Nursing Acceleration
Challenge Exam (NACE)
2026/2027
Short Description of the NACE
The Nursing Acceleration Challenge Exam (NACE) is a standardized
examination developed and administered by the National League for Nursing
(NLN). Its primary purpose is to facilitate educational mobility by providing a
valid and reliable instrument for diagnostic evaluation of the nursing knowledge of
individuals—most commonly Licensed Practical Nurses (LPNs) or Licensed
Vocational Nurses (LVNs)—who are seeking advanced placement in a registered
nursing (RN) program. By successfully passing the NACE, candidates may be
awarded credit for foundational nursing courses, thereby shortening the overall
duration of their nursing education.
The NACE is computer-based and remotely proctored, allowing candidates to
test from a secure location. The examination is multiple-choice and is structured
around the nursing process (Assessing, Analyzing, Planning, Implementing, and
Evaluating). The NACE series is organized into several distinct content-area
examinations, including:
• Foundations of Nursing (approximately 100 items) – Basic physiological
and psychosocial needs, fundamentals of nursing practice.
• Care of the Adult Client (approximately 200 items) – Adult health nursing,
including drug administration, nutrition, and nursing interventions.
• Care of the Child (approximately 100 items) – Pediatric nursing.
• Care of the Childbearing Family (approximately 100 items) – Maternal–
newborn nursing.
• Care of the Client with Mental Disorder – Psychiatric–mental health
nursing.
,Performance on the NACE is reported as a criterion-referenced score, and
individual institutions set their own decision scores (passing standards), which
typically range from approximately 62% to 74%, depending on the specific
examination and the program's requirements. Preparation should focus on
NCLEX-PN®-level content, nursing fundamentals, and clinical reasoning across
the lifespan.
The following 300-question practice examination is designed to reflect the
content domains and the nursing-process framework of the NACE. It is organized
into five sections that mirror the NACE content areas. Each question is followed
by the correct answer and a detailed rationale to reinforce learning and clinical
judgment.
SECTION I: FOUNDATIONS OF NURSING (Questions 1–100)
1. A nurse is caring for a client who is scheduled for surgery. Which of the
following actions should the nurse take first?
A. Administer the preoperative medication.
B. Verify the informed consent is signed.
C. Obtain the client's vital signs.
D. Teach the client about postoperative exercises.
Answer: B
Rationale: The nurse's first action should be to verify that the informed consent
has been properly signed and witnessed. Surgery cannot legally proceed without
valid consent. While vital signs and teaching are important, confirming consent is
the priority before any surgical preparation.
2. A client with a new diagnosis of diabetes mellitus is learning to self-
administer insulin. Which statement by the client indicates a need for further
teaching?
A. "I will rotate injection sites to prevent tissue damage."
B. "I will use the same site each day for consistency."
C. "I will check my blood glucose before meals."
D. "I will report any redness or swelling at the injection site."
Answer: B
Rationale: Using the same injection site repeatedly can cause lipohypertrophy or
lipoatrophy, leading to erratic insulin absorption. Sites should be rotated
systematically.
,3. A nurse is assessing a client for signs of dehydration. Which finding is most
indicative of fluid volume deficit?
A. Bounding pulse
B. Decreased urine output
C. Crackles in the lungs
D. Peripheral edema
Answer: B
Rationale: Decreased urine output is a classic sign of fluid volume deficit as the
kidneys attempt to conserve water. Bounding pulse, crackles, and edema are
associated with fluid overload.
4. A
clientxisxplacedxonxcontactxprecautions.xWhichxpersonalxprotectivexequipmentx
isxessentialxforxthexnursextoxwearxwhenxenteringxthexroom?
A.xGlovesxandxgown
B.xMaskxandxgoggles
C.xGownxandxmask
D.xGlovesxonly
Answer:xA
Rationale:xContactxprecautionsxrequirexglovesxandxaxgownxforxanyxcontactxwithxth
exclientxorxcontaminatedxsurfaces.xAxmaskxisxnotxrequiredxunlessxtherexisxaxriskxofxs
plashingxorxthexclientxhasxaxrespiratoryxinfectionxrequiringxdropletxprecautions.
5.xAxnursexisxteachingxaxclientxaboutxaxlow-
sodiumxdiet.xWhichxfoodxshouldxthexclientxbexinstructedxtoxavoid?
A.xFreshxfruits
B.xCannedxsoups
C.xPlainxrice
D.xFreshxvegetables
Answer:xB
Rationale:xCannedxsoupsxarexhighxinxsodiumxduextoxaddedxsaltxduringxprocessing.x
Freshxfoodsxarexgenerallyxlowerxinxsodium.
