APEA Predictor Exam
Cranial nerve IX Glossopharyngeal- swallowing and rise of the palate, gag reflex
Cranial Nerve VIII Acoustic (Hearing and balance)
Cranial Nerve XI Spinal Accessory (upper trapezius)
Deep tendon reflex Ankle- S1 primarily
Knee- Lumbar 2,3,4
Supinator(brachioradialis)-C5,6
BicepTriceps-C6,7
Stroke risk scale CHADS2
C-Congestive heart failure
H-Hypertension
A-Age >75 years
D- Diabetes
S-prior Stroke/TIA
In the majority of children, the first permanent teeth start A. First Molars
to erupt at the age of 6 years. Which of the following are
the first permanent teeth to erupt in this time period?
A. First Molars
B. Second Molars
C. Lower or upper incisors
D. Canines
All of the following are classified as activities of daily D. Grocery shopping
living (ADLs) except:
A. ability to feed self
B. Ability to manage bladder and bowel elimination
C. Personal hygiene and grooming
D. Grocery Shopping
You note the following result on a routine urinalysis of a B. Pregnancy-induced hypertension (pre-eclampsia). Classic triad of symptoms
37-year old primigravida who is at 30 weeks gestation. of preeclampsia include hypertension, edema (weight gain), and proteinuria.
Leukocyte=trace, nitrite=negative, protein=2+,
blood=negative. Her weight has increased by 5 lbs
during the past week. Which of the following is most
likely?
A.HELLP syndrome
B. Pregnancy-induced hypertension (pre-eclampsia)
C. Eclampsia of pregnancy
D. Primary hypertension
The mother of a 12 month old infant reports to the nurse B. Roseola Infantum (Exanthema subitum)
practitioner that her child had a high fever for several
days, which spontaneously resolved. After the fever
resolved, the child developed a maculopapular rash.
Which of the following is the most likely diagnosis?
A. Fifth Disease (erythema infectiosum)
B. Roseola infantum (exanthema subitum)
C. Varicella
D. Infantile maculopapular rashes
A 70-year old male patient complains of a bright red- D. Subconjunctival hemorrhage. Bright red blood in a sharply defined area
colored spot in his left eye for 2 days. He denies eye surrounded by normal-appearing conjunctiva indicates subconjunctival
pain, visual changes, or headaches. He has a new onset hemorrhage.
of cough from a recent viral upper respiratory infection.
The only medicine he is on Bayer aspirin, 1 tablet a day.
Which of the following is most likely?
A. Corneal abrasion
B. Acute bacterial conjunctivitis
C. Acute uveitis
D. Subconjunctival hemorrhage
, APEA Predictor Exam
A woman is being evaluated by the nurse practitioner for A. Atrophic vaginitis. Symptoms of atrophic vaginitis include painful intercourse,
complaints of dyspareunia. A microscopy slide reveals a atrophic squamous epithelial cells, and a decrease in pH. Vaginal atrophy is
large number of atrophic squamous epithelial cells. The caused by lack of or imbalance of estrogen. Normal pH of the vagina is 4.0-5.0
vaginal pH is 4.0. There are very few leukocytes and no (acidic)
RBCs are seen on the wet smear. Which of the following
is most likely?
A. Atrophic vaginitis
B. Bacterial Vaginosis
C. Trichomoniasis
D. This is a normal finding.
The most common type of skin malignancy is: B. Basal skin cancer. It is several times more common that squamous cell skin
A. Squamous cell cancer cancer according to the NIH.
B. Basal skin cancer
C. Melanoma
D. Dysplastic nevi
Koplik's spots are associated with: B. Measles. S/S include fever over 101, coryza, cough, conjunctivitis, rash, and
A. Poxvirius infections koplik's spots on buccal mucosa
B. Measles
C. Kawasaki's disease
D. Reye's syndrome
At what level of prevention would you classify for lung D. primordial prevention. Screening for lung cancer is not currently
cancer? recommended in the general population, but it is secondary prevention.
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Primordial prevention
A test called the visual fields by confrontation is used to A. Peripheral vision
evaluate for:
A. Peripheral vision
B. Central vision
C. Visual acuity
D. Accomodation
What is the most common cause of Cushing's Administration of a glucocorticoid or ACTH.
syndrome? Iatrogenic Cushing's syndrome is the most common type. Exogenous
glucocorticoid administration produces a Cushing's Syndrome that is reversible
by discontinuation of the medication.
A patient with no significant medical history has vericose Elevate her legs periodically.
veins. She complains of '"aching legs". The intervention The intervention that will provide the greatest relief for this patient is elevating her
that will provide the greatest relief for her complaint is to: 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.
A 25-yo female patient presents for a routine well-women Itraductal papilloma.
exam. On physical exam, the NP notes a scant nipple Intraductal papilloma often presents as a non-tender mass with serous or bloody
discharge, absence of palpable mass, and absence of nipple discharge located in the ductal system near the areola. Breast cancer,
lymph node enlargement. What is the most likely although usually non-tender, may present with pain. Chest wall syndrome may
diagnosis? present in some women as breast pain. Fibrocystic breast disease often presents
with bilateral breast pain.
According to the ANA, the role of the NP who provides Direct nursing care role.
primary health care is the: The NP with a traditional nursing care role is a primary health care provider.
Increasing numbers of nurse practitioners are assuming indirect roles such as
educator, administrator, researcher, and consultant.
An 8-mo male presents with hemarthrosis of both knees A type of hemophilia.
and hematuria. The parents give no history of trauma, Hemophilia is usually diagnosed within the first year of life. It commonly presents
but say " he has always bruised easily" The most likely with hemarthrosis, bleeding into soft tissue, hematuria, and prolonged bleeding
diagnosis is: times.
The nurse practitioner is following a child with juvemile most children with JRA achieve complete remission by adulthood, but its effects
rheumatoid arthritis (JRA) who has been previously might cause lifelong limitations.
diagnosed and is being managed for the disease by a Although the active disease does not continue into adulthood, the contractures,
pediatric rheumatologist. The mother asks for information growth retardation, bone deformities, and visual impairment associated with JRA
about the child's long-term prognosis. The appropriate may lead to lifelong functional impairments. A comprehensive treatment program
reply is that: involving physical therapy, occupational therapy, nutrition, education, and regular
opthalmologic care can limit residual functional limitations.
, APEA Predictor Exam
Approximately 70% of the organisms found in canine oral Staphylococcus and Pasteurella multocida.
and nasal fluids, and consequently in fresh dog bite All of these organisms are found in canine oral and nasal fluids, and cultured
wounds, are: from fresh dog bite wounds, but the most common (70%) are Staph and
Pasteurella multocida.
Education of women with fibrocystic breast disease Caffeine may trigger breast pain.
should include which of the following statements? Avoidance of all methylxanthines (eg coffee, tea, chocolate) has been shown to
reduce breast pain in women with fibrocystic breast disease. It is usually a
benign condition, not a precursor of malignancy. Mammography is recommended
once at age 35 years, at least every 1-2 years after age 40, and then annually
beginning at age 50 years. Oral contraceptives may help reduce cyclical pain
and swelling.
Congenital heart disorders present with symptoms at: birth, infancy, or in childhood.
A common misconception is that congenital disorders always present
symptomatically at birth. They can present at various times throughout childhood
and are classified as cyanotic or acyanotic. Cardiac disorders in infants and
children may be acquired from rheumatic fever or kawasaki syndrome.
