Free NEA-BC Practice Test: 50 Questions Weighted to the Current ANCC Blueprint

Fifty original questions, closely weighted to the four domains in ANCC's test content outline effective November 11, 2025. Every answer has a full rationale, your score breaks down by domain, and nothing here asks for an email.

Original Castleport questions written from ANCC's published blueprint. Not official ANCC exam items.

Start the test

Answer before you reveal. At the real exam's pace — 3 hours for 150 questions, about 72 seconds each — these 50 questions are an even 60-minute block if you want to rehearse the clock.

Domain I — Leadership (17 questions)

Question 1 Leadership → Leadership theories and styles and executive presence

A new chief nursing officer inherits a division where three directors run their areas very differently and none of them share performance data. In her first 90 days she wants to build one leadership team. Which approach best reflects transformational rather than transactional leadership?

A. Set individual productivity targets for each director, tied to the annual bonus B. Require weekly one-to-one performance reports to the CNO from each director until results across the three areas converge on a common standard C. Build a shared vision with the directors, tie it to common outcome measures, and develop each director's capacity to lead it D. Standardize all three areas immediately to the policies of the highest-performing area

Question 2 Leadership → Leadership theories and styles and executive presence

At a board finance committee meeting, a trustee challenges the nursing division's overtime spend in front of the whole executive team. The chief nurse executive has the raw figures but has not finished the variance analysis. What best demonstrates executive presence?

A. Defend the current overtime spend using the figures available in the moment B. Acknowledge the concern and commit on the spot to a specific percentage reduction in overtime by the end of next quarter C. Redirect the question to the chief financial officer, who owns the labor budget D. State what is known, name what is not yet analyzed, and commit to a date to return with the analysis

Question 3 Leadership → Leadership theories and styles and executive presence

Two directors report to the CNO. One was promoted three months ago and is hesitant about leading a service-line redesign. The other has led three redesigns and is visibly impatient with oversight. Which approach best fits a situational leadership model?

A. Give the new director more direction and coaching, and give the experienced director delegated authority with agreed checkpoints B. Apply the same level of direction and support to both directors, since treating experienced and new leaders identically is the most equitable approach C. Delegate fully to both and intervene only if outcomes begin to slip D. Direct both closely, because a service-line redesign carries high risk

Question 4 Leadership → Principles of relationship building

The CNE needs medical staff support for a nurse-led discharge protocol. The chief of medicine has been openly skeptical of nursing-led initiatives. What should the CNE do first to build the relationship?

A. Present the outcome data at the next medical executive committee meeting B. Meet privately to understand the chief's specific concerns and what evidence would change his view C. Ask the CEO to signal executive-level support for the protocol before the next medical staff discussion D. Pilot the protocol on a unit whose physicians already support it

Question 5 Leadership → Strategic planning methods

A health system's nursing strategic plan lists 31 initiatives for the coming year across eight hospitals. The CNE is asked to make the plan executable. What is the most appropriate action?

A. Assign each initiative an owner and a due date B. Ask each hospital to choose the initiatives most relevant to its own population and report progress separately C. Sequence all 31 initiatives across three years instead of one D. Cut the list to a small number of system priorities with measurable outcomes and move the rest to a backlog

Question 6 Leadership → Strategic planning methods

Before setting the nursing strategic plan, the CNE assembles data on local population growth, payer mix shifts, competitor service lines, and the regional RN supply. Which planning step does this represent?

A. Gap analysis B. Environmental assessment C. Implementation planning for the chosen strategy D. Outcome evaluation

Question 7 Leadership → Strategic planning methods

The nursing strategic plan sets a goal to "improve the work environment." The board asks how progress will be judged. Which addition most improves the goal?

A. A list of the initiatives that will be undertaken to improve the environment B. A budget sufficient to fund the work across all eight hospitals C. A named measure, a baseline, a target, and a date D. An executive sponsor accountable for each initiative

Question 8 Leadership → Governance structures

A nursing professional governance council and the board's quality committee each assert authority over a proposed change to the RN peer-review process. The work has been stalled for six weeks. Which approach best reflects sound governance?

A. The board committee's view controls, because the board is the senior body B. The nursing council decides, because peer review is nursing practice C. Define the decision rights in advance, with a named escalation path D. The CNO decides now, to end the delay

Question 9 Leadership → Governance structures

A health system board asks the CNE to describe the board's own role in nursing quality. Which description is most accurate?

