ANCC AMB-BC Exam Questions

Correct answer: Apply compression therapy

Applying compression therapy is the most critical intervention for a patient with chronic venous insufficiency. Compression therapy is the standard treatment for improving venous return, reducing edema, and promoting wound healing. It addresses the underlying cause of venous insufficiency and helps prevent further complications.

Elevating the affected limb is beneficial for reducing swelling but is secondary to compression therapy. Encouraging fluid intake is important for overall health but does not directly address venous insufficiency. Informing the provider of the need for antibiotic therapy is only necessary if an infection is present, which is not indicated in this scenario.

Correct answer: Barrel-shaped chest

A barrel-shaped chest is the most consistent physical finding associated with chronic obstructive pulmonary disease (COPD). This deformity results from chronic lung overinflation, which causes the rib cage to remain in a permanently expanded state. The barrel chest is a classic sign of advanced COPD and helps differentiate it from other pulmonary conditions.

Peripheral cyanosis can occur in COPD but is not specific to the disease and can be seen in other conditions as well. A loud S3 heart sound is typically associated with heart failure rather than pulmonary conditions like COPD. Absent breath sounds are more characteristic of a severe condition like lung collapse or pneumothorax, rather than the chronic, progressive nature of COPD, which usually presents with diminished or wheezing breath sounds instead.

Correct answer: Hypothyroidism

Given the fatigue, weight gain, constipation, and elevated thyroid-stimulating hormone (TSH) levels, the most likely explanation is hypothyroidism. Hypothyroidism occurs when the thyroid gland is underactive and unable to produce sufficient thyroid hormones, leading to an increase in TSH as the body attempts to stimulate the thyroid. The symptoms of fatigue, weight gain, and constipation are classic signs of hypothyroidism, resulting from the decreased metabolic rate caused by insufficient thyroid hormone levels.

Hyperthyroidism is characterized by symptoms that are opposite to those of hypothyroidism, such as weight loss, increased heart rate, and heat intolerance; it is not consistent with the patient's presentation.

Subclinical hypothyroidism involves elevated TSH with normal thyroid hormone levels, typically presenting with milder symptoms or being asymptomatic; the patient's symptoms suggest overt hypothyroidism.

Euthyroid sick syndrome is associated with abnormal thyroid function tests due to non-thyroidal illness and does not match the symptoms and elevated TSH levels observed here.

Correct answer: Engage the team in the planning process to gain their input and support

Engaging the team in the planning process to gain their input and support is the most effective first step. Involving the team early on ensures they understand the rationale behind the change; this empowers them to provide valuable feedback and increases the likelihood they will support the new process. This collaborative approach fosters ownership and engagement, which are essential for successful change implementation.

Introducing a new process based on best practices is important, but implementing it without team input may lead to resistance or misunderstandings. Waiting for unanimous agreement may cause unnecessary delays, as consensus is often difficult to achieve. Assigning the task to the most experienced nurse would prevent a more comprehensive team collaboration and reduce overall buy-in.

Correct answer: Long-term abstinence from tobacco

The desired outcome of a smoking cessation program is long-term abstinence from tobacco because this directly correlates with the most significant health improvements. Achieving sustained tobacco-free status reduces the risk of numerous diseases and improves overall health, making it the primary goal of any cessation program.

Reducing the risk of lung cancer is a key benefit of quitting smoking, but it is a long-term outcome rather than the immediate goal of a cessation program. Patient satisfaction with the program is important for engagement but does not necessarily indicate success in quitting smoking. While reducing nicotine cravings is beneficial, it is not a substitute for achieving and maintaining long-term abstinence, which is the true measure of effectiveness.

Correct answer: Frequent changes in healthcare providers

Frequent changes in healthcare providers is the factor most likely to disrupt the continuity of care in an ambulatory care setting. When patients see different providers frequently, it can lead to fragmented care, inconsistent treatment plans, and a lack of familiarity with the patient’s medical history, which are critical for ensuring continuous and coordinated care.

Lack of patient engagement can impact care but does not necessarily disrupt the continuity of care if the healthcare providers maintain consistent communication and follow-up. Poor communication between the patient and nurse can lead to misunderstandings but may not affect the overall continuity if other care team members are involved. Unstable health insurance coverage can affect access to care but is not as directly related to the continuity of care as frequent provider changes.

Correct answer: Current anticoagulation therapy

When a patient has atrial fibrillation, the most immediate concern is the risk of thromboembolic events, particularly stroke. Therefore, evaluating whether the patient is on anticoagulation therapy is the top priority. Anticoagulation therapy reduces the risk of clot formation, which is essential in managing atrial fibrillation. Ensuring the patient is appropriately anticoagulated can significantly reduce the potential complications of this arrhythmia.

