Pre-Predictor Exam Review

PRE-PREDICTOR EXAM REVIEW


Prescriptivepoauthority:po-poans--
maypobepoexercisedpobypogivingpoapoverbalpomedicationpoorderpotopoapopharmacist.

Anpoexamplepoofpoexercisingpoprescriptivepoauthoritypoispogivingpoapoverbalpoorderpotopoap
opharmacistpoorpowritingpoanpoorderpoforpoapoprescriptionpomedication.poPrescriptivepoaut
horityporulespoandporegulationspovarypofrompostatepotopostate.poPrescriptivepoauthoritypoisp
ograntedpoonlypotopothosepoAPRNspowhopomeetpotheporequirementspoofpothepogoverningpo
bodypoforpothepostatepoinpowhichpothepoAPRNpopractices.

Whenpoexaminingpoapopregnantpopatient,powhereposhouldpothepofundalpoheightpobepoatpo2
2poweeks?po-poans--Abovepothepoumbilicus

Betweenpo18poandpo32poweeks,potherepoispogoodpocorrelationpobetweenpofundalpoheightpo
andpogestationalpoagepoofpothepofetus.poThepoexpectedpoheightspoare:po10-
12poweeks:pofundusposlightlypoabovepotheposymphysispopubispo16poweeks:pofunduspomid
waypobetweenpotheposymphysispopubispoandpoumbilicuspo20poweeks:pofunduspoatpothepole
velpoofpoumbilicuspo28poweeks:pofunduspo3pofingerbreadthspoabovepothepoumbilicuspo36po
weeks:pofunduspojustpobelowpothepoxiphoidpoprocess

WhatpointerventionpodoespothepoAmericanpoCollegepoofpoRheumatologyporecommendpoas
pofirst-linepotherapypoforpoosteoarthritis?po-poans--Exercisepoandpoweightpoloss


Exercise,poweightpoloss,poandporestpoareporecommendedpobypothepoAmericanpoCollegepo
ofpoRheumatologypoguidelinespoforpothepoinitialpomanagementpoofpoosteoarthritispo(OA).po
GivenpothepoadversepoeffectspoofpomedicationspousedpotopotreatpoOA,poitpoispobestpotopomi
nimizepodosagepoandpodelaypousepoaspolongpoaspopossible.poAnpoextensivepodiagnosticpo
workuppoisponotporecommendedpounlesspothepopresentationpoispoinpoquestion.poPatientspo
whopohaveposeverepodegenerativepojointpodiseasepo(DJD),pojointpofusion,poorpowhosepopa
inposeveritypoisponotporelievedpobypomorepoconservativepotherapiespomaypobepocandidates
poforpojointporeplacement.poAcetaminophenpoisporecommendedpoaspoapofirst-
linepomedication.

Apo63-year-
oldpomaleporetiredpoaccountantpocomplainspoofpopainpoandpostiffnesspoinpohispofeetpoandpo
handspoofposeveralpoyearspoduration.poHeporeportspothatpothepopainpoandpostiffnesspobeco
mepoworsepowithpoactivity.poOnpoexamination,pohepoisponotedpotopohavepoHeberden'spono

,despobutponopootherpobonypodeformities.poWhichpoofpothepofollowingpoispothepomostpoprob
ablepodiagnosis?po-poans--Osteoarthritispo(OA)

Althoughpohispovocationpoinvolvedposedentarypoactivity,pothispopatientpoisponotpoatpogreatp
oriskpoforpoosteoarthritis.poRheumatoidpoarthritispoispocharacterizedpobyposeveralpojointpod
eformities,pousuallypobilaterallyposymmetrical.poRApoispocharacterizedpobypoinflammatoryp
oprocesses,powhilepoOApoisponot.poRApoandpoOApoarepochronicpoconditions.poGoutpoispoch
aracterizedpobypoacutepoexacerbationsporelatedpotopoapodefectpoinpopurinepometabolism,po
increasedpouricpoacidpoproduction,poorpodecreasedpouricpoacidpoexcretion.

Thepofamilypoofpoapo78-year-
oldpomanpomovedpohimpointopoanpoassistedpolivingpocenterpobecausepohepocanponopolong
erpobepoleftpoatpohomepoalone.poHepoispounablepotopotoiletpowhenpoaskedpotopodoposopoand
pohepohaspohadposeveralpoepisodespoofpoincontinence.poHepohaspowalkedpooutpoofpothepof
acilitypotwicepoandpobeenpounablepotopofindpohispowaypobackpofrompo3poblockspoaway.poO
npoexamination,pohepoispopleasantpobutpomildlypoconfused.poWhichpoofpohispomedicationsp
oispoLEASTpolikelypocontributingpotopohispobehavior?po-poans--ramiprilpo(Altace®)