A. The board holds fiduciary accountability for the quality and safety of care and oversees performance, while management runs operations B. The board reviews and approves nursing policies and procedures C. The board delegates responsibility for clinical quality to the medical staff, which holds the clinical expertise the board itself lacks D. The board reviews individual adverse events and determines accountability for them

Question 10 Leadership → Change management and complex project management and oversight

A system is consolidating three separate nursing education departments into one. Staff are anxious, the timeline is fixed, and the CNE must make the change stick. Which action most directly addresses the risk that the change reverts?

A. Communicate the consolidation timeline widely and repeat it at every management and staff forum through the transition date B. Hold listening sessions at each of the three sites before the transition date C. Appoint an experienced project manager to track milestones to go-live D. Define the new structure's roles, decision rights, and measures, and build them into job descriptions and reporting lines

Question 11 Leadership → Change management and complex project management and oversight

A $12M electronic documentation upgrade is four months into a nine-month schedule. The vendor's status report says the project is on track. The organization's own nurse builders say testing scripts are incomplete and two interfaces have not been started. What should the executive sponsor do?

A. Accept the vendor's status report and continue the monthly governance cadence B. Require reporting against verified deliverable completion, confirmed by the organization's own experts, then reset the date C. Redirect nursing resources from other projects to catch up the incomplete testing and interface work D. Move the go-live date back by three months to create schedule cushion

Question 12 Leadership → Change management and complex project management and oversight

Six months into implementing a new care model, three of eight hospitals have adopted it and outcomes at those three have improved. The other five report they are "still preparing." What should the CNE examine first?

A. Whether the five hospitals lack commitment to the system's direction B. What differs in the five hospitals' resources, workflows, leadership capacity, and competing priorities C. Whether the data from the three successful hospitals are accurate D. Whether to make adoption of the care model a weighted factor in the hospital presidents' annual performance evaluations

Question 13 Leadership → Coaching, mentoring, and succession planning

A health system faces a shortage of qualified nurse leaders. Several directors are expected to retire within three years. Which action best demonstrates effective executive succession planning?

A. Identify the critical leadership roles and develop internal talent pipelines with readiness assessments B. Begin recruiting external candidates once the vacancies actually occur C. Promote the longest-serving nurse manager into each future vacancy D. Require all nurse managers to complete the same leadership development course within the next 12 months, then rank them

Question 14 Leadership → Coaching, mentoring, and succession planning

A director is technically excellent but repeatedly alienates peers in cross-functional meetings. The CNE has given general feedback twice, with no change. What is the most effective next step?

A. Move the director out of cross-functional assignments and into project work that does not require sustained peer collaboration B. Enroll the director in an executive communication skills workshop offered through the health system C. Document the pattern for the annual performance review D. Give specific behavioral feedback tied to observed incidents, agree on two changes, and set a date to review progress

Question 15 Leadership → Communication techniques and strategies

Nursing and pharmacy disagree about which department should own medication reconciliation on admission. Both cite workload. The CNE convenes them. Which approach is most likely to produce a durable agreement?

A. Split the task evenly between the two departments B. Focus on the shared interest — an accurate medication list at admission — and let reliability decide who owns it C. Decide the matter by executive authority to end the delay D. Assign the task to whichever department currently has more available staff capacity on the day shift admission window

Question 16 Leadership → Business acumen

A health system CNO reviews a proposal to add 12 medical-surgical beds. The system's largest commercial contract pays a fixed rate per case by diagnosis-related group. For the service line's three highest-volume DRGs, average length of stay runs 0.8 days above the expected mean. Finance projects that filling the new beds will increase gross charges by $4.1M annually. Which consideration should weigh most heavily in the CNO's recommendation?

A. Construction cost per bed compared with regional benchmarks B. The projected increase in gross charges from the added volume C. The effect of length of stay on margin under a fixed case rate D. The additional RN full-time equivalents required to staff the beds

Question 17 Leadership → Business acumen

A nursing director proposes a $240,000 annual investment in an internal float pool. She projects it will reduce agency spend by $400,000 a year. The CNE is asked whether the proposal creates value. What is the most important additional question?

A. What assumptions drive the $400,000 agency reduction, and what happens to the estimate if they are wrong B. Whether comparable hospitals in the region operate internal float pools at similar scale C. Whether the float pool can be launched within the current fiscal year D. Whether experienced staff nurses would prefer float pool roles to fixed unit assignments at the current differential

Domain II — Quality and Safety (13 questions)

Question 18 Quality and Safety → Health care standards

A surveyor from a CMS-approved accrediting organization identifies a deficiency in restraint documentation in a sample of hospital records. The CNE must respond. Which action best reflects how deemed-status accreditation and federal participation requirements work?

