Pre-Predictor exam review QUESTIONS
AND ANSWERS
1. A 12-year-old presents with ear pain of 36 hours duration. The nurse practitioner
diagnoses acute otitis media because the: - ANS -bony landmarks are obscured and the
tympanic membrane is mildly erythematous, dull, and immobile.
Serous otitis media typically presents with a flat or bulging and tympanic membrane with
a fluid line and/or tiny bubbles visible posteriorly. The tympanic membrane may be
immobile and retracted against the bony landmarks when the eustachian tube is swollen
or congested as with the common cold or allergies. Narrowing of the external canal with
erythema and extreme tenderness of the canal wall is indicative of otitis externa.
2. A 15-year-old high school student presents with a mild sore throat and low-grade fever
that has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of
appetite. The nurse practitioner suspects mononucleosis. Which of the following is the
LEAST appropriate intervention? - ANS -Obtain a urinalysis and serum for LFTs and
amylase.
The clinical presentation of this patient is typical of mononucleosis. Lymphadenopathy,
splenomegaly, pharyngeal petechiae, and leukocytosis are common additional findings.
Urinalysis, serum amylase, and LFTs would not yield information regarding the
diagnosis. The confirmatory tests are throat culture and the heterophil antibody test.
3. A 16 year old sexually active student presents with complaints of a greenish-gray frothy
vaginal discharge and vaginal itching. The nurse practitioner should suspect: - ANS
-trichomoniasis.
The cardinal symptoms of infection with Trichomonas vaginalis (a flagellated protozoan)
is a frothy, greenish-gray discharge with a fishy odor. The vagina may be very
edematous and red. The cervix may be friable with petechiae ("strawberry cervix").
4. A 16 year-old has been diagnosed with Lyme disease. Which drug should be used to
treat him? - ANS -Doxycycline
Doxycycline is frequently chosen first line to treat Lyme Disease. However, numerous
studies have demonstrated that amoxicillin and cefuroxime have equal efficacy as
doxycycline in treatment of early Lyme Disease. These drugs are recommended in
patients who exhibit erythema migrans. Doxycycline is not recommended in children less
than 9 years of age.
,5. A 17-year-old female presents with painful vesicular lesions on her vulva. Which of the
following would be the most definitive diagnostic test? - ANS -Tzanck prep
Tzanck prep is the only test in this list which is diagnostic for herpes simplex. KOH prep
is used to diagnose candidal and bacterial vaginosis. Gram stain is used to help
distinguish Gram positive and Gram negative organisms. The Papanicolaou (Pap) smear
is used to screen for cervical dysplasia and cancer.
6. A 2-year-old female presents with a 3 day history of high fever, followed by abrupt
resolution and development of a pink, maculopapular rash today. What pharmacological
intervention(s) should the nurse practitioner consider? - ANS -No pharmacologic
intervention is needed, but fluids should be encouraged
This 2 year old has roseola, a human herpes virus. Since the fever has resolved and the
rash will last another day or 2, no pharmacologic intervention is needed. Fluids should
be encouraged because there may be some residual dehydration from the 3 days of
fever.
7. A 28 year-old has a Grade 3 murmur. Which characteristic indicates a need for referral?
- ANS -A fixed split
8. A split is created because of closure of valves. For example, an S2 is created by closure
of the aortic and pulmonic valves. Normally these split with inspiration and almost never
with expiration. Splits should never be fixed. This indicates some pathology like an atrial
septal defect, pulmonic stenosis, or possibly mitral regurgitation. In any event, this
patient needs initial evaluation with an echocardiogram because fixed splits are always
considered abnormal.
9. A 3 year-old female had a fever of 102 degrees F for 3 days. Today she woke up from a
nap and is afebrile. She has a maculopapular rash. Which statement is true? - ANS -The
rash will blanch.
10.
11.This describes a patient with roseola or exanthem subitum. This is a common viral
exanthem found in young children caused by the Human Herpes Virus 6B. It is
characterized by high fever for 3 days followed by the abrupt cessation of fever and the
appearance of a maculopapular rash. This usually resolves in a few days. The child may
return to school or daycare when he has been fever free for 24 hours.
12.A 32 year-old patient is a newly diagnosed diabetic. She has developed a sinus
infection. Her symptoms have persisted for 10 days. Six weeks ago she was treated with
amoxicillin for an upper respiratory infection. It cleared without incident. What should be
recommended today? - ANS -Prescribe amoxicillin-clavulanate today.
13.
14.Amoxicillin is no longer indicated for initial treatment in adults who have acute bacterial
sinusitis. A bacterial cause can be assumed since she's had symptoms for 10 days. A
viral infection likely would have run its course by now. After 10 days of persistent
symptoms, treatment is reasonable with an antibiotic; especially since this patient is
diabetic. She may be having blood sugar elevations that facilitate growth of the
, causative organism of the sinus infection. A decongestant could be added depending on
her blood pressure and personal history of using decongestants.
