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Category Content Domain Number of Questions Percentage
I Assessment 31 21%
II Diagnosis 39 26%
III Clinical Management 65 43%
IV Professional Role 15 10%
TOTAL 150 100%
Body Systems Drug Agents Age Group
1. Cardiovascular 1. Analgesic 1. Infant
2. Endocrine 2. Anti-Infective 2. Preschool
3. Gastrointestinal 3. Cardiovascular 3. School-Age
4. Genitourinary and Renal 4. Endocrine 4. Adolescent
5. Head, Eyes, Ears, Nose, and Throat 5. Eye, Ear, Nose and Skin 5. Young Adult (including late adolescent and emancipated minors)
6. Hematopoietic* 6. Gastrointestinal 6. Adult
7. Immune* 7. Genitourologic 7. Older Adult
8. Integumentary 8. Musculoskeletal 8. Frail Elderly
9. Musculoskeletal 9. Neurological
10. Neurological 10. Psychiatric
11. Psychiatric 11. Reproductive
12. Reproductive 12. Respiratory
1. Evidence-based population health promotion and screening
1. Comprehensive history and physical assessment
2. Focused history and physical assessment
3. Risk assessment (e.g., genetic, behavioral, lifestyle)
4. Functional assessment (e.g., cognitive, developmental, physical capacity)
1. Pathogenesis and clinical manifestations of disease states
1. Differentiating between normal and abnormal physiologic or psychiatric changes
2. Diagnostic test selection and evaluation
III Clinical Management
1. Pharmacotherapeutics, pharmacokinetics, pharmacodynamics, and pharmacogenetics
2. Anticipatory guidance (e.g., developmental, behavioral, disease progression, crisis management, end-of-life care)
3. Age-appropriate primary, secondary, and tertiary prevention interventions
1. Pharmacotherapeutic intervention selection (e.g., interactions, contraindications)
2. Pharmacotherapeutic intervention evaluation (e.g., monitoring, side/adverse effects, patient outcomes)
3. Non-pharmacologic intervention selection and evaluation
4. Therapeutic communication (e.g., motivational interviewing, shared decision making)
5. Culturally congruent practice
6. Resource management (e.g., accessibility, coordination, cost effectiveness)
IV Professional Role
1. Legal and ethical considerations for health care informatics and technology (e.g., confidentiality, accessibility)
2. Scope and standards for advanced practice registered nurses
3. Regulatory guidelines (e.g., reportable diseases, abuse reporting)
4. Evidence-based clinical guidelines and standards of care
5. Ethical and legal principles and issues for patients, populations, and systems (e.g., justice, consent, guardianship, bioethics)
1. Research appraisal (e.g., design, results, clinical applicability)
The ANCC Family Nurse Practitioner board certification examination is a competency based examination that provides a valid and reliable assessment of the entry-level clinical knowledge and skills of nurse practitioners. This certification aligns with the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education. Once you complete eligibility requirements to take the certification examination and successfully pass the exam, you are awarded the credential: Family Nurse Practitioner-Board Certified (FNP-BC). This credential is valid for 5 years. You can continue to use this credential by maintaining your license to practice and meeting the renewal requirements in place at the time of your certification renewal. The Accreditation Board for Specialty Nursing Certification accredits this ANCC certification.
The ANCC certification examinations are developed consistent with the technical guidelines recommended by the American Educational Research Association, the American Psychological Association, and the National Council on Measurement in Education (AERA, APA, NCME; 1999). Additionally, the ANCC certification examinations meet accreditation standards of the Accreditation Board for Specialty Nursing Certification(ABSNC) and the National Commission for Certifying Agencies (NCCA). Each examination is developed by ANCC in cooperation with a Content Expert Panel (CEP) composed ofcarefully selected experts in the field. CEPs analyze the professional skills and abilities from role delineationstudies, which provide the evidence for the test content outline (also called the test blueprint).
Test questions or “items” are written by certified nurses and interprofessional content experts in their discipline who have received training by ANCC staff in writing items. The items are then reviewed by the CEP with the ANCC staff and pilot-tested to ensure validity and psychometric quality before being used as scored items on the genuine examinations. ANCC adheres to a variety of guidelines during the development of items to ensure that the items are appropriate for the specialty and certification level (e.g., APRN vs. RN). This includes editing and coding items, referencing items to the approved test content outlines and reference books, and screening items for bias and stereotypes. Items for the examinations are selected that reflect the test content outline and item distributions. The validity and reliability of the exams are monitored by ANCC staff. Certification examinations are updated approximately every three to five years.