A. Treat the finding as advisory, since only state regulators can compel an actual change in practice B. File an appeal before making any operational change C. Correct the documentation defects in the specific records the surveyor sampled during the survey D. Correct the deficiency and the underlying process, since accreditation status carries regulatory and payer consequences

Question 19 Quality and Safety → Health care standards

For a hospital using a CMS-approved accrediting organization for deemed status, which statement best describes the relationship between a federal Condition of Participation and the accreditor's standards?

A. They are the same requirement, issued by two different organizations B. A Condition of Participation is a federal requirement for Medicare participation; a CMS-approved accreditor's deemed-status standards must meet or exceed that federal floor C. Accreditation standards are legally binding requirements, while conditions of participation are voluntary for hospitals D. Conditions of participation apply only to hospitals, while accreditation applies to all care settings

Question 20 Quality and Safety → Emergency preparedness and management

A regional wildfire forces two skilled nursing facilities to evacuate to the hospital's campus overnight. Incident command is activated. Several department leaders begin sending competing requests for staff and beds directly to senior executives. What should the nurse executive do?

A. Route assignments and resource requests through the established incident command structure and the nurse executive's assigned role B. Approve nursing requests directly, because clinical staffing decisions should bypass incident command C. Let each department negotiate resources independently until the surge stabilizes D. Suspend the incident command structure for staffing decisions because the event is moving too quickly

Question 21 Quality and Safety → Emergency preparedness and management

After an eight-hour regional power event, the system conducts an after-action review. Nursing units reported that they could not find the downtime documentation forms and did not know which outlets were on emergency power. Which action best strengthens preparedness?

A. Redistribute the emergency operations plan to all nurse managers with a required read-and-sign B. Increase the number of outlets connected to emergency power on all inpatient nursing units C. Build the specific failures into scheduled drills, then re-test whether staff can use the resources under simulated conditions D. Assign a designated downtime coordinator on every shift

Question 22 Quality and Safety → Principles of high reliability

Over two quarters, reported near misses across a system fall 40% while serious safety events stay flat. Unit leaders present the decline as evidence that their safety work is succeeding. Which interpretation best reflects high-reliability principles?

A. The decline confirms that the interventions reduced risk B. The decline may reflect reduced reporting rather than reduced risk, and warrants investigation C. Near-miss counts are unreliable and should be removed from the dashboard D. Only serious safety events belong on a system-level safety dashboard

Question 23 Quality and Safety → Principles of high reliability

During a rapid response, the most junior nurse present is the only person who has cared for the patient across the past three shifts. She says the presentation is different from the documented baseline. The attending is prepared to proceed on the documented baseline. Which high-reliability principle most directly applies?

A. Commitment to resilience B. Reluctance to simplify C. Deference to expertise D. Sensitivity to operations

Question 24 Quality and Safety → Risk assessment and evaluation of plan of correction

A serious medication event has occurred. The organization wants to understand how it happened and prevent recurrence. Which method fits, and why?

A. Root cause analysis, because it is a retrospective, structured investigation of an event that has already occurred B. Failure mode and effects analysis, because it identifies and ranks the most severe of the possible failure modes C. Plan-Do-Study-Act, because it tests a change on a small scale D. Statistical process control, because it separates common-cause from special-cause variation

Question 25 Quality and Safety → Risk assessment and evaluation of plan of correction

A system is about to launch a redesigned chemotherapy ordering pathway. No harm has occurred, because the pathway has not gone live. Which method is most appropriate before go-live?

A. Root cause analysis B. Incident report trend review C. Peer review of the prescribers involved D. Failure mode and effects analysis

Question 26 Quality and Safety → Risk assessment and evaluation of plan of correction

Six months after a plan of correction for a fall-related event, falls on the unit have not decreased. The plan's corrective actions were staff education and a reminder poster. What is the best assessment?

A. Staff need the education repeated, with a higher completion rate and a competency check B. The original root cause analysis reached the wrong conclusion C. The corrective actions relied on weak, person-dependent interventions; actions that change the system are needed D. The unit's fall data should be risk-adjusted for patient acuity before anyone draws a conclusion about the plan

Question 27 Quality and Safety → Performance benchmarking interpretation and analysis

Two hospitals in the same system report central line-associated bloodstream infection rates for the quarter. Hospital A: 2.0 per 1,000 central line days across 4,000 line days. Hospital B: 1.0 per 1,000 across 1,000 line days. A board member asks the CNE to scale Hospital B's practices system-wide. Which response is best supported by the data?

