The CPHQ Exam Content Outline: All 7 Domains Explained

I have taught this exam to more than 3,400 people, and the single strongest predictor of who passes comfortably is not clinical background, seniority or hours logged. It is whether the candidate knows how many questions come from each domain before they start revising.

NAHQ publishes that number on its own certification pages. It is free, it takes ten minutes to read, and it tells you exactly where the marks are. Most candidates skip it and build a plan around the topics they already like, which is how a nurse manager arrives at the exam fluent in patient safety and unable to read a control chart.

What follows is the whole blueprint: the seven domains and their weights, how the questions are asked, the format, how the scoring works, and an hour-by-hour allocation derived from the question counts, with the arithmetic shown so you can rework it for your own timetable.

Of the 140 questions you answer, only 125 count. The other 15 are unscored pretest items NAHQ is trialling for future forms of the exam, scattered through the paper with nothing to distinguish them. You cannot spot them, so answer everything as though it counts. Here is how the 125 scored items divide.

Read that table as a market, because that is what it is. Improvement and analytics together carry 53 of the 125 scored items, so any hour spent there has roughly twice the expected return of an hour spent on regulatory and accreditation content. The top four domains carry 90 items between them. Get those four to a comfortable standard and the bottom three cannot fail you on their own.

The opposite reading is the one I meet most often. Candidates from an accreditation background expect the exam to be about standards, chapters and survey preparation, because that is what their working week is about. It is 8 questions. Eight. You should not ignore them, but you should not spend a fortnight on them either.

The weighting table tells you what is on the exam. The cognitive-level split tells you what kind of exam it is, and it is the part almost nobody plans for. NAHQ writes items at three levels: 23% recall, 57% application and 20% analysis.

Those item counts come from applying the published percentages to the 125 scored questions, so treat them as close approximations rather than exact counts. The proportions are the point: fewer than three items in ten reward memory. The other seven ask for judgement, and judgement is not revised, it is practised.

This is why flashcards produce such disappointing mock results. A candidate can name all eight run-chart rules and still choose the wrong response when a chart shows a shift and the scenario mentions a change of measurement method in the same month. The knowledge was there. The decision was untrained.

Three hours is the maximum, not a target. Across 140 questions that is about 77 seconds an item, which sounds tight and is not, provided you never spend four minutes on one stem. My own pacing rule, which I give every cohort: check the clock at question 35, 70 and 105. You want to be at or slightly ahead of 45 minutes, 90 minutes and 135 minutes respectively. If you are behind at the first checkpoint, you are reading too slowly, not thinking too slowly, and the fix is to stop re-reading stems you have already understood.

Two habits protect the clock. Answer every item on first read even when you intend to come back, because an unanswered flagged question is worth the same as a wrong one and the review pass rarely gets as far as you expect. And decide in advance what your abandonment rule is: mine is that any item still unresolved after two readings gets a best answer, a flag and no further thought until every question has been seen once.

You sit it either in person, at one of more than 100 test centres in the United States and at international centres, or online with a live remote proctor. The remote option is the one most of my candidates in Egypt and the Gulf use, and it removes travel from the budget as well as from the day.

Your result comes back as a scaled score between 200 and 800, and 600 passes. A scaled score is a conversion, not a percentage: 600 does not mean 75 per cent, and there is no published number of correct answers that guarantees it. Forms vary slightly in difficulty and the scaling adjusts for that, which is fair to you and frustrating to anyone trying to compute a target.

The practical advice that follows is simple. Stop asking how many you need to get right. Track mock performance by domain instead, because domain-level weakness is the thing you can act on and a single overall percentage is not.

And to settle a question I am asked in every cohort: NAHQ does not publish a CPHQ pass rate. The figures circulating on forums and aggregator sites are fabricated. Nobody outside NAHQ knows.

Three things are outside the published outline, and knowing which questions have no answer saves a great deal of forum reading.

The first is which 15 items are unscored. They are not marked, not grouped and not identifiable by style, so the only sane response is to treat all 140 as scored. The second is whether the scoring requires a minimum standard in each domain or only an overall scaled score of 600. NAHQ determines pass or fail from your overall raw score for the entire examination, not from a minimum in each domain. The score report still breaks your performance down by content category, which is feedback rather than a threshold. Until that is confirmed, plan as though a badly neglected domain can hurt you, which is in any case the safer plan.

The third is the internal split within a domain. The outline gives you a number for Health Data Analytics, not a number for control charts specifically. That granularity does not exist publicly, which is why mock exams matter: your own error pattern across several full papers is the only subdomain map you will ever get. Build it, and revise against it rather than against a syllabus.

NAHQ's guidance is 20 to 50 hours of preparation, and most candidates already working in healthcare quality report six weeks to three months. Take 50 hours as your budget, because most clinicians moving into quality need the upper end, and divide it in proportion to the scored items.

The arithmetic is one step. Fifty hours divided by 125 scored items is 0.4 hours per item, or 24 minutes. Multiply each domain's item count by 0.4.

Rounding leaves one hour spare. Give it to whichever domain your diagnostic test scores worst, not to the one you enjoy. If you have only 20 hours because you already work in quality full time, the multiplier becomes 0.16 hours per item and every figure in the last column scales down by the same factor: about 4 hours for improvement, 4 for analytics, 3 for leadership, and so on. If you want 100 hours because you are new to quality, double the column.

Turning 49 hours into a calendar is the step most plans skip. Over eight weeks that is a little over six hours a week: one weekday evening of two hours, a second of one, and three hours at a weekend. Spend weeks one and two on improvement, weeks three and four on analytics, week five on leadership, week six on patient safety, week seven on quality review with population health, and week eight on regulatory content and full timed papers. The order matters as much as the total, because the two largest domains want the weeks when your motivation is highest and your exam date is still comfortably distant.

Two adjustments are worth making to the pure proportional split. First, take one hour out of every domain and put five hours into full-length timed papers, because pacing is a skill of its own and it cannot be learned in ten-question blocks. Second, if your diagnostic shows analytics well below the rest, borrow from Regulatory and Accreditation rather than from Patient Safety. Eight questions is the cheapest place to be slightly weak.

An even split across seven domains. It feels responsible, it is easy to timetable, and it quietly hands 21.6% of the exam the same preparation as 6.4% of it. On a 50-hour budget an even split spends about 7 hours on 8 questions and 7 hours on 27. That is roughly 54 minutes of preparation per regulatory question and 16 minutes per improvement question, for questions worth exactly the same mark.

The third, and the one I am least able to talk candidates out of, is postponing full-length timed papers until the final week. Pacing across 140 questions is a separate skill from knowing the material, and it is the only skill on this exam that cannot be practised in fragments. A candidate who has never sat three unbroken hours does not discover the problem in revision, they discover it at question 90 with an hour left and fifty items to read.

The second mistake is subtler and more expensive: treating analytics as something to be read about. Health data analytics is 26 scored items, and it is where clinicians lose the exam. You cannot revise a control chart by reading a description of one. You have to look at charts until special cause is something you see rather than something you calculate.

Each domain has its own article, written in the order the exam rewards. Work down this list rather than through the outline alphabetically.

Copy the scored-item column onto one page and pin it where you study. Sit a timed diagnostic before you revise anything, so the hours you allocate are aimed at measured weakness rather than at a hunch, and our free CPHQ practice test is enough to produce that first domain profile. Then build the 50-hour table above into real calendar slots and book your exam date, because an unbooked exam expands to fill whatever time you leave it.

Every domain in this blueprint has a video lesson to work alongside the article, and the whole set sits in our CPHQ study video library in the same weighted order as the table above.