Chapter 7 Ambulatory Health Care

Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 7: Ambulatory Health Care
MULTIPLE CHOICE
1. Ambulatory care nursing is an emerging field of nursing practice in which the nurse
a. deals with clients who will need care for less than 24 hours.
b. offer an integrated system of care to persons within walking distance of the clinic.
c. practices in an interdisciplinary team to offer primary, secondary, and tertiary
interventions.
d. deals only with clients who are not acutely ill.
ANS: c
The ambulatory nurse takes care of clients who are healthy, acutely ill, and chronically ill.
Ambulatory nurses function as a member of an interdisciplinary team.
DIF: Cognitive Level: Knowledge REF: Text Reference: 134, 143;

TOP: Nursing Process Step: N/A MSC: NCLEX: N/A
2. Ambulatory care centers include

a. sleeping accommodations for family member.
b. services for those unable to provide self-care after a procedure.
c. care available 24 hours a day, 7 days a week.
d. care for short-term medical-surgical procedures.
ANS: d
Technological advances allow treatment in a short-term facility that previously required a
hospital stay. Ambulatory care centers meet the need of these clients and avoid a costly inpatient
stay.
DIF: Cognitive Level: Comprehension REF: Text Reference: 133

3. The nurse manager of an ambulatory care center assesses the center for environmental
hazards to comply with guidelines of both the local state’s health department and the
a. Occupational Safety and Health Administration.
b. Ambulatory Care Nursing Administration and Practice.
c. American Nurse’s Credentialing Center.
d. Nurse Practice Act.
ANS: a
The Occupational Safety and Health Administration (OSHA) and the state health department
oversee environmental factors. The other three options address professional practice and
credentials.
Elsevier items and derived items  2005 by Elsevier Inc.

Chapter 7: Ambulatory Health Care 2

4. A client’s wife complains about the quality of her husband’s postoperative care. To
address this concern, the ambulatory care nurse uses skills that are based on
a. staff development protocols.
b. advocacy interventions.
c. evidence-based nursing practice guidelines.
d. clinical quality improvement processes.
ANS: b
The ambulatory nurse is asked to fill many roles in client service; in the advocacy role the nurse
speaks for the client.
DIF: Cognitive Level: Analysis REF: Text Reference: 133

TOP: Nursing Process Step: Intervention
MSC: NCLEX: Health Promotion and Maintenance
5. The facility that could best represent an ambulatory care center is a

a. student health center.
b. home health care agency.
c. rehabilitation center.
d. hospital with less than 50 beds.
ANS: a
The student health center is an ambulatory care center. The other options provide care to clients
in their home, to inpatients, or as a prescribed follow-up service.
DIF: Cognitive Level: Analysis REF: Text Reference: 133, 134;

6. In comparing the ambulatory care setting to an inpatient hospital setting, the nurse-
instructor is correct in stating that the ambulatory care setting
a. may create a feeling of greater stress to the client than a hospital setting.
b. is already in decline and offers limited employment opportunities.
c. provides an environment where the client is less at risk for nosocomial infection.
d. has had so many cost increases that a visit is just as costly as the hospital.
ANS: c
The client using an ambulatory care center is exposed less to nosocomial infection and other
hazards of hospitalization.
DIF: Cognitive Level: Knowledge REF: Text Reference: 133

7. A nurse working in an ambulatory care setting would provide secondary prevention

activities such as

a. giving instructions after minor surgery.

b. teaching young adults the benefits of good nutrition.
c. providing cardiac rehabilitation.
d. carrying out multiphasic hypertension screening.
ANS: d
Multiphasic screening is secondary prevention; the other options are either primary or tertiary.

8. The nurse instructor describes an integrated delivery system and cites the example of
a. providers concerned about generating revenue.
b. a hospital’s alignment with several physician groups to increase hospital referral.
c. enrollees of the system being “locked” into the system of care for services.
d. an outpatient clinic in the hospital.
ANS: b
Hospitals have aligned themselves with groups of physicians to increase hospital referral and
provide greater coordination of care.

9. A health care service that provides a defined population with a stated range of services
through prepayment of an annual or monthly capitation fee is a(n)
a. health maintenance organization (HMO).
b. preferred provider organization (PPO).
c. outpatient service of a community hospital.
d. nurse-managed ambulatory center.
ANS: a
An HMO provides services to members for an annual or monthly capitation fee.

