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100+ Free ACCNS-AG Practice Questions

Pass your AACN Adult-Gerontology Acute Care Clinical Nurse Specialist exam on the first try — instant access, no signup required.

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Question 1
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Per the NACNS Statement on CNS Practice, which of the following is NOT one of the three spheres of impact in CNS practice?

A
B
C
D
to track
2026 Statistics

Key Facts: ACCNS-AG Exam

175

Total Items

AACN ACCNS-AG handbook

150 + 25

Scored + Pretest

AACN ACCNS-AG handbook

3.5h

Exam Time

AACN ACCNS-AG handbook

8

Synergy Nurse Competencies

AACN Synergy Model

3

CNS Spheres of Impact

NACNS Statement on CNS Practice

$270/$380

Member/Nonmember Fee

AACN ACCNS-AG page

2017

Replaced CCNS

AACN CNS exam transition

AACN's ACCNS-AG exam delivers 175 items (150 scored + 25 pretest) in 3.5 hours and replaced the retired CCNS exam in 2017. Content is built on the AACN Synergy Model: the eight Nurse Competencies (Clinical Judgment, Caring Practices, Collaboration, Systems Thinking, Response to Diversity, Clinical Inquiry, Facilitation of Learning, Advocacy/Moral Agency) plus adult-gerontology acute-care content covering geriatric syndromes, Beers Criteria, sepsis bundles, ABCDEF ICU bundle, and CNS-specific scope under the APRN Consensus Model. Fees are $270 AACN members / $380 non-members.

Sample ACCNS-AG Practice Questions

Try these sample questions to test your ACCNS-AG exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Per the NACNS Statement on CNS Practice, which of the following is NOT one of the three spheres of impact in CNS practice?
A.Patient/family sphere
B.Nurses and nursing practice sphere
C.Organization/system sphere
D.Physician collaboration sphere
Explanation: The NACNS framework defines exactly three CNS spheres of impact: (1) patient/family, (2) nurses and nursing practice, and (3) organization/system. Physician collaboration is a CNS competency but is not a separate sphere; it is interwoven across all three.
2The AACN Synergy Model matches patient/family characteristics with how many Nurse Competencies?
A.Five
B.Six
C.Eight
D.Ten
Explanation: The Synergy Model identifies eight Nurse Competencies: clinical judgment, caring practices, collaboration, systems thinking, response to diversity, clinical inquiry, facilitation of learning, and advocacy/moral agency. These are matched to eight patient characteristics.
3An 82-year-old admitted for hip fracture suddenly becomes inattentive, fluctuating in alertness with disorganized thinking. Which validated tool BEST identifies the likely syndrome?
A.Mini-Mental State Examination (MMSE)
B.Confusion Assessment Method (CAM)
C.Geriatric Depression Scale-15
D.Morse Falls Scale
Explanation: The Confusion Assessment Method (CAM) is the validated bedside screen for delirium. It requires (1) acute onset and fluctuating course AND (2) inattention, plus either (3) disorganized thinking OR (4) altered level of consciousness. The vignette describes classic hyperactive/mixed delirium.
4Per the Surviving Sepsis Campaign Hour-1 bundle, which intervention is recommended for adult patients with sepsis-induced hypotension?
A.Begin colloid resuscitation at 10 mL/kg
B.Administer 30 mL/kg crystalloid IV fluids
C.Start vasopressors before fluid resuscitation
D.Wait for lactate result before fluid administration
Explanation: The Surviving Sepsis Campaign Hour-1 bundle recommends 30 mL/kg crystalloid for sepsis-induced hypotension or lactate >=4 mmol/L, ideally completed within 3 hours. Crystalloid (not colloid) is first-line.
5The ABCDEF bundle for ICU liberation includes all the following EXCEPT:
A.Assess, prevent, and manage pain
B.Both spontaneous awakening and breathing trials
C.Daily chlorhexidine bathing
D.Early mobility and exercise
Explanation: The SCCM ABCDEF bundle = Assess/manage pain, Both SAT/SBT, Choice of analgesia/sedation, Delirium assess/prevent/manage, Early mobility, Family engagement. Daily chlorhexidine bathing is a CLABSI/MRSA reduction strategy but is not part of the ABCDEF bundle.
6A CNS leads a unit-based effort to redesign the discharge process to reduce 30-day readmissions for heart failure patients. Which CNS sphere of impact is the PRIMARY focus?
A.Patient/family sphere
B.Nurses and nursing practice sphere
C.Organization/system sphere
D.Interprofessional sphere
Explanation: Redesigning a discharge process to alter readmission rates is system-level work — protocols, throughput, and population outcomes — placing it in the organization/system sphere. Direct teaching of one patient would be patient/family; coaching staff how to deliver the new teach-back would be the nurses/nursing practice sphere.
7Per the 2023 AGS Beers Criteria, which medication class should generally be AVOIDED in older adults due to increased risk of delirium and falls?
A.ACE inhibitors
B.First-generation antihistamines (e.g., diphenhydramine)
C.Statins
D.Loop diuretics
Explanation: First-generation antihistamines (diphenhydramine, hydroxyzine) carry strong anticholinergic effects and are explicitly listed in the 2023 AGS Beers Criteria as potentially inappropriate in older adults due to delirium, sedation, falls, and constipation risk.
8Which of the following BEST describes how the CNS role differs from the NP role under the APRN Consensus Model?
A.CNSs cannot prescribe medications in any U.S. state
B.CNSs focus on systems improvement and indirect care alongside direct care, while NPs primarily deliver direct patient care
C.Only NPs are recognized as APRNs under the Consensus Model
D.CNSs do not require graduate education
Explanation: Under the APRN Consensus Model (LACE), CNS and NP are both APRN roles. The defining difference is emphasis: CNS practice integrates direct care with substantial indirect care — system improvement, staff development, EBP implementation across the three spheres — while NP practice is dominantly direct-care focused.
9A 76-year-old on warfarin presents with melena, BP 88/52, HR 118, Hgb 7.2 g/dL. INR is 5.8. Which intervention should the CNS recommend FIRST?
A.Hold warfarin and recheck INR in 24 hours
B.Administer 4-factor prothrombin complex concentrate (PCC) and IV vitamin K, with crystalloid resuscitation
C.Give fresh frozen plasma alone, then transfer to ICU
D.Administer IV protamine sulfate
Explanation: Active major bleeding with hemodynamic instability and INR 5.8 warrants emergent reversal: 4-factor PCC + IV vitamin K is now first-line over FFP per CHEST/ASH guidance because it reverses faster and avoids volume overload. Crystalloid (and likely PRBC) supports perfusion.
10A CNS is asked to reduce CAUTI rates in a 24-bed ICU. Which intervention has the STRONGEST evidence base?
A.Routine antimicrobial-coated catheters for all ICU patients
B.Daily review of catheter necessity with prompt removal when not indicated
C.Routine bladder irrigation with normal saline
D.Switching to suprapubic catheters by default
Explanation: The single highest-impact CAUTI prevention intervention per CDC/SHEA bundles is daily assessment of catheter necessity with prompt removal; cumulative catheter days drive CAUTI risk. Nurse-driven removal protocols are evidence-based system interventions.

