Ambulatory Care Nursing Practices, Exams of Nursing

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The Ambulatory care Nurse is triaging a client whose chief complaint is chest pain. What is a priority action for the nurse to take? A. Complete full head to toe B. Administer ASA C. Perform Electrocardiogram (ECG) D. Call 911 - ANS C. Perform an Electrocardiogram Which of the following is essential for the ambulatory care nurse to remind the client of when performing an Electrocardiogram? A. Take a deep breath during the test B. Hold you breath during the test C. Try not to move during the test D. You may keep your bra on during the test - ANS C. Try not to move during the test The Ambulatory Care nurse is assessing a client. Which of the following questions will yield more information from the client? A. Are you feeling pain? B. What brought you in today? C. How many Children do you have? D. When was your last menstrual period? - ANS B. What Brought you in today? The ambulatory care nurse is conducting an annual assessment of a client. The client denies frequent urination, blurry vision, excessive thirst or hunger. The clients Blood sugar is 500mg/dl by finger stick. What should the nurse do next? A. Transport client to the ER B. Notify the healthcare provider immediately C. Retest the Blood glucose D. Order a Hemoglobin A1c - ANS C. Retest the blood glucose Which of the following laboratory test is most effective in monitoring a client with DM blood glucose level? A. Urine Glucose Level B. Glucometer blood glucose testing C. Hemoglobin A1C D. Creatinine Levels - ANS C. Hemoglobin A1C

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The client complains of sporadic Abnormal heart rate. An ECG performed showed Normal Sinus rhythm. Labs were WNL and assessment revealed no cardiovascular abnormalities. Which of the following should the nurse anticipate the healthcare provider will order? A. Halter Monitoring B. Admission to the hospital C. Continuous EEG D. Chest X-ray - ANS A. Halter Monitoring The Ambulatory care nurse is preparing the client for the application of a Holter monitor. Which information is vital for the nurse to give the client? A. Check blood glucose during halter monitoring B. Maintain normal diet and exercising C. Avoid Microwaves and the use of cell phones D. Reduce exercise routine - ANS B. Maintain normal Diet and exercise The Ambulatory care nurse is assessing a new graduate nurses' understanding of the importance of getting clients height and weight before chemotherapy. Which statement indicates they understand? A. Height and weight are seldom required B. height and weight are only needed when the chemotherapy regimen is changed C. Height and weight are needed to calculate the correct dosage of chemotherapy D. The chemotherapy dose will remain the same, even if there is an increase in the amount of eight lost. - ANS C. Height and weight are needed to calculate the correct dosage of chemotherapy. The Ambulatory care nurse is performing a guaiac fecal occult blood test (gFOBT), Which of the following would indicate a positive result? A. Green reaction B. Red reaction C. Blue reaction D. Yellow reaction - ANS C. Blue reaction The nurse in the Medical oncology clinic is assessing a client who is undergoing chemotherapy. The nurse obtained an oral temp of 102 degrees. which statement by the nurse indicates an understanding of the clients' condition? A. Since the client is feeling "ok" there is no further intervention B. A temp of 102 is an expected finding after chemotherapy C. Cal the MD to obtain an order of Tylenol as soon as possible D. The client is post chemo and at risk for neutropenia fever. This is an emergency and requires stat ABX or hospitalization - ANS D. The client is post chemo and at risk for neutropenia fever. This is an emergency and requires stat ABX or hospitalization The Ambulatory care nurse is performing a physical assessment on a child who underwent chemotherapy. Which statement by the client indicates that further evaluation is needed?

A. I ate my entire meal B. My ears are ringing C. I play with my rother everyday D. Sometimes I am tired - ANS B. My ears are ringing The ambulatory care nurse is scheduling the client for gFOBT. Which statement made by the client indicates that teaching was effective? A. This is an invasive test B. I will not eat Mushrooms for 48 - 72 hours C. I can take ASA if I am having a headache D. I will reduce my fiber intake - ANS B. I will not eat Mushrooms for 48 - 72 hours Prioritization is an important aspect of the ambulatory care nurse's time management plan. Which of the following clients would the nurse see first? A. A client with a BS of 150mg/dl and is asymptomatic B. A client who complains of blood in urine 24hours POP TURP C. A client with a blood pressure of 140/89 and is asymptomatic D. A client in her 3rd trimester and has signs of preterm labor. - ANS D. A client in her 3rd trimester and has signs of preterm labor. A client informed the ambulatory care nurse that the internet is very helpful to her when reviewing health information. Which actin is appropriate for the nurse to take? A. Encourage the client to continue her independence by taking her health in her own hands. B. Educate the client on credible websites and the importance of protecting private information C. Do nothing. The client is knowledgeable about using the internet. D. Document the clients response in the chart. - ANS B. Educate the client on credible websites and the importance of protecting private information Which of the following strategies is appropriate when facilitating conflict resolution? A. Choose a side as soon as possible B. Refrain from judging C. Use minimal choices and options to reach a speedy solution D. Blame the guilty party - ANS B. Refrain from judging The ambulatory care nurse is working with a healthcare organization that is seeking Magnet recognition. Which of the following activities by the nurse is the best supporting evidence in the Magnet application process A. Being the charge nurse in the clinic B. Participating in the nurses week celebration C. Advancing to RN2 on the clinical ladder D. Being the chairperson of the evidenced based council committee - ANS D. Being the chairperson of the evidenced based council committee

