The American Nurses Credentialing Center (ANCC) offers assessments for certification purposes, and the Acute Care Nurse Practitioner Board Certification Exam is one of the assessments offered. This test is for RNs who have completed graduate work in an acute care NP program and have earned a master’s, post-master’s or doctorate degree. The program must be accredited, and the candidate must have completed at least 500 clinical hours in that program, which must meet specific requirements in order for the candidate to take this test. This test is taken as part of the Acute Care Nurse Practitioner – Board Certified (ACNP-BC) credential.
This test has 175 questions; 25 questions on the test are not scored, as they are used for pre-trial purposes only, but the candidate will not know which questions are scored and which are not. The score is derived from the remaining 150. Candidates must get a minimum of 105 correct in order to receive a passing raw score. The actual score will be weighted on a 500-point scale, and candidates need a minimum of 350 to pass. If a candidate does not succeed on the assessment exam, an account is provided which will help pinpoint the areas that need improvement. The subject areas of the Acute Care Nurse Practitioner Board Certification Exam include:
37 questions on assessing of acute and chronic illness, including questions about particular system health issues, psychosocial health conditions and frequently found issues with acute care
42 questions on clinical management
24 questions on health promotion and disease prevention
22 questions on the NP and patient relationship
19 questions on professional role and policy
6 questions on employing research
If a candidate does not succeed in the first attempt at this assessment, the test can be retaken after a 60-day waiting period. A candidate cannot take the test more than three times within a year of the first try.
ANCC Practice Questions
1. A 44-year-old obese woman recovering from a femoropopliteal bypass develops sudden onset of dyspnea with chest pain on inspiration, cough, and fever of 39°C. An S4 gallop rhythm is present. The ECG shows tachycardia and nonspecific changes in ST and T waves. The most likely diagnosis is:
A. Myocardial infarction
B. Pulmonary embolism
2. Which of the following is the correct procedure to evaluate the function of cranial nerve X (vagus)?
A. Ask the patient to protrude the tongue and move it from side to side against a tongue depressor
B. Observe patient swallowing, and place sugar or salt at back third of tongue to determine if patient can differentiate
C. Ask patient to swallow and speak, and place tongue blade on posterior tongue or pharynx to elicit gag reflex
D. Place hands on patient’s shoulders and ask the patient to shrug against resistance
3. A 25-year-old patient with multiple fractures from an auto accident develops hypoxia, dyspnea, precordial chest pain, tachycardia, and thick milky sputum. Auscultation of the lungs shows crackles and wheezes. The patient complains of headache and has a fever of 40°C. Which of the following interventions should be done first?
A. High-flow oxygen
B. Corticosteroids (IV)
4. A patient is hospitalized for a myocardial infarction and exhibits increased preload, increased afterload, and decreased contractility with decreased cardiac output and increased systemic vascular resistance. BP is 84/40 and pulse 124 bpm, thready, and irregular. The patient has tachypnea, chest pain, basilar rales, and pallor. The most likely diagnosis is:
A. Cardiogenic shock
B. Pulmonary embolism
C. Heart failure
D. Atrial fibrillation
5. A 36-year-old female was injured in a fall when drunk. CT shows contusion on the left side of the brain. The patient responds lethargically to verbal commands and shows some confusion and restlessness. Vital signs: BP 154/76, pulse 68, and respirations 28. Previous records indicate her normal BP was 128/70, pulse 76, and respirations 16. The change in VS is most likely an indication of:
A. Increasing intracranial pressure
B. Stress response
C. Ethanol intoxication
D. Delirium tremens
Answers & Explanations
1. B: Although symptoms of pulmonary embolism may vary widely depending on the size and location of the embolus, dyspnea, inspirational chest pain, cough, fever, S4 sound, tachycardia, and non-specific ECG changes in ST and T waves are common. Risk factors include obesity, recent surgery, history of deep vein thrombosis, and inactivity. Treatment includes oxygen, IV fluids, dobutamine for hypotension, analgesia for anxiety, and medications as indicated (digitalis, diuretic, antiarrhythmic). Intubation and mechanical ventilation may be required. Percutaneous filter may be placed in the inferior vena cava to prevent more emboli from reaching lungs.
2. C: To evaluate cranial nerve X (vagus), ask the patient to swallow and speak, observing for difficulty swallowing or hoarseness, and stimulate the back of the tongue or pharynx to elicit the gag reflex. Other examinations include:
Cranial nerve IX (glossopharyngeal): Observe patient swallowing, and place sugar or salt at back third of tongue to determine if patient can differentiate between them
Cranial nerve XI (spinal accessory): Place hands on patient’s shoulders and ask the patient to shrug against resistance
Cranial nerve XII (hypoglossal): Ask the patient to protrude the tongue and move it from side to side against a tongue depressor
3. A: These symptoms are consistent with fat embolism syndrome (FES), which may cause rapid acute pulmonary edema and ARDS, so the patient should be immediately provided with high-flow oxygen. Controlled-volume ventilation with positive end-expiratory pressure (PEEP) may be indicated to prevent/treat pulmonary edema. Corticosteroids may reduce inflammation of the lungs and reduce cerebral edema. Vasopressors prevent hypotension and interstitial pulmonary edema. Morphine with a benzodiazepine may be indicated for patients who require artificial ventilation.
4. A: These symptoms are consistent with cardiogenic shock. Cardiogenic shock has 3 characteristics: Increased preload, increased afterload, and decreased contractibility. Together these result in a decreased cardiac output and an increase in systemic vascular resistance (SVR) to compensate and protect vital organs. This results in an increase of afterload in the left ventricle with increased need for oxygen. As the cardiac output continues to decrease, tissue perfusion decreases, coronary artery perfusion decreases, fluid backs up, and the left ventricle fails to adequately pump the blood, resulting in pulmonary edema and right ventricular failure.
5. A: These VS changes are consistent with increasing intracranial pressure. Typical findings include widened pulse pressure, with rising blood pressure and depressed heart rate. Because the patient is drunk, evaluating level of consciousness can be difficult, but lethargy, confusion, and restlessness are characteristic of increasing ICP. Stress response usually results in increased BP and pulse. Ethanol intoxication usually causes hypotension, bradycardia with arrhythmias, and respiratory depression. Delirium tremens includes tremors, tachycardia, and cardiac dysrhythmias.