ANCC Nursing Certification Exam — Questions and Answers

Question 1: Which combination of analgesic modalities best represents a multimodal analgesia approach for a post-surgical patient?

Maximizing opioid doses before adding non-opioid adjuvants
Scheduled acetaminophen, scheduled NSAIDs (if not contraindicated), gabapentin, and opioids only as needed (Correct answer)
Morphine PCA alone titrated to pain level
Two different opioids prescribed simultaneously for synergy

Correct answer: Scheduled acetaminophen, scheduled NSAIDs (if not contraindicated), gabapentin, and opioids only as needed

Multimodal analgesia combines analgesics and techniques with different mechanisms to provide superior pain relief at lower opioid doses, reducing opioid-related side effects.

Question 2: A 6-year-old presents with barking cough, inspiratory stridor, and low-grade fever. The child is alert and not drooling. Which nursing intervention is the priority?

Place in cool mist environment and administer racemic epinephrine per order (Correct answer)
Position the child supine for airway assessment
Prepare for immediate intubation at bedside
Obtain throat swab culture before initiating any treatment

Correct answer: Place in cool mist environment and administer racemic epinephrine per order

The presentation describes croup. For mild-to-moderate croup with maintained airway, cool mist and racemic epinephrine for moderate cases are the priority interventions. Dexamethasone is also standard.

Question 3: When assessing pain in a non-verbal older adult with dementia, which scale is most appropriate?

Visual Analog Scale (VAS)
Wong-Baker FACES Scale
Numeric Rating Scale (NRS 0–10)
PAINAD Scale (Correct answer)

Correct answer: PAINAD Scale

The PAINAD (Pain Assessment in Advanced Dementia) scale uses behavioral indicators to assess pain in non-verbal patients.

Question 4: Which physical exam finding is most associated with appendicitis?

Murphy's sign
McBurney's point tenderness
Both B and C (Correct answer)
Rovsing's sign positivity

Correct answer: Both B and C

Both McBurney's point tenderness and a positive Rovsing's sign are classic physical exam findings in appendicitis.

Question 5: When caring for a patient post-CABG, which finding requires immediate intervention?

Serosanguinous drainage from chest tube totaling 50 mL in first hour
Mediastinal chest tube output of 250 mL/hr for two consecutive hours (Correct answer)
Temperature of 37.8 degrees C on postoperative day 1
Urine output of 35 mL/hr

Correct answer: Mediastinal chest tube output of 250 mL/hr for two consecutive hours

Chest tube output greater than 200 mL/hr for 2 consecutive hours post-CABG indicates excessive bleeding requiring immediate surgical re-exploration.

Question 6: A patient with TBI has ICP of 28 mmHg and MAP of 85 mmHg. What is the CPP and is it within the recommended range?

CPP = 57 mmHg; below the recommended minimum of 60-70 mmHg (Correct answer)
CPP = 57 mmHg; within acceptable range
CPP = 28 mmHg; critical ICP elevation only
CPP = 113 mmHg; dangerously high

Correct answer: CPP = 57 mmHg; below the recommended minimum of 60-70 mmHg

CPP = MAP minus ICP = 85 minus 28 = 57 mmHg. The Brain Trauma Foundation recommends CPP of 60-70 mmHg. A CPP of 57 mmHg is below the minimum and requires intervention.

Question 7: A 75-year-old patient is prescribed a statin for hyperlipidemia. Which muscle-related adverse effect requires immediate follow-up?

Mild muscle aching that resolves with rest
Mild creatine kinase elevation only
Joint stiffness in the morning
Severe muscle pain with dark urine suggesting rhabdomyolysis (Correct answer)

Correct answer: Severe muscle pain with dark urine suggesting rhabdomyolysis

Rhabdomyolysis — characterized by severe myopathy and myoglobinuria (dark urine) — is a serious, potentially fatal statin complication.

Question 8: Which preoperative nursing intervention most reduces the risk of surgical site infection (SSI)?

Keeping the patient NPO for 12 hours before surgery
Administering prophylactic antibiotics within 60 minutes before incision (Correct answer)
Applying povidone-iodine scrub the morning of surgery
Shaving the operative site the night before surgery

Correct answer: Administering prophylactic antibiotics within 60 minutes before incision

Evidence-based SSI prevention bundles include prophylactic antibiotics given within 60 minutes before surgical incision.

Question 9: Which regulatory body most directly governs the accreditation standards applicable to ambulatory care organizations seeking to demonstrate quality and safety?

State Board of Nursing exclusively
Centers for Medicare and Medicaid Services (CMS) only
The Joint Commission (TJC) Ambulatory Care Program (Correct answer)
American Medical Association (AMA)

Correct answer: The Joint Commission (TJC) Ambulatory Care Program

The Joint Commission's Ambulatory Care accreditation program sets recognized national standards for quality and patient safety in outpatient settings.

Question 10: According to Piaget's Theory of Cognitive Development, at which of the following ages does a child begin to act with intention and may first attempt to climb over obstacles, such as crib side rails?

18 to 24 months.
9 to 12 months. (Correct answer)
13 to 18 months.
4 to 8 months.

Correct answer: 9 to 12 months.

Explanation: According to Piaget's Theory of Cognitive Development, at age 9 to 12 months, a child begins to act with intention and may first attempt to climb over obstacles, such as crib side rails. This is a transitional stage for the children during which intellectual development progresses and the child begins to understand that hidden objects are not permanently gone. They also begin to associate words and symbols (such as "bye-bye") with events, such as the parent leaving.

Question 11: Which intervention is most supported by evidence to prevent and treat ICU delirium?

Continuous antipsychotic infusion as first-line treatment
Benzodiazepine administration to manage agitation
Routine physical restraints to prevent falls during confusion
Early mobilization, sleep protocol, and reorientation using the ABCDEF bundle (Correct answer)

Correct answer: Early mobilization, sleep protocol, and reorientation using the ABCDEF bundle

The ABCDEF bundle (Assess, Both SAT/SBT, Choice of analgesia/sedation, Delirium assessment, Early mobility, Family engagement) is the evidence-based framework for preventing and treating ICU delirium.

Question 12: The FACES pain scale is most appropriate for use in which pediatric population?

Intubated children regardless of age
Neonates and infants under 6 months
Children aged 3 to 7 years who can communicate (Correct answer)
Adolescents age 12 and older

Correct answer: Children aged 3 to 7 years who can communicate

The Wong-Baker FACES Pain Rating Scale is validated for children aged 3 years and older who can communicate, using facial expression illustrations from no hurt to hurts worst.

Question 13: A child weighing 44 lbs requires amoxicillin 40 mg/kg/day divided every 8 hours. Available suspension is 250 mg/5 mL. How many mL per dose?

5.3 mL (Correct answer)
8.0 mL
3.0 mL
10.7 mL

Correct answer: 5.3 mL

44 lbs divided by 2.2 = 20 kg. Total daily dose = 40 mg/kg x 20 kg = 800 mg/day. Per dose (q8h) = 800/3 = 267 mg. Volume = (267/250) x 5 mL = 5.3 mL.

Question 14: A hospice patient with terminal cancer is actively dying, unconscious, and unable to swallow. Which analgesic route is most appropriate?

Hold all opioids until the patient regains consciousness to provide consent
Use subcutaneous, IV, or transdermal routes for around-the-clock opioid coverage (Correct answer)
Administer oral morphine despite inability to swallow
Dose down opioids as death approaches to prevent addiction

Correct answer: Use subcutaneous, IV, or transdermal routes for around-the-clock opioid coverage

When oral administration is no longer possible, subcutaneous (most common in hospice), IV, or transdermal fentanyl routes maintain analgesic coverage. Opioid dosing is never reduced or withheld based on addiction concerns at end of life.

Question 15: A nurse uses the EHR to access medication history, allergy list, and recent labs from the patient's previous hospitalization at an affiliated facility. This is an example of:

Telemedicine consultation between facilities
Clinical decision support at point of care
Health Information Exchange (HIE) supporting longitudinal patient record access (Correct answer)
Internal auditing and compliance monitoring

Correct answer: Health Information Exchange (HIE) supporting longitudinal patient record access

Health Information Exchange (HIE) enables authorized clinicians to electronically access and share patient clinical information across different healthcare organizations.

Question 16: Which developmental milestone is expected in a 4-month-old infant?

Walking with support
Holds head steady when sitting, follows objects past midline, social smile (Correct answer)
Saying 2-3 words with meaning
Pulls self to standing position

Correct answer: Holds head steady when sitting, follows objects past midline, social smile

At 4 months, expected milestones include head control when supported sitting, tracking objects past midline, cooing, and a well-established social smile.

Question 17: Which electrolyte imbalance is most commonly associated with prolonged nasogastric suctioning?

Hypokalemia and metabolic alkalosis (Correct answer)
Hypernatremia
Hypermagnesemia
Hyperkalemia

Correct answer: Hypokalemia and metabolic alkalosis

NG suctioning causes loss of HCl and K+, resulting in hypokalemia and metabolic alkalosis.

Question 18: When screening for colorectal cancer, at what age should average-risk patients begin colonoscopy screening?

45 years (Correct answer)
40 years
55 years
50 years

Correct answer: 45 years

The USPSTF updated its recommendation in 2021 to begin colorectal cancer screening at age 45 for average-risk adults.

