ANCC Nursing Certification Exam — Questions and Answers

Question 1: 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 rate is too low and should be increased
This is the expected therapeutic response to oxygen therapy
The patient may rely on hypoxic drive, and high oxygen may suppress respiratory effort (Correct answer)
The oxygen should be switched to a face mask for better delivery

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 2: 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
Amoxicillin for 10 days (Correct answer)
Topical corticosteroids

Correct answer: Amoxicillin for 10 days

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

Question 3: Which developmental milestone should a child typically achieve by 12 months of age?

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

Correct answer: Saying single meaningful words

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

Question 4: Which federal law established the legal framework for protecting electronic health information privacy and security in the United States?

The Affordable Care Act (ACA)
The Joint Commission accreditation standards
The American Recovery and Reinvestment Act (ARRA) alone
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 with HITECH amendments (Correct answer)

Correct answer: The Health Insurance Portability and Accountability Act (HIPAA) of 1996 with HITECH amendments

HIPAA (1996) established the foundational privacy and security framework for PHI. The HITECH Act (2009) significantly strengthened HIPAA by extending requirements to business associates and establishing the Breach Notification Rule.

Question 5: A cancer patient expresses that they want to stop curative treatment and focus on comfort. The nurse's most appropriate response is:

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)
Document refusal of treatment and take no further action

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 6: What is the most common cause of dementia in the United States?

Alzheimer's disease (Correct answer)
Lewy body dementia
Frontotemporal dementia
Vascular dementia

Correct answer: Alzheimer's disease

Alzheimer's disease accounts for approximately 60–80% of all dementia cases in the United States.

Question 7: A patient develops petechiae, oozing from IV sites, and a prolonged PT/PTT post-surgery. These findings are most consistent with:

Disseminated intravascular coagulation (DIC) (Correct answer)
Vitamin K deficiency
Heparin-induced thrombocytopenia (HIT)
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 8: Which physical exam finding is most associated with appendicitis?

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

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 9: A 15-year-old girl weighing 54 kg (120 lb.) took ten 500-mg acetaminophen tablets in a suicide attempt 6 hours before discovery. The initial treatment should be:

supportive therapy and psychiatric referral.
GI decontamination with activated charcoal.
to initiate the 72-hour N-acetylcysteine protocol. (Correct answer)
gastric lavage.

Correct answer: to initiate the 72-hour N-acetylcysteine protocol.

Explanation: <br> The 72-hour N-acetylcysteine protocol is recommended between 4- and 24 hours post-ingestion of intentional acetaminophen overdose. This can be initiated while awaiting results of blood work for acetaminophen levels. Only if the patient is exhibiting symptoms after the 24-hour mark may this protocol still be indicated at that time. Gl decontamination must be done within four hours of ingestion and gastric lavage within one hour of ingestion. Supportive therapy and psychiatric referral are also indicated for this patient, after initiating N-acetylcysteine administration.

Question 10: Which cancer screening test has the strongest evidence for reducing both incidence and mortality from colorectal cancer?

Colonoscopy every 10 years (Correct answer)
Fecal occult blood testing (FOBT) annually
Flexible sigmoidoscopy every 5 years
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 11: A patient calls the ambulatory care clinic reporting chest pain and shortness of breath. The nurse's FIRST priority action should be:

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

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 12: 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)
Impaired physical mobility related to skeletal metastases
Risk for injury related to fall risk
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 13: 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?

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

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

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

Correct answer: Streptococcus pneumoniae

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

Question 15: Which model of care delivery is most commonly used in ambulatory care settings to manage high-risk patients with complex chronic conditions?

Care coordination and case management model (Correct answer)
Functional nursing model
Total patient care model
Team nursing 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 16: 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
Posterior wall MI in isolation
Left circumflex artery infarction with mitral regurgitation
Right ventricular infarction complicating inferior STEMI (Correct answer)

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 17: 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?

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

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

Urinary tract infection
Deep vein thrombosis
Pulmonary atelectasis (Correct answer)
Surgical site 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 19: 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?

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

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

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

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 21: A 7-year-old with DKA is receiving IV rehydration. Which finding is an early warning sign of cerebral edema?

Blood glucose decreasing from 450 to 250 mg/dL over 4 hours
Persistent ketonuria 6 hours into treatment
Increasing serum sodium during rehydration
Headache, sudden decrease in LOC, or change in neurological status during treatment (Correct answer)

Correct answer: Headache, sudden decrease in LOC, or change in neurological status during treatment

Cerebral edema in pediatric DKA presents with headache, behavioral changes, decreased LOC, or focal neurological deficits during rehydration. Any neurological deterioration must be treated as cerebral edema until proven otherwise.

Question 22: 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 23: A patient with small cell lung cancer presents with facial edema, distended neck veins, and arm swelling. What is the suspected oncologic emergency?

Tumor lysis syndrome
Hypercalcemia of malignancy
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 24: A post-PCI patient on DAPT (clopidogrel and aspirin) needs emergency appendectomy. Which antiplatelet management is most appropriate?

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

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

Adults over 65 with any smoking history
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
All smokers over age 40

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

Assign only one nurse to avoid conflict
Limit the patient's interactions with other patients
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 27: 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
Severe muscle pain with dark urine suggesting rhabdomyolysis (Correct answer)
Joint stiffness in the morning

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

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

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

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

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 30: Considering Erikson's developmental stages, before carrying out assessment and treatment on a preschooler (ages 3 to 6), the pediatric nurse should:

pretend the assessment/treatment is a game.
give detailed explanations of the purpose of interventions.
allow the child to play with medical equipment. (Correct answer)
sedate the child to lessen anxiety.

Correct answer: allow the child to play with medical equipment.

Explanation: <br> Considering Erikson's developmental stages, before carrying out assessment and treatment on a preschooler (ages 3 to 6), the pediatric nurse should allow the child to play with the medical equipment to lessen the child's anxiety because strange equipment may frighten the child. The parent/caregiver should assist with the assessment/treatment when possible, such as by holding the child, and the pediatric nurse should explain to the child in simple, age-appropriate terms what the assessment/treatment will entail.

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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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

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