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Ambulatory Care Nursing Board Certified Practice Test

AMB-BC test Format | Course Contents | Course Outline | test Syllabus | test Objectives

Exam Code: AMB-BC
Certification Name: Ambulatory Care Nursing Board Certified
Administered by: American Nurses Credentialing Center (ANCC)
Number of Questions: 150 (including 25 unscored pretest questions)
Scored Questions: 125
Question Format: Multiple-choice (single best answer)
Time Allotted: 3 hours (180 minutes)
Passing Standard: Scaled score of 350 (on a scale of 0-500)
Exam Delivery: Computer-based testing (Pearson VUE test centers or online proctored)

- Disease Process (e.g.- acute- chronic)
- Medications
- Preventative care/health promotion
- Expected outcomes (e.g.- optimal health indicators)

- Treatment evaluation
- Triage (e.g.- in-person- virtual- telehealth)
- Physical and psychosocial assessment
- Clinical data interpretation (e.g.- documentation and chart review)

- Care coordination (e.g.- patient resources- population management)
- Disease-specific interventions
- Clinical tasks (e.g.- procedures- point of care testing- wound care)

- Scope and Standards of Practice (i.e.- ANA- AAACN- legal and regulatory bodies)
- Professional development
- Fiscal health (i.e.- reimbursement- resource allocation- billable services)
- Patient- family- and staff advocacy
- Leadership (e.g.- risk management- process improvement)
- Safety and security (e.g.- incident reporting- disaster training- safety rounds- root cause analysis)

- Modes of educational delivery
- Diverse populations
- Communication barriers (e.g.- language- technology- cognitive/sensory disabilities- health literacy)
- Professional communication (e.g.- building trust- therapeutic communication- conflict resolution)

- Chronic Disease Management: Diabetes- hypertension- COPD- heart failure
- Acute Care in Ambulatory Settings: Minor injuries- infections- asthma exacerbations
- Health Promotion & Disease Prevention: Immunizations- screenings (mammograms- colonoscopies)- smoking cessation
- Medication Management: Polypharmacy- adherence- reconciliation
- Telehealth & Remote Monitoring: Virtual visits- RPM (Remote Patient Monitoring)- mHealth
- Wound Care: Basic wound assessment- sterile techniques- diabetic foot care
- Pain Management: Non-opioid strategies- NSAIDs- referral to pain specialists

- Care Transitions: Hospital-to-home- SNF (Skilled Nursing Facility) coordination
- Interprofessional Collaboration: Roles of PCPs- specialists- social workers- pharmacists
- Patient Navigation: Helping patients access resources- overcoming barriers
- Discharge Planning: Follow-up appointments- medication education
- Referral Management: Timely specialist referrals- tracking consults

- Health Literacy: Teach-back method- plain language
- Self-Management Education: Diabetes self-care- inhaler techniques
- Cultural Competency: Addressing disparities- language interpreters
- Motivational Interviewing: OARS (Open-ended questions- Affirmations- Reflections- Summaries)
- Advocacy: Ensuring patient rights- ethical decision-making

- Evidence-Based Practice (EBP): Implementing clinical guidelines
- Quality Metrics: HEDIS (Healthcare Effectiveness Data and Information Set)- CAHPS (Consumer Assessment of Healthcare Providers and Systems)
- Patient Safety: Fall prevention- medication errors- infection control
- Root Cause Analysis (RCA): Identifying system failures
- Regulatory Compliance: HIPAA- OSHA- Joint Commission standards

- Scope of Practice: State nursing regulations- delegation to LPNs/MA
- Ethical Issues: Informed consent- patient autonomy
- Leadership Skills: Conflict resolution- team communication
- Professional Development: Certification maintenance- continuing education (CE)
- Healthcare Economics: Value-based care- bundled payments

