ANCC IQ DOMAINS 1-5 TEST BANK – COMPREHENSIVE PRACTICE
2026/2027 Edition
Aligned with the ANCC Certification Exam Blueprint & Nursing Competency Standards
250 Questions | 5 Domains | Multiple Choice (A–D)
Contents
Section 1: Domain 1 – Assessment & Diagnosis – Health Assessment, Diagnostic Reasoning, Clinical
Decision-Making (50 questions)
Section 2: Domain 2 – Planning & Implementation – Care Planning, Evidence-Based Interventions, Patient Education
(50 questions)
Section 3: Domain 3 – Evaluation & Outcomes – Outcome Evaluation, Quality Improvement, Performance
Measurement (50 questions)
Section 4: Domain 4 – Professional Practice & Ethics – Ethics, Legal Issues, Advocacy, Professional Standards (50
questions)
Section 5: Domain 5 – Leadership & Systems – Leadership, Systems Thinking, Collaboration, Healthcare Policy (50
questions)
How to use this test bank: Work through each domain sequentially. One answer choice per question is correct; the correct
answer and a rationale follow each question. Use the rationales to reinforce nursing concepts across the five ANCC IQ domains.
A reference answer key is provided on the final page.
ANCC IQ Domains 1-5 Test Bank – Comprehensive Practice (2026/2027 Edition) Page 1
, Section 1: Domain 1 – Assessment & Diagnosis – Health Assessment, Diagnostic
Section 1
Reasoning, Clinical Decision-Making (50 questions)
Q1: During the initial assessment of a critically ill patient, which is the nurse's FIRST priority?
A. Airway patency [CORRECT]
B. Level of consciousness
C. Blood pressure
D. Pain level
Correct Answer: A
Rationale: Airway is always assessed first in the ABC framework; without a patent airway, all other assessments are
secondary.
Q2: Which finding is considered SUBJECTIVE data?
A. The patient states the pain is 8 out of 10 [CORRECT]
B. Respiratory rate of 24
C. Temperature of 38.6 C
D. A reddened skin area
Correct Answer: A
Rationale: Subjective data are reported by the patient; the pain rating is the patient's own report, whereas the other
items are observed or measured.
Q3: A patient has altered mental status and cannot provide a history. Which is the BEST source of
information?
A. Family members and the medical record [CORRECT]
B. The patient's roommate
C. The nurse's assumptions
D. Internet resources
Correct Answer: A
Rationale: Family or caregivers and the medical record provide the most reliable history when the patient cannot give
one.
Q4: Which screening tool is used to assess for problematic alcohol use?
A. CAGE questionnaire [CORRECT]
B. PHQ-9
C. Mini-Cog
D. Glasgow Coma Scale
Correct Answer: A
Rationale: The CAGE questionnaire screens for alcohol misuse; PHQ-9 screens for depression and Mini-Cog for
cognition.
Q5: Which heart sounds are normal in a healthy adult?
A. S1 and S2 [CORRECT]
B. S3 and S4
C. A systolic murmur
D. A friction rub
Correct Answer: A
Rationale: S1 (closure of AV valves) and S2 (closure of semilunar valves) are normal; S3, S4, and murmurs may
indicate pathology.
ANCC IQ Domains 1-5 Test Bank – Comprehensive Practice (2026/2027 Edition) Page 2
, Q6: A nurse notes a patient's pulse oximetry drops from 96% to 88% and the patient becomes dyspneic.
Which is the PRIORITY action?
A. Assess the airway and administer oxygen as ordered [CORRECT]
B. Document the change
C. Offer oral fluids
D. Defer action until the provider rounds
Correct Answer: A
Rationale: A drop in oxygen saturation with dyspnea requires immediate airway assessment and oxygen therapy.
Q7: Which is the correct order of the nursing process?
A. Assessment, diagnosis, planning, implementation, evaluation [CORRECT]
B. Planning, assessment, diagnosis, implementation, evaluation
C. Diagnosis, assessment, planning, evaluation, implementation
D. Assessment, planning, diagnosis, implementation, evaluation
Correct Answer: A
Rationale: The nursing process proceeds from assessment to diagnosis, planning, implementation, and evaluation.
Q8: Four patients arrive simultaneously. Which should the nurse assess FIRST?
A. A patient with acute crushing chest pain [CORRECT]
B. A patient requesting a refill of pain medication
C. A patient with a minor laceration
D. A patient scheduled for routine discharge teaching
Correct Answer: A
Rationale: Acute chest pain may indicate myocardial infarction, a life-threatening condition that takes priority under ABC
and triage principles.
Q9: An arterial blood gas shows pH 7.30, PaCO2 50 mmHg, and HCO3 24 mEq/L. The nurse interprets this
as:
A. Respiratory acidosis [CORRECT]
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct Answer: A
Rationale: Low pH with elevated PaCO2 and normal HCO3 indicates respiratory acidosis (hypoventilation).
Q10: Which is the normal serum potassium range?
