ANCC Nurse Executive Certification Examination (NE-BC®) — Comprehensive
Practice Exam V2.0
Table of Contents
Section Content Domain Question Numbers Page
I Human Resource Management 1 – 50 1
II Quality and Safety 51 – 71 15
III Business Management 72 – 91 22
IV Health Care Delivery 92 – 125 28
Answer Key & Rationales 1 – 125 35
SECTION I: HUMAN RESOURCE MANAGEMENT
(40 Scored Questions — 32% of Exam)
• 1. A nurse executive at a 450-bed community hospital is implementing a new competency validation program. Staff have expressed
frustration with the frequency and format of current assessments. The executive has reviewed the ANA Nursing Administration Scope
and Standards of Practice and is now developing a comprehensive competency framework. Which of the following approaches best
aligns with professional standards and addresses staff concerns?
A. Continuing the current annual competency fair with minor modifications to reduce redundancy
<font color="red">••</font> B. Implementing a competency program that includes role-specific, ongoing validation with multiple
assessment methods, staff input, and alignment with the ANA Standards of Professional Performance
C. Eliminating all competency assessments except those required by regulatory agencies to reduce staff burden
D. Replacing all direct competency assessments with self-reported attestations of competence
Rationale: The ANA Nursing Administration Scope and Standards of Practice requires nurse executives to ensure competency
validation that is ongoing, role-specific, and uses multiple methods. Staff input and alignment with professional standards (Standard
12: Professional Practice Evaluation) are essential. Eliminating assessments or relying solely on self-report does not meet regulatory or
professional standards.
• 2. A nurse manager has received a complaint from a staff nurse that a coworker is making offensive comments about the nurse's
religious background. The manager has not observed the behavior directly. Under Title VII of the Civil Rights Act of 1964, what is the
manager's legal obligation?
A. Inform the complaining nurse that the manager cannot take action without firsthand observation of the behavior
B. Suggest that the two nurses resolve the matter informally without managerial involvement
,<font color="red">••</font> C. Conduct a prompt, thorough, and impartial investigation of the complaint and take appropriate
corrective action if the complaint is substantiated
D. Transfer the complaining nurse to another unit to avoid further conflict
Rationale: Under Title VII of the Civil Rights Act of 1964, employers have a legal obligation to investigate complaints of harassment
promptly and take appropriate corrective action. The investigation must be thorough and impartial, regardless of whether the
manager directly observed the behavior. Transferring the complainant or avoiding action does not satisfy legal obligations.
• 3. Which leadership theory is most appropriate for a nurse executive leading a nursing department through a significant
organizational restructuring that requires staff to develop new competencies and adapt to changing roles?
<font color="red">••</font> A. Situational leadership, adapting approach based on staff readiness and developmental level
B. Transactional leadership, using rewards and consequences to drive compliance
C. Laissez-faire leadership, allowing staff to determine their own path through the change
D. Authoritarian leadership, making all decisions centrally to ensure consistency
Rationale: Situational leadership theory proposes that effective leaders adapt their style based on team members' developmental level
and task complexity. During restructuring, staff will have varying levels of readiness and competence; the leader must adapt
accordingly—providing more direction for those with lower readiness and more delegation for those with higher readiness. This
flexibility is essential for navigating complex organizational change.
• 4. A nurse executive is developing a succession plan for key leadership positions, including nurse managers and directors. Which of
the following actions is most critical for ensuring organizational sustainability and leadership pipeline development?
<font color="red">••</font> A. Identifying high-potential internal candidates and providing them with targeted mentoring,
coaching, and developmental assignments
B. Maintaining a database of external recruitment agencies that can be engaged when vacancies occur
C. Focusing succession planning efforts exclusively on the chief nursing officer position
D. Waiting until a leadership position becomes vacant before beginning the search process
Rationale: Succession planning requires proactive identification and development of internal talent through mentoring, coaching, and
deliberate career development. This ensures leadership pipeline sustainability and organizational stability. Relying on external
recruitment or waiting until vacancies occur creates leadership gaps and organizational instability.
• 5. A nurse executive is analyzing employee engagement survey data from a medical-surgical unit that has experienced a 15%
turnover rate over the past 12 months. The unit's engagement scores are the lowest in the organization, particularly in the categories
of "recognition" and "opportunities for professional growth." Which of the following interventions has the strongest evidence for
improving engagement in this context?