There are three ethical principles for human research. Which of the following means the client has the right to elf determination? A. Respect B. Justice C. Beneficence D. Non maleficence - ANS Which of the following organizations is responsible for evaluating proposed research studies prior to their commencement? A. Centers for disease control and prevention B. Department of Health and Human services C. Institution Review Board D. Office of Disease prevention and Health Promotion - ANS C. Institution Review Board According to the Joint Commission standard, when should the initial assessment of the nurse competencies be conducted in a health care setting? A. During the orientation process B. Prior to the orientation process C. During Nursing school D. After the orientation process - ANS A. During the orientation process The purpose of using Scope and Standards of Practice for Ambulatory Care Nursing includes which if the following? A. Use a guide to provide quality of care B. Use to prevent law suits C. Use to increase the income of the facility D. Use to train nurses - ANS A. Use a guide to provide quality of care The ambulatory care nurse is teaching a client ho to change their wound dressing. Which of the following indicates emotional readiness to learn? A. The client accepts the need to learn the new skill B. The client has the psychomotor function to change the dressing C. The client is a wound care medical MD D. The client has dressed his/her own wound in the past - ANS A. The client accepts the need to learn the new skill To educate the client the ambulatory care nurse needs a systematic and planned process that consists of teaching and learning. Which of the following factors could influence the education process? A. Culture B. Learner's readiness C. Gender D. Socio-Economic Status - ANS B. Learner's readiness

The Ambulatory care nurse is discharging a 10 - year-old child from the pediatric clinic. To whom should the nurse given the discharge teaching? A. The Child B. The mother C. Both the child and the caregiver D. the grandparents - ANS C. Both the child and the caregiver The ambulatory care nurse is caring for a Native Hawaiian whose choice of food intake, health and wellbeing perception can pose barriers to life style modification. To be effective in getting the client to participate in dietary modification, which of the following steps should the nurse take? A. Give the client a brochure B. Teach the client about nutrition from a family framework perspective C. Give the client the web address for the dietary information D. Recommend a specific diet regimen - ANS B. Teach the client about nutrition from a family framework perspective The Ambulatory care nurse is working in the client with a variety of clients from different racial and ethnic groups. When providing care, the nurse should know which group has the highest asthma prevalence of any racial/ethnic group in the USA? A. Hispanics B. Caucasian C. African Americans D. Asian - ANS C. African Americans The Joint commission requires accredited healthcare organizations to develop and use a list of abbreviations that should not be used. Which of the following if documented by the ambulatory care nurse indicate understanding of the "Do not Use" list? A. QD B. U C. Unit D. IU - ANS B. U A client fell in the clinic during the intake process. The ambulatory care nurse is documenting the occurrence. Which of the following indicates proper documentation of the incident? A. Document the incident in the patients chart B. Make no mention of the fall in the clients charts C. Report it the the risk management and they will document the incident D. Document the occurrence of the fall in the organization's incident reporting system - ANS D. Document the occurrence of the fall in the organization's incident reporting system Which of the following actions should the ambulatory care nurse implement for a client who presents tot he clinic with chest pain? A. Refer the client immediately to the ER

B. Take vital signs and obtain ECG C. Take detailed history D. Call the EMS for transport - ANS B. Take vital signs and obtain ECG Which of the following is used to determine the type and the numbers of staff needed in an ambulatory clinic? A. Only the volume of client B. Nurses; years of experience C. Nurses college degree D. The complexity and the number of clients - ANS D. The complexity and the number of clients Which action by the ambulatory care nurse indicates that he/she is compliant with the client self-determination Act? A. Asking the client if they have a Advanced Directives B. Completing a head to toe assessment C. Reviewing the clients care plan D. Complying with the client's right to refuse medication - ANS A. Asking the client if they have a Advanced Directives Which of the following medications does the ambulatory care nurse anticipate the MD will prescribe for a client with chronic Asthma for long-term treatment A. Fluticasone (Flovent) B. Albuterol ( Ventolin) C. Ipratropium (Atrovent) D. Levalbuterol (Xopenex) - ANS A. Fluticasone (Flovent) The Ambulatory care nurse asses a client with Shortness of breath, lack of energy, and dry mouth. Which of the following disease should the ambulatory care nurse suspect? A. COPD B. Congestive Heart Failure C. Asthma D. Respiratory Failure - ANS A COPD The parent of an eight year old child reports that the child cannot efficiently use the metered dose inhaler. Which of the following actions should the nurse take? A. Give the child a nebulizer B. Give the child a spacer C. Recommend discontinuation of the medication D. Inform the parent that the medication is not important - ANS B. Give the child a spacer The ambulatory care nurse is formulating a research question using the PICO format. the "C" in PICO stands for which of the following? A. Comparison B. Characteristics

