ANCC Ambulatory Care Nursing Certification Latest Exam Review, Exams of Nursing

Download ANCC Ambulatory Care Nursing Certification Latest Exam Review and more Exams Nursing in PDF only on Docsity! 1 ANCC AMBULATORY CARE NURSING CERTIFICATION LATEST EXAM How many medications does it typically take to be considered "polypharmacy?" A -Three B -Ten C -Twenty-four D -Five or more - Answer D -Five or more The ANP knows that it is her responsibility to report certain things to the proper authorities. Which of the following is NOT required to be reported? A - gunshot wound B - suspected child abuse C - drug abuse D - stab wounds - Answer C - drug abuse Drug abuse is not required by law to be reported. Gunshot wounds, stab wounds, and child abuse (actual or suspected) are required to be reported to the proper authorities. Prior to undergoing an abdominal sonogram, the patient should do what? A - refrain from food and water for 12 hours 2 B - empty his or her bladder C - drink a liter of water D - empty his or her bowels - Answer C - drink a liter of water Prior to an abdominal sonogram, the patient is asked to drink water. In addition fasting for 8 to 12 hours prior to the procedure is often required. Which of the following is NOT part of a nursing diagnosis? A - statement of the patient's actual health status B -signs of illness C - medical diagnosis (such as stroke or pulmonary blockage) D - symptoms of illness - Answer C - medical diagnosis developing, causative and related factors, and signs and symptoms. Nursing diagnoses should never contain medical diagnoses. Rather, the nursing diagnosis is a statement of the patient's actual health status, risks for condition 5 C - Zestril D - Adalat - Answer A - Lanoxin (Digoxin) A digitalis medication is a cardiac glycoside that treats CHF and arrhythmias also for BP support. Bumex is a loop diuretic. Zestril is an ACE inhibitor. Adalat is a calcium blocking agent. Which of the following is not one of the steps in evidence-based practice? A - Constructing the clinical question B - Patient selection C - Appropriate selection of resources D - Appraise the validity of the evidence - Answer B - Patient selection Patent selection is not one of the steps in evidence-based practice. The steps in evidence-based practice consist of 1 - Patient assessment 2 - Constructing the clinical question 3 - Appropriate selection of resources 4 - Appraise the validity of the evidence 5 - Apply the integrated patient preferences, evidence, and clinical expertise 6 - Performance evaluation with patience What is true regarding the respiratory synctical virus (RSV) immune globin? A - This is indicated for children less than 2 years of age with chronic lung disease, and infants <32 weeks. B - Contraindications include a reaction to neomycin or streptomycin products. C - This is indicated for adults without a history of RSV. 6 A nurse finishes a follow up visit with one of her elderly patients and gives him the influenza vaccine before he leaves. This is an example of what type of prevention? D - Palivizumab (Synagis) provides permanent immunity for high-risk infants. - Answer A - This is indicated for children less than 2 years of age with chronic lung disease, and infants <32 weeks. Palivizumab (Synagis) provides temporary, passive immunity for high-risk infants, not adults. The polio vaccine (IPV) is contraindicated for those who have had a reaction to neomycin or streptomycin. A - primary B - secondary 7 C - tertiary D - annual - Answer A - primary Primary prevention, such as an immunization, aims to prevent health problems before they start. Secondary prevention promotes early detection and treatments of diseases. Tertiary prevention is designed to help a patient cope with a current problem or prevent relapse. "Annual" is not a type of prevention. For successful communication, the major criteria would include? A - Forcefulness B - Flexibility C - Evaluation D - Developmental - Answer B - Flexibility The 4 major criteria for successful communication would include: Feedback, Appropriateness, Efficiency, Flexibility A person's knowledge is sometimes measured by which of the following verbs? A -Recall B - List C - Remember D - All of the above - Answer D - all of the above Some of the verbs which might be used to measure a person's knowledge could include: Recall, List, Remember, Identify, State, Define A key value in association with "Baby Boomers" would be considered which of the following? A - Sacrifice 10 B - Common name C - Trade name D - Chemical name - Answer D - Chemical name An older patient presents with swelling in the lower extremities. Which of the following should be ordered to rule out heart failure? A - CBC B - Spirometry study C - Brain natriuretic peptide test D - Ketone balances - Answer C - Brain natriuretic peptide test (BNP) 11 The BNP measures levels of protein made by your heart will be higher than normal since it is produced by your blood vessels in your heart. Nurse Grace knows that the most effective way to educate her patient and assist in her patient care plan is to do what? A - Insist the patient follow the plan exactly as instructed. B - Create a schedule for the patient of future office visits and scheduled treatments. C - Establish a team effort with the patient in the teaching and learning process. D - Ask the patient to involve family members in her care planning. - Answer C - Establish a team effort with the patient in the teaching and learning process. Of the following, which would not be considered an objective symptom for tuberculosis? A - Headaches B - Night sweats C - Weight loss D - Fever - Answer A - Headaches Some of the objective symptoms for tuberculosis would be: Night sweats, Weight loss, Fever, Cough which progresses, Hemoptysis (cough up blood) An order is being written for insulin, how should the dosage order be written? A - 10 ml subq B - 10 units subq C - 10 u subq D - None of the above - Answer B - 10 units subq 12 U for unit is on The Joint Commission's official " Do Not Use" list of abbreviations. Which of the following is NOT a "red flag" of low health literacy in a patient? A - The patient pours pills into his or her hand to identify them by sight. B - The patient is not Caucasian. C - The patient consistently asks you to read healthcare information because he or she has forgotten eyeglasses at home. D - The patient does not ask questions during the appointment. - Answer B - The patient is not Caucasian. 15 D - Treating a patient with an open wound. - Answer C - Treating a patient who is suspected of having avian flu. Treating a patient who is suspected of having avian flu CDC guidelines recommend full barrier precautions for all known and suspected cases of avian flu, due to the high degree of transmission of the disease. Full barrier precautions are also used in treating patients with known or suspected cases of SARS and pandemic influenza, as well as hemorrhagic diseases would be considered the nurse's competency that results from training. A - Education B - Language C - Culture D - Proficiency - Answer D - Proficiency The ambulatory care nurse's role would have all except which of the following role dimensions? A - Workload B - Risk management C - Benefits D - Leadership - Answer C - Benefits Some of the role dimensions for the ambulatory care nurse would include: Workload, Risk management, Leadership, Staffing, Competency concerns, Workplace regulatory compliance Which of the following is NOT a nonmedical expense? A - Linen. 16 B - Uniform. C - Office supplies. D - Hypodermics. - Answer D - Hypodermics. Of the following, which would not be a predisposing factor that might cause a patient to develop a tubercle bacillus infection? A - Cirrhosis B - Alcoholism C - Poor nutrition 17 D - The health care workers that care for low-risk patients - Answer D - The health care workers that care for low-risk patients The is supposed to protect the patients' rights, help them to participate in their healthcare decisions, and provide adequate healthcare education. A - Teacher B - Advocate C - Administrator D - None of the above - Answer B - Advocate When identifying barriers such as language which can obstruct the provision of optimal patient care, which standard of care with the Standards of Professional Clinical Practice for the Ambulatory Care Nurse would it be considered? D - Standard 3 - Answer B - Standard 1 These would include such barriers as language, behavioral health issues, and culture. Nurse Terri is assessing a female patient with red, itchy spots on various parts of the body. She mentions she has no allergies but has recently switched soaps and is trying a new detergent. Terri suspects this is what type of irritation? A - irritant contact dermatitis B - cellulitis C - allergic purpura D - psoriasis - Answer A - irritant contact dermatitis A - Standard 6 B - Standard 1 C - Standard 4 20 D - The color of the meter - Answer D - The color of the meter There are 7 details which should be focused on when choosing a glucometer: The type of the lancing device, Coding of the machine, The look/display of the meter, The memory capacity of the meter, The sample size which will be needed, How long does it take for a result, Are there any additional features Which of the following emphasizes preventive services like notification of contacts for patients with infectious diseases, screenings, and immunization at the local level? 21 A - Local schools B - Local pharmacies C - Public Health departments D - State disease control - Answer C - Public Health departments Public Health departments emphasize preventive services like notification of contacts for patients with infectious diseases, screenings, and immunization at the local level. The public health department plays an integral Lowell Community Health. What is the MOST effective form of research a nurse can do before establishing a diabetes prevention course for patients? A - Making a list of the local endocrinologists that are currently treating diabetic patients. B - Estimating what age groups would attend the course. C - Documenting what causes diabetes and why. D - Finding diabetic-friendly recipes to share with the class. - Answer C - Documenting what causes diabetes and why. When a nurse is planning an event to raise awareness of preventing a disease, the first types of research that should be done is what causes the disease and why. Once this information is documented, the nurse can build her lesson around methods of prevention, warnings signs, etc. One of the more important steps for the ambulatory care nurse during diagnosis would be which of the following? A - Documentation of information B - CT equipment C - State disease control 22 D - X-ray equipment - Answer A - Documentation of information Which of the following abnormal heart sounds is a result of the blood flowing past the normally closed valve? A - valve regurgitation B - valvular stenosis C - ventricular or atrial failure D - electrical conduction defects - Answer A - valve regurgitation The sound of valvular regurgitation is known as a murmur. Murmurs can have a blowing or swishing sound and are categorized in a degree of I to VI. Grade I 25 C - pericarditis D - pneumothorax - Answer C - pericarditis. Patients with pericarditis will often have a scratching or creaking sound. This is known as a pericardial friction rub and results from inflammation of the pericardium. The 5 M's of categorizing information (according to the Failure Mode and Effect Analysis) would include all but which of the following? A - Materials B - Maneuvering C - Methods D - Machines - Answer B = Maneuvering The 5 M's of categorizing information (according to the Failure Mode and Effect Analysis) would include: Machines, Management, Manpower, Materials, Methods Where is the submental lymph node located? A - in the hollow of the clavicle B - right below the chin C - junction between back of head and neck D - behind the ears - Answer B - right below the chin The supraclavicular lymph node is in the hollow of the clavicle. The suboccipital lymph node is located in the junction between the back of the head and neck. The postauricular lymph node is behind the ears. The objective for nursing practice in each state would be considered all of the following except? 