ANCC AMB-BC Exam Questions

Correct answer: Evaluate the patient’s adherence to antihypertensive medications

The first step in managing a patient with consistently elevated blood pressure is to evaluate their adherence to antihypertensive medications. Non-adherence is a common reason for poorly controlled hypertension, and addressing this issue can often bring blood pressure back into target ranges. Understanding whether the patient is taking their medications as prescribed is crucial before making any changes to the treatment plan.

While increasing the dose of medication may be necessary, it should only be considered after ensuring the patient is adhering to their current regimen. Immediate hospitalization is generally reserved for hypertensive emergencies rather than consistently elevated blood pressure without acute symptoms. Suggesting dietary changes, such as reducing sodium intake, is important for long-term blood pressure control. However, this should come only after ensuring that adherence to the medication is not the primary issue.

Correct answer: To stay informed about changes in nursing practice

Staying informed about changes in nursing practice is the most important reason to join a professional nursing organization. This membership provides access to the latest updates in the field, including changes in standards, guidelines, and evidence-based practices. This knowledge is crucial for maintaining competence and delivering high-quality care.

Access to continuing education is a benefit of membership, but staying informed about practice changes has a broader and more critical impact on patient care. Networking with other nurses is valuable for career development, but it is secondary to staying current with changes in practice. Enhancing a resume with organizational membership may be beneficial, but it should not be the primary reason for joining an organization.

Correct answer: Build trust through culturally sensitive communication and care

Building trust through culturally sensitive communication and care is the most effective strategy when educating a patient from a marginalized community with historically limited access to healthcare. This approach acknowledges the patient's background and fosters a supportive environment; this is essential for overcoming potential distrust and ensuring that the patient feels respected and understood.

Ensuring education is provided by another member of the patient’s marginalized community may help but is not always practical or necessary. This approach also neglects the healthcare provider’s responsibility to be culturally competent.

Avoiding discussions of past healthcare inequities may miss an opportunity to address concerns and build trust. Providing education based on techniques tailored for the patient’s community is beneficial but should be secondary to culturally sensitive communication.

Correct answer: Use a formal and respectful tone throughout the session

Using a formal and respectful tone throughout the session is the most effective approach when educating a patient from a culture that values respect for authority. This approach aligns with the cultural expectations and ensures the patient feels respected and comfortable, which can enhance their receptiveness to the information being provided.

Focusing on casual and informal communication may undermine the authority of the healthcare provider in the eyes of the patient and may cause discomfort. Encouraging the patient to practice autonomy can be important, but it should be done within the framework of respecting cultural values and authority. Providing minimal information to avoid overwhelming the patient may leave them under-informed and is not a culturally sensitive approach.

Correct answer: Acknowledge the family member’s concerns and refocus on the patient’s needs

The nurse should acknowledge the family member’s concerns and refocus the discussion on the patient’s needs. This approach validates the family member's feelings while gently steering the conversation back to the primary focus: the patient’s care. It helps to de-escalate the situation and ensures the patient’s well-being remains the priority.

Asking the family member to leave the room to avoid conflict may exacerbate tensions and could make the patient feel unsupported. Defending the healthcare team’s decisions without acknowledging the family member’s concerns might intensify the argument. Avoiding engagement with the family member entirely could lead to unresolved issues and increased frustration, which might negatively impact the patient’s care experience.

Correct answer: Peak expiratory flow rate

Peak expiratory flow rate is the most reliable and objective measure of bronchodilator effectiveness in patients with COPD. This measure reflects the maximum speed at which a patient can exhale, providing direct data on how well the bronchodilator is improving airway function. Regular monitoring of peak expiratory flow rate can help assess whether the medication is effective in reducing airway obstruction and improving breathing.

Oxygen saturation levels are important but do not directly measure the effectiveness of bronchodilators, as they assess oxygenation rather than airway function directly. While exercise tolerance may improve with bronchodilator use, it is a subjective measure and can be influenced by factors unrelated to lung function. The frequency of exacerbations is a useful long-term measure but does not provide immediate feedback on bronchodilator effectiveness, making peak expiratory flow rate the preferred method.

Correct answer: Pericarditis

Pericarditis is the most likely diagnosis for a patient presenting with chest pain that worsens when lying down and improves when sitting up, especially when accompanied by a pericardial friction rub on auscultation. Pericarditis involves inflammation of the pericardium, and the friction rub is a characteristic finding. The positional nature of the pain is also a hallmark of pericarditis, making it the most likely diagnosis in this scenario.