ANCC reports its examinees test score results as pass or fail. If an examinee fails, the score report includes diagnostic feedback for each of the major content areas covered on the examination.
ANCC examinations are criterion-referenced tests, which means that an examinees performance on the examination is not compared to that of other examinees in determining the examinees pass/fail status.
In a criterion-referenced test, an examinee must achieve a score equal to or greater than the minimum passing score for the examination. The minimum passing score represents the absolute minimum standards that the examinee must achieve to demonstrate the ability to practice the profession safely and competently. With the guidance of a measurement expert (e.g., a psychometrician), a panel of subject matter experts in the nursing specialty sets the minimum passing score for each ANCC examination. In setting the minimum passing score, ANCC uses the Modified Angoff Method, which is well-recognized within the measurement field.
Each test contains between 150 to 175 scored test items plus 25 pilot test items that do not count towards the final score. For specific information on the number of items each test contains, please refer to the test content outline associated with that exam.
Scores on ANCC examinations are reported on a scale with a maximum possible score of 500. To pass the ANCC examination, an examinee must achieve a scale score of 350 or higher. Prior to conversion of an examinees score to this scale, the examinees raw score on the examination is determined, which is simplythe number of test items that the examinee answered correctly (e.g., 105 out of 150). The raw score is then converted to a scale score, using a conversion formula.
For examinees who do not achieve a scale score of at least 350, the score report will show the scale score achieved, “fail” status, and diagnostic feedback for each of the content areas covered by the examination
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locate the latest COVID-19 news and assistance in Medscape'sÂ Coronavirus aid center.
what's most astonishing about this particular coronavirus is how infectious it's (not like MERS and SARS) and that americans beneath 50 are disproportionately asymptomatic.
The trajectory of COVID-19 situations has been higher than anticipated. additionally, antibody trying out showed in the spring that the number of infections may well be 10 times bigger than the quantity demonstrated situations.
This year, it may be even more vital for people to get a flu vaccine. A flu outbreak will stress hospitals which are already scuffling with the COVID-19 pandemic.
present medical trials are for individuals over age 18 and don't exclude these at excessive chance, including those over 70 and/or with comorbidities similar to diabetes.
now's the time to put money into public health, which they have not achieved effectively during the past.
This transcript has been edited for clarity.
John Whyte, MD, MPH: you're staring at Coronavirus in Context. i'm Dr John Whyte, chief scientific officer at WebMD. nowadays i'm joined by way of Dr Robert Redfield, the director of the facilities for ailment handle and Prevention (CDC). Dr Redfield, thanks for joining me.
Robert Redfield, MD: wonderful to be here. Thanks for having me.
Whyte: you are a virologist by way of practicing. What has stunned you about this novel coronavirus?
Redfield: I suppose that it's vital that they don't actually recognize this virus very well. They simply got brought about 7 months in the past. The factor that stunned me the most became how infectious this virus is. You comprehend, when they saw that it became a coronavirus, I think they have been considering it changed into going to be extra like SARS or MERS.
Even with the primary cases they recognized in the US, the primary 12 circumstances that they did contact tracing in over 850 individuals, they best found two of those contacts, who have been contaminated both through spouses. So they had a view that this virus became probably going to be more like MERS and SARS, but they all of a sudden understood that this is a tremendously infectious disorder.
I consider it truly is likely the primary issue that shocked us. The 2d thing is that, doubtless for a majority of people beneath the age of fifty, it be disproportionately asymptomatic. I wish they had been invited in early. I had asked my counterpart [in China], George Gao, to have us take part back on January 3, to place CDC in to work alongside him, to are attempting to have in mind the outbreak because it was unfolding in Wuhan. I believe if they had been in a position to get in at the moment, they likely would've learned quicker than they discovered right here that, basically, it's incredibly infectious and that asymptomatic ailment goes to be a critical hallmark of this an infection.
Whyte: We're at 5 million situations. but as you understand, to position it in standpoint for their listeners, they have been at four million instances, roughly, three weeks ago. So the trajectory when it comes to the variety of new situations is bigger than they want. How do you feel they acquired to 5 million? Is it that americans are not doing the safeguards that they should be doing? Are people not taking it severely? i was told you might be in one of the historic battle rooms within the historical govt workplace building. How are they doing in this war in opposition t COVID-19?
