ANCC AMB-BC Exam Questions

Correct answer: Fasting blood glucose of 95 mg/dL

A fasting blood glucose of 95 mg/dL indicates optimal control of type 2 diabetes, as it falls within the normal range (70-130 mg/dL). This outcome suggests effective management of blood glucose levels, which is crucial for reducing the risk of diabetes-related complications such as cardiovascular disease, neuropathy, and retinopathy.

An HbA1c of 8.5% indicates poor long-term glycemic control, as optimal management should aim for an HbA1c of less than 7% to reduce the risk of complications. A postprandial blood glucose of 180 mg/dL is elevated and suggests suboptimal control, with the target postprandial glucose level being below 140 mg/dL for effective management. A random blood glucose of 220 mg/dL indicates hyperglycemia and poor glycemic control.

Correct answer: Correct the error and ensure the treatment is administered on time

Correcting the error and ensuring the treatment is administered on time is the nurse’s immediate and most appropriate action. In critical care situations, ensuring timely treatment is essential for the patient's health, and the nurse’s priority should be to correct the error promptly to avoid potential harm.

Reporting the error to the supervisor and waiting for further instructions may cause an unnecessary delay in care. Documenting the error is important for future reference but does not address the immediate need to correct the scheduling issue. Informing the patient about the delay and asking if they would like to reschedule is not appropriate in urgent or critical care situations where timely intervention is required.

Correct answer: Fasting blood glucose

A fasting blood glucose test is the most helpful laboratory test in confirming a diagnosis of diabetes mellitus in a patient presenting with polyuria, polydipsia, and polyphagia. These symptoms are indicative of hyperglycemia, where elevated blood glucose levels cause excessive thirst, urination, and hunger. The fasting blood glucose test provides a reliable measurement of the patient's baseline glucose levels after fasting, making it a crucial tool for diagnosing diabetes and distinguishing between normal and impaired glucose regulation.

A CBC provides information on blood cell counts but does not assess glucose metabolism. Serum electrolytes can reveal imbalances but are not specific indicators of diabetes. Urine ketones can indicate diabetic ketoacidosis in type 1 diabetes but are not definitive for diagnosing diabetes mellitus itself.

Correct answer: Low sodium consumption

Low sodium consumption is a key component of a heart-healthy diet recommended by healthcare professionals. Reducing sodium intake helps manage blood pressure, reduce fluid retention, and lower the risk of cardiovascular disease. A heart-healthy diet focuses on limiting processed foods, which often contain high levels of sodium, and encourages the consumption of fresh fruits, vegetables, whole grains, and lean proteins.

While a daily glass of red wine has been touted by some for its potential heart health benefits, research indicates that, on its own, red wine does not meaningfully improve heart health and is not a key component of a heart-healthy diet. High carbohydrate intake, particularly from refined sugars and processed foods, is not recommended in a heart-healthy diet. High protein intake can be beneficial in moderation, but it is not the primary focus of a heart-healthy diet and would not contribute to cardiac health like maintaining a low sodium intake would.

Correct answer: No routine INR monitoring is required.

The primary advantage of rivaroxaban over warfarin is that it does not require routine INR monitoring. Rivaroxaban has a predictable pharmacokinetic profile, allowing for consistent anticoagulation without frequent blood tests to monitor INR levels. This feature can make rivaroxaban more convenient for patients and healthcare providers, as it simplifies anticoagulation management and reduces the burden of regular monitoring.

The overall risk of bleeding with rivaroxaban is not significantly lower than that of warfarin, making bleeding risk a less definitive advantage. Unlike warfarin, which is a vitamin K antagonist, Rivaroxaban is not reversible with vitamin K. The half-life of rivaroxaban is not longer than that of warfarin; its convenience advantage lies in the absence of routine INR monitoring rather than the duration of action.

Correct answer: Establishing communication between pediatric and adult providers

Establishing communication between pediatric and adult providers is the most essential component in the care coordination process for a patient transitioning from pediatric to adult care. This ensures a smooth transfer of care, where the adult provider is fully informed about the patient’s medical history, ongoing treatments, and specific needs. Effective communication between providers is crucial to preventing gaps in care during the transition.

Ensuring health insurance coverage is secondary to ensuring continuity of care. Educating the patient on managing their own care should follow the establishment of provider communication. Ensuring the patient understands autonomy is part of the transition process but does not directly impact the immediate coordination between providers.

Correct answer: Stress levels and coping strategies

To explore a psychosocial cause of headaches and irritability in a patient with hypertension, the nurse should assess the patient’s stress levels and coping strategies. Stress can significantly impact both mental and physical health, potentially exacerbating symptoms like headaches and irritability, especially in individuals who are already managing a chronic condition like hypertension.

