ANCC Ambulatory Care Nursing 2 — Questions and Answers
Question 1: A nurse working in an ambulatory infusion center notes that a patient's IV site is red, warm, and swollen. This finding is MOST consistent with:
- Phlebitis (Correct answer)
- Infiltration
- Air embolism
- Speed shock
Correct answer: Phlebitis
Redness, warmth, and swelling at an IV site are classic signs of phlebitis, indicating inflammation of the vein.
Question 2: In ambulatory care nursing, which ethical principle is best demonstrated when a nurse ensures a patient understands their diagnosis and treatment options before signing a consent form?
- Beneficence
- Justice
- Autonomy (Correct answer)
- Nonmaleficence
Correct answer: Autonomy
Autonomy respects the patient's right to make informed decisions about their own health care, which is facilitated by ensuring they fully understand their situation.
Question 3: A nurse is reviewing a patient's medication list and identifies a potential drug-drug interaction. The MOST appropriate next step is to:
- Administer the medications as prescribed and monitor the patient
- Withhold all medications until the physician returns
- Contact the prescribing provider to clarify the order before administration (Correct answer)
- Instruct the patient not to take the medications at home
Correct answer: Contact the prescribing provider to clarify the order before administration
The nurse has a professional and legal responsibility to clarify orders with the prescriber before administering medications involved in a potentially harmful drug interaction.
Question 4: When implementing a quality improvement initiative in an ambulatory care clinic, the PDSA (Plan-Do-Study-Act) cycle is used primarily to:
- Evaluate individual nurse performance annually
- Test changes on a small scale before widespread implementation (Correct answer)
- Create new policies without staff input
- Eliminate the need for data collection
Correct answer: Test changes on a small scale before widespread implementation
The PDSA cycle is a rapid-cycle improvement model that tests interventions on a small scale to gather data before broader implementation.
Question 5: A clinic nurse is assessing a patient's pain on a 0-10 numeric rating scale. The patient rates pain as 7/10. Which intervention is MOST appropriate?
- Document the score and reassess at the next scheduled visit
- Administer the maximum dose of all available analgesics immediately
- Assess the quality, location, and duration of pain, then collaborate with the provider for a treatment plan (Correct answer)
- Reassure the patient that a score of 7 is manageable and advise rest
Correct answer: Assess the quality, location, and duration of pain, then collaborate with the provider for a treatment plan
A comprehensive pain assessment (PQRST) must precede any intervention, and collaboration with the provider ensures an appropriate, individualized treatment plan.
Question 6: In ambulatory care, which federal law primarily governs the privacy and security of patient health information?
- Occupational Safety and Health Act (OSHA)
- Health Insurance Portability and Accountability Act (HIPAA) (Correct answer)
- Emergency Medical Treatment and Labor Act (EMTALA)
- Americans with Disabilities Act (ADA)
Correct answer: Health Insurance Portability and Accountability Act (HIPAA)
HIPAA establishes national standards for protecting the privacy and security of individually identifiable health information (PHI) in all health care settings.
Question 7: Which action BEST demonstrates cultural competence in an ambulatory care nursing encounter?
- Assuming all patients from the same country share identical beliefs
- Using family members as interpreters to save time
- Asking the patient about their health beliefs and preferred language before teaching (Correct answer)
- Providing education only in English to promote consistency
Correct answer: Asking the patient about their health beliefs and preferred language before teaching
Cultural competence requires assessing individual patient beliefs, values, and language preferences to provide respectful and effective care.
ANCC Ambulatory Care Nursing 2
A nurse working in an ambulatory infusion center notes that a patient's IV site is red, warm, and swollen.
This finding is MOST consistent with: