NCC Certification Exam Study Guide: High-Yield Clinical Pearls
This is acomprehensive and concise study guidedesigned for advanced
practice registered nurses (APRNs) preparing for the ANCC certification exam.
The content is organized by key clinical domains to facilitate quick review and
targeted learning.
The guide is a goldmine of high-yield information, covering essential topics such
as:
● Pharmacology:High-risk medications, key adverse effects,black box
warnings, and drug interactions.
● Clinical Assessment:Differentiating between heartmurmurs, interpreting
physical exam findings (e.g., Murphy's sign, Prehn's sign), and
understanding laboratory values.
● Diagnosis & Management:Diagnostic criteria and evidence-based
treatment plans for common conditions in men's health, women's health,
infectious diseases, and pediatrics.
● Professional Practice:Essential knowledge for coding, billing, ethical
, considerations, and quality improvement.
Pharmacology
Gastrointestinal Medications
● H2 Antagonists (-tidine):
○ Examples: famotidine, cimetidine, nizatidine.
○ Adverse Effects (AE):Mental status changes in patientswith
kidney disease.
○ Caution:Avoid if creatinine clearance is <50 mL/minute.
● Proton Pump Inhibitors (PPIs) (-prazole):
○ AE:
■ Increased risk offractures(especially in postmenopausal
women).
■ Increased risk ofpneumonia,C. difficileinfection,
hypomagnesemia,B12 and iron malabsorption,
atrophic gastritis, and kidney disease.
○ Drug Interactions:Interacts with warfarin, diazepam,
carbamazepine, phenytoin, and ketoconazole.
Anticoagulants
● Vitamin K Antagonist (Warfarin):
○ AE:
■ Interacts with "G" herbs (garlic, ginger, gingko, ginseng),
feverfew, green tea, and fish oil.
■ Rarely causespurple toe syndromeor skin necrosis.
, ○ Monitoring INR:
■ Target INR:2.0-3.0 for A-fib, DVT, TIA, CVA.
■ Target INR:2.5-3.5 for mechanical mitral valves.
■ INR takes 5-7 days for full effect, but dose changeis
seen in 2-3 days.
■ Check stable INR every 2-4 weeks, up to 12 weeks.
■ For a single out-of-range INR (<0.5 above or below
target), recheck in 1-2 weeks.
■ If INR is <5 with no significant bleeding risk, omit a dose
or reduce the maintenance dose, then recheck.
○ Patient Education:Do NOT double upif a dose is missed.
Discontinue 7 days before surgery.
● Reversal Agents:
○ Warfarin:Vitamin K
○ Dabigatran:idarucizumab
○ Rivaroxaban (Xarelto) or Apixaban (Eliquis):andexanetalfa
○ Heparin:protamine sulfate
Diabetes Medications
● Thiazolidinediones (TZDs): pioglitazone (Actos), rosiglitazone(Avandia)
○ Black Box Warning:Can cause orexacerbate heart failure;
do NOT use in Class III or IV HF.
○ Contraindications:History of MI, stroke, bladder cancer, Type
1 diabetes, active liver disease.
○ AE:Weight gain, water retention, edema.
, ○ Patient Education:Stop if you experience dyspnea, weight
gain, or cough.
○ Monitoring:Monitor LFTs.
● Biguanides (Metformin):
○ AE:GI side effects (nausea, diarrhea).
○ Caution:Increased risk oflactic acidosisduringhypoxia,
hypoperfusion, or renal insufficiency.
○ Contraindications:Renal disease, hepatic disease,acidosis,
alcoholism.
○ Patient Education:Hold metformin on the day of IVcontrast
dye testing and for 48 hours after.
● Sulfonylureas (-ide):glipizide, glyburide, glimepiride
○ AE:Increased risk ofcardiovascular mortality, hypoglycemia,
blood dyscrasias.
○ Caution:Avoid if hepatic or renal impairment is present.Can
cause weight gain.
● DPP-4 Inhibitors (-gliptin):linagliptin, saxagliptin,sitagliptin
○ AE:Joint pain, angioedema, acute pancreatitis.
○ Benefit:No hypoglycemia, renoprotective effect.
○ Caution:Do NOT mix with incretin mimetics (e.g.,Byetta).
Antihypertensives
● Thiazide Diuretics: hydrochlorothiazide, chlorthalidone, indapamide
○ Indications:HTN, HF, edema.
