Pre-Predictor exam review questions b. b. b.
and complete answers
b. b. b.
Prescriptive authority: - Answer ✔✔ - may be exercised by giving a verbal medication
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
order to a pharmacist.
b. b. b. b.
An example of exercising prescriptive authority is giving a verbal order to a pharmacist
b. b. b. b. b. b. b. b. b. b. b. b. b.
or writing an order for a prescription medication. Prescriptive authority rules and
b. b. b. b. b. b. b. b. b. b. b. b.
regulations vary from state to state. Prescriptive authority is granted only to those
b. b. b. b. b. b. b. b. b. b. b. b. b.
APRNs who meet the requirements of the governing body for the state in which the
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
APRN practices.
b. b.
When examining a pregnant patient, where should the fundal height be at 22 weeks? -
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
Answer ✔✔ - Above the umbilicus
b. b. b. b. b. b. b. b.
Between 18 and 32 weeks, there is good correlation between fundal height and
b. b. b. b. b. b. b. b. b. b. b. b.
gestational age of the fetus. The expected heights are: 10-12 weeks: fundus slightly
b. b. b. b. b. b. b. b. b. b. b. b. b.
above the symphysis pubis 16 weeks: fundus midway between the symphysis pubis
b. b. b. b. b. b. b. b. b. b. b. b.
and umbilicus 20 weeks: fundus at the level of umbilicus 28 weeks: fundus 3
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
fingerbreadths above the umbilicus 36 weeks: fundus just below the xiphoid process
b. b. b. b. b. b. b. b. b. b. b. b.
What intervention does the American College of Rheumatology recommend as first-line
b. b. b. b. b. b. b. b. b. b.
therapy for osteoarthritis? - Answer ✔✔ - Exercise and weight loss
b. b. b. b. b. b. b. b. b. b. b. b. b.
Exercise, weight loss, and rest are recommended by the American College of
b. b. b. b. b. b. b. b. b. b. b.
Rheumatology guidelines for the initial management of osteoarthritis (OA). Given the
b. b. b. b. b. b. b. b. b. b. b.
adverse effects of medications used to treat OA, it is best to minimize dosage and
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
delay use as long as possible. An extensive diagnostic workup is not recommended
b. b. b. b. b. b. b. b. b. b. b. b. b.
unless the presentation is in question. Patients who have severe degenerative joint
b. b. b. b. b. b. b. b. b. b. b. b.
disease (DJD), joint fusion, or whose pain severity is not relieved by more conservative
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
therapies may be candidates for joint replacement. Acetaminophen is recommended as
b. b. b. b. b. b. b. b. b. b. b.
a first-line medication.
b. b. b.
A 63-year-old male retired accountant complains of pain and stiffness in his feet and
b. b. b. b. b. b. b. b. b. b. b. b. b.
hands of several years duration. He reports that the pain and stiffness become worse
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
with activity. On examination, he is noted to have Heberden's nodes but no other bony
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
deformities. Which of the following is the most probable diagnosis? - Answer ✔✔ -
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
Osteoarthritis (OA)
b. b.
,Although his vocation involved sedentary activity, this patient is not at great risk for
b. b. b. b. b. b. b. b. b. b. b. b. b.
osteoarthritis. Rheumatoid arthritis is characterized by several joint deformities, usually
b. b. b. b. b. b. b. b. b. b.
bilaterally symmetrical. RA is characterized by inflammatory processes, while OA is not.
b. b. b. b. b. b. b. b. b. b. b. b.
RA and OA are chronic conditions. Gout is characterized by acute exacerbations
b. b. b. b. b. b. b. b. b. b. b. b.
related to a defect in purine metabolism, increased uric acid production, or decreased
b. b. b. b. b. b. b. b. b. b. b. b. b.
uric acid excretion.
b. b. b.
The family of a 78-year-old man moved him into an assisted living center because he
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
can no longer be left at home alone. He is unable to toilet when asked to do so and he
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
has had several episodes of incontinence. He has walked out of the facility twice and
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
been unable to find his way back from 3 blocks away. On examination, he is pleasant
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
but mildly confused. Which of his medications is LEAST likely contributing to his
b. b. b. b. b. b. b. b. b. b. b. b. b.
behavior? - Answer ✔✔ - ramipril (Altace®)
b. b. b. b. b. b. b. b. b.
