ANCC AMB-BC Exam Questions

Correct answer: Ciprofloxacin

Ciprofloxacin, a fluoroquinolone antibiotic, is most commonly associated with the risk of developing tendonitis or tendon rupture. Fluoroquinolone antibiotics can interfere with collagen synthesis and affect tendon integrity, leading to an increased risk of tendon-related injuries. The Achilles tendon is particularly susceptible, and patients taking ciprofloxacin should be advised to report any signs of tendon pain or swelling promptly.

Amoxicillin, a penicillin antibiotic, does not have the same association with tendonitis or tendon rupture, as its mechanism of action and adverse effect profile differ from those of fluoroquinolones. Azithromycin, a macrolide antibiotic, also does not carry a known risk of tendon-related adverse effects. Metronidazole is used to treat anaerobic bacterial infections and certain protozoal infections. It is not associated with tendonitis or tendon rupture.

Correct answer: Arranging for home health visits

Arranging for home health visits is crucial in preventing hospital readmission for a patient with congestive heart failure. Home health visits allow for continuous monitoring, personalized care, and early intervention if complications arise, ensuring that the patient’s condition is managed effectively outside the hospital setting. This level of care coordination helps address various aspects of the patient's health, which is essential for preventing exacerbations that could lead to readmission.

Ensuring medication affordability does not ensure adherence or proper usage. Follow-up appointments rely more on the patient following the scheduled appointments and do not provide the same support that home health visits do. Dietary education is valuable but is only one piece of the larger care puzzle. Without ongoing monitoring, dietary education alone is not likely to be sufficient to prevent readmission.

Correct answer: Communicating the patient's care needs to the facility

Communicating with the facility about the patient's care needs is the most important care coordination task when transitioning a patient with Alzheimer’s disease to a long-term care facility. This communication ensures that the facility is fully informed about the patient's specific needs, routines, and preferences, which is crucial for providing appropriate care and maintaining the patient's quality of life.

Ensuring all medical records are transferred is necessary but does not replace direct communication about care needs; it is secondary to directly communicating with the receiving facility. Educating the family about the facility’s policies is helpful but not as critical as ensuring the facility staff understands the patient’s care needs. Scheduling a follow-up visit with the primary care provider can facilitate ongoing care but is secondary to the immediate need for effective communication during the transition.

Correct answer: Video tutorials with closed captioning

Video tutorials with closed captioning are likely the most effective educational method for patients with hearing impairments. Closed captions provide a written version of the audio content, ensuring the patient can fully understand the material. Videos also offer a visual component, which can help reinforce the information.

Written instructions with diagrams are also useful but may lack the depth of explanation a video can provide. In-person group classes may not be suitable unless they incorporate sign language interpreters or other accommodations. Telephonic health coaching is generally ineffective for patients with hearing impairments due to the communication barrier.

Correct answer: Online courses

Online courses are the most appropriate educational method for a patient who prefers self-directed learning. These courses offer flexibility and allow patients to learn at their own pace, which is a key characteristic of self-directed learning. Patients can choose when and how they engage with the material, revisit content as needed, and control their learning experience.

Group educational sessions do not provide the autonomy that self-directed learners typically seek. One-on-one verbal instruction involves more direct guidance from a healthcare provider, which may not align with a self-directed learner's preference for independent study. Printed materials can support self-directed learning, but they lack the interactive and often more comprehensive nature of online courses, which can include multimedia resources, quizzes, and other engaging content that enhances the learning experience.

Correct answer: Implementing regular security drills for staff

Implementing regular security drills for staff should be prioritized when developing a new clinic security protocol. Regular drills ensure that staff are prepared to respond effectively in the event of a security threat, enhancing the overall safety of the clinic. Preparedness through training and simulation is a proactive approach that empowers healthcare workers to take appropriate action during emergencies.

Installing more visible signage may serve as a mild deterrent but does not actively improve the preparedness of staff to handle security issues. Reducing clinic hours to limit public access could negatively impact patient care and is not a practical solution for security concerns. Equipping security staff with non-lethal weapons like tasers should be considered as part of a broader security strategy in extreme cases, but it is not a primary factor in improving clinic security.

Correct answer: Areas where patient interactions frequently occur

Prioritizing areas where patient interactions frequently occur is essential for safety rounds because these are high-risk environments for potential accidents, infections, or errors. Ensuring the safety and cleanliness of these spaces is crucial to maintaining patient care standards and minimizing harm to both patients and staff.

While waiting rooms where staff are typically absent may pose some risks, they are generally lower priority than areas where direct patient care is provided. Storage rooms do not pose an immediate risk to patients and staff. Areas equipped with fire extinguishers should also be checked regularly, but they do not typically require the same level of ongoing vigilance as patient care areas unless specific fire hazards have been identified.

