Science Medicine Rheumatology
Pre-Predictor exam review 2025 130
questions and answers
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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
Prescriptive authority: 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.
Above the umbilicus
Between 18 and 32 weeks, there is good correlation between fundal height and
When examining a pregnant patient, where
gestational age of the fetus. The expected heights are: 10-12 weeks: fundus slightly
should the fundal height be at 22 weeks?
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
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
What intervention does the American
adverse effects of medications used to treat OA, it is best to minimize dosage and
College of Rheumatology recommend as
delay use as long as possible. An extensive diagnostic workup is not recommended
first-line therapy for osteoarthritis?
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 Osteoarthritis (OA)
complains of pain and stiffness in his feet
and hands of several years duration. He Although his vocation involved sedentary activity, this patient is not at great risk for
reports that the pain and stiffness become osteoarthritis. Rheumatoid arthritis is characterized by several joint deformities,
worse with activity. On examination, he is usually bilaterally symmetrical. RA is characterized by inflammatory processes, while
noted to have Heberden's nodes but no OA is not. RA and OA are chronic conditions. Gout is characterized by acute
other bony deformities. Which of the exacerbations related to a defect in purine metabolism, increased uric acid
following is the most probable diagnosis? production, or decreased uric acid excretion.
The family of a 78-year-old man moved him ramipril (Altace®)
into an assisted living center because he
can no longer be left at home alone. He is Tricyclic antidepressants, like amitriptyline, have anticholinergic side effects which
unable to toilet when asked to do so and are especially problematic in the elderly because they contribute to urinary
he has had several episodes of retention. Hydrochlorothiazide is a diuretic and may contribute to his incontinence.
incontinence. He has walked out of the Cimetidine is well known to produce adverse reactions such as confusion in elders.
facility twice and been unable to find his Ramipril, an ACE inhibitor, is unlikely to contribute to this patient's incontinence or
way back from 3 blocks away. On confusion. Toileting may be a complicated by the anticholinergic medication and/or
examination, he is pleasant but mildly the diuretic causing diuresis, urge incontinence, and inability to void at will.
confused. Which of his medications is
LEAST likely contributing to his behavior?
See an expert-written answer
elevate her legs periodically.
A patient with no significant medical history
has varicose veins. She complains of The intervention that will provide the greatest relief for this patient is elevating her
"aching legs". The intervention that will legs periodically. This will facilitate venous return. Use of support stockings will
provide the greatest relief for her prolong the length of time she is able to stand in place, but will not provide relief
complaint is to: after her legs begin aching. Support stockings should be applied prior to getting out
of bed.
See an expert-written answer
may be aggravated by caffeine or alcohol.
Stress urinary incontinence is not expected as a result of the normal aging process.
Stress urinary incontinence is: 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.
Ginkgo biloba
Which commonly used herbal remedy is
NOT associated with anxiety and/or Ginkgo biloba is a common herbal remedy associated with enhancement of vascular
depressive symptom relief? 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 Cataract
78-year-old patient, the nurse practitioner
observes dark spots against a red retina. A cataract opacity is seen as a dark disruption of the red reflex on ophthalmoscopic
What diagnosis is this finding most exam.
consistent with?
See an expert-written answer
, A 72 year old female patient reports a 6 Osteoarthritis
month history of progressively more
swollen and painful distal interphalangeal When osteoarthritis affects the hands, the distal interphalangeal (DIP) joints are
(DIP) joints of one hand. There are no usually involved. Rheumatoid arthritis is usually symmetrical, and the proximal
systemic symptoms but the erythrocyte interphalangeal (PIP) joints are more often affected. Inflammation often develops
sedimentation rate (ESR), antinuclear quickly, not gradually. This patient is elderly; therefore, it is expected that the ESR,
antibody (ANA), and rheumatoid factor ANA, and RF will be only somewhat elevated. Over-interpretation of laboratory tests
(RF) are all minimally elevated. What is the without evidence of systemic inflammation can lead to misdiagnosis.
most likely diagnosis?
chronic hepatitis B infection.
The nurse practitioner is evaluating a 35-
year-old female nurse. She has a history of Presence of hepatitis B surface antigen at this time indicates chronic infection with
hospitalization for hepatitis B infection 2 hepatitis B. Lab studies indicating a positive surface antigen on 2 separate occasions
years ago. Her laboratory tests at least 6 months apart indicate chronic infection. Immunization produces positive
demonstrate positive HBsAg. The nurse hepatitis B antibodies in most instances. Hepatitis B surface antigen would not be
practitioner would most likely diagnose: 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.
