Nursing Acceleration Challenge Exam
(NACE). how to pass 2026 QUESTIONS
WITH WELL VERIFIED ANSWERS About
Nursing Acceleration Challenge Exam
(NACE) The Nursing Acceleration
Challenge Examination (NACE)
1. A nurse is administering an intramuscular injection. Which needle length is
appropriate for a ventrogluteal site in an average-sized adult?
A) 1/2 inch
B) 1 inch
C) 1.5 inches
D) 2.5 inches
Correct Answer: C
Rationale: The ventrogluteal site is deep and requires a 1.5-inch needle to ensure
the medication reaches the gluteus medius muscle. A 1-inch needle may be used
for deltoid injections; 1/2 inch is for subcutaneous tissue; 2.5 inches is excessively
long for an adult.
2. A patient with chronic renal failure has a serum potassium level of 6.8 mEq/L.
The nurse should anticipate administering which medication first?
A) Sodium polystyrene sulfonate (Kayexalate)
,B) Intravenous calcium gluconate
C) Regular insulin with 50% dextrose
D) Furosemide (Lasix)
Correct Answer: B
Rationale: In severe hyperkalemia, calcium gluconate is given first to stabilize the
myocardium and prevent life-threatening arrhythmias. Insulin with dextrose or
Kayexalate helps shift or remove potassium but takes longer. Furosemide may be
used later but is not the initial emergency intervention.
3. A patient is receiving a blood transfusion. Fifteen minutes after the start, the
patient develops chills, fever, and low back pain. The nurse’s priority action is to:
A) Slow the transfusion rate and monitor vital signs
B) Stop the transfusion and infuse normal saline
C) Administer acetaminophen and continue the transfusion
D) Notify the blood bank and continue the infusion
Correct Answer: B
Rationale: These symptoms indicate a hemolytic transfusion reaction, which is
life-threatening. The transfusion must be stopped immediately, the IV line kept
open with normal saline, and the provider and blood bank notified. The unit and
tubing are saved for testing.
4. A nurse is performing a sterile dressing change. Which action by the nurse
indicates a break in sterile technique?
A) Holding sterile forceps with tips above the handles
B) Keeping hands above waist level
C) Reaching over the sterile field to open a gauze packet
,D) Pouring sterile solution with the label facing the palm
Correct Answer: C
Rationale: Reaching over the sterile field contaminates it because the arm passes
over the sterile area. Forceps should be held with tips down (not above the handles
unless not in use). Hands should be above the waist, and pouring should avoid
splashing.
5. A patient with left-sided heart failure is most likely to exhibit which finding?
A) Jugular vein distention
B) Hepatomegaly
C) Bibasilar crackles
D) Peripheral edema
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion, leading to
crackles, dyspnea, and orthopnea. Right-sided failure leads to systemic venous
congestion (JVD, hepatomegaly, peripheral edema).
6. The nurse is calculating intake and output for a patient. Which item should be
counted as intake?
A) Mashed potatoes
B) Gelatin dessert
C) Hard candy
D) Banana
Correct Answer: B
Rationale: Any food that is liquid at room temperature (gelatin, ice cream, soup) is
, counted as fluid intake. Mashed potatoes, candy, and banana are solids and not
measured as intake.
7. The most accurate method for verifying placement of a nasogastric tube before
initial use is:
A) Auscultation of injected air
B) Aspiration of gastric contents and pH testing
C) Radiographic (X-ray) confirmation
D) Observing for bubbling when the end is placed in water
Correct Answer: C
Rationale: X-ray confirmation is the gold standard for initial NG tube placement
verification. Auscultation and bubbling are unreliable. pH testing is used to check
ongoing placement, but X-ray is required before first feedings.
8. A patient with diabetes insipidus would have which laboratory finding?
A) Urine specific gravity of 1.030
B) Polyuria and very dilute urine
C) Serum sodium of 135 mEq/L
D) Concentrated urine with low volume
Correct Answer: B
Rationale: Diabetes insipidus is characterized by a deficiency of ADH, causing
polyuria, polydipsia, and dilute urine (specific gravity <1.005). Serum sodium is
often elevated due to water loss. Concentrated urine is seen in SIADH.