Question 19: A 55-year-old patient has a BP reading of 148/94 mmHg on two separate visits. According to JNC guidelines, this is classified as:

Elevated blood pressure
Stage 1 hypertension (Correct answer)
Stage 2 hypertension
Normal blood pressure

Correct answer: Stage 1 hypertension

Stage 1 hypertension is defined as systolic 130–139 mmHg or diastolic 80–89 mmHg; 148/94 meets Stage 2 criteria (≥140/90).

Question 20: Which oncologic emergency is characterized by hypercalcemia, hyperkalemia, hyperphosphatemia, and hyperuricemia after cancer treatment?

Superior vena cava syndrome
Tumor lysis syndrome (Correct answer)
Syndrome of inappropriate ADH (SIADH)
Spinal cord compression

Correct answer: Tumor lysis syndrome

Tumor lysis syndrome results from rapid destruction of cancer cells releasing intracellular contents into the bloodstream.

Question 21: A patient has serum sodium of 118 mEq/L and is symptomatic with seizures. Which IV solution is indicated?

3% Hypertonic saline (Correct answer)
0.9% Normal saline
0.45% Half-normal saline
D5W (5% dextrose in water)

Correct answer: 3% Hypertonic saline

Severe symptomatic hyponatremia with seizures requires hypertonic (3%) saline to rapidly correct sodium and resolve neurologic symptoms.

Question 22: A patient with type 1 diabetes presents with Kussmaul respirations, fruity breath, and blood glucose of 480 mg/dL. This presentation is consistent with:

Hyperosmolar hyperglycemic state (HHS)
Diabetic ketoacidosis (DKA) (Correct answer)
Severe hypoglycemia
Lactic acidosis

Correct answer: Diabetic ketoacidosis (DKA)

DKA presents with Kussmaul respirations (compensatory for metabolic acidosis), fruity breath from ketones, and high glucose.

Question 23: Which chemotherapy agent is classified as an alkylating agent?

Vincristine
Cyclophosphamide (Correct answer)
Doxorubicin
Methotrexate

Correct answer: Cyclophosphamide

Cyclophosphamide is an alkylating agent that works by cross-linking DNA strands, preventing cancer cell replication.

Question 24: A nurse practitioner identifies a grade III/VI systolic murmur in a 7-year-old that radiates to the carotid arteries. The next step is:

Obtain a chest X-ray only
Reassure the parent it is an innocent murmur
Prescribe prophylactic antibiotics
Refer to pediatric cardiology (Correct answer)

Correct answer: Refer to pediatric cardiology

A loud murmur (grade III+) with radiation to carotids suggests a pathologic etiology requiring cardiologic evaluation.

Question 25: A patient on clopidogrel and aspirin for unstable angina — which factor most significantly reduces clopidogrel effectiveness?

Taking clopidogrel with food
History of peptic ulcer treated with ranitidine
CYP2C19 poor metabolizer genetic variant (Correct answer)
Concurrent use of atorvastatin

Correct answer: CYP2C19 poor metabolizer genetic variant

Clopidogrel is a prodrug requiring activation by CYP2C19. Poor metabolizers with loss-of-function alleles have significantly reduced active metabolite levels and diminished platelet inhibition.

Question 26: A nurse in an ambulatory surgery center is providing preoperative teaching to a patient scheduled for a same-day procedure. Which instruction is MOST important to reinforce?

The patient must arrange for a responsible adult to drive them home after discharge (Correct answer)
The patient can shower with regular soap immediately after the procedure
The patient should stop all prescription medications one week before surgery
The patient may eat a light breakfast on the morning of surgery

Correct answer: The patient must arrange for a responsible adult to drive them home after discharge

Patients receiving anesthesia or sedation must have a responsible adult driver arranged for discharge, as they cannot safely drive themselves due to residual effects.

Question 27: The ANCC Magnet Recognition Program's 14 Forces of Magnetism primarily focus on which outcome?

Attracting and retaining excellent nursing staff and improving patient outcomes (Correct answer)
Ensuring compliance with JCAHO accreditation
Standardizing nursing education requirements
Reducing hospital operational costs

Correct answer: Attracting and retaining excellent nursing staff and improving patient outcomes

Magnet recognition designates organizations that attract and retain excellent nurses while demonstrating superior patient care outcomes.

Question 28: Which sign/symptom differentiates pulmonary embolism (PE) from myocardial infarction (MI)?

Hypotension and syncope
Chest pain and shortness of breath
Sudden onset pleuritic chest pain and hemoptysis with normal cardiac enzymes (Correct answer)
Tachycardia and diaphoresis

Correct answer: Sudden onset pleuritic chest pain and hemoptysis with normal cardiac enzymes

Pleuritic chest pain (worsens with breathing), hemoptysis, and normal cardiac enzymes are characteristic of PE rather than MI.

Question 29: For a patient on IABP for cardiogenic shock, what is the primary mechanism by which IABP improves myocardial oxygen supply?

Balloon deflation during systole causes afterload reduction only
Inflation during systole increases cardiac output directly
Continuous forward flow augments LV output by reducing SVR
Inflation during diastole increases coronary artery perfusion pressure (Correct answer)

Correct answer: Inflation during diastole increases coronary artery perfusion pressure

IABP counterpulsation inflates during diastole (triggered by the dicrotic notch), augmenting diastolic pressure and improving coronary perfusion pressure — called diastolic augmentation.

Question 30: A patient post-op for abdominal surgery develops a fever of 38.5°C on postoperative day 2. What is the most likely cause?

Pulmonary atelectasis (Correct answer)
Surgical site infection
Deep vein thrombosis
Urinary tract infection

Correct answer: Pulmonary atelectasis

Pulmonary atelectasis is the most common cause of fever in the first 48 hours after surgery due to hypoventilation.

Question 31: A 4-year-old child is brought in with a barky, seal-like cough that worsens at night. What is the most likely diagnosis?

Bronchiolitis
Asthma
Croup (laryngotracheobronchitis) (Correct answer)
Epiglottitis

Correct answer: Croup (laryngotracheobronchitis)

Croup presents with the classic seal-like barky cough and stridor, typically caused by parainfluenza virus.

Question 32: What is the primary goal of palliative care for older adults with serious illness?

Improving quality of life by managing symptoms and supporting goals of care (Correct answer)
Curative treatment of the underlying disease
Withholding all life-sustaining treatments
Transitioning patients to hospice immediately

Correct answer: Improving quality of life by managing symptoms and supporting goals of care

Palliative care focuses on symptom management, emotional support, and aligning treatment with patient goals — not necessarily withholding treatment.

Question 33: Which finding on a throat culture indicates the need for antibiotic treatment in pharyngitis?

Presence of normal oral flora
White exudates alone
Elevated WBC on CBC
Positive Group A Streptococcus culture (Correct answer)

Correct answer: Positive Group A Streptococcus culture

A positive Group A Streptococcus culture confirms bacterial pharyngitis requiring antibiotic treatment to prevent complications.

Question 34: A patient is prescribed hydromorphone 0.4 mg IV every 4 hours. Available concentration is 2 mg/mL. How many mL per dose?

2 mL
4 mL
0.4 mL
0.2 mL (Correct answer)

Correct answer: 0.2 mL

Volume = Dose divided by Concentration = 0.4 mg divided by 2 mg/mL = 0.2 mL. Hydromorphone is approximately 5-10 times more potent than morphine; careful dose verification is essential.

Question 35: A patient undergoing chemotherapy develops an absolute neutrophil count (ANC) of 450 cells/mcL. Which precaution is most important?

Contact precautions for MRSA
Neutropenic precautions to prevent infection (Correct answer)
Reverse isolation with positive pressure room
Droplet precautions for influenza

Correct answer: Neutropenic precautions to prevent infection

An ANC below 500 cells/mcL indicates severe neutropenia (nadir), requiring protective neutropenic precautions to reduce infection risk.

Question 36: The nurse is caring for a patient with cancer who reports severe, uncontrolled pain rated 9/10. According to the WHO analgesic ladder, which step of therapy is indicated?

Step 4: Interventional procedures only
Step 2: Weak opioids with or without non-opioids
Step 3: Strong opioids with or without non-opioids (Correct answer)
Step 1: Non-opioid analgesics alone

Correct answer: Step 3: Strong opioids with or without non-opioids

Severe pain (7–10) corresponds to Step 3 of the WHO analgesic ladder, requiring strong opioids such as morphine or oxycodone.

Question 37: A patient receiving IV chemotherapy via a peripheral line reports burning pain at the site with surrounding erythema and blanching. This is most consistent with:

Extravasation of a vesicant agent (Correct answer)
Allergic reaction to the drug
Phlebitis
Thrombosis at the catheter site

Correct answer: Extravasation of a vesicant agent

Burning, erythema, and blanching at a chemotherapy infusion site indicate extravasation of a vesicant, which can cause tissue necrosis.

Question 38: A root cause analysis (RCA) is primarily used after a sentinel event to:

Document the event for malpractice liability purposes
Identify system-level factors contributing to the event and prevent recurrence (Correct answer)
Assign blame and discipline responsible staff
Satisfy state licensing board requirements

Correct answer: Identify system-level factors contributing to the event and prevent recurrence

RCA is a systematic process for identifying underlying system causes of adverse events rather than blaming individuals.

Question 39: An ambulatory care nurse is developing a population health initiative to reduce cardiovascular disease risk in the clinic's patient panel. Which intervention addresses the BROADEST population-level impact?

Implementing a standing order protocol for routine blood pressure screening and follow-up for all patients (Correct answer)
Providing individualized counseling for each patient during annual exams
Offering a one-time community health fair
Sending reminder letters to patients with known hypertension

Correct answer: Implementing a standing order protocol for routine blood pressure screening and follow-up for all patients

A standing order protocol for systematic blood pressure screening and follow-up creates a sustainable, population-wide process that reaches all patients, not just those with known diagnoses.