Correct answer: Fluid intake and urine output

When a patient has a low serum sodium level, the most critical next step is to evaluate fluid intake and urine output. Hyponatremia is often associated with fluid imbalances, such as overhydration or conditions like syndrome of inappropriate antidiuretic hormone secretion (SIADH). By assessing fluid intake and output, healthcare providers can better understand the underlying cause of hyponatremia and make informed decisions regarding treatment.

Dietary salt intake is typically not the primary factor in hyponatremia, and focusing on it may overlook more pressing issues related to fluid balance. While serum potassium levels are important in overall electrolyte management, they do not directly explain the cause of low sodium levels. Blood pressure readings can provide indicators of fluid status but are not as directly related to diagnosing or managing hyponatremia as evaluating fluid intake and urine output.

Correct answer: Estimated glomerular filtration rate (eGFR) of 90 mL/min/1.73m²

An estimated glomerular filtration rate (eGFR) of 90 mL/min/1.73m² indicates optimal renal function and suggests the kidneys are filtering blood effectively, without significant impairment. The eGFR is a key measure of kidney function, as it estimates the rate at which the kidneys filter waste products from the blood.

A serum creatinine level of 3.0 mg/dL is elevated and indicates impaired kidney function; normal creatinine levels typically range from 0.6 to 1.2 mg/dL. A blood urea nitrogen (BUN) level of 50 mg/dL is also elevated and indicates impaired renal function; normal BUN levels range from 7 to 20 mg/dL. A serum potassium level of 6.5 mmol/L is elevated and indicates hyperkalemia, a common complication of chronic kidney disease; normal serum potassium levels range from 3.5 to 5.0 mmol/L.

Correct answer: Applying the nursing process to ensure quality care

Applying the nursing process to ensure quality care should be prioritized by a nurse practicing within their scope in an ambulatory care setting. The nursing process, which includes assessment, diagnosis, planning, implementation, and evaluation, is central to providing comprehensive and individualized patient care. This approach ensures care is delivered safely, effectively, and within the nurse's scope of practice.

Completing tasks assigned by physicians is important but does not prioritize the nurse's independent role in the care process. Using evidence-based practice is essential but should be used to optimize patient outcomes rather than focusing solely on efficiency. Relying on protocols for patient care decisions may be necessary, but it should not replace the critical thinking and individualized approach the nursing process provides.

Correct answer: LDL cholesterol levels

In managing hyperlipidemia, the primary goal is to reduce LDL cholesterol levels because they are directly associated with atherosclerosis and increased cardiovascular risk. Dietary changes aimed at lowering LDL can significantly impact a patient's overall cardiovascular health. Prioritizing the measurement of LDL cholesterol provides the most relevant information about the effectiveness of the dietary intervention.

While weight gain or loss may result from dietary changes, it is not a direct indicator of improvements in cholesterol levels or reduced cardiovascular risk associated with hyperlipemia. Although lowering triglycerides is important, LDL reduction is a higher priority due to its stronger link with heart disease. HDL cholesterol is a secondary goal in hyperlipidemia management, with LDL being the most crucial factor to monitor for assessing dietary effectiveness.

Correct answer: Waist circumference reduction by 5 cm

A waist circumference reduction by 5 cm is a key indicator of successful weight loss, as it reflects a decrease in central adiposity. Central adiposity, or abdominal fat, is associated with an increased risk of metabolic syndrome, cardiovascular disease, and type 2 diabetes. Reducing waist circumference indicates a positive change in body composition, suggesting improved metabolic health and reduced risk of obesity-related conditions.

A stable BMI does not indicate successful weight loss, as it suggests no change in body weight or composition. While improved adherence to the weight loss program is important for long-term success, it does not directly measure weight loss outcomes. Normotensive blood pressure is a positive health outcome but is not a direct measure of weight loss success.

Correct answer: Jogging

Jogging is a weight-bearing exercise that is most beneficial for bone health and osteoporosis prevention. This type of exercise places stress on the bones, stimulating bone formation and increasing bone density. By engaging in weight-bearing activities like jogging, individuals can strengthen their bones, reduce the risk of fractures, and combat bone loss associated with osteoporosis.

Swimming is a low-impact exercise that does not provide the weight-bearing stimulus needed for bone health. Cycling is also a low-impact exercise that does not offer the weight-bearing benefits necessary for osteoporosis prevention. Yoga is beneficial for flexibility and balance, but it does not provide the weight-bearing stimulus needed for bone health.

Correct answer: Participating in policy development related to nursing practice

Participating in policy development related to nursing practice best demonstrates adherence to a nurse’s professional role in ambulatory care nursing. Engaging in policy development helps shape the practice environment, ensuring that nursing care is patient-centered, evidence-based, and aligned with professional standards.

