100+ Free ACCNS-N Practice Questions

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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?

Patient/family sphere

Nurses and nursing practice sphere

Organization/system sphere

Neonatologist collaboration sphere

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2026 Statistics

Key Facts: ACCNS-N Exam

175

Total Items

AACN ACCNS-N handbook

150 + 25

Scored + Pretest

AACN ACCNS-N handbook

3.5h

Exam Time

AACN ACCNS-N handbook

Synergy Nurse Competencies

AACN Synergy Model

CNS Spheres of Impact

NACNS Statement on CNS Practice

$270/$380

Member/Nonmember Fee

AACN ACCNS-N page

2017

Replaced CCNS

AACN CNS exam transition

AACN's ACCNS-N exam delivers 175 items (150 scored + 25 pretest) in 3.5 hours and replaced the retired CCNS exam in 2017 with population-specific CNS testing. Content is built on the AACN Synergy Model (eight Nurse Competencies: Clinical Judgment, Caring Practices, Collaboration, Systems Thinking, Response to Diversity, Clinical Inquiry, Facilitation of Learning, Advocacy/Moral Agency) plus neonatal acute-care content covering RDS/BPD, PPHN, HIE/cooling, IVH, NEC, neonatal sepsis, and CNS-specific scope under the APRN Consensus Model. Fees are $270 AACN members / $380 non-members.

Sample ACCNS-N Practice Questions

Try these sample questions to test your ACCNS-N 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.Neonatologist 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. Collaboration with neonatology is a CNS competency woven across all three spheres but is not itself a separate sphere.

2The AACN Synergy Model matches neonatal 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/family characteristics.

3A 36-week neonate develops grunting, retractions, and tachypnea within 30 minutes of birth. Chest X-ray shows diffuse ground-glass opacities and air bronchograms. The MOST likely diagnosis is:

A.Transient tachypnea of the newborn (TTN)

B.Respiratory distress syndrome (RDS)

C.Meconium aspiration syndrome (MAS)

D.Congenital pneumonia

Explanation: Diffuse ground-glass appearance with air bronchograms is the classic radiographic pattern of surfactant deficiency RDS, which still occurs in late preterm infants. Onset within minutes of birth and progressive distress are typical.

4Which intervention is the cornerstone of treatment for surfactant-deficient RDS in a preterm infant who is failing CPAP at FiO2 0.6?

A.Intratracheal exogenous surfactant (e.g., poractant alfa)

B.Intravenous dexamethasone

C.Inhaled nitric oxide

D.Caffeine citrate

Explanation: Exogenous surfactant replacement is the definitive treatment for RDS. Current AAP guidance favors early surfactant administration (often via INSURE or LISA technique) when a preterm infant on CPAP requires FiO2 >= 0.30-0.40 with worsening respiratory failure.

5A term infant with meconium aspiration has refractory hypoxemia, pre-ductal SpO2 95% and post-ductal SpO2 78%, and an oxygenation index (OI) of 28. The MOST appropriate next therapy is:

A.Inhaled nitric oxide

B.High-frequency oscillatory ventilation alone

C.Surfactant replacement

D.Diuretic therapy

Explanation: A pre/post-ductal saturation gap of >10% with OI >= 25 indicates significant right-to-left ductal shunting from PPHN. iNO at 20 ppm is the first-line selective pulmonary vasodilator for PPHN with OI >= 15-25 in infants >= 34 weeks.

6A 24-week infant on day 28 of life remains ventilator-dependent with FiO2 0.45 and chronic interstitial changes on chest X-ray. Per current NIH/Jensen criteria, this infant has:

A.Bronchopulmonary dysplasia (BPD)

B.Chronic lung disease unrelated to prematurity

C.Pulmonary interstitial emphysema

D.Wilson-Mikity syndrome

Explanation: BPD is defined by ongoing oxygen/respiratory support requirement at 36 weeks postmenstrual age in preterm infants. The 2019 Jensen severity classification grades BPD by mode and amount of respiratory support at 36 weeks PMA.

7Which strategy is BEST supported by evidence to reduce BPD in extremely preterm infants?

A.Early routine intubation and surfactant

B.Early non-invasive ventilation (CPAP) with selective surfactant via LISA

C.Prolonged systemic dexamethasone in the first week of life

D.Routine fluid liberalization

Explanation: Trials including SUPPORT, COIN, and the LISA meta-analyses show that early CPAP with selective surfactant via Less Invasive Surfactant Administration reduces death/BPD compared to routine intubation. The CNS leads NICU adoption of bundles supporting this practice.

