Pre-Predictor exam review {apea) test
guide with 100% correct answers
Prescriptive authority: - ANS may be exercised by giving a verbal medication order to
a pharmacist.
An example of exercising prescriptive authority is giving a verbal order to a pharmacist
or writing an order for a prescription medication. Prescriptive authority rules and
regulations vary from state to state. Prescriptive authority is granted only to those
APRNs who meet the requirements of the governing body for the state in which the
APRN practices.
When examining a pregnant patient, where should the fundal height be at 22 weeks? -
ANS Above the umbilicus
Between 18 and 32 weeks, there is good correlation between fundal height and
gestational age of the fetus. The expected heights are: 10-12 weeks: fundus slightly
above the symphysis pubis 16 weeks: fundus midway between the symphysis pubis
and umbilicus 20 weeks: fundus at the level of umbilicus 28 weeks: fundus 3
fingerbreadths above the umbilicus 36 weeks: fundus just below the xiphoid process
What intervention does the American College of Rheumatology recommend as first-line
therapy for osteoarthritis? - ANS Exercise and weight loss
Exercise, weight loss, and rest are recommended by the American College of
Rheumatology guidelines for the initial management of osteoarthritis (OA). Given the
adverse effects of medications used to treat OA, it is best to minimize dosage and delay
use as long as possible. An extensive diagnostic workup is not recommended unless
the presentation is in question. Patients who have severe degenerative joint disease
(DJD), joint fusion, or whose pain severity is not relieved by more conservative
therapies may be candidates for joint replacement. Acetaminophen is recommended as
a first-line medication.
A 63-year-old male retired accountant complains of pain and stiffness in his feet and
hands of several years duration. He reports that the pain and stiffness become worse
with activity. On examination, he is noted to have Heberden's nodes but no other bony
,deformities. Which of the following is the most probable diagnosis? - ANS
Osteoarthritis (OA)
Although his vocation involved sedentary activity, this patient is not at great risk for
osteoarthritis. Rheumatoid arthritis is characterized by several joint deformities, usually
bilaterally symmetrical. RA is characterized by inflammatory processes, while OA is not.
RA and OA are chronic conditions. Gout is characterized by acute exacerbations related
to a defect in purine metabolism, increased uric acid production, or decreased uric acid
excretion.
The family of a 78-year-old man moved him into an assisted living center because he
can no longer be left at home alone. He is unable to toilet when asked to do so and he
has had several episodes of incontinence. He has walked out of the facility twice and
been unable to find his way back from 3 blocks away. On examination, he is pleasant
but mildly confused. Which of his medications is LEAST likely contributing to his
behavior? - ANS ramipril (Altace®)
Tricyclic antidepressants, like amitriptyline, have anticholinergic side effects which are
especially problematic in the elderly because they contribute to urinary retention.
Hydrochlorothiazide is a diuretic and may contribute to his incontinence. Cimetidine is
well known to produce adverse reactions such as confusion in elders. Ramipril, an ACE
inhibitor, is unlikely to contribute to this patient's incontinence or confusion. Toileting
may be a complicated by the anticholinergic medication and/or the diuretic causing
diuresis, urge incontinence, and inability to void at will.
A patient with no significant medical history has varicose veins. She complains of
"aching legs". The intervention that will provide the greatest relief for her complaint is to:
- ANS elevate her legs periodically.
The intervention that will provide the greatest relief for this patient is elevating her legs
periodically. This will facilitate venous return. Use of support stockings will prolong the
length of time she is able to stand in place, but will not provide relief after her legs begin
aching. Support stockings should be applied prior to getting out of bed.
Stress urinary incontinence is: - ANS may be aggravated by caffeine or alcohol.
Stress urinary incontinence is not expected as a result of the normal aging process. The
primary problem is sphincter incompetence. The ingestion of caffeine or alcohol
decreases sphincter control. Anticholinergic and antidepressant medications are
,causative factors related to overflow incontinence. Detrusor muscle instability is the
primary underlying problem causing urge incontinence.