A. Adopt Hospital B's central line protocols system-wide, since its rate is half of Hospital A's B. Note that Hospital B's rate rests on a single event and would double with one more, so the gap may not be stable C. Place Hospital A under a corrective action plan for the quarter D. Explain that hospitals with substantially different volumes cannot be meaningfully compared on an infection rate

Question 28 Quality and Safety → Performance benchmarking interpretation and analysis

A CNE compares her hospital's 30-day heart failure readmission rate against a national benchmark and finds it 2 percentage points higher. Before acting, which check matters most?

A. Whether the benchmark uses the same population definition, counting window, and risk adjustment B. Whether other hospitals in the state and region are also running above the national benchmark C. Whether the hospital's own rate has moved since last year D. Whether the cardiology service agrees with the finding

Question 29 Quality and Safety → Continuum of EBP, PI and QI

A unit council wants to change its pressure injury prevention protocol. A recent systematic review supports a repositioning approach that differs from current practice. Which activity does adopting that approach represent?

A. Research B. Quality improvement C. A performance improvement audit D. Evidence-based practice

Question 30 Quality and Safety → Continuum of EBP, PI and QI

A team runs a two-week PDSA cycle on a discharge-teaching change on one unit and sees improvement. The CNE is asked to spread it across all eight hospitals. What is the most appropriate response?

A. Spread it to all eight hospitals now, since the measured result on the pilot unit improved B. Require a randomized trial before any spread decision C. Test it under varied conditions — shifts, populations, staffing levels — then define the measures to track spread D. Decline to spread until at least 12 months of data are available

Domain III — Human Capital Management (10 questions)

The three questions that follow test general federal employment-law frameworks at the level the blueprint names them. They are not legal advice. Specific employment decisions belong with your HR department and counsel.

Question 31 Human Capital Management → Employee protection and labor laws

An experienced charge nurse returning from an injury submits documentation of a permanent 20-pound lifting restriction. The charge nurse job description lists assisting with patient transfers "as needed." The unit manager wants to move the nurse into an open non-clinical position this week. What should the nurse executive direct first?

A. Transfer the nurse into the open non-clinical position this week, as the unit manager has proposed B. Begin an individualized interactive process on whether accommodation permits the essential functions C. Remove patient transfers from the charge nurse job description D. Place the nurse on unpaid leave until the restriction is lifted

Question 32 Human Capital Management → Employee protection and labor laws

A nurse with a documented disability threatens a coworker during a dispute. The organization's conduct policy, applied uniformly, calls for termination for threats of violence. The nurse states the behavior was related to the disability. What does federal disability law generally permit?

A. The employer must excuse the conduct because it is disability-related B. The employer must first provide a reasonable accommodation and only afterward apply any discipline C. The employer may apply the same discipline it would apply to anyone for violating a uniformly applied, job-related conduct rule D. The employer must place the nurse on leave instead of applying the conduct policy

Question 33 Human Capital Management → Employee protection and labor laws

An eligible employee has used all 12 workweeks of FMLA leave within the 12-month period and still cannot return to work because of a condition that also qualifies as a disability. What does the employer generally need to do next?

A. End employment now, since the employee's FMLA entitlement for this 12-month period has been exhausted B. Return the employee immediately to any position that is currently available C. Extend FMLA leave by a second 12-week period D. Consider whether more leave or another accommodation permits the essential functions, absent undue hardship, then reassignment

Question 34 Human Capital Management → Professional development

A system wants to expand the LPN role in its ambulatory clinics to include assessment tasks currently performed by RNs. The clinics operate in three states. What determines whether this is permissible?

A. The nurse practice act and board rules in each state, alongside organizational competency validation B. The system's own job descriptions and its internal competency validation process for the LPN role C. National professional association position statements on LPN practice D. The delegation decisions of each clinic's medical director

Question 35 Human Capital Management → Professional development

A system reports that 96% of nurses completed annual competency training. Clinical leaders still observe wide variation in how one high-risk skill is performed. What does this most likely indicate?

A. The training content is out of date and needs revision B. Completion was measured rather than competency; validated demonstration establishes competency C. The 4% who did not complete the training account for most of the variation leaders are seeing D. Annual frequency is insufficient for a skill at this risk level

Question 36 Human Capital Management → Diversity, equity, and inclusion

A system's data show that nurses from certain backgrounds are promoted into leadership at lower rates than their representation in the staff nurse workforce, despite similar performance ratings. Which executive action is most likely to change the outcome?

A. Add an unconscious bias training module to the required curriculum for all hiring managers B. Set a numeric representation target for leadership roles C. Survey staff about their perceptions of fairness in promotion D. Examine the promotion process itself and change the mechanism wherever the gap arises

Question 37 Human Capital Management → Develop and monitor healthy workforce environment, workplace safety, and engagement strategies

Assaults on nursing staff in the emergency department have risen over two years. Staff say events often go unreported because "nothing happens." Which executive action addresses the problem most directly?

