ANCC Nursing Certification Exam — Questions and Answers

Question 1: A patient with Type 2 diabetes has an HbA1c of 8.9%. According to ADA guidelines, the initial medication of choice is:

Glipizide
Metformin (Correct answer)
Insulin glargine
Empagliflozin

Correct answer: Metformin

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

Question 2: A patient with burns is placed on an air-fluidized bed to relieve pressure. It is especially important to carefully monitor this patient for:

Temperature
Fluid balance (Correct answer)
Vital signs
Pain level

Correct answer: Fluid balance

Explanation: <br> When a patient, such as a burn patient, is placed on an air-fluidized bed, it is especially important to monitor fluid balance because he or she can easily become dehydrated. Air-fluidized beds contain a mass of fine ceramic microspheres through which warm air flows. The patient is placed on a special polyester filter sheet that allows air to pass through it. The warmth causes perspiration, which is quickly absorbed, so diaphoresis may not be evident.

Question 3: 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 doxorubicin
A patient receiving carboplatin alone
A patient receiving cyclophosphamide

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

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

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

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

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

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

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

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

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 8: 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 9: Which nursing diagnosis is most appropriate for a patient with cancer experiencing cancer-related fatigue?

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

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 10: 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 left subclavian vein was used for a previous central line (Correct answer)
The patient reports mild anxiety about the procedure
The patient took aspirin 81 mg this morning

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 11: For patients with diabetes mellitus, the first indication of diabetic nephropathy is usually:

Microalbuminuria (Correct answer)
Increased blood urea nitrogen (BUN)
Macroalbuminuria
Increased creatinine

Correct answer: Microalbuminuria

Explanation: <br> For patients with diabetes mellitus, the first indication of diabetic nephropathy, the most common cause of end-stage renal disease, is usually microalbuminuria. Microalbuminuria is usually detectable before a decrease in the glomerular filtration rate (GFR) and occurs 10-15 years after the onset of diabetes. With the onset of microalbuminuria, the patient should be maintained on strict glycemic control and treatment of hypertension to slow the progression. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin I| receptor blockers (ARBs) have been shown to slow progression by reducing pressure within the glomeruli.

Question 12: A nurse in an outpatient oncology infusion clinic is preparing to administer a vesicant chemotherapy agent. Which action is the HIGHEST priority before starting the infusion?

Confirm the patient's insurance authorization is current
Verify IV site patency and assess for signs of extravasation risk (Correct answer)
Ensure the patient has eaten a full meal within the last 30 minutes
Check if the patient has a preference for IV arm

Correct answer: Verify IV site patency and assess for signs of extravasation risk

Vesicant chemotherapy can cause severe tissue damage if extravasation occurs, making IV site patency verification the highest priority patient safety action before administration.

Question 13: A nurse notes a sudden GCS decline from 14 to 9, left pupil dilation, and right-sided hemiplegia. Which neurological emergency is most likely?

Hypertensive encephalopathy
Ischemic stroke in the right MCA territory
Subarachnoid hemorrhage from ACoA rupture
Uncal herniation with brainstem compression (Correct answer)

Correct answer: Uncal herniation with brainstem compression

Rapid decline in consciousness with ipsilateral pupil dilation and contralateral hemiplegia is the classic triad of uncal (transtentorial) herniation — a neurosurgical emergency.

Question 14: Which finding is most indicative of increased intracranial pressure (ICP) in a patient with a traumatic brain injury?

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

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

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

Correct answer: Streptococcus pneumoniae

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

Question 16: The ANCC Magnet Recognition Program's 14 Forces of Magnetism primarily focus on which outcome?

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

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

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

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

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

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

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

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

55 years
45 years (Correct answer)
50 years
40 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 21: Which preoperative nursing intervention most reduces the risk of surgical site infection (SSI)?

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

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 22: 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?

Adenosine 6 mg IV push to terminate the flutter
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

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

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

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 24: 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 2: Mild-to-moderate opioids plus non-opioids
Step 3: Strong opioids plus non-opioids with or without adjuvants (Correct answer)
Step 4: Interventional pain management
Step 1: Non-opioid analgesics only

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

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
Contact the family to discuss overriding the patient's decision
Encourage the patient to continue treatment to maximize survival

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 26: A telemetry strip shows a regular atrial rate near 300 bpm with sawtooth deflections and variable ventricular response. Which rhythm does this describe?

Atrial flutter with variable block (Correct answer)
Multifocal atrial tachycardia
Atrial fibrillation with rapid ventricular response
Sinus tachycardia with frequent PACs

Correct answer: Atrial flutter with variable block

Atrial flutter shows regular sawtooth flutter waves at 250-350 bpm (classically 300 bpm) with variable AV block (2:1, 3:1, 4:1), creating a regularly irregular ventricular response.

Question 27: Which vaccine is recommended annually for all persons aged 6 months and older in the United States?

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

Correct answer: Influenza vaccine

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

Question 28: When implementing a quality improvement initiative in an ambulatory care clinic, the PDSA (Plan-Do-Study-Act) cycle is used primarily to:

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

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 29: 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
Refer to pediatric cardiology (Correct answer)
Prescribe prophylactic antibiotics
Reassure the parent it is an innocent murmur

Correct answer: Refer to pediatric cardiology

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

Question 30: A patient calls the ambulatory care clinic reporting chest pain and shortness of breath. The nurse's FIRST priority action should be:

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

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.

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.

Questions

35 min

Time Limit

70%

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