Free ACCNS-N exam Practice Questions

Sample Practice Questions

Try these 10 sample questions from the ACCNS-N exam practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A newborn's heart rate remains 54/min after 30 seconds of ventilation that visibly inflates the lungs. Which resuscitation step is indicated now?

   1. A. Continue assisted ventilation alone while reassessing the heart rate.
   2. B. Begin chest compressions coordinated with assisted ventilation.
   3. C. Give intravascular epinephrine before starting chest compressions.
   4. D. Give intravascular volume expansion before starting chest compressions.

   Answer: B

   Explanation: The AHA states, "In newborn infants, chest compressions are recommended if the heart rate remains less than 60/min despite 30 seconds of ventilation that inflates the lungs, as evidenced by chest movement." The stated rate and effective ventilation meet that threshold; epinephrine follows optimized ventilation and compressions if bradycardia persists.

   Reference: Part 5: Neonatal Resuscitation — Recommendations for Initiating Chest Compressions in Newborn Infants, recommendation 1

2. 2Parents and the neonatal team remain divided about a proposed high-risk treatment despite clinical discussion. Which team should the CNS ask to analyze the dilemma using ethical principles?

   1. A. The institutional ethics team
   2. B. The palliative care consultation team
   3. C. The patient safety and quality team
   4. D. The patient relations team

   Answer: A

   Explanation: The ACCNS-N test plan says the neonatal CNS "Identifies the need to involve the institutional ethics team in finding resolutions to the dilemmas using ethical principles." An unresolved ethical conflict calls for that team.

   Reference: ACCNS-N Exam Handbook — Test Plan p.6, Advocacy/Moral Agency, Neonatal CNS Competencies

3. 3During neonatal resuscitation, a CNS coaches the team on coordinating compressions and breaths for a newborn who still needs compressions. Which compression-to-ventilation ratio aligns with the AHA neonatal recommendation?

   1. A. One compression followed by one ventilation breath (1:1).
   2. B. Three compressions followed by one ventilation breath (3:1).
   3. C. Fifteen compressions followed by two ventilation breaths (15:2).
   4. D. Thirty compressions followed by two ventilation breaths (30:2).

   Answer: B

   Explanation: The neonatal recommendation states, "It may be reasonable to repeatedly deliver 3 compressions followed by a ventilation breath (3:1 ratio) when providing chest compressions to newborn infants." The other ratios are different compression and breath patterns.

   Reference: Part 5: Neonatal Resuscitation — Recommendations for Providing Chest Compressions, recommendation 1

4. 4A family is deciding whether to accept a proposed neonatal healthcare regimen. What information should the CNS facilitate for informed, shared decision making?

   1. A. The regimen's risks, benefits, and outcomes
   2. B. The regimen's costs, staffing, and bed availability
   3. C. The regimen's schedule, location, and equipment
   4. D. The regimen's documentation, coding, and billing

   Answer: A

   Explanation: The ACCNS-N test plan directs the CNS to facilitate understanding of the "risks, benefits and outcomes of proposed healthcare regimens to promote informed, shared decisionmaking." These are the decision-relevant elements for this family.

   Reference: ACCNS-N Exam Handbook — Test Plan p.6, Advocacy/Moral Agency, Core CNS Competencies

5. 5A newborn undergoing chest compressions needs a secure route for continued ventilation, and endotracheal placement is feasible. Which airway is recommended during compressions?

   1. A. An endotracheal tube for ventilation during compressions.
   2. B. A laryngeal mask for ventilation during compressions.
   3. C. A face mask for ventilation during compressions.
   4. D. A nasal cannula for ventilation during compressions.

   Answer: A

   Explanation: The AHA recommendation is, "During chest compressions in newborn infants, ventilation with an endotracheal tube is recommended." A laryngeal mask is described as an alternative for infants at least 34 weeks when intubation is impossible or unsuccessful, which is not the situation here.

   Reference: Part 5: Neonatal Resuscitation — Recommendations for Initiating Chest Compressions in Newborn Infants, recommendation 2

6. 6Nurses report moral distress from recurring conflicts about neonatal treatment limits. Which CNS leadership activity directly addresses their concern?

   1. A. Lead efforts to resolve their ethical conflict
   2. B. Lead efforts to update their technical skills
   3. C. Lead efforts to audit their documentation
   4. D. Lead efforts to coordinate their shift handoffs

   Answer: A

   Explanation: The ACCNS-N test plan states that the CNS "Leads efforts to resolve ethical conflict and moral distress experienced by nurses and nursing staff." The reported problem is moral distress, so ethics resolution is the direct leadership response.

   Reference: ACCNS-N Exam Handbook — Test Plan p.6, Advocacy/Moral Agency, Core CNS Competencies

7. 7An echocardiogram in a preterm infant shows that the connection between the aorta and pulmonary artery remains open after birth. Which congenital defect does this describe?

   1. A. Atrial septal defect
   2. B. Ventricular septal defect
   3. C. Patent ductus arteriosus
   4. D. Pulmonary valve stenosis

   Answer: C

   Explanation: NHLBI explains that patent ductus arteriosus occurs when "a connection between the heart’s two major arteries" does not close after birth, and identifies those arteries as the aorta and pulmonary artery. Septal defects connect chambers; pulmonary stenosis narrows the pulmonary valve.

   Reference: Congenital Heart Defects - Types — Congenital Heart Defects - Types, Patent ductus arteriosus

8. 8A CNS notices that a personal belief may influence counseling of families about a neonatal treatment choice. Which first professional action addresses this source of bias?

   1. A. Assess personal values and beliefs that influence care
   2. B. Assess family learning needs that influence teaching
   3. C. Assess unit resources and costs that influence care
   4. D. Assess team roles and tasks that influence workflow

   Answer: A

   Explanation: The ACCNS-N test plan says the neonatal CNS "Performs self-assessment to identify own personal values and beliefs that influence the provision of care as an expert clinician." Reflecting on the CNS's own belief is the relevant action.

   Reference: ACCNS-N Exam Handbook — Test Plan p.6, Advocacy/Moral Agency, Neonatal CNS Competencies

9. 9A term newborn remains apneic after drying and tactile stimulation. Which respiratory intervention should the CNS ensure is started within the first minute?

   1. A. Provide assisted ventilation to inflate the lungs.
   2. B. Provide nasal CPAP to maintain spontaneous breaths.
   3. C. Provide supplemental oxygen without assisted breaths.
   4. D. Perform routine tracheal suctioning before ventilation.

   Answer: A

   Explanation: AHA states, "Ventilation should be provided within 60 seconds after birth in newborn infants who are gasping or apneic or who are persistently bradycardic (heart rate less than 100/min) despite appropriate initial steps." Apnea after initial steps calls for assisted ventilation; CPAP presumes spontaneous breathing.

   Reference: Part 5: Neonatal Resuscitation — Recommendations for Ventilatory Support, recommendation 1

10. 10Parents receive different explanations of their infant's care from clinicians on successive shifts. Which communication relationship should the CNS assess for a gap?

    1. A. Communication between the family and healthcare professionals
    2. B. Communication between bedside nurses and medical staff
    3. C. Communication between day-shift and night-shift nurses
    4. D. Communication between neonatal and outpatient teams

    Answer: A

    Explanation: The ACCNS-N test plan states that the CNS "Identifies gaps in communication between family members and healthcare professionals." The inconsistent explanations are experienced at that family-clinician interface.

    Reference: ACCNS-N Exam Handbook — Test Plan p.7, Caring Practices, Neonatal CNS Competencies