The Nursing Acceleration Challenge Examination, developed by ATI — Assessment Technologies Institute — is a credit-by-examination program that allows Licensed Practical Nurses (LPNs) and Licensed Vocational Nurses (LVNs) to earn college credit for prior nursing education and experience. Rather than repeating coursework you have already mastered, you challenge the course by passing the NACE exam at a score that your nursing program accepts for credit. Successfully completing the NACE can shorten your LPN-to-RN bridge program by one or more full semesters, saving both time and tuition. This page gives you a free printable NACE practice test PDF you can study with offline.
The NACE series covers multiple nursing courses, but the most commonly taken exam is NACE I, which corresponds to Fundamentals of Nursing. This is the foundational course that covers the nursing process, basic clinical skills, medication administration, patient safety, infection control, and documentation — the core competencies that every RN must command before advancing to specialty coursework. If you passed LPN school and have practiced for at least a year, you already have substantial exposure to this material. The challenge is demonstrating that knowledge under standardized exam conditions.
ATI's NACE exams are proctored tests administered at your nursing school or an approved testing site. Passing scores vary by institution — some programs accept scores at the 60th percentile, others at the 70th or higher. Check with your specific program's articulation coordinator before you begin studying so you know exactly what target score you need. Regardless of the cutoff, a higher score gives you more options if you decide to transfer credits to a different program later in your career.
The questions on this practice PDF reflect the content domains tested on NACE I. Work through them systematically, note which topics you answer confidently and which ones require you to think harder, and use that self-assessment to guide the final phase of your preparation. The nace certification hub on this site has additional topic-specific practice quizzes and resources you can use alongside this printable test.
Printing this PDF and working through it without looking up answers until you have made your best attempt on each question is the most effective way to use it. Self-testing — also called retrieval practice — is consistently the highest-yield study strategy across all healthcare licensing exams. After you complete the PDF, review the explanations for every question you missed, and pay special attention to the reasoning behind the correct answer rather than just memorizing the answer itself.
NACE I covers the full scope of foundational nursing concepts that an LPN entering an RN bridge program is expected to have mastered. The questions are written at the application and analysis levels of Bloom's taxonomy — not simple recall questions, but scenarios that require you to apply a principle to a patient situation and select the most appropriate nursing action. This is the same cognitive level used on the NCLEX-RN, so preparing for the NACE also lays groundwork for the licensure exam you will take after graduation.
Questions on the nursing process test all five steps — assessment, nursing diagnosis, planning, implementation, and evaluation — with particular emphasis on the correct order of operations. A common question type presents a patient scenario and asks what the nurse should do first, which nearly always requires assessment before any intervention. The nursing diagnosis step tests your ability to identify the appropriate NANDA-I diagnostic statement given a set of assessment findings, distinguishing actual diagnoses from risk diagnoses and from medical diagnoses. Planning questions ask you to set measurable, client-centered outcomes using the SMART framework. Evaluation questions require you to determine whether a nursing intervention has achieved its intended goal based on documented patient response.
Vital sign questions test normal ranges across age groups — recognizing that what is normal for a neonate differs significantly from what is normal for an elderly adult — and temperature conversion between Fahrenheit and Celsius. Pulse assessment questions cover both rate and rhythm, including how to assess an apical pulse and when a peripheral pulse is insufficient. Respiratory assessment questions test normal versus abnormal breath sounds (crackles, wheezes, rhonchi, stridor) and their clinical significance. Blood pressure assessment questions cover proper technique, orthostatic hypotension assessment, and the significance of hypertensive readings in different clinical contexts.
Infection control is among the highest-yield content areas on NACE I. Standard precautions apply to every patient in every setting and include hand hygiene (the single most effective infection control measure), use of personal protective equipment (gloves, gown, mask, eye protection) based on anticipated exposure, and safe handling of sharps and contaminated equipment. Transmission-based precautions layer additional measures on top of standard precautions for patients with known or suspected communicable diseases. Contact precautions (gloves and gown required on entry) apply to MRSA, VRE, C. difficile, and wound infections with resistant organisms. Droplet precautions (surgical mask required within three feet) apply to influenza, meningitis, pertussis, and rubella. Airborne precautions (N95 respirator required, negative-pressure room) apply to tuberculosis, varicella, measles, and disseminated herpes zoster.