<font color="red">••</font> A. Implementing a structured recognition program that includes peer-to-peer recognition, manager-
led appreciation, and alignment with organizational values, combined with creating clear professional development pathways
B. Increasing base salaries for all staff on the unit by 10% to address financial concerns
C. Reducing the unit's patient-to-nurse ratio by one patient per nurse to address workload concerns
D. Implementing a mandatory weekly staff meeting to discuss unit issues and concerns
Rationale: Recognition and professional development opportunities are consistently associated with higher employee engagement. A
comprehensive recognition program combined with clear development pathways addresses the specific areas of low engagement
,identified in the survey data. While compensation and workload are important, the evidence indicates that recognition and growth
opportunities are stronger drivers of engagement when these are the identified areas of concern.
• 6. Under the Family and Medical Leave Act (FMLA), an eligible employee requests intermittent leave to care for a spouse with a
serious health condition. The employee anticipates needing two days of leave per month for approximately six months. What is the
employer's obligation?
A. Deny the request because FMLA only applies to continuous, not intermittent, leave
B. Require the employee to use all accrued paid time off before FMLA leave can begin
<font color="red">••</font> C. Grant the intermittent leave request, provided the employee meets eligibility requirements and
the leave is medically necessary
D. Approve the request only if the employee provides documentation of the spouse's condition every 30 days
Rationale: FMLA entitles eligible employees to up to 12 weeks of unpaid, job-protected leave per 12-month period, which may be
taken intermittently when medically necessary. Employers may require medical certification but cannot require recertification more
frequently than every 30 days unless circumstances have changed.
• 7. A nurse executive is implementing a shared governance model across the nursing department. Which of the following elements is
essential for the success of this model?
A. Maintaining all decision-making authority at the executive level to ensure consistency
B. Assigning shared governance responsibilities exclusively to nurse managers
<font color="red">••</font> C. Establishing council structures with clear accountability, decision-making authority, and staff
representation at all levels of the organization
D. Focusing shared governance activities exclusively on quality improvement initiatives
Rationale: Shared governance requires council structures with clear accountability, decision-making authority, and staff representation
at all levels. It distributes authority, accountability, and decision-making to the point of care while maintaining professional
accountability. Successful shared governance empowers staff to participate in decisions affecting their practice and work environment.
• 8. A nurse executive is preparing to conduct a performance appraisal for a nurse manager. The manager has exceeded productivity
targets but has received complaints from staff about a dismissive communication style and lack of recognition. What is the most
appropriate approach to this performance appraisal?
A. Focus the appraisal exclusively on the manager's achievement of productivity targets, as these are objective measures
B. Delay the performance appraisal until the communication complaints have been fully investigated
<font color="red">••</font> C. Address both the productivity achievements and the communication concerns in the appraisal,
providing specific behavioral feedback and developing a performance improvement plan for communication
D. Lower the manager's overall rating based on the communication complaints without addressing the productivity achievements
Rationale: Effective performance management includes addressing both strengths and areas for improvement. The nurse executive
must provide specific, behavior-focused feedback on communication concerns while acknowledging productivity achievements. A
balanced approach that includes a performance improvement plan for identified areas supports professional development and aligns
with Standard 12 of the ANA Nursing Administration Scope and Standards of Practice.
• 9. A nurse executive is concerned about the high number of workplace violence incidents on a behavioral health unit. The executive
has reviewed the literature on workplace violence prevention. Which of the following strategies is most comprehensive and evidence-
, based for preventing workplace violence?
<font color="red">••</font> A. Implementing a comprehensive workplace violence prevention program that includes risk
assessment, staff training in de-escalation techniques, environmental controls, reporting systems, and post-incident support
B. Installing metal detectors at all entrances to the behavioral health unit
C. Requiring security guards to be present on the unit 24 hours per day
D. Restricting all visitors from the behavioral health unit to reduce potential triggers
Rationale: Comprehensive workplace violence prevention programs include risk assessment, staff training (including de-escalation),
environmental controls, reporting systems, and post-incident support. Single interventions are less effective than integrated
approaches. OSHA guidelines and high reliability principles emphasize the importance of comprehensive, multi-faceted approaches to
workplace safety.