A. 3.5 to 5.0 mEq/L [CORRECT]
B. 1.5 to 2.5 mEq/L
C. 6.0 to 8.0 mEq/L
D. 8.5 to 10.5 mEq/L
Correct Answer: A
Rationale: Normal serum potassium is 3.5-5.0 mEq/L; levels outside this range carry cardiac risk.
Q11: Which laboratory test BEST reflects kidney function?
A. Serum creatinine and BUN [CORRECT]
B. Hemoglobin A1c
C. Troponin
D. Amylase
Correct Answer: A
Rationale: Creatinine and BUN are the primary indicators of renal function.
ANCC IQ Domains 1-5 Test Bank – Comprehensive Practice (2026/2027 Edition) Page 3
, Q12: An elevated troponin level indicates:
A. Myocardial injury [CORRECT]
B. Liver dysfunction
C. Pancreatic inflammation
D. Renal failure
Correct Answer: A
Rationale: Troponin is a cardiac biomarker released with myocardial injury or infarction.
Q13: A patient on warfarin should have an INR maintained at approximately:
A. 2.0 to 3.0 [CORRECT]
B. 0.5 to 1.0
C. 4.0 to 5.0
D. 10 to 15
Correct Answer: A
Rationale: The therapeutic INR for most warfarin indications is 2.0-3.0; higher values increase bleeding risk.
Q14: Which laboratory test is used to monitor unfractionated heparin therapy?
A. aPTT [CORRECT]
B. INR
C. Hemoglobin
D. Bilirubin
Correct Answer: A
Rationale: Activated partial thromboplastin time (aPTT) monitors heparin; INR monitors warfarin.
Q15: A hemoglobin A1c of 8.5% indicates:
A. Poor long-term glucose control [CORRECT]
B. Excellent glucose control
C. Normal glucose metabolism
D. Recent hypoglycemia
Correct Answer: A
Rationale: A1c reflects average glucose over 2-3 months; values above 6.5-7% indicate suboptimal control.
Q16: Which finding suggests an infectious process?
A. White blood cell count of 18,000/mm3 [CORRECT]
B. Hemoglobin of 14 g/dL
C. Platelets of 250,000/mm3
D. Potassium of 4.0 mEq/L
Correct Answer: A
Rationale: An elevated white blood cell count (leukocytosis) commonly indicates infection.
Q17: Which is the normal platelet count?
A. 150,000 to 400,000/mm3 [CORRECT]
B. 5,000 to 10,000/mm3
C. 4.5 to 11 million/mm3
D. 50,000 to 80,000/mm3
Correct Answer: A
Rationale: Normal platelets range from 150,000 to 400,000 per cubic millimeter.
ANCC IQ Domains 1-5 Test Bank – Comprehensive Practice (2026/2027 Edition) Page 4
2026/2027 Edition
Aligned with the ANCC Certification Exam Blueprint & Nursing Competency Standards
250 Questions | 5 Domains | Multiple Choice (A–D)
Contents
Section 1: Domain 1 – Assessment & Diagnosis – Health Assessment, Diagnostic Reasoning, Clinical
Decision-Making (50 questions)
Section 2: Domain 2 – Planning & Implementation – Care Planning, Evidence-Based Interventions, Patient Education
(50 questions)
Section 3: Domain 3 – Evaluation & Outcomes – Outcome Evaluation, Quality Improvement, Performance
Measurement (50 questions)
Section 4: Domain 4 – Professional Practice & Ethics – Ethics, Legal Issues, Advocacy, Professional Standards (50
questions)
Section 5: Domain 5 – Leadership & Systems – Leadership, Systems Thinking, Collaboration, Healthcare Policy (50
questions)
How to use this test bank: Work through each domain sequentially. One answer choice per question is correct; the correct
answer and a rationale follow each question. Use the rationales to reinforce nursing concepts across the five ANCC IQ domains.
A reference answer key is provided on the final page.
ANCC IQ Domains 1-5 Test Bank – Comprehensive Practice (2026/2027 Edition) Page 1
, Section 1: Domain 1 – Assessment & Diagnosis – Health Assessment, Diagnostic
Section 1
Reasoning, Clinical Decision-Making (50 questions)
Q1: During the initial assessment of a critically ill patient, which is the nurse's FIRST priority?
A. Airway patency [CORRECT]
B. Level of consciousness
C. Blood pressure
D. Pain level
Correct Answer: A
Rationale: Airway is always assessed first in the ABC framework; without a patent airway, all other assessments are
secondary.
Q2: Which finding is considered SUBJECTIVE data?
A. The patient states the pain is 8 out of 10 [CORRECT]
B. Respiratory rate of 24
C. Temperature of 38.6 C
D. A reddened skin area
Correct Answer: A
Rationale: Subjective data are reported by the patient; the pain rating is the patient's own report, whereas the other
items are observed or measured.
Q3: A patient has altered mental status and cannot provide a history. Which is the BEST source of
information?
A. Family members and the medical record [CORRECT]
B. The patient's roommate
C. The nurse's assumptions
D. Internet resources
Correct Answer: A
Rationale: Family or caregivers and the medical record provide the most reliable history when the patient cannot give
one.
Q4: Which screening tool is used to assess for problematic alcohol use?