8Caffeine citrate is started at 20 mg/kg loading and 5-10 mg/kg/day maintenance in a 26-week infant. The PRIMARY indication is:

A.Treatment of seizures

B.Apnea of prematurity and facilitation of extubation

C.Bronchodilation in BPD

D.Sedation for invasive procedures

Explanation: Caffeine is a respiratory stimulant for apnea of prematurity. The CAP trial showed it reduces BPD, PDA needing treatment, and improves neurodevelopmental outcomes when started early.

9A neonate at 6 hours of life had an Apgar of 2 at 10 minutes, cord pH 6.85, base deficit 18, and now shows hypotonia with seizures. According to NICHD/TOBY criteria, the MOST appropriate intervention is:

A.Therapeutic hypothermia at 33.5C for 72 hours

B.Routine normothermia with phenobarbital

C.Therapeutic hypothermia at 35C for 24 hours

D.Hyperthermia to 38C to enhance metabolism

Explanation: Whole-body cooling to 33.5C (target core 33-34C) for 72 hours initiated within 6 hours of life reduces death and disability in moderate-to-severe HIE per CoolCap, NICHD, and TOBY trials. Eligibility includes >= 36 weeks GA, evidence of perinatal acidosis or low Apgars, and modified Sarnat stage II or III encephalopathy.

10A 27-week infant on day 4 of life has a sudden hematocrit drop, bulging fontanel, and acidosis. Cranial ultrasound shows blood in the ventricles with parenchymal involvement. Per Papile classification, this is:

A.Grade I IVH

B.Grade II IVH

C.Grade III IVH

D.Grade IV IVH (periventricular hemorrhagic infarction)

Explanation: Papile Grade IV IVH (periventricular hemorrhagic infarction) involves bleeding into brain parenchyma adjacent to the ventricle, often a venous infarct. It carries the highest risk of significant neurodevelopmental impairment.

About the ACCNS-N Exam

ACCNS-N is AACN's CNS specialty certification for advanced practice nurses delivering wellness-through-acute-care services to neonates and their families. The exam is built on the AACN Synergy Model competencies and the three CNS spheres of impact: patient/family, nurses/nursing practice, and organization/system, applied to NICU and neonatal acute care contexts.

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-N Exam Content Outline

25%

Clinical Judgment

Differential diagnosis, multi-system organ failure, and complex acute/critical illness in neonates

10%

Caring Practices

Developmental care, neonatal pain assessment, comfort, and family-centered NICU support

10%

Collaboration

Interprofessional team leadership and CNS consultation across NICU disciplines

10%

Systems Thinking

Care coordination, transitions to home/level II, throughput, and population-level NICU improvement

Response to Diversity

Cultural humility, health disparities, and social determinants in neonatal care

10%

Clinical Inquiry

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

10%

Facilitation of Learning

Staff development, NICU competency, and parent education for high-risk newborns

Advocacy and Moral Agency

Ethics, periviability decisions, palliative neonatal care, and family advocacy

CNS Scope and APRN Consensus Model

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

10%

Neonatal Specifics

RDS, BPD, PPHN, HIE/therapeutic hypothermia, IVH, NEC, hyperbilirubinemia, GBS sepsis, thermoregulation, glucose homeostasis

How to Pass the ACCNS-N 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-N 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

3Master neonatal cooling criteria for HIE (gestational age, Sarnat staging, 6-hour window, 33.5C x 72h)

4Learn modified Bell staging for NEC and the surgical thresholds (pneumoperitoneum, persistent acidosis)

5Train surfactant indications, NIV/CPAP escalation, and PPHN management (iNO, oxygenation index)

6Distinguish neonatal CNS scope from NNP scope under the APRN Consensus Model (LACE)

Frequently Asked Questions

How many questions are on the ACCNS-N exam?

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

How long is the ACCNS-N exam?

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

What is the ACCNS-N exam fee?

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

What replaced the CCNS exam for neonatal CNS practice?

AACN retired the population-neutral CCNS exam in 2017 and replaced it with three population-specific CNS exams, including ACCNS-N for the neonatal patient population.

What framework does ACCNS-N use?

ACCNS-N 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 neonatal 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-N questions test integration across all three spheres.

How is a neonatal CNS different from an NNP?

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