While medication adherence is important in managing hypertension, it does not address the psychosocial elements that might be influencing the patient’s condition. A history of childhood abuse, though relevant in psychosocial assessments, is not as immediately pertinent to the current symptoms as broader stressors that may be contributing. Assessing the patient’s exercise routine focuses more on physical health than on the potential emotional or mental triggers of their symptoms.

Correct answer: Facilitating communication between the specialists

Facilitating communication between the specialists is the most important role of the ambulatory care nurse in coordinating care for a patient managed by multiple specialists. Effective communication ensures that all providers are aware of each other's treatment plans, preventing conflicting interventions and ensuring cohesive care. This coordination is crucial in managing CHF, where fragmented care can lead to poor outcomes.

Ensuring that all providers receive the patient’s updated medical records is necessary but does not replace the need for direct communication and is less likely to support interdisciplinary collaboration than direct intervention by the nurse. Educating the patient about their CHF management plan is important, but it does not ensure coordination between specialists. Scheduling appointments is a logistical task and is less critical than ensuring effective communication between providers.

Correct answer: Lifestyle stressors

When a patient with hypertension reports feeling increasingly anxious, the nurse should focus on assessing lifestyle stressors as a potential psychosocial factor. Chronic stress can exacerbate both hypertension and anxiety, making it important to understand the patient’s daily life and any ongoing stressors that may be contributing to their symptoms. By identifying these factors, the nurse can help the patient find appropriate coping mechanisms and support.

While medication side effects can cause anxiety, these would be a physical factor, not a psychosocial factor. Although family history of anxiety might be relevant in understanding the patient's background, it does not provide immediate insight into the current psychosocial factors influencing their anxiety. Assessing the patient’s occupation is part of understanding lifestyle stressors, but the nurse should take a more comprehensive approach to evaluating all potential sources of stress rather than focusing on a single factor.

Correct answer: Address the issue directly with the provider and explain how their behavior was perceived

Addressing the issue directly with the provider and explaining how their behavior was perceived is the best course of action. Direct communication allows the provider to be aware of how their actions may have impacted the patient and allows them to modify their behavior in future interactions.

Reporting the incident directly to the supervisor may be necessary if the behavior continues but could escalate the situation prematurely. Documenting the incident without taking further action does not address the issue in the moment and could lead to a recurrence. Waiting to address the behavior until a pattern emerges may allow for continued mistreatment and does not advocate for the patient’s immediate well-being.

Correct answer: Clearly defining roles and responsibilities for all participants

Clearly defining roles and responsibilities for all participants is the most critical component in ensuring the drill’s effectiveness. Disaster preparedness hinges on clear communication and coordination, and each team member must know their specific role and what is expected of them during an emergency situation. This clarity allows for smooth execution and quick response during actual disasters, reducing confusion and chaos.

Basing the drill on an extreme and unlikely scenario may not prepare staff for more realistic, likely events and could create a false sense of preparedness. Focusing on individual staff performance shifts the focus away from teamwork and overall response effectiveness, which are essential in disaster situations. Ensuring all staff can anticipate what will happen during the drill may lessen its effectiveness, as the element of surprise helps better evaluate how the team responds under pressure.

Correct answer: Respect the patient's autonomy and support their decision

Respecting the patient’s autonomy and supporting their decision is the most appropriate action. Autonomy is a fundamental principle of bioethics, and the nurse’s role is to ensure the patient’s choices regarding their care are upheld, even if family members disagree.

Advocating that the patient consider the family member’s suggestion may add pressure to and undermine the patient’s autonomy. Implementing the family member’s request without the patient's consent would violate the patient’s rights and could result in ethical and legal consequences. Asking the family to reach a consensus may overlook the fact that it is the patient’s decision that matters, not the family's agreement.

Correct answer: Check the patient's blood glucose level immediately

The most important step when a diabetic patient reports dizziness and confusion is to check their blood glucose level immediately. These symptoms are commonly associated with hypoglycemia, which is a medical emergency that requires swift intervention to prevent more severe complications like loss of consciousness or seizures. By promptly measuring blood glucose, the nurse can determine the appropriate course of action, such as administering glucose if needed.

While sitting down and hydrating might help the patient feel better temporarily, it does not address the underlying issue of possible hypoglycemia and can result in ineffective treatment and worsening hypoglycemia. Measuring blood pressure is also less urgent in this context, as the immediate concern should be assessing blood sugar levels.

Giving juice and peanut butter without confirming hypoglycemia could be harmful if the patient is actually experiencing another condition. Blood glucose measurement should be the priority to determine the next steps in treatment.