A. CAGE questionnaire [CORRECT]
B. PHQ-9
C. Mini-Cog
D. Glasgow Coma Scale
Correct Answer: A
Rationale: The CAGE questionnaire screens for alcohol misuse; PHQ-9 screens for depression and Mini-Cog for
cognition.
Q5: Which heart sounds are normal in a healthy adult?
A. S1 and S2 [CORRECT]
B. S3 and S4
C. A systolic murmur
D. A friction rub
Correct Answer: A
Rationale: S1 (closure of AV valves) and S2 (closure of semilunar valves) are normal; S3, S4, and murmurs may
indicate pathology.
ANCC IQ Domains 1-5 Test Bank – Comprehensive Practice (2026/2027 Edition) Page 2
, Q6: A nurse notes a patient's pulse oximetry drops from 96% to 88% and the patient becomes dyspneic.
Which is the PRIORITY action?
A. Assess the airway and administer oxygen as ordered [CORRECT]
B. Document the change
C. Offer oral fluids
D. Defer action until the provider rounds
Correct Answer: A
Rationale: A drop in oxygen saturation with dyspnea requires immediate airway assessment and oxygen therapy.
Q7: Which is the correct order of the nursing process?
A. Assessment, diagnosis, planning, implementation, evaluation [CORRECT]
B. Planning, assessment, diagnosis, implementation, evaluation
C. Diagnosis, assessment, planning, evaluation, implementation
D. Assessment, planning, diagnosis, implementation, evaluation
Correct Answer: A
Rationale: The nursing process proceeds from assessment to diagnosis, planning, implementation, and evaluation.
Q8: Four patients arrive simultaneously. Which should the nurse assess FIRST?
A. A patient with acute crushing chest pain [CORRECT]
B. A patient requesting a refill of pain medication
C. A patient with a minor laceration
D. A patient scheduled for routine discharge teaching
Correct Answer: A
Rationale: Acute chest pain may indicate myocardial infarction, a life-threatening condition that takes priority under ABC
and triage principles.
Q9: An arterial blood gas shows pH 7.30, PaCO2 50 mmHg, and HCO3 24 mEq/L. The nurse interprets this
as:
A. Respiratory acidosis [CORRECT]
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct Answer: A
Rationale: Low pH with elevated PaCO2 and normal HCO3 indicates respiratory acidosis (hypoventilation).
Q10: Which is the normal serum potassium range?
A. 3.5 to 5.0 mEq/L [CORRECT]
B. 1.5 to 2.5 mEq/L
C. 6.0 to 8.0 mEq/L
D. 8.5 to 10.5 mEq/L
Correct Answer: A
Rationale: Normal serum potassium is 3.5-5.0 mEq/L; levels outside this range carry cardiac risk.
Q11: Which laboratory test BEST reflects kidney function?
A. Serum creatinine and BUN [CORRECT]
B. Hemoglobin A1c
C. Troponin
D. Amylase
Correct Answer: A
Rationale: Creatinine and BUN are the primary indicators of renal function.
ANCC IQ Domains 1-5 Test Bank – Comprehensive Practice (2026/2027 Edition) Page 3
, Q12: An elevated troponin level indicates:
A. Myocardial injury [CORRECT]
B. Liver dysfunction
C. Pancreatic inflammation
D. Renal failure
Correct Answer: A
Rationale: Troponin is a cardiac biomarker released with myocardial injury or infarction.
Q13: A patient on warfarin should have an INR maintained at approximately:
A. 2.0 to 3.0 [CORRECT]
B. 0.5 to 1.0
C. 4.0 to 5.0
D. 10 to 15
Correct Answer: A
Rationale: The therapeutic INR for most warfarin indications is 2.0-3.0; higher values increase bleeding risk.
Q14: Which laboratory test is used to monitor unfractionated heparin therapy?
A. aPTT [CORRECT]
B. INR
C. Hemoglobin
D. Bilirubin
Correct Answer: A
Rationale: Activated partial thromboplastin time (aPTT) monitors heparin; INR monitors warfarin.
Q15: A hemoglobin A1c of 8.5% indicates:
A. Poor long-term glucose control [CORRECT]
B. Excellent glucose control
C. Normal glucose metabolism
D. Recent hypoglycemia
Correct Answer: A
Rationale: A1c reflects average glucose over 2-3 months; values above 6.5-7% indicate suboptimal control.
Q16: Which finding suggests an infectious process?
A. White blood cell count of 18,000/mm3 [CORRECT]
B. Hemoglobin of 14 g/dL
C. Platelets of 250,000/mm3
D. Potassium of 4.0 mEq/L
Correct Answer: A
Rationale: An elevated white blood cell count (leukocytosis) commonly indicates infection.
Q17: Which is the normal platelet count?
A. 150,000 to 400,000/mm3 [CORRECT]
B. 5,000 to 10,000/mm3
C. 4.5 to 11 million/mm3
D. 50,000 to 80,000/mm3
Correct Answer: A
Rationale: Normal platelets range from 150,000 to 400,000 per cubic millimeter.
ANCC IQ Domains 1-5 Test Bank – Comprehensive Practice (2026/2027 Edition) Page 4
