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Exam Review

Key Facts: ACCNS-P Exam

175

Questions

AACN

3.5 hours

Time Limit

AACN

$270

Member Fee

AACN

$380

Non-Member Fee

AACN

Criterion

Scoring Method

AACN

The ACCNS-P exam has 175 questions and a 3.5-hour time limit. The exam fee is $270 for AACN members and $380 for non-members. AACN does not publish raw cut scores; results are criterion-referenced.

Sample ACCNS-P Practice Questions

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

1Within the NACNS framework, which of the three spheres of impact is most directly addressed when a CNS designs and pilots a unit-wide protocol for early sepsis recognition in pediatric inpatients?
A.Patient/client sphere
B.Nurses and nursing practice sphere
C.Organization/system sphere
D.Interprofessional sphere
Explanation: The NACNS Statement on CNS Practice describes three spheres of impact: patient/client, nurses and nursing practice, and organizations/systems. Designing and piloting a unit-wide sepsis protocol most directly targets the organization/systems sphere because it changes structures, workflows, and system-level outcomes rather than acting only on a single patient or coaching one nurse.
2What is the upper limit of normal heart rate for an awake, well child age 1–2 years according to PALS reference ranges?
A.120 bpm
B.150 bpm
C.170 bpm
D.190 bpm
Explanation: PALS lists awake heart rate for a child age 1–2 years as approximately 100–150 bpm. Persistent heart rates above this range warrant evaluation for fever, pain, dehydration, hypoxia, or arrhythmia.
3A 5-year-old with severe status asthmaticus remains hypoxic despite continuous albuterol, IV methylprednisolone, and ipratropium. Which adjunct has the strongest evidence to add next?
A.Intravenous magnesium sulfate 25–50 mg/kg
B.Inhaled budesonide nebulization
C.Intravenous theophylline loading dose
D.Intramuscular epinephrine 0.01 mg/kg
Explanation: For pediatric severe acute asthma exacerbations not responding to first-line therapy, IV magnesium sulfate (25–50 mg/kg, max 2 g) over 20 minutes is the recommended next-line adjunct in NHLBI/GINA pediatric guidance. It produces bronchial smooth muscle relaxation and improves lung function.
4Holliday-Segar maintenance fluid for a 22 kg child using the 4-2-1 rule is closest to:
A.44 mL/hr
B.62 mL/hr
C.82 mL/hr
D.120 mL/hr
Explanation: Holliday-Segar 4-2-1: 4 mL/kg/hr for the first 10 kg (40), 2 mL/kg/hr for the next 10 kg (20), and 1 mL/kg/hr for each kg above 20 (2 for 22 kg). 40+20+2 = 62 mL/hr.
5A 3-month-old with bronchiolitis presents with grunting, nasal flaring, and SpO2 88% on room air. The CNS-led acute care bundle should prioritize which intervention first?
A.Empiric IV ceftriaxone
B.Nebulized racemic epinephrine
C.Supplemental oxygen and high-flow nasal cannula trial
D.Chest physiotherapy every 2 hours
Explanation: AAP bronchiolitis guidance favors supportive care, with supplemental O2 for hypoxia and a high-flow nasal cannula trial for moderate–severe respiratory distress. Antibiotics are not indicated unless bacterial coinfection is suspected, and routine chest physiotherapy and bronchodilators are not recommended.
6A 2-year-old with barky cough, inspiratory stridor at rest, and moderate retractions has a Westley croup score of 6. Which combination is most appropriate?
A.Oral dexamethasone alone
B.Nebulized racemic epinephrine plus oral or IM dexamethasone, then 3–4 hour observation
C.Nebulized albuterol plus inhaled corticosteroid
D.Heliox without steroids
Explanation: Moderate-to-severe croup (stridor at rest, retractions) is treated with nebulized racemic epinephrine for rapid mucosal vasoconstriction plus a single dose of dexamethasone (0.6 mg/kg, max 16 mg) and observation for at least 3–4 hours due to potential rebound after epinephrine wears off.
7Which assessment tool is most appropriate to quantify pain in a non-verbal, intubated 4-year-old in the PICU?
A.Numeric Rating Scale 0–10
B.Wong-Baker FACES
C.FLACC (Face, Legs, Activity, Cry, Consolability)
D.Visual Analog Scale
Explanation: FLACC is a behavioral observation pain scale validated for nonverbal children including those who are intubated, sedated, or developmentally delayed. It scores five items 0–2 each for a total 0–10.
8An 8-year-old (28 kg) presents in compensated septic shock. Per pediatric Surviving Sepsis Campaign guidance, the recommended initial isotonic crystalloid bolus is:
A.5 mL/kg over 30 minutes
B.10–20 mL/kg over 5–10 minutes, reassess
C.40 mL/kg as a single bolus
D.60 mL/kg as a single bolus
Explanation: The 2020 pediatric Surviving Sepsis Campaign guidelines recommend 10–20 mL/kg boluses given over 5–10 minutes, with reassessment for fluid overload after each bolus, especially where intensive care is unavailable. Older guidance of routine 60 mL/kg was revised because of overload risk.
9A 10-year-old with new-onset DKA has glucose 612 mg/dL, pH 7.10, bicarbonate 8. After initial 10 mL/kg NS bolus, the next priority is:
A.Begin IV insulin bolus 0.1 units/kg
B.Begin IV insulin infusion at 0.05–0.1 units/kg/hr without bolus
C.Administer IV bicarbonate 1 mEq/kg
D.Switch fluids to D5 0.45% saline at maintenance
Explanation: ISPAD/PES pediatric DKA guidance recommends starting an insulin infusion at 0.05–0.1 units/kg/hr 1–2 hours after fluids are started, without an initial bolus, because boluses increase the risk of cerebral edema without faster recovery.
10In the pediatric early warning score (PEWS), which three domains are scored?
A.Behavior, cardiovascular, respiratory
B.Pain, behavior, family concern
C.Glasgow Coma Scale, hemodynamics, oxygenation
D.Behavior, respiratory, neurologic
Explanation: The Brighton/standard PEWS is composed of three domains scored 0–3 each: behavior, cardiovascular, and respiratory, for a total of 0–9. Higher scores trigger escalation per local algorithms.