- Ambulatory Care: Outpatient clinics- urgent care- telehealth
- Population Health: Risk stratification- preventive care
- SBAR (Situation-Background-Assessment-Recommendation): Communication tool
- ACO (Accountable Care Organization): Value-based care model
- EHR (Electronic Health Record): Documentation- interoperability

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Question: 503
An outpatient clinic nurse is documenting a 70-year-old female�s visit for COPD (FEV1 50%, normal:
>80%) in an EHR. The patient�s pulmonologist, in a different system, cannot access accurate spirometry
results. What is the best action to ensure care coordination?
A. Document the spirometry results in a paper chart
B. Email the results to the pulmonologist
C. Share the results via a secure HIE
D. Wait for the EHR systems to integrate
Answer: C
Explanation: Sharing the spirometry results (FEV1 50%) via a secure Health Information Exchange (HIE)
ensures care coordination by providing the pulmonologist immediate access to critical data, enabling
timely COPD management. Paper charts risk loss, emailing is insecure, and waiting for integration delays
care.
Question: 504
In a value-based care clinic, a patient with T2DM (HbA1c 8.5%) misses follow-ups due to transportation
issues. What action aligns with bundled payment goals?
A. Refer to a social worker for transportation assistance
B. Document non-compliance and reduce follow-up frequency
C. Increase HbA1c monitoring to track control
D. Coordinate telehealth visits to Strengthen access
Answer: D
Explanation: Coordinating telehealth visits addresses access barriers, improving outcomes in a bundled
payment model. Reducing follow-ups risks worse control. Increasing monitoring does not address access.
Referral to a social worker is helpful but less immediate than telehealth.
Question: 505
A non-English-speaking patient diagnosed with heart failure frequently misses follow-ups. To best
address health disparities, what intervention is most likely to Strengthen appointment adherence?
A. Increase appointment reminders only
B. Assign a bilingual nurse navigator for care coordination
C. Provide English-only after-visit summaries
D. Schedule appointments without consultation
Answer: B
Explanation: A bilingual nurse navigator supports both language needs and systemic navigation, reducing
disparities and improving adherence.
Question: 506
A patient with COPD presents with an SpO2 of 88% on room air and increased dyspnea. The nurse
follows 2026 GOLD guidelines, which recommend oxygen therapy for SpO2 <90%. The patient�s FEV1
is 45% of predicted. What is the nurse�s priority action?
A. Order a chest CT to evaluate for pulmonary embolism
B. Administer oxygen at 2 L/min via nasal cannula
C. Start prednisone 40 mg daily for exacerbation
D. Teach the patient pursed-lip breathing techniques
Answer: B
Explanation: The 2026 GOLD guidelines recommend oxygen therapy for COPD patients with SpO2
<90% to Strengthen oxygenation (Administer oxygen at 2 L/min via nasal cannula). Ordering a CT (Order a
chest CT to evaluate for pulmonary embolism) or starting prednisone (Start prednisone 40 mg daily for
exacerbation) requires provider orders. Teaching breathing techniques (Teach the patient pursed-lip
breathing techniques) is supportive but not the priority for acute hypoxia.
Question: 507
A 62-year-old woman is being monitored for warfarin therapy for atrial fibrillation. Her INR today is 5.1
and her last dose was this morning. She is not bleeding but complains of mild bruising. What is the
correct action?
A. Hold warfarin, repeat INR in 24 hours, and notify provider
B. Administer oral vitamin K and continue warfarin
C. Increase warfarin dose and recheck INR in 48 hours
D. Send immediately to emergency department for reversal
Answer: A
Explanation: For an INR between 5 and 9 without bleeding, holding warfarin and repeating the INR is
recommended; vitamin K is reserved for higher INRs or if at increased bleeding risk. Immediate ER
referral or increasing the dose is inappropriate.