A 21-yo patient presents with abdominal guarding, rigid Appendicitis.
abdominal musculature, rebound tenderness at McBurney's point is the RLQ abdominal landmark for the appendix. Rigid
McBurney's point, and leukocytosis. What is the most abdominal musculature, rebound tenderness, and positive psoas sign (inflamed
likely diagnosis? psoas muscle), indicates inflammation of the peritoneum. Cholecystitis presents
with RUQ pain and positive Murphy's inspriatory arrest. Ilcerative colitis presents
with LLQ pain. Pain associated with pancreatitis is typically in the epigastric
region.
Atenolol (Tenormin) should be avoided in: a 43-yo female with asthma.
Atenolol is a beta blocker. It should be avoided in pateints with asthma or other
bronchospastic conditions. These patients often require beta stimulation, not beta
blockade. Although atenolol is a beta 1-selective agent, at higher doses beta 2
receptors (bronchial and vascular) are blocked. Beta blockers, specifically
atenolol, are beneficial post-myocardial infarction because they have
demonstrated a reduction in morbidity and mortality.
All of the following interventions with pediatric patients Pre-medicate the patient prior to all painful interventions.
are appropriate EXCEPT: Pre-medication is not warranted prior to all painful interventions. For example,
premedication is not warranted prior to routine immunizations but it certainly is
prior to suturing. Pain management should be an integral part of patient
management.
Infants with veliac disease (gluten eneteropathy) are at Intususseption or volvulus.
risk for multiple complications. The most urgen Intuseusseption and volvulus are surgical emergencies. Delay releasing the
complication of this disease is: invaginated or "telescoped" bowel (intususseption), or releasing the twisted
bowel (volvulus) may result in tissue death and gangrene, perforation, peritonitis,
and/or sepsis, and fatality. There is also a high rate of intususseption and
volvulus among infants with cistic fibrosis.
Which activities are NOT characteristic of preschool Always follow rules during playground games.
children? Since preschoolers are just beginning to learn moral behaviors, they often cheat
to win. While most preschoolers toilet independently, accidents occasionally
occur and bed-wetting is not unusual. The use of a security item such as a
blanket is common.
A 38-yo pregnant patient at 18 weeks gestation, Blood pressure normally decreases during pregnancy and can cause this
complains of feeling light-headed when standing. Which symptom.
of the following is an appropriate response by the NP?
Blood pressure normally decreases during pregnancy, reaching the lowest point
during the second or third trimesters and rising there after. Patient education to
rise slowly from sitting or lying is important. Low blood glucose may be the
etiology, but an oral glucose tolerance test at this point is not indicated. A fasting
blood glucose could be ordered, however, an electrocardiogram is not indicated.
An 80 year old Caucasian female has heart failure. What Weight gain.
symptom is an early indicator of failure? Early signs of heart failure include weight gain (the most sensitive indicator), S3
gallop, dyspnea on exertion, peripheral edema. Moderate signs include nocturnal
cough, tachycardia. Late signs include ascities, frothy sputum, and hypotension.
, APEA Predictor Exam
A 6 yo had an acute onset of fever, pharyngitis, and Scarlet fever; treat with antibiotics.
headache 2 days ago. Today, he presents with cervical This disease is due to infection with Group A Beta-hemolytic streptococcus. The
lymphadenopathy and sandpaper textured rash rash is thought to be due to a systemic reaction to the toxin produced by the
everywhere except on his face. A rapid streptococcal microorganism. The rash fades with pressure and ultimately desquamates. A
antigen test is positive. The remainder of the assessment deep, nonblanching rash on the flexor surfaces of the skin is referred to as pastia
in unremarkable. What is the most likely diagnosis and lines.
the most appropriate action?
A patient has been diagnosed with hypothyroidism and 6 weeks.
thyroid hormone replacement therapy is prescribed. The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7
When should the nurse practitioner check the patient's days. The earliest that meaningful changes will be observed is at 4-6 weeks.
TSH? Therefore, the NP should wait a minimum of 4-6 weeks before checking the
patient's TSH.