Question 40: A patient with non-Hodgkin lymphoma is prescribed rituximab. The nurse monitors for which infusion-related reaction most commonly occurring during the first infusion?

Severe peripheral neuropathy
Hypertension and tachycardia only
Anaphylaxis with urticaria and angioedema
Fever, chills, rigors, hypotension, and bronchospasm (Correct answer)

Correct answer: Fever, chills, rigors, hypotension, and bronchospasm

Rituximab commonly causes infusion reactions including fever, chills, rigors, hypotension, and bronchospasm, especially during the first infusion.

Question 41: According to the ANCC Ambulatory Care Nursing scope and standards, telephone nursing practice (telehealth triage) requires the nurse to document which essential element?

The clinical decision-making process, advice given, and patient response (Correct answer)
Only the final disposition and next appointment date
The patient's insurance provider and policy number
The nurse's personal opinion about the patient's condition

Correct answer: The clinical decision-making process, advice given, and patient response

Thorough documentation of the clinical reasoning, instructions provided, and patient understanding is essential for legal accountability and continuity of care in telephone nursing.

Question 42: Which action BEST demonstrates cultural competence in an ambulatory care nursing encounter?

Assuming all patients from the same country share identical beliefs
Asking the patient about their health beliefs and preferred language before teaching (Correct answer)
Providing education only in English to promote consistency
Using family members as interpreters to save time

Correct answer: Asking the patient about their health beliefs and preferred language before teaching

Cultural competence requires assessing individual patient beliefs, values, and language preferences to provide respectful and effective care.

Question 43: Which ECG finding is consistent with left ventricular hypertrophy (LVH)?

ST elevation in leads II, III, and aVF
S wave in V1 + R wave in V5 or V6 at or above 35 mm (Sokolow-Lyon criteria) (Correct answer)
Sawtooth baseline at 300 bpm in leads II, III, aVF
Delta wave and shortened PR interval

Correct answer: S wave in V1 + R wave in V5 or V6 at or above 35 mm (Sokolow-Lyon criteria)

The Sokolow-Lyon criteria for LVH: S wave depth in V1 plus the tallest R wave in V5 or V6 at or above 35 mm. LVH reflects increased myocardial mass from hypertension or aortic stenosis.

Question 44: A patient with PAD reports cramping calf pain after walking two blocks that reliably resolves with rest. This symptom pattern is called:

Deep vein thrombosis
Rest pain
Intermittent claudication (Correct answer)
Critical limb ischemia

Correct answer: Intermittent claudication

Intermittent claudication is reproducible ischemic muscle pain during exercise that reliably resolves with rest, resulting from inadequate arterial flow to meet muscle oxygen demands during exertion.

Question 45: Which laboratory finding is most consistent with dehydration in an older adult?

BUN:creatinine ratio less than 10:1
Low serum sodium (hyponatremia)
BUN:creatinine ratio greater than 20:1 (Correct answer)
Low hematocrit

Correct answer: BUN:creatinine ratio greater than 20:1

A BUN:creatinine ratio >20:1 indicates prerenal azotemia, commonly caused by dehydration in older adults.

Question 46: A 45-year-old male presents with fatigue, cold intolerance, weight gain, and constipation. The most likely diagnosis is:

Cushing syndrome
Hypothyroidism (Correct answer)
Hyperthyroidism
Diabetes mellitus type 2

Correct answer: Hypothyroidism

The classic constellation of fatigue, cold intolerance, weight gain, and constipation is characteristic of hypothyroidism.

Question 47: Which of the following is the most common cause of community-acquired pneumonia in otherwise healthy adults?

Mycoplasma pneumoniae
Streptococcus pneumoniae (Correct answer)
Staphylococcus aureus
Haemophilus influenzae

Correct answer: Streptococcus pneumoniae

Streptococcus pneumoniae (pneumococcus) is the leading bacterial cause of community-acquired pneumonia in adults.

Question 48: Which leadership style is most appropriate when managing a highly experienced and motivated nursing team?

Bureaucratic leadership
Transactional leadership
Delegative (laissez-faire) leadership (Correct answer)
Autocratic leadership

Correct answer: Delegative (laissez-faire) leadership

Delegative leadership is most effective with expert, self-motivated teams who require minimal direction but maximum autonomy.

Question 49: A patient is preparing for permanent pacemaker insertion. Which finding is most important to communicate to the proceduralist?

Blood pressure is 138/82 mmHg
The patient took aspirin 81 mg this morning
The left subclavian vein was used for a previous central line (Correct answer)
The patient reports mild anxiety about the procedure

Correct answer: The left subclavian vein was used for a previous central line

Previous subclavian vein use may have caused stenosis or occlusion, preventing pacemaker lead placement via that route. The proceduralist needs this information to plan venous access.

Question 50: A nurse manager uses transformational leadership during a major unit restructuring. Which behavior best exemplifies this leadership style?

Maintaining existing workflows to minimize disruption
Inspiring staff with a shared vision and fostering individual growth (Correct answer)
Delegating all change decisions to senior staff
Enforcing compliance with new policies through discipline

Correct answer: Inspiring staff with a shared vision and fostering individual growth

Transformational leaders inspire through vision, empower staff, and foster individual growth rather than relying on authority or rules.

Question 51: The cultural group in which grandmothers often have an active role in childcare or are primary caregivers is:

Mexican.
African American. (Correct answer)
Middle Eastern.
Asian.

Correct answer: African American.

Explanation: The cultural group in which grandmothers often have an active role in child care or are primary caregivers is African American. Extended family is very important among African Americans and children are expected to be obedient and respectful. Children often avoid eye contact as a sign of respect, and this can be misinterpreted as being evasive. High rates of obesity are common among children and increase the risk of hypertension and diabetes.

Question 52: In conducting evidence-based research, which of the following types of studies represents one in which those with a condition (such as infection) are compared to those without the condition?

Retrospective cohort study
Prospective cohort study
Cross-sectional study
Case-control study (Correct answer)

Correct answer: Case-control study

Explanation: Case-control studies compare those with a condition (cases) to a group without (controls) to determine if the affected group has characteristics that are different. Prospective cohort studies choose a group of patients without the disease, assess risk factors, and then follow the group over time to determine (prospect for) which ones develop the disease. Retrospective cohort studies are initiated after a condition develops and data are collected retrospectively from medical records to evaluate whether members of the cohort selected had exposure and developed disease. Cross-sectional studies assess disease and exposure at the same time in a target population, evaluating the presence of disease at a point in time.

Question 53: A nurse is conducting a suicide risk assessment. Which factor is most strongly associated with completed suicide?

Experiencing grief
Being female
Living alone
Previous suicide attempt (Correct answer)

Correct answer: Previous suicide attempt

A previous suicide attempt is the single strongest predictor of a future completed suicide.

Question 54: A patient on IV heparin for DVT develops platelet count drop from 210,000 to 62,000/uL on day 7 and has a new arterial clot in the left arm. Which condition is suggested?

Heparin-induced thrombocytopenia Type II (HIT) with thrombosis (HITT) (Correct answer)
Disseminated intravascular coagulation (DIC)
Idiopathic immune thrombocytopenic purpura (ITP)
Heparin-associated thrombocytopenia Type I (benign)

Correct answer: Heparin-induced thrombocytopenia Type II (HIT) with thrombosis (HITT)

HIT Type II presents with platelet count drop greater than 50% on days 5-10 of heparin therapy plus paradoxical thrombosis. When combined with thrombosis it is called HITT.

Question 55: Which model of care delivery is most commonly used in ambulatory care settings to manage high-risk patients with complex chronic conditions?

Functional nursing model
Team nursing model
Care coordination and case management model (Correct answer)
Total patient care model

Correct answer: Care coordination and case management model

Care coordination and case management are the predominant models in ambulatory care for managing complex, high-risk patients across multiple providers and settings.

Question 56: A patient with small cell lung cancer presents with facial edema, distended neck veins, and arm swelling. What is the suspected oncologic emergency?

Hypercalcemia of malignancy
Tumor lysis syndrome
Pericardial tamponade
Superior vena cava syndrome (Correct answer)

Correct answer: Superior vena cava syndrome

Superior vena cava syndrome is caused by tumor compression of the SVC, producing characteristic venous congestion in the upper body.

Question 57: According to USPSTF recommendations, which population should be screened for lung cancer with low-dose CT (LDCT)?

All smokers over age 40
Adults 50–80 years with 20 pack-year history who currently smoke or quit within the past 15 years (Correct answer)
Anyone with a first-degree relative with lung cancer
Adults over 65 with any smoking history

Correct answer: Adults 50–80 years with 20 pack-year history who currently smoke or quit within the past 15 years

USPSTF recommends annual LDCT for adults aged 50–80 with at least 20 pack-year smoking history who are current or recent quitters.

Question 58: The SBAR communication tool stands for:

Situation, Brief, Assessment, Report
Safety, Background, Assessment, Response
Status, Background, Action, Resolution
Situation, Background, Assessment, Recommendation (Correct answer)

Correct answer: Situation, Background, Assessment, Recommendation

SBAR (Situation, Background, Assessment, Recommendation) is a standardized communication framework used to convey critical patient information.

Question 59: Which medication class is considered first-line pharmacotherapy for generalized anxiety disorder (GAD) in adults?

