NSG 6998 Pre-Predictor Exam Review: Questions With
Definite Solutions
Prescriptive 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 related to overflow
incontinence. Detrusor muscle instability is the primary underlying problem
causing urge incontinence.
Which commonly used herbal remedy is NOT associated with anxiety and/or
depressive symptom relief? Correct Answer - Ginkgo biloba
Ginkgo biloba is a common herbal remedy associated with enhancement of
vascular 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 78-year-old patient, the nurse
practitioner observes dark spots against a red retina. What diagnosis is this
finding most consistent with? Correct Answer - Cataract
A cataract opacity is seen as a dark disruption of the red reflex on
ophthalmoscopic exam.
A 72 year old female patient reports a 6 month history of progressively more
swollen and painful distal interphalangeal (DIP) joints of one hand. There are
no systemic symptoms but the erythrocyte sedimentation rate (ESR),
antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally
elevated. What is the most likely diagnosis? Correct Answer -
Osteoarthritis
When osteoarthritis affects the hands, the distal interphalangeal (DIP) joints
are usually involved. Rheumatoid arthritis is usually symmetrical, and the
proximal interphalangeal (PIP) joints are more often affected. Inflammation
often develops quickly, not gradually. This patient is elderly; therefore, it is
expected that the ESR, ANA, and RF will be only somewhat elevated. Over-
interpretation of laboratory tests without evidence of systemic inflammation
can lead to misdiagnosis.
, The nurse practitioner is evaluating a 35-year-old female nurse. She has a
history of hospitalization for hepatitis B infection 2 years ago. Her laboratory
tests demonstrate positive HBsAg. The nurse practitioner would most likely
diagnose: Correct Answer - chronic hepatitis B infection.
Presence of hepatitis B surface antigen at this time indicates chronic infection
with hepatitis B. Lab studies indicating a positive surface antigen on 2
separate occasions at least 6 months apart indicate chronic infection.
Immunization produces positive hepatitis B antibodies in most instances.
Hepatitis B surface antigen would not be 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.
One exception to the recommendation to limit dietary fat intake is: Correct
Answer - children under 2 years-of-age.
In order for myelinization of the nervous system to occur, children under 2
years-of-age require > 30% daily dietary fat.
The most effective primary prevention of skin cancer is to educate the public
about: Correct Answer - limiting exposure to natural solar radiation.
Primary prevention of skin cancer includes limiting sun exposure, avoiding
tanning facilities, and applying sunscreen. Examining the skin and recognizing
melanoma are both secondary prevention measures.
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? Correct Answer - Offer
an anti-emetic medication such as prochlorperazine (Compazine®) and
provide oral fluid and electrolyte replacement instruction.
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.
Definite Solutions
Prescriptive 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 related to overflow
incontinence. Detrusor muscle instability is the primary underlying problem
causing urge incontinence.
Which commonly used herbal remedy is NOT associated with anxiety and/or
depressive symptom relief? Correct Answer - Ginkgo biloba
Ginkgo biloba is a common herbal remedy associated with enhancement of
vascular 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 78-year-old patient, the nurse
practitioner observes dark spots against a red retina. What diagnosis is this
finding most consistent with? Correct Answer - Cataract
A cataract opacity is seen as a dark disruption of the red reflex on
ophthalmoscopic exam.
A 72 year old female patient reports a 6 month history of progressively more
swollen and painful distal interphalangeal (DIP) joints of one hand. There are
no systemic symptoms but the erythrocyte sedimentation rate (ESR),
antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally
elevated. What is the most likely diagnosis? Correct Answer -
Osteoarthritis
When osteoarthritis affects the hands, the distal interphalangeal (DIP) joints
are usually involved. Rheumatoid arthritis is usually symmetrical, and the
proximal interphalangeal (PIP) joints are more often affected. Inflammation
often develops quickly, not gradually. This patient is elderly; therefore, it is
expected that the ESR, ANA, and RF will be only somewhat elevated. Over-
interpretation of laboratory tests without evidence of systemic inflammation
can lead to misdiagnosis.
, The nurse practitioner is evaluating a 35-year-old female nurse. She has a
history of hospitalization for hepatitis B infection 2 years ago. Her laboratory
tests demonstrate positive HBsAg. The nurse practitioner would most likely
diagnose: Correct Answer - chronic hepatitis B infection.
Presence of hepatitis B surface antigen at this time indicates chronic infection
with hepatitis B. Lab studies indicating a positive surface antigen on 2
separate occasions at least 6 months apart indicate chronic infection.
Immunization produces positive hepatitis B antibodies in most instances.
Hepatitis B surface antigen would not be 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.
One exception to the recommendation to limit dietary fat intake is: Correct
Answer - children under 2 years-of-age.
In order for myelinization of the nervous system to occur, children under 2
years-of-age require > 30% daily dietary fat.
The most effective primary prevention of skin cancer is to educate the public
about: Correct Answer - limiting exposure to natural solar radiation.
Primary prevention of skin cancer includes limiting sun exposure, avoiding
tanning facilities, and applying sunscreen. Examining the skin and recognizing
melanoma are both secondary prevention measures.
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? Correct Answer - Offer
an anti-emetic medication such as prochlorperazine (Compazine®) and
provide oral fluid and electrolyte replacement instruction.
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.
