ANCC IQ
DOMAIN 2: ADVANCED PRACTICE
SKILLS
FINAL ASSESSMENT REVIEW
2026
A 58-year-old patient with a history of COPD presents with increased dyspnea and
productive cough. Which clinical assessment finding most strongly indicates an
acute exacerbation? A) Decreased respiratory rate B) Clear breath sounds bilaterally
C) Use of accessory muscles during breathing D) Bradycardia Answer: C Rationale:
Use of accessory muscles indicates increased work of breathing common in COPD
exacerbations, whereas decreased respiratory rate or clear breath sounds are less
likely
2. True/False:
Capillary refill time greater than 3 seconds consistently indicates poor peripheral
perfusion and requires immediate intervention.
Answer: True
Rationale: Prolonged capillary refill is a classic sign of poor perfusion and can
indicate shock or peripheral vascular compromise.
3. Short Answer:
Name two advanced diagnostic tools used in bedside cardiac assessment that
improve upon auscultation alone.
Answer: Point-of-care ultrasound (POCUS), handheld echocardiography
Rationale: These tools provide real-time imaging, allowing visualization of cardiac
function beyond traditional auscultation.
4. Fill in the Blank:
The Glasgow Coma Scale is composed of three components: Eye opening,
_______________, and Motor response.
Answer: Verbal response
1
,Rationale: GCS evaluates eye, verbal, and motor responses to assess neurologic
status.
5. Multiple Choice:
During a neurological exam, a patient exhibits pronator drift. This finding is most
highly suggestive of:
A) Cerebellar dysfunction
B) Upper motor neuron lesion
C) Lower motor neuron lesion
D) Peripheral neuropathy
Answer: B
Rationale: Pronator drift indicates corticospinal tract (upper motor neuron)
involvement.
6. True/False:
Tactile fremitus is decreased over areas of lung consolidation.
Answer: False
Rationale: Fremitus increases over consolidated lung tissue due to better sound
transmission.
7. Fill in the Blank:
In advanced assessment of heart failure, _____________ measured via POCUS
correlates with elevated right atrial pressures.
Answer: Inferior vena cava (IVC) diameter and collapsibility
Rationale: IVC size and collapsibility reflect right atrial pressure and volume status.
Therapeutic Communication
8. Short Answer:
Identify one open-ended question you would use to begin a therapeutic conversation
with a highly anxious patient.
Answer: "Can you tell me more about what is worrying you today?"
Rationale: Open-ended questions encourage patient expression and engagement.
9. Multiple Choice:
Which communication strategy is most effective for a patient exhibiting resistance to
behavioral change?
A) Confrontation
B) Empathy and reflective listening
C) Closed-ended questions
D) Ignoring their concerns
Answer: B
Rationale: Empathy and reflective listening build trust and reduce resistance.
2
, 10. True/False:
Nonverbal cues such as maintaining eye contact and an open posture generally
facilitate therapeutic communication.
Answer: True
Rationale: Positive nonverbal cues promote rapport and patient comfort.
11. Fill in the Blank:
When addressing a patient's cultural beliefs that impact their health decisions, the
nurse practitioner should use ________________ communication to respect and
incorporate these values.
Answer: culturally competent
Rationale: Culturally competent communication acknowledges and integrates patient
diversity in care plans.
12. Multiple Choice:
Which phase of the therapeutic nurse-patient relationship focuses on setting goals
and planning interventions?
A) Orientation
B) Working
C) Termination
D) Pre-interaction
Answer: B
Rationale: The working phase concentrates on collaborative goal-setting and
intervention implementation.
13. True/False:
Silence is a valuable therapeutic tool that can encourage patient reflection during
difficult conversations.
Answer: True
Rationale: Proper use of silence allows patients space to process and disclose
information.
List one example of a barrier to effective therapeutic communication in acute
settings.
Answer: Patient’s altered mental status or pain interfering with focus
Rationale: Cognitive or physical impairments reduce communication effectiveness.
Advanced Interventions
15. Multiple Choice:
Which medication adjustment is appropriate to avoid serotonin syndrome in a patient
starting a new antidepressant with a current SSRI regimen?
