Ambulatory Care Nurse Certification Exam (ANCC) With 100% Correct Answers 2024, Exams of Nursing

Download Ambulatory Care Nurse Certification Exam (ANCC) With 100% Correct Answers 2024 and more Exams Nursing in PDF only on Docsity! Ambulatory Care Nurse Certification Exam (ANCC) With 100% Correct Answers 2024 The Ambulatory care Nurse is triaging a client whose chief complaint is chest pain. What is a priority action for the nurse to take? A. Complete full head to toe B. Administer ASA C. Perform Electrocardiogram (ECG) D. Call 911 - Correct Answer-C. Perform an Electrocardiogram Which of the following is essential for the ambulatory care nurse to remind the client of when performing an Electrocardiogram? A. Take a deep breath during the test B. Hold you breath during the test C. Try not to move during the test D. You may keep your bra on during the test - Correct Answer- C. Try not to move during the test The Ambulatory Care nurse is assessing a client. Which of the following questions will yield more information from the client? A. Are you feeling pain? B. What brought you in today? C. How many Children do you have? D. When was your last menstrual period? - Correct Answer-B. What Brought you in today? The ambulatory care nurse is conducting an annual assessment of a client. The client denies frequent urination, blurry vision, excessive thirst or hunger. The clients Blood sugar is 500mg/dl by finger stick. What should the nurse do next? A. Transport client to the ER B. Notify the healthcare provider immediately C. Retest the Blood glucose D. Order a Hemoglobin A1c - Correct Answer-C. Retest the blood glucose Which of the following laboratory test is most effective in monitoring a client with DM blood glucose level? D. Yellow reaction - Correct Answer-C. Blue reaction The nurse in the Medical oncology clinic is assessing a client who is undergoing chemotherapy. The nurse obtained an oral temp of 102 degrees. which statement by the nurse indicates an understanding of the clients' condition? A. Since the client is feeling "ok" there is no further intervention B. A temp of 102 is an expected finding after chemotherapy C. Cal the MD to obtain an order of Tylenol as soon as possible D. The client is post chemo and at risk for neutropenia fever. This is an emergency and requires stat ABX or hospitalization - Correct Answer-D. The client is post chemo and at risk for neutropenia fever. This is an emergency and requires stat ABX or hospitalization The Ambulatory care nurse is performing a physical assessment on a child who underwent chemotherapy. Which statement by the client indicates that further evaluation is needed? A. I ate my entire meal B. My ears are ringing C. I play with my rother everyday D. Sometimes I am tired - Correct Answer-B. My ears are ringing The ambulatory care nurse is scheduling the client for gFOBT. Which statement made by the client indicates that teaching was effective? A. This is an invasive test B. I will not eat Mushrooms for 48-72 hours C. I can take ASA if I am having a headache D. I will reduce my fiber intake - Correct Answer-B. I will not eat Mushrooms for 48-72 hours Prioritization is an important aspect of the ambulatory care nurse's time management plan. Which of the following clients would the nurse see first? A. A client with a BS of 150mg/dl and is asymptomatic B. A client who complains of blood in urine 24hours POP TURP C. A client with a blood pressure of 140/89 and is asymptomatic D. A client in her 3rd trimester and has signs of preterm labor. - Correct Answer-D. A client in her 3rd trimester and has signs of preterm labor. A client informed the ambulatory care nurse that the internet is very helpful to her when reviewing health information. Which actin is appropriate for the nurse to take? A. Encourage the client to continue her independence by taking her health in her own hands. B. Educate the client on credible websites and the importance of protecting private information C. Do nothing. The client is knowledgeable about using the internet. D. Document the clients response in the chart. - Correct Answer-B. Educate the client on credible websites and the importance of protecting private information Which of the following strategies is appropriate when facilitating conflict resolution? A. Choose a side as soon as possible B. Refrain from judging C. Use minimal choices and options to reach a speedy solution D. Blame the guilty party - Correct Answer-B. Refrain from judging The ambulatory care nurse is teaching a client ho to change their wound dressing. Which of the following indicates emotional readiness to learn? A. The client accepts the need to learn the new skill B. The client has the psychomotor function to change the dressing C. The client is a wound care medical MD D. The client has dressed his/her own wound in the past - Correct Answer-A. The client accepts