Question: 508
A nurse is monitoring a bundled payment care path for post-MI patients. The expected value of nurse
interventions is measured by:
A. Increasing tests ordered per visit
B. Reducing duplicative services and improving coordinated follow-up
C. Scheduling unnecessary appointments
D. Maximizing per-claim reimbursement
Answer: B
Explanation: Value-based bundled models reward reductions in duplicative care and improvements in
coordination, not increasing unnecessary utilization.
Question: 509
An outpatient clinic nurse is documenting a 70-year-old female�s visit for atrial fibrillation (CHA2DS2-
VASc score 5, high stroke risk). The EHR shows an INR of 1.8 (therapeutic: 2.0-3.0). Using SBAR,
what is the most appropriate recommendation?
A. Continue the current warfarin dose and recheck in 1 week
B. Stop warfarin and start a direct oral anticoagulant
C. Increase the warfarin dose and schedule urgent INR recheck
D. Switch to aspirin and monitor for bleeding
Answer: C
Explanation: Increasing the warfarin dose and scheduling an urgent INR recheck is appropriate, as the
subtherapeutic INR (1.8) indicates inadequate anticoagulation for a high stroke risk patient (CHA2DS2-
VASc score 5). Continuing the dose risks stroke, switching to another anticoagulant or aspirin requires
provider oversight and may not address the immediate issue.
Question: 510
A patient categorized as �moderate risk� during ambulatory risk stratification has the following: Charlson
score 4, HR 112, accurate hospitalization. What is the likely odds ratio for hospital admission, based on
2026 literature?
A. 0.95
B. 1.15
C. 2.40
D. 0.12
Answer: C
Explanation: Moderate Charlson index correlates to an odds ratio of ~2.4 for hospital admission in recent
studies.
Question: 511
A 75-year-old with cognitive impairment, diabetes, and hypertension is brought in by family confused,
sleepy, and with a sodium of 124mmol/L, urine sodium 10mmol/L, and serum osmolality 263mOsm/kg.
Which is the cause of his hyponatremia?
A. Chronic kidney disease
B. Volume depletion
C. Primary polydipsia
D. Medication-induced SIADH
Answer: B
Explanation: Low urine sodium and low serum osmolality with symptoms suggest hypovolemic (volume-
depleted) hyponatremia rather than SIADH or CKD.
Question: 512
A 68-year-old patient with heart failure is discharged from the hospital to home. The discharge plan
includes digoxin 0.125 mg daily and a cardiology referral. The patient�s serum digoxin level is 2.2
ng/mL, and they report nausea. What is the nurse�s priority action?
A. Contact the PCP to review digoxin dosing
B. Educate the patient on digoxin toxicity symptoms
C. Instruct the patient to increase dietary fiber
D. Schedule a cardiology appointment in 2 weeks
Answer: A
Explanation: A digoxin level of 2.2 ng/mL (therapeutic range 0.5�2.0 ng/mL) and nausea suggest
possible digoxin toxicity. Contacting the PCP to review the dose is the priority to prevent serious
complications like arrhythmias. Educating on toxicity symptoms is important but secondary to addressing
the elevated level. Dietary fiber is unrelated to the issue. A cardiology appointment in 2 weeks is too
delayed.
Question: 513
A 23-year-old patient with type 1 diabetes has a accurate serum creatinine of 2.4mg/dL, eGFR
36mL/min/1.73m�, and UA reveals 3+ proteinuria. What is the most likely explanation for his abnormal
lab values?
A. Laboratory error
B. Uncontrolled hypertension causing nephropathy
C. Incorrect urine collection technique
D. Early diabetic nephropathy
Answer: D
Explanation: This lab pattern (elevated creatinine, reduced eGFR, and proteinuria) is consistent with
diabetic nephropathy. Uncontrolled hypertension may worsen this, but diabetic nephropathy is the
primary etiology in a young type 1 diabetic.
Question: 514
A 55-year-old patient with asthma is discharged from the hospital with a prescription for
budesonide/formoterol 160/4.5 mcg two puffs twice daily. The ambulatory care nurse notes the patient�s
peak expiratory flow rate (PEFR) is 60% of predicted. What is the nurse�s priority action?
