ANCC Nursing Certification Exam — Questions and Answers

Question 1: 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?

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

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

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

Correct answer: Saying single meaningful words

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

Question 3: Which framework is used to evaluate the evidence quality of research studies in evidence-based nursing practice?

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

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

Croup (laryngotracheobronchitis) (Correct answer)
Epiglottitis
Asthma
Bronchiolitis

Correct answer: Croup (laryngotracheobronchitis)

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

Question 5: 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
Schedule a follow-up visit at 2 months
Order thyroid function tests

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

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

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

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

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 8: 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 9: A 9-year-old with asthma exacerbation (RR 28, SpO2 92%, accessory muscle use) receives albuterol nebulizer treatment. Which finding indicates effectiveness?

Child becomes drowsy and respiratory rate decreases to 10
PaCO2 rises from 38 to 50 mmHg on blood gas
Respiratory rate increases to 32 and SpO2 drops to 89%
Wheezing decreases, respiratory rate normalizes to 22, and SpO2 improves to 97% (Correct answer)

Correct answer: Wheezing decreases, respiratory rate normalizes to 22, and SpO2 improves to 97%

Effective bronchodilator treatment is indicated by decreased wheezing, normalized respiratory rate, improved SpO2, and decreased work of breathing.

Question 10: In ambulatory care, which federal law primarily governs the privacy and security of patient health information?

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

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

Hyperkalemia
Hypernatremia
Hypermagnesemia
Hypokalemia and metabolic alkalosis (Correct answer)

Correct answer: Hypokalemia and metabolic alkalosis

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

Question 12: 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
Call rapid response team and wait for assistance
Confirm pulselessness, call for help and crash cart, then begin CPR immediately (Correct answer)
Apply synchronized cardioversion at 200 joules

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 13: A CDS alert fires 400 times per month but 92% are overridden by clinicians. This phenomenon is called:

Usability deficit
Alert fatigue (Correct answer)
False negative error rate
Clinical relevance failure

Correct answer: Alert fatigue

Alert fatigue occurs when clinicians are overwhelmed by excessive, low-specificity alerts and begin routinely overriding them without adequate evaluation, including clinically significant alerts.

Question 14: 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
Superior vena cava syndrome (Correct answer)
Pericardial tamponade
Tumor lysis syndrome

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

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 16: 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)
Loop diuretics
Corticosteroid therapy
IV 3% hypertonic saline

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

Intermittent claudication (Correct answer)
Deep vein thrombosis
Rest pain
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 18: 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)
Severe hypoglycemia
Diabetic ketoacidosis (DKA) (Correct answer)
Lactic acidosis

Correct answer: Diabetic ketoacidosis (DKA)

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

Question 19: A 45-year-old male presents with fatigue, cold intolerance, weight gain, and constipation. The most likely diagnosis is:

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

Correct answer: Hypothyroidism

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

Question 20: A nurse practicing trauma-informed care should prioritize which of the following?

Detailed discussion of traumatic events at every visit
Focusing exclusively on PTSD diagnosis and pharmacotherapy
Confronting trauma avoidance behaviors directly
Creating an environment of safety, choice, and collaboration (Correct answer)

Correct answer: Creating an environment of safety, choice, and collaboration

Trauma-informed care prioritizes physical and emotional safety, patient choice, collaboration, and empowerment.

Question 21: Which theory of depression focuses on negative cognitive triad (negative views of self, world, and future)?

Biopsychosocial model
Interpersonal theory
Psychoanalytic theory
Cognitive-behavioral theory (Beck) (Correct answer)

Correct answer: Cognitive-behavioral theory (Beck)

Aaron Beck's cognitive theory identifies the negative cognitive triad as a core feature maintaining depression.

Question 22: Which approach is MOST consistent with evidence-based practice in ambulatory care nursing?

Implementing the newest interventions immediately upon publication without review
Integrating current best research evidence with clinical expertise and patient preferences (Correct answer)
Relying solely on physician orders for all clinical decisions
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 23: A patient on clopidogrel and aspirin for unstable angina — which factor most significantly reduces clopidogrel effectiveness?

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

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 24: When serving as a mentor for a newly licensed nurse, the primary role of the pediatric nurse is to:

supervise patient care.
assign duties.
provide support and guidance. (Correct answer)
assess the nurse's skills.

Correct answer: provide support and guidance.

Explanation: <br> When serving as a mentor for a newly licensed nurse, the primary role of the pediatric nurse is to provide support and guidance. The nurse should feel free to bring questions and concerns to the mentor. Skills that enhance mentoring include nurturing, providing clinical expertise, motivating, modeling, and providing feedback. Mentoring is usually a one-on-one relationship although a pediatric nurse may also serve as a mentor to a group.

Question 25: 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 26: A 30-year-old woman presents with painful, grouped vesicles on her labia. Which test would confirm the diagnosis?

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

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 27: 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 = 113 mmHg; dangerously high
CPP = 28 mmHg; critical ICP elevation only
CPP = 57 mmHg; below the recommended minimum of 60-70 mmHg (Correct answer)
CPP = 57 mmHg; within acceptable range

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 28: 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:

Stage 2 hypertension
Stage 1 hypertension (Correct answer)
Elevated blood pressure
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 29: Which physical exam finding is most associated with appendicitis?

Both B and C (Correct answer)
Murphy's sign
McBurney's point tenderness
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 30: 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)
Using family members as interpreters to save time
Providing education only in English to promote consistency

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.

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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