Redfield: well, I feel you might be correct. it's a warfare. I think the first element that i would want to say is that we're relatively assured that this virus slowly entered the united states in late January and February. And there wasn't wide an infection all over February. they now have about 5 different traces of evidence to support that conclusion that they have now posted.
but evidently, in March, there all started to be greater introduction, above all from Europe, and they truly ceded enormous parts of the us. once they looked at March, April, and might, they had about 2 million infections that were clinically determined, as you alluded to. What's wonderful is that after they went returned and did antibody checking out during that length, they actually had evidence that for each one case that changed into clinically determined, there have been truly 10 greater infections. likely in those first 3 months, they definitely had 20 million individuals. but if you divide 20 million via 90 days, that you can see that we're probably over 200,000 infections a day, despite the fact that they were handiest recognizing 10,000 or 15,000.
Whyte: Dr Redfield, we're over 160,000 deaths in the united states up to now. Do you predict COVID to be a number one cause of demise with the aid of the end of the 12 months?
Redfield: You be aware of, John, I consider it be clearly going to be one of them. in case you regarded again and used their surveillance methods that we've â€” and they have one which appears at demise via pneumonia â€” they had either pneumonia, influenza-like disease, or COVID-like illness, and they all likely represented COVID.
At one point in time in April, early may, 27% of all deaths in the u.s. have been caused by way of pneumonia, influenza, or a COVID-like [illness]. i can display you the curve â€” a massive spike when this outbreak hit long island and then the follow-up deaths. So or not it's obviously going to be a tremendous cause of demise within the u.s..
fortuitously, the mortality is improving, in reality for 2 factors. One is we're recognizing more infections, so the denominator is distinctive. but additionally, they definitely are getting improved as physicians at managing these patients: good awareness of the hypercoagulable state, the magnitude of anticoagulation, the attention that steroids have a role in superior sickness, the earlier capability to make use of remdesivir. So the mortality, I think, continues to decline.
Whyte: now they have also modified ventilator protocols.
Redfield: Very critical, the agent in ventilator protocols, as you know. and i think they now have realized lots as clinicians â€” i am an internist too â€” in a way to manage these patients. confidently they are going to see on the horizon â€” now not too distant â€” additional new therapeutics are available to add to the armamentarium that clinicians have.
ultimately this virus is going to have its day. it be both going to contaminate a majority of the world inhabitants or they will have a organic countermeasure; it truly is going to be a great vaccine it is going to stay away from it from infecting [the global population].
Whyte: well, they hope. Let's discuss vaccines. however first I want to speak concerning the flu vaccine. you've gotten been talking about and cautioning how critical it's, notably this 12 months, to get the flu vaccine as they combat COVID. closing yr, roughly no longer even 50% of those that may still have gotten the flu vaccine got it. How do you consider we'll do more desirable this 12 months? And remind viewers why or not it's so critical this yr.
Redfield: it's in reality essential. I've mentioned that if there may be one factor they all can do, besides the magnitude of wearing a mask, social distancing, handwashing, and being sensible about gatherings, is eventually put together ourselves for the autumn to get the flu vaccine. As you outlined, about 47% people got the flu vaccine.
Whyte: CDC often recommends the purpose to be 60%-70%.
Redfield: that's appropriate. sure, my goal this year was to get it as much as sixty five%. and that i think one of the crucial messages we're trying is to swap it from the "anti-vax" or "vaccine hesitancy" to a campaign of "to vaccinate with confidence," and attempting to inform the American public, "Please don't depart this critical accomplishment of yankee drugs on the shelf for yourself, your household, your church, your team of workers."
with the aid of getting vaccinated, you could offer protection to your little ones. clearly, after they seem at the mortality that they see with flu, one aspect is for definite: The kids who get vaccinated truly get covered in opposition t death. It additionally has an have an impact on on the relaxation of us when it comes to severity of sickness and hospitalization. Some americans do not understand that during the past 10 years, 360,000 individuals died in this nation from flu. Flu is a huge explanation for death. we've a biological countermeasure and a vaccine, and they do have remedy. And this is the 12 months i am asking americans to truly believe deep down about getting the flu vaccine.
we have worked with business. industry is plussing up the quantity of vaccine they'll make purchasable â€” doubtless over a hundred million doses this yr, a hundred ninety million doses. The CDC and myself, we've got bought an extra 10 million doses. normally they best purchase about 500,000 doses for uninsured adults to supply to the states. This yr, I've bought 10 million doses for uninsured adults within the states to make certain states can get this flu vaccine now.