Monoamine oxidase inhibitors
Tricyclic antidepressants
Benzodiazepines
SSRIs/SNRIs (Correct answer)

Correct answer: SSRIs/SNRIs

SSRIs and SNRIs are first-line treatments for GAD due to their efficacy and more favorable safety profile compared to benzodiazepines.

Question 60: Which approach is MOST consistent with evidence-based practice in ambulatory care nursing?

Relying solely on physician orders for all clinical decisions
Integrating current best research evidence with clinical expertise and patient preferences (Correct answer)
Implementing the newest interventions immediately upon publication without review
Following traditional routines that have been used for many years regardless of research

Correct answer: Integrating current best research evidence with clinical expertise and patient preferences

Evidence-based practice integrates best available research, clinical expertise, and patient values/preferences to guide clinical decision-making.

Question 61: What does 'meaningful use' (now called 'Promoting Interoperability') of EHRs refer to?

The hospital's internal policy for mandatory EHR training completion
A CMS incentive program requiring certified EHR technology use to improve quality, safety, and care coordination in exchange for Medicare/Medicaid payments (Correct answer)
Using the EHR for efficient nursing documentation without wasted clicks
A measure of nursing staff satisfaction with the EHR system

Correct answer: A CMS incentive program requiring certified EHR technology use to improve quality, safety, and care coordination in exchange for Medicare/Medicaid payments

Meaningful Use (now Promoting Interoperability under CMS) is the federal incentive program established by the HITECH Act requiring specific EHR use criteria to receive Medicare/Medicaid incentive payments and avoid payment penalties.

Question 62: A 5-year-old admitted following a first-time febrile seizure lasting 90 seconds. Which statement is most accurate?

Most febrile seizures are benign, self-limited, and do not require anti-epileptic treatment (Correct answer)
Simple febrile seizures are associated with a high risk of developing epilepsy
All febrile seizures require prophylactic anti-epileptic medication
Lumbar puncture is mandatory after every febrile seizure in children under 6

Correct answer: Most febrile seizures are benign, self-limited, and do not require anti-epileptic treatment

Simple febrile seizures are benign and self-limited. They are not treated with anti-epileptic drugs. Epilepsy risk is only 2-3% versus 1% baseline.

Question 63: A patient with neuropathic pain from diabetic peripheral neuropathy needs medication. Which first-line agent is most evidence-supported?

Tramadol 50 mg every 6 hours as needed
Oxycodone extended release 10 mg every 12 hours
Ibuprofen 600 mg every 8 hours
Duloxetine (Cymbalta) or pregabalin (Lyrica) (Correct answer)

Correct answer: Duloxetine (Cymbalta) or pregabalin (Lyrica)

First-line treatments for diabetic peripheral neuropathy per ADA, AAN, and NeuPSIG guidelines are duloxetine (SNRI), pregabalin (alpha-2-delta ligand), or gabapentin.

Question 64: A patient on radiation therapy to the head and neck develops severe mucositis. Which nursing intervention takes priority?

Apply hydrogen peroxide rinses four times daily
Restrict oral intake until mucositis resolves
Encourage eating solid foods to maintain weight
Assess pain and provide oral care with appropriate analgesics (Correct answer)

Correct answer: Assess pain and provide oral care with appropriate analgesics

Pain assessment and gentle oral care with analgesics are priority interventions to prevent infection and maintain comfort with mucositis.

Question 65: A patient with HFrEF (EF 30%) is being discharged. Which medication combination has the strongest evidence for reducing mortality?

ACE inhibitor or ARNI, beta-blocker, aldosterone antagonist, and SGLT2 inhibitor (Correct answer)
Digoxin and furosemide
Nitrate monotherapy and aspirin
Calcium channel blocker and loop diuretic

Correct answer: ACE inhibitor or ARNI, beta-blocker, aldosterone antagonist, and SGLT2 inhibitor

The four pillars of HFrEF therapy with mortality benefit are: ACE inhibitor or ARNI (sacubitril/valsartan), beta-blocker, aldosterone antagonist, and SGLT2 inhibitor.

Question 66: An intubated ICU patient has partial facial tightening (face 2), fully bent upper limbs with finger flexion (upper limbs 3), and is tolerating the ventilator (compliance 1). What is the BPS total score and what does it indicate?

Score 5: adequate sedation confirmed
Score 7: extreme pain requiring immediate opioid escalation
Score 6: clinically significant pain requiring intervention (Correct answer)
Score 3: minimal discomfort within acceptable range

Correct answer: Score 6: clinically significant pain requiring intervention

BPS total: face 2 + upper limbs 3 + ventilator compliance 1 = 6. BPS scores at or above 5 indicate significant pain requiring intervention.

Question 67: A patient develops acute respiratory distress with absent breath sounds on the left side after central line placement. What is the priority intervention?

Obtain a STAT chest X-ray before intervening
Reposition the patient to the right lateral decubitus position
Administer supplemental oxygen and monitor
Prepare for immediate needle decompression or chest tube insertion (Correct answer)

Correct answer: Prepare for immediate needle decompression or chest tube insertion

Absent breath sounds after central line placement indicate tension pneumothorax, requiring immediate decompression.

Question 68: A patient with SIADH has a serum sodium of 124 mEq/L and is asymptomatic. The appropriate initial treatment is:

Fluid restriction to 800–1000 mL/day (Correct answer)
IV 3% hypertonic saline
Corticosteroid therapy
Loop diuretics

Correct answer: Fluid restriction to 800–1000 mL/day

Fluid restriction is the first-line treatment for mild to moderate asymptomatic SIADH, addressing the underlying water excess.

Question 69: A 67-year-old woman with osteoporosis has a T-score of -2.8. First-line pharmacological treatment includes:

Calcium supplementation only
Calcitonin nasal spray
Bisphosphonates (e.g., alendronate) (Correct answer)
Teriparatide injection

Correct answer: Bisphosphonates (e.g., alendronate)

Bisphosphonates are first-line pharmacotherapy for osteoporosis due to evidence reducing vertebral and hip fracture risk.

Question 70: A post-PCI patient on DAPT (clopidogrel and aspirin) needs emergency appendectomy. Which antiplatelet management is most appropriate?

Stop both agents 7-10 days before surgery with no bridge therapy
Replace clopidogrel with warfarin as a bridge
Continue both antiplatelet agents through surgery to prevent stent thrombosis
Consult cardiology; if within 30 days of BMS or 12 months of DES, delay surgery if possible (Correct answer)

Correct answer: Consult cardiology; if within 30 days of BMS or 12 months of DES, delay surgery if possible

Premature DAPT discontinuation within 30 days of BMS or 6-12 months of DES carries high stent thrombosis risk. Emergency surgery requires cardiology consultation to weigh bleeding versus stent thrombosis risk.

Question 71: Which grading scale is most commonly used to classify chemotherapy-related adverse effects in oncology clinical practice?

Karnofsky Performance Scale
TNM Staging System
ECOG Performance Status Scale
NCI Common Terminology Criteria for Adverse Events (CTCAE) (Correct answer)

Correct answer: NCI Common Terminology Criteria for Adverse Events (CTCAE)

The NCI CTCAE is the standardized system for grading the severity of adverse events in oncology clinical trials and practice.

Question 72: Anticipatory guidance most appropriate for a male child during early adolescence (11-14) includes:

age-appropriate sports activities.
risk-taking behaviors (drugs, drinking, smoking, speeding).
bodily changes and secondary sex characteristics. (Correct answer)
abstinence, safe sex, and contraception.

Correct answer: bodily changes and secondary sex characteristics.

Explanation: Anticipatory guidance most appropriate for a male child during early adolescence (11-14) includes bodily changes and the development of secondary sexual characteristics. The child will change thought patterns and awareness so the child's feelings about academic responsibilities should be explored. The child may begin to experience peer pressure to conform to the norms of a group, so the pediatric nurse should begin discussions about issues such as gangs, tobacco, drugs, alcohol, and abusive relationships (which should be explored more during adolescence).

Question 73: An 80-year-old patient scores 18/30 on the Mini-Mental State Examination (MMSE). This score indicates:

Normal cognition
Severe cognitive impairment
Mild cognitive impairment
Moderate cognitive impairment (Correct answer)

Correct answer: Moderate cognitive impairment

MMSE scores of 10–18 indicate moderate cognitive impairment; scores ≥24 are considered normal.

Question 74: Which of the following best describes the primary focus of ambulatory care nursing practice?

Coordinating hospice care for terminally ill patients
Managing long-term care for residents in skilled nursing facilities
Delivering health services to patients who are not admitted overnight (Correct answer)
Providing acute inpatient care to hospitalized patients

Correct answer: Delivering health services to patients who are not admitted overnight

Ambulatory care nursing focuses on patients who receive health services without being admitted to an inpatient facility, including clinics, physician offices, and outpatient centers.

Question 75: A patient develops petechiae, oozing from IV sites, and a prolonged PT/PTT post-surgery. These findings are most consistent with:

Vitamin K deficiency
Heparin-induced thrombocytopenia (HIT)
Disseminated intravascular coagulation (DIC) (Correct answer)
Immune thrombocytopenic purpura (ITP)

Correct answer: Disseminated intravascular coagulation (DIC)

DIC is characterized by simultaneous clotting and bleeding, with petechiae, coagulation factor consumption, and prolonged PT/PTT.