Tricyclicpoantidepressants,polikepoamitriptyline,pohavepoanticholinergicposidepoeffectspowhi
chpoarepoespeciallypoproblematicpoinpothepoelderlypobecausepotheypocontributepotopourinar
yporetention.poHydrochlorothiazidepoispoapodiureticpoandpomaypocontributepotopohispoincont
inence.poCimetidinepoispowellpoknownpotopoproducepoadverseporeactionsposuchpoaspoconf
usionpoinpoelders.poRamipril,poanpoACEpoinhibitor,poispounlikelypotopocontributepotopothispop
atient'spoincontinencepoorpoconfusion.poToiletingpomaypobepoapocomplicatedpobypothepoant
icholinergicpomedicationpoand/
orpothepodiureticpocausingpodiuresis,pourgepoincontinence,poandpoinabilitypotopovoidpoatpowi
ll.

Apopatientpowithponoposignificantpomedicalpohistorypohaspovaricosepoveins.poShepocomplai
nspoofpo"achingpolegs".poThepointerventionpothatpowillpoprovidepothepogreatestporeliefpoforpo
herpocomplaintpoispoto:po-poans--elevatepoherpolegspoperiodically.

Thepointerventionpothatpowillpoprovidepothepogreatestporeliefpoforpothispopatientpoispoelevati
ngpoherpolegspoperiodically.poThispowillpofacilitatepovenousporeturn.poUsepoofposupportposto
ckingspowillpoprolongpothepolengthpoofpotimeposhepoispoablepotopostandpoinpoplace,pobutpowi
llponotpoprovideporeliefpoafterpoherpolegspobeginpoaching.poSupportpostockingsposhouldpobe
poappliedpopriorpotopogettingpooutpoofpobed.


Stresspourinarypoincontinencepois:po-poans--
maypobepoaggravatedpobypocaffeinepoorpoalcohol.

Stresspourinarypoincontinencepoisponotpoexpectedpoaspoaporesultpoofpotheponormalpoagingp
oprocess.poThepoprimarypoproblempoisposphincterpoincompetence.poThepoingestionpoofpoc
affeinepoorpoalcoholpodecreasesposphincterpocontrol.poAnticholinergicpoandpoantidepressa
ntpomedicationspoarepocausativepofactorsporelatedpotopooverflowpoincontinence.poDetrusor

,pomusclepoinstabilitypoispothepoprimarypounderlyingpoproblempocausingpourgepoincontinenc
e.

WhichpocommonlypousedpoherbalporemedypoispoNOTpoassociatedpowithpoanxietypoand/
orpodepressiveposymptomporelief?po-poans--Ginkgopobiloba

Ginkgopobilobapoispoapocommonpoherbalporemedypoassociatedpowithpoenhancementpoofpo
vascularpoandpocerebralpoperfusionpoandpomemory.poTheponursepopractitionerposhouldpob
epoawarepowhenpothepopatientpoispotakingpoanypoherbalposupplementpotopoavoidporiskpoofp
odrugpointeractions.


Uponpoophthalmoscopicpoexaminationpoofpoapo78-year-
oldpopatient,potheponursepopractitionerpoobservespodarkpospotspoagainstpoaporedporetina.po
Whatpodiagnosispoispothispofindingpomostpoconsistentpowith?po-poans--Cataract

Apocataractpoopacitypoisposeenpoaspoapodarkpodisruptionpoofpotheporedporeflexpoonpoophtha
lmoscopicpoexam.

Apo72poyearpooldpofemalepopatientporeportspoapo6pomonthpohistorypoofpoprogressivelypomo
reposwollenpoandpopainfulpodistalpointerphalangealpo(DIP)pojointspoofpoonepohand.poTherep
oareponoposystemicposymptomspobutpothepoerythrocyteposedimentationporatepo(ESR),poant
inuclearpoantibodypo(ANA),poandporheumatoidpofactorpo(RF)poarepoallpominimallypoelevate
d.poWhatpoispothepomostpolikelypodiagnosis?po-poans--Osteoarthritis

Whenpoosteoarthritispoaffectspothepohands,pothepodistalpointerphalangealpo(DIP)pojointspoa
repousuallypoinvolved.poRheumatoidpoarthritispoispousuallyposymmetrical,poandpothepoproxi
malpointerphalangealpo(PIP)pojointspoarepomorepooftenpoaffected.poInflammationpooftenpod
evelopspoquickly,ponotpogradually.poThispopatientpoispoelderly;potherefore,poitpoispoexpecte
dpothatpothepoESR,poANA,poandpoRFpowillpobepoonlyposomewhatpoelevated.poOver-
interpretationpoofpolaboratorypotestspowithoutpoevidencepoofposystemicpoinflammationpoca
npoleadpotopomisdiagnosis.