the need to learn the new skill To educate the client the ambulatory care nurse needs a systematic and planned process that consists of teaching and learning. Which of the following factors could influence the education process? A. Culture B. Learner's readiness C. Gender D. Socio-Economic Status - Correct Answer-B. Learner's readiness The Ambulatory care nurse is discharging a 10-year-old child from the pediatric clinic. To whom should the nurse given the discharge teaching? A. The Child B. The mother C. Both the child and the caregiver D. the grandparents - Correct Answer-C. Both the child and the caregiver The ambulatory care nurse is caring for a Native Hawaiian whose choice of food intake, health and wellbeing perception can pose barriers to life style modification. To be effective in getting the client to participate in dietary modification, which of the following steps should the nurse take? A. Give the client a brochure B. Teach the client about nutrition from a family framework perspective C. Give the client the web address for the dietary information D. Recommend a specific diet regimen - Correct Answer-B. Teach the client about nutrition from a family framework perspective The Ambulatory care nurse is working in the client with a variety of clients from different racial and ethnic groups. When providing care, the nurse should know which group has the highest asthma prevalence of any racial/ethnic group in the USA? A. Hispanics B. Caucasian C. African Americans D. Asian - Correct Answer-C. African Americans The Joint commission requires accredited healthcare organizations to develop and use a list of abbreviations that should not be used. Which of the following if documented by the ambulatory care nurse indicate understanding of the "Do not Use" list? A. QD B. U C. Unit D. IU - Correct Answer-B. U A client fell in the clinic during the intake process. The ambulatory care nurse is documenting the occurrence. Which D. Levalbuterol (Xopenex) - Correct Answer-A. Fluticasone (Flovent) The Ambulatory care nurse asses a client with Shortness of breath, lack of energy, and dry mouth. Which of the following disease should the ambulatory care nurse suspect? A. COPD B. Congestive Heart Failure C. Asthma D. Respiratory Failure - Correct Answer-A COPD The parent of an eight year old child reports that the child cannot efficiently use the metered dose inhaler. Which of the following actions should the nurse take? A. Give the child a nebulizer B. Give the child a spacer C. Recommend discontinuation of the medication D. Inform the parent that the medication is not important - Correct Answer-B. Give the child a spacer The ambulatory care nurse is formulating a research question using the PICO format. the "C" in PICO stands for which of the following? A. Comparison B. Characteristics C. Culture D. Cure - Correct Answer-B. Characteristics PICO (T) Format - Correct Answer-Formula for creating answerable research questions. P: Population/patient - age, gender, ethnicity, individuals with a certain disorder I: Intervention/indicator (Variable of Interest) - exposure to a disease, risk behavior, prognostic factor C: Comparison/control - could be a placebo or "business as usual" as in no disease, absence of risk factor, Prognostic factor B O: Outcome - risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome T: Time - the time it takes for the intervention to achieve an outcome or how long participants are observed The ambulatory care nurse is teaching a client how to use the peak flow meter. Which statement indicates that teaching was effective? A. I Should move the indicator to the bottom of the number scale before suing the meter B. I Should blow out as slowly as possible C. I should blow multiple time in a meter during a single test D. I should lie down when using the meter - Correct Answer-A. I Should move the indicator to the bottom of the number scale before suing the meter Which of the following if noted in the clients urine analysis would require further actions? A. Protein B. Bacteria C. Bilirubin D. White Blood Cells. - Correct Answer-C. Bilirubin The client is being scheduled for a lower gastrointestinal study using double-contrast barium enema. Which of the following should be included in the clients teaching? A. The procedure will take 6 hours D. Give information that is general that can be applied to most clients. - Correct Answer-A. Take a quick and accurate history in order to make an accurate decision The ambulatory care nurse is assessing a client. Which questions should the nurse ask to assess the clients health goals? A. It seems to me that you want to be healthy, Is that true? B. What are your health goals? C. Do you want to be healthy? D. Do you exercise? - Correct Answer-B. What are your health goals? The ambulatory care nurse is caring for an elderly client. The nurse caring for the client