Question 76: A 36-year-old male patient has acute sexually transmitted epididymitis. In addition to antibiotics during the acute phase of the disease, the treatment regimen should include:

Bed rest and scrotal elevation (Correct answer)
Ice compresses
Scrotal support
Warm compresses

Correct answer: Bed rest and scrotal elevation

Explanation: If a 36-year-old male patient has acute sexually transmitted epididymitis, in addition to antibiotics during the acute phase of the disease, the treatment regimen should include bed rest and scrotal elevation, which may help to alleviate some of the pain. Treatment usually continues for 10-21 days. Sexually transmitted epididymitis is most common in males younger than age 40. Laboratory findings include elevated white blood cell (WBC) count and left shift. Gram stain may be done to isolate the pathogen for sexually transmitted disease.

Question 77: When a nurse manager delegates a task to a nursing assistant, which task is outside the nursing assistant's scope of practice?

Ambulating a stable post-surgical patient
Taking and reporting vital signs
Performing initial nursing assessment after patient admission (Correct answer)
Assisting with bathing and oral hygiene

Correct answer: Performing initial nursing assessment after patient admission

Initial nursing assessment requires clinical judgment and is within the registered nurse's scope of practice only.

Question 78: Which finding best distinguishes dementia from delirium in an older patient?

Gradual onset over months to years (Correct answer)
Impaired executive function
Memory impairment
Acute onset and fluctuating course

Correct answer: Gradual onset over months to years

Gradual insidious onset over months to years is the hallmark that distinguishes dementia from the acute onset of delirium.

Question 79: During a mental status exam, a patient demonstrates flight of ideas. This finding is most consistent with which condition?

Schizophrenia
Major depressive disorder
Generalized anxiety disorder
Manic episode (Correct answer)

Correct answer: Manic episode

Flight of ideas — rapidly shifting, loosely connected thoughts — is a hallmark feature of manic episodes.

Question 80: A patient with chronic heart failure develops acute pulmonary edema with SpO2 84%, severe dyspnea, and pink frothy sputum. Which initial intervention has highest priority?

Administer oral furosemide and reassess in 30 minutes
Position upright (high Fowler's), apply high-flow oxygen or NIV, and prepare IV furosemide (Correct answer)
Start IV fluid bolus to increase preload and improve cardiac output
Obtain 12-lead ECG to identify precipitating arrhythmia

Correct answer: Position upright (high Fowler's), apply high-flow oxygen or NIV, and prepare IV furosemide

Acute pulmonary edema is a respiratory emergency. Immediate priorities: upright positioning (reduces preload), high-flow O2 or NIV (improves oxygenation), and IV furosemide (rapid diuresis). These occur simultaneously.

Question 81: A FLACC assessment shows grimacing (face 2), legs drawn up (legs 2), rigid body (activity 2), crying continuously (cry 2), and inconsolable (consolability 2). Total score and clinical meaning?

Total score 10: severe pain requiring immediate intervention (Correct answer)
Total score 6: mild-to-moderate pain
Total score 10: sedation-related symptoms, not pain
Total score 8: moderate pain

Correct answer: Total score 10: severe pain requiring immediate intervention

FLACC scores each of 5 categories 0-2 with maximum total = 10. A score of 10 (2+2+2+2+2) indicates severe pain requiring immediate pharmacological and non-pharmacological intervention.

Question 82: A patient with chronic kidney disease has a potassium level of 6.3 mEq/L and peaked T-waves on ECG. Which intervention is most urgent?

Dietary potassium restriction counseling
Administer calcium gluconate IV to stabilize cardiac membranes (Correct answer)
Administer sodium polystyrene sulfonate (Kayexalate)
Schedule dialysis within 24 hours

Correct answer: Administer calcium gluconate IV to stabilize cardiac membranes

Calcium gluconate is the fastest intervention to stabilize cardiac membrane potential and prevent life-threatening arrhythmia from hyperkalemia.

Question 83: A patient diagnosed with schizophrenia is experiencing command hallucinations. Which nursing intervention is the priority?

Administer an antipsychotic medication immediately
Place the patient in a quiet room alone
Document the hallucinations without intervening
Assess whether the patient intends to act on the commands (Correct answer)

Correct answer: Assess whether the patient intends to act on the commands

Assessing the patient's intent to act on command hallucinations is the priority because it determines the immediate safety risk.

Question 84: A patient with asthma visits the ambulatory clinic for a routine follow-up. Which finding would indicate POOR asthma control requiring escalation of therapy?

No limitation of normal activities in the past four weeks
Using a rescue inhaler fewer than two days per week
Nighttime awakenings due to asthma symptoms more than twice per month (Correct answer)
Peak flow readings consistently above 80% of personal best

Correct answer: Nighttime awakenings due to asthma symptoms more than twice per month

Nighttime awakenings more than twice per month is a key indicator of poorly controlled asthma per GINA guidelines and warrants a step-up in therapy.

Question 85: A child presents with a strawberry tongue, sandpaper-like rash, and positive rapid strep test. Which treatment is indicated?

Azithromycin for 5 days
Watchful waiting
Topical corticosteroids
Amoxicillin for 10 days (Correct answer)

Correct answer: Amoxicillin for 10 days

Scarlet fever (Group A Streptococcus) is treated with amoxicillin for 10 days to prevent rheumatic fever.

Question 86: Post-op day 1 after a right hemicolectomy, a patient's ostomy stoma appears pale and dusky. What is the correct interpretation?

Stoma requires more frequent irrigation
Stoma is adequately perfused
Possible stoma ischemia requiring immediate provider notification (Correct answer)
Normal appearance for the first 24 hours

Correct answer: Possible stoma ischemia requiring immediate provider notification

A healthy stoma should be beefy red; a pale or dusky stoma suggests ischemia or necrosis requiring urgent assessment.

Question 87: A patient underwent PCI via the right radial artery. Which complication should the nurse assess for first post-procedure?

Venous thromboembolism at the access site
Radial artery occlusion and hand ischemia (Correct answer)
Retroperitoneal hemorrhage
Contrast-induced nephropathy only after 72 hours

Correct answer: Radial artery occlusion and hand ischemia

Radial artery occlusion is the most common complication of transradial PCI, occurring in 1-10% of cases. Assessment of radial pulse, capillary refill, and hand perfusion is the priority.

Question 88: A patient with Type 2 diabetes has an HbA1c of 8.9%. According to ADA guidelines, the initial medication of choice is:

Insulin glargine
Empagliflozin
Metformin (Correct answer)
Glipizide

Correct answer: Metformin

Metformin remains the first-line pharmacologic treatment for Type 2 diabetes in most patients unless contraindicated.

Question 89: A patient with inferior STEMI has ST elevation in II, III, aVF; ST depression in V1-V2; and elevated JVP without pulmonary congestion. Which structure is most likely involved?

Left anterior descending artery infarction with cardiogenic shock
Right ventricular infarction complicating inferior STEMI (Correct answer)
Posterior wall MI in isolation
Left circumflex artery infarction with mitral regurgitation

Correct answer: Right ventricular infarction complicating inferior STEMI

Inferior STEMI with ST depression in V1-V2 (posterior involvement) and elevated JVP without pulmonary edema (right-sided heart failure) indicates right ventricular infarction. Confirm with right-sided leads (V4R ST elevation).

Question 90: When managing a patient on continuous renal replacement therapy (CRRT), which electrolyte imbalance requires the most frequent monitoring?

Hypernatremia
Hyperkalemia
Hypercalcemia
Hypophosphatemia (Correct answer)

Correct answer: Hypophosphatemia

Hypophosphatemia is the most common electrolyte complication of CRRT due to continuous phosphate removal via dialysate/replacement fluid.

Question 91: Fifteen hours after a patient was involved in an accident that resulted in a comminuted fracture of the femur, the patient exhibits increasing dyspnea and tachypnea as well as confusion, difficulty speaking, and a petechial rash in the mouth and upper body. The most likely cause of this triad of symptoms is:

Pneumonia
Fat embolism syndrome (Correct answer)
Stroke
Pulmonary embolism

Correct answer: Fat embolism syndrome

Explanation: The most likely cause of this triad of symptoms is fat embolism syndrome. Fat emboli enter the bloodstream and lodge in the lungs where platelets, red blood cells, and fibrin adhere to them, leading to respiratory distress syndrome. They can migrate to the skin (causing petechiae) and to the brain (causing central nervous system [CNS] problems).

Question 92: A patient with complete heart block shows ventricular rate 32 bpm and hemodynamic instability. What is the immediate treatment?

Transcutaneous pacing followed by transvenous pacing (Correct answer)
Amiodarone 150 mg IV bolus
Metoprolol IV to slow atrial rate
Synchronized cardioversion at 120 joules

Correct answer: Transcutaneous pacing followed by transvenous pacing

Symptomatic third-degree AV block requires immediate transcutaneous pacing as a bridge to transvenous pacing. Amiodarone and beta-blockers are contraindicated as they worsen bradycardia.

Question 93: Which nursing theory is most associated with nursing as a 'caring science' and the human-to-human relationship?

Betty Neuman's Systems Model
Virginia Henderson's Need Theory
Dorothea Orem's Self-Care Deficit Theory
Jean Watson's Theory of Human Caring (Correct answer)

Correct answer: Jean Watson's Theory of Human Caring

Jean Watson's Theory of Human Caring positions caring as a moral ideal and the essence of nursing practice.

Question 94: In the ambulatory care setting, patient self-management education for a newly diagnosed type 2 diabetic should emphasize which concept?

Avoidance of all sugars, including fruit
Strict adherence to physician instructions without modification
The patient's passive role in receiving care
Empowerment through health literacy and shared decision-making (Correct answer)

Correct answer: Empowerment through health literacy and shared decision-making

Ambulatory care nursing promotes patient empowerment, health literacy, and shared decision-making to support chronic disease self-management.

