ANCC AMB-BC Exam Questions

Correct answer: Review the patient's alcohol intake history

When a patient has elevated AST and ALT levels, the most appropriate next step is to review their alcohol intake history. Excessive alcohol consumption is a common cause of liver enzyme elevation, and identifying this as a contributing factor is crucial for managing and preventing further liver damage. By addressing alcohol intake, healthcare providers can take steps to reduce liver strain and improve the patient’s overall liver function.

Recommending a liver biopsy is a more invasive procedure that would only follow initial assessment of health factors, such as alcohol history and lifestyle assessment. It would typically only be considered if there was a serious concern for liver disease.

Advising immediate cessation of all medications may be excessive without first determining whether alcohol or other factors are responsible for the elevated enzymes. An MRI of the liver may be needed if further imaging is required, but it is not the first line of action; initial assessment should focus on modifiable or causative lifestyle factors like alcohol consumption.

Correct answer: Assess the patient’s adherence to their recommended treatments

When a patient’s fasting blood glucose levels are consistently elevated, the first step should be to assess their adherence to the recommended treatment plan. Non-adherence to medications, dietary guidelines, or other lifestyle recommendations is a common reason for poor glycemic control. By understanding the patient’s adherence, the nurse can identify any gaps in care and address them before making changes to the treatment plan.

Increasing the dosage of insulin or recommending dietary changes, such as a high-protein, low-carb diet, may be necessary in some cases, but these actions should only be taken after confirming adherence to the current plan. Adjusting medication or diet without addressing potential adherence issues could lead to unnecessary changes that do not solve the underlying problem. Checking fasting A1C levels is useful for long-term monitoring but is not the immediate priority in managing consistently elevated fasting glucose levels.

Correct answer: Assess for allergies to local anesthetics

Assessing for allergies to local anesthetics is the nurse's priority action before the procedure. Ensuring the patient does not have an allergy to the anesthetic is crucial for preventing an allergic reaction during the suturing process. This safety check must be completed before proceeding with the treatment.

Administering a tetanus shot is important but should not be considered more important than confirming the patient’s safety for the procedure. Assessing the patient’s availability for follow-up suture removal could be necessary for planning but is not the immediate priority. Ensuring the wound is sterilized with iodine is not a routine intervention. Even if it is necessary, confirming the patient can safely receive anesthesia is a higher-priority intervention.

Correct answer: Pulmonary function tests (PFTs)

Pulmonary function tests (PFTs) are the most critical preoperative assessment for a patient with chronic obstructive pulmonary disease (COPD) scheduled for surgery. PFTs provide valuable information on lung function, measuring parameters such as forced vital capacity and forced expiratory volume, which are essential for evaluating the patient's respiratory status.

A CBC provides hematologic status but does not assess respiratory function. An ECG evaluates cardiac function but does not directly address the pulmonary issues related to COPD. LFTs assess hepatic function, not respiratory risks or COPD status.

Correct answer: Apologize and provide the necessary information, allowing time for questions

The most effective way to handle this situation is to apologize and provide the necessary information, allowing time for questions. This approach acknowledges the patient’s concerns and demonstrates a commitment to providing comprehensive care.

Defending the previous care provided could make the patient feel dismissed and may escalate the situation. Suggesting the patient review written materials provided earlier may not address their immediate concerns or the reason they felt inadequately informed. Redirecting the conversation to the current visit avoids the issue and could further erode the patient’s trust.

Correct answer: Signs of dehiscence

Signs of dehiscence are the most important factor for the nurse to assess during the initial wound inspection. Dehiscence, or the partial or complete separation of the wound edges, can lead to complications such as infection and delayed healing. Identifying this early is crucial for timely intervention.

The type of sutures used could be relevant for understanding the closure method but does not directly impact the immediate assessment of wound healing. Retained foreign bodies should be assessed if there are signs of complications, but this would be uncommon in a straightforward surgical incision. The patient’s pain level is secondary to ensuring the wound is intact and free from dehiscence.

Correct answer: Encouraging the family to participate in decision-making

Encouraging the family to participate in decision-making is the best strategy for involving a patient’s family in the care coordination process. Family involvement in decision-making helps ensure the patient’s preferences and values are respected, and that the family is fully engaged in the care plan. This collaborative approach fosters better communication and alignment of care goals between the patient, family, and healthcare team.

Inviting the family to attend all medical appointments may be beneficial, but it can be impractical for the family and does not necessarily ensure active participation. Providing a copy of the care plan is helpful but does not engage the family in the decision-making process. Assigning a specific family member as the primary caregiver does not involve the broader family in care coordination and is not necessarily a good approach if the patient does not require a primary caregiver.