should know what about elder abuse? A. All victims of elder abuse are victims of poly-victimization B More than 3 in 5 victims are men and 75 years or older C. Elder abuse can be the result of intentional or unintentional neglect D. elder abuse is not an issue, the nurse should not be concerned about. - Correct Answer-C. Elder abuse can be the result of intentional or unintentional neglect The ambulatory care nurse is caring for a 30 year old married woman in the clinic who was accompanied by her husband. Upon assessment, the nurse noted bruises on the clients arm. What action should the nurse take? A. Conduct further assessment without the clients husband in the room. B. Ask both the husband and the client what happened C. Call 911 D. Inform the client to leave her husband for safety - Correct Answer-A. Conduct further assessment without the clients husband in the room. When coding for visits of new patients, the key component that must be included to document the correct level of evaluation and management (E/M) are: A. History, physical and medical decision making B. Physical exam and medical decision making C. History and physical exam D. Age, DX, and medical decision making - Correct Answer-A. History, physical and medical decision making If a patient is trying to make an informed decision about whether to have surgery or more conservative treatment for prostate cancer and asks the ambulatory care nurse for advise on making the decision, the nurse should: A. Advise the patient on the best course of treatment B. Suggest the patient carry our research before deciding C. provide the patient with print and online resources D. Advise the patient to ask the physician for more information - Correct Answer-C. provide the patient with print and online resources An Ambulatory care center has analyzed the type of patient complaints and finds there are four complaints that are most common ( delays, rescheduling, difficulty scheduling and parking) but not easily solvable and that staff members handle these complaints in different manners. The service recovery program should begin by: A. Posting signs apologizing for these problems B. Warning patients in advanced that these problems may occur C. Providing patents with complaint forms D. Establishing protocols for dealing with complaints - Correct Answer-D. Establishing protocols for dealing with complaints A. Democratic B. Laissez-faire C. Authoritarian D. Bureaucratic - Correct Answer-C. Authoritarian The ambulatory care nurse is preparing electronic educational material to be viewed over the internet and plans to include both deep links to articles and inline links to images from commercial sites. The nurse should: A. Include the links as desired B. Ask permission to utilize links C. Provide a works cited list D. Provide the course link in the text - Correct Answer-B. Ask permission to utilize links With problem based learning, the role of the instructor is that of: A. Leader B. Lecturer C. Observer D. Facilitator - Correct Answer-A. Leader If delegating a task to staff person, the first issue to consider is whether the: A. Task is suitable for the individual B.. Individual has time to carry out the task C. Individual can be adequately supervised D. Individual wants to carry out the task - Correct Answer-A. Task is suitable for the individual A family practice physician's office schedule is usually fully booked with patients scheduled every 15 minutes, but the MD routinely adds patients who have acute needs to the schedule resulting in delays in seeing patients, unpaid staff OT and staff complaints. The best solution for the nurse manager may be to: A. Schedule staff later in the day B. Suggest referring patient to ED C. As for payment for any OT D. Leave open slots in the schedule - Correct Answer-D. Leave open slots in the schedule When conducting a test for the erythrocyte sedimentation (ESR) rate using the Sediplast kit rack, after the blood in the Sediplast tube is inserted into the vial, the results should be checked in: A. 10 min B. 30 min C. 60 Min D. 90 min - Correct Answer-C. 60 min If a patient comes to the ambulatory care center with a 1inch gash on he left foot from a dog bite, the initial response should be to: A. Wash the wound area with soap and water B. Irrigate the wound with -ml of NS C. Irrigate the wound with - ml of hydrogen peroxide D. Soak the foot in povidone-iodine/NS (50/50) solution - Correct Answer-D. Soak the foot in povidone-iodine/NS (50/50) solution If one of the patients nursing diagnosis on the care plan is "Self care deficit" which of the following is an appropriate desired outcome? If a physician is registered as a Vaccines for Children's (VFC) provider and plans to administer vaccines to four patients, which of the following patient would be eligible for the program? A. 6 year old whose health insurance is provided by Medicaid