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These 10 free ACCNS-AG questions are organized by exam domain, so you can see how each part of the Clinical Nurse Specialist; Wellness through Acute Care (Adult-Gerontology) (ACCNS-AG) blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Clinical Judgment (67%) - Patient Care Problems: Applies to exams taken on and after January 31, 2024. I. CLINICAL JUDGMENT (67%) Validated Competencies are detailed on pages 7-11 of this test plan. 1A. Cardiovascular (11%) 1. Acute coronary syndrome 2. Acute inflammatory disease (e.g., myocarditis, endocarditis, pericarditis) 3. Cardiac surgery a. On-pump b. Off-pump c. Valve procedures d. Hybrid procedures e. Revascularization procedures 4. Cardiac tamponade 5. Cardiac trauma (blunt and penetrative) 6. Cardiogenic shock 7. Cardiomyopathies (e.g., hypertrophic, dilated, restrictive, idiopathic) 8. Coronary artery disease 9. Dyslipidemia 10. Dysrhythmias 11. Heart failure a. Acute b. Chronic c. Advanced 12. Hypertension 13. Hypertensive urgencies or emergencies 14. Peripheral vascular insufficiency (e.g., acute arterial occlusion, carotid artery stenosis, endarterectomy, peripheral stents and Fem-Pop bypass) 15. Pulmonary edema 16. Ruptured or dissecting aneurysm 17. Structural heart defects and disease (acquired and congenital) 18. Mechanical circulatory support a. IABP b. VA ECMO c. VV ECMO d. Impella e. LVAD 2A. Respiratory (9%) 1. Acute pulmonary embolus 2. Acute respiratory distress syndrome (ARDS) 3. Acute respiratory failure 4. Air-leak syndromes (e.g., pneumothorax, pulmonary interstitial emphysema, pneumopericardium, pneumomediastinum) 5. Airway obstruction (e.g., angioedema, mucus plug, air space-occupying lesions) 6. Aspiration 7. Asthma/reactive airway disease 8. Chronic lung disease (e.g., COPD exacerbation, interstitial pulmonary fibrosis, cystic fibrosis) 9. Chronic respiratory failure (e.g., ventilator dependency) 10. Obstructive sleep apnea 11. Pulmonary hemorrhage 12. Pulmonary arterial hypertension 13. Pulmonary infections (e.g., pneumonia, tuberculosis) 14. Thoracic surgery (e.g., lung reduction, pneumonectomy, lobectomy, tracheal, lung transplant) 15. Thoracic and pulmonary trauma and injuries (e.g., lung contusions, fractured ribs, hemothorax) 16. Restrictive lung disease (e.g., obesity hypoventilation, tumor metastasis, pulmonary fibrosis) 17. Pleural effusion Endocrine/Hematology/Gastrointestinal/Renal/ Integumentary 3A. Endocrine (5%) 1. Adrenal disorders 2. Diabetes mellitus 3. Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) 4. Hyperglycemia 5. Hypoglycemia 6. Pituitary disorders 7. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 8. Diabetes insipidus (DI) 9. Thyroid disorders 3B. Hematology/Immunology/Oncology (3%) 1. AIDS and HIV 2. Anemias (e.g., microcytic, macrocytic) 3. Autoimmune diseases 4. Coagulopathies (e.g., VTE, DIC, hypercoagulable states) 5. Congenital and acquired immunosuppression 6. HELLP syndrome 7. Myelosuppression (e.g., neutropenia, anemia, thrombocytopenia) 8. Sickle cell disease 3C. Gastrointestinal (5%) 1. Abdominal trauma 2. GI hemorrhage 3. Bowel infarction/obstruction/perforation 4. Gastroesophageal reflux 5. Gastrointestinal infectious disorders 6. GI motility disorders (e.g., constipation, diarrhea, ileus, gastroparesis) 7. GI surgeries 8. Hepatorenal syndrome 9. Liver disease (e.g., hepatitis, hepatic failure) 10. Malnutrition 11. Nausea/vomiting 12. Pancreatitis 13. Peptic ulcer disease 3D. Renal/Genitourinary (6%) 1. Acute kidney injury (AKI) 2. Chronic kidney disease (CKD) 3. Contrast-induced nephropathy 4. Electrolyte imbalances 5. Fluid volume imbalances 6. Incontinence 7. Infections (e.g., UTI, PID, STIs) 8. GU Trauma 3E. Integumentary (3%) 1. Exfoliative skin disorders (e.g., Stevens- Johnson syndrome) 2. Extravasation 3. Pressure injuries 4. Wounds (surgical and nonsurgical) Musculoskeletal/Neurology/Psychosocial 4A. Musculoskeletal (3%) 1. Mobility disorders (e.g., immobility, debility secondary to acute, chronic or critical illness) 2. Infections (e.g., necrotizing fasciitis, osteomyelitis) 3. Neuromuscular dysfunction related to illness 4. Osteoarthritis 5. Spinal disease (e.g., scoliosis, kyphosis, disc disease) 6. Musculoskeletal trauma 4B. Neurology (5%) 1. Brain death 2. Cerebral salt wasting 3. Encephalopathy 4. Head and brain trauma/injury 5. Hydrocephalus 6. Intracranial hypertension 7. Intracerebral hemorrhage 8. Neurologic infectious diseases 9. Neuromuscular disorders 