Question 95: A stable patient with new-onset atrial flutter (rate 150 bpm) has estimated onset greater than 48 hours ago. What is the priority before electrical cardioversion?

Amiodarone IV infusion for rhythm conversion
Rate control followed by anticoagulation for at least 3 weeks before cardioversion (Correct answer)
Immediate synchronized cardioversion at 50 joules
Adenosine 6 mg IV push to terminate the flutter

Correct answer: Rate control followed by anticoagulation for at least 3 weeks before cardioversion

For AF/flutter with onset greater than 48 hours or unknown duration in a stable patient, at least 3 weeks of therapeutic anticoagulation is required before cardioversion, or a TEE must rule out left atrial thrombus.

Question 96: Under the Health Insurance Portability and Accountability Act (HIPAA), which action by a nurse violates patient privacy?

Discussing patient information with a colleague in a public elevator within earshot of others (Correct answer)
Documenting in the medical record under the nurse's own login
Providing the patient's spouse with discharge instructions at the patient's request
Sharing patient information with direct care providers on a need-to-know basis

Correct answer: Discussing patient information with a colleague in a public elevator within earshot of others

Discussing patient information in public areas where unauthorized persons may overhear constitutes a HIPAA privacy violation.

Question 97: A cancer patient expresses that they want to stop curative treatment and focus on comfort. The nurse's most appropriate response is:

Document refusal of treatment and take no further action
Contact the family to discuss overriding the patient's decision
Encourage the patient to continue treatment to maximize survival
Acknowledge the patient's wishes and facilitate a palliative/goals-of-care discussion with the team (Correct answer)

Correct answer: Acknowledge the patient's wishes and facilitate a palliative/goals-of-care discussion with the team

Respecting patient autonomy requires acknowledging their wishes and ensuring they receive appropriate palliative care planning.

Question 98: A patient with sickle cell disease in vaso-occlusive crisis reports 9/10 pain after two doses of IV hydromorphone with minimal relief. Which intervention is most appropriate to advocate for next?

Administer ketorolac as the sole treatment to avoid opioid escalation
Reassure the patient that the pain will self-resolve and encourage discharge planning
Advocate for increased opioid dosing, shorter dosing intervals, or patient-controlled analgesia (PCA) (Correct answer)
Suggest non-pharmacological interventions only and avoid further opioids

Correct answer: Advocate for increased opioid dosing, shorter dosing intervals, or patient-controlled analgesia (PCA)

Sickle cell vaso-occlusive crisis involves severe ischemic pain requiring aggressive, patient-tailored opioid management. When standard doses are inadequate, escalation to higher doses, shorter intervals, or PCA is evidence-based.

Question 99: A 2-year-old weighing 13 kg needs acetaminophen 15 mg/kg every 4-6 hours. Available concentration is 160 mg/5 mL. How many mL per dose?

3.0 mL
4.1 mL
2.5 mL
6.1 mL (Correct answer)

Correct answer: 6.1 mL

Dose = 15 mg/kg x 13 kg = 195 mg. Volume = (195/160) x 5 mL = 6.09 mL, approximately 6.1 mL.

Question 100: Which cancer screening test has the strongest evidence for reducing both incidence and mortality from colorectal cancer?

Flexible sigmoidoscopy every 5 years
Fecal occult blood testing (FOBT) annually
Colonoscopy every 10 years (Correct answer)
CT colonography every 5 years

Correct answer: Colonoscopy every 10 years

Colonoscopy every 10 years allows both detection and removal of precancerous polyps, reducing incidence and mortality.

Question 101: A patient with chronic low back pain (7/10) takes oxycodone 10 mg every 4 hours plus acetaminophen. Which WHO analgesic ladder step does this represent?

Step 1: Non-opioid analgesics only
Step 3: Strong opioids plus non-opioids with or without adjuvants (Correct answer)
Step 4: Interventional pain management
Step 2: Mild-to-moderate opioids plus non-opioids

Correct answer: Step 3: Strong opioids plus non-opioids with or without adjuvants

Oxycodone is a strong opioid, placing this regimen at WHO Step 3 — for moderate-to-severe pain using strong opioids (morphine, oxycodone, hydromorphone, fentanyl) with or without non-opioids and adjuvants.

Question 102: A 30-year-old woman presents with painful, grouped vesicles on her labia. Which test would confirm the diagnosis?

KOH preparation
Tzanck smear or PCR for HSV (Correct answer)
RPR for syphilis
Culture for gonorrhea

Correct answer: Tzanck smear or PCR for HSV

Grouped painful vesicles are characteristic of herpes simplex virus (HSV), confirmed by PCR or Tzanck smear.

Question 103: What does CPOE stand for and what is its primary patient safety benefit?

Computerized Physician Order Entry — eliminates handwriting-related errors and enables real-time CDS (Correct answer)
Comprehensive Patient Outcome Evaluation — tracks outcomes data
Clinical Protocol Order Entry — standardizes care pathways
Central Pharmacy Order Execution — automates dispensing

Correct answer: Computerized Physician Order Entry — eliminates handwriting-related errors and enables real-time CDS

CPOE enables electronic medical orders, eliminating illegible handwriting and transcription errors, and enabling real-time CDS including drug interactions, allergy checks, and dosing alerts.

Question 104: A patient has a mechanical mitral valve replacement and is prescribed warfarin. What is the correct target INR range?

3.0-4.0
1.5-2.0
2.0-3.0
2.5-3.5 (Correct answer)

Correct answer: 2.5-3.5

Mechanical mitral valves carry higher thromboembolic risk and require a target INR of 2.5-3.5. Mechanical aortic valves in normal sinus rhythm with low thrombogenic features may have a target of 2.0-3.0.

Question 105: Which framework is used to evaluate the evidence quality of research studies in evidence-based nursing practice?

SBAR framework
SWOT analysis
Levels of Evidence hierarchy (e.g., systematic reviews at level I) (Correct answer)
PICO(T) question model

Correct answer: Levels of Evidence hierarchy (e.g., systematic reviews at level I)

The levels of evidence hierarchy categorizes research strength, with systematic reviews and meta-analyses at the highest level.

Question 106: Which finding most directly indicates severe acute pancreatitis per the Revised Atlanta Classification?

Serum lipase 4 times upper limit of normal
Serum amylase 3 times upper limit of normal
Organ failure persisting more than 48 hours (Correct answer)
C-reactive protein greater than 150 mg/L at 48 hours

Correct answer: Organ failure persisting more than 48 hours

The Revised Atlanta Classification defines severe acute pancreatitis as persistent organ failure lasting more than 48 hours involving respiratory, cardiovascular, or renal systems.

Question 107: A 28-week gestation newborn in the NICU — which finding is most consistent with respiratory distress syndrome (RDS)?

Apnea episodes lasting 15 seconds with rapid spontaneous resolution
Expiratory grunting, nasal flaring, subcostal retractions, and cyanosis on room air (Correct answer)
Coarse crackles with productive cough and purulent secretions
Unilateral absent breath sounds with mediastinal shift

Correct answer: Expiratory grunting, nasal flaring, subcostal retractions, and cyanosis on room air

RDS in preterm neonates presents with expiratory grunting, nasal flaring, intercostal/subcostal retractions, and cyanosis — classic signs of surfactant deficiency.

Question 108: A patient with a history of atrial fibrillation is anticoagulated. The nurse assesses sudden onset of severe right leg pain, pallor, and pulselessness. What is the priority action?

Notify the provider immediately for suspected acute arterial occlusion (Correct answer)
Elevate the affected leg and apply warm compresses
Apply compression stockings to the affected leg
Reassess in 1 hour for spontaneous improvement

Correct answer: Notify the provider immediately for suspected acute arterial occlusion

The 6 Ps of arterial occlusion (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia) require immediate provider notification and intervention.

Question 109: A nurse executive is developing a staffing plan using the patient classification system. What is the primary purpose of this system?

To track nursing overtime hours
To measure patient acuity and quantify nursing care requirements (Correct answer)
To schedule physician rounding times
To determine patient room assignments

Correct answer: To measure patient acuity and quantify nursing care requirements

Patient classification systems measure acuity to objectively determine the nursing hours required per patient per shift.

Question 110: An infant at a well-child visit is noted to have not regained birth weight by 2 weeks of age. What is the priority intervention?

Order thyroid function tests
Schedule a follow-up visit at 2 months
Evaluate feeding technique and frequency (Correct answer)
Refer to endocrinology

Correct answer: Evaluate feeding technique and frequency

Most newborn weight loss is due to inadequate intake; assessing feeding is the first step before pursuing diagnostic workup.

Question 111: A breast cancer patient completes 5 years of tamoxifen therapy. What is the most serious long-term adverse effect the nurse should educate her about?

Endometrial cancer and thromboembolic events (Correct answer)
Cardiomyopathy
Permanent alopecia
Osteoporosis and bone fractures

Correct answer: Endometrial cancer and thromboembolic events

Tamoxifen's estrogenic activity in the uterus increases risk of endometrial cancer, and it also increases venous thromboembolism risk.

Question 112: A patient on warfarin has an INR of 4.8 with no bleeding. The most appropriate next step is:

Continue warfarin and recheck in 1 week
Hold warfarin dose and recheck INR in 1–2 days (Correct answer)
Administer fresh frozen plasma
Administer vitamin K 10 mg IV immediately

Correct answer: Hold warfarin dose and recheck INR in 1–2 days

For supratherapeutic INR without bleeding, holding warfarin and rechecking INR within 1–2 days is the appropriate management.

