Ambulatory Care Nursing Certification
ACTUAL EXAM 2026/2027 | 150
Verified Q&A | A+ Graded | Pass
Guaranteed - A+ Graded
Domain 1: Clinical Practice (Questions 1–40)
Q1: A 45-year-old patient calls the ambulatory care clinic reporting chest pressure, shortness of breath,
and diaphoresis that started 20 minutes ago while at rest. The patient has a history of hypertension.
Which telephone triage action is the nurse's priority?
A. Schedule the patient for a same-day clinic appointment in 2 hours
B. Advise the patient to take an aspirin and rest while monitoring symptoms
C. "Instruct the patient to call 911 immediately for emergency transport; chest pain with shortness of
breath and diaphoresis indicates acute coronary syndrome requiring rapid intervention. [CORRECT]" D.
Recommend the patient drive to the nearest urgent care center
Correct Answer: C
Rationale: Chest pain with autonomic symptoms (diaphoresis) and respiratory distress indicates
potential acute coronary syndrome. Immediate EMS activation ensures rapid transport, ECG monitoring,
and access to definitive cardiac care.
Q2: A 28-year-old patient calls with a sore throat, fever of 101.5°F, and swollen anterior cervical lymph
nodes for 2 days. No difficulty breathing or swallowing. Using telephone triage protocols, which
disposition is most appropriate?
A. Direct to emergency department immediately
B. "Schedule a same-day clinic visit for rapid strep testing and physical examination; symptoms are
consistent with streptococcal pharyngitis requiring evaluation and possible antibiotic therapy.
[CORRECT]" C. Advise home care with follow-up in 1 week if not improved
D. Prescribe antibiotics over the phone without examination
Correct Answer: B
Rationale: Fever, sore throat, and cervical lymphadenopathy are classic for streptococcal pharyngitis.
,Same-day evaluation allows rapid strep testing, accurate diagnosis, and appropriate treatment to
prevent rheumatic fever complications.
Q3: A 62-year-old patient with type 2 diabetes calls reporting blood glucose readings of 280-320 mg/dL
for 3 days, increased thirst, and frequent urination. The patient recently had a urinary tract infection
treated with antibiotics. Which action should the nurse take first?
A. Advise the patient to increase oral hypoglycemic medication dosage
B. "Instruct the patient to check urine ketones, maintain hydration, and come to the clinic today for
evaluation of possible infection-related hyperglycemia or medication adjustment needs. [CORRECT]" C.
Tell the patient this is normal during antibiotic treatment
D. Recommend the patient skip meals to lower blood glucose
Correct Answer: B
Rationale: Persistent hyperglycemia >250 mg/dL with polyuria and polydipsia requires ketone
assessment to rule out DKA. Infection and certain antibiotics can worsen glycemic control, necessitating
prompt in-person evaluation.
Q4: A 35-year-old patient presents to the ambulatory clinic with a laceration on the forearm from a
kitchen knife 2 hours ago. The wound is 3 cm long, clean-edged, and bleeding has stopped. Which
intervention is the nurse's priority?
A. Apply topical antibiotic and send home without closure
B. "Irrigate the wound with normal saline, assess for foreign bodies, and prepare for primary closure
with sutures or adhesive strips within the 6-8 hour window for optimal healing. [CORRECT]" C. Delay
closure for 48 hours to allow natural debridement
D. Administer oral antibiotics prophylactically without wound care
Correct Answer: B
Rationale: Clean lacerations on the forearm can be closed primarily within 6-8 hours. Proper irrigation,
foreign body assessment, and timely closure reduce infection risk and promote cosmesis.
Q5: A 55-year-old patient with COPD calls reporting increased shortness of breath, productive cough
with green sputum, and using rescue inhaler every 2 hours for the past day. Which telephone triage
disposition is most appropriate?
A. Advise increasing home oxygen flow rate
B. "Direct the patient to the emergency department for evaluation of COPD exacerbation; increased
rescue inhaler use and purulent sputum indicate possible infection requiring urgent assessment.
