Adult-Gerontology Primary Care Nurse Practitioner Exam Chronic Disease Management in Older Adults 1 — Questions and Answers
Question 1: According to current US guidelines, the target blood pressure for adults aged 65 and older without significant comorbidities is:
- <150/90 mmHg
- <130/80 mmHg (Correct answer)
- <140/90 mmHg
- <120/70 mmHg
Correct answer: <130/80 mmHg
The 2017 ACC/AHA guidelines recommend a BP target of <130/80 mmHg for most adults ≥65, including those with high cardiovascular risk.
Question 2: A 70-year-old patient with type 2 diabetes has an A1C of 9.2%. The most appropriate A1C target for this otherwise healthy older adult is:
- <6.5%
- <7.5% (Correct answer)
- <8.5%
- <9.0%
Correct answer: <7.5%
For healthy older adults with diabetes, the ADA recommends an A1C target of <7.5%, balancing glycemic control with hypoglycemia risk.
Question 3: Which class of antidiabetic medication is considered high-risk in older adults due to its association with severe hypoglycemia?
- SGLT-2 inhibitors
- GLP-1 receptor agonists
- Sulfonylureas (Correct answer)
- DPP-4 inhibitors
Correct answer: Sulfonylureas
Sulfonylureas stimulate insulin secretion independent of blood glucose levels, making them high-risk for hypoglycemia in older adults with irregular eating patterns.
Question 4: When managing heart failure with reduced ejection fraction (HFrEF) in an 80-year-old, which medication class has demonstrated mortality benefit and should be initiated?
- Calcium channel blockers
- Beta-blockers (Correct answer)
- Loop diuretics
- Digoxin
Correct answer: Beta-blockers
Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) are evidence-based, guideline-directed therapy for HFrEF that reduce mortality and hospitalizations.
Question 5: An older adult with COPD is most appropriately staged using which classification system?
- NYHA Classification
- GOLD Staging System (Correct answer)
- Wells Criteria
- CURB-65 Score
Correct answer: GOLD Staging System
The GOLD (Global Initiative for Chronic Obstructive Lung Disease) staging system uses spirometry results and symptom burden to classify COPD severity and guide treatment.
Question 6: A 75-year-old with CKD stage 3b (eGFR 32 mL/min) and type 2 diabetes should have metformin:
- Continued at full dose
- Dose-reduced
- Discontinued (Correct answer)
- Replaced with insulin only
Correct answer: Discontinued
Metformin is contraindicated when eGFR falls below 30 mL/min, and should be discontinued at eGFR <30 due to lactic acidosis risk; at eGFR 30–45, dose reduction is advised.
Adult-Gerontology Primary Care Nurse Practitioner Exam Chronic Disease Management in Older Adults 1
According to current US guidelines, the target blood pressure for adults aged 65 and older without significant comorbidities is: