1
Santa Clara County Ambulatory
Care Nurse Examination
Comprehensive Practice
Examination a well detailed one
written and graded
A+ upgraded
Number of Questions: 150 scored items (plus 25 pretest items in actual examination)
Content Domains: Clinical Practice (34%), Communication (19%), Professional Issues (22%),
Systems (11%), Education (14%)
SECTION I: CLINICAL PRACTICE – Assessment, Medication Management, and Disease
Process/Pathophysiology
Questions 1–50
1. A 68-year-old male with a history of hypertension and type 2 diabetes presents to the
ambulatory care clinic with complaints of dizziness, palpitations, and diaphoresis. His blood
, 2
pressure is 88/52 mmHg, pulse is 118 bpm and irregular, and blood glucose is 48 mg/dL. What
is the nurse's PRIORITY action?
A) Administer 50% dextrose IV push immediately
B) Obtain a stat 12-lead EKG
C) Place the patient in a supine position with legs elevated
D) Notify the provider and prepare for emergency transfer
-detailed answer 100% correct :- A
Rationale: The patient is experiencing severe hypoglycemia with hemodynamic instability.
Administration of dextrose is the priority intervention to reverse life-threatening hypoglycemia.
While EKG, positioning, and provider notification are appropriate, they are secondary to
immediate glucose correction. The ABCs and acute glucose correction take precedence in this
scenario.
2. A 45-year-old female patient with a history of migraine headaches reports taking
sumatriptan (Imitrex) as needed. She states she has been using it almost daily for the past
two weeks. Which assessment finding would be MOST concerning?
A) Mild nausea and photophobia
B) Chest tightness and arm heaviness
C) Fatigue after medication use
D) Rebound headaches in the morning
-detailed answer 100% correct :- B
Rationale: Chest tightness and arm heaviness may indicate coronary vasospasm, a serious
adverse effect of triptan medications. Sumatriptan is contraindicated in patients with coronary
artery disease and can cause vasoconstriction. Daily use exceeding recommended limits
increases this risk. Options A, C, and D are common migraine symptoms or expected side effects
that do not indicate immediate danger.
3. A 72-year-old patient on multiple antihypertensive medications is found to have an
elevated serum creatinine of 2.1 mg/dL (baseline 1.0 mg/dL) during a routine clinic visit.
Which medication is MOST likely contributing to this finding?
A) Lisinopril
B) Amlodipine
, 3
C) Metoprolol
D) Hydrochlorothiazide
-detailed answer 100% correct :- A
Rationale: Lisinopril, an ACE inhibitor, can cause acute kidney injury, particularly in patients with
renal artery stenosis, dehydration, or concurrent NSAID use. The 100% increase in serum
creatinine from baseline is significant and warrants evaluation. Amlodipine, metoprolol, and
hydrochlorothiazide are less likely to cause this degree of renal impairment.
4. A 28-year-old female presents with fatigue, weight gain, cold intolerance, and constipation.
Physical examination reveals bradycardia and a palpable goiter. Which laboratory finding
would confirm the suspected diagnosis?
A) Elevated TSH, low free T4
B) Low TSH, elevated free T4
C) Elevated TSH, elevated free T4
D) Normal TSH, low free T4
-detailed answer 100% correct :- A
Rationale: The patient's signs and symptoms are classic for hypothyroidism. Primary
hypothyroidism is characterized by elevated TSH with low free T4 due to thyroid gland failure.
This pattern confirms the diagnosis and guides levothyroxine replacement therapy.
5. A 60-year-old patient with COPD is prescribed tiotropium (Spiriva) via HandiHaler. Which
instruction is ESSENTIAL for the nurse to include in patient education?
A) "Take this medication only when you feel short of breath"
B) "Do not swallow the capsule; place it in the device and inhale"
C) "This medication works immediately to relieve acute symptoms"
D) "You may use this medication up to 6 times per day"
-detailed answer 100% correct :- B
Rationale: Tiotropium is delivered via HandiHaler, which requires the patient to place the
capsule in the device, pierce it, and inhale the powder. Patients must understand not to swallow
the capsule. Tiotropium is a long-acting anticholinergic used for maintenance therapy, not acute
symptom relief, and is typically dosed once daily.