(NACE). how to pass 2026 QUESTIONS
WITH WELL VERIFIED ANSWERS About
Nursing Acceleration Challenge Exam
(NACE) The Nursing Acceleration
Challenge Examination (NACE)
1. A nurse is administering an intramuscular injection. Which needle length is
appropriate for a ventrogluteal site in an average-sized adult?
A) 1/2 inch
B) 1 inch
C) 1.5 inches
D) 2.5 inches
Correct Answer: C
Rationale: The ventrogluteal site is deep and requires a 1.5-inch needle to ensure
the medication reaches the gluteus medius muscle. A 1-inch needle may be used
for deltoid injections; 1/2 inch is for subcutaneous tissue; 2.5 inches is excessively
long for an adult.
2. A patient with chronic renal failure has a serum potassium level of 6.8 mEq/L.
The nurse should anticipate administering which medication first?
A) Sodium polystyrene sulfonate (Kayexalate)
,B) Intravenous calcium gluconate
C) Regular insulin with 50% dextrose
D) Furosemide (Lasix)
Correct Answer: B
Rationale: In severe hyperkalemia, calcium gluconate is given first to stabilize the
myocardium and prevent life-threatening arrhythmias. Insulin with dextrose or
Kayexalate helps shift or remove potassium but takes longer. Furosemide may be
used later but is not the initial emergency intervention.
3. A patient is receiving a blood transfusion. Fifteen minutes after the start, the
patient develops chills, fever, and low back pain. The nurse’s priority action is to:
A) Slow the transfusion rate and monitor vital signs
B) Stop the transfusion and infuse normal saline
C) Administer acetaminophen and continue the transfusion
D) Notify the blood bank and continue the infusion
Correct Answer: B
Rationale: These symptoms indicate a hemolytic transfusion reaction, which is
life-threatening. The transfusion must be stopped immediately, the IV line kept
open with normal saline, and the provider and blood bank notified. The unit and
tubing are saved for testing.
4. A nurse is performing a sterile dressing change. Which action by the nurse
indicates a break in sterile technique?
A) Holding sterile forceps with tips above the handles
B) Keeping hands above waist level
C) Reaching over the sterile field to open a gauze packet
,D) Pouring sterile solution with the label facing the palm
Correct Answer: C
Rationale: Reaching over the sterile field contaminates it because the arm passes
over the sterile area. Forceps should be held with tips down (not above the handles
unless not in use). Hands should be above the waist, and pouring should avoid
splashing.
5. A patient with left-sided heart failure is most likely to exhibit which finding?
A) Jugular vein distention
B) Hepatomegaly
C) Bibasilar crackles
D) Peripheral edema
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion, leading to
crackles, dyspnea, and orthopnea. Right-sided failure leads to systemic venous
congestion (JVD, hepatomegaly, peripheral edema).
6. The nurse is calculating intake and output for a patient. Which item should be
counted as intake?
A) Mashed potatoes
B) Gelatin dessert
C) Hard candy
D) Banana
Correct Answer: B
Rationale: Any food that is liquid at room temperature (gelatin, ice cream, soup) is
, counted as fluid intake. Mashed potatoes, candy, and banana are solids and not
measured as intake.
7. The most accurate method for verifying placement of a nasogastric tube before
initial use is:
A) Auscultation of injected air
B) Aspiration of gastric contents and pH testing
C) Radiographic (X-ray) confirmation
D) Observing for bubbling when the end is placed in water
Correct Answer: C
Rationale: X-ray confirmation is the gold standard for initial NG tube placement
verification. Auscultation and bubbling are unreliable. pH testing is used to check
ongoing placement, but X-ray is required before first feedings.
8. A patient with diabetes insipidus would have which laboratory finding?
A) Urine specific gravity of 1.030
B) Polyuria and very dilute urine
C) Serum sodium of 135 mEq/L
D) Concentrated urine with low volume
Correct Answer: B
Rationale: Diabetes insipidus is characterized by a deficiency of ADH, causing
polyuria, polydipsia, and dilute urine (specific gravity <1.005). Serum sodium is
often elevated due to water loss. Concentrated urine is seen in SIADH.