Tricyclic antidepressants, like amitriptyline, have anticholinergic side effects which are
b. b. b. b. b. b. b. b. b.
especially problematic in the elderly because they contribute to urinary retention.
b. b. b. b. b. b. b. b. b. b. b.
Hydrochlorothiazide is a diuretic and may contribute to his incontinence. Cimetidine is
b. b. b. b. b. b. b. b. b. b. b. b.
well known to produce adverse reactions such as confusion in elders. Ramipril, an ACE
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
inhibitor, is unlikely to contribute to this patient's incontinence or confusion. Toileting
b. b. b. b. b. b. b. b. b. b. b. b.
may be a complicated by the anticholinergic medication and/or the diuretic causing
b. b. b. b. b. b. b. b. b. b. b. b.
diuresis, urge incontinence, and inability to void at will.
b. b. b. b. b. b. b. b. b.
A patient with no significant medical history has varicose veins. She complains of
b. b. b. b. b. b. b. b. b. b. b. b.
"aching legs". The intervention that will provide the greatest relief for her complaint is to:
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
- Answer ✔✔ - elevate her legs periodically.
b. b. b. b. b. b. b. b. b. b.
The intervention that will provide the greatest relief for this patient is elevating her legs
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
periodically. This will facilitate venous return. Use of support stockings will prolong the
b. b. b. b. b. b. b. b. b. b. b. b. b.
length of time she is able to stand in place, but will not provide relief after her legs begin
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
aching. Support stockings should be applied prior to getting out of bed.
b. b. b. b. b. b. b. b. b. b. b. b.
Stress urinary incontinence is: - Answer ✔✔ - may be aggravated by caffeine or
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
alcohol.
b.
Stress urinary incontinence is not expected as a result of the normal aging process. The
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
primary problem is sphincter incompetence. The ingestion of caffeine or alcohol
b. b. b. b. b. b. b. b. b. b. b.
decreases sphincter control. Anticholinergic and antidepressant medications are
b. b. b. b. b. b. b. b.
causative factors related to overflow incontinence. Detrusor muscle instability is the
b. b. b. b. b. b. b. b. b. b. b.
primary underlying problem causing urge incontinence.
b. b. b. b. b. b.
Which commonly used herbal remedy is NOT associated with anxiety and/or depressive
b. b. b. b. b. b. b. b. b. b. b.
symptom relief? - Answer ✔✔ - Ginkgo biloba
b. b. b. b. b. b. b. b. b. b.
Ginkgo biloba is a common herbal remedy associated with enhancement of vascular
b. b. b. b. b. b. b. b. b. b. b.
and cerebral perfusion and memory. The nurse practitioner should be aware when the
b. b. b. b. b. b. b. b. b. b. b. b. b.
patient is taking any herbal supplement to avoid risk of drug interactions.
b. b. b. b. b. b. b. b. b. b. b. b.
, Upon ophthalmoscopic examination of a 78-year-old patient, the nurse practitioner
b. b. b. b. b. b. b. b. b.
observes dark spots against a red retina. What diagnosis is this finding most consistent
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
with? - Answer ✔✔ - Cataract
b. b. b. b. b. b. b. b.
A cataract opacity is seen as a dark disruption of the red reflex on ophthalmoscopic
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
exam.
b.
A 72 year old female patient reports a 6 month history of progressively more swollen
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
and painful distal interphalangeal (DIP) joints of one hand. There are no systemic
b. b. b. b. b. b. b. b. b. b. b. b. b.
symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA),
b. b. b. b. b. b. b. b. b. b.
and rheumatoid factor (RF) are all minimally elevated. What is the most likely
b. b. b. b. b. b. b. b. b. b. b. b. b.
diagnosis? - Answer ✔✔ - Osteoarthritis
b. b. b. b. b. b. b. b.
When osteoarthritis affects the hands, the distal interphalangeal (DIP) joints are usually
b. b. b. b. b. b. b. b. b. b. b.
involved. Rheumatoid arthritis is usually symmetrical, and the proximal interphalangeal
b. b. b. b. b. b. b. b. b. b.
(PIP) joints are more often affected. Inflammation often develops quickly, not gradually.
b. b. b. b. b. b. b. b. b. b. b. b.