6.xAxclientxreportsxdifficultyxsleeping.xWhichxnursingxinterventionxisxmostxapp
ropriatexinitially?
A.xAdministerxaxprescribedxsedative.
B.xEncouragexthexclientxtoxtakexaxwarmxbathxbeforexbed.
, C.xRestrictxallxfluidsxafterx6xPM.
D.xKeepxthextelevisionxonxforxdistraction.
Answer:xB
Rationale:xNon-
pharmacologicalxinterventionsxshouldxbexattemptedxfirst.xAxwarmxbathxpromotesxre
laxationxandxsleepxhygiene.xSedativesxarexusedxwhenxotherxmeasuresxfail.
7.xAxnursexisxperformingxaxsterilexdressingxchange.xWhichxactionxviolatesxsteri
lextechnique?
A.xKeepingxthexsterilexfieldxabovexwaistxlevel
B.xTurningxawayxfromxthexsterilexfieldxtoxsneeze
C.xUsingxsterilexglovesxtoxhandlexsterilexsupplies
D.xOpeningxsterilexpackagesxawayxfromxthexbody
Answer:xB
Rationale:xTurningxawayxfromxthexsterilexfieldxandxsneezingxcontaminatesxthexfiel
d.xThexnursexshouldxstepxawayxandxturnxcompletelyxaway,xorxhavexanotherxpersonxt
akexover.
8.xAxclientxisxatxriskxforxpressurexinjuries.xWhichxinterventionxisxmostximporta
nt?
A.xRepositioningxthexclientxeveryx2xhours
B.xMassagingxbonyxprominences
C.xKeepingxthexheadxofxthexbedxelevatedxatx90xdegrees
D.xApplyingxtight-fittingxsheets
Answer:xA
Rationale:xRegularxrepositioningxrelievesxpressurexoverxbonyxprominencesxandxisx
thexcornerstonexofxpressurexinjuryxprevention.xMassagingxreddenedxareasxisxnoxlon
gerxrecommended.
9.xAxnursexisxcalculatingxthexintakexandxoutputxforxaxclient.xWhichxitemxshoul
dxbexrecordedxasxintake?
A.xUrine
B.xVomitus
C.xIcexchips
D.xWoundxdrainage
Challenge Exam (NACE)
2026/2027
Short Description of the NACE
The Nursing Acceleration Challenge Exam (NACE) is a standardized
examination developed and administered by the National League for Nursing
(NLN). Its primary purpose is to facilitate educational mobility by providing a
valid and reliable instrument for diagnostic evaluation of the nursing knowledge of
individuals—most commonly Licensed Practical Nurses (LPNs) or Licensed
Vocational Nurses (LVNs)—who are seeking advanced placement in a registered
nursing (RN) program. By successfully passing the NACE, candidates may be
awarded credit for foundational nursing courses, thereby shortening the overall
duration of their nursing education.
The NACE is computer-based and remotely proctored, allowing candidates to
test from a secure location. The examination is multiple-choice and is structured
around the nursing process (Assessing, Analyzing, Planning, Implementing, and
Evaluating). The NACE series is organized into several distinct content-area
examinations, including:
• Foundations of Nursing (approximately 100 items) – Basic physiological
and psychosocial needs, fundamentals of nursing practice.
• Care of the Adult Client (approximately 200 items) – Adult health nursing,
including drug administration, nutrition, and nursing interventions.
• Care of the Child (approximately 100 items) – Pediatric nursing.
• Care of the Childbearing Family (approximately 100 items) – Maternal–
newborn nursing.
• Care of the Client with Mental Disorder – Psychiatric–mental health
nursing.
,Performance on the NACE is reported as a criterion-referenced score, and
individual institutions set their own decision scores (passing standards), which
typically range from approximately 62% to 74%, depending on the specific
examination and the program's requirements. Preparation should focus on
NCLEX-PN®-level content, nursing fundamentals, and clinical reasoning across
the lifespan.
The following 300-question practice examination is designed to reflect the
content domains and the nursing-process framework of the NACE. It is organized
into five sections that mirror the NACE content areas. Each question is followed
by the correct answer and a detailed rationale to reinforce learning and clinical
judgment.
SECTION I: FOUNDATIONS OF NURSING (Questions 1–100)
1. A nurse is caring for a client who is scheduled for surgery. Which of the
following actions should the nurse take first?
