ANCC certification exam with answers
2025/2026
H2 antagonists correct answers - famotidine
- cimetidine
- nizatidine
AE
- mental status changes with kidney disease
- avoid if kidney disease with creatinine clearance of < 50 mL/minute
PPI correct answers - prazole
AE
- increased risk of fractures (postmenopausal women), pneumonia, C Diff,
hypomagnesemia, B12 and iron malabsorption, atrophic gastritis, kidney disease
- Interacts with Warfarin, diazepam, carbamazepine, phenytoin, ketoconazole
Vitamin K anatagonist correct answers - warfarin
AE
- interacts with "G" herbs such as garlic, ginger, gingko, and ginseng, feverfew, green
tea, fish oil
- discontinue 7 days before surgery
INR
- a-fib, DVT, TIA, CVA 2.0 to 3.0
- mechanical mitral valves 2.5 to 3.5
- INR will increase 2-3 days after the warfarin dose but the full anticoagulation effect
takes longer 5-7 days
- check consistently stable INR q2-4 weeks up to 12 weeks
- single out of range <0.5 above or below repeat in 1-2 weeks
- INR < 5 with no significant risk of bleeding omit one dose and/or reduce maintenance
dose; recheck
- do NOT double up if missed dose
RARE: purple toe syndrome: skin necrosis located in subcutaneous fat, breasts,
extremities, trunk within first few days
TZDs correct answers - pioglitazone (Actos)
- BLACK BOX: cause or exacerbate HF; do NOT use if class III or IV
- contraindicated in HX of MI, Stroke, bladder ca, type I diabetes, eye or liver problems
- Stop if dyspnea, weight gain, cough
Atypical antipsychotics correct answers - risperidone
- olanzapine
,- quetiapine
AE
- weight gain, metabolic syndrome, type II diabetes, monitor weight q3months
- BLACK BOX: higher mortality in elderly
- Monitor TSH, lipids, blood glucose, weight/BMI
Bisphosphonates correct answers - alendronate
- risedronate
AE
- erosive esophagitis (chest pain when eating, odonophagia, dysphagia, heartburn) stop
immediately if s/s of esophagitis (chest pain, difficulty swallowing, boring mid back) or
jaw pain (oestonecrosis)
- take upon waking with 8-oz glass of water before breakfast; do not lie down for 30
minutes afterward; do not mix with other drugs
Contraindications: Active GI disease (GERD, PUD), CKD, esophageal strictures/varices
Statins correct answers - Do not mix with grapefruit juice, drug induced-hepatitis or
rhabdomyolysis higher if mixed with axle antifungals
- high dose simvastatin (zocor) 80mg has highest risk of rhabomyolysis
- CHINESE: higher risk of myopathy or rhabdomyolysis when taking simvastatin 40 mg
or higher with niacin
- CK elevated
lincosamides correct answers - Clindamycin (Cleocin)
- higher risk of CDAD
Inhaled Corticosteroids correct answers - adrenal insufficiency possible in children
(longterm > 6 months high dose in low BMI child)
- suspect if hypoglycemia, hypotension, altered mental status, weakness, and
cushingoid features
- growth decelerations or failure
systemic glucocorticoids correct answers - cataracts, osteoporosis, skin changes,
(telangiectasia, easy bruising), emotional liability, weight gain, high BP
Phenytoin correct answers - earliest sign of toxicity (horizontal nystagmus, unsteady
gait) if severe then slurred speech, lethargy, confusion, coma
- gingival hyperplasia
Digoxin correct answers - second/third line tx for HF with reduced ejection fraction
(HFrEF)
- therapeutic range 0.5-2.0 ng/mL
- suspect intake of poisonous plants with cardiac glycosides (foxglove, oleander, lily of
the valley) refer to ED
- life threatening effects: severe bradycardia, HB, V-tach, v-fib
,- overdose: GI (n/v), hyperkalemia, dysrhythmias, confusion, visual changes
(yellow/green)
reversal agents correct answers warfarin- vit K
Dabigatran - idarucizumab
rivaroxban (Xarelto) or apixaban (eliquis) - anceexanet alfa
heparin - protamine sulfate
Thiazide diuretics correct answers - HTN, HF, Edema, diabetes insipidus
- HTN accompanied by osteopenia or osteoporosis
- hydrochlorothiazide
- chlorthalidone
- Indapamide
Contradictions: Lithium/sulfa allergy (give K sparing instead)
AE: hyperglycemia, hyperlipidemia, hyperuricemia, hypokalemia
K+ sparing diuretics correct answers - alternatives for sulfa allergy
- triamterene
- Amiloride
- Spironolactone
- do NOT combine with ACEI/ARBs
BLACK BOX: increased risk of benign or malignant tumors
Loop diuretic correct answers - Edema from HF, cirrhosis, renal disease, HTN
- more potent than thiazides but short duration of action
- Furosemide
- Bumetanide
BLACK BOX: excessive lassie may lead to profound diuresis
- contraindicated for sulfa allergy
AE: HYPO- kalemia, natremia, mg, chlorine
