Pre-Predictor exam review
1. Prescriptive authority:: 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 pharma-
cist 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.
2. When examining a pregnant patient, where should the fundal height be at
22 weeks?: 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
3. What intervention does the American College of Rheumatology recommend
as first-line therapy for osteoarthritis?: 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.
4. 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?: 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.
, Pre-Predictor exam review
5. 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?: 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.
6. A patient with no significant medical history has varicose veins. She com-
plains of "aching legs". The intervention that will provide the greatest relief for
her complaint is to:: 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.
7. Stress urinary incontinence is:: 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.
8. Which commonly used herbal remedy is NOT associated with anxiety and/or
depressive symptom relief?: 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.
9. 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?: Cataract
, Pre-Predictor exam review
A cataract opacity is seen as a dark disruption of the red reflex on ophthalmoscopic
exam.
10. 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), anti-
nuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated.
What is the most likely diagnosis?: 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.
11. 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:: 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.
12. One exception to the recommendation to limit dietary fat intake is:: 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.
13. The most effective primary prevention of skin cancer is to educate the
public about:: 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.
14. A patient has experienced nausea and vomiting, headache, malaise,
low-grade fever, abdominal cramps, and diarrhea for 32 hours. The white count
, Pre-Predictor exam review
is slightly elevated with a shift to the left. He is requesting medication for
diarrhea. What is the most appropriate response?: Offer an anti-emetic medica-
tion 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.
15. A child with Type 1 diabetes mellitus brings in a glucose diary indicating
consistent morning hyperglycemia. How can the nurse practitioner differenti-
ate the Somogyi effect from dawn phenomenon?: 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.
16. Of the following signs and symptoms of heart failure (HF), the earliest
clinical manifestation is:: weight gain.
The earliest and most sensitive clinical indicator of HF is weight gain. A patient with
HF should be instructed to weigh himself daily to note changes in his weight. The
best time of day to weigh is early morning. The other clinical manifestations listed
will present after the weight gain. Another early, clinical manifestation of CHF not
listed above is fatigue.
17. The mother of a 6-month-old infant asks about the use of an infant walker.
The most appropriate response is to:: discourage the use of walkers and encour-
age parental holding and floor play.
Baby walkers are a significant cause of injuries in young children. Their use should
be discouraged and parental holding and floor play should be encouraged instead.
18. A mother complains that her 3-month-old infant becomes constipated eas-
ily. She states she has been using her 4-year-old sibling's suppositories, but
they make the baby "fussy" and have diarrhea stools. The nurse practitioner
should recommend:: adding 1 to 2 teaspoons of corn syrup to the infant's bottle
twice a day.
1. Prescriptive authority:: 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 pharma-
cist 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.
2. When examining a pregnant patient, where should the fundal height be at
22 weeks?: 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
3. What intervention does the American College of Rheumatology recommend
as first-line therapy for osteoarthritis?: 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.
4. 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?: 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.
, Pre-Predictor exam review
5. 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?: 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.
6. A patient with no significant medical history has varicose veins. She com-
plains of "aching legs". The intervention that will provide the greatest relief for
her complaint is to:: 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.
7. Stress urinary incontinence is:: 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.
8. Which commonly used herbal remedy is NOT associated with anxiety and/or
depressive symptom relief?: 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.
9. 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?: Cataract
, Pre-Predictor exam review
A cataract opacity is seen as a dark disruption of the red reflex on ophthalmoscopic
exam.
10. 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), anti-
nuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated.
What is the most likely diagnosis?: 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.
11. 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:: 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.
12. One exception to the recommendation to limit dietary fat intake is:: 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.
13. The most effective primary prevention of skin cancer is to educate the
public about:: 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.
14. A patient has experienced nausea and vomiting, headache, malaise,
low-grade fever, abdominal cramps, and diarrhea for 32 hours. The white count
, Pre-Predictor exam review
is slightly elevated with a shift to the left. He is requesting medication for
diarrhea. What is the most appropriate response?: Offer an anti-emetic medica-
tion 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.
15. A child with Type 1 diabetes mellitus brings in a glucose diary indicating
consistent morning hyperglycemia. How can the nurse practitioner differenti-
ate the Somogyi effect from dawn phenomenon?: 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.
16. Of the following signs and symptoms of heart failure (HF), the earliest
clinical manifestation is:: weight gain.
The earliest and most sensitive clinical indicator of HF is weight gain. A patient with
HF should be instructed to weigh himself daily to note changes in his weight. The
best time of day to weigh is early morning. The other clinical manifestations listed
will present after the weight gain. Another early, clinical manifestation of CHF not
listed above is fatigue.
17. The mother of a 6-month-old infant asks about the use of an infant walker.
The most appropriate response is to:: discourage the use of walkers and encour-
age parental holding and floor play.
Baby walkers are a significant cause of injuries in young children. Their use should
be discouraged and parental holding and floor play should be encouraged instead.
18. A mother complains that her 3-month-old infant becomes constipated eas-
ily. She states she has been using her 4-year-old sibling's suppositories, but
they make the baby "fussy" and have diarrhea stools. The nurse practitioner
should recommend:: adding 1 to 2 teaspoons of corn syrup to the infant's bottle
twice a day.