15.A 32-year-old female patient presents with fever, chills, right flank pain, right
costovertebral angle tenderness, and hematuria. Her urinalysis is positive for leukocytes
and red blood cells. The nurse practitioner diagnoses pyelonephritis. The most
appropriate intervention is: - ANS -collect a urine for culture/sensitivity, order a CBC and
an antibiotic.
Physician collaboration should be considered in patients with pyelonephritis.
Ciprofloxacin is a drug choice for pyelonephritis, but a 14 day course is needed and the
urine sensitivity must indicate ciprofloxacin. It is not usually necessary to order blood
cultures unless sepsis is suspected. If the patient is not septic appearing and does not
have a deterioration in her condition, choice D, with 24-48 hour follow up is prudent.
16.A 37 year-old overweight male is diagnosed today with Type II diabetes. His fasting
glucose is 159 mg/dL. He is hyperlipidemic (LDL = 210 mg/dL) and hypertensive
(146/102). What medications should be initiated today? - ANS -Metformin, atorvastatin,
ramipril, ASA
This patient needs several medications started today. American Diabetes Association
recommends starting treatment with metformin. This should be initiated today. The drug
class of choice for treatment of his LDL cholesterol is a statin. Dietary modifications are
usually attempted for 3 months prior to initiation of a statin. However, considering this
patient's LDLs of 210 mg/dL (goal of less than 100 mg/dL), strong consideration should
be given to initiating therapy today with a statin. An ACE inhibitor is the preferred
antihypertensive medication to treat blood pressure elevations in this patient. An aspirin
should be initiated if there are no contraindications.
17.A 45 year old with Type 1 diabetes mellitus has had itching and burning lesions between
her toes for 6 months. Scrapings of the lesions confirm the diagnosis tinea pedis. What
is the best treatment option for this patient? - ANS -Prescribe an anti-fungal powder for
application between her toes and in her shoes and a topical prescription strength
anti-fungal cream for other affected areas. Monitor for a secondary bacterial infection.
If the patient follows the treatment plan as outlined in choice "A", she should get some
relief in a couple of weeks and resolution in 4 to 6 weeks. She should also monitor for a
secondary bacterial infection. She has diabetes, may have poor circulation, and thus,
might be expected to have a more difficult resolution of this problem might be more
difficult. If this course of treatment fails, the nurse practitioner should consider oral
antifungal therapy.
18.A 45 year-old female patient has a screening TSH performed. Her TSH value is 13
mU/L. It was repeated in one week and found to be 15 mU/L. What explains this finding?
- ANS -Hypothyroidism
This patient has hypothyroidism because her TSH exceeds 5 mU/L. Common symptoms
associated with hypothyroidism include fatigue, weight gain, dry skin, cold intolerance,
AND ANSWERS
1. A 12-year-old presents with ear pain of 36 hours duration. The nurse practitioner
diagnoses acute otitis media because the: - ANS -bony landmarks are obscured and the
tympanic membrane is mildly erythematous, dull, and immobile.
Serous otitis media typically presents with a flat or bulging and tympanic membrane with
a fluid line and/or tiny bubbles visible posteriorly. The tympanic membrane may be
immobile and retracted against the bony landmarks when the eustachian tube is swollen
or congested as with the common cold or allergies. Narrowing of the external canal with
erythema and extreme tenderness of the canal wall is indicative of otitis externa.
2. A 15-year-old high school student presents with a mild sore throat and low-grade fever
that has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of
appetite. The nurse practitioner suspects mononucleosis. Which of the following is the
LEAST appropriate intervention? - ANS -Obtain a urinalysis and serum for LFTs and
amylase.
The clinical presentation of this patient is typical of mononucleosis. Lymphadenopathy,
splenomegaly, pharyngeal petechiae, and leukocytosis are common additional findings.
Urinalysis, serum amylase, and LFTs would not yield information regarding the
diagnosis. The confirmatory tests are throat culture and the heterophil antibody test.
3. A 16 year old sexually active student presents with complaints of a greenish-gray frothy
vaginal discharge and vaginal itching. The nurse practitioner should suspect: - ANS
-trichomoniasis.
The cardinal symptoms of infection with Trichomonas vaginalis (a flagellated protozoan)
is a frothy, greenish-gray discharge with a fishy odor. The vagina may be very
edematous and red. The cervix may be friable with petechiae ("strawberry cervix").
4. A 16 year-old has been diagnosed with Lyme disease. Which drug should be used to
treat him? - ANS -Doxycycline
Doxycycline is frequently chosen first line to treat Lyme Disease. However, numerous
studies have demonstrated that amoxicillin and cefuroxime have equal efficacy as
doxycycline in treatment of early Lyme Disease. These drugs are recommended in
patients who exhibit erythema migrans. Doxycycline is not recommended in children less
than 9 years of age.
,5. A 17-year-old female presents with painful vesicular lesions on her vulva. Which of the
following would be the most definitive diagnostic test? - ANS -Tzanck prep
Tzanck prep is the only test in this list which is diagnostic for herpes simplex. KOH prep
is used to diagnose candidal and bacterial vaginosis. Gram stain is used to help
distinguish Gram positive and Gram negative organisms. The Papanicolaou (Pap) smear
is used to screen for cervical dysplasia and cancer.