B. a 19 year old AA patient C. A 13 year old with insurance coverage for vaccines D. A 3 year old Polynesian patient with insurance but unpaid deductible - Correct Answer-A. 6 year old whose health insurance is provided by Medicaid If an office practice has 3 FTE physicians, approximately how many FTE support staff persons are likely to be necessary? A. 5 B. 10 C. 15 D.20 - Correct Answer-C. 15 ( 1 FTE physician requires 4.5-5.5 support staff) Which of the following ethnic groups is at the highest risk of stroke? A. Caucasians B. Hispanics C. Asians D. African Americans - Correct Answer-D. African Americans The type of budget that is used for daily operations and general expenses, such as salaries associated with an ambulatory surgery center is the: A. Master budget B. Operating Budget C. Capitol Budget D. Cash balance Budget - Correct Answer-B. Operating Budget According to the Spalding classifications system for disinfection and sterilization, an example of an item that would be classified as Semi-critical is: A. Bronchoscope B. Surgical instrument C. BP Cuff D. Bedpan - Correct Answer-A. Bronchoscope If a patients nursing DX is "Activity intolerance" on the care plan and the desired outcomes are the for the patient to feel less tire and carry out activities without signs of physical distress, which of the following is an appropriate nursing intervention: A. Keep patient awake during daytime hours B. Limit activities to those that are essential C. instruct patient in energy saving techniques D. Encourage patient to take mid-morning and mid afternoon naps. - Correct Answer-C. instruct patient in energy saving techniques When preparing a budget for a community education project, the ambulatory care nurse needs to consider both direct and indirect costs. Indirect costs may include: A. Supplies and Equipment B. Salaries C. Employee benefits D. Housekeeping Services - Correct Answer-D. Housekeeping Services D. Avoid eating meat products for two days - Correct Answer- C. Avoid Strenuous exercise The ambulatory care nurse is reviewing a patient's history to determine if the patient is a candidate for an intrauterine device (IUD). Contraindications for an IUD include: A. Menorrhagia B. History of pelvic inflammatory disease 3 years previously C. History of renal Cancer D. History of ectopic pregnancy - Correct Answer-D. History of ectopic pregnancy The purpose of an Advanced Beneficiary Notice is to: A. Identify beneficiaries of a wall B. inform Medicare Patients of non coverage C. Inform patients of Medicaid eligibility D. Inform patients of insurance coverage - Correct Answer-B. inform Medicare Patients of non coverage Which of the following are excluded from the Nurse Licensure compact A. RNs B. LVNs C. LPNs D. APRNs - Correct Answer-D. APRNs (They must get a license in each state they plan to work in) When setting up a dashboard to show progress towards meeting goals, the first consideration when determining which information to include should be: A. Relevance to goals B. Method of Display C. Frequency of needed updates D. Ease of gathering data - Correct Answer-A. Relevance to goals The first step in development of a safety and health program to meet OSHA's guidelines is to: A. Takes steps to reduce hazards B. Establish a medical management program C. Conduct a workplace analysis D. Establish a staff training program - Correct Answer-D. Establish a staff training program When interviewing a patient who reports that everything is "fine" the ambulatory care nurse notes that the patients pupils are dilated, the patient is sweating profusely and the patient frequently licks the lips. According to these observations the nurse likely concludes that the patient is: A. actually fine B. withholding information C. Experiencing a physical health problem D. Afraid of the nurse - Correct Answer-B. withholding information Under provisions of the Americans with Disabilities Act (ADA) in relation to access, which of the following is allowed: A. Examining a wheelchair bound patient in a wheelchair because an adjustable exam table is not available B. Refusing to treat a patient because accessible equipment is not available C. Asking a disabled person to bring a caregiver to assist with patients examination D. Having accessible equipment for patient with disabilities in some examination rooms but not all - Correct Answer-D. Having accessible equipment for patient with disabilities in some examination rooms but not all A. Research the topic and obtain disease-focused date B. Express concerns to other staff members C. Complain about the lack of information D. Suggest Stockpiling mosquito repellant to patients - Correct Answer-A. Research the topic and obtain disease-focused date If Medicare has denied a claim, how ling does the appellent have to file an appeal: A. 30 days B. 60 days C. 90 days D. 120 days - Correct Answer-D. 