• 10. A nurse executive is leading a change initiative to implement a new electronic health record system. Staff have expressed
significant anxiety about the change, and the executive has observed resistance from several key opinion leaders on the units. Which
change management framework would be most appropriate for this situation?
A. Conducting a root cause analysis of the resistance and addressing individual concerns on a case-by-case basis
<font color="red">••</font> B. Applying Kotter's 8-Step Change Model, beginning with creating a sense of urgency, building a
guiding coalition, and developing a vision and strategy
C. Implementing the change on a single pilot unit first, then evaluating and spreading to other units
D. Allowing staff to choose whether to adopt the new system or continue using the old system
Rationale: Kotter's 8-Step Change Model is specifically designed for leading organizational change and addressing resistance. It
begins with creating a sense of urgency, building a guiding coalition, and developing a vision and strategy—critical steps when
resistance is present. PDSA cycles are for quality improvement, not large-scale change management. Allowing choice undermines the
change initiative.
• 11. A nurse executive is reviewing the Americans with Disabilities Act (ADA) requirements in response to a request from a nurse with a
mobility impairment who uses a wheelchair. The nurse is qualified for a position that requires occasional patient transport. What is the
employer's obligation?
A. Deny the accommodation request because patient transport is an essential function of the position
B. Offer the nurse a different position that does not require patient transport
<font color="red">••</font> C. Engage in an interactive process to determine whether reasonable accommodations, such as
providing an electric wheelchair or modifying the transport process, would allow the nurse to perform essential functions without
undue hardship
D. Require the nurse to provide extensive medical documentation before considering any accommodation
Rationale: The ADA requires employers to engage in an interactive process to determine reasonable accommodations.
Accommodations must be considered unless they would cause undue hardship. The employer cannot simply deny the request without
exploring options. The interactive process is a legal requirement under the ADA.
• 12. Which of the following best describes the concept of cultural humility in nursing leadership?
A. Memorizing the cultural practices and beliefs of all patient populations served by the organization
B. Implementing mandatory annual diversity training for all staff members
Practice Exam V2.0
Table of Contents
Section Content Domain Question Numbers Page
I Human Resource Management 1 – 50 1
II Quality and Safety 51 – 71 15
III Business Management 72 – 91 22
IV Health Care Delivery 92 – 125 28
Answer Key & Rationales 1 – 125 35
SECTION I: HUMAN RESOURCE MANAGEMENT
(40 Scored Questions — 32% of Exam)
• 1. A nurse executive at a 450-bed community hospital is implementing a new competency validation program. Staff have expressed
frustration with the frequency and format of current assessments. The executive has reviewed the ANA Nursing Administration Scope
and Standards of Practice and is now developing a comprehensive competency framework. Which of the following approaches best
aligns with professional standards and addresses staff concerns?
A. Continuing the current annual competency fair with minor modifications to reduce redundancy
<font color="red">••</font> B. Implementing a competency program that includes role-specific, ongoing validation with multiple
assessment methods, staff input, and alignment with the ANA Standards of Professional Performance
C. Eliminating all competency assessments except those required by regulatory agencies to reduce staff burden
D. Replacing all direct competency assessments with self-reported attestations of competence
Rationale: The ANA Nursing Administration Scope and Standards of Practice requires nurse executives to ensure competency
validation that is ongoing, role-specific, and uses multiple methods. Staff input and alignment with professional standards (Standard
12: Professional Practice Evaluation) are essential. Eliminating assessments or relying solely on self-report does not meet regulatory or
professional standards.
• 2. A nurse manager has received a complaint from a staff nurse that a coworker is making offensive comments about the nurse's
religious background. The manager has not observed the behavior directly. Under Title VII of the Civil Rights Act of 1964, what is the
manager's legal obligation?
A. Inform the complaining nurse that the manager cannot take action without firsthand observation of the behavior
B. Suggest that the two nurses resolve the matter informally without managerial involvement
,<font color="red">••</font> C. Conduct a prompt, thorough, and impartial investigation of the complaint and take appropriate
corrective action if the complaint is substantiated
D. Transfer the complaining nurse to another unit to avoid further conflict
Rationale: Under Title VII of the Civil Rights Act of 1964, employers have a legal obligation to investigate complaints of harassment
promptly and take appropriate corrective action. The investigation must be thorough and impartial, regardless of whether the
manager directly observed the behavior. Transferring the complainant or avoiding action does not satisfy legal obligations.