,[CORRECT]" C. Recommend doubling the daily corticosteroid dose
D. Schedule a routine clinic appointment in 3 days
Correct Answer: B
Rationale: COPD exacerbation with increased rescue inhaler dependence and purulent sputum indicates
possible bacterial infection. Emergency evaluation ensures oxygenation assessment, chest X-ray, and
potential hospitalization.
Q6: A 7-year-old child is brought to the pediatric ambulatory clinic for a well-child visit. The parent
requests the influenza vaccine. The child has a mild runny nose without fever. Which action should the
nurse take?
A. Defer vaccination until the child is completely asymptomatic
B. "A mild illness without fever is not a contraindication to influenza vaccination; administer the vaccine
and document the encounter. [CORRECT]" C. Require a prescription from the provider before
administering
D. Refer to the emergency department for evaluation
Correct Answer: B
Rationale: Mild acute illness without fever does not contraindicate inactivated influenza vaccination.
Deferring unnecessarily leaves the child unprotected. Live-attenuated nasal spray requires more
stringent health screening.
Q7: A 68-year-old patient with heart failure calls reporting weight gain of 5 pounds in 3 days, increased
ankle swelling, and orthopnea. The patient is taking furosemide 40 mg daily. Which action should the
nurse take?
A. Advise the patient to stop taking furosemide due to dehydration
B. "Instruct the patient to come to the clinic today for evaluation; 5-pound weight gain with edema and
orthopnea indicates fluid overload requiring medication adjustment. [CORRECT]" C. Tell the patient to
double the furosemide dose for 2 days
D. Recommend increasing salt intake to improve blood pressure
Correct Answer: B
Rationale: Rapid weight gain with edema and orthopnea signals acute decompensated heart failure.
Same-day evaluation allows assessment of renal function, electrolytes, and diuretic adjustment under
provider supervision.
, Q8: A 40-year-old patient presents for a pre-employment physical requiring a tuberculosis screening.
The patient has no symptoms and no known exposure. Which test is most appropriate?
A. Chest X-ray
B. "Administer a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) based on clinic
protocol and patient preference; both are acceptable for latent TB screening in asymptomatic
individuals. [CORRECT]" C. Sputum culture for acid-fast bacilli
D. CT scan of the chest
Correct Answer: B
Rationale: Asymptomatic TB screening uses TST or IGRA. Chest imaging and sputum cultures are
reserved for symptomatic patients or positive screening tests. IGRA is preferred for BCG-vaccinated
individuals.
Q9: A 50-year-old patient calls reporting a blood pressure reading of 188/110 mmHg at home, severe
headache, and blurred vision. The patient takes lisinopril 10 mg daily. Which telephone triage action is
priority?
A. Advise the patient to take an extra lisinopril tablet
B. "Instruct the patient to call 911 or go to the emergency department immediately; hypertensive
emergency with neurological symptoms requires urgent evaluation to rule out stroke. [CORRECT]" C.
Schedule a clinic appointment for next week
D. Recommend lying down and rechecking in 1 hour
Correct Answer: C
Rationale: Blood pressure ≥180/120 with neurological symptoms (headache, visual changes) constitutes
hypertensive emergency. Immediate ED evaluation is required for possible hypertensive encephalopathy
or stroke.
Q10: A 33-year-old patient presents with a painful, swollen right knee after twisting it during basketball
2 days ago. There is mild effusion, limited range of motion, and no deformity. Which nursing action is
most appropriate?
A. Apply a heating pad and encourage weight-bearing
B. "Apply RICE therapy (rest, ice, compression, elevation), provide crutches if needed, and arrange for X-
ray to rule out fracture based on Ottawa Knee Rules. [CORRECT]" C. Perform joint aspiration in the clinic
D. Administer intramuscular corticosteroid
Correct Answer: B
Rationale: Acute knee injury with effusion and limited ROM requires RICE management and imaging to
ACTUAL EXAM 2026/2027 | 150
Verified Q&A | A+ Graded | Pass
Guaranteed - A+ Graded
Domain 1: Clinical Practice (Questions 1–40)
Q1: A 45-year-old patient calls the ambulatory care clinic reporting chest pressure, shortness of breath,
and diaphoresis that started 20 minutes ago while at rest. The patient has a history of hypertension.