A. Administer the preoperative medication.
B. Verify the informed consent is signed.
C. Obtain the client's vital signs.
D. Teach the client about postoperative exercises.
Answer: B
Rationale: The nurse's first action should be to verify that the informed consent
has been properly signed and witnessed. Surgery cannot legally proceed without
valid consent. While vital signs and teaching are important, confirming consent is
the priority before any surgical preparation.
2. A client with a new diagnosis of diabetes mellitus is learning to self-
administer insulin. Which statement by the client indicates a need for further
teaching?
A. "I will rotate injection sites to prevent tissue damage."
B. "I will use the same site each day for consistency."
C. "I will check my blood glucose before meals."
D. "I will report any redness or swelling at the injection site."
Answer: B
Rationale: Using the same injection site repeatedly can cause lipohypertrophy or
lipoatrophy, leading to erratic insulin absorption. Sites should be rotated
systematically.
,3. A nurse is assessing a client for signs of dehydration. Which finding is most
indicative of fluid volume deficit?
A. Bounding pulse
B. Decreased urine output
C. Crackles in the lungs
D. Peripheral edema
Answer: B
Rationale: Decreased urine output is a classic sign of fluid volume deficit as the
kidneys attempt to conserve water. Bounding pulse, crackles, and edema are
associated with fluid overload.
4. A
clientxisxplacedxonxcontactxprecautions.xWhichxpersonalxprotectivexequipmentx
isxessentialxforxthexnursextoxwearxwhenxenteringxthexroom?
A.xGlovesxandxgown
B.xMaskxandxgoggles
C.xGownxandxmask
D.xGlovesxonly
Answer:xA
Rationale:xContactxprecautionsxrequirexglovesxandxaxgownxforxanyxcontactxwithxth
exclientxorxcontaminatedxsurfaces.xAxmaskxisxnotxrequiredxunlessxtherexisxaxriskxofxs
plashingxorxthexclientxhasxaxrespiratoryxinfectionxrequiringxdropletxprecautions.
5.xAxnursexisxteachingxaxclientxaboutxaxlow-
sodiumxdiet.xWhichxfoodxshouldxthexclientxbexinstructedxtoxavoid?
A.xFreshxfruits
B.xCannedxsoups
C.xPlainxrice
D.xFreshxvegetables
Answer:xB
Rationale:xCannedxsoupsxarexhighxinxsodiumxduextoxaddedxsaltxduringxprocessing.x
Freshxfoodsxarexgenerallyxlowerxinxsodium.
6.xAxclientxreportsxdifficultyxsleeping.xWhichxnursingxinterventionxisxmostxapp
ropriatexinitially?
A.xAdministerxaxprescribedxsedative.
B.xEncouragexthexclientxtoxtakexaxwarmxbathxbeforexbed.
, C.xRestrictxallxfluidsxafterx6xPM.
D.xKeepxthextelevisionxonxforxdistraction.
Answer:xB
Rationale:xNon-
pharmacologicalxinterventionsxshouldxbexattemptedxfirst.xAxwarmxbathxpromotesxre
laxationxandxsleepxhygiene.xSedativesxarexusedxwhenxotherxmeasuresxfail.
7.xAxnursexisxperformingxaxsterilexdressingxchange.xWhichxactionxviolatesxsteri
lextechnique?
A.xKeepingxthexsterilexfieldxabovexwaistxlevel
B.xTurningxawayxfromxthexsterilexfieldxtoxsneeze
C.xUsingxsterilexglovesxtoxhandlexsterilexsupplies
D.xOpeningxsterilexpackagesxawayxfromxthexbody
Answer:xB
Rationale:xTurningxawayxfromxthexsterilexfieldxandxsneezingxcontaminatesxthexfiel
d.xThexnursexshouldxstepxawayxandxturnxcompletelyxaway,xorxhavexanotherxpersonxt
akexover.
8.xAxclientxisxatxriskxforxpressurexinjuries.xWhichxinterventionxisxmostximporta
nt?
A.xRepositioningxthexclientxeveryx2xhours
B.xMassagingxbonyxprominences
C.xKeepingxthexheadxofxthexbedxelevatedxatx90xdegrees
D.xApplyingxtight-fittingxsheets
Answer:xA
Rationale:xRegularxrepositioningxrelievesxpressurexoverxbonyxprominencesxandxisx
thexcornerstonexofxpressurexinjuryxprevention.xMassagingxreddenedxareasxisxnoxlon
gerxrecommended.
9.xAxnursexisxcalculatingxthexintakexandxoutputxforxaxclient.xWhichxitemxshoul
dxbexrecordedxasxintake?
A.xUrine
B.xVomitus
C.xIcexchips
D.xWoundxdrainage
