Ambulatory Care Test Ambulatory Care Nursing 5 — Questions and Answers
Question 1: A patient in the ambulatory oncology clinic asks why their chemotherapy is being given in smaller weekly doses rather than the traditional larger doses every three weeks. What is the most accurate nursing explanation?
- Weekly dosing is cheaper and easier for the pharmacy to prepare
- Metronomic or dose-dense schedules can reduce cumulative toxicity while maintaining antitumor effect (Correct answer)
- The patient's insurance only covers weekly administration
- Smaller doses are used when the full dose would not fit in one IV bag
Correct answer: Metronomic or dose-dense schedules can reduce cumulative toxicity while maintaining antitumor effect
Metronomic dosing strategies aim to minimize toxicity and exploit anti-angiogenic properties while maintaining efficacy compared to traditional bolus dosing.
Question 2: Under HIPAA, an ambulatory care nurse may share a patient's protected health information (PHI) without written authorization in which situation?
- Sharing the patient's diagnosis with their employer upon request
- Disclosing information to the patient's treating specialist for care coordination (Correct answer)
- Releasing records to the patient's adult child without a signed release
- Providing information to a researcher studying the clinic's patient population
Correct answer: Disclosing information to the patient's treating specialist for care coordination
HIPAA permits disclosure of PHI for treatment purposes, including sharing with providers directly involved in the patient's care, without additional authorization.
Question 3: A nurse is reviewing a patient's chart before a dermatology visit and notices the patient has not had a tetanus booster (Td) in 12 years. The patient is age 52 with no other immunization concerns. What is the nurse's best action?
- Administer Tdap now since the patient is overdue
- Notify the provider of the immunization gap and obtain an order for Tdap before the patient leaves (Correct answer)
- Schedule a separate immunization visit so today's appointment is not delayed
- Document the finding and defer to the patient's primary care provider
Correct answer: Notify the provider of the immunization gap and obtain an order for Tdap before the patient leaves
Ambulatory nurses use every healthcare encounter to close immunization gaps; flagging the gap to the provider and obtaining a same-visit order optimizes the opportunity.
Question 4: A patient diagnosed with depression is being seen for a routine physical in the ambulatory care clinic. The PHQ-9 score is 19. The patient denies suicidal ideation. What is the most appropriate nursing action?
- File the PHQ-9 in the chart and wait for the provider to address it at the visit
- Alert the provider immediately and ensure the patient is not left alone until the provider evaluates (Correct answer)
- Encourage the patient to call a mental health hotline after the appointment
- Reassure the patient that a score of 19 is manageable with lifestyle changes
Correct answer: Alert the provider immediately and ensure the patient is not left alone until the provider evaluates
A PHQ-9 score of 19 indicates severe depression; the provider must be immediately informed so the patient can receive timely evaluation and safety planning.
Question 5: An ambulatory care nurse is coordinating care for a patient recently discharged from the hospital after a heart failure exacerbation. Which nursing action best reduces 30-day readmission risk?
- Mailing the patient an educational pamphlet about heart failure diet
- Scheduling a follow-up visit within 7 days of discharge, conducting a medication reconciliation, and performing a teach-back on daily weights and symptom monitoring (Correct answer)
- Calling the patient once two weeks after discharge
- Ensuring the patient has a cardiology appointment within 90 days
Correct answer: Scheduling a follow-up visit within 7 days of discharge, conducting a medication reconciliation, and performing a teach-back on daily weights and symptom monitoring
Early post-discharge follow-up, medication reconciliation, and confirmed patient education on self-monitoring are the evidence-based bundle most effective at reducing heart failure readmissions.
Question 6: A nurse working in a primary care clinic is conducting a social determinants of health (SDOH) screening. A patient discloses food insecurity. Which is the most appropriate immediate nursing response?
- Document the finding and recommend the patient budget better
- Acknowledge the patient's disclosure, provide information about local food assistance programs, and include SDOH findings in the care plan (Correct answer)
- Refer the patient to social work at the next visit if they bring it up again
- Advise the patient to apply for Medicaid to cover food costs
Correct answer: Acknowledge the patient's disclosure, provide information about local food assistance programs, and include SDOH findings in the care plan
Acknowledging the disclosure, providing actionable community resources, and incorporating SDOH into the care plan reflects patient-centered ambulatory nursing care.
Question 7: Which infection control practice is most important for an ambulatory care nurse to perform between patients in a busy outpatient clinic?
- Changing scrubs between each patient contact
- Performing hand hygiene using soap and water or alcohol-based hand rub before and after every patient contact (Correct answer)
- Wearing a new N95 respirator for each patient room
- Applying a fresh layer of gloves over existing gloves to save time
Correct answer: Performing hand hygiene using soap and water or alcohol-based hand rub before and after every patient contact
Hand hygiene is the single most effective measure for preventing healthcare-associated infection transmission in any clinical setting.
