Ambulatory nurse certification exam 38 Questions with Verified Answers
The nursing process is foundational to the process of patient education. Which
... [Show More] of the following describes the evaluation phase of patient education?
a. Tailoring teaching, learning strategies, and interventions.
b. Measuring learning attained and level of self-efficacy.
c. Determining readiness to learn and learning needs?
d. Mutually setting goals and outcomes expected. - CORRECT ANSWER B. Measuring learning attained and level of self-efficacy
For patients with chronic pain, educational interventions should include:
a. Masking nonverbal indications of pain to reduce the anxiety of their family and other caregivers.
b. Learning to tolerate mild to moderate pain without interventions to avoid addiction to pain medications.
c. Recognizing distraction and relaxation techniques are rarely helpful in reducing pain significantly.
d. Understanding the length of action of various medications and which can be taken together or alternately. - CORRECT ANSWER D. Understanding the length of action of various medications and which can be taken together or alternately.
Patients with chronic illnesses need to develop the ability to deal with all the disease and its treatment entail. Core skills for chronic disease self-management include:
a. Understanding the evidence-based guidelines.
b. Becoming familiar with community and Internet resources.
c. Problem solving, decision making, and taking actions.
d. Focusing on the health issues that contribute to emergency department visits or hospitalizations. - CORRECT ANSWER C. Problem-solving, decision making and taking actions.
The Patient Protection and Affordable Care Act of 2010 (PPACA) encourages health care providers to focus on efforts such as implementing evidence-based educational programs and encourage patient self-efficacy. What is the best definition of patient self-efficacy?
a. The patient plays a central role in preventing and managing his or her illness.
b. Health plans cover preventive services and wellness care, making them more affordable to patients.
c. Nurses and other providers of health care are responsible for reinforcing patients' and families' responsibility for health care.
d. The patient's perception of his or her own ability to attain health care goals. - CORRECT ANSWER d. The patients perception of his or her own ability to attain health care goals.
The Centers for Disease Control recently set a goal to reduce the number of unintended pregnancies in the United States by 30% in the next few years. Nurses providing counseling should consider for the following:
a. Unintended pregnancies are most common in women in their 20's.
b. All contraceptive methods also protect against sexually transmitted diseases.
c. Cultural and ethnic beliefs may affect family planning options.
d. With sufficient education about the contraceptive method chosen, follow-up may not be necessary. - CORRECT ANSWER c. Cultural and ethnic beliefs may affect family planning options.
In counseling about childhood or adolescent drinking, which of the following should be considered?
a. The physical and psychological effects of alcohol use.
b. Consumption of alcohol during pregnancy can lead to severe physical and mental problems for the infant.
c. Risky drinking has been defined as more than four drinks per occasion for males and more than three drinks per occasion for females.
d. Speaking frequently with a child about drinking is likely to alienate him or her and may have a negative rather than positive effect on behavior. - CORRECT ANSWER a. The physical and psychological effects of alcohol use.
Childhood obesity has become a national health problem in the United States. Topics important to include in counseling for the parents of school-aged children include:
a. Diets high in energy are also high in nutritional value.
b. Provide a variety of foods, including grains, fruits, and vegetables.
c. School-aged children will automatically choose the right nutrients for themselves if they see their parents and other role models doing so.
d. A multivitamin is important to supplement a child's diet at this age. - CORRECT ANSWER b. Provide a variety of foods, including grains, fruits, and vegetables.
Mr. McIntire is a 37 year old patient who has a 25 pack a year history of smoking. Today, he has told his physician he is ready to quit. Ryan, the ambulatory care nurse, has been asked to assist Mr. McIntire. Which of the following describes a potential method to assist this patient to quit smoking?
a. Explain that relapsing is part of the process.
b. Advise Mr. McIntire about the harms of smoking, which impact nearly every organ in the body.
c. Set specific goals and a quit date.
d. Use motivational interviewing to help him understand his ambivalence about quitting. - CORRECT ANSWER c. Set specific goals and a quit date.
A 53 year old man has recently been diagnosed with diabetes. The provider has sent him to the nurse for instruction about glucose monitoring at home. The patient arrives for teaching as scheduled, but has not yet purchased the electronic monitoring device. Which of the following would be the best nursing action at this time?
a. Assess the patient's current understanding and his interest in learning about self-monitoring his glucose.
b. Demonstrate the procedure using the glucose-monitoring device used in the office.
c. Have the office assistant give him written materials about glucose control and schedule him to return another day to discuss. - CORRECT ANSWER a. Assess the patients current understanding and his interest in learning about self-montoring his glucose.