C. Culture D. Cure - ANS B. Characteristics PICO (T) Format - ANS Formula for creating answerable research questions. P: Population/patient - age, gender, ethnicity, individuals with a certain disorder I: Intervention/indicator (Variable of Interest) - exposure to a disease, risk behavior, prognostic factor C: Comparison/control - could be a placebo or "business as usual" as in no disease, absence of risk factor, Prognostic factor B O: Outcome - risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome T: Time - the time it takes for the intervention to achieve an outcome or how long participants are observed The ambulatory care nurse is teaching a client how to use the peak flow meter. Which statement indicates that teaching was effective? A. I Should move the indicator to the bottom of the number scale before suing the meter B. I Should blow out as slowly as possible C. I should blow multiple time in a meter during a single test D. I should lie down when using the meter - ANS A. I Should move the indicator to the bottom of the number scale before suing the meter Which of the following if noted in the clients urine analysis would require further actions? A. Protein B. Bacteria C. Bilirubin D. White Blood Cells. - ANS C. Bilirubin The client is being scheduled for a lower gastrointestinal study using double-contrast barium enema. Which of the following should be included in the clients teaching? A. The procedure will take 6 hours B. Have a low residual diet 1 - 2 days before the procedure C. Decrease fluid intake after the procedure D. East a light meal the night before the procedure. - ANS B. Have a low residual diet 1 - 2 days before the procedure The ambulatory care nurse reviews the clients lab results and notices that the creatinine is mg/dl. What action should the nurse take? A. Notify the healthcare provider immediately B. Collect urine ample C. Do nothing, The result is WNL D. Administer diuretics - ANS C. Do nothing, The result is WNL A client wit a DX of bipolar disorder is being seen in the clinic. The healthcare provider prescribed Lithium. Which of the following is important for the ambulatory care nurse to teach a client?

A. You can breast feed while taking the medication B. Low Sodium level can lead to toxicity C. Minimize fluid intake D. There is no need to use contraceptives while on this medication - ANS B. Low Sodium level can lead to toxicity Which of the following statements if reported to the ambulatory care nurse indicates that the treatment for a client with CHF needs to be modified? A. The client gains 1 pound in hours B. The client now sleeps sitting up C. The clients BP is / D. Increased Activity tolerance. - ANS B. The client now sleeps sitting up With the implementation of telemedicine, the method of triaging has changed. What components would an ambulatory care nurse utilize when triaging using the telephone? A. Take a quick and accurate history in order to make an accurate decision B. HIPPA law does not allow client to call ambulatory care facility with health issues C. Call 911 as soon as the client states there is a problem D. Give information that is general that can be applied to most clients. - ANS A. Take a quick and accurate history in order to make an accurate decision The ambulatory care nurse is assessing a client. Which questions should the nurse ask to assess the clients health goals? A. It seems to me that you want to be healthy, Is that true? B. What are your health goals? C. Do you want to be healthy? D. Do you exercise? - ANS B. What are your health goals? The ambulatory care nurse is caring for an elderly client. The nurse caring for the client should know what about elder abuse? A. All victims of elder abuse are victims of poly-victimization B More than 3 in 5 victims are men and 75 years or older C. Elder abuse can be the result of intentional or unintentional neglect D. elder abuse is not an issue, the nurse should not be concerned about. - ANS C. Elder abuse can be the result of intentional or unintentional neglect The ambulatory care nurse is caring for a 30 year old married woman in the clinic who was accompanied by her husband. Upon assessment, the nurse noted bruises on the clients arm. What action should the nurse take? A. Conduct further assessment without the clients husband in the room. B. Ask both the husband and the client what happened C. Call 911 D. Inform the client to leave her husband for safety - ANS A. Conduct further assessment without the clients husband in the room.

When coding for visits of new patients, the key component that must be included to document the correct level of evaluation and management (E/M) are: A. History, physical and medical decision making B. Physical exam and medical decision making C. History and physical exam D. Age, DX, and medical decision making - ANS A. History, physical and medical decision making If a patient is trying to make an informed decision about whether to have surgery or more conservative treatment for prostate cancer and asks the ambulatory care nurse for advise on making the decision, the nurse should: A. Advise the patient on the best course of treatment B. Suggest the patient carry our research before deciding C. provide the patient with print and online resources D. Advise the patient to ask the physician for more information - ANS C. provide the patient with print and online resources An Ambulatory care center has analyzed the type of patient complaints and finds there are four complaints that are most common ( delays, rescheduling, difficulty scheduling and parking) but not easily solvable and that staff members handle these complaints in different manners. The service recovery program should begin by: A. Posting signs apologizing for these problems B. Warning patients in advanced that these problems may occur C. Providing patents with complaint forms D. Establishing protocols for dealing with complaints - ANS D. Establishing protocols for dealing with complaints If a patient is to have an arthrodesis and injection of corticosteroid into the right knee and the ambulatory care nurse is setting up equipment, the correct needle gauge syringe sizes are: A. 18G needle and 10 - 20ml syringe B. 20G needle and 20ml syringe C. 16G needle and 10 - 20ml syringe D. 19g needle and 50ml syringe - ANS A. 18G needle and 10 - 20ml syringe The coding system that is used for outpatient procedure claims is: A. ICD- 10 - PCS B. HCPCS/CPT C. ICD- 10 - CM D. ICD- 9 - ANS B. HCPCS/CPT The issue of licensure portability is especially a concern with: A. Outreach programs B. Collaboration among medical facilities and programs C. Telemedicine D. Recruitment of healthcare personnel - ANS C. Telemedicine