120 days Health literacy is directly affected by general literacy, so when educating patients, the ambulatory care nurse should realize that the approximate percentage of adults in the US who are classified as illiterate or low literate is: A. 25% B. 40% C. 50% D. 70% - Correct Answer-C. 50% The Ambulatory care nurse is participating in a community effort to screen for hypertension. Screening for disease is an example of what type of prevention: A. Primary B. Secondary C. Tertiary D. Quaternary - Correct Answer-B. Secondary Primary prevention examples - Correct Answer-- Discuss a low-fat diet and the need for regular physical exercise with clients. - when a nurse provides health education and training for daycare workers about issues of health and hygiene, such as proper hand hygiene, diapering, and food preparation and storage - Immunizations, importance of wearing seatbelts, taking folic acid supplementation at preconception to prevent neural tube defects, fluoridation of water supplies to prevent dental caries, and actions taken to reduce human exposure to agents that may cause cancer - Implement a community level program like walking for exercise to assist citizens in improving health behaviors related to lifestyle. - Use the Code of Ethics for Nurses to guide your nursing practice - Use the information exchange process to increase the client's understanding of how to use the health care system and the health promotion strategies that will maintain health. - Complete a family genogram and assess health risks with the family to contract for family health activities to prevent diseases from developing Secondary prevention examples - Correct Answer-- Implement blood pressure and cholesterol screening; give a treadmill stress test. - Health screenings - teach an asthmatic client to recognize and avoid exposure to asthma triggers and assist the family to implement specific protection strategies such as replacing carpets, keeping air systems clean and free of mold, staying inside when the pollution level is high, and avoiding pets. - mammography to detect breast cancer, Papanicolaou (Pap) smears to detect cervical cancer, colonoscopy for early Autonomy: Recognizing that the patient is the one who is responsible for making changes and respecting the patients choices. Female patients should generally be advised to begin breast cancer screening with routine mammos at about the age: A. 20-30 B. 30-40 C. 40-50 D. 50-60 - Correct Answer-C. 40-50 One of the primary indications that a patient is ready to learn is when the patient: A. Appears confused B. Expresses frustration C. Admits lack of knowledge D. Asks a question - Correct Answer-D. Asks a question When assessing a patient over the telephone, the ambulatory care nurse is unsure what the client is saying because the patient's explanation is confusing. Which of the following is the best response? A. Could you explain that again, I just want to make sure I understand B. That was so confusing, Could you repeat it? C. I'm afraid I didn't understand what you were saying D. Is there someone else present who could explain this to me - Correct Answer-A. Could you explain that again, I just want to make sure I understand If a female patient at an ambulatory care clinic speaks only Arabic and is accompanied by her 8 year old daughter and a male neighbor who both peak English and Arabic, the best way to communicate is: A. Use pantomime to help the patient communicate B. Ask the daughter to translate C. Ask the neighbor to translate D. Arrange for a medical Translator - Correct Answer-D. Arrange for a medical Translator When providing anticipatory guidance to a patient who has recently been diagnosed with DM type I, the most important information that the ambulatory care nurse should cover is how to deal with: A. Weight loss B. Changes in Activity C. Diabetic ketoacidosis D. HTN - Correct Answer-C. Diabetic ketoacidosis Which of the following infectious agents is only transmitted through direct contact, such as when the infectious agent is present on an environment surface? A. C-Diff B. Lyme disease C. Rubella Virus D. Varicella -Zoster virus - Correct Answer-A. C-Diff If an ambulatory care nurse wants to determine if there is a recall for a specific medications, the nurse should seek information from the? A. CDC B. Consumer product safety commission C. Agency for toxic substance and disease registry D. Food and Drug Administration - Correct Answer-D. Food and Drug Administration D. Keep a log of CICs and problems involved - Correct Answer- C. Do a return demonstration In written materials for patients, which of the following sentences is likely to be the most easily understood by the general public A. A low sodium diet is recommended for cardiovascular disease B. High blood pressure can lead to a stroke C. People who smoke cigarettes' are prone to pulmonary disease