Medication administration questions on NACE I cover the rights of medication administration — the traditional five rights (right patient, right drug, right dose, right route, right time) expanded in modern practice to include right documentation, right reason, and right response. Drug calculation questions test the desired-over-have-times-volume formula for oral medications, dimensional analysis for IV calculations, and weight-based dosing in mg/kg for pediatric patients. High-alert medications — including insulin, heparin, warfarin, and concentrated electrolytes — are tested for their specific safety protocols, including double-checks, reversal agents, and monitoring parameters. Routes of administration questions cover oral, sublingual, buccal, topical, ophthalmic, otic, nasal, rectal, and parenteral routes, including safe injection technique and site rotation for subcutaneous and intramuscular injections.
Patient safety is a content thread that runs through every section of NACE I because safe practice is the foundation of professional nursing at every level. Fall prevention questions test your ability to identify patients at high fall risk using tools like the Morse Fall Scale — high-risk factors include a history of falls, use of assistive devices, altered gait, cognitive impairment, and use of sedating or antihypertensive medications. The appropriate response to a high-risk patient includes bed in lowest position, call light in reach, non-slip footwear, hourly rounding, and a bed alarm. Fall prevention questions often present a scenario and ask which intervention is most appropriate given the specific patient presentation.
Wound care questions test wound classification by etiology and contamination level, wound assessment using the parameters of location, size, depth, wound bed appearance, exudate characteristics, and wound edge condition, and wound dressing selection based on wound characteristics. Dressing types tested include dry sterile dressings for clean wounds, moisture-retentive dressings (hydrocolloid, foam, hydrogel) for wounds requiring a moist wound healing environment, and negative pressure wound therapy principles. Wound irrigation and packing techniques are also commonly tested, as is documentation of wound assessment findings using consistent terminology.
Perioperative nursing questions cover all three phases of the surgical experience. Pre-operative assessment includes NPO status (typically nothing by mouth after midnight for solid foods, with institution-specific variations for clear liquids), informed consent verification, allergy documentation, baseline vital signs, and pre-operative teaching. Intraoperative nursing roles include circulating nurse and scrub nurse responsibilities, maintaining the sterile field, and positioning-related injury prevention. Post-anesthesia care unit (PACU) nursing tests priority assessments after general anesthesia — airway patency and oxygenation first, then cardiovascular stability, then level of consciousness — and common post-operative complications including hypoventilation, laryngospasm, hypotension, nausea and vomiting, hypothermia, and emergence delirium.
Leadership and management content on NACE I focuses on delegation, which is a high-yield topic for LPN-to-RN candidates because the scope of delegation authority expands significantly with the RN license. The five rights of delegation — right task, right circumstance, right person, right direction/communication, and right supervision — provide a framework for determining what can be safely delegated to unlicensed assistive personnel (UAP) versus what must be retained by the RN. Tasks that require assessment, evaluation, nursing judgment, or the development and modification of the care plan cannot be delegated. Stable, routine tasks with predictable outcomes and established procedures can generally be delegated to competent UAP under appropriate supervision.
Nutrition and elimination content includes therapeutic diet prescriptions (low-sodium for heart failure, carbohydrate-controlled for diabetes, low-protein for renal disease, high-fiber for constipation), enteral nutrition via nasogastric and gastrostomy tubes (tube placement verification, formula administration, aspiration prevention positioning), urinary catheter care (insertion technique, maintaining a closed drainage system, recognizing catheter-associated urinary tract infection), and ostomy care basics (stoma assessment, pouch changing technique, identifying normal versus abnormal stoma findings). Documentation standards tested on NACE I include the components of SOAP notes, the legal requirements for nursing documentation, and the principles of accurate, timely, and objective charting.