, 4
6. A 55-year-old male with hypertension and hyperlipidemia presents for a follow-up visit. His
blood pressure is 148/92 mmHg despite taking lisinopril 20 mg daily. Which action should the
nurse take FIRST?
A) Add amlodipine 5 mg to the current regimen
B) Increase lisinopril to 40 mg daily
C) Assess medication adherence and obtain home blood pressure readings
D) Schedule a renal function test
-detailed answer 100% correct :- C
Rationale: Before adjusting medications, the nurse must first assess medication adherence and
obtain accurate home blood pressure readings to rule out white coat hypertension or non-
adherence. This is a fundamental principle of medication management in ambulatory care.
Adding medications or increasing doses without adherence assessment may lead to
unnecessary polypharmacy.
7. A 34-year-old pregnant patient at 28 weeks gestation presents with new-onset
hypertension (150/95 mmHg) and proteinuria (3+ on dipstick). She reports headache and
visual changes. What is the nurse's priority action?
A) Schedule a follow-up appointment in one week
B) Educate about preeclampsia and recommend bed rest
C) Immediately notify the provider and prepare for urgent evaluation
D) Obtain a 24-hour urine collection for protein
-detailed answer 100% correct :- C
Rationale: The patient is exhibiting signs of severe preeclampsia with headache and visual
changes, which may indicate impending eclampsia. This is a medical emergency requiring
immediate provider notification and urgent evaluation, potentially including delivery planning.
Delaying care could result in maternal and fetal complications.
8. A 50-year-old patient with a 30-pack-year smoking history presents with a new cough,
hemoptysis, and unintentional weight loss. The chest X-ray shows a right upper lobe mass.
The nurse recognizes that the patient's symptoms are most consistent with which condition?
Santa Clara County Ambulatory
Care Nurse Examination
Comprehensive Practice
Examination a well detailed one
written and graded
A+ upgraded
Number of Questions: 150 scored items (plus 25 pretest items in actual examination)
Content Domains: Clinical Practice (34%), Communication (19%), Professional Issues (22%),
Systems (11%), Education (14%)
SECTION I: CLINICAL PRACTICE – Assessment, Medication Management, and Disease
Process/Pathophysiology
Questions 1–50
1. A 68-year-old male with a history of hypertension and type 2 diabetes presents to the
ambulatory care clinic with complaints of dizziness, palpitations, and diaphoresis. His blood
, 2
pressure is 88/52 mmHg, pulse is 118 bpm and irregular, and blood glucose is 48 mg/dL. What
is the nurse's PRIORITY action?
A) Administer 50% dextrose IV push immediately
B) Obtain a stat 12-lead EKG
C) Place the patient in a supine position with legs elevated
D) Notify the provider and prepare for emergency transfer
-detailed answer 100% correct :- A
Rationale: The patient is experiencing severe hypoglycemia with hemodynamic instability.
Administration of dextrose is the priority intervention to reverse life-threatening hypoglycemia.
While EKG, positioning, and provider notification are appropriate, they are secondary to
immediate glucose correction. The ABCs and acute glucose correction take precedence in this
scenario.
2. A 45-year-old female patient with a history of migraine headaches reports taking
sumatriptan (Imitrex) as needed. She states she has been using it almost daily for the past
two weeks. Which assessment finding would be MOST concerning?
A) Mild nausea and photophobia
B) Chest tightness and arm heaviness
C) Fatigue after medication use
D) Rebound headaches in the morning
-detailed answer 100% correct :- B
Rationale: Chest tightness and arm heaviness may indicate coronary vasospasm, a serious
adverse effect of triptan medications. Sumatriptan is contraindicated in patients with coronary
artery disease and can cause vasoconstriction. Daily use exceeding recommended limits
increases this risk. Options A, C, and D are common migraine symptoms or expected side effects
that do not indicate immediate danger.
