ANCC Ambulatory Care Nursing
Certification Practice Examination
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 56-year-old patient with type 2 diabetes calls the clinic reporting nausea,
vomiting, and abdominal pain for the past 24 hours. The patient states, “I
haven’t been able to keep anything down and I stopped taking my
metformin this morning.” Which action should the nurse take first?
A. Instruct the patient to resume metformin with the next small meal.
B. Advise the patient to increase fluid intake with a sports drink.
C. Arrange for the patient to be seen immediately for evaluation.
D. Instruct the patient to check urine ketones and report the result.
Answer: D
Rationale: The patient is at risk for diabetic ketoacidosis or dehydration-related
hyperglycemia, even with type 2 diabetes, especially during illness. Metformin
should be held during acute vomiting due to risk of lactic acidosis and renal
hypoperfusion. Checking urine ketones helps determine if the patient has
ketonemia, which requires urgent medical attention. The nurse’s priority is to
assess for ketosis before deciding on disposition. If ketones are moderate or
large, immediate evaluation is indicated; if negative, home management may
be possible with provider guidance. Instructing to resume metformin or simply
increasing fluids without assessment could be dangerous.
2. A nurse is triaging a telephone call from a parent of a 3-year-old with a fever
of 101.2°F (38.4°C) and a barking cough that started suddenly at night. The
child is fully immunized. Which question is most important to assess the
, severity of the illness?
A. “Has your child had any exposure to someone with croup?”
B. “How many wet diapers has your child had today?”
C. “Is your child able to lie flat without difficulty breathing?”
D. “Did your child receive the influenza vaccine this season?”
Answer: C
Rationale: The presentation suggests croup (laryngotracheobronchitis). The
most critical assessment is for stridor at rest and respiratory distress. Asking if
the child can lie flat without difficulty breathing evaluates for airway
compromise and retractions. Significant distress requires immediate emergency
care. Fluid intake is important but secondary to airway patency. Exposure history
and vaccination status do not assess severity. The nurse should determine if the
child has stridor at rest, which indicates severe upper airway obstruction.
3. The nurse is reviewing a lipid panel for a 48-year-old female patient without
diabetes or cardiovascular disease. Results: total cholesterol 220 mg/dL,
LDL 140 mg/dL, HDL 50 mg/dL, triglycerides 150 mg/dL. According to
current guidelines, what is the recommended initial intervention?
A. Initiate a moderate-intensity statin immediately.
B. Calculate the 10-year ASCVD risk score to guide therapy.
C. Provide education on lifestyle modifications and recheck in 6 months.
D. Refer the patient to a cardiologist for further evaluation.
Answer: C
Rationale: For primary prevention in a woman under 50 without risk-enhancing
factors, a 10-year ASCVD risk calculation is typically done for adults 40-79 years.
This patient is 48; guidelines recommend risk assessment. However, with LDL
140 mg/dL and no diabetes, first-line management is lifestyle modification
unless the risk score is elevated. The question does not provide enough risk
factors to justify immediate statin. The nurse’s role is to educate on diet,
exercise, and weight management, then reassess. Statins are initiated when risk
is ≥7.5% or LDL ≥190, etc. So education and follow-up are appropriate.
, 4. A patient newly prescribed warfarin for atrial fibrillation asks, “Can I still
have a glass of wine with dinner?” Which response by the nurse is best?
A. “You should avoid all alcohol while taking warfarin.”
B. “Moderate alcohol intake is usually acceptable, but it must be
consistent and discussed with your provider.”
C. “Alcohol has no effect on warfarin, so it is safe to continue.”
D. “You may drink wine only on weekends.”
Answer: B
Rationale: Moderate alcohol intake may be allowed with warfarin therapy, but
it can affect INR by interfering with warfarin metabolism and increasing
bleeding risk if excessive. Consistency is key, and the provider should be aware.
Total abstinence is not always necessary. The nurse should counsel on
maintaining a stable intake and reporting any signs of bleeding. Saying it has no
effect is incorrect and dangerous.
5. During a well-woman visit, a 32-year-old patient reports a history of
migraines with aura. She uses combined hormonal oral contraceptives.
Which action is the nurse’s priority?
A. Reassure her that migraines with aura are not a contraindication to
combined pills.