The genuine reason is they will have COVID within the fall and they will have flu within the fall. And either one of these by way of themselves can stress certain health center programs. I've considered clinic intensive care gadgets stretched by way of a extreme flu season, and certainly they now have all viewed it currently with COVID. So with the aid of getting that flu vaccine, you may well be capable of then negate the necessity to need to take up a health center mattress. after which that health facility mattress can be extra purchasable for those that probably get hospitalized for COVID.
Whyte: Let's speak in regards to the COVID vaccine. How confident are you that they are going to see a vaccine early next 12 months? and may you provide us a much better sense of timeframe? As you know, Russia introduced today that Sputnik V, their vaccine, is authorized while they are nonetheless in phase 2. So how functional is it that they will have anything in January or February? Or are they pondering greater later first quarter?
Redfield: i'm very cautiously optimistic that they will have one or extra vaccines deployed earlier than the primary of the year. right now, there is Operation Warp speed â€” i'm on the board of it. i've been in vaccine construction all my lifestyles, in the years I've spent within the armed forces at Walter Reed after which at the tuition of Maryland. I've not ever considered vaccine building move like this.
there may be in fact a really useful private-public partnership with the deepest sector. And there are six vaccines now that are moving ahead extremely hastily, three of which now are already in section 3 trials â€” and that i suspect there'll be a fourth. So i'm very confident that they will have one or extra vaccines attainable.
in view that we're going so speedy, some people agonize that we're chopping corners. there isn't a scientific integrity to corners being reduce; there isn't a nook reduce for defense. The corner that we're slicing is the investment in being in a position to make the vaccine. So when groups were ready for part three trials, the united states govt begun construction of one hundred million doses of the vaccine, as if it become going to work.
Whyte: but in equity in timelines, we're in August. probably the most business had 5000; they still want 25,000 greater contributors to attain their part threeÂ enrollment. individuals still ought to trap the virus, appropriate? and then they now have a handle community that they should compare to. So the timeline is fairly compressed if we're pondering of anything with the aid of the conclusion of the year. is rarely that correct? Early next yr, after which it nevertheless must be reviewed.
Redfield: We're moving very straight away. If there may be any gentle to the fact of the sudden surge and the challenge of the entire new cases we're having, it's the variety of trial sites which are up and working. They began 2 weeks in the past. they are enrolling very hastily. I do believe they may all have their enrollment executed between now and the conclusion of September, and then we'll see what the information reveal.
The different factor I want to say it truly is so diverse and so critical here is, unlike the pains that you just can also had been concerned with, and i comprehend i was involved with, we're no longer aside from the aged.
Whyte: it's right.
Redfield: so you can in fact get within the trial when you are 65 or 70 years old. We're now not aside from americans with diabetes, obesity, and coronary heart disorder, who continually do not get in trials. We're no longer apart from pregnancy. So the high-possibility people that we're hoping this vaccine is used for are being included in these phase three trials, which will examine whether it's probably going to have immunogenicity and safeguard within the population at most risk, as a result of that's really where they need to get this vaccine as quick as possible.
Whyte: My understanding turned into that there isn't anyone enrolled beneath age 18. Is that correct?
Redfield: you are correct. The existing trials have not blanketed babies. That doesn't mean there don't seem to be going to be companion trials. but now all of the trials are over 18. however in contrast to a lot of them that i have been involved with in the past that do not sign up individuals over the age of forty five, this one's enrolling individuals all of the approach as much as over 70. same with varied scientific diseases.
So there'll have to be observe-up trials for children under the age of 18, however certainly there's a complete trial presently with a view to accommodate the people who're most in danger because of comorbidities and age or because of their jobs; there are physicians, nurses, intensivists, and so on.
Whyte: What does Thanksgiving seem like this year, Dr Redfield?
Redfield: smartly, I pray it's a moment of thanksgiving. You be aware of, this total issue all started for me on New 12 months's Eve. and i can say that or not it's been all arms on deck on the grounds that then, once I got my first name in regards to the new mysterious pneumonia in China on December 31.
naturally it be just about a story of two cities. If the American public will in fact take to coronary heart what I've requested â€” wear a masks, social distance, use remarkable hand hygiene, and be smart about crowds â€” and all of us try this... I maintain telling people, i'm not asking some of the us to do it; now they have all got to do it. this is one of those interventions it is got to be ninety five%, 96%, 97%, ninety eight%, 99% if it's going to work for us.
