
neurodegenerative diseases, and metabolic disturbances.
Section 2: Diabetes Mellitus and Metabolic Disorders
Question 7
A 56-year-old male patient screened for diabetes has a fasting plasma glucose level of 96
mg/dL. The nurse practitioner's management plan includes:
A. Repeat fasting plasma glucose in three years
B. Prescribe metformin 500 mg PO BID
C. Repeat fasting plasma glucose in one year
D. Refer to ophthalmology for eye exam
Answer: A