Correct answer: Immediately ensure the exit is fully accessible

Immediately ensuring the exit is fully accessible is the most appropriate action. Keeping emergency exits clear is crucial for patient and staff safety, and addressing the issue immediately helps ensure compliance with safety regulations.

Assessing if other emergency exits are available does not resolve the immediate safety hazard of the blocked exit. Informing the staff to use another exit still leaves the hazard unaddressed. Immediately reporting the blockage to the safety officer does not address the hazard nor ensure the exit is immediately accessible, something the nurse is capable of doing.

Correct answer: Advise the patient to use their rescue inhaler

For a patient with asthma experiencing increased wheezing and difficulty breathing, the first and most critical step is to advise them to use their rescue inhaler. Rescue inhalers are designed to provide rapid relief during asthma exacerbations by opening the airways and reducing symptoms such as wheezing and shortness of breath. This immediate intervention can prevent the situation from worsening and provide the necessary relief

Scheduling a same-day in-person appointment may be important for follow-up care, but it should not precede the use of the rescue inhaler. Staying on the phone with the patient might delay the use of the inhaler, which is most important for managing acute symptoms. Over-the-counter decongestants are not appropriate for treating asthma exacerbations, making them unsuitable as a first response.

Correct answer: Independently performing assessments and interventions 

Independently performing assessments and interventions is an essential component of the scope of practice for ambulatory care nurses. Ambulatory care nurses are responsible for independently assessing patients and performing necessary interventions, using their clinical judgment to manage patient care effectively.

Practicing only under direct supervision is not accurate for ambulatory care nursing, as these nurses are often expected to function autonomously under their licenses. Administering medications without prior assessment is unsafe and not within the scope of practice. Delegating all patient care to unlicensed personnel is inappropriate, as nurses are responsible for ensuring that delegated tasks are appropriate and that patient care standards are maintained.

Correct answer: Cleanse the puncture site with alcohol and let it dry

Cleansing the puncture site with alcohol and letting it dry is the most appropriate action when performing a point-of-care blood glucose test. Cleaning the site reduces the risk of infection and contamination while allowing it to dry ensures the alcohol does not interfere with the test results. This step is crucial for obtaining an accurate blood glucose reading.

Using the first drop of blood after puncture is incorrect, as the first drop is often wiped away to avoid contamination with tissue fluid. Ensuring the patient has fasted for eight hours is only necessary for fasting glucose tests, not routine point-of-care tests. Squeezing the finger to obtain an adequate sample size can dilute the blood with tissue fluid, potentially leading to inaccurate results, so it should be avoided.

Correct answer: Arrange an immediate in-person evaluation

For a patient experiencing sudden severe back pain after lifting, arranging an immediate in-person evaluation is essential to rule out serious conditions such as a herniated disc, vertebral fracture, or other musculoskeletal injuries. An in-person evaluation allows the healthcare provider to conduct a thorough physical exam and potentially order imaging studies to accurately diagnose the problem and develop an appropriate treatment plan.

Suggesting bed rest and pain relievers alone might help alleviate the pain but risks missing a serious injury that requires immediate attention. Advising the patient to visit the emergency department is appropriate only if there are more severe symptoms, like neurological deficits. Scheduling a physical therapy appointment without first evaluating the injury could be inappropriate, as some conditions might need more urgent medical intervention before rehabilitation begins.

Correct answer: Reviewing and adjusting staff assignments based on patient volume

Reviewing and adjusting staff assignments based on patient volume is the most effective strategy for improving resource allocation because it aligns staffing with demand, ensuring that resources are used efficiently without compromising patient care. By optimizing staff distribution, the clinic can handle patient flow more effectively, thereby improving overall efficiency.

Prioritizing high-cost interventions for all patients is not fiscally responsible and may result in unnecessary expenses. Encouraging patients to use high-cost medications can lead to unnecessary increases in financial burdens on patients and is contrary to the nurse’s obligation to act as a patient advocate. Reducing the number of supplies used during each procedure can compromise the quality of care and should not be considered unless supplies are being used unnecessarily.

Correct answer: To evaluate the patient's understanding

The teach-back method is an educational strategy primarily used to evaluate the patient's understanding of the information shared with them. This approach involves asking the patient to repeat or explain the information in their own words, which allows the healthcare provider to assess how well the patient has comprehended the instructions. If the patient struggles or provides incorrect information, the provider can immediately clarify any misunderstandings, ensuring that the patient leaves with accurate knowledge.

Although confirming that a patient has read provided materials is important, it is not the focus of the teach-back method, which centers on understanding rather than the intake of information. Encouraging the patient to ask questions is a valuable practice, but it is not the primary goal of assessing comprehension that the teach-back uses. The teach-back method does not aim to have the patient take on an educational role; instead, it ensures they have properly understood the instructions or information given to them.