AMB-BC Ambulatory care nursing certification
validating expertise in outpatient care, health
promotion, patient education, and chronic disease
management.
Question 1
A 45-year-old patient with hypertension calls the ambulatory clinic reporting a
blood pressure of 158/94 mmHg at home. The patient states, "I forgot to take my
medication yesterday." Which action should the nurse take FIRST?
A) Schedule an immediate clinic visit
B) Instruct the patient to take the missed dose and resume the regular
schedule
C) Advise the patient to double the next dose
D) Refer the patient to the emergency department
Rationale: For a single missed dose of antihypertensive medication, the
appropriate action is to instruct the patient to take the missed dose if it is not close
to the next scheduled dose and resume the regular schedule. Doubling the next
dose can cause hypotension. Immediate clinic visit or ED referral is not necessary
for a single missed dose without concerning symptoms.
Question 2
A 62-year-old patient with diabetes reports a fasting blood glucose of 210 mg/dL
for three consecutive days. The patient is taking metformin 1,000 mg twice daily.
What is the nurse's PRIORITY action?
A) Assess for factors contributing to hyperglycemia including diet, illness, and
medication adherence
B) Increase the metformin dose
C) Initiate insulin therapy
D) Refer the patient to a dietitian
Rationale: Before making any changes to the treatment plan, the nurse must assess
for contributing factors such as dietary changes, infection, stress, medication
adherence, or new medications. Increasing the dose or initiating insulin without
,assessment could be dangerous. Dietitian referral may be appropriate but is not the
priority.
Question 3
A 38-year-old patient presents to the ambulatory clinic with a 2-day history of
fever, cough, and myalgia. Vital signs: temperature 101.2°F (38.4°C), heart rate 98
bpm, respiratory rate 22 breaths/min, blood pressure 118/76 mmHg, oxygen
saturation 96% on room air. Which action should the nurse take FIRST?
A) Perform a focused respiratory assessment and obtain a chest X-ray if
indicated
B) Administer antipyretics immediately
C) Start empiric antibiotics
D) Send the patient home with symptomatic treatment
Rationale: The nurse should perform a focused respiratory assessment to evaluate
for signs of pneumonia or other respiratory conditions. Antipyretics may be
appropriate but should not be given before assessment. Empiric antibiotics are not
indicated without a definitive diagnosis. Sending the patient home without
assessment is unsafe.
Question 4
A 55-year-old patient with a history of heart failure reports a 5-pound weight gain
in 3 days and increased shortness of breath. Which assessment finding is MOST
concerning?
A) Mild ankle edema
B) Jugular venous distension and crackles in the lung bases
C) Fatigue
D) Occasional cough
Rationale: Jugular venous distension and crackles indicate worsening pulmonary
congestion and fluid overload, requiring prompt intervention. Ankle edema,
fatigue, and occasional cough are also concerning but less acute than signs of
pulmonary congestion.
,Question 5
During a telehealth visit, a 70-year-old patient reports feeling "dizzy and
lightheaded" when standing up. Which question should the nurse ask FIRST?
A) "Have you been eating properly?"
B) "Are you taking any new medications or have any of your doses changed
recently?"
C) "Have you had any falls recently?"
D) "Do you have a history of heart problems?"
Rationale: Medication changes are a common cause of orthostatic hypotension in
older adults. The nurse should first assess for recent medication changes, including
new prescriptions, dose adjustments, or over-the-counter medications. This
information is critical for identifying the cause and determining the appropriate
intervention.
Question 6
A 48-year-old patient with a new diagnosis of type 2 diabetes is being evaluated.
The patient's hemoglobin A1c is 9.2%. Which assessment is MOST important to
include?
A) Assess for symptoms of hyperglycemia including polyuria, polydipsia, and
polyphagia
B) Assess for signs of hypoglycemia
C) Assess for diabetic ketoacidosis
D) Assess for peripheral neuropathy
Rationale: An A1c of 9.2% indicates poor glycemic control. The nurse should
assess for symptoms of hyperglycemia, which may indicate the need for treatment
intensification. While peripheral neuropathy and other complications may be
present, the priority is assessing current glycemic status and symptoms.
