Chapter 5: Ambulatory Health Care Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 5: Ambulatory Health Care

MULTIPLE CHOICE

1. Ambulatory care nursing is an emerging field of nursing practice in which the nurse

a.

deals with clients who are ambulatory and able to walk into the clinic.

b.

is part of an interdisciplinary team offering primary, secondary, and tertiary care.

c.

offers an integrated system of care to persons within walking distance of the clinic.

d.

works only with clients who are not acutely ill.

ANS: B

The ambulatory nurse takes care of clients who are healthy, acutely ill, and chronically ill. Ambulatory nurses function as a member of an interdisciplinary team.

PTS: 1 DIF: Knowledge/Remembering REF: pp. 59-60, 61

OBJ: Intervention MSC: Health Promotion and Maintenance Health and Wellness

2. Ambulatory care centers include

a.

care available 24 hours a day, 7 days a week.

b.

care for short-term medical-surgical procedures.

c.

services for those unable to provide self-care after a procedure.

d.

sleeping accommodations for a family member.

ANS: B

Technological advances allow treatment in a short-term facility that previously required a hospital stay. Ambulatory care centers meet the needs of these clients and avoid a costly inpatient stay. They may or may not be open 24 hours, 7 days a week. A person who needed help with self-care would probably need in-home or hospital care. And since care duration is less than 24 hours, sleeping accommodations are not provided as part of ambulatory care centers.

PTS: 1 DIF: Comprehension/Understanding REF: p. 59

OBJ: N/A MSC: N/A

3. The nurse manager of an ambulatory care center assesses the center for environmental hazards to comply with guidelines of both the local state health department and the

a.

Ambulatory Care Nursing Administration and Practice.

b.

American Nurses Credentialing Center.

c.

Nurse Practice Act.

d.

Occupational Safety and Health Administration.

ANS: D

The Occupational Safety and Health Administration (OSHA) and the state health department oversee environmental factors. The other three options address professional practice and credentials.

PTS: 1 DIF: Comprehension REF: p. 69

OBJ: N/A

MSC: Safe, Effective Care Environment Safety and Infection Control-Accident Prevention

4. The facility that could best represent an ambulatory care center is a

a.

home health care agency.

b.

hospital with less than 50 beds.

c.

rehabilitation center.

d.

student health center.

ANS: D

The student health center is an ambulatory care center. The other options provide care to clients in their home, to inpatients, or as a prescribed follow-up service.

PTS: 1 DIF: Comprehension/Understanding REF: p. 65

OBJ: N/A MSC: N/A

5. In comparing the ambulatory care setting to an inpatient hospital setting, the nurse- instructor is correct in stating that the ambulatory care setting

a.

has had so many cost increases that a visit is just as costly as the hospital.

b.

is already in decline and offers limited employment opportunities.

c.

may create a feeling of greater stress to the client than a hospital setting.

d.

provides an environment where the client is less at risk for nosocomial infection.

ANS: D

The client using an ambulatory care center is exposed less to nosocomial infection and other hazards of hospitalization. Care is much more cost-efficient in ambulatory care centers. Employment opportunities are increasing in ambulatory care. Ambulatory care centers often are less stressful than hospitals for clients.

PTS: 1 DIF: Knowledge/Remembering REF: p. 59

OBJ: N/A MSC: Safe, Effective Care Environment Management of Care

6. A nurse working in an ambulatory care setting would provide secondary prevention activities such as

a.

carrying out hypertension screening.

b.

giving instructions after minor surgery.

c.

providing cardiac rehabilitation.

d.

teaching young adults the benefits of good nutrition.

ANS: A

Screening activities are secondary prevention. Teaching nutrition and giving instructions to prevent complications after minor surgery are both primary prevention. Cardiac rehabilitation is an example of tertiary prevention.

PTS: 1 DIF: Comprehension/Understanding REF: p. 61

OBJ: Intervention MSC: Health Promotion and Maintenance Disease Prevention

7. The nurse instructor describes an integrated delivery system and cites the example of

a.

a hospitals alignment with several physician groups to increase hospital referral.

b.

an outpatient clinic in the hospital.

c.

enrollees of the system being locked into the system of care for services.

d.

providers concerned about generating revenue.