• 3. Which leadership theory is most appropriate for a nurse executive leading a nursing department through a significant
organizational restructuring that requires staff to develop new competencies and adapt to changing roles?
<font color="red">••</font> A. Situational leadership, adapting approach based on staff readiness and developmental level
B. Transactional leadership, using rewards and consequences to drive compliance
C. Laissez-faire leadership, allowing staff to determine their own path through the change
D. Authoritarian leadership, making all decisions centrally to ensure consistency
Rationale: Situational leadership theory proposes that effective leaders adapt their style based on team members' developmental level
and task complexity. During restructuring, staff will have varying levels of readiness and competence; the leader must adapt
accordingly—providing more direction for those with lower readiness and more delegation for those with higher readiness. This
flexibility is essential for navigating complex organizational change.
• 4. A nurse executive is developing a succession plan for key leadership positions, including nurse managers and directors. Which of
the following actions is most critical for ensuring organizational sustainability and leadership pipeline development?
<font color="red">••</font> A. Identifying high-potential internal candidates and providing them with targeted mentoring,
coaching, and developmental assignments
B. Maintaining a database of external recruitment agencies that can be engaged when vacancies occur
C. Focusing succession planning efforts exclusively on the chief nursing officer position
D. Waiting until a leadership position becomes vacant before beginning the search process
Rationale: Succession planning requires proactive identification and development of internal talent through mentoring, coaching, and
deliberate career development. This ensures leadership pipeline sustainability and organizational stability. Relying on external
recruitment or waiting until vacancies occur creates leadership gaps and organizational instability.
• 5. A nurse executive is analyzing employee engagement survey data from a medical-surgical unit that has experienced a 15%
turnover rate over the past 12 months. The unit's engagement scores are the lowest in the organization, particularly in the categories
of "recognition" and "opportunities for professional growth." Which of the following interventions has the strongest evidence for
improving engagement in this context?
<font color="red">••</font> A. Implementing a structured recognition program that includes peer-to-peer recognition, manager-
led appreciation, and alignment with organizational values, combined with creating clear professional development pathways
B. Increasing base salaries for all staff on the unit by 10% to address financial concerns
C. Reducing the unit's patient-to-nurse ratio by one patient per nurse to address workload concerns
D. Implementing a mandatory weekly staff meeting to discuss unit issues and concerns
Rationale: Recognition and professional development opportunities are consistently associated with higher employee engagement. A
comprehensive recognition program combined with clear development pathways addresses the specific areas of low engagement
,identified in the survey data. While compensation and workload are important, the evidence indicates that recognition and growth
opportunities are stronger drivers of engagement when these are the identified areas of concern.
• 6. Under the Family and Medical Leave Act (FMLA), an eligible employee requests intermittent leave to care for a spouse with a
serious health condition. The employee anticipates needing two days of leave per month for approximately six months. What is the
employer's obligation?
A. Deny the request because FMLA only applies to continuous, not intermittent, leave
B. Require the employee to use all accrued paid time off before FMLA leave can begin
<font color="red">••</font> C. Grant the intermittent leave request, provided the employee meets eligibility requirements and
the leave is medically necessary
D. Approve the request only if the employee provides documentation of the spouse's condition every 30 days
Rationale: FMLA entitles eligible employees to up to 12 weeks of unpaid, job-protected leave per 12-month period, which may be
taken intermittently when medically necessary. Employers may require medical certification but cannot require recertification more
frequently than every 30 days unless circumstances have changed.
• 7. A nurse executive is implementing a shared governance model across the nursing department. Which of the following elements is
essential for the success of this model?
A. Maintaining all decision-making authority at the executive level to ensure consistency
B. Assigning shared governance responsibilities exclusively to nurse managers
<font color="red">••</font> C. Establishing council structures with clear accountability, decision-making authority, and staff
representation at all levels of the organization
D. Focusing shared governance activities exclusively on quality improvement initiatives
Rationale: Shared governance requires council structures with clear accountability, decision-making authority, and staff representation
at all levels. It distributes authority, accountability, and decision-making to the point of care while maintaining professional
accountability. Successful shared governance empowers staff to participate in decisions affecting their practice and work environment.