6. A 2-year-old female presents with a 3 day history of high fever, followed by abrupt
resolution and development of a pink, maculopapular rash today. What pharmacological
intervention(s) should the nurse practitioner consider? - ANS -No pharmacologic
intervention is needed, but fluids should be encouraged
This 2 year old has roseola, a human herpes virus. Since the fever has resolved and the
rash will last another day or 2, no pharmacologic intervention is needed. Fluids should
be encouraged because there may be some residual dehydration from the 3 days of
fever.
7. A 28 year-old has a Grade 3 murmur. Which characteristic indicates a need for referral?
- ANS -A fixed split
8. A split is created because of closure of valves. For example, an S2 is created by closure
of the aortic and pulmonic valves. Normally these split with inspiration and almost never
with expiration. Splits should never be fixed. This indicates some pathology like an atrial
septal defect, pulmonic stenosis, or possibly mitral regurgitation. In any event, this
patient needs initial evaluation with an echocardiogram because fixed splits are always
considered abnormal.
9. A 3 year-old female had a fever of 102 degrees F for 3 days. Today she woke up from a
nap and is afebrile. She has a maculopapular rash. Which statement is true? - ANS -The
rash will blanch.
10.
11.This describes a patient with roseola or exanthem subitum. This is a common viral
exanthem found in young children caused by the Human Herpes Virus 6B. It is
characterized by high fever for 3 days followed by the abrupt cessation of fever and the
appearance of a maculopapular rash. This usually resolves in a few days. The child may
return to school or daycare when he has been fever free for 24 hours.
12.A 32 year-old patient is a newly diagnosed diabetic. She has developed a sinus
infection. Her symptoms have persisted for 10 days. Six weeks ago she was treated with
amoxicillin for an upper respiratory infection. It cleared without incident. What should be
recommended today? - ANS -Prescribe amoxicillin-clavulanate today.
13.
14.Amoxicillin is no longer indicated for initial treatment in adults who have acute bacterial
sinusitis. A bacterial cause can be assumed since she's had symptoms for 10 days. A
viral infection likely would have run its course by now. After 10 days of persistent
symptoms, treatment is reasonable with an antibiotic; especially since this patient is
diabetic. She may be having blood sugar elevations that facilitate growth of the
, causative organism of the sinus infection. A decongestant could be added depending on
her blood pressure and personal history of using decongestants.
15.A 32-year-old female patient presents with fever, chills, right flank pain, right
costovertebral angle tenderness, and hematuria. Her urinalysis is positive for leukocytes
and red blood cells. The nurse practitioner diagnoses pyelonephritis. The most
appropriate intervention is: - ANS -collect a urine for culture/sensitivity, order a CBC and
an antibiotic.
Physician collaboration should be considered in patients with pyelonephritis.
Ciprofloxacin is a drug choice for pyelonephritis, but a 14 day course is needed and the
urine sensitivity must indicate ciprofloxacin. It is not usually necessary to order blood
cultures unless sepsis is suspected. If the patient is not septic appearing and does not
have a deterioration in her condition, choice D, with 24-48 hour follow up is prudent.
16.A 37 year-old overweight male is diagnosed today with Type II diabetes. His fasting
glucose is 159 mg/dL. He is hyperlipidemic (LDL = 210 mg/dL) and hypertensive
(146/102). What medications should be initiated today? - ANS -Metformin, atorvastatin,
ramipril, ASA
This patient needs several medications started today. American Diabetes Association
recommends starting treatment with metformin. This should be initiated today. The drug
class of choice for treatment of his LDL cholesterol is a statin. Dietary modifications are
usually attempted for 3 months prior to initiation of a statin. However, considering this
patient's LDLs of 210 mg/dL (goal of less than 100 mg/dL), strong consideration should
be given to initiating therapy today with a statin. An ACE inhibitor is the preferred
antihypertensive medication to treat blood pressure elevations in this patient. An aspirin
should be initiated if there are no contraindications.
17.A 45 year old with Type 1 diabetes mellitus has had itching and burning lesions between
her toes for 6 months. Scrapings of the lesions confirm the diagnosis tinea pedis. What
is the best treatment option for this patient? - ANS -Prescribe an anti-fungal powder for
application between her toes and in her shoes and a topical prescription strength
anti-fungal cream for other affected areas. Monitor for a secondary bacterial infection.
If the patient follows the treatment plan as outlined in choice "A", she should get some
relief in a couple of weeks and resolution in 4 to 6 weeks. She should also monitor for a
secondary bacterial infection. She has diabetes, may have poor circulation, and thus,
might be expected to have a more difficult resolution of this problem might be more
difficult. If this course of treatment fails, the nurse practitioner should consider oral
antifungal therapy.
18.A 45 year-old female patient has a screening TSH performed. Her TSH value is 13
mU/L. It was repeated in one week and found to be 15 mU/L. What explains this finding?
- ANS -Hypothyroidism
This patient has hypothyroidism because her TSH exceeds 5 mU/L. Common symptoms
associated with hypothyroidism include fatigue, weight gain, dry skin, cold intolerance,