3. A 72-year-old patient on multiple antihypertensive medications is found to have an
elevated serum creatinine of 2.1 mg/dL (baseline 1.0 mg/dL) during a routine clinic visit.
Which medication is MOST likely contributing to this finding?
A) Lisinopril
B) Amlodipine
, 3
C) Metoprolol
D) Hydrochlorothiazide
-detailed answer 100% correct :- A
Rationale: Lisinopril, an ACE inhibitor, can cause acute kidney injury, particularly in patients with
renal artery stenosis, dehydration, or concurrent NSAID use. The 100% increase in serum
creatinine from baseline is significant and warrants evaluation. Amlodipine, metoprolol, and
hydrochlorothiazide are less likely to cause this degree of renal impairment.
4. A 28-year-old female presents with fatigue, weight gain, cold intolerance, and constipation.
Physical examination reveals bradycardia and a palpable goiter. Which laboratory finding
would confirm the suspected diagnosis?
A) Elevated TSH, low free T4
B) Low TSH, elevated free T4
C) Elevated TSH, elevated free T4
D) Normal TSH, low free T4
-detailed answer 100% correct :- A
Rationale: The patient's signs and symptoms are classic for hypothyroidism. Primary
hypothyroidism is characterized by elevated TSH with low free T4 due to thyroid gland failure.
This pattern confirms the diagnosis and guides levothyroxine replacement therapy.
5. A 60-year-old patient with COPD is prescribed tiotropium (Spiriva) via HandiHaler. Which
instruction is ESSENTIAL for the nurse to include in patient education?
A) "Take this medication only when you feel short of breath"
B) "Do not swallow the capsule; place it in the device and inhale"
C) "This medication works immediately to relieve acute symptoms"
D) "You may use this medication up to 6 times per day"
-detailed answer 100% correct :- B
Rationale: Tiotropium is delivered via HandiHaler, which requires the patient to place the
capsule in the device, pierce it, and inhale the powder. Patients must understand not to swallow
the capsule. Tiotropium is a long-acting anticholinergic used for maintenance therapy, not acute
symptom relief, and is typically dosed once daily.
, 4
6. A 55-year-old male with hypertension and hyperlipidemia presents for a follow-up visit. His
blood pressure is 148/92 mmHg despite taking lisinopril 20 mg daily. Which action should the
nurse take FIRST?
A) Add amlodipine 5 mg to the current regimen
B) Increase lisinopril to 40 mg daily
C) Assess medication adherence and obtain home blood pressure readings
D) Schedule a renal function test
-detailed answer 100% correct :- C
Rationale: Before adjusting medications, the nurse must first assess medication adherence and
obtain accurate home blood pressure readings to rule out white coat hypertension or non-
adherence. This is a fundamental principle of medication management in ambulatory care.
Adding medications or increasing doses without adherence assessment may lead to
unnecessary polypharmacy.
7. A 34-year-old pregnant patient at 28 weeks gestation presents with new-onset
hypertension (150/95 mmHg) and proteinuria (3+ on dipstick). She reports headache and
visual changes. What is the nurse's priority action?
A) Schedule a follow-up appointment in one week
B) Educate about preeclampsia and recommend bed rest
C) Immediately notify the provider and prepare for urgent evaluation
D) Obtain a 24-hour urine collection for protein
-detailed answer 100% correct :- C
Rationale: The patient is exhibiting signs of severe preeclampsia with headache and visual
changes, which may indicate impending eclampsia. This is a medical emergency requiring
immediate provider notification and urgent evaluation, potentially including delivery planning.
Delaying care could result in maternal and fetal complications.
8. A 50-year-old patient with a 30-pack-year smoking history presents with a new cough,
hemoptysis, and unintentional weight loss. The chest X-ray shows a right upper lobe mass.
The nurse recognizes that the patient's symptoms are most consistent with which condition?