A 15 yo malue has a history of cryptorchidism which was testicular self-examination.
surgically repaired. Because of this information, it is Cryptorchidism, even with surgical repair, is associated with increased risk for
essential for the nurse practitioner to teach him about: testicular cancer.
The treatment of choice for chronic bacterial prostatitis a flouroquinolone twice daily for 3 weeks to 4 months.
(CBP) is: The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months.
The cure rate with Bactrim-DS is only about 30-40%.
A 25 yo female has a history of frequent candidal vaginal Diabetes.
infections in the past year. She is in a monogamous
sexual relationship and uses and IUD for contraception. A common underlying cause of frequent infections is diabetes mellitus.
Of the following, which is the most likely underlying Pregnancy increases the incidence of candidiasis, but is unlikely a factor with this
conidition predisposing her to recurring candidal patient.
vaginitis?
Which of the following is NOT a characteristic of the S3 The sound is high-pitched and occurs just prior to the S1 heart sound.
heart sound? The S3 heart sound is low-pitched and occurs just after the S2 heart sound. It is
produced by rapid ventricular filling and is best auscultated in the mitral area. It is
a common finding with right-sided heart failure, rapid growth, and the last
trimester of pregnancy.
Following the finding of prostate gland abnormalities on normal PSA is 10ng/ml or less.
DRE, the NP orders the appropriate labs. Whem Normal PSA is 4ng/ml or less. PSA levels greater the 4 and less than 10 are
preparing to review lab reports with the patient, the nurse associated with BPH. A 10 or greater PSA level suggests prostate cancer.
practitioner knows all of the following are true EXCEPT: Positive serum acid phosphatase is associated with malignancy of the prostate
gland with bone metasasis.
A 66 yo female presents to your clinic. She states that Elevated Troponin I levels
yesterday evening she had chest pain for 20-30 minutes. An elevated creatinine kinase (CK) is not diagnostic of a myocardial infarction
Which finding most strongly correlates with myocardial (MI). CK may be elevated from an IM injection, surgery, ot any type of extensive
infarction? skeletal muscle trauma or prolonged, strenuous physical exertion. ST segment
depression on EKG usually indicates an ischemic myocardium, but, not
necessarily, one post-MI. Elevated ST seghments reflect mycardial damage. MB
bands are specific for myocardial smooth muscle. If these are elevated, the
patient MAY HAVE had a very recent MI. The most accurate marker of cardiac
damage, because it is more specific and sensitive than CK MB, is a troponin
measurement.
What is a secondary cause of hyperlipidemia? hypothyroidism
Hypothyroidism is a common secondary cause of hyperlipidemia. In the
evaluation of a patient with hyperlipidemia, a TSH should always be checked and
corrected before attempting treatment for hyperlipidemia. Other possible causes
of seconday hyperlipidemia include pregnancy, excessive weight gain, excessive
alcohol intake, insulin resistance or deficiency, obstructive liver disease, and
uremia. Some medications can produce secondary hypothyroidism too: thiazide
diuretics, some beta-blockers, oral contraceptives, and corticosteroids.
A 35-yo male presents with a complaint of low pelvic A sterile in-and-out catheter specimen would identify only organisms in the
pain, dysuria, hesitancy, urgency, and reduced for of bladder and would not differentiate between bladder, kidney, or prostate site
stream. The nurse practitioner suspects acute bacterial infection. The sequence for obtaining specimens when prostat infection is
prostatitis. The NP would appropriately collect all of the suspected is: 1. voided urethral urine, 2. Voided mid-stream bladder urine, and 3.
following specimens EXCEPT a: sterile in-and-out voided post-prostate massage urine.
catheter urine specimen.
A 24 yo female taking an oral contraceptive has missed Double today's dose and tomorrow's dose and use a barrier method for the rest
her last 2 pills. What should the nurse practitioner advise of the month.
her to do to minimize her risk of pregnancy? If 2 mills are missed on consecutive days, the next 2 days' doseages should be
doubled and a barrier method recommended for the remainder of the cycle.
