ANCC AMB-BCFree Ambulatory Care Nursing practice test

Correct answer: D. Pap smear

A Pap smear is the correct recommendation because guidelines support cervical cancer screening beginning at age 21 and continuing through age 65. The test identifies precancerous cervical changes, enabling early intervention to prevent progression to cervical cancer. A mammogram is not indicated for average-risk women at this age; routine breast cancer screening generally starts around age 40, making it inappropriate for a 25-year-old with no special risk factors. Colonoscopy is not warranted because colorectal cancer screening begins at age 45 for average-risk individuals. This procedure is unnecessary in a young, asymptomatic patient without predisposing risk factors. Stating that no screening is needed is incorrect because cervical cancer screening is recommended for women starting at age 21. Omitting this would represent a missed preventive care opportunity.

Correct answer: A. Limiting outdoor exposure during peak UV hours

Limiting outdoor exposure during peak UV hours is the most effective measure for decreasing skin cancer risk. Midday sun produces the most intense UV radiation, which damages skin cells and raises cancer risk. Staying in shade, wearing protective clothing, and applying sunscreen all complement this strategy. Using indoor tanning equipment does not lower risk; tanning beds produce UV radiation that can damage skin and increase cancer risk just as natural sunlight does. Wearing sunscreen only on clear days is insufficient because UV rays penetrate cloud cover. Sunscreen should be applied whenever spending time outdoors, regardless of weather conditions. Applying sunscreen once per day without reapplication does not maintain continuous protection. Sunscreen should be reapplied every two hours and after swimming or perspiring heavily.

Correct answer: B. DASH diet

The DASH (Dietary Approaches to Stop Hypertension) diet is the recommended approach because it is specifically designed to lower blood pressure. It emphasizes fruits, vegetables, whole grains, lean proteins, and low-fat dairy while restricting sodium, saturated fats, and added sugars—all of which support cardiovascular health and blood pressure control. Redirecting the patient away from dietary guidance is inappropriate because both nutrition and exercise are critical components of hypertension management. Ignoring dietary modifications overlooks a key opportunity to reduce blood pressure. A vegetarian diet can support cardiovascular health, but it lacks the specific structure around sodium and nutrient balance that makes the DASH diet particularly effective for blood pressure reduction. A low-fat diet alone does not adequately target sodium intake or emphasize the nutrient-rich foods that help reduce blood pressure. The DASH diet offers a more comprehensive, evidence-based strategy for hypertension management.

Correct answer: B. Chest X-ray to screen for pulmonary pathology

A chest X-ray should be prioritized because it offers a rapid, comprehensive view of the lungs and can reveal abnormalities such as masses, infiltrates, or other serious pathology. In a patient with unintentional weight loss and chronic cough, ruling out malignancy or active tuberculosis takes precedence before pursuing other investigations. Spirometry is valuable for diagnosing obstructive conditions like asthma or COPD, but it does not address the concern for serious underlying disease that must be excluded when unexplained weight loss is present. A sputum culture can identify bacterial organisms but provides a narrower evaluation compared to imaging and should not precede the chest X-ray in this clinical picture. Allergy testing may be relevant when allergy or asthma is suspected, but it is not appropriate as the first step in evaluating a patient with weight loss and chronic cough where more serious conditions must be ruled out.

Correct answer: D. Congestive heart failure

Congestive heart failure is most consistent with this presentation because bilateral pitting edema combined with dyspnea points to systemic fluid overload from impaired cardiac output. A history of hypertension is a well-established risk factor for heart failure, further supporting this diagnosis. Deep vein thrombosis characteristically produces unilateral swelling with localized pain and erythema rather than bilateral edema. The bilateral and systemic nature of this patient's findings argues against a localized vascular process. Cor pulmonale reflects right-sided heart failure secondary to chronic pulmonary disease. Without evidence of underlying lung pathology, this diagnosis is less likely than congestive heart failure given the patient's history. Hypertensive crisis is defined by severely elevated blood pressure causing acute end-organ damage, typically involving neurological or renal manifestations. The described presentation is more consistent with chronic fluid retention than an acute hypertensive emergency.