A. Contact the PCP to review the inhaler regimen
B. Educate the patient on peak flow monitoring
C. Teach the patient proper inhaler technique
D. Request a pulmonology referral
Answer: D
Explanation: A PEFR of 60% of predicted indicates poorly controlled asthma, requiring specialist
evaluation to optimize treatment. Requesting a pulmonology referral is the priority to prevent
exacerbations. Reviewing the inhaler regimen may be needed but is not the first step without specialist
input. Peak flow monitoring and inhaler technique education are important but secondary to ensuring
specialist care.
Question: 515
A patient newly diagnosed with atrial fibrillation is prescribed warfarin. Which laboratory value best
guides initial dosing?
A. Fasting blood glucose
B. Serum bilirubin
C. Hemoglobin A1c
D. International normalized ratio (INR)
Answer: D
Explanation: Warfarin dosage is titrated to maintain INR within a therapeutic target, optimizing safety
and efficacy. Other lab values do not guide warfarin dosing.
Question: 516
A 60-year-old with HTN, DM2, and CKD stage 3 has a BP of 165/97mmHg on three medications.
Which modification is best supported by guidelines?
A. Add ACE inhibitor if not on one already
B. Decrease diuretic dose
C. Advise only dietary sodium restriction
D. Avoid statin use for cholesterol
Answer: A
Explanation: Adding or continuing an ACE inhibitor is renal-protective and a first-line choice for
diabetics with CKD and hypertension.
Question: 517
A nurse is asked to supervise a medical assistant (MA) performing point-of-care INR testing. Which is
the appropriate initial step before delegation?
A. Providing on-the-spot training for the procedure
B. Assuming the MA can perform all lab tests
C. Only allowing RNs to perform INR testing
D. Reviewing the MA�s documented competency for INR testing
Answer: D
Explanation: The nurse must review and confirm documented competency according to regulations
before delegating clinical tasks; scope of practice varies and cannot be assumed or established informally.
Question: 518
A 58-year-old male with hypertension and diabetes visits the ambulatory care clinic. The nurse
implements a clinical guideline recommending annual microalbuminuria testing. Which lab result would
suggest early diabetic nephropathy requiring adjustment of therapy as per EBP guidelines?
A. Microalbumin/Creatinine ratio 35mg/g
B. Blood urea nitrogen (BUN) 11mg/dL
C. Urine specific gravity 1.020
D. Serum creatinine 0.9mg/dL
Answer: A
Explanation: Microalbumin/Creatinine ratio 35mg/g indicates microalbuminuria, reflecting early
nephropathy as detected by evidence-based guidelines. Blood urea nitrogen and serum creatinine within
normal range, and urine specific gravity do not specifically indicate nephropathy in this scenario.
Question: 519
A patient with CKD (eGFR 40 mL/min/1.73m�) refuses a recommended low-sodium diet, citing personal
food preferences. What action respects patient autonomy?
A. Schedule a nutritionist consult without patient consent
B. Escalate to the provider to enforce the diet
C. Document the refusal and educate on dietary alternatives
D. Warn of dialysis as a consequence
Answer: C
Explanation: Documenting the refusal and educating on alternatives respects autonomy while addressing
health needs. Enforcing the diet or scheduling without consent violates autonomy. Warning of dialysis
without education is coercive.
Question: 520
An outpatient clinic nurse is documenting a 68-year-old male�s visit for heart failure (EF 35%, normal:
>50%) in an EHR with interoperability issues. The patient�s cardiologist, in a different system, cannot
access accurate labs (BNP 800 pg/mL, normal: <100 pg/mL). What is the best action to ensure care
continuity?
A. Use a secure HIE to share the BNP result with the cardiologist
B. Email the lab results directly to the cardiologist
C. Request an IT upgrade for full EHR interoperability
D. Document the BNP result in a paper chart for the patient to carry
Answer: A
Explanation: Using a secure Health Information Exchange (HIE) ensures care continuity by securely
