ANCC AMB-BC Exam Questions

Correct answer: Have the container replaced with a new one immediately

Having the container replaced with a new one immediately is the correct action. Ensuring that sharps disposal containers are properly maintained is crucial to preventing injuries and contamination. A nearly full container poses a risk of needlestick injuries or accidental exposure. Prompt replacement ensures a safe work environment for both patients and healthcare staff.

Carefully pressing the contents down to make more space is dangerous and violates safety protocols, increasing the risk of injury. Continuing to use the container until it is full disregards the safety guideline that sharps containers should be replaced before they are full. Avoiding the use of sharps until the container is replaced is impractical and may delay patient care, making it an unreasonable solution.

Correct answer: Conduct a root cause analysis to identify the factors contributing to the errors

Conducting a root cause analysis to identify the factors contributing to the errors is the most appropriate first step. A root cause analysis will help to systematically identify the underlying issues contributing to medication errors, which is crucial for developing effective solutions.

Advocating for a new electronic medication administration system might help, but without understanding the root causes, it may not address the specific issues. Providing additional training sessions might be useful but may not be the solution if the errors are due to other factors. Advocating for increased staff might alleviate workload issues, but without a root cause analysis, it is not likely to directly address the specific cause of the errors.

Correct answer: Four weeks

Evaluating the effectiveness of a new antidepressant after four weeks is recommended because most antidepressants take this long to reach steady-state levels and produce noticeable effects on symptoms. This period allows the medication to build up in the system enough for the patient to begin experiencing potential benefits. Evaluating too early might lead to premature changes in the treatment plan, potentially hindering the overall effectiveness of the therapy.

Assessing at one or two weeks is generally too early, as antidepressants usually do not produce their full effects within this short time frame. One week might show no significant change, and even after two weeks, the effects may still be limited. Waiting eight weeks for the first evaluation might result in prolonged ineffective treatment if the medication is not working, as the efficacy of the medication can be determined before that.

Correct answer: Provide large print materials and verbal instructions

Providing large print materials and verbal instructions is the most appropriate approach when educating a patient with poor vision. This combination ensures the patient can access information in a format they can read more easily while also receiving verbal instructions to reinforce and clarify the content.

Treating visual deficits before attempting education may not be feasible or timely and could delay necessary education. Relying only on verbal or audio-recorded instructions might exclude patients who benefit from some form of visual reinforcement, such as large print materials. Reading all written information to the patient as it is presented may not be sufficient if the patient also needs materials they can reference independently later.

Correct answer: Use verbal instructions and pictorial aids

Using verbal instructions and pictorial aids is the most effective way to educate a patient who has difficulty reading. Verbal instructions ensure the patient receives the necessary information, while pictorial aids provide visual reinforcement, making the content easier to understand and remember. This combination respects the patient's limitations while still effectively conveying essential information.

Encouraging the use of interactive mobile applications may not be helpful if the applications require reading skills. Teaching basic reading techniques while providing healthcare education might overwhelm the patient or distract from the goal of learning health materials and is not the nurse’s primary responsibility in this context. Encouraging the patient to enroll in reading classes could be beneficial in the long term but does not address their immediate healthcare needs.

Correct answer: Signs of bleeding or bruising

When a patient has a significant decrease in platelet count, the primary concern is the increased risk of bleeding due to impaired clotting. The nurse should immediately assess for signs of bleeding or bruising, as these can indicate the patient is already experiencing complications from thrombocytopenia. Quick identification and management of bleeding is crucial to prevent severe outcomes such as hemorrhage.

While ALT and AST levels are important for assessing liver function, they do not provide immediate information about the bleeding risks associated with low platelets. Dietary intake of vitamin K affects clotting factors but is not directly related to platelet count; focusing on signs of active bleeding is more urgent. Checking the white blood cell count might be relevant in other scenarios, such as infections, but it is not the priority when addressing a significant drop in platelet levels.

Correct answer: Elevated serum creatinine

Of the potential choices, elevated serum creatinine is the laboratory finding most indicative of worsening renal function. Serum creatinine is a waste product of muscle metabolism that the kidneys filter out. When renal function declines, creatinine accumulates in the blood due to decreased kidney clearance. Thus, rising serum creatinine levels directly correlate with reduced glomerular filtration rate (GFR), indicating deterioration in kidney function and serving as a key marker for monitoring the progression of CKD.

Decreased hemoglobin can occur in CKD due to anemia of chronic disease but does not directly reflect kidney function. Decreased serum potassium is not typically observed in CKD, where hyperkalemia is more common due to impaired excretion. Elevated BUN alongside creatinine can indicate reduced kidney clearance, but low BUN is not characteristic of worsening kidney function.

