Pre-Predictor exam review 2025/2026
(Actual Exam) Questions with Correct Answers &
Rationales | Complete Exam Study Guide ||Complete
A+ Guide
1. 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?
Answer: Otter an anti-emetic medication such as prochlorperazine (Compazine®) and provide oral
fluid and electrolyte replacement instruction.
Explanation 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.
2. A child with Type 1 diabetes mellitus brings in a glucose diary indicating con-
sistent morning hyperglycemia. How can the nurse practitioner differentiate
the Somogyi effect from dawn phenomenon?
Answer: Instruct the parent to monitor the blood glucose at 3:00 am.
Explanation Dawn phenomenon is an early morning rise in plasma glucose. It indicates a need for increased insulin.
mailto:https://www.stuvia.com/user/Wisdoms
, The Somogyi ettect 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 ditterentiate between the 2 conditions.
3. Prescriptive authority:
Answer: may be exercised by giving a verbal medication order to a pharmacist.
Explanation 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.
4. When examining a pregnant patient, where should the fundal height be at 22
weeks?
Answer: Above the umbilicus
Explanation 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
5. What intervention does the American College of Rheumatology recommend
as first-line therapy for osteoarthritis?
Answer: Exercise and weight loss
Explanation Exercise, weight loss, and rest are recommended by the American College of Rheumatology guidelines
for the initial management of osteoarthritis (OA). Given the adverse ettects 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
mailto:https://www.stuvia.com/user/Wisdoms
, pain severity is not relieved by more conservative therapies may be candidates for joint replacement. Acetaminophen
is recommended as a first-line medication.
6. 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?
Answer: Osteoarthritis (OA)
Explanation 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.
mailto:https://www.stuvia.com/user/Wisdoms
, 7. 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®)
Explanation Tricyclic antidepressants, like amitriptyline, have anticholinergic side ettects 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.
8. 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:
Answer: elevate her legs periodically.
Explanation 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.
9. Stress urinary incontinence is:: may be aggravated by catteine or alcohol.
Explanation Stress urinary incontinence is not expected as a result of the normal aging process. The primary
problem is sphincter incompetence. The ingestion of catteine or alcohol decreases sphincter control.
Anticholinergic and antidepressant medications are causative factors related to overflow incontinence. Detrusor muscle
mailto:https://www.stuvia.com/user/Wisdoms
(Actual Exam) Questions with Correct Answers &
Rationales | Complete Exam Study Guide ||Complete
A+ Guide
1. 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?
Answer: Otter an anti-emetic medication such as prochlorperazine (Compazine®) and provide oral
fluid and electrolyte replacement instruction.
Explanation 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.
2. A child with Type 1 diabetes mellitus brings in a glucose diary indicating con-
sistent morning hyperglycemia. How can the nurse practitioner differentiate
the Somogyi effect from dawn phenomenon?
Answer: Instruct the parent to monitor the blood glucose at 3:00 am.
Explanation Dawn phenomenon is an early morning rise in plasma glucose. It indicates a need for increased insulin.
mailto:https://www.stuvia.com/user/Wisdoms
, The Somogyi ettect 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 ditterentiate between the 2 conditions.
3. Prescriptive authority:
Answer: may be exercised by giving a verbal medication order to a pharmacist.
Explanation 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.
4. When examining a pregnant patient, where should the fundal height be at 22
weeks?
Answer: Above the umbilicus
Explanation 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
5. What intervention does the American College of Rheumatology recommend
as first-line therapy for osteoarthritis?
Answer: Exercise and weight loss
Explanation Exercise, weight loss, and rest are recommended by the American College of Rheumatology guidelines
for the initial management of osteoarthritis (OA). Given the adverse ettects 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
mailto:https://www.stuvia.com/user/Wisdoms
, pain severity is not relieved by more conservative therapies may be candidates for joint replacement. Acetaminophen
is recommended as a first-line medication.
6. 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?
Answer: Osteoarthritis (OA)
Explanation 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.
mailto:https://www.stuvia.com/user/Wisdoms
, 7. 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®)
Explanation Tricyclic antidepressants, like amitriptyline, have anticholinergic side ettects 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.
8. 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:
Answer: elevate her legs periodically.
Explanation 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.
9. Stress urinary incontinence is:: may be aggravated by catteine or alcohol.
Explanation Stress urinary incontinence is not expected as a result of the normal aging process. The primary
problem is sphincter incompetence. The ingestion of catteine or alcohol decreases sphincter control.
Anticholinergic and antidepressant medications are causative factors related to overflow incontinence. Detrusor muscle
mailto:https://www.stuvia.com/user/Wisdoms