A. Provide de-escalation training for all ED nursing staff, unit assistants, and registration clerks B. Build a workplace violence prevention program: hazard assessment, environmental and staffing controls, and visible follow-through C. Increase security officer presence during evening and night shifts D. Require an incident report for every event, with manager sign-off

Question 38 Human Capital Management → Develop and monitor healthy workforce environment, workplace safety, and engagement strategies

Engagement survey results arrive and two units score far below the system mean. Their nurse managers are asked to build action plans. Twelve months later, the scores are unchanged. What most likely went wrong?

A. Action plans were written, but the local drivers were never identified, the changes were not resourced, and nobody followed up B. The survey instrument is not reliable at the unit level C. Both units need new nurse managers, since manager behavior is the dominant driver of engagement D. Twelve months is too short an interval to expect measurable change

Question 39 Human Capital Management → Professional governance

A hospital describes itself as having shared governance, but unit council decisions are routinely reversed by managers. What is the most accurate assessment?

A. The councils need training in group process, facilitation, and decision-making methods B. Managers should be required to attend all council meetings C. Decision authority was never actually transferred, so the structure exists without the substance of professional governance D. Councils should refocus on recognition and social activities, where reversal is unlikely to occur

Question 40 Human Capital Management → Professional governance

A nursing professional governance council asks to take on decision authority for the hospital's capital equipment budget. The CNO must respond. Which response is most appropriate?

A. Approve it, since professional governance should extend to every decision that materially affects nursing B. Decline, since budgets are a management function and councils should stay out of them C. Give the council an advisory role across all budget matters D. Confirm the council's authority over practice, quality, and professional development, and define an advisory role in capital requests

Domain IV — Health Care Delivery (10 questions)

Question 41 Health Care Delivery → Strategies and effectiveness of health care delivery

A system is evaluating a team-based model that pairs each RN with an LPN and a nursing assistant, replacing an all-RN assignment on medical-surgical units. Which evaluation approach is most appropriate before system-wide adoption?

A. Evaluate labor cost together with nurse-sensitive outcomes, turnover, and each state's LPN scope limits B. Compare labor cost per patient day before and after the change on a single medical-surgical pilot unit C. Survey nursing staff about their preference for the model D. Adopt the model first on the units with the highest RN vacancy rates

Question 42 Health Care Delivery → Strategies and effectiveness of health care delivery

A system is adding a virtual nursing role to support admissions, discharges, and documentation on medical-surgical units. Which factor most determines whether the model delivers value?

A. The reliability of the audio and video technology installed in the patient rooms and workstations B. The number of units that adopt the model in the first year C. How the work is actually redistributed — what the bedside nurse stops doing, and who is accountable D. Bedside nurses' reported satisfaction with the virtual role

Question 43 Health Care Delivery → Strategies and effectiveness of health care delivery

A rural hospital in the system has held a 20% RN vacancy rate for three years. Sign-on bonuses have produced hires who leave within 18 months, and local recruiting repeatedly produces too few qualified applicants. Which strategy most directly addresses the pipeline?

A. Increase the sign-on bonus and add a second retention bonus payable at 24 months B. Expand travel nurse contracts to cover the gap while recruiting continues C. Raise base pay to the regional 75th percentile D. Build local supply through academic partnerships and internal pathways, plus retention work on the departures

Question 44 Health Care Delivery → Health care ethics

A family insists that a patient not be told his terminal diagnosis. The patient has decision-making capacity and has asked the nurse direct questions about his prognosis. Which ethical principle most directly governs the nurse executive's guidance to the team?

A. Respect for autonomy, because a patient with capacity holds the right to the information he needs for his own decisions B. Beneficence, because withholding the diagnosis may protect the patient from avoidable distress, fear, and despair C. Justice, because information should be distributed equally among patients D. Nonmaleficence, because disclosure of a terminal prognosis carries a real risk of psychological harm

Question 45 Health Care Delivery → Health care ethics

A system repeatedly faces conflict about admitting patients when no downstream placement exists, producing long boarding stays. The pattern recurs across all eight hospitals. What is the most appropriate organizational ethics response?

A. Refer each case to the ethics consultation service as it arises B. Ask each hospital to develop an approach suited to its own community, capacity, and referral network C. Take the recurring pattern to the organizational ethics structure to develop policy, since consultation cannot resolve it D. Defer the question to the medical staff, which controls admission decisions

Question 46 Health Care Delivery → Research translation and spirit of inquiry

A nursing research study conducted within the system found that a structured rounding protocol reduced call-light use. The CNE wants the finding to change practice. What most determines whether it does?

