Pre-Predictor exam review
1. Prescriptive authorityans 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 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? 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 areans 10-12 weeksans fundus
slightly above the symphysis pubis 16 weeksans fundus midway between the
symphysis pubis and umbilicus 20 weeksans fundus at the level of umbilicus 28
weeksans fundus 3 fingerbreadths above the umbilicus 36 weeksans fundus just
below the xiphoid process
3. 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
, Pre-Predictor exam review
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? 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.
, 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? 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.
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 toans 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.
7. Stress urinary incontinence isans ans may be aggravated by caffeine or
alcohol.
, Pre-Predictor exam review
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? 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.
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? ans Cataract
1. Prescriptive authorityans 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 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? 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 areans 10-12 weeksans fundus
slightly above the symphysis pubis 16 weeksans fundus midway between the
symphysis pubis and umbilicus 20 weeksans fundus at the level of umbilicus 28
weeksans fundus 3 fingerbreadths above the umbilicus 36 weeksans fundus just
below the xiphoid process
3. 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
, Pre-Predictor exam review
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? 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.
, 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? 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.
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 toans 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.
7. Stress urinary incontinence isans ans may be aggravated by caffeine or
alcohol.
, Pre-Predictor exam review
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? 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.
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? ans Cataract