Cranial nerve IX Glossopharyngeal- swallowing and rise of the palate, gag reflex
Cranial Nerve VIII Acoustic (Hearing and balance)
Cranial Nerve XI Spinal Accessory (upper trapezius)
Deep tendon reflex Ankle- S1 primarily
Knee- Lumbar 2,3,4
Supinator(brachioradialis)-C5,6
BicepTriceps-C6,7
Stroke risk scale CHADS2
C-Congestive heart failure
H-Hypertension
A-Age >75 years
D- Diabetes
S-prior Stroke/TIA
In the majority of children, the first permanent teeth start A. First Molars
to erupt at the age of 6 years. Which of the following are
the first permanent teeth to erupt in this time period?
A. First Molars
B. Second Molars
C. Lower or upper incisors
D. Canines
All of the following are classified as activities of daily D. Grocery shopping
living (ADLs) except:
A. ability to feed self
B. Ability to manage bladder and bowel elimination
C. Personal hygiene and grooming
D. Grocery Shopping
You note the following result on a routine urinalysis of a B. Pregnancy-induced hypertension (pre-eclampsia). Classic triad of symptoms
37-year old primigravida who is at 30 weeks gestation. of preeclampsia include hypertension, edema (weight gain), and proteinuria.
Leukocyte=trace, nitrite=negative, protein=2+,
blood=negative. Her weight has increased by 5 lbs
during the past week. Which of the following is most
likely?
A.HELLP syndrome
B. Pregnancy-induced hypertension (pre-eclampsia)
C. Eclampsia of pregnancy
D. Primary hypertension
The mother of a 12 month old infant reports to the nurse B. Roseola Infantum (Exanthema subitum)
practitioner that her child had a high fever for several
days, which spontaneously resolved. After the fever
resolved, the child developed a maculopapular rash.
Which of the following is the most likely diagnosis?
A. Fifth Disease (erythema infectiosum)
B. Roseola infantum (exanthema subitum)
C. Varicella
D. Infantile maculopapular rashes
A 70-year old male patient complains of a bright red- D. Subconjunctival hemorrhage. Bright red blood in a sharply defined area
colored spot in his left eye for 2 days. He denies eye surrounded by normal-appearing conjunctiva indicates subconjunctival
pain, visual changes, or headaches. He has a new onset hemorrhage.
of cough from a recent viral upper respiratory infection.
The only medicine he is on Bayer aspirin, 1 tablet a day.
Which of the following is most likely?
A. Corneal abrasion
B. Acute bacterial conjunctivitis
C. Acute uveitis
D. Subconjunctival hemorrhage
, APEA Predictor Exam
A woman is being evaluated by the nurse practitioner for A. Atrophic vaginitis. Symptoms of atrophic vaginitis include painful intercourse,
complaints of dyspareunia. A microscopy slide reveals a atrophic squamous epithelial cells, and a decrease in pH. Vaginal atrophy is
large number of atrophic squamous epithelial cells. The caused by lack of or imbalance of estrogen. Normal pH of the vagina is 4.0-5.0
vaginal pH is 4.0. There are very few leukocytes and no (acidic)
RBCs are seen on the wet smear. Which of the following
is most likely?
A. Atrophic vaginitis
B. Bacterial Vaginosis
C. Trichomoniasis
D. This is a normal finding.
The most common type of skin malignancy is: B. Basal skin cancer. It is several times more common that squamous cell skin
A. Squamous cell cancer cancer according to the NIH.
B. Basal skin cancer
C. Melanoma
D. Dysplastic nevi
Koplik's spots are associated with: B. Measles. S/S include fever over 101, coryza, cough, conjunctivitis, rash, and
A. Poxvirius infections koplik's spots on buccal mucosa
B. Measles
C. Kawasaki's disease
D. Reye's syndrome
At what level of prevention would you classify for lung D. primordial prevention. Screening for lung cancer is not currently
cancer? recommended in the general population, but it is secondary prevention.