Whyte: Why can not they get individuals to put on masks? It appears like a small cost.
Redfield: they now have received to keep attempting. we've obtained to preserve trying. it's unique; it be very diverse in diverse cities. i used to be lately in a neighborhood where three, 4, 5-year-olds had been all donning their masks. all of the folks. I failed to see anyone without a masks. however i've been in other areas where it be the contrary. They definitely do need to get [out the message that the] masks actually does work. it's truly vital. So for those who question me what Thanksgiving's going to be like, I think or not it's just elegant upon how the American people choose to reply. we'll continue to are trying to do what they are able to to be positive.
As I've pointed out before, when John Kennedy talked about, "Ask no longer what your nation can do for you; ask what which you could do on your country" â€” to paraphrase that, in your nation right now and for the war that we're in towards COVID, i am asking you to do 4 elementary things: put on a masks, social distance, wash your palms, and be smart about crowds.
in case you do these four things, it's going to convey this outbreak down. but if they do not do this, as I referred to ultimate April, this could be the worst fall from a public health standpoint that we've ever had.
Whyte: tell us what you pass over, Dr Redfield. Is it traveling? How has this impacted you in my opinion?
Redfield: once I decided to settle for the possibility to be the CDC director, I needed to surrender some thing that I really love dearly, and that is the reason the follow of medication. I've cared for a few of my sufferers with HIV for greater than 25 years. In a method, i'm anticipating, when my tour of obligation is over, getting back to the observe of medication because I really love practising medication.
At CDC, I suppose or not it's in reality the intensity of what we're doing. i would love somebody like your self to get into the agency and spot how plenty is occurring. I suggest, there are lots and hundreds of people working 24/7 on this pandemic. And the fact is that each one of their focal point is on this pandemic presently.
I produce other essential initiatives: ending the AIDS epidemic in the usa, that the president all started, that we're still committed to. but undoubtedly, a few of that effort gets sidetracked. putting off tobacco use in little ones â€” the entire progress we've got made with e-cigarettes. I are looking to get that again on. Making growth on maternal mortality. there is no explanation why 700-800 mothers must die in this country every year giving birth to children.
Whyte: women of colour, exceptionally.
Redfield: it is correct. And the development that we're trying to make in getting people treated for hepatitis C, the development with diabetes. So there may be loads of classes. And when you look at the collateral hurt of COVID, it is that they have now all had to turn their focal point disproportionately.
I tell my colleagues at CDC, "Please, do the added effort to keep the main classes you're doing relocating forward. here's no longer a time to lose floor." I believe the past 7 months were, as you mentioned earlier than, we're in a conflict. and i hope people know â€” and one of the most things I recognized when I became the director â€” they really have not invested, in this nation, within the core capabilities of public health. it be all the time been something they left for leftovers. I've tried to make the argument that now is the time to put money into public fitness, data, statistics analytics, predictive statistics analysis, laboratory resilience in their public fitness labs, public fitness group of workers. they have some states the place we're all the way down to below 40, 30, 20 contact tracers. after which, of route, they should have the emergency substances to operationalize that with a worldwide footprint and expectantly prefer these items up where they birth, and to put them out earlier than they arrive right here.
that is one in all my hopes that we'll take from this â€” that americans now know that public health matters. This nation goes to spend somewhere between $three trillion and $7 trillion in responding to this pandemic. If they could make that funding in these core capabilities â€” information, lab people â€” and make sure they do it for the entire nation...
I think many people can also no longer understand that CDC is the backbone funding for the general public fitness infrastructure of every metropolis and each state in this nation. They should overinvest. Get overprepared. i will say that in four or five a long time of funding, when the huge one came â€” and here's now not a minor one, here is the highest quality public fitness disaster to hit this nation in a century â€”we were underprepared. And they owe it to their children and grandchildren that this nation is never underprepared once more for a public fitness disaster.
Whyte: Dr Redfield, I are looking to thank you and all your colleagues at CDC for working tirelessly to offer protection to us all the way through this time of the pandemic. and that i hope they will sign in with you to discuss a few of those other priorities that CDC is engaged on to deliver protection to and advance the health of americans and, as you talked about, actually refocus and invest in public health and public health ideas. thank you.
Redfield: thank you very lots. They appear forward to that. God bless.
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