Which telephone triage action is the nurse's priority?
A. Schedule the patient for a same-day clinic appointment in 2 hours
B. Advise the patient to take an aspirin and rest while monitoring symptoms
C. "Instruct the patient to call 911 immediately for emergency transport; chest pain with shortness of
breath and diaphoresis indicates acute coronary syndrome requiring rapid intervention. [CORRECT]" D.
Recommend the patient drive to the nearest urgent care center
Correct Answer: C
Rationale: Chest pain with autonomic symptoms (diaphoresis) and respiratory distress indicates
potential acute coronary syndrome. Immediate EMS activation ensures rapid transport, ECG monitoring,
and access to definitive cardiac care.
Q2: A 28-year-old patient calls with a sore throat, fever of 101.5°F, and swollen anterior cervical lymph
nodes for 2 days. No difficulty breathing or swallowing. Using telephone triage protocols, which
disposition is most appropriate?
A. Direct to emergency department immediately
B. "Schedule a same-day clinic visit for rapid strep testing and physical examination; symptoms are
consistent with streptococcal pharyngitis requiring evaluation and possible antibiotic therapy.
[CORRECT]" C. Advise home care with follow-up in 1 week if not improved
D. Prescribe antibiotics over the phone without examination
Correct Answer: B
Rationale: Fever, sore throat, and cervical lymphadenopathy are classic for streptococcal pharyngitis.
,Same-day evaluation allows rapid strep testing, accurate diagnosis, and appropriate treatment to
prevent rheumatic fever complications.
Q3: A 62-year-old patient with type 2 diabetes calls reporting blood glucose readings of 280-320 mg/dL
for 3 days, increased thirst, and frequent urination. The patient recently had a urinary tract infection
treated with antibiotics. Which action should the nurse take first?
A. Advise the patient to increase oral hypoglycemic medication dosage
B. "Instruct the patient to check urine ketones, maintain hydration, and come to the clinic today for
evaluation of possible infection-related hyperglycemia or medication adjustment needs. [CORRECT]" C.
Tell the patient this is normal during antibiotic treatment
D. Recommend the patient skip meals to lower blood glucose
Correct Answer: B
Rationale: Persistent hyperglycemia >250 mg/dL with polyuria and polydipsia requires ketone
assessment to rule out DKA. Infection and certain antibiotics can worsen glycemic control, necessitating
prompt in-person evaluation.
Q4: A 35-year-old patient presents to the ambulatory clinic with a laceration on the forearm from a
kitchen knife 2 hours ago. The wound is 3 cm long, clean-edged, and bleeding has stopped. Which
intervention is the nurse's priority?
A. Apply topical antibiotic and send home without closure
B. "Irrigate the wound with normal saline, assess for foreign bodies, and prepare for primary closure
with sutures or adhesive strips within the 6-8 hour window for optimal healing. [CORRECT]" C. Delay
closure for 48 hours to allow natural debridement
D. Administer oral antibiotics prophylactically without wound care
Correct Answer: B
Rationale: Clean lacerations on the forearm can be closed primarily within 6-8 hours. Proper irrigation,
foreign body assessment, and timely closure reduce infection risk and promote cosmesis.
Q5: A 55-year-old patient with COPD calls reporting increased shortness of breath, productive cough
with green sputum, and using rescue inhaler every 2 hours for the past day. Which telephone triage
disposition is most appropriate?
A. Advise increasing home oxygen flow rate
B. "Direct the patient to the emergency department for evaluation of COPD exacerbation; increased
rescue inhaler use and purulent sputum indicate possible infection requiring urgent assessment.