Cardiac tamponade typically presents with chest pain, but it is more commonly associated with signs of hemodynamic instability, such as hypotension and jugular venous distension, than with a pericardial friction rub. Pulmonary embolism is characterized by sudden onset chest pain and dyspnea, but it does not present with a friction rub or pain that improves with sitting up. Pneumothorax usually presents with sharp chest pain and absent breath sounds on one side, which is not consistent with the friction rub and positional chest pain seen in pericarditis.

Correct answer: Pause the session and ask the patient how they are feeling about the information

Pausing the session and asking the patient how they are feeling about the information is the most appropriate next step. This approach allows the nurse to assess the patient's emotional state, acknowledge their feelings, and address any concerns or confusion. It also helps the patient feel heard and can facilitate a more effective and supportive conversation.

Ensuring all information is covered and scheduling a follow-up session might overwhelm the patient further and does not address their immediate response to the education. Providing written materials for later review could be helpful, but would be secondary to addressing the patient’s immediate concerns. Ending the session early and rescheduling might leave the patient feeling dismissed and may not address their current emotional state.

Correct answer: A patient has a single point of contact for managing all care transitions.

A patient having a single point of contact for managing all care transitions best demonstrates successful care coordination. Having a single point of contact, such as a case manager, ensures the patient’s care is organized, that transitions between care settings are smooth, and that the patient receives consistent and coordinated support. This approach reduces the likelihood of communication breakdowns and ensures that all aspects of the patient’s care are managed effectively.

Completing a physical therapy program without follow-up does not ensure ongoing coordination of care. Consistent medication refills are important but do not necessarily reflect overall care coordination. Self-reported improvement in symptoms is a positive outcome, but it does not necessarily demonstrate that coordinated care is occurring.

Correct answer: Report the issue to the maintenance team and relocate patients if necessary

The nurse should report the issue to the maintenance team and relocate patients if necessary. In a healthcare setting, patient safety is the top priority, and without power, essential medical equipment may not function properly. By relocating patients, the nurse ensures critical services are available and patient care is not compromised. Reporting the issue ensures the appropriate personnel can address the generator malfunction immediately.

Waiting for power to be restored could delay necessary treatment and jeopardize patient care. Informing patients and asking them to return another day disregards any immediate medical needs. Manually resetting the generator could be dangerous if the nurse is not trained to perform that task, and it may not resolve the underlying issue.

Correct answer: Accurate coding of patient services

Accurate coding of patient services should be prioritized to maximize reimbursement because correct coding ensures the clinic is billing for services in line with healthcare regulations, which helps avoid denials or delays in payment. Proper coding also helps in receiving the appropriate payment for the services provided, maximizing reimbursement while ensuring compliance.

Increasing the number of billed procedures may result in overbilling or billing for unnecessary services, which can lead to audits or penalties and is ethically incorrect. Limiting unpaid follow-up visits could compromise patient care and negatively impact satisfaction. Avoiding non-billable tasks may miss opportunities for comprehensive care, which can indirectly affect reimbursement through patient outcomes or satisfaction.

Correct answer: Inefficient billing practices

Inefficient billing practices are the most likely contributor to financial losses despite high patient volume. Even with a steady influx of patients, if the clinic's billing practices are flawed, potential revenue can be lost. Inefficient billing directly affects the clinic's ability to collect payments for services provided, leading to financial losses.

High staff turnover can increase recruitment and training costs, but it would not usually result in significant financial losses if patient volume remains high. Over-reliance on automated systems could introduce errors, but such systems are typically designed to enhance efficiency, not reduce it. Macroeconomic changes might affect the broader economy but are less likely to be the root cause of financial losses in a clinic with a high patient volume.

Correct answer: Constipation

Constipation is a well-known side effect of opioid analgesics, as these medications can slow gastrointestinal motility and lead to reduced bowel movements. Opioids bind to receptors in the gastrointestinal tract, inhibiting peristalsis and increasing the tone of the anal sphincter, resulting in constipation.

Hypertension is not typically associated with opioid analgesics; these drugs can cause hypotension due to their effects on the central nervous system and vascular tone. Diarrhea is also not a common side effect of opioids; instead, their inhibitory effect on bowel movements makes constipation more likely. Rebound hyperventilation is not commonly linked to opioid use. While opioids can suppress respiratory drive, potentially leading to hypoventilation, there is not typically a clinically significant rebound effect.

Correct answer: Cardiac arrhythmia

Cardiac arrhythmia is the primary concern for a patient presenting with new-onset palpitations and lightheadedness because these symptoms together suggest an irregular heart rhythm. This condition requires immediate evaluation to prevent potentially life-threatening complications and to manage the arrhythmia effectively.