This patient is elderly; therefore, it is expected that the ESR, ANA, and RF will be only
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
somewhat elevated. Over-interpretation of laboratory tests without evidence of systemic
b. b. b. b. b. b. b. b. b. b.
inflammation can lead to misdiagnosis.
b. b. b. b. b.
The nurse practitioner is evaluating a 35-year-old female nurse. She has a history of
b. b. b. b. b. b. b. b. b. b. b. b. b.
hospitalization for hepatitis B infection 2 years ago. Her laboratory tests demonstrate
b. b. b. b. b. b. b. b. b. b. b. b.
positive HBsAg. The nurse practitioner would most likely diagnose: - Answer ✔✔ -
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
chronic hepatitis B infection.
b. b. b. b.
Presence of hepatitis B surface antigen at this time indicates chronic infection with
b. b. b. b. b. b. b. b. b. b. b. b.
hepatitis B. Lab studies indicating a positive surface antigen on 2 separate occasions at
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
least 6 months apart indicate chronic infection. Immunization produces positive
b. b. b. b. b. b. b. b. b. b.
hepatitis B antibodies in most instances. Hepatitis B surface antigen would not be
b. b. b. b. b. b. b. b. b. b. b. b. b.
present in a person who has recovered from hepatitis B infection. This case would not
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
be an acute episode because of the history of hepatitis B infection 2 years prior.
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
One exception to the recommendation to limit dietary fat intake is: - Answer ✔✔ -
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
children under 2 years-of-age.
b. b. b. b.
In order for myelinization of the nervous system to occur, children under 2 years-of-age
b. b. b. b. b. b. b. b. b. b. b. b. b.
require > 30% daily dietary fat.
b. b. b. b. b. b.
The most effective primary prevention of skin cancer is to educate the public about: -
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
Answer ✔✔ - limiting exposure to natural solar radiation.
b. b. b. b. b. b. b. b. b. b. b.
Primary prevention of skin cancer includes limiting sun exposure, avoiding tanning
b. b. b. b. b. b. b. b. b. b.
facilities, and applying sunscreen. Examining the skin and recognizing melanoma are
b. b. b. b. b. b. b. b. b. b. b.
both secondary prevention measures.
b. b. b. b.
and complete answers
b. b. b.
Prescriptive authority: - Answer ✔✔ - may be exercised by giving a verbal medication
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
order to a pharmacist.
b. b. b. b.
An example of exercising prescriptive authority is giving a verbal order to a pharmacist
b. b. b. b. b. b. b. b. b. b. b. b. b.
or writing an order for a prescription medication. Prescriptive authority rules and
b. b. b. b. b. b. b. b. b. b. b. b.
regulations vary from state to state. Prescriptive authority is granted only to those
b. b. b. b. b. b. b. b. b. b. b. b. b.
APRNs who meet the requirements of the governing body for the state in which the
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
APRN practices.
b. b.
When examining a pregnant patient, where should the fundal height be at 22 weeks? -
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
Answer ✔✔ - Above the umbilicus
b. b. b. b. b. b. b. b.
Between 18 and 32 weeks, there is good correlation between fundal height and
b. b. b. b. b. b. b. b. b. b. b. b.
gestational age of the fetus. The expected heights are: 10-12 weeks: fundus slightly
b. b. b. b. b. b. b. b. b. b. b. b. b.
above the symphysis pubis 16 weeks: fundus midway between the symphysis pubis
b. b. b. b. b. b. b. b. b. b. b. b.
and umbilicus 20 weeks: fundus at the level of umbilicus 28 weeks: fundus 3
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
fingerbreadths above the umbilicus 36 weeks: fundus just below the xiphoid process
b. b. b. b. b. b. b. b. b. b. b. b.
What intervention does the American College of Rheumatology recommend as first-line
b. b. b. b. b. b. b. b. b. b.
therapy for osteoarthritis? - Answer ✔✔ - Exercise and weight loss
b. b. b. b. b. b. b. b. b. b. b. b. b.
Exercise, weight loss, and rest are recommended by the American College of
b. b. b. b. b. b. b. b. b. b. b.