D. Remain NPO for 6 hours prior to the procedure - Correct Answer-B. High blood pressure can lead to a stroke When a patient is angry and aggressive but not yet violent, the first method to use in changing the behavior is to A. Ignore B. Redirect C. Reward D. Interrupt - Correct Answer-D. Interrupt The ambulatory care nurse wants to participate in outreach to a largely Spanish speaking population of Mexican immigrants by setting up booths in the community to screen for High blood pressure and Diabetes. The best places to set up booths are probably: A. Parks and recreation areas B. Churches and shopping areas C. Hospitals and clinics D. police departments and social services offices - Correct Answer-B. Churches and shopping areas When orienting a patient and/or caregiver to the healthcare delivery system, the first step is to: A. Explain the structure of the healthcare delivery system B. Provide literature regarding the healthcare delivery system C. Ask what the patient and/or caregiver wants to know D. Assess the patients and/or caregiver health literacy - Correct Answer-D. Assess the patients and/or caregiver health literacy If a patient with severe joint pain and swelling has been diagnosed w/ Rheumatoid Arthritis and has failed to follow through with referral to a rheumatologist, the ambulatory care nurse should: A. Take no action, this is the patients choice B. Explain how the treatment can help prevent further deterioration and relive pain C. Advise the patient that he or she is exercising bad judgement D. Remind the patient that RA an cause severe damage - Correct Answer-B. Explain how the treatment can help prevent further deterioration and relive pain If a patient asks, "Should I continue w/ chemotherapy or stop?" and the nurse responds with "How do you feel about stopping chemotherapy?" this is an example of: A. Redirection B. Diversion C. Reflection D. Restatement - Correct Answer-C. Reflection When entering the examining room of a patient who is deaf and facing away from the door, the ambulatory care nurse should C. The authority to make decisions D. any type of participation - Correct Answer-C. The authority to make decisions A patient who is an inmate in a correctional facility is scheduled for a colonoscopy to determine the cause of rectal bleeding but the patient refuses to sign the consent, The colonoscopy should be: A. Carried out despite the ack of consent B. Carried out because inmates have no rights to informed consent C. Carried out of the physician signs a treatment without consent form D. Cancelled because of no consent - Correct Answer-D. Cancelled because of no consent If the ambulatory care nurse (Nurse A) noted another nurse (Nurse B) caused severe injury to a patient because Nurse B abandoned the patient in distress to make a personal call, Nurse B should b: A. Advised that the behavior is inappropriate B. Reported to the state board of nursing C. Reported to the police D. Placed on probation status - Correct Answer-B. Reported to the state board of nursing If an ambulatory nurse working in a cancer clinic is in a hurry to leave work and fails to follow protocols for checking IDS allergies resulting in administration of a chemotherapeutic agent to the wrong patient and a severe allergy reaction is an example of A. Gross negligence B. Negligent conduct C. Contributory negligence D. Comparative negligence - Correct Answer-A. Gross negligence if a staff member at an ambulatory center downloaded protected health information(PHI) about a politician in order to profit by selling the information to tabloids rules of breach notification require notification of the A. Patient only within 60 days B. Patient and the HHS secretary within 60 days C. Patient within 60 days and HHS secretary in the annual report D. Patient the media and the HHS within 60 days. - Correct Answer-C. Patient within 60 days and HHS secretary in the annual report Which of the following healthcare services can an adolescent younger than 18 access or refuse without a parental knowledge or consent in most states A. Emergency contraceptives B. Abortion C. Chemotherapy D. Transfusion - Correct Answer-A. Emergency contraceptives The process of time management begins y A. picking a time management tool B. Setting goals and priorities C. Organizing routines D. Ignoring interruptions - Correct Answer-B. Setting goals and priorities The nurse is educating an adult patient regarding medications for asthma. Which order would be the most appropriate for administration Mom has described her childs symptoms as fever for 3 days, and vomiting for the last 24 hours. She states the child has been very sleepy for the last 2-3 hours. What subtle symptom alerts the nurse that this child needs to be seen as soon as possible A. 3 days of fever B. 3 days of fever , 1 day of vomiting C. 1 day of vomiting D. very sleepy for 2-3 hours with