Meningitis, which typically presents with fever, headache, and neck stiffness, does not fit the symptoms of palpitations and lightheadedness, making it an unlikely cause in this scenario. Dehydration could potentially explain the lightheadedness, but it is less likely to be responsible for the palpitations. Stroke generally involves neurological deficits rather than palpitations and lightheadedness, making it less likely in this context.

Correct answer: Use written materials and visual aids

Using written materials and visual aids is the best approach when providing education to a patient with a hearing impairment. These tools ensure the patient can access and understand the information without relying on auditory input. Visual aids, such as diagrams or pictures, can help clarify complex concepts, while written materials allow the patient to review the information at their own pace.

Ensuring the patient is treated for their hearing deficit before education may not always be feasible or timely, and waiting for treatment could delay essential education. Ensuring a sign language interpreter is present for all education can be helpful for patients who use sign language, but this may not be necessary for all patients with hearing impairments. Providing education through group seminars may not be effective, as the patient could miss key information if they cannot hear or fully engage with the content.

Correct answer: Review the disaster plan with the staff and clarify their roles

Reviewing the disaster plan with the staff and clarifying their roles is the best action for the nurse leader to take. Ensuring that each team member understands their role is essential for the success of the disaster response, and the training exercise provides an opportunity to reinforce this knowledge. Taking the time to clarify roles during the exercise can prevent confusion in real-life scenarios and enhance overall preparedness.

Postponing the exercise delays valuable training and does not address the immediate need for role clarification. Allowing the exercise to continue without intervention may perpetuate confusion and undermine the effectiveness of the training. Reassigning roles may create additional confusion and prevent staff from learning their assigned responsibilities as intended in the disaster plan.

Correct answer: Weight loss

Weight loss is the best parameter to monitor when assessing the effectiveness of a diuretic in heart failure patients, as it directly correlates with the reduction of fluid retention, which is the primary goal of this treatment. Diuretics work by helping the body expel excess fluid. A decrease in weight indicates this fluid is being effectively eliminated, thereby relieving symptoms like swelling and shortness of breath associated with heart failure.

While urine output increases with diuretic use, it is not as reliable a measure of effectiveness. It is difficult to monitor specific urinary output without having the patient measure the volume of every void, which is not practical outside a hospital environment. Blood pressure reduction can occur with diuretic use, but it is not the main therapeutic target in heart failure management. Monitoring electrolyte levels does not provide information on whether the heart failure symptoms and fluid volumes are improving in response to diuretic use.

Correct answer: Using repetition and reinforcing key points

Using repetition and reinforcing key points is the most effective technique when educating an elderly patient with cognitive decline. Repetition helps reinforce important information, making it more likely the patient will remember and understand the key aspects of their care. This approach accommodates the memory challenges often associated with cognitive decline and ensures that critical information is emphasized.

Providing education in the morning or mid-afternoon can be helpful if the patient tends to be more alert during these times, but this is not necessarily always the case. Providing written instructions for later reference can be supportive, but may not be as effective as repetition and reinforcement if the patient struggles with memory or comprehension issues. Treating their cognitive decline before education may not always be feasible, and delaying education could prevent timely care.

Correct answer: Hepatotoxicity

Hepatotoxicity is a significant concern in patients taking isoniazid for tuberculosis treatment. Isoniazid can cause liver damage, leading to elevated liver enzymes and, in severe cases, acute liver failure. Due to this risk, patients on isoniazid therapy should be regularly monitored for liver function to detect any signs of hepatotoxicity early.

Hypotension is not a common side effect of isoniazid, as the medication primarily affects the liver and nervous system rather than blood pressure. Hyperglycemia is also not typically associated with isoniazid treatment, as it does not significantly impact blood glucose levels. Bradycardia is not a known side effect of isoniazid, as its primary concerns are related to hepatotoxicity and peripheral neuropathy.

Correct answer: Demonstrating insulin administration using a doll and allowing the child to practice

Demonstrating insulin administration using a doll and allowing the child to practice is the most effective educational approach for ensuring that an 8-year-old understands how to manage their type 1 diabetes. This hands-on approach is age-appropriate and helps the child gain confidence in performing a key task for managing their condition.

Providing a detailed written pamphlet to the parents for review is important, but it does not directly involve the child in learning. Encouraging the child to watch an instructional video can be helpful as a supplementary tool but lacks the interactive and practical component of hands-on practice. Telling the parents not to involve the child in care to avoid over-burdening them is counterproductive, as involving the child in their care is essential for fostering independence and promoting long-term self-management.