Following all physician orders without resistance does not account for the nurse's responsibility of critically evaluating orders and advocating for patient safety. Delegating decision-making to administrative staff is inappropriate, as nurses are responsible for clinical decision-making within their scope of practice. Exercising autonomy on whether to gather patient feedback on their care disregards the importance of consistently seeking patient input to improve care quality.

Correct answer: Structured behavioral therapy

Structured behavioral therapy is considered the most effective intervention for long-term weight loss. This approach provides patients with strategies to modify eating and exercise habits, address emotional and psychological factors, and create sustainable lifestyle changes that support weight management. By focusing on behavior change, structured behavioral therapy helps individuals develop healthier relationships with food and exercise, leading to long-term success in maintaining weight loss.

Strict, long-term calorie counting can be effective for weight loss, but it may not be sustainable for everyone and can lead to burnout. Intermittent fasting may help some individuals lose weight, but it is not the most effective or sustainable approach for everyone. Dietary supplements, while sometimes used for weight loss, often lack scientific support and do not address the underlying behaviors necessary for sustainable weight management.

Correct answer: Ensuring all patient care is documented accurately and promptly

Ensuring all patient care is documented accurately and promptly is the best way for a nurse to contribute to the fiscal health of their organization. Proper documentation ensures that all billable services are captured, leading to accurate billing and reimbursement, which is critical for the clinic’s financial stability.

Facilitating a higher number of patient appointments per day could potentially increase revenue, but it might also compromise the quality of care and patient satisfaction. Recommending only brand-name medications can increase costs for patients, which may not align with promoting cost-effective care. Reducing the time spent on patient education may save time, but it could negatively impact patient outcomes and satisfaction, ultimately affecting the clinic’s reputation and long-term fiscal health.

Correct answer: Prevent joint damage and disease progression

Preventing joint damage and disease progression is the key goal of beginning disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis. DMARDs work by slowing down the disease process, reducing inflammation, and preventing the long-term damage that can lead to disability. Early and aggressive treatment with DMARDs is crucial for preserving joint function and quality of life.

Reducing pain is not the primary role of DMARDs; pain relief can be achieved through other medications like NSAIDs. Improving muscle strength is not the direct goal of DMARDs, though preserving joint function may indirectly help maintain muscle strength. Suppressing the immune system is a mechanism by which DMARDs work, but the ultimate goal is to prevent joint damage and disease progression.

Correct answer: Assess urinary output volumes

The next appropriate step when faced with persistently elevated BUN and creatinine levels is to assess urinary output volumes, as this provides direct information about kidney function. Monitoring urine output helps determine if the kidneys are still able to filter and excrete waste, which is critical in assessing the severity of renal impairment.

Increasing protein intake is not advisable in this context, as it can further strain the kidneys and exacerbate elevated BUN and creatinine levels. Scheduling dialysis should only be considered after thorough evaluation, as not all patients with elevated kidney function markers require immediate dialysis. While fluid intake is important, it is secondary to assessing the kidneys' ability to produce urine and maintain fluid balance, making urinary output the primary focus.

Correct answer: Persistent dizziness accompanied by blurred vision

Persistent dizziness with blurred vision is concerning for serious conditions such as stroke, which requires urgent medical evaluation and possible intervention. This symptom combination suggests there could be a significant impairment in brain function, making it essential to escalate care immediately to prevent further complications.

Dizziness when standing up quickly is usually due to orthostatic hypotension, which is generally managed with non-urgent interventions. Nausea after meals is typically linked to digestive issues, which are not emergency situations. Dizziness that comes and goes is often related to less serious causes, such as dehydration or mild vestibular disturbances, and does not warrant the same immediate escalation of care.

Correct answer: Decreased frequency of exacerbations

A decreased frequency of exacerbations is an expected and intended outcome of pulmonary rehabilitation for a patient with COPD. This improvement indicates better management of symptoms, reduced inflammation, and enhanced lung function, leading to fewer acute flare-ups and hospitalizations. Pulmonary rehabilitation helps patients improve their exercise tolerance, respiratory muscle strength, and overall lung function, contributing to a more stable disease course and improved quality of life.

The absence of dyspnea is unrealistic in COPD management, as most patients continue to experience some level of breathlessness. Instead, the goal is to reduce the severity and frequency of dyspnea rather than eliminate it entirely. Enhanced sputum production is not an expected outcome of effective COPD management, as increased sputum production can indicate worsened airway inflammation. The absence of rales is not a primary indicator of successful COPD management, as the focus should be on overall symptom improvement and exacerbation reduction. Wheezing or decreased breath sounds, not rales, are more characteristic of COPD.