A) Combining both drugs simultaneously
B) Tapering the current SSRI before initiating the new antidepressant
3
DOMAIN 2: ADVANCED PRACTICE
SKILLS
FINAL ASSESSMENT REVIEW
2026
A 58-year-old patient with a history of COPD presents with increased dyspnea and
productive cough. Which clinical assessment finding most strongly indicates an
acute exacerbation? A) Decreased respiratory rate B) Clear breath sounds bilaterally
C) Use of accessory muscles during breathing D) Bradycardia Answer: C Rationale:
Use of accessory muscles indicates increased work of breathing common in COPD
exacerbations, whereas decreased respiratory rate or clear breath sounds are less
likely
2. True/False:
Capillary refill time greater than 3 seconds consistently indicates poor peripheral
perfusion and requires immediate intervention.
Answer: True
Rationale: Prolonged capillary refill is a classic sign of poor perfusion and can
indicate shock or peripheral vascular compromise.
3. Short Answer:
Name two advanced diagnostic tools used in bedside cardiac assessment that
improve upon auscultation alone.
Answer: Point-of-care ultrasound (POCUS), handheld echocardiography
Rationale: These tools provide real-time imaging, allowing visualization of cardiac
function beyond traditional auscultation.
4. Fill in the Blank:
The Glasgow Coma Scale is composed of three components: Eye opening,
_______________, and Motor response.
Answer: Verbal response
1
,Rationale: GCS evaluates eye, verbal, and motor responses to assess neurologic
status.
5. Multiple Choice:
During a neurological exam, a patient exhibits pronator drift. This finding is most
highly suggestive of:
A) Cerebellar dysfunction
B) Upper motor neuron lesion
C) Lower motor neuron lesion
D) Peripheral neuropathy
Answer: B
Rationale: Pronator drift indicates corticospinal tract (upper motor neuron)
involvement.
6. True/False:
Tactile fremitus is decreased over areas of lung consolidation.
Answer: False
Rationale: Fremitus increases over consolidated lung tissue due to better sound
transmission.
7. Fill in the Blank:
In advanced assessment of heart failure, _____________ measured via POCUS
correlates with elevated right atrial pressures.
Answer: Inferior vena cava (IVC) diameter and collapsibility
Rationale: IVC size and collapsibility reflect right atrial pressure and volume status.
Therapeutic Communication
8. Short Answer:
Identify one open-ended question you would use to begin a therapeutic conversation
with a highly anxious patient.
Answer: "Can you tell me more about what is worrying you today?"
Rationale: Open-ended questions encourage patient expression and engagement.
9. Multiple Choice:
Which communication strategy is most effective for a patient exhibiting resistance to
behavioral change?
A) Confrontation
B) Empathy and reflective listening
C) Closed-ended questions
D) Ignoring their concerns
Answer: B
Rationale: Empathy and reflective listening build trust and reduce resistance.
2
, 10. True/False:
Nonverbal cues such as maintaining eye contact and an open posture generally
facilitate therapeutic communication.
Answer: True
Rationale: Positive nonverbal cues promote rapport and patient comfort.
11. Fill in the Blank:
When addressing a patient's cultural beliefs that impact their health decisions, the
nurse practitioner should use ________________ communication to respect and
incorporate these values.
Answer: culturally competent
Rationale: Culturally competent communication acknowledges and integrates patient
diversity in care plans.
12. Multiple Choice:
Which phase of the therapeutic nurse-patient relationship focuses on setting goals
and planning interventions?
A) Orientation
B) Working
C) Termination
D) Pre-interaction
Answer: B
Rationale: The working phase concentrates on collaborative goal-setting and
intervention implementation.
13. True/False:
Silence is a valuable therapeutic tool that can encourage patient reflection during
difficult conversations.
Answer: True
Rationale: Proper use of silence allows patients space to process and disclose
information.
List one example of a barrier to effective therapeutic communication in acute
settings.
Answer: Patient’s altered mental status or pain interfering with focus
Rationale: Cognitive or physical impairments reduce communication effectiveness.
Advanced Interventions
15. Multiple Choice:
Which medication adjustment is appropriate to avoid serotonin syndrome in a patient
starting a new antidepressant with a current SSRI regimen?
A) Combining both drugs simultaneously
B) Tapering the current SSRI before initiating the new antidepressant
3