26 A - Will define the practice of professional nursing. B - Provide the disciplinary action of licenses for certain causes. C - Will define the length of the shifts that the nurse may work. D - Would set the minimal educational qualifications and other requirements for licensure. - Answer C - Will define the length of the shifts that the nurse may work. The 4 objectives for the nursing practice in each state: Will determine the legal titles and abbreviations nurses may use. Would set the minimal educational qualifications and other requirements for licensure. Provide the disciplinary action of licenses for certain causes. Will define the practice of professional nursing. 27 In negotiations the development of trust would include which of the following? A - Do not prepare beforehand B - Do not share notes C - Develop plans D - None of the above - Answer C - Develop plans The development of trust in negotiations would include: Maintain and share notes. Observe for behavior reflecting dishonesty. Research and prepare beforehand. Develop plans. Demonstrate respect Which of the following is NOT one of the key questions of the Ask Me 3 Model? A - What is my main problem? B - What is the mortality rate for my problem? C - What do I need to do? D - Why is it important for me to do this? - Answer B - What is the mortality rate for my problem? The Ask Me 3 model provides three questions that patients should be able to answer at the end of a health care visit. The mortality rate of a given health problem may be a concern, but this model is more centered on ensuring patient understanding of the condition and the necessary next steps. Disinfectant solution needs to be marked with the name, . A - Date prepared and the date expired. B - Date prepared. C - Date expired. 30 D - Encouraging employees to avoid caffeine, alcohol, and other substances that might interfere with sleep. - Answer B - Putting nurses on either permanent day or permanent night shifts. Shiftwork carries numerous risks, including sleep deprivation and resulting health issues such as immune system depression and digestive problems. Changing shifts often carries problems, but keeping employees on permanent night shifts also carries risks including loss of family time, health problems resulting from difficulties sleeping during the day, sleep deprivation, and emotional problems. 31 Tips for the ambulatory care nurse in association with communication would not include? A- Use open ended questions B - Don't gather feedback from staff members C - Conduct communication at the proper time and place D - Use fewer words - Answer B - Don't gather feedback from staff members Communication tips would include: Use open ended questions. Gather feedback from staff members. Conduct communication at the proper time and place. Use fewer words. Watch language used, avoid using technical terms and acronym which might not be understood by all. Respect the viewpoints and opinions of other's. Use body language to show interest. Use communication to build "USA" - understanding, support, and acceptance At what point in the autoclaving process are wrapped items considered sterile? A - As soon as they reach the recommended temperature. B - Immediately on removal from the autoclave, even if wrapping is still wet. C - As soon as the wrapping is dry. D - As soon as they reach room temperature after removal from the autoclave and all wrappings are dry. - Answer D - As soon as they reach room temperature after removal from the autoclave and all wrappings are dry. It may take several hours for items to be fully dry and cool to room temperature after removing them from the autoclave. Wet packs must at all times be considered non-sterile, even if they have cooled to room temperature. In a clinical workflow chart, what is the link that moves the workflow forward between processes? A - Dynamic connector. B - Hyperlink Process. 32 C - On-page connector. D - Off-page connector. - Answer B - Hyperlink Process. The hyperlink process is also called the hot link. It moves the workflow forward between processes. Which of the following is meant to standardize the patient care practices? A - OSHA regulations B - Respiratory Care protocols C - MSDS sheets 35 important that these be in a patient's own words to perform the most complete and accurate assessment. The preparation of a patient for "anticipated developmental or situational crisis" is known as . A - Anticipatory guidance. B - Preventative care. C - Anticipatory care. D - Preemptive care. - Answer A - Anticipatory guidance. Anticipatory guidance is a nursing intervention in which nurses attempt to prepare patients and/or caregivers for potential developments or situations in treatment. This can involve educating them about potential side effects and negative outcomes. In a critical care setting, it may be necessary to conduct anticipatory guidance with families as well depending on what type of aftercare the patient may need after discharge. Which of the following should be the FIRST step in cleaning up blood or other body fluids from a floor? A - Spray the area with a 1:10 solution of bleach and water. B - Put out orange cones or caution signs. C - Blot up as much of the material as possible. D - Put on latex gloves. - Answer D - Put on latex gloves. When cleaning up blood, vomit, feces, urine, or other body fluids, the first step should always be to put on protective gear. At a minimum, latex gloves should be donned. If there is a possibility of fluid spraying, goggles should be worn; in situations where clothing might come into contact with the spill, a protective gown should also be worn. 36 Which of the following falls within the normal range for BUN:Cr? D - 100 mg/dL - Answer B - 15 mg/dL The normal range for BUN:Cr is 10 - 20 mg/dL. Ratios above 20 may indicate some kidney injury. A - 40 mg/dL B - 15 mg/dL C - 55 mg/dL 37 Screening for cancer in the geriatric population includes all of the following recommendations except: A - prostate cancer B - cervical cancer C - skin cancer D - colon cancer - Answer B - cervical cancer Cervical cancer is not likely in the elderly female. The geriatric population should be screened for heart disease, hearing, vision, and dental problems, hyperlipidemia, hypertension, menopause, osteoporosis, hypothyroidism, and dementia. Cancer screenings include breast, colon, prostate, and skin. A patient is speaking with a telephone nurse and explains that she has had increased acid reflux from a recently diagnosed ulcer. The nurse's first question is to ask if the patient has had what kind of food lately? A - Dairy products. B - Acidic fruits such as oranges or lemons. C - Beans or lentils. D - Alcoholic or caffeinated beverages. - Answer D - Alcoholic or caffeinated beverages. The nurse should explain to the patient beverages with alcohol or caffeine can stimulate gastric acid production and irritate gastric lining. The nurse should advise the patient to avoid these type of foods and for the patient to see their physician if symptoms persist. would be considered the federal law which helps to protect the privacy of student educational records? 40 The nurse is educating an adult patient regarding medications for asthma. Which order would be the most appropriate for administration? A - Albuterol, Flovent, Tobramycin B - Flovent, Intal, Tobramycin C - Tobramycin, Intal, Albuterol D - Intal, Tobramycin, Albuterol - Answer A - Albuterol, Flovent, Tobramycin Telephone triage may be a responsibility of the ambulatory care nurse. What are the appropriate components of telephone triage? 41 A - The nurse should give generic information and leave the responsibility to the patient or caller B - The nurse should immediately call 911 C - The nurse should state that he or she is unable to discuss medical information and refer the patient to the primary care physician D - The nurse must clearly identify him- or herself, take a quick and accurate history, and quickly be able to make a decision - Answer D - The nurse must clearly identify him- or herself, take a quick and accurate history, and quickly be able to make a decision What are the best question types to ask when gaining information from a patient? A - specific, open-ended questions regarding current symptoms and medical history B - general questions with yes or no answers C - questions related to childhood diseases D - demographics questions - Answer A - specific, open-ended questions regarding current symptoms and medical history In what order would the nurse prioritize the care of the following patients presenting to the clinic at the same time: a parent carrying a smiling infant with a fever, a pale and sweaty male with flank pain for two days, a carpenter with a nail in his thumb, and a three-year-old with vomiting. A - flank pain, three-year-old with vomiting, infant with a fever, and man with the nail B - three-year-old with vomiting, flank pain, man with the nail, and infant with fever C - flank pain, infant with fever, three-year-old with vomiting, and man with the nail 42 D - three-year-old with vomiting, infant with fever, flank pain, and man with the nail - Answer A - flank pain, three-year-old with vomiting, infant with a fever, and man with the nail Mom has described her child's symptoms as fever for three days and vomiting for the last 24 hours. She states the child has been very sleepy for the last two to three hours. What subtle symptom alerts the nurse that this child needs to be seen as soon as possible? A - three days of fever 45 The ambulatory care setting must include which of the following for the nurse to be able to properly triage a patient? C - vending machines D - private room for triage - Answer D - private room for triage A 50-year-old male comes to the clinic stating he cannot shake this "flu." You observe that he is clammy, pale, and has an irregular heart rate. He is a large man with a rugged appearance. He is friendly and apologetic for bothering you with his silly complaints. What is your plan of care for this