fever for 3 days. - Correct Answer-D. very sleepy for 2-3 hours with fever for 3 days. The ambulatory care nurse takes a phone call from the daughter of a 60 year old man stating that he isn't himself today. When questioned further the nurse discovers that the man has had periods of slurred speech for a few minutes on 2 occasions in the last 24 hours. What is your recommendation for this caller regarding what should be done. A. You understand that slurred speech may be the result of too much alcohol or lack of sleep and you encourage her to call back again if it occur B. You advise her to come to the clinic in the next 24-48 hours for some blood work C. You advise her that slurred speech may b a symptoms of TIA or impending stroke, especially in relation to him not being himself and to go to nearest ER D. You tell her you will call her ack when you can contact the MD for advise. - Correct Answer-C. You advise her that slurred speech may b a symptoms of TIA or impending stroke, especially in relation to him not being himself and to go to nearest ER A 70 year old female presents to the ambulatory care clinic complaining of fatigue. You begin you triage assessment and he has a HR of 50, Respiratory rate of 24, and BP 70/40. She denies Chest pain but you notice she rubs her elbows and states her arthritis is acting up. What would be your first priority when caring for this patient A. Offer her Tylenol and send her to the waiting room B. offer her Motrin for pain C. Continue her triage and history and finish the paperwork D. place her in a room, do an EKG and notify the MD to see her first - Correct Answer-D. place her in a room, do an EKG and notify the MD to see her first A mother presents to the clinic with a very wheezy 3 year old in her arms. You notice the child is pale and listless. What is your immediate response A. Triage the infant before the other patients waiting B. Bring the child to an exam room and wait for MD C. Bring the child to an exam room to finish triage in the privacy of a room D. Bring the child to a room, Get the MD, and prepare to give Nebulizer treatment and possible transfer to acute facility - Correct Answer-D. Bring the child to a room, Get the MD, and prepare to give Nebulizer treatment and possible transfer to acute facility What nonverbal clues would indicate that a patient of any age is having difficulty breathing A. Change in color, retractions and noisy breathing B. laughing and joking during triage assessment C. Slight wheezing when lifting heavy objects D. Sweating in a warm room with exertion - Correct Answer-A. Change in color, retractions and noisy breathing D. The desire to help others - Correct Answer-B. Assessment and communication skills The triage nurse is responsible for screening, assessment and the initial patient contact in the ambulatory care setting. It is important to look for verbal and nonverbal cues when doing a triage assessment. What important information should the triage nurse screen for with every patient during every visit regardless of complaint A. Marital status B. Signs of Abuse C. Financial Status D Dental history - Correct Answer-B. Signs of Abuse What is the most appropriate way to ask a patient about possible physical abuse during the triage process A. Ask questions regarding abuse in front of the spouse so there is a witness B. Never ask if the information is not offered. It is an invasion of privacy C. Ask the patient directly without the spouse or parent in the room D. Begin describing your own experience in an attempt to get the patient to open up - Correct Answer-C. Ask the patient directly without the spouse or parent in the room Which statement defines the term "telephone triage" clearly A. Anyone can talk on the telephone and gain the complaint of the patient B. The nurse must have a clear conversation on the telephone to prioritize the urgency of the patients needs C. The risk for the nurse is slim when triaging over the telephone D. The definition for triage equals that of interrogation - Correct Answer-B. The nurse must have a clear conversation on the telephone to prioritize the urgency of the patients needs The telephone triage nurse has taken a call from a client and wants to document and share patient information with the facility where she has sent the client. What multimedia tools may the nurse use in her tele-practice that would be appropriate and safe A. Computer, fax machine or email B. No information should be sent by email containing patient information C. Only share by telephone D. There is no audio/visual equipment available to a triage nurse - Correct Answer-A. Computer, fax machine or email What skills would be most helpful when triaging a client on the telephone A. Should be curt and encourage the client to get to the point B. Ask non specific questions to make the client feel comfortable C. Listen, use auditory