B. Recommend increasing the estrogen dose to reduce migraines.
C. Assess for other cardiovascular risk factors and collaborate to discuss
progestin-only contraception.
D. Instruct the patient to stop the oral contraceptive immediately and
switch to a barrier method.
Answer: C
Rationale: Migraine with aura is associated with an increased risk of ischemic
stroke, and combined hormonal contraceptives further elevate that risk. The CDC
MEC classifies this as a category 4 (unacceptable health risk) for combined
hormonal methods. The nurse should assess additional risk factors, educate the
patient, and facilitate a discussion about progestin-only options. Abrupt
, discontinuation without alternative planning could lead to unintended
pregnancy. Reassurance would be unsafe.
6. A 70-year-old patient in the ambulatory clinic reports a fall at home. The
nurse performs a fall risk assessment. Which finding warrants immediate
intervention?
A. The patient wears reading glasses.
B. The patient uses a cane occasionally.
C. The patient has orthostatic hypotension with a systolic drop of 25 mm
Hg upon standing.
D. The patient has mild arthritis in both knees.
Answer: C
Rationale: Orthostatic hypotension with a drop of ≥20 mm Hg systolic or ≥10 mm
Hg diastolic is a significant fall risk and requires immediate management,
including medication review and hydration strategies. All other findings
contribute to risk but are less acute. The nurse should report this and implement
safety measures.
7. A patient with chronic obstructive pulmonary disease (COPD) is on home
oxygen at 2 L/min. The nurse notes the patient’s pulse oximetry is 90% at
rest. Which intervention should the nurse implement first?
A. Increase oxygen to 4 L/min.
B. Administer a bronchodilator nebulizer treatment.
C. Assess the patient’s respiratory rate, effort, and breath sounds.
D. Notify the provider for arterial blood gas orders.
Answer: C
Rationale: An SpO2 of 90% may be acceptable for some COPD patients per
target ranges (88-92%). The nurse must first assess the patient’s clinical status,
including work of breathing and lung sounds, before adjusting therapy.
Increasing oxygen without assessment could lead to hypercapnia. Assessment
guides the next step.
Certification Practice Examination
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 56-year-old patient with type 2 diabetes calls the clinic reporting nausea,
vomiting, and abdominal pain for the past 24 hours. The patient states, “I
haven’t been able to keep anything down and I stopped taking my
metformin this morning.” Which action should the nurse take first?
A. Instruct the patient to resume metformin with the next small meal.
B. Advise the patient to increase fluid intake with a sports drink.
C. Arrange for the patient to be seen immediately for evaluation.
D. Instruct the patient to check urine ketones and report the result.
Answer: D
Rationale: The patient is at risk for diabetic ketoacidosis or dehydration-related
hyperglycemia, even with type 2 diabetes, especially during illness. Metformin
should be held during acute vomiting due to risk of lactic acidosis and renal
hypoperfusion. Checking urine ketones helps determine if the patient has
ketonemia, which requires urgent medical attention. The nurse’s priority is to
assess for ketosis before deciding on disposition. If ketones are moderate or
large, immediate evaluation is indicated; if negative, home management may
be possible with provider guidance. Instructing to resume metformin or simply
increasing fluids without assessment could be dangerous.
2. A nurse is triaging a telephone call from a parent of a 3-year-old with a fever
of 101.2°F (38.4°C) and a barking cough that started suddenly at night. The
child is fully immunized. Which question is most important to assess the
, severity of the illness?
A. “Has your child had any exposure to someone with croup?”
B. “How many wet diapers has your child had today?”
C. “Is your child able to lie flat without difficulty breathing?”
D. “Did your child receive the influenza vaccine this season?”
Answer: C
Rationale: The presentation suggests croup (laryngotracheobronchitis). The
most critical assessment is for stridor at rest and respiratory distress. Asking if
the child can lie flat without difficulty breathing evaluates for airway
compromise and retractions. Significant distress requires immediate emergency
care. Fluid intake is important but secondary to airway patency. Exposure history
and vaccination status do not assess severity. The nurse should determine if the
child has stridor at rest, which indicates severe upper airway obstruction.