patient? A - You suspect there is more to his complaint than he states and immediately begin a cardiac workup by placing him in a room and ordering an EKG B - You suspect he has the newest flu going around and offer him hot tea while he waits to see the physician C - You suspect he has a low tolerance for being ill and offer him Tylenol while he waits to see the physician D - You finish the triage and send him to the waiting room, understanding that the flu affects everyone differently - Answer A - You suspect there is more to his complaint than he states and immediately begin a cardiac workup by placing him in a room and ordering an EKG Each person has how many intelligences (according to Howard Garner's multiple intelligence theory)? - Answer 8 - According to the Howard Garner's multiple intelligence theory, each individual has 8 intelligences. These intelligences form the basis for the individuals learning throughout their life. A - television B - computer 46 You are conducting an assessment with a male patient. It is important to know that a normal prostate is the size of what? A -grape D -walnut - Answer D - Walnut What type of budget should be done for a new practice? A- Zero based B -Hyperlink Process B -peanut C -orange 47 C -Historical based budget D -Capital budget. - Answer A - Zero based - Zero based budgets are used with new practices and requires expenses to be tracked and managed carefully. You are performing an assessment with a patient. On auscultation of heart sounds, you hear a scratching, creaking sound. Which of the following conditions might this heart sound indicate? A -congestive heart failure B -benign heart murmur C -pericarditis D -pneumothorax - Answer C - pericarditis - Patients with pericarditis will often have a scratching or creaking sound. This is known as a pericardial friction rub and results from inflammation of the pericardium. The 5 M's of categorizing information (according to the Failure Mode and Effect Analysis) would include all but which of the following? A -Materials B -Maneuvering C -Methods D -Machines - Answer B - maneuvering is not 5 Ms-Machines, Management, Manpower, Materials, Methods Where is the submental lymph node located? A -in the hollow of the clavicle B -right below the chin 50 patient to have a pacemaker implanted would include: Asystole, Sick-sinus syndrome, Atrial tachyarrhythmias, Bradyarrhythmias, Heart block At what point in the autoclaving process are wrapped items considered sterile? A -As soon as they reach the recommended temperature. B -Immediately on removal from the autoclave, even if wrapping is still wet. C -As soon as the wrapping is dry. D -As soon as they reach room temperature after removal from the autoclave and all wrappings are dry. - Answer D -As soon as they reach room temperature after removal from the autoclave and all wrappings are dry. 51 -It may take several hours for items to be fully dry and cool to room temperature after removing them from the autoclave. Wet packs must at all times be considered non-sterile, even if they have cooled to room temperature. What are the 5 steps of the nursing process? - Answer Assessment Diagnosis Planning Implementation Evaluation The preparation of a patient for "anticipated developmental or situational crisis" is known as . A -Anticipatory guidance. B -Preventative care. C -Anticipatory care. D -Preemptive care. - Answer A -Anticipatory guidance. Anticipatory guidance is a nursing intervention in which nurses attempt to prepare patients and/or caregivers for potential developments or situations in treatment. This can involve educating them about potential side effects and negative outcomes. A brief account by the patient of any signs or symptoms he or she is experiencing is known as what? A -functional assessment B -focused assessment C -review of systems D -systemic review - Answer C -review of systems 52 In the review of systems, the patient tells the nurse in his or her own words what signs or symptoms he or she has experienced in various body systems. It is important that these be in a patient's own words to perform the most complete and accurate assessment. Of the following, which is the greatest risk factor for childhood obesity? A -Lack of cognitive stimulation. B - Poverty. C -Parental divorce. D -Parental Education. - Answer A -Lack of cognitive stimulation. 55 How far out do most health care facilities' capital budgets plan? A -5-10 years. B -Less than 1 year. C -20 years. D -1-3 years. - Answer D -1-3 years. Because they deal with long-life items, most capital budgets plan for 1-3 years out from the present. It is important for nurses who work on budgets to be aware of their facility's capital budget plans for the next years so that they can appropriately request budget resources for their own units. would be when a leader aligns themselves with others to help obtain information, ideas, advice, power, and influence? A -Consensus-building B -Negotiation C -Networking D -Development - Answer C -Networking Networking would be when a leader aligns themselves with others to help obtain information, ideas, advice, power, and influence. The most effective negotiation process would have a win-win outcome. What is the MOST effective form of research a nurse can do before establishing a diabetes prevention course for patients? A -Making a list of the local endocrinologists that are currently treating diabetic patients. B -Estimating what age groups would attend the course. C -Documenting what causes diabetes and why. D -Finding diabetic-friendly recipes to share with the class. - Answer C - Documenting what causes diabetes and why. 56 When a nurse is planning an event to raise awareness of preventing a disease, the first types of research that should be done is what causes the disease and why. Once this information is documented, the nurse can build her lesson around methods of prevention, warnings signs, etc. Which of the following abnormal heart sounds is a result of the blood flowing past the normally closed valve? A - valve regurgitation B -valvular stenosis 57 C -ventricular or atrial failure D -electrical conduction defects - Answer A - valve regurgitation The sound of valvular regurgitation is known as a murmur. Murmurs can have a blowing or swishing sound and are categorized in a degree of I to VI. Grade I murmurs are very soft, while grade VI murmurs are extremely loud and can be heard with the stethoscope one inch away from the chest wall. Each person has how many intelligences (according to Howard Garner's multiple intelligence theory)? A -8 B -12 C -3 D -38 - Answer A -8 Tips for the ambulatory care nurse in association with communication would NOT include? A -Use open ended questions B -Don't gather feedback from staff members C -Conduct communication at the proper time and place D -Use fewer words - Answer B -Don't gather feedback from staff members In a clinical workflow chart, what is the link that moves the workflow forward between processes? A -Dynamic connector. B -Hyperlink Process. 60 A -Investigate whether a different anti-depressant that does not carry the risk of headaches is available. B -Educate the patient about the potential negative outcomes of untreated depression. C -Investigate whether another drug can be prescribed to ease the patient's headaches. D -Investigate whether natural remedies for depression are appropriate for this patient. - Answer A -Investigate whether a different anti-depressant that does not carry the risk of headaches is available. 61 would be considered the federal law which helps to protect the privacy of student educational records? A -FMLA B -ADA C -FERPA D -HIPAA - Answer C -FERPA FERPA stands for Family Educational Rights and Privacy Act. This is a federal law which helps to protect the privacy of student educational records. When defibrillating a patient, the second shock is typically at which dose? A -100 B -360 C -200 to 300 D -300 - Answer C -200 to 300 When defibrillating a patient, the shock levels are typically: First-200 joules Second-200 to 300 joules All of the rest-360 joules You are conducting an assessment with a patient who says that sometimes she feels as though she should have been born male. She prefers to dress in men's clothing and feels disgust toward the overtly female parts of her body. Which of the following is an appropriate nursing diagnosis for this patient? A- delusions B -thought processes, altered C -gender dysphoria 62 D -personal identity disturbance - Answer C -gender dysphoria This patient is demonstrating gender dysphoria. Gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics. What is the overarching vision of Healthy People 2020? A -To provide universal health care. B- To promote a society in which all people live long, healthy lives. C -To eliminate poverty worldwide. 65 Some objectives of ambulatory care nursing would include: To help minimize suffering, prevent injury, protect the patient's health, promote the patient's health, maximize health literacy/education, prevent illness, apply nursing interventions to human responses in health, illness, disease, disability, and end- of-life circumstances, actively advocate for optimal coordinated healthcare of families, individuals, communities, and populations that are aimed at the improvement of the whole person's well-being. How often should biological indicators be tested? A -Daily B -Hourly C -Weekly D -After each use of a machine. - Answer C -Weekly A patient is being prescribed Glucophage but this brand is not available. Which of the following drugs may be substituted? A -Repaglinide B -Troglitazone C -Acarbose D -Metformin - Answer D -Metformin A kilogram would be mg? A -100,000 B -100 C -1,000,000 D -5,000,000 - Answer C -1,000,000 66 It takes 1000 grams to equal 1 kilogram. It takes 1000 mg to equal 1 gram. It would take 1,000,000 mg to equal 1 kilogram. The central nervous system is composed of what? A -brain and spinal cord B -brain and sympathetic nervous system C -brain, spine, and nerve cells D -brain, heart, and lungs - Answer A -brain and spinal cord The central nervous system (CNS) is the main control center for the body. It is comprised of the brain and spinal cord. 67 Why is it recommended that pregnant women be screened for domestic violence? A -The bodily strains of pregnancy may create injuries similar to domestic violence. B -Pregnant women are at the greatest risk for both new and continuing domestic violence. C -Concern for the welfare of the unborn child. violence. Because they represent a group with the high risk of domestic violence, all pregnant women should be screened for domestic violence even if they have not reported violence before. Violence may begin during pregnancy, or a woman may be more willing to report violence out of concern for her child than she might have been previously. When judging the quality of care, which method evaluates performance after the patient is released? A -Quality improvement. B -A retrospective nursing audit. C -Qualitative research. D -A concurrent nursing audit . - Answer B -A retrospective nursing audit. Nursing audits are done to improve the quality of care. There are two