ANS: A

Hospitals have aligned themselves with groups of physicians to increase hospital referral and provide greater coordination of care.

PTS: 1 DIF: Comprehension/Understanding REF: p. 63

OBJ: N/A MSC: Safe, Effective Care Environment Management of Care

8. A health care service that provides a defined population with a stated range of services through prepayment of an annual or monthly capitation fee is a(n)

a.

health maintenance organization (HMO).

b.

nurse-managed ambulatory center.

c.

outpatient service of a community hospital.

d.

preferred provider organization (PPO).

ANS: A

An HMO provides services to members for an annual or monthly capitation fee. Physicians who contract with a preferred provider organization get paid at a reduced rate for each service they provide.

PTS: 1 DIF: Knowledge/Remembering REF: p. 63

OBJ: N/A MSC: Safe, Effective Care Environment Management of Care

9. The facility least suited to the provision of primary health care is a(n)

a.

ambulatory care center.

b.

emergency department.

c.

HMO.

d.

hospital outpatient clinic.

ANS: B

Emergency departments (EDs) are organized according to the clinical model and are essentially dedicated to meet acute care needs. Providing primary care is a basic function of the ambulatory care center. An HMO is an organization with which physicians contract to receive payment for caring for enrollees. Primary health care could be provided at a hospital outpatient clinic.

PTS: 1 DIF: Knowledge/Remembering REF: p. 63

OBJ: N/A MSC: Safe, Effective Care Environment Management of Care

10. The nurse-manager explains to a new nurse at the ambulatory clinic that the service for which the telephone nursing practice is not feasible is

a.

assessing a clients needs based on the nurses perception.

b.

developing a collaborative plan of care with a client.

c.

evaluating outcomes of practice and care.

d.

prioritizing the urgency of a clients needs.

ANS: A

To assess a clients needs based on a nurses perceptions, the nurse would need to be able to assess the nonverbal responses, which usually are not available on a phone. All other options are feasible by phone.

PTS: 1 DIF: Comprehension/Understanding REF: p. 68

OBJ: Assessment

MSC: Safe, Effective Care Environment Management of Care-Legal Rights and Responsibilities

11. The nurse contacts a client by follow-up telephone call after the clients visit to an ambulatory care center. The client who would benefit most from this intervention

a.

has undergone cast removal.

b.

has undergone same-day surgery.

c.

is having blood pressure monitored.

d.

is having blood sugar monitored.

ANS: B

Telephone follow-up calls are used for clients who have had ambulatory surgery or for those subject to daily changes in condition.

PTS: 1 DIF: Application/Applying REF: p. 68

OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Continuity of Care

12. The nurse who is seeking legal guidance in delegating assignments to assist workers in an ambulatory care setting would best consult

a.

agency protocols.

b.

recently published texts.

c.

the agencys legal counsel.

d.

the state nurse practice act.

ANS: D

Nurse practice acts (NPAs) for each state define legal delegation guidelines. Agency protocols cannot override the NPA; the legal counsel would certainly reference the NPA; and texts cannot address each states NPA.

PTS: 1 DIF: Comprehension/Understanding REF: p. 69

OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Delegation

13. The purpose of the mutual recognition model (MRM), implemented through an interstate contract, is to

a.

ensure an increasing supply of nurses entering the work force.

b.

monitor the number of nurses working in more than one field of specialty.

c.

provide educational incentives for nurses to continue working full-time.

d.

reduce barriers to interstate nursing practice.

ANS: D

The MRM allows nurses to communicate and recommend health practices to persons out of state, thus reducing the barriers to interstate nursing practice, especially as it applies to telehealth services.

PTS: 1 DIF: Comprehension/Understanding REF: pp. 70-71

OBJ: N/A

MSC: Safe, Effective Care Environment Management of Care-Legal Rights and Responsibilities

14. One challenge for nurses working in ambulatory care centers is

a.

clients give overall responsibility for self-care to the center.

b.

duties are rigidly defined within the interdisciplinary team.

c.

length of client visit is short, reducing assessment time.

d.

use of telephones and computers eases assessment potential.