Correct answer: A. PSA blood test

The PSA blood test is the most widely used tool for prostate cancer screening. It measures circulating prostate-specific antigen, which may be elevated in the presence of prostate cancer, helping identify individuals who warrant further diagnostic evaluation. The fecal occult blood test detects hidden blood in stool and is used for colorectal cancer screening. It does not evaluate prostate tissue and is not applicable for prostate cancer detection. Digital rectal examination can identify prostate abnormalities on palpation, but it is less sensitive for early-stage cancer and serves as a complement to PSA testing rather than a primary screening modality. Pelvic ultrasound is not a standard first-line screening tool for prostate cancer. Imaging is generally reserved for further characterization after an abnormal screening result, not for initial population-level screening.

Correct answer: C. Smoking cessation counseling

Smoking cessation counseling is the highest-priority intervention because tobacco use is the leading cause of COPD. Eliminating cigarette exposure directly reduces disease risk and slows progression, making it the most impactful action for preserving long-term respiratory health. Regular aerobic exercise offers broad health benefits and supports respiratory endurance, but it does not remove the primary driver of COPD development. It should be encouraged alongside, not instead of, smoking cessation. Keeping immunizations current helps guard against respiratory infections that can aggravate lung disease, but vaccination does not address the underlying mechanism by which COPD develops. It represents supportive care rather than primary prevention. Diaphragmatic breathing exercises can help optimize respiratory mechanics and are useful for symptom management, but they do not prevent COPD from occurring. They are more appropriate for patients who already have the disease.

Correct answer: D. Pulmonary function tests (PFTs)

Pulmonary function tests are the most critical preoperative assessment for a patient with COPD facing surgery. They quantify lung function by measuring parameters such as forced vital capacity and forced expiratory volume, providing essential data for anesthetic planning and predicting postoperative respiratory risk. A complete blood count offers information about hematologic status but does not evaluate the patient's underlying pulmonary impairment or surgical respiratory risk. An electrocardiogram assesses cardiac electrical activity but does not directly characterize the degree of airflow obstruction or respiratory compromise associated with COPD. Liver function tests evaluate hepatic function, which is unrelated to the pulmonary concerns that are central to preoperative risk stratification in a COPD patient.

Correct answer: B. Perform a 12-lead ECG

Performing a 12-lead ECG is the most appropriate initial assessment because it rapidly identifies ischemic changes that could indicate myocardial infarction—the most immediately life-threatening cause of chest pain and dyspnea. Rapid recognition of cardiac ischemia allows for timely, potentially life-saving intervention. Obtaining a thorough history is valuable for overall diagnostic workup but should not delay the ECG when a cardiac emergency is suspected. Clinical history can be gathered concurrently or immediately after. Administering nitroglycerin is premature before confirming the cause of the symptoms via ECG. Giving vasodilators without a confirmed diagnosis could be harmful in certain conditions. Checking the blood glucose level is relevant in a diabetic patient but does not take precedence when acute cardiac pathology is suspected. Glucose measurement does not identify the source of the chest pain as efficiently as an ECG.

Correct answer: C. Engaging in regular physical activity

Engaging in regular physical activity is the most impactful lifestyle modification for reducing coronary artery disease risk. Exercise lowers blood pressure, improves lipid profiles, enhances circulation, and supports weight management—together creating broad and significant cardiovascular benefit. Following the DASH diet supports heart health, especially through blood pressure reduction and improved nutrition. However, it does not address the full spectrum of cardiovascular risk factors as comprehensively as regular exercise does. Avoiding secondhand smoke reduces exposure to cardiovascular toxins and is a worthwhile intervention, but it is largely passive and does not provide the wide-ranging physiological benefits of an active exercise regimen. Genetic risk factors cannot be changed through lifestyle choices, making this option irrelevant when the question focuses on modifiable behaviors that the patient can act on.