- hypovolemia, hypotension
- pancreatitis, jaundice rash
- ototoxicity
captopril correct answers - ACEIs
- associated with agranulocytosis, neutropenia, and leukopenia
- monitor CBC
CCB correct answers - HTN, angina pectoris, coronary artery spasm, supra ventricular
dysthymia's, pulmonary HTN, hypertrophic cardiomyopathy, Raynaud's phenomenon
(1st line)
Dihydropyridines (vascular selective- HTN)
- cause peripheral edema, HA, flushing, lightheadedness
-dipine
- amlodipine and nifedipine may cause positional pedal edema
, -- reduce dose or take at night
Nondihydropyridines (myocardium selective- antiarthymic)
- may worsen CO and cause bradycardia and constipation
- verapamil ( do not mix with erythromycin or clarithromycin )
- diltiazem
contraindicated: AV block (2nd and 3rd degree), bradycardia, HFrEF
- may cause reflex tachycardia
Beta Blocker contraindications correct answers - Cardioselective BB more potent
(atenolol and metoprolol)
- X asthma, chronic bronchitis, COPD, emphysema, bradycardia, and no abrupt
discontinuation
neprilysin inhibitor and angioneurotic angioedema correct answers - sacubitril/valsartan
(entresto)
- adult HF (class II-IV), pediatric HF > 1 yr
BLACK BOX: fetal toxicity
contraindications: ACEIs, Aliskiren in diabetes, angioedema, renal artery stenosis
AE: hyperkalemia, angioedema, dizziness, cough
Alpha- blockers correct answers - relaxes smooth muscle on the bladder neck and the
prostate and improves s/s of BPH
- osin; recommended as initial therapy BUT terazosin and doxazosin can also lower BP
AE: orthostatic hypotension, dizziness, priapism (tamsulosin?Flomax)
*Do NOT give during cataract or glaucoma surgery- floppy iris syndrome*
First generation cephalosporins correct answers - Cephalexin (Reflex)
Skin: uncomplicated skin and soft tissue infections (not caused by MRSA) , impetigo
Pregnancy: UTI
Second generation cephalosporins correct answers - cefuroxime
- cefprozil
- cefaclor
ENT: Rhinosinusitis, OM
Lungs: CAP, exacerbation of chronic bronchitis
avoid using cefaclor because it does not cover common pathogens
Third Generation Cephalosporins correct answers - Ceftriaxone (Rocephin)
- Cefixime
- Cefdinir
STDs: Gonorrhea, PID
REnAL: polynephritis
ENT: OM in children, Rhinosinusitis, OM
GU: pyelonephritis
Lungs: CAP
2025/2026
H2 antagonists correct answers - famotidine
- cimetidine
- nizatidine
AE
- mental status changes with kidney disease
- avoid if kidney disease with creatinine clearance of < 50 mL/minute
PPI correct answers - prazole
AE
- increased risk of fractures (postmenopausal women), pneumonia, C Diff,
hypomagnesemia, B12 and iron malabsorption, atrophic gastritis, kidney disease
- Interacts with Warfarin, diazepam, carbamazepine, phenytoin, ketoconazole
Vitamin K anatagonist correct answers - warfarin
AE
- interacts with "G" herbs such as garlic, ginger, gingko, and ginseng, feverfew, green
tea, fish oil
- discontinue 7 days before surgery
INR
- a-fib, DVT, TIA, CVA 2.0 to 3.0
- mechanical mitral valves 2.5 to 3.5
- INR will increase 2-3 days after the warfarin dose but the full anticoagulation effect
takes longer 5-7 days
- check consistently stable INR q2-4 weeks up to 12 weeks
- single out of range <0.5 above or below repeat in 1-2 weeks
- INR < 5 with no significant risk of bleeding omit one dose and/or reduce maintenance
dose; recheck
- do NOT double up if missed dose
RARE: purple toe syndrome: skin necrosis located in subcutaneous fat, breasts,
extremities, trunk within first few days
TZDs correct answers - pioglitazone (Actos)
- BLACK BOX: cause or exacerbate HF; do NOT use if class III or IV
- contraindicated in HX of MI, Stroke, bladder ca, type I diabetes, eye or liver problems
- Stop if dyspnea, weight gain, cough
Atypical antipsychotics correct answers - risperidone
- olanzapine
,- quetiapine
AE
- weight gain, metabolic syndrome, type II diabetes, monitor weight q3months
- BLACK BOX: higher mortality in elderly
- Monitor TSH, lipids, blood glucose, weight/BMI
Bisphosphonates correct answers - alendronate
- risedronate
AE
- erosive esophagitis (chest pain when eating, odonophagia, dysphagia, heartburn) stop
immediately if s/s of esophagitis (chest pain, difficulty swallowing, boring mid back) or
jaw pain (oestonecrosis)
- take upon waking with 8-oz glass of water before breakfast; do not lie down for 30
minutes afterward; do not mix with other drugs
Contraindications: Active GI disease (GERD, PUD), CKD, esophageal strictures/varices
Statins correct answers - Do not mix with grapefruit juice, drug induced-hepatitis or