○ Unique Benefit:Recommended for HTN with
This is acomprehensive and concise study guidedesigned for advanced
practice registered nurses (APRNs) preparing for the ANCC certification exam.
The content is organized by key clinical domains to facilitate quick review and
targeted learning.
The guide is a goldmine of high-yield information, covering essential topics such
as:
● Pharmacology:High-risk medications, key adverse effects,black box
warnings, and drug interactions.
● Clinical Assessment:Differentiating between heartmurmurs, interpreting
physical exam findings (e.g., Murphy's sign, Prehn's sign), and
understanding laboratory values.
● Diagnosis & Management:Diagnostic criteria and evidence-based
treatment plans for common conditions in men's health, women's health,
infectious diseases, and pediatrics.
● Professional Practice:Essential knowledge for coding, billing, ethical
, considerations, and quality improvement.
Pharmacology
Gastrointestinal Medications
● H2 Antagonists (-tidine):
○ Examples: famotidine, cimetidine, nizatidine.
○ Adverse Effects (AE):Mental status changes in patientswith
kidney disease.
○ Caution:Avoid if creatinine clearance is <50 mL/minute.
● Proton Pump Inhibitors (PPIs) (-prazole):
○ AE:
■ Increased risk offractures(especially in postmenopausal
women).
■ Increased risk ofpneumonia,C. difficileinfection,
hypomagnesemia,B12 and iron malabsorption,
atrophic gastritis, and kidney disease.
○ Drug Interactions:Interacts with warfarin, diazepam,
carbamazepine, phenytoin, and ketoconazole.
Anticoagulants
● Vitamin K Antagonist (Warfarin):
○ AE:
■ Interacts with "G" herbs (garlic, ginger, gingko, ginseng),
feverfew, green tea, and fish oil.
■ Rarely causespurple toe syndromeor skin necrosis.
, ○ Monitoring INR:
■ Target INR:2.0-3.0 for A-fib, DVT, TIA, CVA.
■ Target INR:2.5-3.5 for mechanical mitral valves.
■ INR takes 5-7 days for full effect, but dose changeis
seen in 2-3 days.
■ Check stable INR every 2-4 weeks, up to 12 weeks.
■ For a single out-of-range INR (<0.5 above or below
target), recheck in 1-2 weeks.
■ If INR is <5 with no significant bleeding risk, omit a dose
or reduce the maintenance dose, then recheck.
○ Patient Education:Do NOT double upif a dose is missed.
Discontinue 7 days before surgery.
● Reversal Agents:
○ Warfarin:Vitamin K
○ Dabigatran:idarucizumab
○ Rivaroxaban (Xarelto) or Apixaban (Eliquis):andexanetalfa
○ Heparin:protamine sulfate
Diabetes Medications
● Thiazolidinediones (TZDs): pioglitazone (Actos), rosiglitazone(Avandia)
○ Black Box Warning:Can cause orexacerbate heart failure;
do NOT use in Class III or IV HF.
○ Contraindications:History of MI, stroke, bladder cancer, Type
1 diabetes, active liver disease.
○ AE:Weight gain, water retention, edema.
, ○ Patient Education:Stop if you experience dyspnea, weight
gain, or cough.
○ Monitoring:Monitor LFTs.
● Biguanides (Metformin):
○ AE:GI side effects (nausea, diarrhea).
○ Caution:Increased risk oflactic acidosisduringhypoxia,
hypoperfusion, or renal insufficiency.
○ Contraindications:Renal disease, hepatic disease,acidosis,
alcoholism.
○ Patient Education:Hold metformin on the day of IVcontrast
dye testing and for 48 hours after.
● Sulfonylureas (-ide):glipizide, glyburide, glimepiride
○ AE:Increased risk ofcardiovascular mortality, hypoglycemia,
blood dyscrasias.
○ Caution:Avoid if hepatic or renal impairment is present.Can
cause weight gain.
● DPP-4 Inhibitors (-gliptin):linagliptin, saxagliptin,sitagliptin
○ AE:Joint pain, angioedema, acute pancreatitis.
○ Benefit:No hypoglycemia, renoprotective effect.
○ Caution:Do NOT mix with incretin mimetics (e.g.,Byetta).
Antihypertensives
● Thiazide Diuretics: hydrochlorothiazide, chlorthalidone, indapamide
○ Indications:HTN, HF, edema.
○ Unique Benefit:Recommended for HTN with