transmitting the elevated BNP result (800 pg/mL) to the cardiologist, enabling timely heart failure
management despite interoperability issues. Paper charts risk loss, emailing is insecure, and an IT
upgrade is a long-term solution not addressing the immediate need.
Question: 521
During SBAR handoff, a nurse states: �Background: Patient admitted last month for pneumonia, now has
RR 38, O2 sat 85% on 3L NC, and crackles.� What element is missing for complete SBAR?
A. Name of patient�s insurance provider
B. Recommendation for next action
C. Phlebotomy orders
D. Date of documentation
Answer: B
Explanation: A specific recommendation is integral to SBAR handoff and missing here; insurance and
orders are not part of structured communication.
Question: 522
A 60-year-old woman presents for routine visit with BP 122/68, HR 68, BMI 27. She asks about
colorectal screening; she had a colonoscopy 4 years ago with 2 tubular adenomas removed. What is most
appropriate?
A. Repeat colonoscopy in 1 year
B. Repeat colonoscopy in 5 years
C. Annual FIT
D. Sigmoidoscopy in 10 years
Answer: B
Explanation: Colonoscopy 3�5 years after detecting 1�2 small (<10mm) adenomas is guideline
recommendation. Annual FIT is for average risk, but adenomas put her at increased risk. Sigmoidoscopy
is less comprehensive.
Question: 523
A 66-year-old patient with chronic kidney disease (CKD) is discharged from the hospital. The discharge
plan includes lisinopril 10 mg daily and a nephrology referral. The patient�s eGFR is 35 mL/min/1.73 m�,
and serum potassium is 5.4 mEq/L. What is the nurse�s priority action?
A. Schedule a nephrology appointment in 2 weeks
B. Educate the patient on a low-potassium diet
C. Contact the PCP to review lisinopril use
D. Teach the patient about fluid restriction
Answer: C
Explanation: Lisinopril, an ACE inhibitor, can exacerbate hyperkalemia (potassium 5.4 mEq/L) and
worsen renal function in CKD (eGFR 35 mL/min/1.73 m�). Contacting the PCP to review the medication
is the priority to prevent complications like severe hyperkalemia or renal failure. A low-potassium diet
may be helpful but requires provider approval. A nephrology appointment in 2 weeks is too delayed
given the lab abnormalities. Fluid restriction is not indicated without specific fluid overload symptoms.
Question: 524
A 45-year-old patient from a minority group with hypertension (BP 150/90 mmHg) expresses concerns
about medication side effects due to cultural beliefs about Western medicine. The nurse aims to provide
culturally competent care. Which action is most appropriate?
A. Refer the patient to a cultural healer
B. Offer an alternative herbal remedy
C. Provide a standard medication guide
D. Explore the patient�s beliefs and discuss evidence-based benefits of treatment
Answer: D
Explanation: Exploring the patient�s beliefs and discussing evidence-based benefits respects cultural
concerns while promoting adherence, aligning with cultural competency. Offering herbal remedies (Offer
an alternative herbal remedy) lacks evidence and is inappropriate. Providing a standard guide (Provide a
standard medication guide) ignores cultural beliefs. Referring to a cultural healer (Refer the patient to a
cultural healer) may not address the medical need.
Question: 525
The nurse leader is conducting a root cause analysis (RCA) after a medication error involving a
mislabeled syringe. The RCA reveals inadequate labeling protocols. Which intervention best addresses
the root cause?
A. Require annual medication safety training
B. Increase staff hours to allow more time for labeling
C. Mandate verbal confirmation of syringe contents
D. Implement a barcode scanning system for medication verification
Answer: D
Explanation: Implementing a barcode scanning system directly addresses mislabeling by ensuring
accurate verification, per ISMP guidelines. Increasing hours or verbal confirmation are less effective, and
annual training doesn�t target the specific protocol gap.
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