Correct answer: Start a supervised exercise program

Starting a supervised exercise program is the primary intervention for a patient with peripheral arterial disease (PAD) experiencing claudication. Exercise, particularly walking, can improve circulation, reduce symptoms, and increase the distance a patient can walk without pain. It is a non-invasive, first-line treatment that addresses the underlying issues of PAD.

Prescribing long-term bed rest is inappropriate and can worsen the condition by reducing circulation. Increasing dietary fat intake is not beneficial and may exacerbate atherosclerosis, a common cause of PAD. Beginning subcutaneous heparin therapy is not indicated for claudication, as heparin is used for acute blood clot prevention and treatment, not chronic PAD management.

Correct answer: Lisinopril

Lisinopril is contraindicated in patients with a history of angioedema associated with previous ACE inhibitor therapy. Angioedema is a potentially life-threatening condition that can cause swelling of the face, tongue, and airway, leading to respiratory distress. ACE inhibitors like lisinopril are known to cause angioedema in some patients, particularly those with a prior history of this reaction. As a result, lisinopril should be avoided in these individuals to prevent recurrent episodes of angioedema and associated complications.

Metoprolol, a beta-blocker, is not contraindicated in patients with a history of ACE inhibitor-induced angioedema, as it is not an ACE inhibitor. Losartan, an angiotensin II receptor blocker, is often used as an alternative to ACE inhibitors in patients with a history of angioedema due to its lower risk of inducing this reaction. Amlodipine is a calcium channel blocker and is also not contraindicated, as it does not share the same mechanism of action as ACE inhibitors.

Correct answer: Report the missing fire extinguisher to the safety officer immediately

Immediately reporting the missing fire extinguisher to the safety officer is the most appropriate action. The safety officer is responsible for ensuring fire safety equipment is properly maintained and available in case of an emergency. Reporting the issue immediately allows for prompt action to replace the extinguisher and ensure the clinic remains compliant with safety regulations.

Replacing the fire extinguisher with one from another area would leave another part of the clinic unprotected. Documenting the issue and continuing with the safety check without notifying the appropriate personnel may delay the replacement. Assessing if there is a pattern of missing fire extinguishers could delay corrective action.

Correct answer: 140/85 mmHg

A blood pressure reading of 140/85 mmHg best indicates a successful response to a low-sodium diet in a patient with hypertension. This reading, while still slightly elevated, is the best blood pressure reading of the options listed. The low-sodium diet aims to reduce blood pressure by minimizing fluid retention and vascular resistance, contributing to improved cardiovascular health. Achieving a blood pressure of 140/85 mmHg likely demonstrates the effectiveness of dietary modifications in managing hypertension and reducing the risk of complications associated with high blood pressure.

A blood pressure reading of 160/90 mmHg is elevated and does not indicate successful management of hypertension. A blood pressure reading of 180/95 mmHg is elevated and reflects poor control of hypertension. A blood pressure reading of 75/55 mmHg indicates hypotension and could indicate an underlying condition rather than the effects of a low-sodium diet.

Correct answer: Sharing knowledge from recent conferences

Sharing knowledge from recent conferences best illustrates a nurse's role in contributing to the professional development of peers. By sharing new information and insights gained from conferences, nurses help their colleagues stay informed about the latest trends, research, and best practices, thus supporting the overall professional growth of the team.

Critiquing colleagues' work during team meetings should be done constructively and not as a primary method of contributing to professional development. This approach should be used with discretion, as it can come across as overly critical.

Volunteering to help develop feedback for colleagues’ annual performance reviews does not have as direct an impact on ongoing professional development as sharing new knowledge. It could be seen as overstepping the nurse’s role if they are not involved in a leadership role.

Regularly reviewing current literature and guidelines is important for personal development, but does not support the development of a nurse’s peers unless they share the information with their peers.

Correct answer: Assess adherence to the prescribed regimen

The first step in evaluating the lack of improvement in a patient's hypertension management should be to assess adherence to the prescribed regimen. Non-adherence is a common reason for treatment failure, and confirming the patient is taking their medication as directed is critical before making any changes to the treatment plan. This approach helps identify and address barriers to adherence, which can improve the effectiveness of the current treatment.