If a leader wants to influence others in an organization to change attitudes, the first step is to: A. Provide incentives to change B. Outline disciplinary actions for failure to change C. Outline the desired change D. Model the desired change - ANS D. Model the desired change When conducting a urine permanency test, the specimen should be: A. First voided in AM B. Second voiding the AM C. Obtained after the patient drinks 8 oz of liquid D. Obtained any time - ANS A. First voided in AM In a crisis situation which decisions must be made quickly and effectively, the most effective leadership style is probably: A. Democratic B. Laissez-faire C. Authoritarian D. Bureaucratic - ANS C. Authoritarian The ambulatory care nurse is preparing electronic educational material to be viewed over the internet and plans to include both deep links to articles and inline links to images from commercial sites. The nurse should: A. Include the links as desired B. Ask permission to utilize links C. Provide a works cited list D. Provide the course link in the text - ANS B. Ask permission to utilize links With problem based learning, the role of the instructor is that of: A. Leader B. Lecturer C. Observer D. Facilitator - ANS A. Leader If delegating a task to staff person, the first issue to consider is whether the: A. Task is suitable for the individual B.. Individual has time to carry out the task C. Individual can be adequately supervised D. Individual wants to carry out the task - ANS A. Task is suitable for the individual A family practice physician's office schedule is usually fully booked with patients scheduled every 15 minutes, but the MD routinely adds patients who have acute needs to the schedule resulting in delays in seeing patients, unpaid staff OT and staff complaints. The best solution for the nurse manager may be to: A. Schedule staff later in the day

B. Suggest referring patient to ED C. As for payment for any OT D. Leave open slots in the schedule - ANS D. Leave open slots in the schedule When conducting a test for the erythrocyte sedimentation (ESR) rate using the Sediplast kit rack, after the blood in the Sediplast tube is inserted into the vial, the results should be checked in: A. 10 min B. 30 min C. 60 Min D. 90 min - ANS C. 60 min If a patient comes to the ambulatory care center with a 1inch gash on he left foot from a dog bite, the initial response should be to: A. Wash the wound area with soap and water B. Irrigate the wound with - ml of NS C. Irrigate the wound with - ml of hydrogen peroxide D. Soak the foot in povidone-iodine/NS (50/50) solution - ANS D. Soak the foot in povidone-iodine/NS (50/50) solution If one of the patients nursing diagnosis on the care plan is "Self care deficit" which of the following is an appropriate desired outcome? A. The patient will achieve maximal physical activity B. The patient will perform self care within physical limitations and activity restrictions C. The patient exhibit increased ability to engage in activities D. The patient will need no assistance with persona care - ANS B. The patient will perform self care within physical limitations and activity restrictions If the ambulatory care nurse is interviewing an adolescent patient with autism spectrum disorder and the patient states at the wall and repeatedly states, "You don't want to be here," this likely means that the patient: A. Senses the nurse doesn't want to be there B. Wants the nurse to leave C. Doesn't want to be there D. Is just repeating a random phrase - ANS C. Doesn't want to be there An ambulatory surgery center that has received accreditation and deemed status from the Joint Commission: A. Does not need to undergo the CMS certification process B. Must still undergo the CMS certification process C. Must undergo an abbreviated CMS certification process D. Can opt to pay a fee rather than undergo CMS certification - ANS A. Does not need to undergo the CMS certification process If the Ambulatory nurse is carrying out a point of care rapid HIV test on a patient, the nurse should:

A. Advise the patient that the test is simply routine B. Remind the patient of the right to refuse test C. Tell the patient not to worry because most test are negative D. Discuss the implications of the test with the patient first. - ANS D. Discuss the implications of the test with the patient first. According to the CDCs infection prevention and control assessment tool for outpatient settings, the organization's written infection prevention policies and procedures should be reassessed at least every: A. month B. 6 months C. 12 months D. 24 Months - ANS C. 12 months If a physician is registered as a Vaccines for Children's (VFC) provider and plans to administer vaccines to four patients, which of the following patient would be eligible for the program? A. 6 year old whose health insurance is provided by Medicaid B. a 19 year old AA patient C. A 13 year old with insurance coverage for vaccines D. A 3 year old Polynesian patient with insurance but unpaid deductible - ANS A. 6 year old whose health insurance is provided by Medicaid If an office practice has 3 FTE physicians, approximately how many FTE support staff persons are likely to be necessary? A. 5 B. 10 C. 15 D.20 - ANS C. 15 ( 1 FTE physician requires 4.5-5.5 support staff) Which of the following ethnic groups is at the highest risk of stroke? A. Caucasians B. Hispanics C. Asians D. African Americans - ANS D. African Americans The type of budget that is used for daily operations and general expenses, such as salaries associated with an ambulatory surgery center is the: A. Master budget B. Operating Budget C. Capitol Budget D. Cash balance Budget - ANS B. Operating Budget According to the Spalding classifications system for disinfection and sterilization, an example of an item that would be classified as Semi-critical is: A. Bronchoscope

B. Surgical instrument C. BP Cuff D. Bedpan - ANS A. Bronchoscope If a patients nursing DX is "Activity intolerance" on the care plan and the desired outcomes are the for the patient to feel less tire and carry out activities without signs of physical distress, which of the following is an appropriate nursing intervention: A. Keep patient awake during daytime hours B. Limit activities to those that are essential C. instruct patient in energy saving techniques D. Encourage patient to take mid-morning and mid afternoon naps. - ANS C. instruct patient in energy saving techniques When preparing a budget for a community education project, the ambulatory care nurse needs to consider both direct and indirect costs. Indirect costs may include: A. Supplies and Equipment B. Salaries C. Employee benefits D. Housekeeping Services - ANS D. Housekeeping Services The three goals of accreditation by the national committee for Quality Assurance are (1) better patient experience, (2) Better health and (3): A. Lower staff turnover B. Lower per capita cost C. Lower rates of medical errors D. Higher reimbursement rates - ANS B. Lower per capita cost An Ambulatory care nurse reviewed clinic statistics regarding the number of patients who missed or came late to an appointment, established a telephone reminder system to improve attendance and then conducted a review each week and published findings for the staff showing the improvement. This is an example of: A. Internal benchmarking B. Functional Benchmarking C. External Benchmarking D. Competitive benchmarking - ANS A. Internal benchmarking If when utilizing the Plan Do Study Act (PDSA) method of continuous quality improvement study of the outcomes of a trial indicates that the solution that was instituted was not effective, the next step is to: A. Return to plan step B. Return to DO step C. Discontinue the process D. Continue to Act step - ANS A. Return to plan step Plan Do Study Act (PDSA) method of continuous quality improvement study - ANS Plan: Define the problem, brainstorm and collect data