Which commonly used herbal remedy is NOT associated with anxiety and/or depressive
symptom relief? - ANS Ginkgo biloba
Ginkgo biloba is a common herbal remedy associated with enhancement of vascular
and cerebral perfusion and memory. The nurse practitioner should be aware when the
patient is taking any herbal supplement to avoid risk of drug interactions.
Upon ophthalmoscopic examination of a 78-year-old patient, the nurse practitioner
observes dark spots against a red retina. What diagnosis is this finding most consistent
with? - ANS Cataract
A cataract opacity is seen as a dark disruption of the red reflex on ophthalmoscopic
exam.
A 72 year old female patient reports a 6 month history of progressively more swollen
and painful distal interphalangeal (DIP) joints of one hand. There are no systemic
symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA),
and rheumatoid factor (RF) are all minimally elevated. What is the most likely
diagnosis? - ANS Osteoarthritis
When osteoarthritis affects the hands, the distal interphalangeal (DIP) joints are usually
involved. Rheumatoid arthritis is usually symmetrical, and the proximal interphalangeal
(PIP) joints are more often affected. Inflammation often develops quickly, not gradually.
This patient is elderly; therefore, it is expected that the ESR, ANA, and RF will be only
somewhat elevated. Over-interpretation of laboratory tests without evidence of systemic
inflammation can lead to misdiagnosis.
The nurse practitioner is evaluating a 35-year-old female nurse. She has a history of
hospitalization for hepatitis B infection 2 years ago. Her laboratory tests demonstrate
positive HBsAg. The nurse practitioner would most likely diagnose: - ANS chronic
hepatitis B infection.
Presence of hepatitis B surface antigen at this time indicates chronic infection with
hepatitis B. Lab studies indicating a positive surface antigen on 2 separate occasions at
least 6 months apart indicate chronic infection. Immunization produces positive hepatitis
B antibodies in most instances. Hepatitis B surface antigen would not be present in a
, person who has recovered from hepatitis B infection. This case would not be an acute
episode because of the history of hepatitis B infection 2 years prior.
One exception to the recommendation to limit dietary fat intake is: - ANS children
under 2 years-of-age.
In order for myelinization of the nervous system to occur, children under 2 years-of-age
require > 30% daily dietary fat.
The most effective primary prevention of skin cancer is to educate the public about: -
ANS limiting exposure to natural solar radiation.
Primary prevention of skin cancer includes limiting sun exposure, avoiding tanning
facilities, and applying sunscreen. Examining the skin and recognizing melanoma are
both secondary prevention measures.
A patient has experienced nausea and vomiting, headache, malaise, low-grade fever,
abdominal cramps, and diarrhea for 32 hours. The white count is slightly elevated with a
shift to the left. He is requesting medication for diarrhea. What is the most appropriate
response? - ANS Offer an anti-emetic medication such as prochlorperazine
(Compazine®) and provide oral fluid and electrolyte replacement instruction.
Enterocolitis is the most common clinical presentation of salmonellosis. Diagnosis is
made by clinical presentation, and can be confirmed only with stool or blood cultures.
Most healthy adults have a course that is self-limiting to 72 hours. Antibiotics should be
used very discriminantly as resistance approaches 50%. Anti-diarrheal agents
potentially increase complications and predispose the patient to bacteremia.
A child with Type 1 diabetes mellitus brings in a glucose diary indicating consistent
morning hyperglycemia. How can the nurse practitioner differentiate the Somogyi effect
from dawn phenomenon? - ANS Instruct the parent to monitor the blood glucose at
3:00 am.
Dawn phenomenon is an early morning rise in plasma glucose. It indicates a need for
increased insulin. The Somogyi effect is a rise in plasma glucose in response to
hypoglycemia. It is usually accompanied by weight gain and hunger and is corrected by
decreasing the evening insulin dose. A series of 3 early morning measurements of
blood glucose will help differentiate between the 2 conditions.
guide with 100% correct answers
Prescriptive authority: - ANS may be exercised by giving a verbal medication order to
a pharmacist.