10. Seizure disorders 11. Space-occupying lesions 12. Spinal cord injury 13. Stroke 14. Vascular malformation 4C. Psychosocial/Behavioral/Cognitive Health Issues (5%) 1. Aggression 2. Agitation 3. Anxiety disorders (e.g., PTSD, OCD, fears, phobias) 4. Capacity for decision-making 5. Delirium 6. Dementia 7. Maltreatment 8. Medical nonadherence 9. Mood disorders (e.g., depression) 10. Personality disorders (e.g., anti-social behaviors, schizophrenia) 11. Post-ICU syndrome 12. Substance use disorder 13. Suicidal behavior Factors Influencing Wellness and Health Status/ Multisystem 5A. Factors Influencing Health Status (risk assessment, prevention and wellness) (5%) 1. Advance care planning 2. Cancer prevention (e.g., tobacco cessation, sunscreen) 3. Caregiver burden 4. Life stage transitions 5. Immunizations 6. Mental health screenings (e.g., depression, suicidal ideation, eating disorders) 7. Nutrition and weight management 8. Pain prevention and management 9. Prudent heart living 10. Risk-taking behaviors (e.g., substance use, unprotected sex) 11. Secondary prevention (e.g., cardiac rehab, pulmonary rehab) 12. Sleep hygiene 13. Vulnerable population screens (e.g., intimate partner violence, human trafficking) 14. Social determinants of health (e.g., access to care, socioeconomic factors, health literacy) 15. Population health 16. Team-based care 5B. Multisystem (7%) 1. Acid-base imbalances 2. Bariatric care issues 3. Burns 4. Compartment syndrome 5. Distributive shock (e.g., anaphylaxis, neurogenic) 6. End-of-life issues 7. Failure to thrive 8. Hospital-acquired conditions (e.g., CAUTI, CLABSI, falls, pressure injuries) 9. Hypovolemic shock 10. Hypoxic ischemic encephalopathy 11. Infectious diseases (e.g., viral, bacterial) 12. Methemoglobinemia 13. Multisystem trauma 14. Nonfatal drowning 15. Pain 16. Palliative care issues 17. Rhabdomyolysis 18. Sensory impairment (e.g., hearing loss) 19. Sepsis/septic shock and MODS 20. Toxic exposures, ingestions and inhalations (e.g., overdose, carbon monoxide, lead, asbestos) 21. Transgender care issues 22. Withdrawal (e.g., alcohol, opioids, benzodiazepines) 23. Antimicrobial stewardship; Skills and Procedures: In addition to classifying exam items according to the specified patient care problems and identifying related underlying competencies, items may require an understanding of skills and procedures pertinent to the adult-gerontology CNS. The study of practice sought to determine whether selected skills and procedures are performed and important to the adult- gerontology CNS. The following skills and procedures may be incorporated within items. This list is not intended to be all- encompassing; that is, other well-established skills and procedures may also be included in the exam content. Cardiovascular • Adjust temporary pacemakers • Determine lead selection for patient care monitoring (e.g., ST-segment monitoring) • Direct cardiopulmonary resuscitation • Interpret 12-lead ECGs • Interpret hemodynamic values • Interpret noninvasive hemodynamic values • Manage patient with arterial sheath removal • Manage patient with cardiac assist devices (e.g., RVAD, BVAD, LVAD, ECMO) • Manage patient with dysrhythmias • Manage patient with epicardial pacemakers • Manage patient with hemodynamic monitoring requiring pharmacological intervention • Manage patient with temporary transvenous pacemakers • Manage patient with transcutaneous (external) pacemakers • Manage patient with venous sheath removal • Perform synchronized cardioversion • Use data from echocardiograms Respiratory • Interpret pulmonary function tests • Manage patient receiving nitric oxide • Manage patient with artificial airways • Manage patient with chest tubes • Manage patient with mechanical ventilation • Manage patient with multimodal oxygen therapy • Manage patient with noninvasive ventilation/CPAP • Perform end-tidal CO2 monitoring • Perform extubation • Perform terminal ventilator withdrawal • Remove chest tube Endocrine • Manage patient with corticosteroid tapering • Manage fluid and electrolyte levels of patients with endocrine disorders • Manage patient with insulin infusions • Manage patient with insulin pumps • Manage patient with hyperglycemia • Manage patient with hypoglycemia Hematology/Immunology/Oncology • Manage patient with cancer treatment symptoms • Manage patient with chemotherapy and biotherapy • Manage patient with immunosuppression therapy Gastrointestinal • Manage patient with drainage catheters (e.g., biliary drains) • Manage