10. The facility least suited to the provision of primary health care is a(n)
a. hospital outpatient clinic.
b. emergency department.
c. HMO
d. ambulatory care center
ANS: b
Emergency departments (EDs) are organized according to the clinical model and are essentially
dedicated to meet acute care needs.


11. The nurse-instructor defines “designated treatment clinic” and gives the example of a
a. diabetes clinic.
b. hypertension clinic.
c. cardiovascular clinic.
d. wound clinic.
ANS: d
A wound clinic deals only with concerns of wounds, not the multifaceted concerns of clients
with chronic diseases.

12. The nurse-manager explains to a new nurse at the ambulatory clinic that the service
for which the telephone nursing practice is not feasible is
a. assessing a client’s needs based on the nurse’s perception.
b. prioritizing the urgency of a client’s needs.
c. developing a collaborative plan of care with a client.
d. evaluating outcomes of practice and care.
ANS: a
To assess a client’s needs based on a nurse’s perceptions, the nurse would need to be able to
assess the nonverbal responses, which usually are not available on a phone. All other options are
feasible by phone.

13. The nurse contacts a client by follow-up telephone call after the client’s visit to an
ambulatory care center. The client who would benefit best from this intervention
a. is having blood pressure monitored.
b. has undergone same-day surgery.
c. is having blood sugar monitored.
d. has undergone cast removal.
ANS: d
Telephone follow-up calls are used for clients who have had ambulatory surgery or for those
subject to daily changes in condition.
DIF: Cognitive Level: Application REF: Text Reference: 142

TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity
14. The nurse who is seeking legal guidance in delegating assignments to assist workers

in an ambulatory care setting would best consult

a. agency protocols.
b. the state nurse practice act.
c. the agency’s legal counsel.
d. recently published texts.
ANS: b
Nurse practice acts (NPAs) for each state define legal delegation guidelines. Agency protocols
cannot override the NPA; the legal counsel would certainly reference the NPA; and texts cannot
address each state’s NPA.

15. The purpose of the Mutual Recognition Model (MRM), implemented through an
Interstate Compact, is to
a. ensure an increasing supply of nurses entering the work force.
b. monitor the number of nurses working in more than one field of specialty.
c. provide educational incentives for nurses to continue working full-time.
d. reduce barriers to interstate nursing practice.
ANS: d
The MRM allows nurses to communicate and recommend health practices to persons out of
state, thus reducing the barriers to interstate nursing practice, especially as it applies to
Telehealth services.

16. The ambulatory care nurse explains to a curious client that nurses in an ambulatory
care center have several different challenges than nurses in other care settings
because
a. clients give overall responsibility for self-care to the center.
b. duties are rigidly defined within the interdisciplinary team.
c. use of telephones and computers eases assessment potential.
d. length of client visit is short, reducing assessment time.
ANS: d
The short time of the ambulatory care visit makes assessment difficult and makes omissions in
the assessment almost impossible to correct.

17. The model on which most ambulatory care centers are organized is the
a. Levels of Prevention Model.
b. Clinical Model.

c. Primary Health Care Model.

d. Services-for-Fee Model.
ANS: b
Most centers are styled on the Clinical Model because typically, clients still seek service only
when they are ill.

18. A client is confused about the difference between primary health care and managed
health care. The nurse explains that
a. primary health care is care coordinated by one primary provider.
b. managed care is an approach to health care that focuses on cost control.
c. managed care is health promotion based on health education.
d. primary health care deals with intervention for a primary health problem.
ANS: b
Managed care is based on cost containment. Primary health care is the universal right of
individuals to basic health care.

19. When designing a post–myocardial infarct health plan for a man from Saudi Arabia,
the ambulatory care center nurse will consider least the cultural concept of
a. making food modifications culturally appropriate.
b. recognizing that cultural family roles may be rigidly defined.
c. considering that some cultures reject female authority.
d. recording the significant research data on culturally motivated responses.
ANS: d
Although all options are significant, the first three are considerations for client welfare and,
consequently, are more important.

20. A study by Haas and Hackbarth revealed that many ambulatory care center nurses
spend much of their workday performing
a. client teaching.
b. technical procedures.
c. care planning.
d. client advocacy.
ANS: b

The study indicated that many work hours are taken up with technical and enabling operations.