About the ACCNS-P Exam

The ACCNS-P (Pediatric Acute Care Clinical Nurse Specialist Wellness through Acute Care) is AACN's CNS certification for advanced practice nurses caring for pediatric patients from neonatal/early infancy through young adulthood across the wellness-through-acute-care continuum. The exam is administered by AACN Certification Corporation through PSI test centers.

Exam sponsor: AACN Certification Corporation. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

175 questions

Time Limit

3.5 hours

Passing Score

Scaled score (criterion-referenced)

Exam / Certification Fees

$270 (AACN members), $380 (non-members)

Exam sponsor website

Reported exam pass rate: N/A. AACN Certification Corporation does not publish ACCNS-P pass rates. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

30%

Pediatric Acute Care Clinical Judgment

Differential diagnosis and management of common acute pediatric presentations including respiratory failure, status asthmaticus, bronchiolitis, croup, sepsis, DKA, status epilepticus, dehydration, accidental ingestion, and congenital heart disease.

15%

CNS Core Competencies

NACNS framework with three spheres of impact (patient/client, nurses/nursing practice, organization/system) and core CNS competencies including consultation, leadership, and EBP.

15%

Pediatric Assessment & Developmental Considerations

Tanner staging, growth charts, developmental milestones, age-based vital signs, FLACC and Wong-Baker FACES pain scales, Pediatric Glasgow Coma Scale, and PEWS.

10%

Pediatric Pharmacology

Weight-based dosing, age-specific pharmacokinetics, common drugs for asthma, seizures, sedation, anaphylaxis, and PALS algorithm pharmacology.

10%

Family-Centered Care, Advocacy & Ethics

Assent versus consent, child life integration, family presence during procedures and codes, and pediatric ethics frameworks.

10%

Quality, Safety & Evidence-Based Practice

Pediatric-specific safety bundles, weight-based medication safety, family-centered rounds, and EBP project leadership.

10%

Systems & Leadership

Transitions of care, pediatric-to-adult transition for chronic disease, care coordination, and pediatric quality measures.

Preparing for the ACCNS-P Exam

What You Need to Know

  • Passing score: Scaled score (criterion-referenced)
  • Exam length: 175 questions
  • Time limit: 3.5 hours
  • Exam / certification fees: $270 (AACN members), $380 (non-members) Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

ACCNS-P: Suggested Study Strategy

1Review the AACN ACCNS-P exam blueprint and content outline so you know the weight of each domain.
2Memorize PALS algorithms (bradycardia, tachycardia, cardiac arrest, post-resuscitation) and pediatric vital sign ranges by age.
3Practice weight-based medication dosing problems including the Holliday-Segar 4-2-1 maintenance fluid rule.
4Use age-appropriate pain assessment tools confidently: FLACC for nonverbal, Wong-Baker FACES for ages 3-7, numeric for older children.
5Reinforce the NACNS three spheres of impact with examples from your own practice.

Frequently Asked Questions

What is the ACCNS-P exam?

The ACCNS-P is AACN's CNS certification for nurses providing advanced practice care to pediatric patients from neonatal/early infancy through young adulthood across the wellness-through-acute-care continuum.

How many questions are on the ACCNS-P exam?

The ACCNS-P exam has 175 multiple-choice questions, with a 3.5-hour time limit.

How much does the ACCNS-P exam cost?

The ACCNS-P exam costs $270 for AACN members and $380 for non-members.

Who administers the ACCNS-P?

The ACCNS-P is administered by AACN Certification Corporation, with testing delivered through PSI test centers.

What is the passing score for the ACCNS-P?

The ACCNS-P uses a criterion-referenced scaled score; AACN Certification Corporation does not publish a raw cut score.