Primary prevention of HIV and other sexually transmitted diseases (STDs) would include the following:
a. Use of condoms and avoidance of anonymous partners.
b. Vaccination against herpes, hepatitis and meninogococcal infections..
c. Prophylactic antibiotics for any oral sex.
d. Annual health screenings. - CORRECT ANSWER a. use of condoms and avoidance of anonymous partners.
One of the developmental considerations for teaching an adolescent is :
a. They tend to build on past life experiences which may be relevant to the new learning.
b. They are reflecting on unsatisfactory life aspects.
c. One should anticipate negative responses, but support autonomy by involving them in decision-making whenever possible.
d. Parents are strong role models for the development of health habits at this stage. - CORRECT ANSWER c. One should anticipate negative responses, but support autonomy by involving them in decision-making whenever possible.
An ambulatory nurse should teach adults the importance of routine screening for which of the following?
a. Lung cancer
b. Ovarian cancer
c. Colorectal cancer
d. bladder cancer - CORRECT ANSWER c. Colorectal cancer
Legal mandates for professional nurses to educate patients include:
a. The Joint Commission's requirements
b. State's nurse practice acts.
c. American Nurses Association's standards of practice.
d. American Hospital Association's list of patient rights. - CORRECT ANSWER b. State's nurse practice acts.
As an advocate for patients, an ambulatory care nurse may provide coordination of care across service lines and venues. Patient education by the nurse related to this role may include:
a. Expressing his or her voice in the allocation of health resources.
b. Evaluating services available and applying process improvement to decrease inefficiencies and resolve gaps.
c. Increasing outreach efforts in the community.
d. Orienting the patient to services available that may meet their needs. - CORRECT ANSWER d. Orienting the patient to services available that may meet their needs.
Ms. Brown, a 21 year old university student, has been diagnosed with hepatitis A. she insists she is able to return to classes. An important aspect of her patient education includes:
a. Hepatitis A is contagious and she needs to take precautions to prevent its transmission to others.
b. Hepatitis A is a reportable disease, so she needs to contact the health department.
c. She probably contracted this illness because has not been taking good care of herself, with proper rest and nutrition.
d. Smoking or secondhand smoke exposure will delay her recovery. - CORRECT ANSWER a. Hepatitis A is contagious and she needs to take precautions to prevent its transmission to others.
What is the most important factor to consider in choosing printed materials for patient education?
a. Age of the patient
b. Developmental stage of the patient
c. Patient readiness to learn
d. Literacy level of the patient - CORRECT ANSWER d. Literacy level of the patient
Following a breast biopsy under moderate sedation, the nurse is preparing to discharge the patient. What patient education is the most important for the patient's safety in the next few hours?
a. How to take care of the wound and identify signs of infection.
b. How to obtain the biopsy results.
c. Eating and drinking lightly until the nausea from the sedation subsides.
d. Avoiding driving or operating machinery for the rest of the day. - CORRECT ANSWER d. Avoiding drinking or operating machinery for the rest of the day.
If a patient is screened and found to have hypertension and dyslipidemia, what lifestyle recommendations should be considered?
a. Plan for a screening stress electrocardiogram every 5 years.
b. Manage weight through diet and exercise.
c. Avoid constipation through fluids and high fiber foods to prevent straining to have a bowel movement.
d. Because of the risk of kidney damage, drink the equivalent of eight glasses of water daily. - CORRECT ANSWER b. Manage weight through diet and exercise.
Healthy people 2020 identifies nationwide priorities for health improvement. Included is an objective that health care providers address health literacy needs by several actions, including:
a. Asking the patient to describe how he or she will follow the instructions provided.
b. Facilitating access to specialized health services.
c. Addressing the patient's emotional readiness to learn.
d. Providing more written materials and/or internet resources. - CORRECT ANSWER a. Asking the patient to describe how he or she will follow the instructions provided.
A telephone triage RN receives a call from a 45 year old woman complaining of a "migraine headache". The nurse determines this patient has many knowledge deficits related to headaches and their management. What would be an appropriate rationale for deferring the education to another time?
a. Migraine headaches are more common in some ethnic minorities, and the nurse is unsure about this woman's ethnic background.
b. The patient may not be physically or emotionally ready to learn since she is in significant pain.
c. Patients with migraine headaches need to be seen and evaluated by a provider urgently, so the nurse needs to facilitate an urgent appointment or emergency room visit.
d. She is unable to provide this patient with the clinic's standard teaching sheet for migraine headaches. - CORRECT ANSWER b. The patient may not be physically or emotionally ready to learn since she is in significant pain.