An example of exercising prescriptive authority is giving a verbal order to a pharmacist
or writing an order for a prescription medication. Prescriptive authority rules and
regulations vary from state to state. Prescriptive authority is granted only to those
APRNs who meet the requirements of the governing body for the state in which the
APRN practices.
When examining a pregnant patient, where should the fundal height be at 22 weeks? -
ANS Above the umbilicus
Between 18 and 32 weeks, there is good correlation between fundal height and
gestational age of the fetus. The expected heights are: 10-12 weeks: fundus slightly
above the symphysis pubis 16 weeks: fundus midway between the symphysis pubis
and umbilicus 20 weeks: fundus at the level of umbilicus 28 weeks: fundus 3
fingerbreadths above the umbilicus 36 weeks: fundus just below the xiphoid process
What intervention does the American College of Rheumatology recommend as first-line
therapy for osteoarthritis? - ANS Exercise and weight loss
Exercise, weight loss, and rest are recommended by the American College of
Rheumatology guidelines for the initial management of osteoarthritis (OA). Given the
adverse effects of medications used to treat OA, it is best to minimize dosage and delay
use as long as possible. An extensive diagnostic workup is not recommended unless
the presentation is in question. Patients who have severe degenerative joint disease
(DJD), joint fusion, or whose pain severity is not relieved by more conservative
therapies may be candidates for joint replacement. Acetaminophen is recommended as
a first-line medication.
A 63-year-old male retired accountant complains of pain and stiffness in his feet and
hands of several years duration. He reports that the pain and stiffness become worse
with activity. On examination, he is noted to have Heberden's nodes but no other bony
,deformities. Which of the following is the most probable diagnosis? - ANS
Osteoarthritis (OA)
Although his vocation involved sedentary activity, this patient is not at great risk for
osteoarthritis. Rheumatoid arthritis is characterized by several joint deformities, usually
bilaterally symmetrical. RA is characterized by inflammatory processes, while OA is not.
RA and OA are chronic conditions. Gout is characterized by acute exacerbations related
to a defect in purine metabolism, increased uric acid production, or decreased uric acid
excretion.
The family of a 78-year-old man moved him into an assisted living center because he
can no longer be left at home alone. He is unable to toilet when asked to do so and he
has had several episodes of incontinence. He has walked out of the facility twice and
been unable to find his way back from 3 blocks away. On examination, he is pleasant
but mildly confused. Which of his medications is LEAST likely contributing to his
behavior? - ANS ramipril (Altace®)
Tricyclic antidepressants, like amitriptyline, have anticholinergic side effects which are
especially problematic in the elderly because they contribute to urinary retention.
Hydrochlorothiazide is a diuretic and may contribute to his incontinence. Cimetidine is
well known to produce adverse reactions such as confusion in elders. Ramipril, an ACE
inhibitor, is unlikely to contribute to this patient's incontinence or confusion. Toileting
may be a complicated by the anticholinergic medication and/or the diuretic causing
diuresis, urge incontinence, and inability to void at will.
A patient with no significant medical history has varicose veins. She complains of
"aching legs". The intervention that will provide the greatest relief for her complaint is to:
- ANS elevate her legs periodically.
The intervention that will provide the greatest relief for this patient is elevating her legs
periodically. This will facilitate venous return. Use of support stockings will prolong the
length of time she is able to stand in place, but will not provide relief after her legs begin
aching. Support stockings should be applied prior to getting out of bed.
Stress urinary incontinence is: - ANS may be aggravated by caffeine or alcohol.
Stress urinary incontinence is not expected as a result of the normal aging process. The
primary problem is sphincter incompetence. The ingestion of caffeine or alcohol
decreases sphincter control. Anticholinergic and antidepressant medications are
,causative factors related to overflow incontinence. Detrusor muscle instability is the
primary underlying problem causing urge incontinence.