See an expert-written answer
children under 2 years-of-age.
One exception to the recommendation to
limit dietary fat intake is: In order for myelinization of the nervous system to occur, children under 2 years-of-
age require > 30% daily dietary fat.
limiting exposure to natural solar radiation.
The most effective primary prevention of
Primary prevention of skin cancer includes limiting sun exposure, avoiding tanning
skin cancer is to educate the public about:
facilities, and applying sunscreen. Examining the skin and recognizing melanoma are
both secondary prevention measures.
Offer an anti-emetic medication such as prochlorperazine (Compazine®) and
A patient has experienced nausea and
provide oral fluid and electrolyte replacement instruction.
vomiting, headache, malaise, low-grade
fever, abdominal cramps, and diarrhea for
Enterocolitis is the most common clinical presentation of salmonellosis. Diagnosis is
32 hours. The white count is slightly
made by clinical presentation, and can be confirmed only with stool or blood
elevated with a shift to the left. He is
cultures. Most healthy adults have a course that is self-limiting to 72 hours. Antibiotics
requesting medication for diarrhea. What is
should be used very discriminantly as resistance approaches 50%. Anti-diarrheal
the most appropriate response?
agents potentially increase complications and predispose the patient to bacteremia.
Instruct the parent to monitor the blood glucose at 3:00 am.
A child with Type 1 diabetes mellitus brings
in a glucose diary indicating consistent Dawn phenomenon is an early morning rise in plasma glucose. It indicates a need for
morning hyperglycemia. How can the increased insulin. The Somogyi effect is a rise in plasma glucose in response to
nurse practitioner differentiate the Somogyi hypoglycemia. It is usually accompanied by weight gain and hunger and is corrected
effect from dawn phenomenon? by decreasing the evening insulin dose. A series of 3 early morning measurements of
blood glucose will help differentiate between the 2 conditions.
See an expert-written answer
weight gain.
Of the following signs and symptoms of The earliest and most sensitive clinical indicator of HF is weight gain. A patient with
heart failure (HF), the earliest clinical HF should be instructed to weigh himself daily to note changes in his weight. The
manifestation is: 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.
Pre-Predictor exam review 2025 130
questions and answers
Flashcard sets Study guides
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
Prescriptive authority: 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.
Above the umbilicus
Between 18 and 32 weeks, there is good correlation between fundal height and
When examining a pregnant patient, where
gestational age of the fetus. The expected heights are: 10-12 weeks: fundus slightly
should the fundal height be at 22 weeks?
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
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
What intervention does the American
adverse effects of medications used to treat OA, it is best to minimize dosage and
College of Rheumatology recommend as
delay use as long as possible. An extensive diagnostic workup is not recommended
first-line therapy for osteoarthritis?
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 Osteoarthritis (OA)
complains of pain and stiffness in his feet
and hands of several years duration. He Although his vocation involved sedentary activity, this patient is not at great risk for
reports that the pain and stiffness become osteoarthritis. Rheumatoid arthritis is characterized by several joint deformities,
worse with activity. On examination, he is usually bilaterally symmetrical. RA is characterized by inflammatory processes, while
noted to have Heberden's nodes but no OA is not. RA and OA are chronic conditions. Gout is characterized by acute
other bony deformities. Which of the exacerbations related to a defect in purine metabolism, increased uric acid
following is the most probable diagnosis? production, or decreased uric acid excretion.
The family of a 78-year-old man moved him ramipril (Altace®)
into an assisted living center because he
can no longer be left at home alone. He is Tricyclic antidepressants, like amitriptyline, have anticholinergic side effects which
unable to toilet when asked to do so and are especially problematic in the elderly because they contribute to urinary
he has had several episodes of retention. Hydrochlorothiazide is a diuretic and may contribute to his incontinence.
incontinence. He has walked out of the Cimetidine is well known to produce adverse reactions such as confusion in elders.
facility twice and been unable to find his Ramipril, an ACE inhibitor, is unlikely to contribute to this patient's incontinence or
way back from 3 blocks away. On confusion. Toileting may be a complicated by the anticholinergic medication and/or
examination, he is pleasant but mildly the diuretic causing diuresis, urge incontinence, and inability to void at will.
confused. Which of his medications is
LEAST likely contributing to his behavior?
See an expert-written answer
elevate her legs periodically.