Rheumatology guidelines for the initial management of osteoarthritis (OA). Given the
b. b. b. b. b. b. b. b. b. b. b.
adverse effects of medications used to treat OA, it is best to minimize dosage and
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
delay use as long as possible. An extensive diagnostic workup is not recommended
b. b. b. b. b. b. b. b. b. b. b. b. b.
unless the presentation is in question. Patients who have severe degenerative joint
b. b. b. b. b. b. b. b. b. b. b. b.
disease (DJD), joint fusion, or whose pain severity is not relieved by more conservative
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
therapies may be candidates for joint replacement. Acetaminophen is recommended as
b. b. b. b. b. b. b. b. b. b. b.
a first-line medication.
b. b. b.
A 63-year-old male retired accountant complains of pain and stiffness in his feet and
b. b. b. b. b. b. b. b. b. b. b. b. b.
hands of several years duration. He reports that the pain and stiffness become worse
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
with activity. On examination, he is noted to have Heberden's nodes but no other bony
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
deformities. Which of the following is the most probable diagnosis? - Answer ✔✔ -
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
Osteoarthritis (OA)
b. b.
,Although his vocation involved sedentary activity, this patient is not at great risk for
b. b. b. b. b. b. b. b. b. b. b. b. b.
osteoarthritis. Rheumatoid arthritis is characterized by several joint deformities, usually
b. b. b. b. b. b. b. b. b. b.
bilaterally symmetrical. RA is characterized by inflammatory processes, while OA is not.
b. b. b. b. b. b. b. b. b. b. b. b.
RA and OA are chronic conditions. Gout is characterized by acute exacerbations
b. b. b. b. b. b. b. b. b. b. b. b.
related to a defect in purine metabolism, increased uric acid production, or decreased
b. b. b. b. b. b. b. b. b. b. b. b. b.
uric acid excretion.
b. b. b.
The family of a 78-year-old man moved him into an assisted living center because he
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
can no longer be left at home alone. He is unable to toilet when asked to do so and he
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
has had several episodes of incontinence. He has walked out of the facility twice and
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
been unable to find his way back from 3 blocks away. On examination, he is pleasant
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
but mildly confused. Which of his medications is LEAST likely contributing to his
b. b. b. b. b. b. b. b. b. b. b. b. b.
behavior? - Answer ✔✔ - ramipril (Altace®)
b. b. b. b. b. b. b. b. b.
Tricyclic antidepressants, like amitriptyline, have anticholinergic side effects which are
b. b. b. b. b. b. b. b. b.
especially problematic in the elderly because they contribute to urinary retention.
b. b. b. b. b. b. b. b. b. b. b.
Hydrochlorothiazide is a diuretic and may contribute to his incontinence. Cimetidine is
b. b. b. b. b. b. b. b. b. b. b. b.
well known to produce adverse reactions such as confusion in elders. Ramipril, an ACE
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
inhibitor, is unlikely to contribute to this patient's incontinence or confusion. Toileting
b. b. b. b. b. b. b. b. b. b. b. b.
may be a complicated by the anticholinergic medication and/or the diuretic causing
b. b. b. b. b. b. b. b. b. b. b. b.
diuresis, urge incontinence, and inability to void at will.
b. b. b. b. b. b. b. b. b.
A patient with no significant medical history has varicose veins. She complains of
b. b. b. b. b. b. b. b. b. b. b. b.
"aching legs". The intervention that will provide the greatest relief for her complaint is to:
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
- Answer ✔✔ - elevate her legs periodically.
b. b. b. b. b. b. b. b. b. b.
The intervention that will provide the greatest relief for this patient is elevating her legs
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
periodically. This will facilitate venous return. Use of support stockings will prolong the
b. b. b. b. b. b. b. b. b. b. b. b. b.
length of time she is able to stand in place, but will not provide relief after her legs begin
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
aching. Support stockings should be applied prior to getting out of bed.
b. b. b. b. b. b. b. b. b. b. b. b.
Stress urinary incontinence is: - Answer ✔✔ - may be aggravated by caffeine or
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
alcohol.
b.
Stress urinary incontinence is not expected as a result of the normal aging process. The
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
primary problem is sphincter incompetence. The ingestion of caffeine or alcohol
b. b. b. b. b. b. b. b. b. b. b.
decreases sphincter control. Anticholinergic and antidepressant medications are
b. b. b. b. b. b. b. b.
causative factors related to overflow incontinence. Detrusor muscle instability is the
b. b. b. b. b. b. b. b. b. b. b.
primary underlying problem causing urge incontinence.
b. b. b. b. b. b.