Which commonly used herbal remedy is NOT associated with anxiety and/or depressive
symptom relief? - ANS Ginkgo biloba
Ginkgo biloba is a common herbal remedy associated with enhancement of vascular
and cerebral perfusion and memory. The nurse practitioner should be aware when the
patient is taking any herbal supplement to avoid risk of drug interactions.
Upon ophthalmoscopic examination of a 78-year-old patient, the nurse practitioner
observes dark spots against a red retina. What diagnosis is this finding most consistent
with? - ANS Cataract
A cataract opacity is seen as a dark disruption of the red reflex on ophthalmoscopic
exam.
A 72 year old female patient reports a 6 month history of progressively more swollen
and painful distal interphalangeal (DIP) joints of one hand. There are no systemic
symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA),
and rheumatoid factor (RF) are all minimally elevated. What is the most likely
diagnosis? - ANS Osteoarthritis
When osteoarthritis affects the hands, the distal interphalangeal (DIP) joints are usually
involved. Rheumatoid arthritis is usually symmetrical, and the proximal interphalangeal
(PIP) joints are more often affected. Inflammation often develops quickly, not gradually.
This patient is elderly; therefore, it is expected that the ESR, ANA, and RF will be only
somewhat elevated. Over-interpretation of laboratory tests without evidence of systemic
inflammation can lead to misdiagnosis.
The nurse practitioner is evaluating a 35-year-old female nurse. She has a history of
hospitalization for hepatitis B infection 2 years ago. Her laboratory tests demonstrate
positive HBsAg. The nurse practitioner would most likely diagnose: - ANS chronic
hepatitis B infection.
Presence of hepatitis B surface antigen at this time indicates chronic infection with
hepatitis B. Lab studies indicating a positive surface antigen on 2 separate occasions at
least 6 months apart indicate chronic infection. Immunization produces positive hepatitis
B antibodies in most instances. Hepatitis B surface antigen would not be present in a
, person who has recovered from hepatitis B infection. This case would not be an acute
episode because of the history of hepatitis B infection 2 years prior.
One exception to the recommendation to limit dietary fat intake is: - ANS children
under 2 years-of-age.
In order for myelinization of the nervous system to occur, children under 2 years-of-age
require > 30% daily dietary fat.
The most effective primary prevention of skin cancer is to educate the public about: -
ANS limiting exposure to natural solar radiation.
Primary prevention of skin cancer includes limiting sun exposure, avoiding tanning
facilities, and applying sunscreen. Examining the skin and recognizing melanoma are
both secondary prevention measures.
A patient has experienced nausea and vomiting, headache, malaise, low-grade fever,
abdominal cramps, and diarrhea for 32 hours. The white count is slightly elevated with a
shift to the left. He is requesting medication for diarrhea. What is the most appropriate
response? - ANS Offer an anti-emetic medication such as prochlorperazine
(Compazine®) and provide oral fluid and electrolyte replacement instruction.
Enterocolitis is the most common clinical presentation of salmonellosis. Diagnosis is
made by clinical presentation, and can be confirmed only with stool or blood cultures.
Most healthy adults have a course that is self-limiting to 72 hours. Antibiotics should be
used very discriminantly as resistance approaches 50%. Anti-diarrheal agents
potentially increase complications and predispose the patient to bacteremia.
A child with Type 1 diabetes mellitus brings in a glucose diary indicating consistent
morning hyperglycemia. How can the nurse practitioner differentiate the Somogyi effect
from dawn phenomenon? - ANS Instruct the parent to monitor the blood glucose at
3:00 am.
Dawn phenomenon is an early morning rise in plasma glucose. It indicates a need for
increased insulin. The Somogyi effect is a rise in plasma glucose in response to
hypoglycemia. It is usually accompanied by weight gain and hunger and is corrected by
decreasing the evening insulin dose. A series of 3 early morning measurements of
blood glucose will help differentiate between the 2 conditions.
