NSG 6440; PREDICTOR TEST QUESTIONS AND ANSWERS WITH RATIONALE 100% CORRECT Predictor ltest 1) A l15 lyears lold lhigh lschool lstudent lwith la lmild lsore lthroat land llow-grade lfever lthat lhas lpersisted lfor labout l3 lweeks. lShe lreports lgeneral lmalaise, lfatigue, land lloss lof lappetite. lThe lNP lsuspects lmononucleosis. lWhich lof lthe lfollowing lis lthe lLEAST lappropriate lintervention? a. Palpate lthe llymph lnodes land lspleen b. Examine lthe lposterior loropharynx lfor lpetechiae c. Obtain la lCBC, lthroat lculture, land lheterophil lantibody ltest. ld. Obtain lan lurinalyses land lserum lfor lLFTs land lamylase Explanation: lmononucleosis lis la lsymptomatic linfection lcaused lby lthe lEpstein -Bar lvirus. lCommon lis lpeople l15-24 lyears lof lage. lCommon lsigns land lsymptoms lfollowing lincubation lperiod l(1-2 lmonths) linclude lfatigue, lchills, lmalaise, lanorexia, lwhite ltonsillar lexudates land llymphadenopathy lor lposterior lcervical lregion. lSplenomegaly lcan lbe lpresent. lA lmaculopapular lor loccasionally la lpetechial lrash loccurs lin lless lthan l15% lof lpatients. lA ldiagnosis lis lusually lmade lusing lthe lMonospot. lIn laddition, lneutropenia land llymphocytosis lare lusually ldetected lin lthe lCBC. 2) A l32 lyears lold lmale lpatient lcomplaint lof lurinary lfrequency land lburning lon lurination lfor l3 ldays. lUrinalyses lreveals lbacteriuria land lpositive lnitrites. lHe ldenie s lany lpast lhx. lOf lurinary ltract linfections. lThe linitial ltreatment lshould lbe: a. trimethoprim -sulfamethoxazole l(Bactrim, lSulfatrim) lfor l7-10 lday b. ciprofloxacin l(Cipro) lfor l3-5 ldays c. Trimethoprim -Sulfamethoxazole lfor l3 ldays d. 750 lmg lciprofloxacin las la lone-time ldose Explanation: ltrimethoprim -sulfamethoxazole l(TMPS) lis lusually ln lappropriate lmedication lto ltreat lurinary ltract linfections lin lmost lpatients. lIn lthe lcase lof lcommunity lresistance lto lTMPS >20%^, lanother lmedication lshould lbe lsubstituted. lIn lmen, lthe lappropriate llength lof ltime lis l7-10 ldays. lWomen lmay lbe ltreated lfor l3 ldays lfor luncomplicated lUTI 3) Which lagent lis lmost leffective lfor lthe ltreatment lof lnodulocystic lacne? a. Benzoyl lperoxide l(Benzac) b. Retinoic lacid l(Retin lA) c. Topical ltetracycline ld. Isotretinoin) l Explanation: lIsotretinoin l(Accutane) lis la lsystemic lagent lindicated lfor ltreatment lwith lsevere linflammatory lacne. lGuidelines lfor lits luse lmust lbe lclearly lunderstood lby lthe lpatient. lA lwoman lof lchildbearing lage lmust luse lan leffective lmethod lof lcontraception lbecause lisotretinoin lis lteratogenic. lThere lare lmany lrestrictions lin lprescribing lthis lmedication lbecause lof lthe lteratogenic leffects lis lgiven lduring lpregnancy. lTherefore, lit lis la lpregnancy lcategory lX. 4) An l18 ly/o lwoman lis ltaking la lcombined lhormonal loral lcontraceptive. lShe lshould lbe linstructed lto luse la lbackup lmethod lfor lthe lprevention lof lpregnancy a. Throughout lthe lweek lof lplacebo lpills b. If lprescribed ltopiramate l(Topamax) lfor lthe ltreatment lof lmigraines. l c. If lprescribed lamoxicillin/clavulanate l(Augmentin) lfor la lsinus linfection d. if lshe lforgets lto ltake la lsingle ldose lof lthe lcontraceptive Explanation: lAnticonvulsant lincluding lphenytoin l(Dilantin), lcarbamazepine l(Tegretol), lprimidone l(Mysoline), ltopiramate