Which commonly used herbal remedy is NOT associated with anxiety and/or depressive
b. b. b. b. b. b. b. b. b. b. b.
symptom relief? - Answer ✔✔ - Ginkgo biloba
b. b. b. b. b. b. b. b. b. b.
Ginkgo biloba is a common herbal remedy associated with enhancement of vascular
b. b. b. b. b. b. b. b. b. b. b.
and cerebral perfusion and memory. The nurse practitioner should be aware when the
b. b. b. b. b. b. b. b. b. b. b. b. b.
patient is taking any herbal supplement to avoid risk of drug interactions.
b. b. b. b. b. b. b. b. b. b. b. b.
, Upon ophthalmoscopic examination of a 78-year-old patient, the nurse practitioner
b. b. b. b. b. b. b. b. b.
observes dark spots against a red retina. What diagnosis is this finding most consistent
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
with? - Answer ✔✔ - Cataract
b. b. b. b. b. b. b. b.
A cataract opacity is seen as a dark disruption of the red reflex on ophthalmoscopic
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
exam.
b.
A 72 year old female patient reports a 6 month history of progressively more swollen
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
and painful distal interphalangeal (DIP) joints of one hand. There are no systemic
b. b. b. b. b. b. b. b. b. b. b. b. b.
symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA),
b. b. b. b. b. b. b. b. b. b.
and rheumatoid factor (RF) are all minimally elevated. What is the most likely
b. b. b. b. b. b. b. b. b. b. b. b. b.
diagnosis? - Answer ✔✔ - Osteoarthritis
b. b. b. b. b. b. b. b.
When osteoarthritis affects the hands, the distal interphalangeal (DIP) joints are usually
b. b. b. b. b. b. b. b. b. b. b.
involved. Rheumatoid arthritis is usually symmetrical, and the proximal interphalangeal
b. b. b. b. b. b. b. b. b. b.
(PIP) joints are more often affected. Inflammation often develops quickly, not gradually.
b. b. b. b. b. b. b. b. b. b. b. b.
This patient is elderly; therefore, it is expected that the ESR, ANA, and RF will be only
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
somewhat elevated. Over-interpretation of laboratory tests without evidence of systemic
b. b. b. b. b. b. b. b. b. b.
inflammation can lead to misdiagnosis.
b. b. b. b. b.
The nurse practitioner is evaluating a 35-year-old female nurse. She has a history of
b. b. b. b. b. b. b. b. b. b. b. b. b.
hospitalization for hepatitis B infection 2 years ago. Her laboratory tests demonstrate
b. b. b. b. b. b. b. b. b. b. b. b.
positive HBsAg. The nurse practitioner would most likely diagnose: - Answer ✔✔ -
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
chronic hepatitis B infection.
b. b. b. b.
Presence of hepatitis B surface antigen at this time indicates chronic infection with
b. b. b. b. b. b. b. b. b. b. b. b.
hepatitis B. Lab studies indicating a positive surface antigen on 2 separate occasions at
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
least 6 months apart indicate chronic infection. Immunization produces positive
b. b. b. b. b. b. b. b. b. b.
hepatitis B antibodies in most instances. Hepatitis B surface antigen would not be
b. b. b. b. b. b. b. b. b. b. b. b. b.
present in a person who has recovered from hepatitis B infection. This case would not
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
be an acute episode because of the history of hepatitis B infection 2 years prior.
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
One exception to the recommendation to limit dietary fat intake is: - Answer ✔✔ -
b. b. b. b. b. b. b. b. b. b. b. b. b. b. b. b.
children under 2 years-of-age.
b. b. b. b.
In order for myelinization of the nervous system to occur, children under 2 years-of-age
b. b. b. b. b. b. b. b. b. b. b. b. b.
require > 30% daily dietary fat.
b. b. b. b. b. b.
The most effective primary prevention of skin cancer is to educate the public about: -
b. b. b. b. b. b. b. b. b. b. b. b. b. b.
Answer ✔✔ - limiting exposure to natural solar radiation.
b. b. b. b. b. b. b. b. b. b. b.
Primary prevention of skin cancer includes limiting sun exposure, avoiding tanning
b. b. b. b. b. b. b. b. b. b.
facilities, and applying sunscreen. Examining the skin and recognizing melanoma are
b. b. b. b. b. b. b. b. b. b. b.
both secondary prevention measures.
b. b. b. b.