types of audits, concurrent and retrospective. A retrospective nursing audit is done after a patient is released. What is indirect cost subtracted from the contribution margin? A -Gross income. D -Such screenings are covered by insurance when part of prenatal care. - Answer B -Pregnant women are at the greatest risk for both new and continuing domestic 70 D -None of the above - Answer B -Pharmacotherapeutics The branch of pharmacology that includes the use of medications to treat, prevent or diagnose would be considered pharmacotherapeutics. Pharmacology would be considered the study of medications, which also includes the medications interactions with living systems. would be when the patient's verbal communication matches their non-verbal communication? A -Discongruent B -Congruent C -Non-congruent 71 D -Incongruent - Answer B -Congruent The term which would be used to mean the art of teaching adults would be considered which of the following? A -Andragogy B -Visions C -Consultation D -Instructing - Answer A -Andragogy Which of the following is the largest category of expenditure for most health care facilities? C -Capital budget D -Malpractice insurance. - Answer B -Personnel budget The acronym "ABCD" (associated with written objectives) stands for which of the following? A -Ambition, behavioral, confusion, and diffusion B -Audience, behavioral, condition, and degree of attainment C -Analysis, benign, commission, and district D -Able, believable, conditioning, and delivery - Answer B -Audience, behavioral, condition, and degree of attainment A nurse is examining a skin growth on one of her patients. The patients hasn't felt any symptoms but has noticed the growth is starting to look abnormal. This type of examination is considered what type of prevention? A -Operating budget B -Personnel budget 72 A -Infectious B -Secondary C -Primary D -Primordial. - Answer B -Secondary Secondary Examining the abnormal skin growth is an example of secondary prevention due to the fact the patient has already come forward with an abnormality or possible illness and the nurse is examining it to ensure there are no further complications from it. Although the patient is not having symptoms at this time, the nurse will monitor the growth to see if he will in the future. 75 B -Feedback C -Evaluation D -Implementation - Answer A -Efficiency Efficiency would be considered correct for a type of major criteria that is associated with successful communication where there are simple, clear words delivered at a pace that is suitable to the participants. Several control measures exist with prevention of disease. The following are all accurate statements regarding control measures except: A -Measures directed against the reservoir include isolation, quarantine, and insect spraying. B -Measures that interrupt the transmission of organisms include water purification, milk pasteurization, and barrier protection during sexual intercourse. C -Measures that reduce host susceptibility include immunization, appropriate use of antibiotics, and improved nutrition. D -Measures that cure disease include adequate diagnosis, appropriate treatment regimen, and necessary follow-up and homecare. - Answer D -Measures that cure disease include adequate diagnosis, appropriate treatment regimen, and necessary follow-up and homecare. While curative measures are important, they are not part of the control measures. Which of the following patients is an appropriate candidate for TEE? A -a female patient with dysphagia B -a male patient who is obese C -a male patient who has a history of gastroesophageal disease D -a patient who is allergic to topic anesthetic - Answer B -a male patient who is obese 76 TEE is often used with patients who are obese because obesity can make it difficult to get a clear picture of the heart with regular echocardiography. Patients with a history of gastroesophageal disease, who have dysphagia, and who are allergic to topic anesthetics are not considered candidates for TEE. Which of the following methods is MOST effective for measuring the effectiveness of a community program to reduce childhood obesity?A -Compare national rates of childhood obesity from before and after program implementation. 77 B -Compare citywide rates of childhood obesity from before and after program implementation. C -Follow up with program participants after 6 months to see if they have experienced weight loss. D -Conduct a new survey to see how many children in the community are overweight. - Answer C -Follow up with program participants after 6 months to see if they have experienced weight loss. This strategy is most likely to indicate the effectiveness of the program because if measures effects on those who actually participated in the program. Comparing national or citywide rates does not reveal whether a specific intervention had any effect on childhood obesity. Which of the following is an example of objective data? A -Patient reports feeling chills. B -Patient has a fever. C -Patient has a temperature of 102° F. D -Patient has as elevated temperature. - Answer C -Patient has a temperature of 102° F. Objective data must be measurable and verifiable. Simply saying the patient has a fever or an elevated temperature does not tell the health care team very much. Providing a direct measurement of the patient's temperature is far more useful in crafting a care plan and diagnosis. How many liters does interstitial fluid need to exceed before it becomes apparent? A -2.5 to 3.5 liters B -4.0 to 5.5 liters 80 There are 6 clinical practice standards for the ambulatory care nursing: Assessment, Nursing diagnosis, Identification of expected outcomes/goals, Planning, Implementation, Evaluation The more common side effects of anticholinergics would include all but which of the following? A -Hyperpyrexia B -Dry lips C -Blurred vision D -Schizophrenia - Answer D -Schizophrenia 81 With learning, the person typically changes which of the following because of knowledge that is new? A -Occupations B -Behavior C -Physical functional status D -Financial process - Answer B -Behavior Learning helps the person to change the following as a result of exposure to knowledge that is new: Behavior, Emotional, functioning, Mental The ANP recognizes the danger signals for skin disease. Which of the following skin diseases is characterized (among other things) by a petechial rash appearing on the wrist and ankles and spreading rapidly toward the trunk and the face on the second to third day of the disease? A -Rocky Mountain Spotted Fever B -Shingles C -Meningococcemia D -Actinic Keratosis - Answer A -Rocky Mountain Spotted Fever petechial rash appears starting on the wrist and ankles and spreads rapidly toward the trunk and the face. Which of the following does principalism use? A -Nonmalefience B -Fidelity C -Veracity This disease has an acute onset of high fever and myalgia (muscle pain), severe headache, fatigue, nausea and vomiting and rash. By the second to third day, a 82 D -All of the above - Answer D -All of the above Principalism uses: Nonmalefience, Fidelity, Veracity, Beneficence, Autonomy, Justice Which of the following is true regarding current factors that support the greater emphasis on health promotion and disease prevention? A - Only 20% of illness and disease is related to lifestyle and unhealthy decisions. B -Healthy People 2020 was developed as a outline of prevention agenda by the American Nurses Association. 1 ANCC AMBULATORY CARE NURSING CERTIFICATION LATEST EXAM How many medications does it typically take to be considered "polypharmacy?" A -Three B -Ten C -Twenty-four D -Five or more - Answer D -Five or more The ANP knows that it is her responsibility to report certain things to the proper authorities. Which of the following is NOT required to be reported? A - gunshot wound B - suspected child abuse C - drug abuse D - stab wounds - Answer C - drug abuse Drug abuse is not required by law to be reported. Gunshot wounds, stab wounds, and child abuse (actual or suspected) are required to be reported to the proper authorities. Prior to undergoing an abdominal sonogram, the patient should do what? A - refrain from food and water for 12 hours 2 B - empty his or her bladder C - drink a liter of water D - empty his or her bowels - Answer C - drink a liter of water Prior to an abdominal sonogram, the patient is asked to drink water. In addition fasting for 8 to 12 hours prior to the procedure is often required. Which of the following is NOT part of a nursing diagnosis? A - statement of the patient's actual health status B -signs of illness C - medical diagnosis (such as stroke or pulmonary blockage) D - symptoms of illness - Answer C - medical diagnosis developing, causative and related factors, and signs and symptoms. Nursing diagnoses should never contain medical diagnoses. Rather, the nursing diagnosis is a statement of the patient's actual health status, risks for condition 5 C - Zestril D - Adalat - Answer A - Lanoxin (Digoxin) A digitalis medication is a cardiac glycoside that treats CHF and arrhythmias also for BP support. Bumex is a loop diuretic. Zestril is an ACE inhibitor. Adalat is a calcium blocking agent. Which of the following is not one of the steps in evidence-based practice? A - Constructing the clinical question B - Patient selection C - Appropriate selection of resources D - Appraise the validity of the evidence - Answer B - Patient selection Patent selection is not one of the steps in evidence-based practice. The steps in evidence-based practice consist of 1 - Patient assessment 2 - Constructing the clinical question 3 - Appropriate selection of resources 4 - Appraise the validity of the evidence 5 - Apply the integrated patient preferences, evidence, and clinical expertise 6 - Performance evaluation with patience What is true regarding the respiratory synctical virus (RSV) immune globin? A - This is indicated for children less than 2 years of age with chronic lung disease, and infants <32 weeks. B - Contraindications include a reaction to neomycin or streptomycin products. C - This is indicated for adults without a history of RSV. 6 A nurse finishes a follow up visit with one of her elderly patients and gives him the influenza vaccine before he leaves. This is an example of what type of prevention? D - Palivizumab (Synagis) provides permanent immunity for high-risk infants. - Answer A - This is indicated for children less than 2 years of age with chronic lung disease, and infants <32 weeks. Palivizumab (Synagis) provides temporary, passive immunity for high-risk infants, not adults. The polio vaccine (IPV) is contraindicated for those who have had a reaction to neomycin or streptomycin. A - primary B - secondary 7 C - tertiary D - annual - Answer A - primary Primary prevention, such as an immunization, aims to prevent health problems before they start. Secondary prevention promotes early detection and treatments of diseases. Tertiary prevention is designed to help a patient cope with a current problem or prevent relapse. "Annual" is not a type of prevention. For successful communication, the major criteria would include? A - Forcefulness B - Flexibility C - Evaluation D - Developmental - Answer B - Flexibility The 4 major criteria for successful communication would include: Feedback, Appropriateness, Efficiency, Flexibility A person's knowledge is sometimes measured by which of the following verbs? A -Recall B - List C - Remember D - All of the above - Answer D - all of the above Some of the verbs which might be used to measure a person's knowledge could include: Recall, List, Remember, Identify, State, Define A key value in association with "Baby Boomers" would be considered which of the following? A - Sacrifice 10 B - Common name C - Trade name D - Chemical name - Answer D - Chemical name An older patient presents with swelling in the lower extremities. Which of the following should be ordered to rule out heart failure? A - CBC B - Spirometry study C - Brain natriuretic peptide test D - Ketone balances - Answer C - Brain natriuretic peptide test (BNP) 11 The BNP measures levels of protein made by your heart will be higher than normal since it is produced by your blood vessels in your heart. Nurse Grace knows that the most effective way to educate her patient and assist in her patient care plan is to do what? A - Insist the patient follow the plan exactly as instructed. B - Create a schedule for the patient of future office visits and scheduled treatments. C - Establish a team effort with the patient in the teaching and learning process. D - Ask the patient to involve family members in her care planning. - Answer C - Establish a team effort with the patient in the teaching and learning process. Of the following, which would not be considered an objective symptom for tuberculosis? A - Headaches B - Night sweats C - Weight loss D - Fever - Answer A - Headaches Some of the objective symptoms for tuberculosis would be: Night sweats, Weight loss, Fever, Cough which progresses, Hemoptysis (cough up blood) An order is being written for insulin, how should the dosage order be written? A - 10 ml subq B - 10 units subq C - 10 u subq D - None of the above - Answer B - 10 units subq 12 U for unit is on The Joint Commission's official " Do Not Use" list of abbreviations. Which of the following is NOT a "red flag" of low health literacy in a patient? A - The patient pours pills into his or her hand to identify them by sight. B - The patient is not Caucasian. C - The patient consistently asks you to read healthcare information because he or she has forgotten eyeglasses at home. D - The patient does not ask questions during the appointment. - Answer B - The patient is not Caucasian. 15 D - Treating a patient with an open wound. - Answer C - Treating a patient who is suspected of having avian flu. Treating a patient who is suspected of having avian flu CDC guidelines recommend full barrier precautions for all known and suspected cases of avian flu, due to the high degree of transmission of the disease. Full barrier precautions are also used in treating patients with known or suspected cases of SARS and pandemic influenza, as well as hemorrhagic diseases would be considered the nurse's competency that results from training. A - Education B - Language C - Culture D - Proficiency - Answer D - Proficiency The ambulatory care nurse's role would have all except which of the following role dimensions? A - Workload B - Risk management C - Benefits D - Leadership - Answer C - Benefits Some of the role dimensions for the ambulatory care nurse would include: Workload, Risk management, Leadership, Staffing, Competency concerns, Workplace regulatory compliance Which of the following is NOT a nonmedical expense? A - Linen. 16 B - Uniform. C - Office supplies. D - Hypodermics. - Answer D - Hypodermics. Of the following, which would not be a predisposing factor that might cause a patient to develop a tubercle bacillus infection? A - Cirrhosis B - Alcoholism C - Poor nutrition 17 D - The health care workers that care for low-risk patients - Answer D - The health care workers that care for low-risk patients The is supposed to protect the patients' rights, help them to participate in their healthcare decisions, and provide adequate healthcare education. A - Teacher B - Advocate C - Administrator D - None of the above - Answer B - Advocate When identifying barriers such as language which can obstruct the provision of optimal patient care, which standard of care with the Standards of Professional Clinical Practice for the Ambulatory Care Nurse would it be considered? D - Standard 3 - Answer B - Standard 1 These would include such barriers as language, behavioral health issues, and culture. Nurse Terri is assessing a female patient with red, itchy spots on various parts of the body. She mentions she has no allergies but has recently switched soaps and is trying a new detergent. Terri suspects this is what type of irritation? A - irritant contact dermatitis B - cellulitis C - allergic purpura D - psoriasis - Answer A - irritant contact dermatitis A - Standard 6 B - Standard 1 C - Standard 4 20 D - The color of the meter - Answer D - The color of the meter There are 7 details which should be focused on when choosing a glucometer: The type of the lancing device, Coding of the machine, The look/display of the meter, The memory capacity of the meter, The sample size which will be needed, How long does it take for a result, Are there any additional features Which of the following emphasizes preventive services like notification of contacts for patients with infectious diseases, screenings, and immunization at the local level? 21 A - Local schools B - Local pharmacies C - Public Health departments D - State disease control - Answer C - Public Health departments Public Health departments emphasize preventive services like notification of contacts for patients with infectious diseases, screenings, and immunization at the local level. The public health department plays an integral Lowell Community Health. What is the MOST effective form of research a nurse can do before establishing a diabetes prevention course for patients? A - Making a list of the local endocrinologists that are currently treating diabetic patients. B - Estimating what age groups would attend the course. C - Documenting what causes diabetes and why. D - Finding diabetic-friendly recipes to share with the class. - Answer C - Documenting what causes diabetes and why. When a nurse is planning an event to raise awareness of preventing a disease, the first types of research that should be done is what causes the disease and why. Once this information is documented, the nurse can build her lesson around methods of prevention, warnings signs, etc. One of the more important steps for the ambulatory care nurse during diagnosis would be which of the following? A - Documentation of information B - CT equipment C - State disease control 22 D - X-ray equipment - Answer A - Documentation of information Which of the following abnormal heart sounds is a result of the blood flowing past the normally closed valve? A - valve regurgitation B - valvular stenosis C - ventricular or atrial failure D - electrical conduction defects - Answer A - valve regurgitation The sound of valvular regurgitation is known as a murmur. Murmurs can have a blowing or swishing sound and are categorized in a degree of I to VI. Grade I 25 C - pericarditis D - pneumothorax - Answer C - pericarditis. Patients with pericarditis will often have a scratching or creaking sound. This is known as a pericardial friction rub and results from inflammation of the pericardium. The 5 M's of categorizing information (according to the Failure Mode and Effect Analysis) would include all but which of the following? A - Materials B - Maneuvering C - Methods D - Machines - Answer B = Maneuvering The 5 M's of categorizing information (according to the Failure Mode and Effect Analysis) would include: Machines, Management, Manpower, Materials, Methods Where is the submental lymph node located? A - in the hollow of the clavicle B - right below the chin C - junction between back of head and neck D - behind the ears - Answer B - right below the chin The supraclavicular lymph node is in the hollow of the clavicle. The suboccipital lymph node is located in the junction between the back of the head and neck. The postauricular lymph node is behind the ears. The objective for nursing practice in each state would be considered all of the following except? 26 A - Will define the practice of professional nursing. B - Provide the disciplinary action of licenses for certain causes. C - Will define the length of the shifts that the nurse may work. D - Would set the minimal educational qualifications and other requirements for licensure. - Answer C - Will define the length of the shifts that the nurse may work. The 4 objectives for the nursing practice in each state: Will determine the legal titles and abbreviations nurses may use. Would set the minimal educational qualifications and other requirements for licensure. Provide the disciplinary action of licenses for certain causes. Will define the practice of professional nursing. 27 In negotiations the development of trust would include which of the following? A - Do not prepare beforehand B - Do not share notes C - Develop plans D - None of the above - Answer C - Develop plans The development of trust in negotiations would include: Maintain and share notes. Observe for behavior reflecting dishonesty. Research and prepare beforehand. Develop plans. Demonstrate respect Which of the following is NOT one of the key questions of the Ask Me 3 Model? A - What is my main problem? B - What is the mortality rate for my problem? C - What do I need to do? D - Why is it important for me to do this? - Answer B - What is the mortality rate for my problem? The Ask Me 3 model provides three questions that patients should be able to answer at the end of a health care visit. The mortality rate of a given health problem may be a concern, but this model is more centered on ensuring patient understanding of the condition and the necessary next steps. Disinfectant solution needs to be marked with the name, . A - Date prepared and the date expired. B - Date prepared. C - Date expired. 30 D - Encouraging employees to avoid caffeine, alcohol, and other substances that might interfere with sleep. - Answer B - Putting nurses on either permanent day or permanent night shifts. Shiftwork carries numerous risks, including sleep deprivation and resulting health issues such as immune system depression and digestive problems. Changing shifts often carries problems, but keeping employees on permanent night shifts also carries risks including loss of family time, health problems resulting from difficulties sleeping during the day, sleep deprivation, and emotional problems. 