Theponursepopractitionerpoispoevaluatingpoapo35-year-
oldpofemaleponurse.poShepohaspoapohistorypoofpohospitalizationpoforpohepatitispoBpoinfectio
npo2poyearspoago.poHerpolaboratorypotestspodemonstratepopositivepoHBsAg.poTheponursep
opractitionerpowouldpomostpolikelypodiagnose:po-poans--chronicpohepatitispoBpoinfection.


PresencepoofpohepatitispoBposurfacepoantigenpoatpothispotimepoindicatespochronicpoinfectio
npowithpohepatitispoB.poLabpostudiespoindicatingpoapopositiveposurfacepoantigenpoonpo2pose
paratepooccasionspoatpoleastpo6pomonthspoapartpoindicatepochronicpoinfection.poImmuniza
tionpoproducespopositivepohepatitispoBpoantibodiespoinpomostpoinstances.poHepatitispoBpos
urfacepoantigenpowouldponotpobepopresentpoinpoapopersonpowhopohasporecoveredpofrompo
hepatitispoBpoinfection.poThispocasepowouldponotpobepoanpoacutepoepisodepobecausepoofpo
thepohistorypoofpohepatitispoBpoinfectionpo2poyearspoprior.

, Onepoexceptionpotopotheporecommendationpotopolimitpodietarypofatpointakepois:po-poans--
childrenpounderpo2poyears-of-age.

Inpoorderpoforpomyelinizationpoofpotheponervousposystempotopooccur,pochildrenpounderpo2po
years-of-ageporequirepo>po30%podailypodietarypofat.

Thepomostpoeffectivepoprimarypopreventionpoofposkinpocancerpoispotopoeducatepothepopubli
cpoabout:po-poans--limitingpoexposurepotoponaturalposolarporadiation.

Primarypopreventionpoofposkinpocancerpoincludespolimitingposunpoexposure,poavoidingpota
nningpofacilities,poandpoapplyingposunscreen.poExaminingpotheposkinpoandporecognizingpo
melanomapoarepobothposecondarypopreventionpomeasures.

Apopatientpohaspoexperiencedponauseapoandpovomiting,poheadache,pomalaise,polow-
gradepofever,poabdominalpocramps,poandpodiarrheapoforpo32pohours.poThepowhitepocountp
oisposlightlypoelevatedpowithpoaposhiftpotopothepoleft.poHepoisporequestingpomedicationpoforpo
diarrhea.poWhatpoispothepomostpoappropriateporesponse?po-poans--Offerpoanpoanti-
emeticpomedicationposuchpoaspoprochlorperazinepo(Compazine®)poandpoprovidepooralpofl
uidpoandpoelectrolyteporeplacementpoinstruction.

Enterocolitispoispothepomostpocommonpoclinicalpopresentationpoofposalmonellosis.poDiagn
osispoispomadepobypoclinicalpopresentation,poandpocanpobepoconfirmedpoonlypowithpostoolpo
orpobloodpocultures.poMostpohealthypoadultspohavepoapocoursepothatpoispoself-
limitingpotopo72pohours.poAntibioticsposhouldpobepousedpoverypodiscriminantlypoasporesista
ncepoapproachespo50%.poAnti-
diarrhealpoagentspopotentiallypoincreasepocomplicationspoandpopredisposepothepopatientpo
topobacteremia.

ApochildpowithpoTypepo1podiabetespomellituspobringspoinpoapoglucosepodiarypoindicatingpoc
onsistentpomorningpohyperglycemia.poHowpocanpotheponursepopractitionerpodifferentiatepot
hepoSomogyipoeffectpofrompodawnpophenomenon?po-poans--
Instructpothepoparentpotopomonitorpothepobloodpoglucosepoatpo3:00poam.

Dawnpophenomenonpoispoanpoearlypomorningporisepoinpoplasmapoglucose.poItpoindicatespo
aponeedpoforpoincreasedpoinsulin.poThepoSomogyipoeffectpoispoaporisepoinpoplasmapoglucos
epoinporesponsepotopohypoglycemia.poItpoispousuallypoaccompaniedpobypoweightpogainpoan
dpohungerpoandpoispocorrectedpobypodecreasingpothepoeveningpoinsulinpodose.poAposeriesp
oofpo3poearlypomorningpomeasurementspoofpobloodpoglucosepowillpohelppodifferentiatepobet
weenpothepo2poconditions.

Ofpothepofollowingposignspoandposymptomspoofpoheartpofailurepo(HF),pothepoearliestpoclinic
alpomanifestationpois:po-poans--weightpogain.

ThepoearliestpoandpomostposensitivepoclinicalpoindicatorpoofpoHFpoispoweightpogain.poApopa
tientpowithpoHFposhouldpobepoinstructedpotopoweighpohimselfpodailypotoponotepochangespoi
npohispoweight.poThepobestpotimepoofpodaypotopoweighpoispoearlypomorning.poThepootherpoc