l(Topamax) land loxcarbazepine l(Trileptal) lreduce lthe leffectiveness lof lcontraceptives. lDepo -medroxyprogesterone lacetate linjections lor llevonorgestrel - lreleasing lintrauterine ldevices lwould lbe la lbetter lmethod lof lcontraceptive lfor lpatients ltaking lanticonvulsants. lMost lcommonly lused lantibiotics lhave lnot lbeen lproven lto lreduce lthe leffectiveness lof lcontraceptives. lRifampin lis lan lexception, land ladditional l…. lBe lused lby lwomen ltaking lthis ldrug land lusing loral lcontraceptives, ltransdermal, lor lvaginal lring lpreparations. Additional lbackup lcontraception lshould lbe lused lif ltaking lantifungal lagents. lNo ladditional lprotection lis lneeded lthought lthe lweek lof lplacebo lpills. lMissing lone lsingle ldose lof lcontraceptive ldoes lnot lrequire ladditional lprotection, lmissing lmore lthan lone ldoses ldoes. 5) A l44 lyears lold lfemale lpatient lhas ldiabetes. lHer ltotal lcholesterol l(TC) lis l250 lmg/dl l(6.5 lmmol/L), lLDL= l190 lmg/dL l(4.94 lmmol/L), lHDL= l25 lmg/dL l(65 lmmol/L), land ltriglycerides= l344 lmg/dL l(8.94 lmmol/L). lWhat lagent lhave lthe lgreatest leffect lon limproving lher llipid lprofile land lreducing lmorbidity land lmortality lassociates lwith ldyslipidemia? a. Niacin l(Niaspan) lb. Atorvastatin c. Omega l3 lfatty lacids d. Fenofibrates Explanation: lFirst land lforemost, lit lis lessential lto leducate lindividuals lon la lheart -healthy llifestyle. lLDL-C lis lone lof lthe lmajor lculprits lin lthe ldevelopment lof latherosclerotic lheart ldisease. lThe ltarget llevel lof lLDL -C lis lbetween l50 lto l70mg/dl lto lprevent lplaque lformation lin lthe lblood lvessels. lGuidelines lstrongly lrecommend lstatin ltherapy lbecause lthey lprimarily llower lLDL -C llevels, lbut lthey lalso lhave lthe lsecondary leffects lof llowering ltriglyceride land lincreasing lHDL -C llevels. 6) A l30 lyears lold lfemale lcomes linto la lclinic lwith lclassic lsigns land lsymptoms lof lappendicitis. lThe lNP lfails lto lrefer lthe lpatient lto la lsurgeon. lThe lappendix lruptures land lthe lwoman ldie. lThis lis lan lexample lof a. Failure lof ldiligence b. Professional lliability c. Negligence l
d. lMalpractice l Explanation : lmalpractice, la lnegligence ltort, loccurs lwhen la lhealth lcare lprofessional’s lactions lfall lbellow lthe lappropriate lstandard lof lcare land lhurts lthe lpatient. lIn lthis lcase lthe lpatient lcame lwith lsings land lsymptoms lindicating lappendicitis land lthe lNP lfailed lto lrefer lthe lpatient.. 7) A lNP lhas lrecently lbeen lhired lto lwork lin la lfast ltrack lfacility. lThe lNP lemployer lasked lif lshe lhas l―a lproblem lprescribing lmedications lfor lemergency lcontraception.‖ lThe lNP lreplies laffirmatively. lThis lis: a. Grounds lfor ldismissal
d. lMalpractice l Explanation : lmalpractice, la lnegligence ltort, loccurs lwhen la lhealth lcare lprofessional’s lactions lfall lbellow lthe lappropriate lstandard lof lcare land lhurts lthe lpatient. lIn lthis lcase lthe lpatient lcame lwith lsings land lsymptoms lindicating lappendicitis land lthe lNP lfailed lto lrefer lthe lpatient.. 7) A lNP lhas lrecently lbeen lhired lto lwork lin la lfast ltrack lfacility. lThe lNP lemployer lasked lif lshe lhas l―a lproblem lprescribing lmedications lfor lemergency lcontraception.‖ lThe lNP lreplies laffirmatively. lThis lis: a. Grounds lfor ldismissal