Do: Generate solutions, choose one and implement a trial Study: Evaluate outcomes Act: Identify changes needed for full implementation and continue to monitor If a patient is scheduled for a routine serum creatinine to evaluate renal function, the patient should be advised to prepare for this test by: A. Carrying out routine activities B. Fasting for 12 hours C. Avoid Strenuous exercise D. Avoid eating meat products for two days - ANS C. Avoid Strenuous exercise The ambulatory care nurse is reviewing a patient's history to determine if the patient is a candidate for an intrauterine device (IUD). Contraindications for an IUD include: A. Menorrhagia B. History of pelvic inflammatory disease 3 years previously C. History of renal Cancer D. History of ectopic pregnancy - ANS D. History of ectopic pregnancy The purpose of an Advanced Beneficiary Notice is to: A. Identify beneficiaries of a wall B. inform Medicare Patients of non coverage C. Inform patients of Medicaid eligibility D. Inform patients of insurance coverage - ANS B. inform Medicare Patients of non coverage Which of the following are excluded from the Nurse Licensure compact A. RNs B. LVNs C. LPNs D. APRNs - ANS D. APRNs (They must get a license in each state they plan to work in) When setting up a dashboard to show progress towards meeting goals, the first consideration when determining which information to include should be: A. Relevance to goals B. Method of Display C. Frequency of needed updates D. Ease of gathering data - ANS A. Relevance to goals The first step in development of a safety and health program to meet OSHA's guidelines is to: A. Takes steps to reduce hazards B. Establish a medical management program C. Conduct a workplace analysis D. Establish a staff training program - ANS D. Establish a staff training program

When interviewing a patient who reports that everything is "fine" the ambulatory care nurse notes that the patients pupils are dilated, the patient is sweating profusely and the patient frequently licks the lips. According to these observations the nurse likely concludes that the patient is: A. actually fine B. withholding information C. Experiencing a physical health problem D. Afraid of the nurse - ANS B. withholding information Under provisions of the Americans with Disabilities Act (ADA) in relation to access, which of the following is allowed: A. Examining a wheelchair bound patient in a wheelchair because an adjustable exam table is not available B. Refusing to treat a patient because accessible equipment is not available C. Asking a disabled person to bring a caregiver to assist with patients examination D. Having accessible equipment for patient with disabilities in some examination rooms but not all - ANS D. Having accessible equipment for patient with disabilities in some examination rooms but not all Waste is considered corrosive and hazardous if it has a pH of: A. Less than 2 or greater than 12. B. Less than 4 or greater than 10. C. Between 6 and 12 D. Greater than 12.5 - ANS A. Less than 2 or greater than 12. When reviewing a number of articles as part of development of Evidence-based practice guidelines, the first step to reading critically should be to: A. Review the authors credentials B. Consider the source C. Read the article conclusion D. Evaluate the overall article - ANS A. Review the authors credentials The nursing hazard that is usually of most concern is an ambulatory surgical center is: A. Back injuries B. Slips and falls C. Exposure to bloodborne pathogens D. Latex Allergies - ANS C. Exposure to bloodborne pathogens The HIPPA security rule applies to protected health information (PHI) that is transmitted: A. Orally B. In Writing C. Electronically D. In Any Manner - ANS C. Electronically In a therapeutic relationship between an ambulatory care nurse and a patient, the focus should be on the :

A. Nurse's Needs B. Patient ideas and feelings C. Medical Needs D. Treatment Options - ANS B. Patient ideas and feelings If the ambulatory care nurse is concerned about a potential influx of patients infected with the Zika Virus, the most appropriate response is to: A. Research the topic and obtain disease-focused date B. Express concerns to other staff members C. Complain about the lack of information D. Suggest Stockpiling mosquito repellant to patients - ANS A. Research the topic and obtain disease-focused date If Medicare has denied a claim, how ling does the appellent have to file an appeal: A. 30 days B. 60 days C. 90 days D. 120 days - ANS D. 120 days Health literacy is directly affected by general literacy, so when educating patients, the ambulatory care nurse should realize that the approximate percentage of adults in the US who are classified as illiterate or low literate is: A. 25% B. 40% C. 50% D. 70% - ANS C. 50% The Ambulatory care nurse is participating in a community effort to screen for hypertension. Screening for disease is an example of what type of prevention: A. Primary B. Secondary C. Tertiary D. Quaternary - ANS B. Secondary Primary prevention examples - ANS - Discuss a low-fat diet and the need for regular physical exercise with clients.