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Primordial prevention
A test called the visual fields by confrontation is used to A. Peripheral vision
evaluate for:
A. Peripheral vision
B. Central vision
C. Visual acuity
D. Accomodation
What is the most common cause of Cushing's Administration of a glucocorticoid or ACTH.
syndrome? Iatrogenic Cushing's syndrome is the most common type. Exogenous
glucocorticoid administration produces a Cushing's Syndrome that is reversible
by discontinuation of the medication.
A patient with no significant medical history has vericose Elevate her legs periodically.
veins. She complains of '"aching legs". The intervention The intervention that will provide the greatest relief for this patient is elevating her
that will provide the greatest relief for her complaint is to: 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.
A 25-yo female patient presents for a routine well-women Itraductal papilloma.
exam. On physical exam, the NP notes a scant nipple Intraductal papilloma often presents as a non-tender mass with serous or bloody
discharge, absence of palpable mass, and absence of nipple discharge located in the ductal system near the areola. Breast cancer,
lymph node enlargement. What is the most likely although usually non-tender, may present with pain. Chest wall syndrome may
diagnosis? present in some women as breast pain. Fibrocystic breast disease often presents
with bilateral breast pain.
According to the ANA, the role of the NP who provides Direct nursing care role.
primary health care is the: The NP with a traditional nursing care role is a primary health care provider.
Increasing numbers of nurse practitioners are assuming indirect roles such as
educator, administrator, researcher, and consultant.
An 8-mo male presents with hemarthrosis of both knees A type of hemophilia.
and hematuria. The parents give no history of trauma, Hemophilia is usually diagnosed within the first year of life. It commonly presents
but say " he has always bruised easily" The most likely with hemarthrosis, bleeding into soft tissue, hematuria, and prolonged bleeding
diagnosis is: times.
The nurse practitioner is following a child with juvemile most children with JRA achieve complete remission by adulthood, but its effects
rheumatoid arthritis (JRA) who has been previously might cause lifelong limitations.
diagnosed and is being managed for the disease by a Although the active disease does not continue into adulthood, the contractures,
pediatric rheumatologist. The mother asks for information growth retardation, bone deformities, and visual impairment associated with JRA
about the child's long-term prognosis. The appropriate may lead to lifelong functional impairments. A comprehensive treatment program
reply is that: involving physical therapy, occupational therapy, nutrition, education, and regular
opthalmologic care can limit residual functional limitations.
, APEA Predictor Exam
Approximately 70% of the organisms found in canine oral Staphylococcus and Pasteurella multocida.
and nasal fluids, and consequently in fresh dog bite All of these organisms are found in canine oral and nasal fluids, and cultured
wounds, are: from fresh dog bite wounds, but the most common (70%) are Staph and
Pasteurella multocida.
Education of women with fibrocystic breast disease Caffeine may trigger breast pain.
should include which of the following statements? Avoidance of all methylxanthines (eg coffee, tea, chocolate) has been shown to
reduce breast pain in women with fibrocystic breast disease. It is usually a
benign condition, not a precursor of malignancy. Mammography is recommended
once at age 35 years, at least every 1-2 years after age 40, and then annually
beginning at age 50 years. Oral contraceptives may help reduce cyclical pain
and swelling.
Congenital heart disorders present with symptoms at: birth, infancy, or in childhood.
A common misconception is that congenital disorders always present
symptomatically at birth. They can present at various times throughout childhood
and are classified as cyanotic or acyanotic. Cardiac disorders in infants and
children may be acquired from rheumatic fever or kawasaki syndrome.