• 8. A nurse executive is preparing to conduct a performance appraisal for a nurse manager. The manager has exceeded productivity
targets but has received complaints from staff about a dismissive communication style and lack of recognition. What is the most
appropriate approach to this performance appraisal?
A. Focus the appraisal exclusively on the manager's achievement of productivity targets, as these are objective measures
B. Delay the performance appraisal until the communication complaints have been fully investigated
<font color="red">••</font> C. Address both the productivity achievements and the communication concerns in the appraisal,
providing specific behavioral feedback and developing a performance improvement plan for communication
D. Lower the manager's overall rating based on the communication complaints without addressing the productivity achievements
Rationale: Effective performance management includes addressing both strengths and areas for improvement. The nurse executive
must provide specific, behavior-focused feedback on communication concerns while acknowledging productivity achievements. A
balanced approach that includes a performance improvement plan for identified areas supports professional development and aligns
with Standard 12 of the ANA Nursing Administration Scope and Standards of Practice.
• 9. A nurse executive is concerned about the high number of workplace violence incidents on a behavioral health unit. The executive
has reviewed the literature on workplace violence prevention. Which of the following strategies is most comprehensive and evidence-
, based for preventing workplace violence?
<font color="red">••</font> A. Implementing a comprehensive workplace violence prevention program that includes risk
assessment, staff training in de-escalation techniques, environmental controls, reporting systems, and post-incident support
B. Installing metal detectors at all entrances to the behavioral health unit
C. Requiring security guards to be present on the unit 24 hours per day
D. Restricting all visitors from the behavioral health unit to reduce potential triggers
Rationale: Comprehensive workplace violence prevention programs include risk assessment, staff training (including de-escalation),
environmental controls, reporting systems, and post-incident support. Single interventions are less effective than integrated
approaches. OSHA guidelines and high reliability principles emphasize the importance of comprehensive, multi-faceted approaches to
workplace safety.
• 10. A nurse executive is leading a change initiative to implement a new electronic health record system. Staff have expressed
significant anxiety about the change, and the executive has observed resistance from several key opinion leaders on the units. Which
change management framework would be most appropriate for this situation?
A. Conducting a root cause analysis of the resistance and addressing individual concerns on a case-by-case basis
<font color="red">••</font> B. Applying Kotter's 8-Step Change Model, beginning with creating a sense of urgency, building a
guiding coalition, and developing a vision and strategy
C. Implementing the change on a single pilot unit first, then evaluating and spreading to other units
D. Allowing staff to choose whether to adopt the new system or continue using the old system
Rationale: Kotter's 8-Step Change Model is specifically designed for leading organizational change and addressing resistance. It
begins with creating a sense of urgency, building a guiding coalition, and developing a vision and strategy—critical steps when
resistance is present. PDSA cycles are for quality improvement, not large-scale change management. Allowing choice undermines the
change initiative.
• 11. A nurse executive is reviewing the Americans with Disabilities Act (ADA) requirements in response to a request from a nurse with a
mobility impairment who uses a wheelchair. The nurse is qualified for a position that requires occasional patient transport. What is the
employer's obligation?
A. Deny the accommodation request because patient transport is an essential function of the position
B. Offer the nurse a different position that does not require patient transport
<font color="red">••</font> C. Engage in an interactive process to determine whether reasonable accommodations, such as
providing an electric wheelchair or modifying the transport process, would allow the nurse to perform essential functions without
undue hardship
D. Require the nurse to provide extensive medical documentation before considering any accommodation
Rationale: The ADA requires employers to engage in an interactive process to determine reasonable accommodations.
Accommodations must be considered unless they would cause undue hardship. The employer cannot simply deny the request without
exploring options. The interactive process is a legal requirement under the ADA.
• 12. Which of the following best describes the concept of cultural humility in nursing leadership?
A. Memorizing the cultural practices and beliefs of all patient populations served by the organization
B. Implementing mandatory annual diversity training for all staff members