Aspirin therapy has recently been approved for primary prevention of cardiovascular events. However, the risk-to-benefit ratio should be assessed because aspirin is known to increase risk of:
a. Hot flashes in post-menopausal women.
b. Bronchospasm in patients with asthma
c. Gastrointestinal bleeding
d. Gall bladder information - CORRECT ANSWER c. Gastrointestinal bleeding
Which of the following is cited frequently as a barrier to patient counseling in ambulatory care?
a. Lack of interest by patients
b. Time constraints for clinicians and the episodic nature of interactions.
c. Inability to overcome language barrier and low literacy.
d. Lack of community resources and printed materials. - CORRECT ANSWER b. Time constraints for Clinicians and episodic nature of interactions
Motivational interviewing has been described as a patient-centered and collaborative method of changing behavior. A feature of motivational interviewing involves individuals who:
a. Learn by observing others
b. Change behavior in response to reinforcements; increasing rewards for healthy behaviors and decreasing rewards for unhealthy ones.
c. Take health related action if they perceive susceptibility to and severity of an illness can be reduced by taking the action.
d. Have self-eficacy and can be guided to evaluate their own behavior and generate their own behavior and generate their own solutions to change. - CORRECT ANSWER d. Have self-eficacy and can be guided to evaluate their own behavior and generate their own solutions to change.
In providing health education about weight management to a large group, which instructional method is most likely to be successful?
a. Case study
b. Role playing
c. Powerpoint presentation and discussion.
d. Simulation exercises - CORRECT ANSWER c. Powerpoint presentation and discussion
Whitney, a 24- year-old African American, presented in labor for her first baby, having had no prenatal care. She does not want any extra tests done on her baby, and does not see the reason for hang the baby tested for sickle cell disease, since she had her husband are both healthy. Her nurse would best explain the reason for the testing by saying:
a. One in 10 African Americans has sickle cell trait, and 1 in 325 has sickle cell disease.
b. Whitney may have sickle cell disease and not know it, because the chronic anemia and vasocculsive effects of sickle cell disease usually occur when a woman is older.
c. Although she and her husband may be healthy they may still have sickle cell trait, which could result in disease in their baby.
d. There are four major variants of the disease, and she or her husband may have one of the milder forms. - CORRECT ANSWER c. Although she and her husband may be healthy they may still have sickle cell trait which could result in disease in their baby.
The goal of performance improvement is to:
a. Identify root causes of problems and errors.
b. Validate existing knowledge and to generate new knowledge.
c. Measure and report the health status of patients.
d. Improve the delivery of care. - CORRECT ANSWER d. Improve the delivery of care
The ambulatory infusion center has collected data about environmental contamination with chemotherapeutic agents to evaluate their preventive practices and spill management. The findings indicate detectable levels of the agents on the floor in the area of the IV pole near infusion chair#1, but no measurable chemotherapeutic agents elsewhere in the infusion suite. This degree of variation in the data may be called:
a. Common-cause variation
b. Internal benchmarking
c. Special-cause variation
d. Prospective data - CORRECT ANSWER C. Special - cause variation
The purpose of a rating system for levels of evidence in evidence-based practice guidelines is to:
a. Indicate the optimal treatment plan that promotes the best patient outcomes.
b. Allow the reviewer to estimate the quality and strength of the evidence.
c. Enhance the adoption of best practices
d. Demonstrate the strength of the link to national standards. - CORRECT ANSWER b. Allow the reviewer to estimate the quality and strength of the evidence.
Which of the following is true about evidence-based practice?
a. Relies on established clinical practices from within an organization and the personal experiences of clinicians as the basis for designing practice protocols.
b. Integrates research evidence with clinical experience to support the best recommended guideline for practice.
c. Best evidence comes from a single descriptive or qualitative study.
d. Evidence-based practice measures the outcomes or results of care. - CORRECT ANSWER b. Integrates research evidence with clinical experience to support the best recommended guideline for practice.
Questions 30- 32 use this scenario: The group practice is purchasing an office building and renovating it for ambulatory care for both family medicine and medical specialities. It is not adjacent to the hospital, but is in an area that is considered "low crime" and otherwise safe. From a nursing perspective, which of the following is most important regarding the exterior of the building?
a. Conveniently accessible via public transportation.
b. Signage at the street is visible and clearly describes the facility.
c. The parking lot and curbs do not pose fall hazards and allow for wheelchair and stretcher access.
d. The facade and landscaping are attractive and congruent with the environment. - CORRECT ANSWER c. The parking lot and curbs do not pose fall hazards and allow for wheelchair and stretcher access.