patient with enteral nutrition • Manage patient with large-bore nasogastric tubes • Manage patient with PEG/JT catheters • Manage patient with small-bore nasogastric tubes Integumentary • Implement measures to prevent surgical site infections • Implement pressure injury prevention strategies • Manage patient with pressure injuries • Provide wound care • Stage pressure injuries Neurology • Manage patient with epidural catheters • Manage patient with intracranial pressure (ICP) monitoring devices • Manage patient with lumbar drain • Manage patient receiving neuromuscular blockade • Manage patient undergoing bispectral index monitoring • Manage patient undergoing targeted temperature management • Perform brain death testing Behavioral • Manage assaultive behavior • Manage patient in restraints • Suggest restraint alternatives • Use de-escalation techniques (e.g., crisis prevention) Multisystem • Implement measures to prevent hospital-acquired infections • Interpret diagnostic imaging (e.g., radiographic, CT, MRI) • Manage patient with complex pain problems • Pandemic management • Perform procedural sedation • Provide nonpharmacological interventions for pain; Validated Competencies - applicability: In addition to classifying exam items according to the previous specifications, each item is written to reflect one of the following competencies validated through the study of practice. These competencies are eligible for assessing knowledge of content. Validated Competencies: Core CNS Competencies • Synthesizes assessment findings using advanced knowledge, expertise, critical thinking, and clinical judgment to formulate differential diagnoses • Prescribes medications, therapeutics, diagnostic studies, equipment, and procedures to manage the health issues of patients • Provides expert specialty consultation to nurses related to complex patient care needs • Conducts a comprehensive health assessment in diverse care settings including psychosocial, functional, physical, and environmental factors • Provides expert consultation based on a broad range of theories and evidence for patients with complex healthcare needs Adult-Gerontology CNS Competencies • Conducts a comprehensive, holistic assessment of individuals, including those who are nonverbal, developmentally, functionally, and/or cognitively impaired • Assesses physiological and functional changes associated with aging and development across the adult continuum • Assesses age-specific and genetic risk factors • Assesses the interaction between acute and chronic physical and mental health problems • Recognizes the presence of comorbidities and psychosocial issues that may impact optimal level of health • Uses reliable and valid age-appropriate assessment instruments to assess acute and chronic health concerns, including but not limited to, mental status, delirium, dementia, and pain • Assesses for manifestations of health disorders or health disruptions, e.g., infection, adverse drug effect, dehydration, ischemia, and geriatric syndromes • Evaluates for common mental health disorders such as depression, dementia, anxiety, or substance- related disorders • Conducts a pharmacologic assessment including polypharmacy, drug interactions, over-the-counter and herbal product use, and the ability to safely and correctly store and self-administer medications • Interprets values/results of laboratory and diagnostic tests with consideration of age, ethnicity, and health status • Assesses patient, family, and caregiver’s ability to implement complex plans of care • Determines diagnoses in the complex patient and takes into consideration physiologic and pathophysiologic changes, morbidities and comorbidities, events across the life span, and patient’s pharmacologic history • Manages or appropriately refers the patient with signs and symptoms of physical and mental health disorders across the adult lifespan, including geriatric syndromes • Intervenes to prevent or minimize iatrogenesis • Intervenes to facilitate transitions of care with emphasis on quality, safety, and risk avoidance • Designs a comprehensive, individualized, age- and disease-appropriate plan for health promotion • Modifies health information, patient education programs, and interventions for patients with sensory, perceptual, cognitive, and physical and mental illness limitations
Question 1
A 74-year-old with heart failure has cool extremities, BP 82/48 mmHg, elevated JVP, rising creatinine, and worsening dyspnea. Which action should the CNS prioritize?
