Pre-Predictor exam review
Prescriptive authority: - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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: - ✔✔- ACTUAL 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: - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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: -
✔✔- ACTUAL 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: - ✔✔-
ACTUAL 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: - ✔✔- ACTUAL 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? - ✔✔- ACTUAL ANSWER- Offer an anti-emetic
medication such as prochlorperazine (Compazine®) and provide oral fluid and
electrolyte replacement instruction.
Prescriptive authority: - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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: - ✔✔- ACTUAL 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: - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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? - ✔✔- ACTUAL 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: -
✔✔- ACTUAL 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: - ✔✔-
ACTUAL 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: - ✔✔- ACTUAL 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? - ✔✔- ACTUAL ANSWER- Offer an anti-emetic
medication such as prochlorperazine (Compazine®) and provide oral fluid and
electrolyte replacement instruction.