The waiting area for all the specialities is planned for one centralized location, with check in windows for each clinical unit. Privacy of the check in and registration areas is supported by partitioning and sound proofing. A play area for children is planned in one cluster of seating. What other layout issue for the entrance, check-in, and waiting areas would be most important from a nursing perspective?
a. The space is warm and welcoming.
b. The patient's entrance is separate from the staff entrance.
c. There are bulletproof glass enclosures around the cashiers.
d. There is a separate waiting space for patients with potentially communicable diseases. - CORRECT ANSWER d. There is a separate waiting space for patients with potentially communicable diseases.
Prior to final approval of the space plan, the nurse manager identifies several additional clinical concerns. Which of the following is most important to safe patient care?
a. Appropriate containers to hold dirty instruments for transport, disposal, or reprocessing.
b. A flag or light system for communicating the status of the exam and treatment rooms.
c. Standarized exam room layouts
d. Space for patient teaching and nursing interventions in close proximity to the telephone work space. - CORRECT ANSWER a. appropriate containers to hold dirty instruments for transport, disposal or reprocessing.
In managing the budget of an outpatient clinic, which of the following would be considered a direct and variable cost of providing patient services?
a. Rent of the suite of offices and exam rooms
b. Cost of the human resources department, which manages hiring, payroll, and benefits.
c. Cost of the vaccines and other stock medications.
d. Liability insurance. - CORRECT ANSWER C. Cost of the vaccines and other stock medications
The general surgery physician group is planning to hire a bariatric surgeon to provide surgical interventions for patients who are morbidly obese. Which of the following facilities and equipment changes would be most important for staff safety?
a. Hallway and doorway clearance will accommodate extra-wide wheelchairs?
b. The area to discharge the patient from the clinic is near the exit of the building.
c. Patient transfer and lift devices are provided.
d. There are hallway safety rails installed. - CORRECT ANSWER c. patient transfer and lift devices are provided.
When doing a check on the emergency cart's defibrillator, the nurse finds it fails to charge rapidly to the appropriate level. In contacting the equipment maintenance department, she learns there have been similar issues with several defibrillators in the facility. After assuring well-functioning equipment is in place in the patient care areas, what is the most important action she should take next?
a. Assure a report is submitted to the manufacturer and the food and drug administration regarding the equipment failure.
b. Negotiate with the manufacturer for replacement or reimbursement for the defective equipment.
c. Educate other personnel about the policy regarding use of defibrillators.
d. Reassess how many defibrillators and other types of emergency equipment need to be available for patient emergencies across the facility. - CORRECT ANSWER a. Assure a report is submitted to the manufacturer and the food and drug administration regarding the equipment failure.
The growth in ambulatory care in the past 20 years has been primarily driven by:
a. Increased payment by health maintenance organizations for the use of new technology in outpatient settings.
b. Changes in reimbursement that have made it more cost effective to provide care in outpatient settings.
c. Patient preferences to have their care delivered in outpatient settings whenever possible.
d. Increased demand for services overall, as people are living longer with chronic illness. - CORRECT ANSWER b. changes in reimbursement that have made it more cost effective to provide care in outpatient setting.
Which of the following is true about determining staffing in ambulatory care?
a. Benchmarking surveys provide ratios that are useful in all ambulatory care specialties.
b. There are several well-researched and validated formulas and tools in the literature for determining staffing in ambulatory care.
c. Factors that influence staffing include payer mix, types of patient encounters, and requirements for each encounter.
d. Primary care clinics and surgical specialty clinics have very similar staffing requirements. - CORRECT ANSWER c. factors that influence staffing include payer mix, types of patient encounters, and requirements for each encounter.
Andrew Kim, RN, works as a member of a primary care team. There are multiple other roles on the team, including physicians, nurse practitioners, a clinical pharmacist (PharmD), medical assistants, clerks, and a social worker. A young female patient presents with a conflict in her family, and anxiety that her husband is leaving them. What would Andy's best action be?
a. Briefly assess and recommend the social worker's assistance to the patient.
b. Refer to outpatient psychiatry for crisis intervention.
c. determine if the patient is seeing a counselor'
d. Ask the physician to provide the assessment and support functions this patient might require. - CORRECT ANSWER a. Briefly access and recommend the social workers assistance to the patient. [Show Less]