31 Tips for the ambulatory care nurse in association with communication would not include? A- Use open ended questions B - Don't gather feedback from staff members C - Conduct communication at the proper time and place D - Use fewer words - Answer B - Don't gather feedback from staff members Communication tips would include: Use open ended questions. Gather feedback from staff members. Conduct communication at the proper time and place. Use fewer words. Watch language used, avoid using technical terms and acronym which might not be understood by all. Respect the viewpoints and opinions of other's. Use body language to show interest. Use communication to build "USA" - understanding, support, and acceptance At what point in the autoclaving process are wrapped items considered sterile? A - As soon as they reach the recommended temperature. B - Immediately on removal from the autoclave, even if wrapping is still wet. C - As soon as the wrapping is dry. D - As soon as they reach room temperature after removal from the autoclave and all wrappings are dry. - Answer D - As soon as they reach room temperature after removal from the autoclave and all wrappings are dry. It may take several hours for items to be fully dry and cool to room temperature after removing them from the autoclave. Wet packs must at all times be considered non-sterile, even if they have cooled to room temperature. In a clinical workflow chart, what is the link that moves the workflow forward between processes? A - Dynamic connector. B - Hyperlink Process. 32 C - On-page connector. D - Off-page connector. - Answer B - Hyperlink Process. The hyperlink process is also called the hot link. It moves the workflow forward between processes. Which of the following is meant to standardize the patient care practices? A - OSHA regulations B - Respiratory Care protocols C - MSDS sheets 35 important that these be in a patient's own words to perform the most complete and accurate assessment. The preparation of a patient for "anticipated developmental or situational crisis" is known as . A - Anticipatory guidance. B - Preventative care. C - Anticipatory care. D - Preemptive care. - Answer A - Anticipatory guidance. Anticipatory guidance is a nursing intervention in which nurses attempt to prepare patients and/or caregivers for potential developments or situations in treatment. This can involve educating them about potential side effects and negative outcomes. In a critical care setting, it may be necessary to conduct anticipatory guidance with families as well depending on what type of aftercare the patient may need after discharge. Which of the following should be the FIRST step in cleaning up blood or other body fluids from a floor? A - Spray the area with a 1:10 solution of bleach and water. B - Put out orange cones or caution signs. C - Blot up as much of the material as possible. D - Put on latex gloves. - Answer D - Put on latex gloves. When cleaning up blood, vomit, feces, urine, or other body fluids, the first step should always be to put on protective gear. At a minimum, latex gloves should be donned. If there is a possibility of fluid spraying, goggles should be worn; in situations where clothing might come into contact with the spill, a protective gown should also be worn. 36 Which of the following falls within the normal range for BUN:Cr? D - 100 mg/dL - Answer B - 15 mg/dL The normal range for BUN:Cr is 10 - 20 mg/dL. Ratios above 20 may indicate some kidney injury. A - 40 mg/dL B - 15 mg/dL C - 55 mg/dL 37 Screening for cancer in the geriatric population includes all of the following recommendations except: A - prostate cancer B - cervical cancer C - skin cancer D - colon cancer - Answer B - cervical cancer Cervical cancer is not likely in the elderly female. The geriatric population should be screened for heart disease, hearing, vision, and dental problems, hyperlipidemia, hypertension, menopause, osteoporosis, hypothyroidism, and dementia. Cancer screenings include breast, colon, prostate, and skin. A patient is speaking with a telephone nurse and explains that she has had increased acid reflux from a recently diagnosed ulcer. The nurse's first question is to ask if the patient has had what kind of food lately? A - Dairy products. B - Acidic fruits such as oranges or lemons. C - Beans or lentils. D - Alcoholic or caffeinated beverages. - Answer D - Alcoholic or caffeinated beverages. The nurse should explain to the patient beverages with alcohol or caffeine can stimulate gastric acid production and irritate gastric lining. The nurse should advise the patient to avoid these type of foods and for the patient to see their physician if symptoms persist. would be considered the federal law which helps to protect the privacy of student educational records? 40 The nurse is educating an adult patient regarding medications for asthma. Which order would be the most appropriate for administration? A - Albuterol, Flovent, Tobramycin B - Flovent, Intal, Tobramycin C - Tobramycin, Intal, Albuterol D - Intal, Tobramycin, Albuterol - Answer A - Albuterol, Flovent, Tobramycin Telephone triage may be a responsibility of the ambulatory care nurse. What are the appropriate components of telephone triage? 41 A - The nurse should give generic information and leave the responsibility to the patient or caller B - The nurse should immediately call 911 C - The nurse should state that he or she is unable to discuss medical information and refer the patient to the primary care physician D - The nurse must clearly identify him- or herself, take a quick and accurate history, and quickly be able to make a decision - Answer D - The nurse must clearly identify him- or herself, take a quick and accurate history, and quickly be able to make a decision What are the best question types to ask when gaining information from a patient? A - specific, open-ended questions regarding current symptoms and medical history B - general questions with yes or no answers C - questions related to childhood diseases D - demographics questions - Answer A - specific, open-ended questions regarding current symptoms and medical history In what order would the nurse prioritize the care of the following patients presenting to the clinic at the same time: a parent carrying a smiling infant with a fever, a pale and sweaty male with flank pain for two days, a carpenter with a nail in his thumb, and a three-year-old with vomiting. A - flank pain, three-year-old with vomiting, infant with a fever, and man with the nail B - three-year-old with vomiting, flank pain, man with the nail, and infant with fever C - flank pain, infant with fever, three-year-old with vomiting, and man with the nail 42 D - three-year-old with vomiting, infant with fever, flank pain, and man with the nail - Answer A - flank pain, three-year-old with vomiting, infant with a fever, and man with the nail Mom has described her child's symptoms as fever for three days and vomiting for the last 24 hours. She states the child has been very sleepy for the last two to three hours. What subtle symptom alerts the nurse that this child needs to be seen as soon as possible? A - three days of fever 45 The ambulatory care setting must include which of the following for the nurse to be able to properly triage a patient? C - vending machines D - private room for triage - Answer D - private room for triage A 50-year-old male comes to the clinic stating he cannot shake this "flu." You observe that he is clammy, pale, and has an irregular heart rate. He is a large man with a rugged appearance. He is friendly and apologetic for bothering you with his silly complaints. What is your plan of care for this patient? A - You suspect there is more to his complaint than he states and immediately begin a cardiac workup by placing him in a room and ordering an EKG B - You suspect he has the newest flu going around and offer him hot tea while he waits to see the physician C - You suspect he has a low tolerance for being ill and offer him Tylenol while he waits to see the physician D - You finish the triage and send him to the waiting room, understanding that the flu affects everyone differently - Answer A - You suspect there is more to his complaint than he states and immediately begin a cardiac workup by placing him in a room and ordering an EKG Each person has how many intelligences (according to Howard Garner's multiple intelligence theory)? - Answer 8 - According to the Howard Garner's multiple intelligence theory, each individual has 8 intelligences. These intelligences form the basis for the individuals learning throughout their life. A - television B - computer 46 You are conducting an assessment with a male patient. It is important to know that a normal prostate is the size of what? A -grape D -walnut - Answer D - Walnut What type of budget should be done for a new practice? A- Zero based B -Hyperlink Process B -peanut C -orange 47 C -Historical based budget D -Capital budget. - Answer A - Zero based - Zero based budgets are used with new practices and requires expenses to be tracked and managed carefully. You are performing an assessment with a patient. On auscultation of heart sounds, you hear a scratching, creaking sound. Which of the following conditions might this heart sound indicate? A -congestive heart failure B -benign heart murmur C -pericarditis D -pneumothorax - Answer C - pericarditis - Patients with pericarditis will often have a scratching or creaking sound. This is known as a pericardial friction rub and results from inflammation of the pericardium. The 5 M's of categorizing information (according to the Failure Mode and Effect Analysis) would include all but which of the following? A -Materials B -Maneuvering C -Methods D -Machines - Answer B - maneuvering is not 5 Ms-Machines, Management, Manpower, Materials, Methods Where is the submental lymph node located? A -in the hollow of the clavicle B -right below the chin 50 patient to have a pacemaker implanted would include: Asystole, Sick-sinus syndrome, Atrial tachyarrhythmias, Bradyarrhythmias, Heart block At what point in the autoclaving process are wrapped items considered sterile? A -As soon as they reach the recommended temperature. B -Immediately on removal from the autoclave, even if wrapping is still wet. C -As soon as the wrapping is dry. D -As soon as they reach room temperature after removal from the autoclave and all wrappings are dry. - Answer D -As soon as they reach room temperature after removal from the autoclave and all wrappings are dry. 51 -It may take several hours for items to be fully dry and cool to room temperature after removing them from the autoclave. Wet packs must at all times be considered non-sterile, even if they have cooled to room temperature. What are the 5 steps of the nursing process? - Answer Assessment Diagnosis Planning Implementation Evaluation The preparation of a patient for "anticipated developmental or situational crisis" is known as . A -Anticipatory guidance. B -Preventative care. C -Anticipatory care. D -Preemptive care. - Answer A -Anticipatory guidance. Anticipatory guidance is a nursing intervention in which nurses attempt to prepare patients and/or caregivers for potential developments or situations in treatment. This can involve educating them about potential side effects and negative outcomes. A brief account by the patient of any signs or symptoms he or she is experiencing is known as what? A -functional assessment B -focused assessment C -review of systems D -systemic review - Answer C -review of systems 52 In the review of systems, the patient tells the nurse in his or her own words what signs or symptoms he or she has experienced in various body systems. It is important that these be in a patient's own words to perform the most complete and accurate assessment. Of the following, which is the greatest risk factor for childhood obesity? A -Lack of cognitive stimulation. B - Poverty. C -Parental divorce. D -Parental Education. - Answer A -Lack of cognitive stimulation. 