While recent electrolyte levels and blood pressure trends are important in managing the broader cardiovascular health of the patient, they do not address the immediate risk of stroke associated with atrial fibrillation. A history of cardiovascular disease does not directly influence the urgent need to initiate or adjust anticoagulation therapy. These factors are all secondary to ensuring proper anticoagulation is in place.

Correct answer: Chest pain and shortness of breath

Chest pain and shortness of breath together are the most serious symptom combination in this context because they strongly suggest the possibility of a heart attack or pulmonary embolism, both of which are life-threatening conditions that require immediate medical attention. The urgency of these symptoms means that rapid evaluation and intervention are critical to prevent potentially fatal outcomes.

Fever and headache often suggest an infection that is less likely to be immediately life-threatening compared to a cardiac event. Nausea and vomiting do not usually indicate an acute emergency on their own. Cough and sore throat are typically related to minor respiratory infections, which do not require the same urgent response as the combination of chest pain and shortness of breath.

Correct answer: Diagnosing non-critical medical conditions

Diagnosing non-critical medical conditions is outside the scope of practice for an ambulatory care nurse, as diagnosis is the responsibility of licensed healthcare providers such as physicians or nurse practitioners. Nurses play a critical role in the assessment and identification of patient issues, but making a formal diagnosis is not within their authority unless they hold an advanced practice role.

Administering vaccines is within the scope of ambulatory care nurses, as they are trained to provide immunizations safely. Conducting comprehensive patient assessments is a core function of nursing practice and is essential for identifying patient needs. Educating patients on health management is also a standard nursing role, enabling patients to manage their conditions and make informed health decisions.

Correct answer: A patient drooling after eating a food they are allergic to

A patient drooling after consuming an allergen may indicate angioedema that could potentially lead to airway compromise. Immediate care is necessary to prevent this situation from escalating into a life-threatening emergency, making it the most critical complaint that requires urgent intervention.

A sprained ankle, although painful and potentially debilitating, does not pose an immediate threat to life and can be managed without immediate emergency intervention. Severe abdominal pain often requires urgent but not emergency evaluation unless accompanied by more severe symptoms. A sore throat with a high fever points to an infection but does not pose an immediate threat to the airway or overall health, which requires emergency care.

Correct answer: Politely request the patient remove the item from the premises

Politely requesting the patient remove the item from the premises is the most appropriate action. This approach maintains patient rapport and ensures compliance with clinic rules while avoiding unnecessary confrontation.

Confiscating the item may escalate the situation and could lead to legal or ethical concerns. Ignoring the item could jeopardize safety if the item poses a risk. Notifying law enforcement is only appropriate if the item poses a serious, immediate threat to safety.

Correct answer: Gout

Gout is characterized by elevated levels of uric acid in the blood, leading to the deposition of urate crystals in the joints. This condition results in episodes of acute inflammation, pain, and swelling, typically affecting the big toe or other joints. Hyperuricemia, or elevated uric acid levels, is a hallmark of gout and can lead to crystal formation when uric acid exceeds its solubility threshold. Gout flares occur when these crystals trigger an inflammatory response, causing severe joint pain and swelling that requires medical management to reduce uric acid levels and control inflammation.

Osteoarthritis is characterized by cartilage degeneration that leads to joint pain and stiffness and is unrelated to uric acid levels. Rheumatoid arthritis is an autoimmune disorder causing joint inflammation and damage and is not linked to elevated uric acid levels. Osteoporosis involves decreased bone density and is not connected to uric acid levels.

Correct answer: Lisinopril

Lisinopril, an ACE inhibitor, is most likely to cause a dry cough as a side effect. This cough occurs due to the accumulation of bradykinin in the respiratory tract, a known effect of ACE inhibitor therapy. Bradykinin is a peptide that can cause irritation in the lungs, leading to a persistent, non-productive cough in some patients. This side effect is well-documented and may necessitate switching to an alternative medication for those who experience significant discomfort.

Amlodipine, a calcium channel blocker, is not commonly associated with causing a dry cough. It primarily affects vascular smooth muscle to lower blood pressure and does not impact bradykinin levels or the respiratory tract. Atenolol, a beta-blocker, also does not typically cause a dry cough, as its action focuses on reducing heart rate and contractility without meaningfully affecting the respiratory tract. Furosemide, a loop diuretic, is not linked to a dry cough either, as it works by increasing urine output through action on the kidneys rather than the respiratory system.

Correct answer: Review their state’s nursing practice act

Reviewing their state’s nursing practice act is the first step an ambulatory care nurse should take when encountering a situation that may be outside their scope of practice. The state’s nursing practice act defines the legal scope of practice for nurses, providing clear guidelines on what is permissible. By reviewing this, the nurse can make an informed decision about whether the situation falls within their scope.