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Correct answer: B - Evaluate for cardiogenic shock and initiate hemodynamic support strategies
Question 2
A ventilated patient suddenly develops hypotension, absent right breath sounds, and increased peak airway pressures. What is the most likely cause?
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Correct answer: A - Right tension pneumothorax
Question 3
An older adult becomes confused two days after surgery. Attention fluctuates and awareness changes throughout the day. Which finding supports delirium?
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Correct answer: C - Acute fluctuating inattention
Question 4
A patient receiving insulin is diaphoretic and confused with glucose 48 mg/dL. What is the first action?
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Correct answer: A - Give rapid-acting carbohydrate if safe to swallow
Question 5
A septic patient has persistent elevated lactate after initial therapy. What does this finding suggest?
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Correct answer: B - Possible ongoing tissue hypoperfusion requiring reassessment
Question 6
ABG: pH 7.28, PaCO2 55 mmHg, HCO3 25 mEq/L. Which disorder is present?
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Correct answer: C - Acute respiratory acidosis
Question 7
An older adult takes 12 medications and reports dizziness after a new prescription. What assessment is the priority?
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Correct answer: A - Assess polypharmacy and medication interactions
Question 8
A patient with AKI has potassium 6.8 mEq/L and peaked T waves. What is the priority concern?
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Correct answer: C - Life-threatening dysrhythmia
Question 9
A patient develops pain, swelling, and discoloration around an IV medication site. What should the CNS recognize?
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Correct answer: A - Possible extravasation
Domain 2: Advocacy/Moral Agency (3%) - Validated Competencies: Core CNS Competencies • Facilitates patient and family understanding of the risks, benefits, and outcomes of proposed healthcare regimens to promote informed, shared decision-making • Facilitates resolution of ethical conflicts in complex patient care situations • Analyzes the ethical impact of scientific advances, including cost and clinical effectiveness, on patient and family values and preferences • Advocates for patient’s preferences and rights • Leads efforts to resolve ethical conflict and moral distress experienced by nurses and nursing staff • Demonstrates stewardship of human and fiscal resources in decision-making • Advocates for equitable healthcare by participating in professional organizations and public policy activities • Advocates for ethical principles in protecting the dignity, uniqueness, and safety of all Adult-Gerontology CNS Competencies • Facilitates decision-making regarding treatment options with the patient, family, caregivers and/or healthcare proxy • Applies ethical principles in safeguarding the confidentiality, dignity, and safety of all adult-older adult research participants, including the vulnerable and those with impaired decision-making capacity • Facilitates resolution of ethical conflicts: identifies ethical implications of complex care situations; considers the impact of scientific advances, cost, clinical effectiveness, patient and family values and preferences, and other external influences; applies ethical principles to resolving concerns across the three spheres of influence • Promotes a practice climate conducive to providing ethical care • Balances patient and family preferences, threats to patient safety, and risk/benefit analysis of interventions, such as fall prevention, pain management, and treatment choices • Facilitates interdisciplinary teams to address ethical concerns, risks or considerations, benefits and outcomes of patient care • Articulates the role and significance of the CNS in improving healthcare outcomes for adults-older adults to other healthcare providers and the public • Facilitates patient and family understanding of the risks, benefits, and outcomes of proposed healthcare regimen to promote informed decision-making • Advocates for equitable patient care by participating in organizational, local, state, national, or international level of policy-making activities for issues related to their expertise; evaluating the impact of legislative and regulatory policies as they apply to nursing practice and patient or population outcomes • Promotes the role and scope of practice of the CNS to legislators, regulators, other healthcare providers, and the public: communicates information that promotes nursing, the role of the CNS and outcomes of nursing and CNS practice through the use of the media, advanced technologies, and community networks • Advocates for the CNS/APRN role and for positive legislative response to issues affecting nursing practice
Question 10
A patient with decision-making capacity refuses a recommended procedure after risks and benefits are explained. What should the CNS do?