A 21-yo patient presents with abdominal guarding, rigid Appendicitis.
abdominal musculature, rebound tenderness at McBurney's point is the RLQ abdominal landmark for the appendix. Rigid
McBurney's point, and leukocytosis. What is the most abdominal musculature, rebound tenderness, and positive psoas sign (inflamed
likely diagnosis? psoas muscle), indicates inflammation of the peritoneum. Cholecystitis presents
with RUQ pain and positive Murphy's inspriatory arrest. Ilcerative colitis presents
with LLQ pain. Pain associated with pancreatitis is typically in the epigastric
region.
Atenolol (Tenormin) should be avoided in: a 43-yo female with asthma.
Atenolol is a beta blocker. It should be avoided in pateints with asthma or other
bronchospastic conditions. These patients often require beta stimulation, not beta
blockade. Although atenolol is a beta 1-selective agent, at higher doses beta 2
receptors (bronchial and vascular) are blocked. Beta blockers, specifically
atenolol, are beneficial post-myocardial infarction because they have
demonstrated a reduction in morbidity and mortality.
All of the following interventions with pediatric patients Pre-medicate the patient prior to all painful interventions.
are appropriate EXCEPT: Pre-medication is not warranted prior to all painful interventions. For example,
premedication is not warranted prior to routine immunizations but it certainly is
prior to suturing. Pain management should be an integral part of patient
management.
Infants with veliac disease (gluten eneteropathy) are at Intususseption or volvulus.
risk for multiple complications. The most urgen Intuseusseption and volvulus are surgical emergencies. Delay releasing the
complication of this disease is: invaginated or "telescoped" bowel (intususseption), or releasing the twisted
bowel (volvulus) may result in tissue death and gangrene, perforation, peritonitis,
and/or sepsis, and fatality. There is also a high rate of intususseption and
volvulus among infants with cistic fibrosis.
Which activities are NOT characteristic of preschool Always follow rules during playground games.
children? Since preschoolers are just beginning to learn moral behaviors, they often cheat
to win. While most preschoolers toilet independently, accidents occasionally
occur and bed-wetting is not unusual. The use of a security item such as a
blanket is common.
A 38-yo pregnant patient at 18 weeks gestation, Blood pressure normally decreases during pregnancy and can cause this
complains of feeling light-headed when standing. Which symptom.
of the following is an appropriate response by the NP?
Blood pressure normally decreases during pregnancy, reaching the lowest point
during the second or third trimesters and rising there after. Patient education to
rise slowly from sitting or lying is important. Low blood glucose may be the
etiology, but an oral glucose tolerance test at this point is not indicated. A fasting
blood glucose could be ordered, however, an electrocardiogram is not indicated.
An 80 year old Caucasian female has heart failure. What Weight gain.
symptom is an early indicator of failure? Early signs of heart failure include weight gain (the most sensitive indicator), S3
gallop, dyspnea on exertion, peripheral edema. Moderate signs include nocturnal
cough, tachycardia. Late signs include ascities, frothy sputum, and hypotension.
, APEA Predictor Exam
A 6 yo had an acute onset of fever, pharyngitis, and Scarlet fever; treat with antibiotics.
headache 2 days ago. Today, he presents with cervical This disease is due to infection with Group A Beta-hemolytic streptococcus. The
lymphadenopathy and sandpaper textured rash rash is thought to be due to a systemic reaction to the toxin produced by the
everywhere except on his face. A rapid streptococcal microorganism. The rash fades with pressure and ultimately desquamates. A
antigen test is positive. The remainder of the assessment deep, nonblanching rash on the flexor surfaces of the skin is referred to as pastia
in unremarkable. What is the most likely diagnosis and lines.
the most appropriate action?
A patient has been diagnosed with hypothyroidism and 6 weeks.
thyroid hormone replacement therapy is prescribed. The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7
When should the nurse practitioner check the patient's days. The earliest that meaningful changes will be observed is at 4-6 weeks.
TSH? Therefore, the NP should wait a minimum of 4-6 weeks before checking the
patient's TSH.
A 15 yo malue has a history of cryptorchidism which was testicular self-examination.
surgically repaired. Because of this information, it is Cryptorchidism, even with surgical repair, is associated with increased risk for
essential for the nurse practitioner to teach him about: testicular cancer.