55 How far out do most health care facilities' capital budgets plan? A -5-10 years. B -Less than 1 year. C -20 years. D -1-3 years. - Answer D -1-3 years. Because they deal with long-life items, most capital budgets plan for 1-3 years out from the present. It is important for nurses who work on budgets to be aware of their facility's capital budget plans for the next years so that they can appropriately request budget resources for their own units. would be when a leader aligns themselves with others to help obtain information, ideas, advice, power, and influence? A -Consensus-building B -Negotiation C -Networking D -Development - Answer C -Networking Networking would be when a leader aligns themselves with others to help obtain information, ideas, advice, power, and influence. The most effective negotiation process would have a win-win outcome. What is the MOST effective form of research a nurse can do before establishing a diabetes prevention course for patients? A -Making a list of the local endocrinologists that are currently treating diabetic patients. B -Estimating what age groups would attend the course. C -Documenting what causes diabetes and why. D -Finding diabetic-friendly recipes to share with the class. - Answer C - Documenting what causes diabetes and why. 56 When a nurse is planning an event to raise awareness of preventing a disease, the first types of research that should be done is what causes the disease and why. Once this information is documented, the nurse can build her lesson around methods of prevention, warnings signs, etc. Which of the following abnormal heart sounds is a result of the blood flowing past the normally closed valve? A - valve regurgitation B -valvular stenosis 57 C -ventricular or atrial failure D -electrical conduction defects - Answer A - valve regurgitation The sound of valvular regurgitation is known as a murmur. Murmurs can have a blowing or swishing sound and are categorized in a degree of I to VI. Grade I murmurs are very soft, while grade VI murmurs are extremely loud and can be heard with the stethoscope one inch away from the chest wall. Each person has how many intelligences (according to Howard Garner's multiple intelligence theory)? A -8 B -12 C -3 D -38 - Answer A -8 Tips for the ambulatory care nurse in association with communication would NOT include? A -Use open ended questions B -Don't gather feedback from staff members C -Conduct communication at the proper time and place D -Use fewer words - Answer B -Don't gather feedback from staff members In a clinical workflow chart, what is the link that moves the workflow forward between processes? A -Dynamic connector. B -Hyperlink Process. 60 A -Investigate whether a different anti-depressant that does not carry the risk of headaches is available. B -Educate the patient about the potential negative outcomes of untreated depression. C -Investigate whether another drug can be prescribed to ease the patient's headaches. D -Investigate whether natural remedies for depression are appropriate for this patient. - Answer A -Investigate whether a different anti-depressant that does not carry the risk of headaches is available. 61 would be considered the federal law which helps to protect the privacy of student educational records? A -FMLA B -ADA C -FERPA D -HIPAA - Answer C -FERPA FERPA stands for Family Educational Rights and Privacy Act. This is a federal law which helps to protect the privacy of student educational records. When defibrillating a patient, the second shock is typically at which dose? A -100 B -360 C -200 to 300 D -300 - Answer C -200 to 300 When defibrillating a patient, the shock levels are typically: First-200 joules Second-200 to 300 joules All of the rest-360 joules You are conducting an assessment with a patient who says that sometimes she feels as though she should have been born male. She prefers to dress in men's clothing and feels disgust toward the overtly female parts of her body. Which of the following is an appropriate nursing diagnosis for this patient? A- delusions B -thought processes, altered C -gender dysphoria 62 D -personal identity disturbance - Answer C -gender dysphoria This patient is demonstrating gender dysphoria. Gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics. What is the overarching vision of Healthy People 2020? A -To provide universal health care. B- To promote a society in which all people live long, healthy lives. C -To eliminate poverty worldwide. 65 Some objectives of ambulatory care nursing would include: To help minimize suffering, prevent injury, protect the patient's health, promote the patient's health, maximize health literacy/education, prevent illness, apply nursing interventions to human responses in health, illness, disease, disability, and end- of-life circumstances, actively advocate for optimal coordinated healthcare of families, individuals, communities, and populations that are aimed at the improvement of the whole person's well-being. How often should biological indicators be tested? A -Daily B -Hourly C -Weekly D -After each use of a machine. - Answer C -Weekly A patient is being prescribed Glucophage but this brand is not available. Which of the following drugs may be substituted? A -Repaglinide B -Troglitazone C -Acarbose D -Metformin - Answer D -Metformin A kilogram would be mg? A -100,000 B -100 C -1,000,000 D -5,000,000 - Answer C -1,000,000 66 It takes 1000 grams to equal 1 kilogram. It takes 1000 mg to equal 1 gram. It would take 1,000,000 mg to equal 1 kilogram. The central nervous system is composed of what? A -brain and spinal cord B -brain and sympathetic nervous system C -brain, spine, and nerve cells D -brain, heart, and lungs - Answer A -brain and spinal cord The central nervous system (CNS) is the main control center for the body. It is comprised of the brain and spinal cord. 67 Why is it recommended that pregnant women be screened for domestic violence? A -The bodily strains of pregnancy may create injuries similar to domestic violence. B -Pregnant women are at the greatest risk for both new and continuing domestic violence. C -Concern for the welfare of the unborn child. violence. Because they represent a group with the high risk of domestic violence, all pregnant women should be screened for domestic violence even if they have not reported violence before. Violence may begin during pregnancy, or a woman may be more willing to report violence out of concern for her child than she might have been previously. When judging the quality of care, which method evaluates performance after the patient is released? A -Quality improvement. B -A retrospective nursing audit. C -Qualitative research. D -A concurrent nursing audit . - Answer B -A retrospective nursing audit. Nursing audits are done to improve the quality of care. There are two types of audits, concurrent and retrospective. A retrospective nursing audit is done after a patient is released. What is indirect cost subtracted from the contribution margin? A -Gross income. D -Such screenings are covered by insurance when part of prenatal care. - Answer B -Pregnant women are at the greatest risk for both new and continuing domestic 70 D -None of the above - Answer B -Pharmacotherapeutics The branch of pharmacology that includes the use of medications to treat, prevent or diagnose would be considered pharmacotherapeutics. Pharmacology would be considered the study of medications, which also includes the medications interactions with living systems. would be when the patient's verbal communication matches their non-verbal communication? A -Discongruent B -Congruent C -Non-congruent 71 D -Incongruent - Answer B -Congruent The term which would be used to mean the art of teaching adults would be considered which of the following? A -Andragogy B -Visions C -Consultation D -Instructing - Answer A -Andragogy Which of the following is the largest category of expenditure for most health care facilities? C -Capital budget D -Malpractice insurance. - Answer B -Personnel budget The acronym "ABCD" (associated with written objectives) stands for which of the following? A -Ambition, behavioral, confusion, and diffusion B -Audience, behavioral, condition, and degree of attainment C -Analysis, benign, commission, and district D -Able, believable, conditioning, and delivery - Answer B -Audience, behavioral, condition, and degree of attainment A nurse is examining a skin growth on one of her patients. The patients hasn't felt any symptoms but has noticed the growth is starting to look abnormal. This type of examination is considered what type of prevention? A -Operating budget B -Personnel budget 72 A -Infectious B -Secondary C -Primary D -Primordial. - Answer B -Secondary Secondary Examining the abnormal skin growth is an example of secondary prevention due to the fact the patient has already come forward with an abnormality or possible illness and the nurse is examining it to ensure there are no further complications from it. Although the patient is not having symptoms at this time, the nurse will monitor the growth to see if he will in the future. 75 B -Feedback C -Evaluation D -Implementation - Answer A -Efficiency Efficiency would be considered correct for a type of major criteria that is associated with successful communication where there are simple, clear words delivered at a pace that is suitable to the participants. Several control measures exist with prevention of disease. The following are all accurate statements regarding control measures except: A -Measures directed against the reservoir include isolation, quarantine, and insect spraying. B -Measures that interrupt the transmission of organisms include water purification, milk pasteurization, and barrier protection during sexual intercourse. C -Measures that reduce host susceptibility include immunization, appropriate use of antibiotics, and improved nutrition. D -Measures that cure disease include adequate diagnosis, appropriate treatment regimen, and necessary follow-up and homecare. - Answer D -Measures that cure disease include adequate diagnosis, appropriate treatment regimen, and necessary follow-up and homecare. While curative measures are important, they are not part of the control measures. Which of the following patients is an appropriate candidate for TEE? A -a female patient with dysphagia B -a male patient who is obese C -a male patient who has a history of gastroesophageal disease D -a patient who is allergic to topic anesthetic - Answer B -a male patient who is obese 76 TEE is often used with patients who are obese because obesity can make it difficult to get a clear picture of the heart with regular echocardiography. Patients with a history of gastroesophageal disease, who have dysphagia, and who are allergic to topic anesthetics are not considered candidates for TEE. Which of the following methods is MOST effective for measuring the effectiveness of a community program to reduce childhood obesity?A -Compare national rates of childhood obesity from before and after program implementation. 