Consulting the legal department may be necessary later but is not the first step. Referring the situation to the ethics committee is appropriate if there are ethical concerns, but it comes after clarifying their scope of practice. Reporting the situation to their supervisor is important, but first, the nurse should clarify their professional boundaries as outlined by the nursing practice act.

Correct answer: Diuresis

The primary therapeutic action of furosemide in heart failure is diuresis. Furosemide is a loop diuretic that works by inhibiting the reabsorption of sodium and chloride in the ascending loop of Henle, leading to increased urine output. By promoting diuresis, furosemide helps reduce fluid overload, decrease blood volume, and alleviate symptoms such as edema and pulmonary congestion. This reduction in fluid volume can relieve the heart's workload, improve cardiac efficiency, and enhance patient comfort by reducing the symptoms associated with heart failure.

Furosemide’s primary action is diuresis, not vasodilation. It does not directly increase cardiac output but can improve cardiac function indirectly by reducing fluid overload and decreasing the heart's workload. Furosemide does not replenish electrolytes; instead, it can lead to electrolyte imbalances, such as hypokalemia, due to increased excretion of potassium and other electrolytes in the urine.

Correct answer: Ensure that the patient receives a clear explanation of the procedure before it is performed

Ensuring the patient receives a clear explanation of the procedure before it is performed is the best way to advocate for the patient. This ensures the patient can make an informed decision about their care, which is critical for patient autonomy and informed consent.

Reassuring the patient that the procedure is necessary after personally verifying it does not ensure the patient’s understanding of the procedure. Encouraging the patient to decline the procedure may be unnecessary if the patient gains sufficient understanding after proper education. Delaying the procedure until the patient consents is important, but the focus should be on ensuring the patient is fully informed first.

Correct answer: Arrange for the patient to visit the nearest emergency department

When a patient reports shortness of breath and leg swelling, the most appropriate action is to arrange for them to visit the nearest emergency department. These symptoms can be indicative of severe conditions such as heart failure, pulmonary embolism, or other cardiovascular issues that require immediate evaluation and intervention. Prompt emergency care can help prevent further deterioration and potentially life-threatening complications.

Scheduling a same-day in-person visit delays the necessary urgent care, which could be critical for emergent conditions like heart failure or a blood clot. Recommending leg elevation and rest may temporarily relieve some symptoms but fails to address the possible severity of the underlying condition. Asking the patient to weigh themselves is not a priority in this acute situation, as it does not help in diagnosing or managing the immediate threat posed by shortness of breath and leg swelling.

Correct answer: Participating in a professional nursing association

Participating in a professional nursing association best represents a nurse demonstrating a commitment to lifelong learning. By engaging in professional organizations, nurses have access to the latest evidence-based practices, continuing education opportunities, and networking with peers, all of which contribute to ongoing professional development.

Attending annual mandatory training is required by most employers, but it does not necessarily reflect a personal commitment to lifelong learning. Providing patient education is an important aspect of nursing, but it is focused on patient care rather than on the nurse’s own learning. Teaching hospital policies to student nurses is valuable but primarily involves applying knowledge of existing practices rather than ongoing personal development.

Correct answer: Emotional well-being and stress levels

In a patient with diabetes who reports missing insulin doses due to feeling overwhelmed, the nurse should prioritize assessing emotional well-being and stress levels. Stress and feeling emotionally overwhelmed can significantly impact a patient’s ability to adhere to complex medical regimens like diabetes management. By understanding the patient’s emotional state, the nurse can identify the underlying causes of non-adherence and provide targeted support to address these challenges.

Monitoring blood glucose levels does not directly address the reasons for missed doses. While ensuring the patient understands their diabetes management is important, it is secondary to addressing the emotional barriers that are currently interfering with adherence. Access to insulin supplies is a valid concern, but given the patient’s report of feeling overwhelmed, the primary focus should be on assessing and supporting their emotional well-being to improve adherence.

Correct answer: Create a safe and non-judgmental environment by inviting questions

The best approach is to create a safe and non-judgmental environment by inviting questions. By explicitly encouraging the patient to ask questions, the nurse can help the patient feel more comfortable and confident in expressing their concerns. This approach fosters open communication and ensures the patient receives the information they need.

Actively inviting questions during the consultation is more effective than providing the patient with time and space, as this may not be the reason they are hesitant to ask questions. Explaining that asking questions is not required may discourage the patient from seeking clarification. Suggesting the patient write down questions for the next visit can be useful as a supplement but should not replace the opportunity for immediate dialogue.