21. In a telephone consultation the ambulatory care center nurse may

a. give advice based on the nurse’s phone assessment.
b. decide how soon the client should be seen at the center.
c. teach a specific procedure based on approved protocols.
d. assess cardiac or fetal monitoring.
ANS: c
The telephone consult is designed for teaching or advising the client based on prescribed
protocols, not on phone assessment (option 1). Triage (option 2) and surveillance (option 4) are
not considered within the definition of “consult.”
DIF: Cognitive Level: Analysis REF: Text Reference: 141, 142;

22. After each Telehealth communication the nurse should

a. inform the physician of the information or teaching given.
b. schedule a later call to check on the client’s progress.
c. immediately document the content of the call in the client’s record.
d. send the client a written form of the pertinent information.
ANS: c
All information pertinent to the call should be recorded in the client record.
DIF: Cognitive Level: Application REF: Text Reference: 142

23. An ambulatory care center nurse who is counseling with a young client with sickle
cell anemia can best access evidence-based guidelines from
a. Occupational Safety and Health Administration (OSHA).
b. integrated hospital care plans and protocols.
c. Agency for Health Care Research and Quality (AHRQ).
d. current nursing texts.
ANS: c
AHCRQ has evidence-based guidelines for many common problems, including sickle cell
anemia.


24. The ambulatory care center nurse assures a dubious client that she has been certified
as an ambulatory nurse by
a. passing a specialized examination.
b. working as an ambulatory care nurse for 5 years.
c. membership in the National Committee for Quality Assurance.
d. application to the Accreditation Association for Ambulatory Health Care.
ANS: a
Ambulatory care nurses may be certified by passing a practice-specific examination, as well as
the consideration for amount of time worked in an ambulatory care center. Options 3 and 4 are
agency-accrediting bodies.
DIF: Cognitive Level: Knowledge REF: Text Reference: 143, 144;

25. The nurse explains that to work at an independent, nurse-supervised ambulatory care
center, there is a minimum requirement of a(n)
a. LVN/LPN.
b. Associate degree.
c. Bachelor’s degree.
d. Master’s degree.
ANS: c
A Bachelor’s degree is the minimum requirement for a nurse to work at an independent
ambulatory care center.


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Chapter 7 Ambulatory Health Care

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Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive

Outcomes, 7th Edition

Chapter 7: Ambulatory Health Care

DIF: Cognitive Level: Knowledge REF: Text Reference: 134, 143;

2. Ambulatory care centers include

DIF: Cognitive Level: Comprehension REF: Text Reference: 133

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Comprehension REF: Text Reference: 143

DIF: Cognitive Level: Analysis REF: Text Reference: 133

5. The facility that could best represent an ambulatory care center is a

DIF: Cognitive Level: Analysis REF: Text Reference: 133, 134;

DIF: Cognitive Level: Knowledge REF: Text Reference: 133

7. A nurse working in an ambulatory care setting would provide secondary prevention

Elsevier items and derived items  2005 by Elsevier Inc.

a. giving instructions after minor surgery.

DIF: Cognitive Level: Comprehension REF: Text Reference: 135

DIF: Cognitive Level: Comprehension REF: Text Reference: 137

DIF: Cognitive Level: Comprehension REF: Text Reference: 137

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 139

DIF: Cognitive Level: Analysis REF: Text Reference: 142

DIF: Cognitive Level: Comprehension REF: Text Reference: 142

DIF: Cognitive Level: Application REF: Text Reference: 142

Elsevier items and derived items  2005 by Elsevier Inc.

in an ambulatory care setting would best consult

DIF: Cognitive Level: Comprehension REF: Text Reference: 143

DIF: Cognitive Level: Comprehension REF: Text Reference: 144

DIF: Cognitive Level: Comprehension REF: Text Reference: 134

Elsevier items and derived items  2005 by Elsevier Inc.

c. Primary Health Care Model.

DIF: Cognitive Level: Comprehension REF: Text Reference: 134

DIF: Cognitive Level: Comprehension REF: Text Reference: 135

DIF: Cognitive Level: Analysis REF: Text Reference: 140

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 141

21. In a telephone consultation the ambulatory care center nurse may

DIF: Cognitive Level: Analysis REF: Text Reference: 141, 142;

22. After each Telehealth communication the nurse should

DIF: Cognitive Level: Application REF: Text Reference: 142

DIF: Cognitive Level: Comprehension REF: Text Reference: 143

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 143, 144;

DIF: Cognitive Level: Comprehension REF: Text Reference: 143

Elsevier items and derived items  2005 by Elsevier Inc.

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