The treatment of choice for chronic bacterial prostatitis a flouroquinolone twice daily for 3 weeks to 4 months.
(CBP) is: The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months.
The cure rate with Bactrim-DS is only about 30-40%.
A 25 yo female has a history of frequent candidal vaginal Diabetes.
infections in the past year. She is in a monogamous
sexual relationship and uses and IUD for contraception. A common underlying cause of frequent infections is diabetes mellitus.
Of the following, which is the most likely underlying Pregnancy increases the incidence of candidiasis, but is unlikely a factor with this
conidition predisposing her to recurring candidal patient.
vaginitis?
Which of the following is NOT a characteristic of the S3 The sound is high-pitched and occurs just prior to the S1 heart sound.
heart sound? The S3 heart sound is low-pitched and occurs just after the S2 heart sound. It is
produced by rapid ventricular filling and is best auscultated in the mitral area. It is
a common finding with right-sided heart failure, rapid growth, and the last
trimester of pregnancy.
Following the finding of prostate gland abnormalities on normal PSA is 10ng/ml or less.
DRE, the NP orders the appropriate labs. Whem Normal PSA is 4ng/ml or less. PSA levels greater the 4 and less than 10 are
preparing to review lab reports with the patient, the nurse associated with BPH. A 10 or greater PSA level suggests prostate cancer.
practitioner knows all of the following are true EXCEPT: Positive serum acid phosphatase is associated with malignancy of the prostate
gland with bone metasasis.
A 66 yo female presents to your clinic. She states that Elevated Troponin I levels
yesterday evening she had chest pain for 20-30 minutes. An elevated creatinine kinase (CK) is not diagnostic of a myocardial infarction
Which finding most strongly correlates with myocardial (MI). CK may be elevated from an IM injection, surgery, ot any type of extensive
infarction? skeletal muscle trauma or prolonged, strenuous physical exertion. ST segment
depression on EKG usually indicates an ischemic myocardium, but, not
necessarily, one post-MI. Elevated ST seghments reflect mycardial damage. MB
bands are specific for myocardial smooth muscle. If these are elevated, the
patient MAY HAVE had a very recent MI. The most accurate marker of cardiac
damage, because it is more specific and sensitive than CK MB, is a troponin
measurement.
What is a secondary cause of hyperlipidemia? hypothyroidism
Hypothyroidism is a common secondary cause of hyperlipidemia. In the
evaluation of a patient with hyperlipidemia, a TSH should always be checked and
corrected before attempting treatment for hyperlipidemia. Other possible causes
of seconday hyperlipidemia include pregnancy, excessive weight gain, excessive
alcohol intake, insulin resistance or deficiency, obstructive liver disease, and
uremia. Some medications can produce secondary hypothyroidism too: thiazide
diuretics, some beta-blockers, oral contraceptives, and corticosteroids.
A 35-yo male presents with a complaint of low pelvic A sterile in-and-out catheter specimen would identify only organisms in the
pain, dysuria, hesitancy, urgency, and reduced for of bladder and would not differentiate between bladder, kidney, or prostate site
stream. The nurse practitioner suspects acute bacterial infection. The sequence for obtaining specimens when prostat infection is
prostatitis. The NP would appropriately collect all of the suspected is: 1. voided urethral urine, 2. Voided mid-stream bladder urine, and 3.
following specimens EXCEPT a: sterile in-and-out voided post-prostate massage urine.
catheter urine specimen.
A 24 yo female taking an oral contraceptive has missed Double today's dose and tomorrow's dose and use a barrier method for the rest
her last 2 pills. What should the nurse practitioner advise of the month.
her to do to minimize her risk of pregnancy? If 2 mills are missed on consecutive days, the next 2 days' doseages should be
doubled and a barrier method recommended for the remainder of the cycle.
