PRE-PREDICTOR EXAM REVIEW-
COMPLETE QUESTIONS AND CORRECT
ANSWERS
An 80 year-old is having difficulty hearing. When the nurse practitioner
examines him, she is unable to visualize the tympanic membrane
because of cerumen impaction. This produces what kind of hearing
loss? - CORRECT ANSWER- Conductive
This is a conductive hearing loss provided he is able to hear when the
cerumen is removed. Anything that inhibits the ability of sound to enter
the external canal and middle ear will produce a conductive hearing loss.
Sensorineural hearing loss can be produced by aging, Meniere's
disease, noise trauma, or cranial nerve VIII pathology.
The hearing loss associated with aging involves: - CORRECT
ANSWER- sensorineural hearing loss
Hearing loss associated with aging is termed presbycusis and is a form
of sensorineural hearing loss. This can be influenced by a number of
factors including heredity. Conductive hearing loss involves the external
canal and the middle ear. Sound cannot travel beyond the middle ear.
The 8th cranial nerve and the inner ear are involved in sensorineural
hearing loss. Noise damage can produce a sensorineural hearing loss.
This usually occurs over time but is not necessarily associated with
aging.
What is the usual age for vision screening in young children? -
CORRECT ANSWER- 3 years
Initial vision screening should take place at 3 years of age. If the child is
not cooperative, screening should be attempted 6 months later. If the
,child is still not cooperative at 3.5 years, it should be attempted at 4
years. Generally, children are cooperative at 4 years of age. The usual
vision of a 3 year-old is 20/50.
An elderly patient who has a red eye with tearing was diagnosed with
conjunctivitis. What characteristics below indicate viral conjunctivitis? -
CORRECT ANSWER- Profuse tearing
A patient with viral conjunctivitis typically has profuse tearing and
minimal exudate. Patients with bacterial conjunctivitis have moderate
tearing and exudate. Both are considered highly contagious. Patients
should refrain from work or group activities for 48 hours until symptoms
have subsided.
A patient diagnosed with Strept throat received a prescription for
azithromycin. She has not improved in 48 hours. What course of action
is acceptable? - CORRECT ANSWER- A penicillin or cephalosporin
with beta lactamase coverage should be considered.
The patient should demonstrate improvement after 48 hours if an
antibiotic with the appropriate antimicrobial spectra was prescribed. A
macrolide would be a poor choice because there are high rates of Strept
resistance to macrolide antibiotics. In light of this, strong consideration
should be given to an antibiotic with different antimicrobial spectra. Since
Strept was diagnosed and azithromycin was ineffective, the prescriber
should consider that the causative agent has macrolide resistance and
could be beta lactamase producing. An antibiotic with beta lactamase
coverage should be considered. Choice d provides this
coveragePrescriptive authority: - CORRECT ANSWER- 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? - CORRECT ANSWER- 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? - CORRECT
ANSWER- 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? - CORRECT ANSWER-
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? - CORRECT ANSWER- 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: - CORRECT ANSWER- 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: - CORRECT ANSWER- 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
COMPLETE QUESTIONS AND CORRECT
ANSWERS
An 80 year-old is having difficulty hearing. When the nurse practitioner
examines him, she is unable to visualize the tympanic membrane
because of cerumen impaction. This produces what kind of hearing
loss? - CORRECT ANSWER- Conductive
This is a conductive hearing loss provided he is able to hear when the
cerumen is removed. Anything that inhibits the ability of sound to enter
the external canal and middle ear will produce a conductive hearing loss.
Sensorineural hearing loss can be produced by aging, Meniere's
disease, noise trauma, or cranial nerve VIII pathology.
The hearing loss associated with aging involves: - CORRECT
ANSWER- sensorineural hearing loss
Hearing loss associated with aging is termed presbycusis and is a form
of sensorineural hearing loss. This can be influenced by a number of
factors including heredity. Conductive hearing loss involves the external
canal and the middle ear. Sound cannot travel beyond the middle ear.
The 8th cranial nerve and the inner ear are involved in sensorineural
hearing loss. Noise damage can produce a sensorineural hearing loss.
This usually occurs over time but is not necessarily associated with
aging.
What is the usual age for vision screening in young children? -
CORRECT ANSWER- 3 years
Initial vision screening should take place at 3 years of age. If the child is
not cooperative, screening should be attempted 6 months later. If the
,child is still not cooperative at 3.5 years, it should be attempted at 4
years. Generally, children are cooperative at 4 years of age. The usual
vision of a 3 year-old is 20/50.
An elderly patient who has a red eye with tearing was diagnosed with
conjunctivitis. What characteristics below indicate viral conjunctivitis? -
CORRECT ANSWER- Profuse tearing
A patient with viral conjunctivitis typically has profuse tearing and
minimal exudate. Patients with bacterial conjunctivitis have moderate
tearing and exudate. Both are considered highly contagious. Patients
should refrain from work or group activities for 48 hours until symptoms
have subsided.
A patient diagnosed with Strept throat received a prescription for
azithromycin. She has not improved in 48 hours. What course of action
is acceptable? - CORRECT ANSWER- A penicillin or cephalosporin
with beta lactamase coverage should be considered.
The patient should demonstrate improvement after 48 hours if an
antibiotic with the appropriate antimicrobial spectra was prescribed. A
macrolide would be a poor choice because there are high rates of Strept
resistance to macrolide antibiotics. In light of this, strong consideration
should be given to an antibiotic with different antimicrobial spectra. Since
Strept was diagnosed and azithromycin was ineffective, the prescriber
should consider that the causative agent has macrolide resistance and
could be beta lactamase producing. An antibiotic with beta lactamase
coverage should be considered. Choice d provides this
coveragePrescriptive authority: - CORRECT ANSWER- 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? - CORRECT ANSWER- 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? - CORRECT
ANSWER- 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? - CORRECT ANSWER-
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? - CORRECT ANSWER- 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: - CORRECT ANSWER- 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: - CORRECT ANSWER- 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
