Adult-Gerontology NP (AGNP) Certification
2026 Review — Exam-Focused Clinical
Concepts
Adult-Gerontology NP (AGNP) Certification
2026 Review — Exam-Focused Clinical
Concepts
V
1. A 68-year-old male with hypertension presents for annual exam.
His blood pressure today is 148/86 mmHg. He takes no medications.
Repeat BP next week is 150/88. What is the most appropriate initial
treatment?
• Answer: Initiate low-dose thiazide diuretic (chlorthalidone
12.5 mg) or ACE inhibitor (lisinopril 5-10 mg)
• Rationale: According to 2025 ACC/AHA guidelines,
pharmacologic treatment is indicated for adults >60 years with BP
≥140/90 after lifestyle modification. First-line agents: thiazides,
ACE inhibitors, ARBs, or CCBs. Target BP <130/80.
2. A 72-year-old female with heart failure with preserved ejection
fraction (HFpEF, EF 60%) presents with worsening dyspnea and leg
edema. She is on furosemide 40 mg daily. Which medication has
been shown to reduce hospitalizations specifically in HFpEF?
• Answer: SGLT2 inhibitor (empagliflozin or dapagliflozin)
, • Rationale: EMPEROR-Preserved and DELIVER trials
demonstrated that SGLT2 inhibitors reduce HF hospitalizations in
HFpEF patients regardless of diabetes status. This is now
guideline-directed therapy.
3. A 75-year-old male presents with acute-onset, tearing chest pain
radiating to the back. BP is 160/50 in the right arm and 100/40 in the
left arm. What is the most likely diagnosis?
• Answer: Aortic dissection (Stanford Type A)
• Rationale: Tearing chest pain radiating to the back + pulse
differential + widened mediastinum on CXR = aortic dissection.
Type A involves the ascending aorta and requires emergent
cardiothoracic surgery. Immediate management: IV beta-blocker
(esmolol) to reduce shear force.
4. A 65-year-old with atrial fibrillation has a CHA₂DS₂-VASc score
of 4. His creatinine clearance is 55 mL/min. Which anticoagulant is
preferred?
• Answer: Apixaban 5 mg BID
• Rationale: DOACs are preferred over warfarin for
nonvalvular AFib. Apixaban is the only DOAC with reduced renal
excretion (~25%), making it safe in CKD. Reduce to 2.5 mg BID if
≥2 of: age ≥80, weight ≤60 kg, Cr ≥1.5.
5. A 70-year-old male with bradycardia (HR 42) and syncope is
found to have a 3-second pause on ECG. He takes metoprolol for
hypertension. What is the next step?
, • Answer: Discontinue metoprolol and evaluate for pacemaker
(symptomatic bradycardia with pause >3 seconds is Class I
indication for pacing)
• Rationale: Symptomatic bradycardia from AV block or sinus
node dysfunction requires pacemaker when reversible causes
(medications, electrolyte abnormalities) are excluded. Metoprolol
should be stopped or reduced.
6. An 80-year-old presents with new-onset exertional chest pressure
relieved by rest. He has a history of hypertension and diabetes.
What is the most appropriate initial diagnostic test?
• Answer: Exercise stress test (if able to exercise) or
pharmacologic stress test (if unable)
• Rationale: For stable angina with intermediate pretest
probability, noninvasive stress testing is first-line. In older adults
who cannot exercise, dobutamine or vasodilator (regadenoson)
stress with echocardiography or nuclear imaging is appropriate.
7. A 72-year-old with heart failure with reduced ejection fraction
(HFrEF, EF 35%) is on carvedilol, lisinopril, and furosemide. His
potassium is 5.6. Which medication should be added with caution?
• Answer: Spironolactone (MRA) – check potassium and renal
function first; start 12.5-25 mg if K+ <5.0 and Cr <2.5
• Rationale: MRAs (spironolactone, eplerenone) reduce
mortality in HFrEF but cause hyperkalemia. Hold if K+ >5.0.
Monitor K+ and creatinine within 3 days and at 1 month.
, 8. A 78-year-old female with hypertension presents with
lightheadedness and falls. Orthostatic vitals: supine BP 130/80,
standing BP 100/60 with dizziness. What is the most common cause?
• Answer: Medication-induced orthostatic hypotension (likely
antihypertensives)
• Rationale: In older adults, orthostatic hypotension is most
often iatrogenic from antihypertensives (especially diuretics,
alpha-blockers, and high-dose ACE inhibitors). Also consider
dehydration, autonomic dysfunction (Parkinson's, diabetes), and
varicose veins.
9. A 65-year-old presents with sudden, painless vision loss in the
right eye described as "a curtain coming down." He has a history of
carotid bruit. What is the diagnosis?
• Answer: Amaurosis fugax (transient monocular vision loss
from retinal embolus)
• Rationale: Amaurosis fugax is a TIA of the retina, most often
from emboli originating from ipsilateral carotid artery stenosis.
Urgent carotid ultrasound. If >50% stenosis, carotid
endarterectomy or stenting.
10. A 75-year-old with chronic venous insufficiency presents with a
non-healing ulcer above the medial malleolus. Surrounding skin is
hyperpigmented and indurated. What is first-line treatment?