A. Publication of the findings in a peer-reviewed journal B. A translation plan: appraise applicability, adapt to local workflow, support implementation, measure uptake C. Presentation of the findings at the annual system nursing research and evidence-based practice conference D. Addition of the protocol to the nursing policy manual

Question 47 Health Care Delivery → Research translation and spirit of inquiry

A nurse asks why her unit changes IV tubing on a schedule that differs from the unit next door. Her manager answers that it is the unit's long-standing practice. What is the best executive response to this pattern?

A. Standardize both units to the more conservative of the two schedules B. Ask the manager to document the history of the practice for the record C. Allow each unit to keep its own practice as long as infection outcomes remain acceptable D. Build routines where nurses are expected to ask what the evidence is, and get evidence rather than tradition in reply

Question 48 Health Care Delivery → Monitor patient outcomes

A CNE reviews a nursing dashboard showing falls, CLABSI, CAUTI, pressure injuries, and patient experience by unit, updated monthly as a single number per measure. Which addition would most improve the dashboard's usefulness for executive decisions?

A. Display each measure over time, with a comparison and enough context to separate real change from variation B. Add measures until every significant nursing activity is represented on the dashboard C. Rank the units from best to worst on each measure D. Report the same measures weekly instead of monthly

Question 49 Health Care Delivery → Guiding integration and implementation of technology

A system plans to deploy a vendor's sepsis prediction model across eight hospitals. The vendor supplies performance statistics drawn from its own development population. What should the nurse executive require before go-live?

A. A communication plan announcing the new model to clinical staff well ahead of the planned launch date B. Documentation from nurses explaining why they did not act on each alert C. Local validation on the system's own patients, a defined response workflow, and ongoing monitoring D. A phased launch at the largest hospital first, to build momentum

Question 50 Health Care Delivery → Guiding integration and implementation of technology

A ransomware attack takes down the electronic health record across the system. Clinical operations have to continue. What is the nurse executive's priority?

A. Restore electronic documentation as soon as any workaround becomes available B. Activate downtime procedures to maintain safe care and essential information flow, coordinating through incident command C. Hold clinical processes unchanged until information technology has restored all the systems D. Divert all patients to other facilities until the systems are back

Your score, and what it means

Count your correct answers by domain:

This is practice feedback on these 50 questions. It is not an ANCC scaled score and it does not predict whether you will pass. ANCC uses a criterion-referenced standard and reports exam results as pass or fail; candidates who do not pass also receive a scaled score and LOW, MEDIUM, or HIGH diagnostic feedback by content area. Your lowest domain here is your weakest result on this set — with 10 to 17 questions per domain, a two-question difference can materially move the percentage, so treat the result as a place to look rather than a verdict.

Why the split looks like this

ANCC publishes the number of scored questions in each domain: Leadership 42, Quality and Safety 32, Human Capital Management 26, Health Care Delivery 25, out of 125 scored questions. This set uses the closest whole-question allocation across 50 items: 17, 13, 10, and 10. Human Capital Management lands on 10 here, or 20%, while ANCC publishes 21% for that domain; that one-point difference is a consequence of using whole questions in a smaller set, not a judgment about importance.

What to review next

Work from the questions you missed, not from the domain total. Each question above carries its blueprint topic in italics beneath the question number. Find the topics you missed and take them back to the source.

Two questions worth answering honestly as you review. Did you miss the item because you did not know the concept, or because you knew it and misread what the question was asking for? Those need different fixes. And for every question you got right by narrowing to two and guessing, read the rationale anyway — a lucky correct answer can hide a concept you still need to review.

The official test content outline lists every topic under each domain, and the official reference list names 13 authoritative texts used to develop the examination. ANCC says that reference list is not all-inclusive. Together, those two documents are a strong free study map for the exam.

What changed in the NEA-BC blueprint on November 11, 2025

If your review manual or course was built before late 2025, this is the section to read carefully.

The question counts moved

Human Capital Management grew by almost half. Health Care Delivery lost roughly a quarter of its questions. The question form stayed at 150 total questions, with 125 scored and 25 unscored pretest items.

ANCC's published percentages total 101% because of rounding, which is noted on the outline itself.

The topics moved too

Why it changed

ANCC ran a role delineation study in 2024 and 2025. An expert panel of certified nurse executives met October 7–8, 2024; the national survey ran from November 8 to December 16, 2024; and 274 people completed either the pilot or national survey, whose data were combined for analysis. Examination specifications were finalized on February 6, 2025. According to ANCC's own summary of that study, item allocations were set using mean importance ratings for the knowledge and skill statements plus panel discussion. That process produced the current allocations.