77 B -Compare citywide rates of childhood obesity from before and after program implementation. C -Follow up with program participants after 6 months to see if they have experienced weight loss. D -Conduct a new survey to see how many children in the community are overweight. - Answer C -Follow up with program participants after 6 months to see if they have experienced weight loss. This strategy is most likely to indicate the effectiveness of the program because if measures effects on those who actually participated in the program. Comparing national or citywide rates does not reveal whether a specific intervention had any effect on childhood obesity. Which of the following is an example of objective data? A -Patient reports feeling chills. B -Patient has a fever. C -Patient has a temperature of 102° F. D -Patient has as elevated temperature. - Answer C -Patient has a temperature of 102° F. Objective data must be measurable and verifiable. Simply saying the patient has a fever or an elevated temperature does not tell the health care team very much. Providing a direct measurement of the patient's temperature is far more useful in crafting a care plan and diagnosis. How many liters does interstitial fluid need to exceed before it becomes apparent? A -2.5 to 3.5 liters B -4.0 to 5.5 liters 80 There are 6 clinical practice standards for the ambulatory care nursing: Assessment, Nursing diagnosis, Identification of expected outcomes/goals, Planning, Implementation, Evaluation The more common side effects of anticholinergics would include all but which of the following? A -Hyperpyrexia B -Dry lips C -Blurred vision D -Schizophrenia - Answer D -Schizophrenia 81 With learning, the person typically changes which of the following because of knowledge that is new? A -Occupations B -Behavior C -Physical functional status D -Financial process - Answer B -Behavior Learning helps the person to change the following as a result of exposure to knowledge that is new: Behavior, Emotional, functioning, Mental The ANP recognizes the danger signals for skin disease. Which of the following skin diseases is characterized (among other things) by a petechial rash appearing on the wrist and ankles and spreading rapidly toward the trunk and the face on the second to third day of the disease? A -Rocky Mountain Spotted Fever B -Shingles C -Meningococcemia D -Actinic Keratosis - Answer A -Rocky Mountain Spotted Fever petechial rash appears starting on the wrist and ankles and spreads rapidly toward the trunk and the face. Which of the following does principalism use? A -Nonmalefience B -Fidelity C -Veracity This disease has an acute onset of high fever and myalgia (muscle pain), severe headache, fatigue, nausea and vomiting and rash. By the second to third day, a 82 D -All of the above - Answer D -All of the above Principalism uses: Nonmalefience, Fidelity, Veracity, Beneficence, Autonomy, Justice Which of the following is true regarding current factors that support the greater emphasis on health promotion and disease prevention? A - Only 20% of illness and disease is related to lifestyle and unhealthy decisions. B -Healthy People 2020 was developed as a outline of prevention agenda by the American Nurses Association. 85 What is the best instruction Jan can provide with her assessment? A -to take deep breaths very slowly B -to hold his breath for 15 seconds or until he is calm C -to take rapid shallow breaths to increase air flow D -to perform pursed lip breathing. - Answer D -to perform pursed lip breathing. The process of pursed lip breathing is designed to prevent the collapse of the lung and lung tissues. This breathing also helps the patient control his own rate and depth of his breathing, which calms and soothes the patient during stressful moments. Which of the following is an example of indirect costs? A -Medical equipment. B -Gas. C -Salaries. D -Insurance. - Answer B -Gas. According to Bloom's Taxonomy in 1956, which of the following would be considered a learning domain? A -Concurrent B -Release C -Affective D -Assumption - Answer C -Affective According to Bloom, the 3 learning domains would be: Cognitive, Affective, Psychomotor Nurse Jan is examining a patient in the clinic who has been recently diagnosed with emphysema. While in the office he becomes short of breath and restless. 86 The limitations when using technology for learning would include all but which of the following? A -There would be face-to-face training time B -Computer literacy of learner and instructor C -Content not appropriate for technology D -The cost is high - Answer A -There would be face-to-face training time You are providing pre-procedural care to a patient who will undergo TEE. Which of the following is NOT part of patient preparation for this procedure? 87 A -The patient should fast for 6 hours prior to the procedure. B -The back of the patient's throat is sprayed with topical anesthetic. C -The patient should remove dentures. D -The patient is put under general anesthetic. - Answer B -The back of the patient's throat is sprayed with topical anesthetic. Common side effects of loop diuretics would include which of the following? A -Ototoxicity B -Confusion C -Dehydration D -All of the above - Answer D -All of the above According to the number 1 provision of The Ethics for Nurses (ANA), which should a nurse practice? A -To practice with compassion and respect B -Preserve integrity and safety C -Collaborate with others to meet health needs D -None of the above - Answer A -To practice with compassion and respect -number 5 provision of the ANA code of Ethics for Nurses defines that the nurse should preserve integrity and safety. Side effects of thiazides (diuretics) would include all but which of the following? C -Pancreatitis A -Hyperglycemia B -Hypercalcemia 90 Mentorship is a method that ensures evidence based nursing is passed on. Research and clinical support also ensure that evidence based nursing continues. A patient with an Mean Corpuscular Volume (MCV) of 60 fL is likely suffering from which of the following? A -Hemolytic anemia B -Iron deficiency anemia C -Pernicious anemia D -Macrocytic anemia - Answer B -Iron deficiency anemia 91 You are conducting an assessment with a patient. The patient tells you during the assessment that he is sure that the gastrointestinal discomfort he is experiencing is the result of the nurses in his long-term care facility poisoning his food. Which of the following is an appropriate nursing diagnosis for this patient? A -delusional B -impaired mentation C -altered nutrition D -disturbed thought processes - Answer D -disturbed thought processes Which of the following medicines should be used sparingly in the elderly because as people get older, their kidneys are less able to excrete it? A -antihypertensives B -Digoxin C -analgesics D -antidiabetic drugs - Answer B -Digoxin Analgesics - Cause confusion or dizziness. Antidiabetic drugs - lower blood sugar levels for extended period of time. Antihypertensives - slow the heart rate and worsen depression. Digoxin - less able to excrete as people get older. Which of the following is NOT likely to present a barrier to patient learning? A -Pain. B -Anxiety about paying for treatment. An MCV of 60 is considered quite low, and is a sign of iron deficiency anemia. All the other choices listed here are associated with higher than normal MCV. 92 C -Lack of information about the diagnosis on the part of the patient. D -Negative past experiences with medical care. - Answer C -Lack of information about the diagnosis on the part of the patient. Which of the following is used to sterilize medical equipment that is sensitive to heat or moisture? A -Autoclave. B -Ethylene Oxide. C -Peracetic acid. D -Microwaves. - Answer B -Ethylene Oxide. 95 C -Hispanic D -None of the above - Answer B -African-American Which of the following is NOT one of the stages of motivational interviewing? A -Guiding stage. B -Following stage. C -Directing stage. D -Recommendation stage. - Answer D -Recommendation stage. A condition in which the fluid in the chest of a pneumonia patient becomes infected is known as what? A -bactermi B -empyema.C -sepsis D- pneumothorax - Answer B -empyema. This condition occurs when the fluid in the lungs becomes infected. A chest tube, or more rarely surgery, is required for treatment. A principle of professional boundaries would not include? A -It would be the responsibility of the patient to delineate and maintain boundaries between themselves and the nurses. B -The nurse should always work within the "zone of helpfulness," C -The nurse would be the person responsible for delineating and maintaining boundaries between themselves and patients. D -The nurse should avoid any dual relationships with patients. - Answer A -It would be the responsibility of the patient to delineate and maintain boundaries between themselves and the nurses. In regards to behavior, which of the following would CARE stand for? 96 A -Commission, assessment, realism, and encourage B -Clarify, assess, realistic, and evaluation C -Clarify, articulate, request, and encourage D -Check, analyze, revolve, and encourage - Answer B -Clarify, assess, realistic, and evaluation Which of the following has the MOST influence on an individual's health status? A -Income. B -Gender B -Race. 97 F - Health literacy. - Answer F - Health literacy.Recent studies have shown that a person's health literacy level is the greatest deteriminant of his or her health status, over and above income, SES, race, and education. Which of the following is an appropriate way to pass sharps to other care providers during a procedure? A -Announce that you are handing a sharp to your colleague. B - Sharps should be exchanged through a sharp tray, never by hand. C - A fresh sharp should be used by each care provider. D - Hand the sharp to your colleague with the sharp end pointing away from him or her. - Answer B - Sharps should be exchanged through a sharp tray, never by hand. You are conducting an assessment with a patient who is being admitted prior to surgery for breast cancer. She expresses that she is worried that she will not be says she feels very guilty about the amount of time she will take to recover, and she does not know how she will feel about her husband having to take over day- to-day parenting tasks during that time. Which of the following is an appropriate B -risk for parental role confusion C -parental role conflict D -Self-esteem deficit. Situational, r/t confusion over parental role performance - Answer D -Self-esteem deficit. Situational, r/t confusion over parental role performance able to provide care for her two small children while she is recovering, and she is concerned that her husband will not provide the same kind of care she does. She diagnosis for this patient? A -parental role confusion