Correct answer: Mid-systolic click

A mid-systolic click is the most indicative auscultatory finding of mitral valve prolapse (MVP). This sound occurs when the mitral valve leaflets suddenly tense as they prolapse into the left atrium during systole, a characteristic feature of MVP. The mid-systolic click is often followed by a late systolic murmur if mitral regurgitation is present, making it a key diagnostic clue for this condition.

A loud S2 sound is more commonly associated with conditions like pulmonary hypertension and does not suggest mitral valve prolapse. A pericardial friction rub is indicative of pericarditis and is unrelated to valvular disorders like MVP. Diastolic murmurs are generally associated with valve issues during the diastolic phase, such as aortic or mitral stenosis, and do not characterize MVP, which presents with a systolic click rather than a diastolic sound.

Correct answer: Evaluate current medications for possible side effects

When a patient experiences frequent dizziness and low blood pressure, the first step is to evaluate their current medications for possible side effects. Many medications, particularly those used to treat high blood pressure or fluid retention, can lower blood pressure too much or cause dizziness. Identifying and adjusting any medications that may be contributing to these symptoms can help alleviate the problem without the need for more invasive interventions.

Increasing fluid intake can be beneficial for raising blood pressure, but it should not be the first course of action if medication side effects are suspected. Recommending a high-salt diet may not be appropriate for all patients and is not the initial priority. A neurological evaluation is only necessary if there are additional neurological symptoms; otherwise, medication review is the most logical first step in addressing the dizziness and low blood pressure.

Correct answer: Interactive mobile health applications

Interactive mobile health applications are particularly effective for engaging young adults in their health management. These apps can offer personalized content, reminders, and tracking features that appeal to tech-savvy young adults who are accustomed to using their mobile devices for various tasks. The interactivity and convenience of mobile apps help sustain engagement and make managing health a more integrated part of their daily lives.

Routine, engaging social media posts can also capture attention but may not provide the depth of information or tools that mobile apps offer. Group educational sessions and face-to-face counseling, while beneficial, may not be as appealing or convenient for young adults as the digital tools they are accustomed to using.

Correct answer: History of childhood abuse

A history of childhood abuse is a key indicator that the symptoms of fatigue, difficulty concentrating, and headaches may have a psychological cause. Experiences of trauma, especially in childhood, can lead to long-term emotional and mental health issues, including anxiety, depression, and post-traumatic stress disorder (PTSD), which often manifest with physical symptoms such as those described. This assessment finding strongly suggests that the root cause of the symptoms may be psychological rather than physical.

A normal respiratory rate suggests no underlying respiratory issues are contributing to the symptoms but does not specifically point to a psychological cause. An elevated heart rate could be linked to physical conditions such as anemia or dehydration, making it less indicative of a psychological origin. Palpitations might suggest anxiety, which is psychological, but they are also associated with physical conditions like arrhythmias or hyperthyroidism and are not specific to psychological pathologies.

Correct answer: Zoster vaccine

The zoster vaccine is recommended for adults to prevent shingles, a painful condition caused by the reactivation of the varicella-zoster virus. Shingles can lead to severe pain and complications, such as postherpetic neuralgia, making vaccination an essential preventive measure for adults, particularly those aged 50 and older. By receiving the zoster vaccine, individuals can significantly reduce their risk of developing shingles and its associated complications, improving their quality of life and overall health.

The influenza vaccine is important for preventing seasonal flu but is ineffective against shingles, as it targets a different virus. The hepatitis B vaccine protects against hepatitis B virus infection but does not prevent shingles. The MMR (measles, mumps, rubella) vaccine protects against these three viral infections but is ineffective against the varicella-zoster virus, which causes shingles.

Correct answer: Explore the patient’s reasons for refusal and discuss alternative options

The most effective way for the nurse to address the situation is to explore the patient’s reasons for refusal and discuss alternative options. This approach demonstrates respect for the patient’s autonomy while also seeking to understand their concerns. By exploring alternatives, the nurse can find a solution that aligns with the patient’s values and preferences, increasing the likelihood of adherence.

Explaining that the patient needs to follow medical advice to experience good outcomes is not likely to address the underlying reasons for their refusal. Documenting the refusal is important but should follow a discussion aimed at resolving the issue. Enlisting the support of the patient’s family can be helpful in some cases, but it should only be done with the patient’s consent and after directly exploring their reasons for refusal.

Correct answer: Review the patient's inhaler technique

Reviewing the patient's inhaler technique is the first step the nurse should take when a patient expresses difficulty managing their asthma. Improper inhaler technique is a common issue that can lead to poor asthma control, so ensuring the patient is using their inhaler correctly is crucial before considering other interventions. By correcting the technique, the nurse may resolve the patient's difficulties without needing to escalate care.

Adjusting the patient’s medication regimen should only be considered after confirming proper inhaler use, as improper technique may mimic the need for stronger medication. Referring the patient to a pulmonologist is not the first step and should only be done if issues persist after initial interventions. Reviewing the patient’s understanding of asthma triggers is important but secondary to ensuring they are using their inhaler correctly.

Correct answer: Bone mineral density increased by 5%

An increase in bone mineral density (BMD) by 5% suggests an effective response to bisphosphonate therapy in a patient with osteoporosis. Bisphosphonates are used to increase bone density and reduce the risk of fractures by inhibiting bone resorption. An improvement in BMD demonstrates the medication is effectively enhancing bone strength and reducing the likelihood of fractures.

Serum calcium levels of 6 mg/dL indicate hypocalcemia, which is not a desirable outcome of bisphosphonate therapy, as maintaining normal calcium levels is important for overall health and bone metabolism. While the absence of bone fractures is a positive outcome, it is not a direct measure of the effectiveness of bisphosphonates, as BMD improvement provides a more specific indicator of therapy success. Evaluating the response to bisphosphonates should not be considered subjective, as objective measures like BMD changes provide empirical data on treatment efficacy.

Correct answer: Assess the patient’s cardiac rhythm

When a patient has a potassium level of 3.0 mEq/L, the most appropriate action is to assess their cardiac rhythm. Hypokalemia can lead to serious cardiac arrhythmias, and early detection of any abnormal rhythms is critical for preventing potentially life-threatening complications. Monitoring the patient’s heart rhythm allows for timely intervention if any arrhythmias are present.

Recommending potassium-rich foods is an important aspect of long-term management of hypokalemia, but it does not address the immediate risks posed by low potassium levels or assess the potential impact this is causing. Adjusting the dose of any diuretics to prevent further potassium loss may be necessary but should only be done after evaluating the patient’s current cardiac status. Scheduling a repeat potassium test can help monitor the effectiveness of any interventions, but the initial focus should be on assessing the cardiac impact of the current hypokalemia.

Correct answer: Explain how the information will help provide better care

Explaining how the information will help provide better care is the most effective communication strategy to build trust. This approach helps the patient understand the relevance of the questions and how sharing personal details can lead to more tailored and effective treatment. By emphasizing the benefit to the patient, the nurse can alleviate concerns and encourage openness.

Insisting the patient provide the necessary details may increase resistance and damage trust. Moving on to the next section of the assessment without addressing the patient’s reluctance may leave important information uncollected and unresolved. While explaining HIPAA and information protection is important, it assumes the reason they are reluctant to share information; it is not likely to address their underlying discomfort.

Correct answer: Naloxone

Naloxone is an opioid antagonist that works by quickly binding to opioid receptors, displacing opioids, and reversing their effects, including respiratory depression, sedation, and hypotension. Naloxone's rapid action makes it an essential tool in emergency settings where opioid overdose is suspected. Its administration can be life-saving by restoring normal respiration and consciousness in affected individuals.

Flumazenil is effective in reversing benzodiazepine overdose but does not have an impact on opioid receptors and is not suitable for treating opioid toxicity. Atropine is an anticholinergic medication that does not reverse the effects of opioid overdose. Epinephrine is a vasoconstrictor used in anaphylaxis and cardiac arrest but does not interact with opioid receptors or address opioid overdose.

Correct answer: Stroke

In a patient with a history of atrial fibrillation, stroke is the most significant complication. Atrial fibrillation causes irregular heartbeats, leading to turbulence and stasis of blood flow in the atria, which can result in clot formation. These clots can embolize, most commonly traveling to the brain and causing an ischemic stroke, making stroke the primary risk for patients with atrial fibrillation. Anticoagulation therapy is often prescribed to mitigate this risk and prevent thromboembolic events.

Myocardial infarction is linked to coronary artery disease and is not typically caused by atrial fibrillation. Heart block is characterized by slow electrical conduction, not the rapid irregular rhythm of atrial fibrillation. Ventricular fibrillation is a distinct arrhythmia not directly caused by or related to atrial fibrillation.

Correct answer: Evaluation of the current scheduling process to identify bottlenecks

Evaluating the current scheduling process to identify bottlenecks is the most appropriate priority. By identifying where delays occur in the scheduling process, the nurse leader can develop targeted interventions to reduce wait times and improve patient satisfaction.

Extending clinic hours may help, but it does not address the underlying inefficiencies causing the long wait times. Increasing staffing levels may alleviate the issue temporarily but could be costly without solving the root cause. Reducing the time spent with each patient may negatively impact the quality of care and further reduce patient satisfaction.