The resulting specifications contain 13 knowledge areas and 11 skills across the four domains.

What it means for your materials

A manual or course that still follows the January 2021 outline can under-cover Human Capital Management and may omit newer named topics such as high reliability, governance structures, succession planning, DEI, professional governance, reimbursement methods, and AI or predictive analytics. It may also retain "meaningful use," which is no longer named in the current outline. ANCC's handbook says certification examinations are updated approximately every three to five years; that is a general update cadence, not a guarantee that this blueprint will remain unchanged for a specific period.

Check that you are studying for the right exam

Several free "NEA-BC practice test" results are actually built for NE-BC, which is a different ANCC credential with a different blueprint. It is an easy mistake to make and an expensive one to discover late.

Two of the four NE-BC domain names do not exist on the NEA-BC exam. If the practice material you are using uses Business Management and Human Resource Management as domain headings, or treats staffing fundamentals, social determinants of health, person-centered care, or nurse-sensitive indicators as NE-BC blueprint topics or examples, it is describing NE-BC rather than the current NEA-BC blueprint.

One caveat on those pass rates: they describe two different candidate populations sitting two different exams. The gap does not establish that one exam is harder than the other.

What the NEA-BC exam actually looks like

• 150 questions, of which 125 are scored and 25 are unscored pretest items you cannot identify. Answer every one of them.
• 3 hours of testing time, which works out to about 72 seconds per question. Plan for longer than 3 hours at the center — check-in, instructions, and an optional computer practice session sit outside the testing clock.
• Multiple choice, closed book. No calculator, notes, phone, or reference of any kind. You are issued a dry-erase board for notes.
• No penalty for guessing. You can mark questions and come back to them.
• Scored against a fixed standard, not against other candidates. ANCC uses the Modified Angoff method to set the passing standard. Scores are reported on a scale with a maximum of 500, and 350 passes.
• Results are pass or fail. If you fail, the report also includes a scaled score and LOW, MEDIUM, or HIGH diagnostic feedback for each content area. This practice set gives domain-level raw counts instead; it does not reproduce ANCC's diagnostic categories.
• Prometric test center only. ANCC states that the certification exam can only be taken at a Prometric testing center.
• 120 days from your Authorization to Test to sit for the exam. One testing-window re-assignment is available for a $100 fee, and the new window has to begin less than six months after the first one ends.
• Cost: $395 for non-members, $295 for ANA members. Both include a $140 non-refundable administrative fee.
• 2025 results: 973 first-time candidates tested and 706 passed, a 73% pass rate. That means 267 did not pass on a first attempt. ANCC's annual report does not break those results out by exam-outline version, so do not treat the 2025 rate as a pass rate for the current November 11, 2025 blueprint.

Who can sit for the NEA-BC exam

ANCC lists four requirements:

1. A current, active RN license in a US state or territory, or the legally recognized professional equivalent in another country.
2. A graduate degree, with either the baccalaureate or the graduate degree in nursing.
3. At least 2,000 hours within the last 3 years in a leadership, management, or administration position with primary responsibility for organization-wide or system-wide operations and outcomes that include nursing.
4. 30 hours of continuing education in leadership, management, or administration within the last 3 years.

Requirement 2 is the one that stops people, and it is the one some third-party summaries leave out entirely. Requirement 3 is the line between this exam and NE-BC — unit-level or departmental responsibility is not organization-wide or system-wide responsibility.

ANCC audits applications at random. If you are audited for practice hours, you will be asked for a letter from your immediate supervisor on organizational letterhead attesting to the hours, plus completion certificates for the continuing education you claimed. Keep those documents as you go rather than reconstructing them later. Confirm your own eligibility on ANCC's certification page before you pay.

If you did not pass

• You may retest 60 calendar days after the date you last tested.
• You may not test more than three times in any 12-month period.
• You submit a new retest application, meet the eligibility requirements in force at the time you apply, pay the retest fee, and retake the entire exam.
• Your score report's domain-level LOW, MEDIUM, or HIGH is the most useful thing you own right now. Weight your study by how many scored questions each domain actually carries: a LOW in Leadership is 42 questions, a LOW in Health Care Delivery is 25.
• Come back to this set and work the domain you scored LOW in, then re-read the rationales on questions you got right by guessing.

Other free official NEA-BC resources

If you want another no-cost check after this set, use the exam owner's own materials:

ANCC also states that practice materials are not required to qualify for the exam and do not imply successful performance.