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Correct answer: B - Respect the informed decision and discuss consequences
Domain 3: Caring Practices (4%) - Validated Competencies: Core CNS Competencies • Uses relationship-building communication to promote health and wellness, healing, self-care, and peaceful end-of-life • Engages nurses in reflective practice activities that promote self-awareness and invite peer feedback to improve the practice of nursing • Fosters a healthy work environment by exhibiting positive regard, conveying mutual respect, and acknowledging the contributions of others Adult-Gerontology CNS Competencies • Creates therapeutic, health-promoting, aging- friendly environments • Implements system-level changes based on analysis and evaluation of age-specific outcomes of care • Intervenes to facilitate transitions of care with emphasis on quality, safety, and risk avoidance • Designs a comprehensive, individualized, age- and disease-appropriate plan for health promotion • Develops age-specific, individualized treatment plans and interventions with consideration of cognitive status, sensory function, perception, and the environment • Advises patients, families and caregivers on how to address sensitive issues such as sexually transmitted diseases, suicide prevention, substance use and potential for abuse, driving and independent living, end-of-life concerns, advance care planning, and finances • Uses behavioral, communication, and environmental-modification strategies with individuals who have cognitive and psychiatric impairments • Coordinates care with other healthcare providers and community resources, with special attention to the needs of the nonverbal and developmentally and cognitively impaired patient and frail older adult
Domain 4: Response to Diversity (4%) - Validated Competencies: Core CNS Competencies • Promotes interventions that prevent the impact of implicit bias on relationship-building and outcomes • Leads and facilitates change in response to organizational and community needs in a dynamic healthcare environment Adult-Gerontology CNS Competencies • Assesses patient, caregiver, and family’s preferences in relation to cultural, spiritual, quality of life, and lifestyle choices • Promotes healthcare policy and system changes that facilitate access to care and address biases (e.g., socioeconomic, ethnic, ageism, sexism, cultural, and mental health stigma) • Promotes system-wide policies and protocols that address cultural, ethnic, spiritual, and intergenerational/age differences among patients, healthcare providers, and caregivers • Provides programs for the development of healthcare providers, students, and caregivers that incorporate age-specific cultural competence and skills
Domain 5: Facilitation of Learning (4%) - Validated Competencies: Core CNS Competencies • Designs and employs educational strategies that consider readiness to learn, individual preferences, and other social determinants of health • Provides education and coaching to patients with complex learning needs and atypical responses • Mentors nurses and nursing staff in using evidence- based practice principles • Facilitates opportunities for nurses, students, and other staff to acquire knowledge and skills that foster professional development Adult-Gerontology CNS Competencies • Coordinates formal and informal education for healthcare providers to improve adult-older adult healthcare outcomes • Designs educational programs that enhance the knowledge of older adults, families, and caregivers regarding normal changes of aging, myths and stereotypes of aging, and health promotion and prevention activities for older adults • Provides education to patients, families, caregivers, and the community, including but not limited to, the following topics: health promotion, high-risk behaviors and their impact on health, and the interaction between physical and mental health • Mentors healthcare providers, students, and others to develop expertise in the care of the vulnerable adult including the frail elderly patient
Domain 6: Collaboration (6%) - Validated Competencies: Core CNS Competencies • Uses advanced communication skills in complex situations and difficult conversations • Employs conflict management and negotiation skills to promote a healthy work environment • Cultivates a practice environment in which mutual respect, communication, and collaboration contribute to safe, quality outcomes • Uses leadership, team building, negotiation, collaboration, and conflict resolution to build partnerships within and across systems and/or communities • Provides leadership for the interprofessional team in identifying, developing, implementing, and evaluating evidence-based practices and research opportunities • Disseminates CNS practice and fiscal outcomes to internal stakeholders and the public • Promotes nursing’s