• when a nurse provides health education and training for daycare workers about issues of health and hygiene, such as proper hand hygiene, diapering, and food preparation and storage
• Immunizations, importance of wearing seatbelts, taking folic acid supplementation at preconception to prevent neural tube defects, fluoridation of water supplies to prevent dental caries, and actions taken to reduce human exposure to agents that may cause cancer
• Implement a community level program like walking for exercise to assist citizens in improving health behaviors related to lifestyle.
• Use the Code of Ethics for Nurses to guide your nursing practice

• Use the information exchange process to increase the client's understanding of how to use the health care system and the health promotion strategies that will maintain health.
• Complete a family genogram and assess health risks with the family to contract for family health activities to prevent diseases from developing Secondary prevention examples - ANS - Implement blood pressure and cholesterol screening; give a treadmill stress test.
• Health screenings
• teach an asthmatic client to recognize and avoid exposure to asthma triggers and assist the family to implement specific protection strategies such as replacing carpets, keeping air systems clean and free of mold, staying inside when the pollution level is high, and avoiding pets.
• mammography to detect breast cancer, Papanicolaou (Pap) smears to detect cervical cancer, colonoscopy for early detection of colon cancer, prenatal screening of pregnant women to screen for gestational diabetes
• Provide mental health interventions after stressful events.
• The public health nurse provides toxin screenings for migrant workers who may be exposed to pesticides.
• Implement a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center.
• Encourage clients who are pregnant to participate in prenatal care and Special Supplemental Nutrition Program for Women, Infants and Children to increase the number of healthy babies and reduce the costs related to preterm baby care.
• Use case finding to identify existing health problems in your caseload and the population served by your agency. Timely, holistic assessments and interventions can slow disease trajectories and promote healing and health.
• Assess disaster victims and triage for care.
• Investigate an outbreak of flulike illness in a local school.
• Provide programs in child development and behavior management for families who have not yet abused their children but whose children are brought to the attention of social authorities for aggressive behavior problems.
• Develop a way for homeless individuals to read their TB skin test, if necessary, and to transfer the results back to the facility at which the skin test was administered.
• To prevent the spread of disease
• Notify partners and trace contacts (HIV) tertiary prevention examples - ANS 1. Prevent pressure ulcers after SCI

2. Promote independence after TBI
3. Referral to support groups
4. Rehab The three primary elements of motivational interviewing are: A. Collaboration, Evocation, and autonomy B. Orientation, identification and autonomy C. Input, Discussion and output

D. Identification of barriers, conflict resolution and implementation - ANS A. Collaboration, Evocation, and autonomy Collaboration: Working with the patient rather than confronting the patient in order to resolve issues Evocation: Drawing out ideas from the patient about problems and solutions rather than imposing ideas of an interviewer Autonomy: Recognizing that the patient is the one who is responsible for making changes and respecting the patients choices. Female patients should generally be advised to begin breast cancer screening with routine mammos at about the age: A. 20 - 30 B. 30 - 40 C. 40 - 50 D. 50 - 60 - ANS C. 40 - 50 One of the primary indications that a patient is ready to learn is when the patient: A. Appears confused B. Expresses frustration C. Admits lack of knowledge D. Asks a question - ANS D. Asks a question When assessing a patient over the telephone, the ambulatory care nurse is unsure what the client is saying because the patient's explanation is confusing. Which of the following is the best response? A. Could you explain that again, I just want to make sure I understand B. That was so confusing, Could you repeat it? C. I'm afraid I didn't understand what you were saying D. Is there someone else present who could explain this to me - ANS A. Could you explain that again, I just want to make sure I understand If a female patient at an ambulatory care clinic speaks only Arabic and is accompanied by her 8 year old daughter and a male neighbor who both peak English and Arabic, the best way to communicate is: A. Use pantomime to help the patient communicate B. Ask the daughter to translate C. Ask the neighbor to translate D. Arrange for a medical Translator - ANS D. Arrange for a medical Translator When providing anticipatory guidance to a patient who has recently been diagnosed with DM type I, the most important information that the ambulatory care nurse should cover is how to deal with: A. Weight loss B. Changes in Activity C. Diabetic ketoacidosis D. HTN - ANS C. Diabetic ketoacidosis

Which of the following infectious agents is only transmitted through direct contact, such as when the infectious agent is present on an environment surface? A. C-Diff B. Lyme disease C. Rubella Virus D. Varicella - Zoster virus - ANS A. C-Diff If an ambulatory care nurse wants to determine if there is a recall for a specific medications, the nurse should seek information from the? A. CDC B. Consumer product safety commission C. Agency for toxic substance and disease registry D. Food and Drug Administration - ANS D. Food and Drug Administration If a patient is scheduled for a colonoscopy, the patient should be advised that the procedure will generally require the patient to withhold which of the following medications for 7-14 days before the test A. Iron supplements B. Antihypertensive C. Acetaminophen D. Levothyroxine - ANS A. Iron supplements A Patient is to undergo the MOHS procedure for a removal of a squamous cell carcinoma from the left face. The patient should be advised that following the initial excision of the lesion, the patient will be expected to A. Stay flat for 72 hours B. Wait for the results of the tissue analysis C. Be discharged from the facility D. Consult a plastic surgeon for repair - ANS B. Wait for the results of the tissue analysis Which of the following conditions of the breast may pose the greatest risk for the development of breast cancer A. Lipoma B. Cyst C. Epithelial related calcifications D. Atypical ductal hyperplasia - ANS D. Atypical ductal hyperplasia As part of the hazard vulnerability assessment, the family practice clinic has noted a number of areas (earthquake, fire, infant abduction and bomb threats) in which their risk is moderate to high. The next step is to A. Identify cost related to decreasing risk B. Increase staff education regarding risk C. Assess preparedness for each risk element