How these questions were built

We wrote all 50 items from ANCC's published test content outline, allocated them as closely as a 50-question set allows to the published domain counts, and tagged each one to the current outline's topic wording. The outline establishes what is on the exam; it does not establish that a particular answer is correct. During this audit, consequential administration, legal, safety, payment, ethics, emergency-management, workplace-violence, and predictive-analytics claims were checked against current public sources from ANCC, EEOC, CMS, AHRQ, OSHA, ANA, ASPR/FEMA, and FDA. ANCC's own reference list remains useful study guidance, but ANCC states that the 13-title list is not all-inclusive.

Every item was re-read against its stem, answer key, rationale, and domain tag during this audit. The finance and benchmarking arithmetic was recalculated, and ambiguous or overbroad items were repaired before this final version.

Are these official ANCC questions?

No. They are original Castleport Test Prep questions written for practice from the publicly published content outline. They are not recalled, leaked, reconstructed, or lightly rewritten official items. ANCC's certification exams are copyrighted proprietary examinations and candidates sign a confidentiality agreement before testing; material circulating as "real exam questions" should be treated as both unreliable and a risk to your certification.

Does my percentage here predict whether I'll pass?

No. Fifty questions written by an independent publisher produce a raw practice percentage. ANCC's exam produces a scaled score against a standard set by a panel of subject matter experts, on a different set of items, under time pressure, at a test center. This set is useful for finding concepts you have not thought about carefully and for practicing one-best-answer reasoning.

Is this a full-length practice exam?

No, and we would rather say so. The real exam is 150 questions. This is 50, weighted as closely as a 50-question whole-number set permits, which is a long study block rather than a simulation.

Sources

The current ANCC certification page, Test Content Outlines, Reference List, Certification Handbook, 2025 Certification Data, and Role Delineation Study were checked on September 18, 2026. Additional authority links below were checked for the cited item-level principles.

• ANCC Nurse Executive, Advanced certification page — eligibility, fees, exam length, testing window, renewal
• NEA-BC Test Content Outline, effective November 11, 2025 — domain counts, percentages, and all subdomain wording (document updated August 29, 2025)
• NEA-BC Test Content Outline, effective January 10, 2021 — the previous blueprint, used for the comparison above (last updated February 3, 2022)
• NEA-BC Reference List, effective November 11, 2025 — ANCC's current 13-title, non-exhaustive reference list
• ANCC Certification Handbook — scoring, passing score, diagnostic feedback, retesting, testing window, test-day rules (effective June 2025; Version 4, January 23, 2026)
• 2025 ANCC Certification Data — first-time tested, passed, and pass rate by certification
• NEA-BC Role Delineation Study Executive Summary, May 2025 — how the current outline was developed
• ANCC NEA-BC sample test questions
• Nurse Executive (NE-BC) Test Content Outline, effective October 15, 2025 — used only for the wrong-exam comparison
• EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship under the ADA — essential functions, the interactive process, reassignment as a last resort, conduct rules, and the ADA–FMLA relationship
• AHRQ Patient Safety Network: High Reliability — the five high-reliability principles and the treatment of near misses
• CMS: Inpatient Prospective Payment System — predetermined per-discharge payment and outlier payments
• CMS: Accrediting Organizations — deemed-status relationship between CMS Conditions of Participation and CMS-approved accrediting organizations
• CMS: Conditions of Participation — federal participation requirements
• ASPR: NIMS Implementation for Healthcare Organizations — healthcare use of incident command structures and defined response roles
• OSHA: Healthcare Workplace Violence — workplace-violence prevention programs, hazard assessment, controls, training, and follow-through
• ANA Code of Ethics for Nurses, Provision 1.4 — patient self-determination and accurate information for informed decisions
• FDA: Methods and Tools for Effective Postmarket Monitoring of AI-Enabled Medical Devices — site/population change and ongoing performance monitoring for AI-enabled tools
• Schedule with Prometric

Last verified: September 18, 2026 — covering ANCC's exam format, fees, eligibility, scoring, retest policy, test content outline, reference list, published pass rate, and the item-level authority links cited in this resource.

Castleport Test Prep Editorial Team

Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by the American Nurses Credentialing Center or the American Nurses Association. NEA-BC, NE-BC, and related exam and credential names are used only to identify the subject of this independent study resource. The 50 practice questions on this page are original and unofficial. Nothing on this page guarantees passing, a score, certification, licensure, or employment. The employment-law questions describe general federal frameworks for exam preparation and are not legal advice; take specific employment decisions to your HR department and counsel. Verify all fees, eligibility requirements, and policies with ANCC before you apply.

This page was researched and drafted with AI assistance. The source links above are provided so current exam rules and cited principles can be checked directly.