About the ACCNS-AG Exam

ACCNS-AG is AACN's CNS specialty certification for advanced practice nurses delivering wellness-through-acute-care services to adult and geriatric patients. The exam emphasizes the AACN Synergy Model competencies and the three CNS spheres of impact: patient/family, nurses/nursing practice, and organization/system.

Questions

175 scored questions

Time Limit

3.5 hours

Passing Score

Scaled cut score (criterion-referenced)

Exam Fee

$270 AACN members / $380 non-members (AACN Certification Corporation / PSI)

ACCNS-AG Exam Content Outline

25%

Clinical Judgment

Differential diagnosis, multi-system organ failure, and complex acute/critical illness in adult-gero patients

10%

Caring Practices

Symptom management, pain assessment, palliative care, and end-of-life support

10%

Collaboration

Interprofessional team leadership and CNS consultation

10%

Systems Thinking

Care coordination, transitions of care, throughput, length of stay, population-level improvement

5%

Response to Diversity

Cultural humility, health disparities, social determinants of health

10%

Clinical Inquiry

Evidence-based practice, research utilization, PICOT, quality improvement

10%

Facilitation of Learning

Staff development, competency, patient/family education

5%

Advocacy and Moral Agency

Ethics, advance directives, end-of-life decision-making

5%

CNS Scope and APRN Consensus Model

Three spheres of impact, NACNS framework, CNS vs NP role differentiation under LACE

10%

Adult-Gerontology Specifics

Geriatric syndromes, Beers Criteria, STOPP/START, common acute presentations (sepsis, ARDS, ACS, stroke, AKI, GI bleed, DKA)

How to Pass the ACCNS-AG Exam

What You Need to Know

  • Passing score: Scaled cut score (criterion-referenced)
  • Exam length: 175 questions
  • Time limit: 3.5 hours
  • Exam fee: $270 AACN members / $380 non-members

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

ACCNS-AG Study Tips from Top Performers

1Memorize the eight AACN Synergy Model Nurse Competencies and the eight Patient/Family characteristics
2Drill the three NACNS CNS spheres of impact and which interventions belong in each sphere
3Practice geriatric syndrome screens (CAM for delirium, Mini-Cog, Morse Falls Scale, GDS-15)
4Learn 2023 Beers Criteria potentially inappropriate medications and STOPP/START high-yield rules
5Train Surviving Sepsis hour-1 bundle and ICU ABCDEF bundle until they are automatic
6Distinguish CNS scope from NP scope under the APRN Consensus Model (LACE)

Frequently Asked Questions

How many questions are on the ACCNS-AG exam?

AACN's ACCNS-AG exam has 175 multiple-choice items: 150 scored and 25 pretest (unscored).

How long is the ACCNS-AG exam?

AACN allots a 3.5-hour exam appointment for ACCNS-AG testing.

What is the ACCNS-AG exam fee?

AACN's handbook lists $270 for AACN members and $380 for non-members.

What replaced the CCNS exam?

AACN retired the population-neutral CCNS exam and replaced it in 2017 with three population-specific CNS exams including ACCNS-AG (adult-gerontology acute care).

What framework does ACCNS-AG use?

ACCNS-AG is built on the AACN Synergy Model, which matches eight Nurse Competencies (clinical judgment, caring practices, collaboration, systems thinking, response to diversity, clinical inquiry, facilitation of learning, advocacy) to patient/family characteristics.

What are the three CNS spheres of impact?

Per the NACNS framework, the three CNS spheres are: (1) patient/family, (2) nurses and nursing practice, and (3) organization/system. ACCNS-AG questions test integration across all three.

How is CNS different from NP?

Both are APRNs under the Consensus Model, but CNS practice emphasizes systems-level improvement, staff development, and indirect care alongside direct care, while NPs focus primarily on direct patient care and prescriptive management.