,[CORRECT]" C. Recommend doubling the daily corticosteroid dose
D. Schedule a routine clinic appointment in 3 days
Correct Answer: B
Rationale: COPD exacerbation with increased rescue inhaler dependence and purulent sputum indicates
possible bacterial infection. Emergency evaluation ensures oxygenation assessment, chest X-ray, and
potential hospitalization.
Q6: A 7-year-old child is brought to the pediatric ambulatory clinic for a well-child visit. The parent
requests the influenza vaccine. The child has a mild runny nose without fever. Which action should the
nurse take?
A. Defer vaccination until the child is completely asymptomatic
B. "A mild illness without fever is not a contraindication to influenza vaccination; administer the vaccine
and document the encounter. [CORRECT]" C. Require a prescription from the provider before
administering
D. Refer to the emergency department for evaluation
Correct Answer: B
Rationale: Mild acute illness without fever does not contraindicate inactivated influenza vaccination.
Deferring unnecessarily leaves the child unprotected. Live-attenuated nasal spray requires more
stringent health screening.
Q7: A 68-year-old patient with heart failure calls reporting weight gain of 5 pounds in 3 days, increased
ankle swelling, and orthopnea. The patient is taking furosemide 40 mg daily. Which action should the
nurse take?
A. Advise the patient to stop taking furosemide due to dehydration
B. "Instruct the patient to come to the clinic today for evaluation; 5-pound weight gain with edema and
orthopnea indicates fluid overload requiring medication adjustment. [CORRECT]" C. Tell the patient to
double the furosemide dose for 2 days
D. Recommend increasing salt intake to improve blood pressure
Correct Answer: B
Rationale: Rapid weight gain with edema and orthopnea signals acute decompensated heart failure.
Same-day evaluation allows assessment of renal function, electrolytes, and diuretic adjustment under
provider supervision.
, Q8: A 40-year-old patient presents for a pre-employment physical requiring a tuberculosis screening.
The patient has no symptoms and no known exposure. Which test is most appropriate?
A. Chest X-ray
B. "Administer a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) based on clinic
protocol and patient preference; both are acceptable for latent TB screening in asymptomatic
individuals. [CORRECT]" C. Sputum culture for acid-fast bacilli
D. CT scan of the chest
Correct Answer: B
Rationale: Asymptomatic TB screening uses TST or IGRA. Chest imaging and sputum cultures are
reserved for symptomatic patients or positive screening tests. IGRA is preferred for BCG-vaccinated
individuals.
Q9: A 50-year-old patient calls reporting a blood pressure reading of 188/110 mmHg at home, severe
headache, and blurred vision. The patient takes lisinopril 10 mg daily. Which telephone triage action is
priority?
A. Advise the patient to take an extra lisinopril tablet
B. "Instruct the patient to call 911 or go to the emergency department immediately; hypertensive
emergency with neurological symptoms requires urgent evaluation to rule out stroke. [CORRECT]" C.
Schedule a clinic appointment for next week
D. Recommend lying down and rechecking in 1 hour
Correct Answer: C
Rationale: Blood pressure ≥180/120 with neurological symptoms (headache, visual changes) constitutes
hypertensive emergency. Immediate ED evaluation is required for possible hypertensive encephalopathy
or stroke.
Q10: A 33-year-old patient presents with a painful, swollen right knee after twisting it during basketball
2 days ago. There is mild effusion, limited range of motion, and no deformity. Which nursing action is
most appropriate?
A. Apply a heating pad and encourage weight-bearing
B. "Apply RICE therapy (rest, ice, compression, elevation), provide crutches if needed, and arrange for X-
ray to rule out fracture based on Ottawa Knee Rules. [CORRECT]" C. Perform joint aspiration in the clinic
D. Administer intramuscular corticosteroid
Correct Answer: B
Rationale: Acute knee injury with effusion and limited ROM requires RICE management and imaging to