A patient with no significant medical history
has varicose veins. She complains of The intervention that will provide the greatest relief for this patient is elevating her
"aching legs". The intervention that will legs periodically. This will facilitate venous return. Use of support stockings will
provide the greatest relief for her prolong the length of time she is able to stand in place, but will not provide relief
complaint is to: after her legs begin aching. Support stockings should be applied prior to getting out
of bed.
See an expert-written answer
may be aggravated by caffeine or alcohol.
Stress urinary incontinence is not expected as a result of the normal aging process.
Stress urinary incontinence is: 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.
Ginkgo biloba
Which commonly used herbal remedy is
NOT associated with anxiety and/or Ginkgo biloba is a common herbal remedy associated with enhancement of vascular
depressive symptom relief? 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 Cataract
78-year-old patient, the nurse practitioner
observes dark spots against a red retina. A cataract opacity is seen as a dark disruption of the red reflex on ophthalmoscopic
What diagnosis is this finding most exam.
consistent with?
See an expert-written answer
, A 72 year old female patient reports a 6 Osteoarthritis
month history of progressively more
swollen and painful distal interphalangeal When osteoarthritis affects the hands, the distal interphalangeal (DIP) joints are
(DIP) joints of one hand. There are no usually involved. Rheumatoid arthritis is usually symmetrical, and the proximal
systemic symptoms but the erythrocyte interphalangeal (PIP) joints are more often affected. Inflammation often develops
sedimentation rate (ESR), antinuclear quickly, not gradually. This patient is elderly; therefore, it is expected that the ESR,
antibody (ANA), and rheumatoid factor ANA, and RF will be only somewhat elevated. Over-interpretation of laboratory tests
(RF) are all minimally elevated. What is the without evidence of systemic inflammation can lead to misdiagnosis.
most likely diagnosis?
chronic hepatitis B infection.
The nurse practitioner is evaluating a 35-
year-old female nurse. She has a history of Presence of hepatitis B surface antigen at this time indicates chronic infection with
hospitalization for hepatitis B infection 2 hepatitis B. Lab studies indicating a positive surface antigen on 2 separate occasions
years ago. Her laboratory tests at least 6 months apart indicate chronic infection. Immunization produces positive
demonstrate positive HBsAg. The nurse hepatitis B antibodies in most instances. Hepatitis B surface antigen would not be
practitioner would most likely diagnose: 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.
See an expert-written answer
children under 2 years-of-age.
One exception to the recommendation to
limit dietary fat intake is: In order for myelinization of the nervous system to occur, children under 2 years-of-
age require > 30% daily dietary fat.
limiting exposure to natural solar radiation.
The most effective primary prevention of
Primary prevention of skin cancer includes limiting sun exposure, avoiding tanning
skin cancer is to educate the public about:
facilities, and applying sunscreen. Examining the skin and recognizing melanoma are
both secondary prevention measures.
Offer an anti-emetic medication such as prochlorperazine (Compazine®) and
A patient has experienced nausea and
provide oral fluid and electrolyte replacement instruction.
vomiting, headache, malaise, low-grade
fever, abdominal cramps, and diarrhea for
Enterocolitis is the most common clinical presentation of salmonellosis. Diagnosis is
32 hours. The white count is slightly
made by clinical presentation, and can be confirmed only with stool or blood
elevated with a shift to the left. He is
cultures. Most healthy adults have a course that is self-limiting to 72 hours. Antibiotics
requesting medication for diarrhea. What is
should be used very discriminantly as resistance approaches 50%. Anti-diarrheal
the most appropriate response?
agents potentially increase complications and predispose the patient to bacteremia.
Instruct the parent to monitor the blood glucose at 3:00 am.
A child with Type 1 diabetes mellitus brings
in a glucose diary indicating consistent Dawn phenomenon is an early morning rise in plasma glucose. It indicates a need for
morning hyperglycemia. How can the increased insulin. The Somogyi effect is a rise in plasma glucose in response to
nurse practitioner differentiate the Somogyi hypoglycemia. It is usually accompanied by weight gain and hunger and is corrected
effect from dawn phenomenon? by decreasing the evening insulin dose. A series of 3 early morning measurements of
blood glucose will help differentiate between the 2 conditions.
See an expert-written answer
weight gain.
Of the following signs and symptoms of The earliest and most sensitive clinical indicator of HF is weight gain. A patient with
heart failure (HF), the earliest clinical HF should be instructed to weigh himself daily to note changes in his weight. The
manifestation is: 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.