3. The nurse is reviewing a lipid panel for a 48-year-old female patient without
diabetes or cardiovascular disease. Results: total cholesterol 220 mg/dL,
LDL 140 mg/dL, HDL 50 mg/dL, triglycerides 150 mg/dL. According to
current guidelines, what is the recommended initial intervention?
A. Initiate a moderate-intensity statin immediately.
B. Calculate the 10-year ASCVD risk score to guide therapy.
C. Provide education on lifestyle modifications and recheck in 6 months.
D. Refer the patient to a cardiologist for further evaluation.
Answer: C
Rationale: For primary prevention in a woman under 50 without risk-enhancing
factors, a 10-year ASCVD risk calculation is typically done for adults 40-79 years.
This patient is 48; guidelines recommend risk assessment. However, with LDL
140 mg/dL and no diabetes, first-line management is lifestyle modification
unless the risk score is elevated. The question does not provide enough risk
factors to justify immediate statin. The nurse’s role is to educate on diet,
exercise, and weight management, then reassess. Statins are initiated when risk
is ≥7.5% or LDL ≥190, etc. So education and follow-up are appropriate.
, 4. A patient newly prescribed warfarin for atrial fibrillation asks, “Can I still
have a glass of wine with dinner?” Which response by the nurse is best?
A. “You should avoid all alcohol while taking warfarin.”
B. “Moderate alcohol intake is usually acceptable, but it must be
consistent and discussed with your provider.”
C. “Alcohol has no effect on warfarin, so it is safe to continue.”
D. “You may drink wine only on weekends.”
Answer: B
Rationale: Moderate alcohol intake may be allowed with warfarin therapy, but
it can affect INR by interfering with warfarin metabolism and increasing
bleeding risk if excessive. Consistency is key, and the provider should be aware.
Total abstinence is not always necessary. The nurse should counsel on
maintaining a stable intake and reporting any signs of bleeding. Saying it has no
effect is incorrect and dangerous.
5. During a well-woman visit, a 32-year-old patient reports a history of
migraines with aura. She uses combined hormonal oral contraceptives.
Which action is the nurse’s priority?
A. Reassure her that migraines with aura are not a contraindication to
combined pills.
B. Recommend increasing the estrogen dose to reduce migraines.
C. Assess for other cardiovascular risk factors and collaborate to discuss
progestin-only contraception.
D. Instruct the patient to stop the oral contraceptive immediately and
switch to a barrier method.
Answer: C
Rationale: Migraine with aura is associated with an increased risk of ischemic
stroke, and combined hormonal contraceptives further elevate that risk. The CDC
MEC classifies this as a category 4 (unacceptable health risk) for combined
hormonal methods. The nurse should assess additional risk factors, educate the
patient, and facilitate a discussion about progestin-only options. Abrupt
, discontinuation without alternative planning could lead to unintended
pregnancy. Reassurance would be unsafe.
6. A 70-year-old patient in the ambulatory clinic reports a fall at home. The
nurse performs a fall risk assessment. Which finding warrants immediate
intervention?
A. The patient wears reading glasses.
B. The patient uses a cane occasionally.
C. The patient has orthostatic hypotension with a systolic drop of 25 mm
Hg upon standing.
D. The patient has mild arthritis in both knees.
Answer: C
Rationale: Orthostatic hypotension with a drop of ≥20 mm Hg systolic or ≥10 mm
Hg diastolic is a significant fall risk and requires immediate management,
including medication review and hydration strategies. All other findings
contribute to risk but are less acute. The nurse should report this and implement
safety measures.
7. A patient with chronic obstructive pulmonary disease (COPD) is on home
oxygen at 2 L/min. The nurse notes the patient’s pulse oximetry is 90% at
rest. Which intervention should the nurse implement first?
A. Increase oxygen to 4 L/min.
B. Administer a bronchodilator nebulizer treatment.
C. Assess the patient’s respiratory rate, effort, and breath sounds.
D. Notify the provider for arterial blood gas orders.
Answer: C
Rationale: An SpO2 of 90% may be acceptable for some COPD patients per
target ranges (88-92%). The nurse must first assess the patient’s clinical status,
including work of breathing and lung sounds, before adjusting therapy.
Increasing oxygen without assessment could lead to hypercapnia. Assessment
guides the next step.