unique contributions to advancing health to stakeholders (e.g., the organization, community, public, and policymakers) Adult-Gerontology CNS Competencies • Provides consultation to the interdisciplinary team regarding the patient’s mental status, home environment, mobility, functional status, self-care, and caregiver’s abilities • Advocates for access to hospice and palliative care services for patients across the adult age spectrum • Leads collaborative efforts of the healthcare team in focusing on individuals and systems issues that impact the adult-older adult patient • Balances patient and family preferences, threats to patient safety, and risk/benefit analysis of interventions such as fall prevention, pain management, and treatment choices • Identifies potential risks to patient safety, autonomy and quality of care based on assessments across the patient, nurse and system spheres of influence
Domain 7: Systems Thinking (6%) - Validated Competencies: Core CNS Competencies • Implements customized evidence-based advanced nursing interventions, including the provision of direct care • Leads and facilitates coordinated care and transitions in collaboration with the patient and interprofessional team • Advocates for nurses to practice to the full extent of their role in the delivery of healthcare • Leads nurses in the process of planning, implementing, and evaluating change, considering intended and unintended consequences • Mentors nurses to analyze legislative, regulatory, and fiscal policies that affect nursing practice and patient outcomes • Consults with healthcare team members to integrate the needs, preferences, and strengths of a population into the healthcare plan to optimize health outcomes and patient experience within a healthcare system • Leads and participates in systematic quality improvement and safety initiatives based on precise problem/etiology identification, gap analysis, and process evaluation • Leads and participates in the process of selecting, integrating, managing, and evaluating technology and products to promote safety, quality, efficiency, and optimal health outcomes • Evaluates system-level interventions, programs, and outcomes based on the analysis of information from relevant sources Adult-Gerontology CNS Competencies • Manages patient’s transitions of care in collaboration with the individual, family, caregivers, and interdisciplinary team members, including analyzing the readiness of the patient and family to transition, determining appropriate level and/or setting of care, and coordinating implementation of transition • Assists healthcare team members to integrate the needs, preferences, and strengths of the patient into the healthcare plan in order to optimize health outcomes • Integrates information technology into systems of care to enhance safety and monitor health outcomes • Provides leadership to address threats to healthcare safety and quality in the adult-older adult population • Participates in development, implementation, and evaluation of clinical practice guidelines that address patient needs across the adult age spectrum • Facilitates access to and use of information and care technology based on assessment of the ability and preferences of patients across the adult age spectrum
Domain 8: Clinical Inquiry (6%) - Validated Competencies: Core CNS Competencies • Designs evidence-based, cost-effective interventions, including advanced nursing therapies, to meet the multifaceted needs of complex patients • Evaluates impact of nursing interventions on patients’ aggregate outcomes using a scientific approach • Assesses the nursing practice environment and processes for improvement opportunities • Uses evidence-based knowledge as a foundation for nursing practice to achieve optimal nurse-sensitive outcomes • Evaluates the outcomes of nursing practice using methods that provide valid data • Partners with research-focused, doctorally-prepared (i.e. PhD) colleagues to translate, conduct, and disseminate research that addresses gaps and improves clinical knowledge and practice Adult-Gerontology CNS Competencies • Facilitates the incorporation of evidence-based practices, products, and technology that are specific to adult-older adult populations, into clinical practice and policies • Provides leadership in identifying gaps in data and analyses specific to age-related outcomes of care • Facilitates the incorporation of evidence related to adults-older adults when formulating and reviewing age-specific policies, procedures, and protocols • Evaluates innovative approaches to delivering care to the adult-older adult populations • Identifies areas of inquiry relevant to the adult-older adult population • Advocates the use of data collection tools and consents that are understandable and appropriate for adult-older adult populations
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