Question 7
A 28-year-old female patient presents with complaints of fatigue, cold intolerance,
and weight gain. Vital signs: heart rate 54 bpm, blood pressure 110/72 mmHg.
Which laboratory test should the nurse anticipate?
, A) Thyroid-stimulating hormone (TSH)
B) Complete blood count
C) Fasting blood glucose
D) Electrolyte panel
Rationale: The patient's symptoms (fatigue, cold intolerance, weight gain,
bradycardia) are consistent with hypothyroidism. TSH is the initial screening test
for thyroid dysfunction. Other tests may be ordered but TSH is the priority.
Question 8
A 65-year-old patient with chronic kidney disease stage 3 has a serum creatinine of
2.2 mg/dL (baseline 1.4 mg/dL). The patient reports taking ibuprofen for knee
pain. Which action should the nurse take?
A) Instruct the patient to stop taking ibuprofen and notify the provider
B) Continue ibuprofen as needed for pain
C) Increase the ibuprofen dose for better pain control
D) Switch to naproxen
Rationale: NSAIDs can cause acute kidney injury, especially in patients with pre-
existing renal disease. The nurse should instruct the patient to stop taking
ibuprofen and notify the provider. Continuing NSAIDs or switching to another
NSAID could worsen renal function.
Question 9
A 72-year-old patient presents to the ambulatory clinic for a routine visit. The
patient's family reports that the patient has become increasingly forgetful over the
past 6 months and has difficulty managing finances. Which screening tool should
the nurse use?
A) Mini-Cog
B) PHQ-9
C) Morse Fall Scale
D) Braden Scale
Rationale: The Mini-Cog is a brief, validated screening tool for cognitive
impairment that includes a three-item recall test and a clock-drawing test. It is
practical for use in ambulatory settings. The PHQ-9 screens for depression, the
validating expertise in outpatient care, health
promotion, patient education, and chronic disease
management.
Question 1
A 45-year-old patient with hypertension calls the ambulatory clinic reporting a
blood pressure of 158/94 mmHg at home. The patient states, "I forgot to take my
medication yesterday." Which action should the nurse take FIRST?
A) Schedule an immediate clinic visit
B) Instruct the patient to take the missed dose and resume the regular
schedule
C) Advise the patient to double the next dose
D) Refer the patient to the emergency department
Rationale: For a single missed dose of antihypertensive medication, the
appropriate action is to instruct the patient to take the missed dose if it is not close
to the next scheduled dose and resume the regular schedule. Doubling the next
dose can cause hypotension. Immediate clinic visit or ED referral is not necessary
for a single missed dose without concerning symptoms.
Question 2
A 62-year-old patient with diabetes reports a fasting blood glucose of 210 mg/dL
for three consecutive days. The patient is taking metformin 1,000 mg twice daily.
What is the nurse's PRIORITY action?
A) Assess for factors contributing to hyperglycemia including diet, illness, and
medication adherence
B) Increase the metformin dose
C) Initiate insulin therapy
D) Refer the patient to a dietitian
Rationale: Before making any changes to the treatment plan, the nurse must assess
for contributing factors such as dietary changes, infection, stress, medication
adherence, or new medications. Increasing the dose or initiating insulin without
,assessment could be dangerous. Dietitian referral may be appropriate but is not the
priority.
Question 3
A 38-year-old patient presents to the ambulatory clinic with a 2-day history of
fever, cough, and myalgia. Vital signs: temperature 101.2°F (38.4°C), heart rate 98
bpm, respiratory rate 22 breaths/min, blood pressure 118/76 mmHg, oxygen
saturation 96% on room air. Which action should the nurse take FIRST?