D. Hire a consultant to advise clinic on reducing risk - ANS C. Assess preparedness for each risk element The ambulatory care nurse is educating a patient one-on-one to manage clean intermittent catheterization (CIC) independently. The best method to assess the effectiveness of teaching i to ask the patient to A. Describe the procedures involved B. Take a quiz about the procedure C. Do a return demonstration D. Keep a log of CICs and problems involved - ANS C. Do a return demonstration In written materials for patients, which of the following sentences is likely to be the most easily understood by the general public A. A low sodium diet is recommended for cardiovascular disease B. High blood pressure can lead to a stroke C. People who smoke cigarettes' are prone to pulmonary disease D. Remain NPO for 6 hours prior to the procedure - ANS B. High blood pressure can lead to a stroke When a patient is angry and aggressive but not yet violent, the first method to use in changing the behavior is to A. Ignore B. Redirect C. Reward D. Interrupt - ANS D. Interrupt The ambulatory care nurse wants to participate in outreach to a largely Spanish speaking population of Mexican immigrants by setting up booths in the community to screen for High blood pressure and Diabetes. The best places to set up booths are probably: A. Parks and recreation areas B. Churches and shopping areas C. Hospitals and clinics D. police departments and social services offices - ANS B. Churches and shopping areas When orienting a patient and/or caregiver to the healthcare delivery system, the first step is to: A. Explain the structure of the healthcare delivery system B. Provide literature regarding the healthcare delivery system C. Ask what the patient and/or caregiver wants to know D. Assess the patients and/or caregiver health literacy - ANS D. Assess the patients and/or caregiver health literacy

If a patient with severe joint pain and swelling has been diagnosed w/ Rheumatoid Arthritis and has failed to follow through with referral to a rheumatologist, the ambulatory care nurse should: A. Take no action, this is the patients choice B. Explain how the treatment can help prevent further deterioration and relive pain C. Advise the patient that he or she is exercising bad judgement D. Remind the patient that RA an cause severe damage - ANS B. Explain how the treatment can help prevent further deterioration and relive pain If a patient asks, "Should I continue w/ chemotherapy or stop?" and the nurse responds with "How do you feel about stopping chemotherapy?" this is an example of: A. Redirection B. Diversion C. Reflection D. Restatement - ANS C. Reflection When entering the examining room of a patient who is deaf and facing away from the door, the ambulatory care nurse should A. Approach from the direction the patient is facing B. Say the patients name C. Approach and touch the patient D. Clap hands or tap your foot. - ANS D. Clap hands or tap your foot. (Sensitive to vibrations) if a patient with severe dysarthria because of MS but with good cognition is admitted to an ambulatory surgery center and needs to answer questions. the best way to get information is to ask A. Open ended questions B. Yes/no questions C. The patient to write answers D. Questions of the caregiver - ANS B. Yes/no questions In handoff communication, the SBAR technique involves S B A and r is: A. Rating B. Recommendation C. Response D. Requirement - ANS B. Recommendation Patient with passive aggressive personalities often attempt to hide an underlying feeling of A. Depression B. Hurt C. Guilt D. anger - ANS D. anger

If the ambulatory care nurse leader of a task group has completed the tasks assigned to the group and is in its final termination phase, the primary role of the nurse leader is to A. Review the group process and achievements B. Disband the group without further input C. Evaluate the participation of the group members D. Make recommendations about future projects - ANS A. Review the group process and achievements In shared governance, empowerment refers to A. The ability to provide input and decisions B. The assignment of a title C. The authority to make decisions D. any type of participation - ANS C. The authority to make decisions A patient who is an inmate in a correctional facility is scheduled for a colonoscopy to determine the cause of rectal bleeding but the patient refuses to sign the consent, The colonoscopy should be: A. Carried out despite the ack of consent B. Carried out because inmates have no rights to informed consent C. Carried out of the physician signs a treatment without consent form D. Cancelled because of no consent - ANS D. Cancelled because of no consent If the ambulatory care nurse (Nurse A) noted another nurse (Nurse B) caused severe injury to a patient because Nurse B abandoned the patient in distress to make a personal call, Nurse B should b: A. Advised that the behavior is inappropriate B. Reported to the state board of nursing C. Reported to the police D. Placed on probation status - ANS B. Reported to the state board of nursing If an ambulatory nurse working in a cancer clinic is in a hurry to leave work and fails to follow protocols for checking IDS allergies resulting in administration of a chemotherapeutic agent to the wrong patient and a severe allergy reaction is an example of A. Gross negligence B. Negligent conduct C. Contributory negligence D. Comparative negligence - ANS A. Gross negligence if a staff member at an ambulatory center downloaded protected health information(PHI) about a politician in order to profit by selling the information to tabloids rules of breach notification require notification of the A. Patient only within 60 days B. Patient and the HHS secretary within 60 days C. Patient within 60 days and HHS secretary in the annual report