• Answer: Compression therapy (multi-layer compression
bandages or 30-40 mmHg stockings) after ruling out arterial
disease (ABI >0.9)
2026 Review — Exam-Focused Clinical
Concepts
Adult-Gerontology NP (AGNP) Certification
2026 Review — Exam-Focused Clinical
Concepts
V
1. A 68-year-old male with hypertension presents for annual exam.
His blood pressure today is 148/86 mmHg. He takes no medications.
Repeat BP next week is 150/88. What is the most appropriate initial
treatment?
• Answer: Initiate low-dose thiazide diuretic (chlorthalidone
12.5 mg) or ACE inhibitor (lisinopril 5-10 mg)
• Rationale: According to 2025 ACC/AHA guidelines,
pharmacologic treatment is indicated for adults >60 years with BP
≥140/90 after lifestyle modification. First-line agents: thiazides,
ACE inhibitors, ARBs, or CCBs. Target BP <130/80.
2. A 72-year-old female with heart failure with preserved ejection
fraction (HFpEF, EF 60%) presents with worsening dyspnea and leg
edema. She is on furosemide 40 mg daily. Which medication has
been shown to reduce hospitalizations specifically in HFpEF?
• Answer: SGLT2 inhibitor (empagliflozin or dapagliflozin)
, • Rationale: EMPEROR-Preserved and DELIVER trials
demonstrated that SGLT2 inhibitors reduce HF hospitalizations in
HFpEF patients regardless of diabetes status. This is now
guideline-directed therapy.
3. A 75-year-old male presents with acute-onset, tearing chest pain
radiating to the back. BP is 160/50 in the right arm and 100/40 in the
left arm. What is the most likely diagnosis?
• Answer: Aortic dissection (Stanford Type A)
• Rationale: Tearing chest pain radiating to the back + pulse
differential + widened mediastinum on CXR = aortic dissection.
Type A involves the ascending aorta and requires emergent
cardiothoracic surgery. Immediate management: IV beta-blocker
(esmolol) to reduce shear force.
4. A 65-year-old with atrial fibrillation has a CHA₂DS₂-VASc score
of 4. His creatinine clearance is 55 mL/min. Which anticoagulant is
preferred?
• Answer: Apixaban 5 mg BID
• Rationale: DOACs are preferred over warfarin for
nonvalvular AFib. Apixaban is the only DOAC with reduced renal
excretion (~25%), making it safe in CKD. Reduce to 2.5 mg BID if
≥2 of: age ≥80, weight ≤60 kg, Cr ≥1.5.
5. A 70-year-old male with bradycardia (HR 42) and syncope is
found to have a 3-second pause on ECG. He takes metoprolol for
hypertension. What is the next step?
, • Answer: Discontinue metoprolol and evaluate for pacemaker
(symptomatic bradycardia with pause >3 seconds is Class I
indication for pacing)
• Rationale: Symptomatic bradycardia from AV block or sinus
node dysfunction requires pacemaker when reversible causes
(medications, electrolyte abnormalities) are excluded. Metoprolol
should be stopped or reduced.
6. An 80-year-old presents with new-onset exertional chest pressure
relieved by rest. He has a history of hypertension and diabetes.
What is the most appropriate initial diagnostic test?
• Answer: Exercise stress test (if able to exercise) or
pharmacologic stress test (if unable)
• Rationale: For stable angina with intermediate pretest
probability, noninvasive stress testing is first-line. In older adults
who cannot exercise, dobutamine or vasodilator (regadenoson)
stress with echocardiography or nuclear imaging is appropriate.
7. A 72-year-old with heart failure with reduced ejection fraction
(HFrEF, EF 35%) is on carvedilol, lisinopril, and furosemide. His
potassium is 5.6. Which medication should be added with caution?
• Answer: Spironolactone (MRA) – check potassium and renal
function first; start 12.5-25 mg if K+ <5.0 and Cr <2.5
• Rationale: MRAs (spironolactone, eplerenone) reduce
mortality in HFrEF but cause hyperkalemia. Hold if K+ >5.0.
Monitor K+ and creatinine within 3 days and at 1 month.
, 8. A 78-year-old female with hypertension presents with
lightheadedness and falls. Orthostatic vitals: supine BP 130/80,
standing BP 100/60 with dizziness. What is the most common cause?
• Answer: Medication-induced orthostatic hypotension (likely
antihypertensives)
• Rationale: In older adults, orthostatic hypotension is most
often iatrogenic from antihypertensives (especially diuretics,
alpha-blockers, and high-dose ACE inhibitors). Also consider
dehydration, autonomic dysfunction (Parkinson's, diabetes), and
varicose veins.
9. A 65-year-old presents with sudden, painless vision loss in the
right eye described as "a curtain coming down." He has a history of
carotid bruit. What is the diagnosis?
• Answer: Amaurosis fugax (transient monocular vision loss
from retinal embolus)
• Rationale: Amaurosis fugax is a TIA of the retina, most often
from emboli originating from ipsilateral carotid artery stenosis.
Urgent carotid ultrasound. If >50% stenosis, carotid
endarterectomy or stenting.
10. A 75-year-old with chronic venous insufficiency presents with a
non-healing ulcer above the medial malleolus. Surrounding skin is
hyperpigmented and indurated. What is first-line treatment?
• Answer: Compression therapy (multi-layer compression
bandages or 30-40 mmHg stockings) after ruling out arterial
disease (ABI >0.9)