rhabdomyolysis higher if mixed with axle antifungals
- high dose simvastatin (zocor) 80mg has highest risk of rhabomyolysis
- CHINESE: higher risk of myopathy or rhabdomyolysis when taking simvastatin 40 mg
or higher with niacin
- CK elevated
lincosamides correct answers - Clindamycin (Cleocin)
- higher risk of CDAD
Inhaled Corticosteroids correct answers - adrenal insufficiency possible in children
(longterm > 6 months high dose in low BMI child)
- suspect if hypoglycemia, hypotension, altered mental status, weakness, and
cushingoid features
- growth decelerations or failure
systemic glucocorticoids correct answers - cataracts, osteoporosis, skin changes,
(telangiectasia, easy bruising), emotional liability, weight gain, high BP
Phenytoin correct answers - earliest sign of toxicity (horizontal nystagmus, unsteady
gait) if severe then slurred speech, lethargy, confusion, coma
- gingival hyperplasia
Digoxin correct answers - second/third line tx for HF with reduced ejection fraction
(HFrEF)
- therapeutic range 0.5-2.0 ng/mL
- suspect intake of poisonous plants with cardiac glycosides (foxglove, oleander, lily of
the valley) refer to ED
- life threatening effects: severe bradycardia, HB, V-tach, v-fib
,- overdose: GI (n/v), hyperkalemia, dysrhythmias, confusion, visual changes
(yellow/green)
reversal agents correct answers warfarin- vit K
Dabigatran - idarucizumab
rivaroxban (Xarelto) or apixaban (eliquis) - anceexanet alfa
heparin - protamine sulfate
Thiazide diuretics correct answers - HTN, HF, Edema, diabetes insipidus
- HTN accompanied by osteopenia or osteoporosis
- hydrochlorothiazide
- chlorthalidone
- Indapamide
Contradictions: Lithium/sulfa allergy (give K sparing instead)
AE: hyperglycemia, hyperlipidemia, hyperuricemia, hypokalemia
K+ sparing diuretics correct answers - alternatives for sulfa allergy
- triamterene
- Amiloride
- Spironolactone
- do NOT combine with ACEI/ARBs
BLACK BOX: increased risk of benign or malignant tumors
Loop diuretic correct answers - Edema from HF, cirrhosis, renal disease, HTN
- more potent than thiazides but short duration of action
- Furosemide
- Bumetanide
BLACK BOX: excessive lassie may lead to profound diuresis
- contraindicated for sulfa allergy
AE: HYPO- kalemia, natremia, mg, chlorine
- hypovolemia, hypotension
- pancreatitis, jaundice rash
- ototoxicity
captopril correct answers - ACEIs
- associated with agranulocytosis, neutropenia, and leukopenia
- monitor CBC
CCB correct answers - HTN, angina pectoris, coronary artery spasm, supra ventricular
dysthymia's, pulmonary HTN, hypertrophic cardiomyopathy, Raynaud's phenomenon
(1st line)
Dihydropyridines (vascular selective- HTN)
- cause peripheral edema, HA, flushing, lightheadedness
-dipine
- amlodipine and nifedipine may cause positional pedal edema
, -- reduce dose or take at night
Nondihydropyridines (myocardium selective- antiarthymic)
- may worsen CO and cause bradycardia and constipation
- verapamil ( do not mix with erythromycin or clarithromycin )
- diltiazem
contraindicated: AV block (2nd and 3rd degree), bradycardia, HFrEF
- may cause reflex tachycardia
Beta Blocker contraindications correct answers - Cardioselective BB more potent
(atenolol and metoprolol)
- X asthma, chronic bronchitis, COPD, emphysema, bradycardia, and no abrupt
discontinuation
neprilysin inhibitor and angioneurotic angioedema correct answers - sacubitril/valsartan
(entresto)
- adult HF (class II-IV), pediatric HF > 1 yr
BLACK BOX: fetal toxicity
contraindications: ACEIs, Aliskiren in diabetes, angioedema, renal artery stenosis
AE: hyperkalemia, angioedema, dizziness, cough
Alpha- blockers correct answers - relaxes smooth muscle on the bladder neck and the
prostate and improves s/s of BPH
- osin; recommended as initial therapy BUT terazosin and doxazosin can also lower BP
AE: orthostatic hypotension, dizziness, priapism (tamsulosin?Flomax)
*Do NOT give during cataract or glaucoma surgery- floppy iris syndrome*
First generation cephalosporins correct answers - Cephalexin (Reflex)
Skin: uncomplicated skin and soft tissue infections (not caused by MRSA) , impetigo
Pregnancy: UTI
Second generation cephalosporins correct answers - cefuroxime
- cefprozil
- cefaclor
ENT: Rhinosinusitis, OM
Lungs: CAP, exacerbation of chronic bronchitis
avoid using cefaclor because it does not cover common pathogens
Third Generation Cephalosporins correct answers - Ceftriaxone (Rocephin)
- Cefixime
- Cefdinir
STDs: Gonorrhea, PID
REnAL: polynephritis
ENT: OM in children, Rhinosinusitis, OM
GU: pyelonephritis
Lungs: CAP