D. Patient the media and the HHS within 60 days. - ANS C. Patient within 60 days and HHS secretary in the annual report Which of the following healthcare services can an adolescent younger than 18 access or refuse without a parental knowledge or consent in most states A. Emergency contraceptives B. Abortion C. Chemotherapy D. Transfusion - ANS A. Emergency contraceptives The process of time management begins y A. picking a time management tool B. Setting goals and priorities C. Organizing routines D. Ignoring interruptions - ANS B. Setting goals and priorities The nurse is educating an adult patient regarding medications for asthma. Which order would be the most appropriate for administration A. Flovent, Intal, Tobramycin B. Tobramycin, Intal, Albuterol C. Albuterol, Flovent, Tobramycin D. Intal, Tobramycin, Albuterol - ANS C. Albuterol, Flovent, Tobramycin (bronchodilator first to open, Corticosteroid to reduce inflammation, ABX last to make sure more can be absorbed) Telephone triage may be a responsibility of the ambulatory care nurse. What are the appropriate components of telephone triage? A. The nurse should state that he or she is unable to discuss medical information and refer the patient to the PCP B. The nurse must clearly identify him or herself, take a quick and accurate history and quickly be able to make a decision C. The nurse should call 911 D. The nurse should give generic information and leave the responsibility to the patient or caller - ANS B. The nurse must clearly identify him or herself, take a quick and accurate history and quickly be able to make a decision What are the best question types to ask when gaining inforation from a patient? A. Specific, open ended questions regarding current symptoms and medical history B. General questions with a yes or no answer C. Questions related to childhood diseases D. Demographics questions - ANS A. Specific, open ended questions regarding current symptoms and medical history IN what order would the nurse prioritize the care of the following patients presenting to the clinic at the same times: A parent carrying a smiling infant with a fever, a pale and

sweaty male wit flank pain for 2 days, a carpenter with a nail in his thumb, and a 3 year old with vomiting A. Flank pain, Infant with fever, 3 year old vomiting, man with nail B. Flank pain, 3 year old vomiting, infant with fever, man with nail C. 3 year old vomiting, infant with fever, flank pain, man with nail D. 3 year old with vomiting, flank pain, man with nail, and infant with fever - ANS B. Flank pain, 3 year old vomiting, infant with fever, man with nail Mom has described her childs symptoms as fever for 3 days, and vomiting for the last 24 hours. She states the child has been very sleepy for the last 2 - 3 hours. What subtle symptom alerts the nurse that this child needs to be seen as soon as possible A. 3 days of fever B. 3 days of fever , 1 day of vomiting C. 1 day of vomiting D. very sleepy for 2 - 3 hours with fever for 3 days. - ANS D. very sleepy for 2 - 3 hours with fever for 3 days. The ambulatory care nurse takes a phone call from the daughter of a 60 year old man stating that he isn't himself today. When questioned further the nurse discovers that the man has had periods of slurred speech for a few minutes on 2 occasions in the last 24 hours. What is your recommendation for this caller regarding what should be done. A. You understand that slurred speech may be the result of too much alcohol or lack of sleep and you encourage her to call back again if it occur B. You advise her to come to the clinic in the next 24 - 48 hours for some blood work C. You advise her that slurred speech may b a symptoms of TIA or impending stroke, especially in relation to him not being himself and to go to nearest ER D. You tell her you will call her ack when you can contact the MD for advise. - ANS C. You advise her that slurred speech may b a symptoms of TIA or impending stroke, especially in relation to him not being himself and to go to nearest ER A 70 year old female presents to the ambulatory care clinic complaining of fatigue. You begin you triage assessment and he has a HR of 50, Respiratory rate of 24, and BP 70/40. She denies Chest pain but you notice she rubs her elbows and states her arthritis is acting up. What would be your first priority when caring for this patient A. Offer her Tylenol and send her to the waiting room B. offer her Motrin for pain C. Continue her triage and history and finish the paperwork D. place her in a room, do an EKG and notify the MD to see her first - ANS D. place her in a room, do an EKG and notify the MD to see her first A mother presents to the clinic with a very wheezy 3 year old in her arms. You notice the child is pale and listless. What is your immediate response A. Triage the infant before the other patients waiting B. Bring the child to an exam room and wait for MD C. Bring the child to an exam room to finish triage in the privacy of a room

D. Bring the child to a room, Get the MD, and prepare to give Nebulizer treatment and possible transfer to acute facility - ANS D. Bring the child to a room, Get the MD, and prepare to give Nebulizer treatment and possible transfer to acute facility What nonverbal clues would indicate that a patient of any age is having difficulty breathing A. Change in color, retractions and noisy breathing B. laughing and joking during triage assessment C. Slight wheezing when lifting heavy objects D. Sweating in a warm room with exertion - ANS A. Change in color, retractions and noisy breathing What would be the most appropriate order of importance for information an adult client shares when coming to a clinic visit. A. Past medical, past surgical, medications, allergies and insurance information B. Current complaints, past 24 - 48 ours leading to complaint, meds, allergies and past medical history C. Current meds, allergies, past medical and past surgical D. Current demographics, current insurance, complaint, medical history and surgical history - ANS B. Current complaints, past 24-48 ours leading to complaint, meds, allergies and past medical history A 50 year old male comes to the clinic stating he cannot shake this "flu" you observe that he is clammy, pale and has an irregular HR. He is a large man with rugged appearance. He is friendly and apologetic for bothering you with his silly complaints. What is your plan of care for this patient A. You suspect he ahs a low tolerance for being ill and offer him Tylenol while he waits to see the MD B. You suspect he has the newest flu going around and offer him hot tea while he waits to see the MD C. You suspect there is more to his complaint than he states and immediately begin a cardiac workup by placing him in a room and ordering EKG D. You finish the triage and send him to the waiting room understanding - ANS C. You suspect there is more to his complaint than he states and immediately begin a cardiac workup by placing him in a room and ordering EKG The ambulatory care setting must include which of the following for the nurse to be able to properly triage a patient. A. Television B. Vending machines C. Private room for triage D. Computer - ANS D. Computer The nurse working in the ambulatory care setting must have which of the following skills to perform the role of triage nurse A Assessment and typing skills