ANCC AGACNP-BCFree Adult-Gerontology Acute Care Nurse Practitioner practice test

Correct answer: C. Serum thiamine level

Checking the serum thiamine level is the top priority. Disorientation paired with gait instability in a patient with alcohol use disorder is the classic triad pointing to Wernicke's encephalopathy, which develops from thiamine deficiency. Identifying and rapidly correcting this deficiency with thiamine replacement is essential to prevent permanent neurological injury. Low magnesium is also common in alcohol use disorder but does not account for these specific neurological findings. Brain MRI may eventually show changes consistent with Wernicke's but is not required to initiate treatment. The serum alcohol level reflects acute intoxication rather than the underlying nutritional deficiency driving these symptoms.

Correct answer: D. Central retinal artery occlusion

Central retinal artery occlusion (CRAO) is the most likely diagnosis. Acute blockage of the central retinal artery causes diffuse retinal ischemia, which appears as a whitened, edematous retina on fundoscopy. The fovea, which receives its blood supply from the choroid rather than the retinal artery, retains its normal reddish color, producing the characteristic cherry-red spot. Retinal detachment typically manifests as photopsia or a shadow moving across the visual field rather than a cherry-red spot. Central retinal vein occlusion produces widespread flame hemorrhages and disc edema, giving the fundus a stormy appearance. Optic neuritis causes painful visual loss with an inflamed optic disc but does not produce a cherry-red macular spot.

Correct answer: B. Hemoglobin A1c

Hemoglobin A1c is the preferred screening test for assessing diabetes risk. It reflects average blood glucose over the preceding two to three months, requires no fasting, and can identify both prediabetes and diabetes with a single draw. A fasting lipid panel is used to gauge cardiovascular risk and does not screen for diabetes. Urine microalbumin is employed to detect early diabetic kidney disease once diabetes has already been diagnosed, not to screen for the disease itself. A point-of-care blood glucose measurement captures only a single moment in time and is not adequate for long-term risk assessment.

Correct answer: B. Mediterranean diet

The Mediterranean diet has the strongest evidence base for reducing cardiovascular risk. Characterized by abundant fruits and vegetables, whole grains, olive oil, nuts, and fish, with limited red meat, this pattern reduces LDL cholesterol, decreases systemic inflammation, and improves vascular endothelial function. A high-protein, low-carbohydrate diet may aid weight reduction but lacks the long-term cardiovascular outcome data supporting the Mediterranean approach. A legume-inclusive vegan diet can be heart-healthy but has less robust evidence for cardioprotection and carries a higher risk of nutritional deficiencies if not carefully planned. The ketogenic diet promotes fat as a primary fuel source and raises concerns about long-term cardiovascular effects when not carefully balanced.

Correct answer: D. Performing a stress test

A stress test is the most appropriate next step. Exertional chest discomfort raises concern for underlying ischemic heart disease, and stress testing evaluates myocardial perfusion during exercise to detect significant coronary artery disease. A lipid panel is useful for long-term cardiovascular risk stratification but does not address the patient's current exertional symptoms. Reassuring the patient and advising rest would ignore potentially serious underlying pathology. A STAT ECG with serial troponins is most appropriate for acute chest pain suggestive of myocardial infarction, whereas this patient's symptoms are mild and reproducibly exercise-related.

Correct answer: C. Annual fecal immunochemical test (FIT)

Annual fecal immunochemical testing (FIT) is the most appropriate recommendation for this average-risk patient. FIT is noninvasive, cost-effective, and detects occult fecal blood that may signal colorectal cancer. Annual testing has been demonstrated to meaningfully lower colorectal cancer mortality. Colonoscopy every five years is more frequent than evidence-based guidelines recommend; for average-risk individuals with a normal baseline result, the interval is ten years. Virtual colonoscopy every two years is not widely used for routine screening and necessitates a follow-up optical colonoscopy if polyps are found. Double-contrast barium enema has been largely supplanted by more sensitive and specific options such as FIT and optical colonoscopy.

Correct answer: B. Within 3 hours of symptom onset

Standard guidelines recommend administering intravenous thrombolytic therapy, such as alteplase (tPA), within 3 hours of stroke symptom onset for eligible patients. In carefully selected individuals, this window may be extended to 4.5 hours, but the 3-hour threshold remains the benchmark for optimal outcomes. The 6-hour and 24-hour windows apply to mechanical thrombectomy for large vessel occlusions, not to intravenous thrombolytics. While treatment as early as possible improves results, the 1-hour target is rarely feasible given the time needed for clinical evaluation and imaging before lytic therapy can be safely initiated.

Correct answer: C. Non-contrast head CT scan

A non-contrast head CT scan is the initial test of choice. This presentation is classic for subarachnoid hemorrhage, and non-contrast CT is highly sensitive for detecting acute intracranial bleeding. Rapid identification is essential because subarachnoid hemorrhage is immediately life-threatening and requires urgent intervention. Lumbar puncture, which can reveal xanthochromia or elevated red blood cells in the cerebrospinal fluid, is reserved for situations where clinical suspicion remains high after a negative CT result. MRI provides excellent anatomical detail but is impractical in the acute setting due to longer acquisition and interpretation times. Electroencephalography measures cortical electrical activity and offers no diagnostic value in evaluating a hemorrhagic event.

Correct answer: D. Arterial blood gas analysis

Arterial blood gas (ABG) analysis is the most informative study during an acute COPD exacerbation. It directly measures oxygenation, carbon dioxide retention, and acid-base balance, allowing clinicians to determine exacerbation severity and decide whether supplemental oxygen, noninvasive ventilation, or intubation is required. Spirometry is contraindicated during active exacerbations because the effort involved may worsen dyspnea; it is reserved for stable monitoring. A chest X-ray helps exclude complications such as pneumonia or pneumothorax but cannot quantify the degree of physiological compromise. A sputum culture can identify an infectious pathogen but is not used for initial severity assessment.

Correct answer: C. Recommend a low-fat diet and regular exercise

Recommending a low-fat diet combined with regular physical activity is the most appropriate strategy for an average-risk woman seeking breast cancer risk reduction. Evidence supports that healthy body weight, consistent exercise, and a balanced, low-fat diet can lower breast cancer risk while also improving overall health without significant adverse effects. Tamoxifen for chemoprevention is reserved for women at elevated risk, such as those with a strong family history or a known genetic mutation. Annual MRI screening is similarly recommended only for high-risk populations. BRCA mutation testing is not warranted in the absence of a family history or other high-risk features.