clues such as tone of voice and ask very specific questions related to the client complaint D. no specific skills are needed to speak over the telephone - Correct Answer-C. Listen, use auditory clues such as tone of voice and ask very specific questions related to the client complaint The telephone triage nurse is alone when the phone rings on all three lines. What would be the most appropriate action for the nurse to take wen prioritizing these patients. Documentation of the patients agreement to the pan with call back date, and when and where the patient will follow up so tracking can be done is measurable The nurse in the ambulatory care setting uses a fax machine to gain information about a client from another facility. what must be included with the fax in order to obtain this information A. Fax cover sheet B. fax cover sheet and signed release of information C. signed release of information D. no need for anything but a phone call from the facility - Correct Answer-B. fax cover sheet and signed release of information Which of the following influence how nurses practice? A. Suggestions from other colleagues B. Clinical Pathways C. Evidence-based practice D. Organization policy - Correct Answer-C. Evidence-based practice What database should the ambulatory clinic nurse use when searching for nursing articles A. Medscape B. Webmd C. Google Chrome D. CINHAHL - Correct Answer-D. CINHAHL The ambulatory care nurse is developing a care plan for a client. The client is at risk for ineffective breathing related to COPD, where on the care plan should the nurse put this information A. Under nursing DX B. Under the goal C. Under intervention D. Under evaluation - Correct Answer-A. Under nursing DX Which of the following is the cause of Type I DM A. Insulin Resistance B. Glucose Intolerance w/first trimester C. Alpha cell destruction D. Beta Cell Destruction - Correct Answer-D. Beta Cell Destruction Which of the following indicates that the client is adhering to plan of care A. Hemoglobin A1C B. Polyuria C. Polydipsia D. Increased Ketone Levels - Correct Answer-A. Hemoglobin A1C A client with a post op hip replacement has the following information on the care plan: Client will achieve a decrease in pain to a level 3 by discharge. Where on the care plan should the nurse put this information A. Under Nursing DX B. Under goal Section C. Under intervention/implementation D. Under evaluation - Correct Answer-B. Under goal Section Which of the following is an early sign of compartment syndrome A client who enrolled in a research study informs the ambulatory clinic nurse that he/she no longer wants to be part of the study. What actions should the nurse take A. Enquire about the reason for withdrawal B. Educate the client on the importance of the study C. Inform the research team of the clients withdrawal D. increase the incentive for participating in the study - Correct Answer-C. Inform the research team of the clients withdrawal If a patient plans to travel overseas to an area where "Travelers diarrhea" is common and plan to take bismuth Subsalicylate (pepto-Bismol) as prophylaxes, the patient should be warned that it may A. Alter Intestinal Flora B. Turn Stools Black C. Cause intestinal Bleeding D. Cause severe constipation - Correct Answer-B. Turns Stool black The plaque formation that is found with coronary artery disease results from accumulation of: A. LDL Particles B. HDL particles C. Triglycerides D. Amino Acids - Correct Answer-A. LDL Particles If a patient is scheduled for a right breast biopsy, but no site markings are visible when the patient is draped, the ambulatory care nurse should A. Assume the surgeon knows the correct site B. Stop the procedure until correct site is confirmed C. Make a note to remind staff to mark surgical sites D. Ask surgeon if the side is correct - Correct Answer-B. Stop the procedure until correct site is confirmed When reviewing data as part of process improvement, the ambulatory care nurse notes an improvement in patient satisfaction from 78-92% after the addition of a new staff, this change is probably a A. Random Event B. Common cause Variation C. Special Cause Variation D Statistical Aberration - Correct Answer-C. Special Cause Variation When assessing key performance measures as part of the ambulatory care process improvement assessment, which of the following relates to access of care A. FTE support staff per MD B. Rejection/Denial rate of insurance C. Immunization rates D. Average telephone wait time - Correct Answer-D. Average telephone wait time Which of the following is a nonverbal clue that a patient may be anxious A. Patient rubs his eyes and yawns B. Patient has flat aspect and responds in monosyllables C. Patient pupils are constricted and patient sniffs repeatedly D. Patient rubs hands together constantly - Correct Answer-D. Patient rubs hands together constantly