Question 113: In ambulatory care nursing, which ethical principle is best demonstrated when a nurse ensures a patient understands their diagnosis and treatment options before signing a consent form?

Justice
Nonmaleficence
Autonomy (Correct answer)
Beneficence

Correct answer: Autonomy

Autonomy respects the patient's right to make informed decisions about their own health care, which is facilitated by ensuring they fully understand their situation.

Question 114: Which nursing diagnosis is most appropriate for a patient with cancer experiencing cancer-related fatigue?

Activity intolerance related to disease process and treatment effects (Correct answer)
Risk for injury related to fall risk
Impaired physical mobility related to skeletal metastases
Ineffective breathing pattern related to dyspnea

Correct answer: Activity intolerance related to disease process and treatment effects

Activity intolerance accurately captures cancer-related fatigue's impact on the patient's ability to sustain physical activity.

Question 115: A clinic nurse is assessing a patient's pain on a 0-10 numeric rating scale. The patient rates pain as 7/10. Which intervention is MOST appropriate?

Document the score and reassess at the next scheduled visit
Administer the maximum dose of all available analgesics immediately
Assess the quality, location, and duration of pain, then collaborate with the provider for a treatment plan (Correct answer)
Reassure the patient that a score of 7 is manageable and advise rest

Correct answer: Assess the quality, location, and duration of pain, then collaborate with the provider for a treatment plan

A comprehensive pain assessment (PQRST) must precede any intervention, and collaboration with the provider ensures an appropriate, individualized treatment plan.

Question 116: A patient with COPD is receiving supplemental oxygen at 2 L/min via nasal cannula. The nurse notes the patient's respiratory rate has decreased to 8/min and SpO2 is 99%. What is the concern?

The oxygen should be switched to a face mask for better delivery
This is the expected therapeutic response to oxygen therapy
The oxygen rate is too low and should be increased
The patient may rely on hypoxic drive, and high oxygen may suppress respiratory effort (Correct answer)

Correct answer: The patient may rely on hypoxic drive, and high oxygen may suppress respiratory effort

Some patients with COPD depend on hypoxic drive to breathe; excessive supplemental oxygen can suppress this and cause respiratory depression.

Question 117: A patient with a chest tube develops subcutaneous emphysema around the insertion site. What does this indicate?

Air is leaking into the subcutaneous tissue, possibly indicating tube displacement (Correct answer)
The chest tube is functioning correctly
The water seal chamber is malfunctioning
This is a normal finding post-thoracostomy

Correct answer: Air is leaking into the subcutaneous tissue, possibly indicating tube displacement

Subcutaneous emphysema (crepitus around the insertion site) suggests the chest tube has become dislodged or there is an air leak.

Question 118: Which finding is most indicative of increased intracranial pressure (ICP) in a patient with a traumatic brain injury?

Heart rate of 110 bpm with normal BP
Mild confusion without vital sign changes
Cushing's triad: hypertension, bradycardia, and irregular respirations (Correct answer)
Temperature of 38.1°C

Correct answer: Cushing's triad: hypertension, bradycardia, and irregular respirations

Cushing's triad (hypertension, bradycardia, irregular respirations) is a late, ominous sign of severely elevated ICP.

Question 119: A patient calls the ambulatory care clinic reporting chest pain and shortness of breath. The nurse's FIRST priority action should be:

Notify the physician and document the call in the patient's chart
Instruct the patient to activate emergency medical services (911) immediately (Correct answer)
Advise the patient to take an antacid and call back if symptoms worsen
Schedule an appointment for the next available opening

Correct answer: Instruct the patient to activate emergency medical services (911) immediately

Chest pain with shortness of breath may indicate a life-threatening emergency such as myocardial infarction, requiring immediate activation of emergency services.

Question 120: Mike Brown has completed gender reassignment surgery (male-to-female) and is now legally Mikaela Brown. Mikaela states that she is still attracted to females and not males. Her sexual orientation should be most appropriately classified as:

Bisexual
Questioning
Lesbian (Correct answer)
Non-binary

Correct answer: Lesbian

Explanation: Once a person completes gender reassignment surgery and legally changes genders, that person is then considered the reassigned gender; thus, Mikaela is considered female, so her attraction to other females would result in her sexual orientation as lesbian. If she were attracted to both males and females, she would be considered bisexual. Mikaela would be questioning if she was still exploring her sexual orientation. Those who are non-binary do not consider themselves exclusively male or female.

Question 121: Which developmental milestone should a child typically achieve by 12 months of age?

Drawing a circle
Saying single meaningful words (Correct answer)
Walking independently
Speaking in 2-word phrases

Correct answer: Saying single meaningful words

Most children say their first meaningful words (e.g., 'mama,' 'dada') by 12 months of age.

Question 122: A patient is receiving a blood transfusion and develops fever, chills, and flank pain 15 minutes after starting. The nurse's priority action is:

Administer acetaminophen and diphenhydramine
Stop the transfusion, maintain IV access with NS, and notify the provider (Correct answer)
Slow the infusion rate and monitor for improvement
Increase the flow rate to complete the transfusion faster

Correct answer: Stop the transfusion, maintain IV access with NS, and notify the provider

These symptoms suggest an acute hemolytic transfusion reaction; stopping the transfusion immediately is the priority to prevent further harm.

Question 123: Which screening tool is most commonly recommended in ambulatory care for universal depression screening in adults?

Patient Health Questionnaire-9 (PHQ-9) (Correct answer)
Mini-Mental State Examination (MMSE)
Beck Anxiety Inventory (BAI)
Montreal Cognitive Assessment (MoCA)

Correct answer: Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is a validated, widely used tool endorsed by the USPSTF for universal depression screening in primary care and ambulatory settings.

Question 124: Which patient receiving chemotherapy is at highest risk for developing chemotherapy-induced peripheral neuropathy (CIPN)?

A patient receiving paclitaxel or vincristine (Correct answer)
A patient receiving cyclophosphamide
A patient receiving carboplatin alone
A patient receiving doxorubicin

Correct answer: A patient receiving paclitaxel or vincristine

Taxanes (paclitaxel) and vinca alkaloids (vincristine) are the agents most associated with dose-limiting peripheral neuropathy.

Question 125: When implementing a quality improvement initiative in an ambulatory care clinic, the PDSA (Plan-Do-Study-Act) cycle is used primarily to:

Eliminate the need for data collection
Test changes on a small scale before widespread implementation (Correct answer)
Evaluate individual nurse performance annually
Create new policies without staff input

Correct answer: Test changes on a small scale before widespread implementation

The PDSA cycle is a rapid-cycle improvement model that tests interventions on a small scale to gather data before broader implementation.

Question 126: Which vaccine is recommended annually for all persons aged 6 months and older in the United States?

Influenza vaccine (Correct answer)
Pneumococcal vaccine
Hepatitis B vaccine
Tdap vaccine

Correct answer: Influenza vaccine

The CDC recommends annual influenza vaccination for all individuals 6 months and older.

Question 127: A nurse working in an ambulatory infusion center notes that a patient's IV site is red, warm, and swollen. This finding is MOST consistent with:

Infiltration
Air embolism
Phlebitis (Correct answer)
Speed shock

Correct answer: Phlebitis

Redness, warmth, and swelling at an IV site are classic signs of phlebitis, indicating inflammation of the vein.

Question 128: A 3-year-old presents with suspected epiglottitis. Which nursing action is the absolute priority?

Avoid any agitation; keep child calm with parent; do NOT examine the throat (Correct answer)
Obtain a throat culture to identify the causative organism
Administer ibuprofen to reduce fever immediately
Place child supine and prepare for bag-mask ventilation

Correct answer: Avoid any agitation; keep child calm with parent; do NOT examine the throat

Epiglottitis is a life-threatening emergency. Throat examination or any agitation can precipitate complete airway obstruction. The child must be kept calm with the parent while an emergent airway team is assembled.

Question 129: A patient is in narrow complex tachycardia at 180 bpm, regular rhythm, hemodynamically stable. Which is the first-line treatment per ACLS?

Synchronized cardioversion at 100 joules
Amiodarone 150 mg IV over 10 minutes
Metoprolol 5 mg IV bolus
Vagal maneuvers followed by adenosine 6 mg rapid IV push (Correct answer)

Correct answer: Vagal maneuvers followed by adenosine 6 mg rapid IV push

Stable narrow complex regular tachycardia (likely AVNRT or AVRT) is treated first with vagal maneuvers. If unsuccessful, adenosine 6 mg rapid IV push is the first-line pharmacologic treatment.

Question 130: In ambulatory care, the concept of 'care transitions' is MOST relevant to which nursing intervention?

Scheduling back-to-back appointments for efficiency
Transferring a patient from one exam room to another within the clinic
Coordinating a patient's handoff from the hospital to outpatient follow-up to reduce readmission (Correct answer)
Transitioning nursing staff between shifts

Correct answer: Coordinating a patient's handoff from the hospital to outpatient follow-up to reduce readmission

Care transitions in ambulatory nursing refer to coordinating the movement of patients between care settings (hospital to home/outpatient) to ensure safety and continuity.

Question 131: Which blood test is the primary tumor marker used to monitor treatment response in prostate cancer?

PSA (prostate-specific antigen) (Correct answer)
AFP (alpha-fetoprotein)
CEA (carcinoembryonic antigen)
CA-125

Correct answer: PSA (prostate-specific antigen)

PSA is the primary serum biomarker for prostate cancer diagnosis, staging, and monitoring treatment response.