Increasing the medication dosage without confirming adherence can lead to unnecessary risks, including potential side effects from overtreatment. Switching to a different medication may not resolve the issue if the patient is not adhering to the original prescription. Although evaluating for obstructive sleep apnea can help indicate a potential underlying cause of the hypertension, it should not precede ensuring the patient is following the current treatment regimen properly.

Correct answer: Setting long-term career goals

Setting long-term career goals is an essential component of a professional growth plan, as it provides a roadmap for future development and helps the nurse focus on the steps necessary to achieve their desired career trajectory. By setting specific, measurable, and achievable goals, the nurse can plan their educational and experiential path to align with these objectives.

Prioritizing job satisfaction is a subjective and fluctuating measure that doesn't offer concrete direction for growth. Taking measures to avoid burnout is important for maintaining work-life balance but does not directly contribute to professional development. Annual performance reviews should not be the sole method for assessing professional growth.

Correct answer: Sumatriptan

Sumatriptan is specifically indicated for the treatment of acute migraine attacks. It is a triptan drug that works by activating serotonin receptors, leading to vasoconstriction of dilated blood vessels in the brain, which is believed to be a contributing factor in migraines. By targeting the underlying mechanisms of migraines, sumatriptan provides effective relief from the headache and associated symptoms.

Ibuprofen, while helpful in alleviating pain, is not as effective as sumatriptan in treating the specific symptoms of a migraine attack. Metoclopramide is an antiemetic and can help alleviate nausea associated with migraines but does not address the headache itself. While it may be used as an adjunct treatment, it is not a primary medication for acute migraine attacks. Ondansetron is also an antiemetic that treats nausea and vomiting but does not directly address migraine headaches.

Correct answer: Regular assessment and updating of billing codes

Regular assessment and updating of billing codes should be advocated to ensure the sustainability of the clinic. Keeping billing codes up-to-date helps ensure the clinic is reimbursed appropriately and in compliance with current regulations, which directly impacts financial stability.

Increasing the availability of elective services may bring in additional revenue, but it doesn't address the core financial operations needed for sustainability. Increasing the clinic’s marketing efforts could attract more patients, but without proper billing practices, it wouldn't guarantee financial success. Regularly increasing pricing may deter patients and reduce the clinic's competitive edge, negatively affecting its sustainability in the long term.

Correct answer: Negotiating better rates with insurance providers

Negotiating better rates with insurance providers should be the focus to optimize the clinic's fiscal performance. This ensures the clinic receives fair reimbursement for services provided and can significantly impact the clinic's revenue without compromising patient care.

Increasing the number of services offered may add complexity and costs without necessarily improving revenue. Reducing the length of patient appointments could negatively impact the quality of care. Limiting the use of diagnostic tests could compromise patient care and does not necessarily align with improving fiscal performance.

Correct answer: Individualizing patient care based on nursing judgment

Individualizing patient care based on nursing judgment is emphasized in the ANA Scope and Standards of Practice for nursing. This standard recognizes that each patient is unique and that care should be tailored to meet individual needs using the nurse's professional judgment and expertise.

Encouraging patient education to be done by physicians overlooks the important role that nurses play in patient education. Delivering patient care strictly according to institutional protocols does not allow for the flexibility needed to address individual patient needs. Referring as many patient care decisions as possible to interdisciplinary healthcare teams is not always appropriate, as nurses are expected to make independent decisions within their scope of practice.

Correct answer: Initiation of a beta-blocker and anticoagulation therapy

Initiation of a beta-blocker and anticoagulation therapy is the priority in the initial management of new-onset atrial fibrillation (AF). A beta-blocker helps control the heart rate, and anticoagulation is crucial to prevent thromboembolic events, such as stroke, which is a major risk in AF.

Immediate cardioversion may be considered if the patient is hemodynamically unstable or after anticoagulation, but it is not the first step for stable new-onset AF. Increasing her antihypertensive medications may not directly address the arrhythmia. Scheduling an elective coronary angiogram is unnecessary unless there is evidence of underlying coronary artery disease.

Correct answer: Waist circumference

Waist circumference is the most important measure to evaluate the effectiveness of an exercise program in a patient with obesity because it directly reflects reductions in visceral fat, which is a significant contributor to obesity-related health risks. A decrease in waist circumference indicates an improvement in central obesity, which is linked to better cardiovascular and metabolic health outcomes, making it a key indicator of the program's success.

Energy levels are subjective and may not correlate with fat loss. Increased muscle strength and endurance are beneficial outcomes typically associated with exercise. They do not necessarily indicate a decrease in central fat, which is the most important outcome in a program designed to reduce health risks associated with obesity.