Pre-Predictor exam review
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
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