A) Perform a focused respiratory assessment and obtain a chest X-ray if
indicated
B) Administer antipyretics immediately
C) Start empiric antibiotics
D) Send the patient home with symptomatic treatment
Rationale: The nurse should perform a focused respiratory assessment to evaluate
for signs of pneumonia or other respiratory conditions. Antipyretics may be
appropriate but should not be given before assessment. Empiric antibiotics are not
indicated without a definitive diagnosis. Sending the patient home without
assessment is unsafe.
Question 4
A 55-year-old patient with a history of heart failure reports a 5-pound weight gain
in 3 days and increased shortness of breath. Which assessment finding is MOST
concerning?
A) Mild ankle edema
B) Jugular venous distension and crackles in the lung bases
C) Fatigue
D) Occasional cough
Rationale: Jugular venous distension and crackles indicate worsening pulmonary
congestion and fluid overload, requiring prompt intervention. Ankle edema,
fatigue, and occasional cough are also concerning but less acute than signs of
pulmonary congestion.
,Question 5
During a telehealth visit, a 70-year-old patient reports feeling "dizzy and
lightheaded" when standing up. Which question should the nurse ask FIRST?
A) "Have you been eating properly?"
B) "Are you taking any new medications or have any of your doses changed
recently?"
C) "Have you had any falls recently?"
D) "Do you have a history of heart problems?"
Rationale: Medication changes are a common cause of orthostatic hypotension in
older adults. The nurse should first assess for recent medication changes, including
new prescriptions, dose adjustments, or over-the-counter medications. This
information is critical for identifying the cause and determining the appropriate
intervention.
Question 6
A 48-year-old patient with a new diagnosis of type 2 diabetes is being evaluated.
The patient's hemoglobin A1c is 9.2%. Which assessment is MOST important to
include?
A) Assess for symptoms of hyperglycemia including polyuria, polydipsia, and
polyphagia
B) Assess for signs of hypoglycemia
C) Assess for diabetic ketoacidosis
D) Assess for peripheral neuropathy
Rationale: An A1c of 9.2% indicates poor glycemic control. The nurse should
assess for symptoms of hyperglycemia, which may indicate the need for treatment
intensification. While peripheral neuropathy and other complications may be
present, the priority is assessing current glycemic status and symptoms.
Question 7
A 28-year-old female patient presents with complaints of fatigue, cold intolerance,
and weight gain. Vital signs: heart rate 54 bpm, blood pressure 110/72 mmHg.
Which laboratory test should the nurse anticipate?
, A) Thyroid-stimulating hormone (TSH)
B) Complete blood count
C) Fasting blood glucose
D) Electrolyte panel
Rationale: The patient's symptoms (fatigue, cold intolerance, weight gain,
bradycardia) are consistent with hypothyroidism. TSH is the initial screening test
for thyroid dysfunction. Other tests may be ordered but TSH is the priority.
Question 8
A 65-year-old patient with chronic kidney disease stage 3 has a serum creatinine of
2.2 mg/dL (baseline 1.4 mg/dL). The patient reports taking ibuprofen for knee
pain. Which action should the nurse take?
A) Instruct the patient to stop taking ibuprofen and notify the provider
B) Continue ibuprofen as needed for pain
C) Increase the ibuprofen dose for better pain control
D) Switch to naproxen
Rationale: NSAIDs can cause acute kidney injury, especially in patients with pre-
existing renal disease. The nurse should instruct the patient to stop taking
ibuprofen and notify the provider. Continuing NSAIDs or switching to another
NSAID could worsen renal function.
Question 9
A 72-year-old patient presents to the ambulatory clinic for a routine visit. The
patient's family reports that the patient has become increasingly forgetful over the
past 6 months and has difficulty managing finances. Which screening tool should
the nurse use?
A) Mini-Cog
B) PHQ-9
C) Morse Fall Scale
D) Braden Scale
Rationale: The Mini-Cog is a brief, validated screening tool for cognitive
impairment that includes a three-item recall test and a clock-drawing test. It is
practical for use in ambulatory settings. The PHQ-9 screens for depression, the