ANS: C

The short time of the ambulatory care visit makes assessment difficult and makes omissions in the assessment almost impossible to correct.

PTS: 1 DIF: Comprehension REF: p. 59

OBJ: Assessment MSC: Safe, Effective Care Environment Management of Care

15. When considering culture as the nurse is designing health plans for clients, the ambulatory care center nurse will consider least the cultural concept of

a.

making food modifications culturally appropriate.

b.

recognizing that cultural family roles may be rigidly defined.

c.

reflecting on research data describing culturally motivated responses.

d.

understanding that some cultures reject female authority.

ANS: C

Although all options are significant, options a, b, and d are considerations for client welfare and, consequently, are more important.

PTS: 1 DIF: Analysis/Analyzing REF: p. 66

OBJ: Intervention MSC: Psychosocial Integrity Cultural Diversity

16. In a telephone consultation, the ambulatory care center nurse may

a.

assess cardiac or fetal monitoring.

b.

decide how soon the client should be seen at the center.

c.

give advice based on the nurses phone assessment.

d.

teach a specific procedure based on approved protocols.

ANS: D

The telephone consult is designed for teaching or advising the client based on prescribed protocols, not on phone assessment (option c). Triage (option b) and surveillance (option d) are not considered within the definition of consult.

PTS: 1 DIF: Analysis/Analyzing REF: p. 68

OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Consultation

17. After each telehealth communication the nurse should

a.

immediately document the content of the call in the clients record.

b.

inform the physician of the information or teaching given.

c.

schedule a later call to check on the clients progress.

d.

send the client a written form of the pertinent information.

ANS: A

All information pertinent to the call should be recorded in the client record.

PTS: 1 DIF: Application/Applying REF: pp. 68-69

OBJ: Intervention MSC: Health Promotion and Maintenance Management of Care

18. An ambulatory care center nurse who is counseling a young client with sickle cell anemia can best access evidence-based practice (EBP) guidelines from

a.

consulting current nursing texts or journals.

b.

integrated hospital care plans and protocols.

c.

the Occupational Safety and Health Administration (OSHA).

d.

the Agency for Healthcare Research and Quality (AHRQ).

ANS: D

AHRQ has evidence-based guidelines for many common problems, including sickle cell anemia, and would be the best source of up-to-date evidence-based practice guidelines. Current textbooks are written approximately 2 years before publication. Journals have up-to-date information but might not have the subject matter needed. Hospital care plans and protocols should be based on current EBP practice, but are often outdated and based on what has always been done. OSHAs role has nothing to do with EBP.

PTS: 1 DIF: Comprehension/Understanding REF: p. 69

OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Staff Education

19. The ambulatory care center nurse assures a dubious client that she has been certified as an ambulatory nurse by

a.

application to the Accreditation Association for Ambulatory Health Care.

b.

membership in the National Committee for Quality Assurance.

c.

passing a specialized examination.

d.

working as an ambulatory care nurse for 5 years.

ANS: C

Ambulatory care nurses may be certified by passing a practice-specific examination. To qualify for the examination, nurses must have worked in ambulatory care for a certain minimum number of hours. The first two options involve agency-accrediting organizations.

PTS: 1 DIF: Knowledge/Remembering REF: p. 70

OBJ: N/A

MSC: Safe, Effective Care Environment Management of Care-Staff Education

20. The nurse explains that to work at an independent, nurse-supervised ambulatory care center, there is a minimum requirement of a(n)

a.

associate degree.

b.

bachelors degree.

c.

LVN/LPN.

d.

masters degree.

ANS: B

A bachelors degree is the minimum requirement for a nurse to work at an independent ambulatory care center.

PTS: 1 DIF: Comprehension/Understanding REF: p. 69

OBJ: Intervention MSC: Safe, Effective Care Environment Management of Care

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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