Question 132: Which is the correct legal standard for involuntary psychiatric hospitalization in the United States?

Patient has a history of psychiatric illness
Patient refuses to take prescribed medications
Family members request hospitalization for the patient
Patient presents a danger to self or others, or is gravely disabled (Correct answer)

Correct answer: Patient presents a danger to self or others, or is gravely disabled

Involuntary commitment legally requires that the patient be an imminent danger to themselves or others, or be gravely disabled.

Question 133: A patient with cancer is receiving opioids for chronic pain and reports new-onset constipation. The first-line intervention is:

Restrict dietary fiber intake
Initiate a bowel regimen with a stimulant laxative when starting opioid therapy (Correct answer)
Administer an opioid antagonist
Stop the opioid medication immediately

Correct answer: Initiate a bowel regimen with a stimulant laxative when starting opioid therapy

Opioid-induced constipation is an expected side effect; a stimulant laxative bowel regimen should be initiated prophylactically at opioid start.

Question 134: A patient with acute pancreatitis is NPO and requesting pain relief. Which analgesic is preferred?

Meperidine (Demerol) IV
Ketorolac IM
Hydromorphone IV (Correct answer)
Morphine sulfate IV

Correct answer: Hydromorphone IV

Hydromorphone is preferred for pancreatitis pain; meperidine is avoided due to toxic normeperidine metabolites, and morphine may cause sphincter of Oddi spasm.

Question 135: In ambulatory care, which federal law primarily governs the privacy and security of patient health information?

Occupational Safety and Health Act (OSHA)
Americans with Disabilities Act (ADA)
Health Insurance Portability and Accountability Act (HIPAA) (Correct answer)
Emergency Medical Treatment and Labor Act (EMTALA)

Correct answer: Health Insurance Portability and Accountability Act (HIPAA)

HIPAA establishes national standards for protecting the privacy and security of individually identifiable health information (PHI) in all health care settings.

Question 136: A psychiatric nurse is applying the Recovery Model of mental illness. Which principle best reflects this model?

Medication compliance is required for recovery
A meaningful life is possible even with ongoing symptoms (Correct answer)
Symptom elimination is the primary goal of treatment
Patients have limited capacity for self-determination

Correct answer: A meaningful life is possible even with ongoing symptoms

The Recovery Model emphasizes hope, self-determination, and meaningful community participation regardless of symptom status.

Question 137: A nurse is reviewing a patient's medication list and identifies a potential drug-drug interaction. The MOST appropriate next step is to:

Contact the prescribing provider to clarify the order before administration (Correct answer)
Instruct the patient not to take the medications at home
Withhold all medications until the physician returns
Administer the medications as prescribed and monitor the patient

Correct answer: Contact the prescribing provider to clarify the order before administration

The nurse has a professional and legal responsibility to clarify orders with the prescriber before administering medications involved in a potentially harmful drug interaction.

Question 138: A patient with borderline personality disorder is engaging in splitting behavior. How should the nursing staff respond?

Limit the patient's interactions with other patients
Assign only one nurse to avoid conflict
Maintain consistent communication and unified team responses (Correct answer)
Allow staff the patient prefers to handle all care

Correct answer: Maintain consistent communication and unified team responses

Consistent team communication prevents the patient from manipulating staff through idealization and devaluation dynamics.

Question 139: Which physiologic change of normal aging most directly affects drug metabolism in older adults?

Increased lean body mass
Increased gastric acid secretion
Increased renal clearance
Decreased hepatic blood flow and liver mass (Correct answer)

Correct answer: Decreased hepatic blood flow and liver mass

Decreased hepatic blood flow and liver mass reduce first-pass metabolism and hepatic drug clearance in older adults.

Question 140: A patient receiving interleukin-2 (IL-2) immunotherapy develops severe hypotension and fluid retention. These findings are characteristic of:

Anaphylaxis from the drug
Tumor lysis syndrome
Septic shock from opportunistic infection
Capillary leak syndrome associated with IL-2 therapy (Correct answer)

Correct answer: Capillary leak syndrome associated with IL-2 therapy

IL-2 therapy causes capillary leak syndrome with massive fluid shifts, resulting in hypotension and peripheral edema.

Question 141: When teaching a patient with heart failure about fluid restriction, the nurse explains that daily weights should be taken:

Each morning after voiding and before eating (Correct answer)
After each meal and before bedtime
Once weekly at the same time
Before and after exercise

Correct answer: Each morning after voiding and before eating

Daily weights taken under standardized conditions (morning, after voiding, before eating) provide accurate fluid status monitoring.

Question 142: After removal of a chest tube, a 48-year-old patient complains of retrosternal and neck pain, is dyspneic, and has slight neck edema. Hamman's sign is positive (precordial systolic crepitus). The probable diagnosis is:

Cardiac tamponade
Pneumomediastinum (Correct answer)
Pneumopericardium
Pneumothorax

Correct answer: Pneumomediastinum

Explanation: Retrosternal and neck pain, dyspnea, and slight neck edema indicate pneumomediastinum. Hamman's sign —a precordial rasping sound heard on auscultation during heartbeat as the heart moves against tissues filled with air-is an indication of both pneumomediastinum and pneumopericardium but is not generally present with pneumothorax or cardiac tamponade. However, neck edema can occur with pneumomediastinum. Air leaks can occur from damage to the pleura during surgery or (less commonly) from obstructed chest tubes. Air leaks usually resolve within a few days but may require the reinsertion of a chest tube.

Question 143: A patient taking lithium reports nausea, vomiting, coarse tremor, and confusion. What is the nurse's priority action?

Give the next lithium dose with food
Reassure the patient that these are expected side effects
Hold the lithium and notify the provider immediately (Correct answer)
Administer an antiemetic and monitor closely

Correct answer: Hold the lithium and notify the provider immediately

These symptoms indicate lithium toxicity, which requires immediate medication hold and provider notification to prevent serious harm.

Question 144: The Institute of Medicine (IOM) 'To Err is Human' report identified which major patient safety concern?

Medical errors cause tens of thousands of preventable deaths annually in US hospitals (Correct answer)
Physician licensing standards are insufficient
Nurse-to-patient ratios are too high nationwide
Hospital infection rates have reached epidemic levels

Correct answer: Medical errors cause tens of thousands of preventable deaths annually in US hospitals

The landmark 1999 IOM report estimated 44,000–98,000 deaths per year from preventable medical errors in US hospitals.

Question 145: A patient presents with sudden tearing chest pain radiating to the back and unequal blood pressures between arms (160/90 right vs 120/70 left). Which diagnosis is most likely?

Pulmonary embolism
Aortic dissection (Correct answer)
ST-elevation myocardial infarction (STEMI)
Hypertensive emergency

Correct answer: Aortic dissection

Tearing chest/back pain with unequal blood pressures between arms is the classic presentation of aortic dissection — a surgical emergency.

Question 146: Which of the following best describes interoperability in health information technology?

The ability of a hospital EHR to generate billing reports
Security encryption used to protect patient data
The ability of different health information systems to exchange and use clinical data seamlessly (Correct answer)
The process of converting paper records to electronic format

Correct answer: The ability of different health information systems to exchange and use clinical data seamlessly

Interoperability refers to the ability of different health information systems, devices, and applications to access, exchange, integrate, and cooperatively use data in a coordinated manner.

Question 147: When counseling a patient about emergency contraception, the nurse practitioner should teach that Plan B (levonorgestrel) is most effective when taken within:

12 hours of unprotected intercourse
72 hours of unprotected intercourse (Correct answer)
120 hours of unprotected intercourse
24 hours of unprotected intercourse

Correct answer: 72 hours of unprotected intercourse

Plan B is most effective when taken within 72 hours of unprotected sex, though it has some efficacy up to 120 hours.

Question 148: A nurse manager notices that turnover on the unit is 34% annually. Which retention strategy is most evidence-based?

Implementing shared governance and improving nurse participation in decision-making (Correct answer)
Increasing base salary for all nurses immediately
Mandating overtime to fill vacancies
Reducing patient-to-nurse ratios through agency staffing only

Correct answer: Implementing shared governance and improving nurse participation in decision-making

Shared governance and professional practice models are evidence-based strategies that improve nurse satisfaction and reduce turnover.

Question 149: A patient develops ventricular fibrillation (VF) on a cardiac monitor and the nurse is alone at the bedside. What is the correct first action?

Administer amiodarone 300 mg IV push first
Confirm pulselessness, call for help and crash cart, then begin CPR immediately (Correct answer)
Apply synchronized cardioversion at 200 joules
Call rapid response team and wait for assistance

Correct answer: Confirm pulselessness, call for help and crash cart, then begin CPR immediately

For witnessed VF with confirmed pulselessness: call for help and crash cart, then immediately begin high-quality CPR. Every minute without defibrillation decreases survival by 7-10%.

Question 150: Which of the following is the hallmark symptom that distinguishes bipolar I disorder from bipolar II disorder?

Rapid cycling between moods
Persistent depressive episodes
At least one full manic episode (Correct answer)
Hypomanic episodes only

Correct answer: At least one full manic episode

Bipolar I disorder requires at least one full manic episode, while bipolar II involves hypomania without full mania.

ANCC Nursing Certification Exam

The ANCC (American Nurses Credentialing Center) administers specialty nursing certification exams that validate clinical expertise across specialties including ambulatory care, cardiac vascular, medical-surgical, oncology nursing, and advanced practice nurse practitioner roles.

150

Questions

180 min

Time Limit

70%

To Pass

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