Pre-Predictor Exam Review Questions With Complete
Solutions
A 12-year-old presents with ear pain of 36 hours duration. The
nurse practitioner diagnoses acute otitis media because the:
Correct Answers bony landmarks are obscured and the
tympanic membrane is mildly erythematous, dull, and immobile.
Serous otitis media typically presents with a flat or bulging and
tympanic membrane with a fluid line and/or tiny bubbles visible
posteriorly. The tympanic membrane may be immobile and
retracted against the bony landmarks when the eustachian tube is
swollen or congested as with the common cold or allergies.
Narrowing of the external canal with erythema and extreme
tenderness of the canal wall is indicative of otitis externa.
A 15-year-old high school student presents with a mild sore
throat and low-grade fever that has persisted for about 3 weeks.
She reports general malaise, fatigue, and loss of appetite. The
nurse practitioner suspects mononucleosis. Which of the
following is the LEAST appropriate intervention? Correct
Answers Obtain a urinalysis and serum for LFTs and amylase.
The clinical presentation of this patient is typical of
mononucleosis. Lymphadenopathy, splenomegaly, pharyngeal
petechiae, and leukocytosis are common additional findings.
Urinalysis, serum amylase, and LFTs would not yield
information regarding the diagnosis. The confirmatory tests are
throat culture and the heterophil antibody test.
,A 16 year old sexually active student presents with complaints
of a greenish-gray frothy vaginal discharge and vaginal itching.
The nurse practitioner should suspect: Correct Answers
trichomoniasis.
The cardinal symptoms of infection with Trichomonas vaginalis
(a flagellated protozoan) is a frothy, greenish-gray discharge
with a fishy odor. The vagina may be very edematous and red.
The cervix may be friable with petechiae ("strawberry cervix").
A 16 year-old has been diagnosed with Lyme disease. Which
drug should be used to treat him? Correct Answers Doxycycline
Doxycycline is frequently chosen first line to treat Lyme
Disease. However, numerous studies have demonstrated that
amoxicillin and cefuroxime have equal efficacy as doxycycline
in treatment of early Lyme Disease. These drugs are
recommended in patients who exhibit erythema migrans.
Doxycycline is not recommended in children less than 9 years of
age.
A 17-year-old female presents with painful vesicular lesions on
her vulva. Which of the following would be the most definitive
diagnostic test? Correct Answers Tzanck prep
Tzanck prep is the only test in this list which is diagnostic for
herpes simplex. KOH prep is used to diagnose candidal and
bacterial vaginosis. Gram stain is used to help distinguish Gram
positive and Gram negative organisms. The Papanicolaou (Pap)
smear is used to screen for cervical dysplasia and cancer.
,A 2-year-old female presents with a 3 day history of high fever,
followed by abrupt resolution and development of a pink,
maculopapular rash today. What pharmacological
intervention(s) should the nurse practitioner consider? Correct
Answers No pharmacologic intervention is needed, but fluids
should be encouraged
This 2 year old has roseola, a human herpes virus. Since the
fever has resolved and the rash will last another day or 2, no
pharmacologic intervention is needed. Fluids should be
encouraged because there may be some residual dehydration
from the 3 days of fever.
A 28 year-old has a Grade 3 murmur. Which characteristic
indicates a need for referral? Correct Answers A fixed split
A split is created because of closure of valves. For example, an
S2 is created by closure of the aortic and pulmonic valves.
Normally these split with inspiration and almost never with
expiration. Splits should never be fixed. This indicates some
pathology like an atrial septal defect, pulmonic stenosis, or
possibly mitral regurgitation. In any event, this patient needs
initial evaluation with an echocardiogram because fixed splits
are always considered abnormal.
A 3 year-old female had a fever of 102 degrees F for 3 days.
Today she woke up from a nap and is afebrile. She has a
maculopapular rash. Which statement is true? Correct Answers
The rash will blanch.
, This describes a patient with roseola or exanthem subitum. This
is a common viral exanthem found in young children caused by
the Human Herpes Virus 6B. It is characterized by high fever for
3 days followed by the abrupt cessation of fever and the
appearance of a maculopapular rash. This usually resolves in a
few days. The child may return to school or daycare when he
has been fever free for 24 hours.
A 32 year-old patient is a newly diagnosed diabetic. She has
developed a sinus infection. Her symptoms have persisted for 10
days. Six weeks ago she was treated with amoxicillin for an
upper respiratory infection. It cleared without incident. What
should be recommended today? Correct Answers Prescribe
amoxicillin-clavulanate today.
Amoxicillin is no longer indicated for initial treatment in adults
who have acute bacterial sinusitis. A bacterial cause can be
assumed since she's had symptoms for 10 days. A viral infection
likely would have run its course by now. After 10 days of
persistent symptoms, treatment is reasonable with an antibiotic;
especially since this patient is diabetic. She may be having blood
sugar elevations that facilitate growth of the causative organism
of the sinus infection. A decongestant could be added depending
on her blood pressure and personal history of using
decongestants.
A 32-year-old female patient presents with fever, chills, right
flank pain, right costovertebral angle tenderness, and hematuria.
Her urinalysis is positive for leukocytes and red blood cells. The
nurse practitioner diagnoses pyelonephritis. The most
Solutions
A 12-year-old presents with ear pain of 36 hours duration. The
nurse practitioner diagnoses acute otitis media because the:
Correct Answers bony landmarks are obscured and the
tympanic membrane is mildly erythematous, dull, and immobile.
Serous otitis media typically presents with a flat or bulging and
tympanic membrane with a fluid line and/or tiny bubbles visible
posteriorly. The tympanic membrane may be immobile and
retracted against the bony landmarks when the eustachian tube is
swollen or congested as with the common cold or allergies.
Narrowing of the external canal with erythema and extreme
tenderness of the canal wall is indicative of otitis externa.
A 15-year-old high school student presents with a mild sore
throat and low-grade fever that has persisted for about 3 weeks.
She reports general malaise, fatigue, and loss of appetite. The
nurse practitioner suspects mononucleosis. Which of the
following is the LEAST appropriate intervention? Correct
Answers Obtain a urinalysis and serum for LFTs and amylase.
The clinical presentation of this patient is typical of
mononucleosis. Lymphadenopathy, splenomegaly, pharyngeal
petechiae, and leukocytosis are common additional findings.
Urinalysis, serum amylase, and LFTs would not yield
information regarding the diagnosis. The confirmatory tests are
throat culture and the heterophil antibody test.
,A 16 year old sexually active student presents with complaints
of a greenish-gray frothy vaginal discharge and vaginal itching.
The nurse practitioner should suspect: Correct Answers
trichomoniasis.
The cardinal symptoms of infection with Trichomonas vaginalis
(a flagellated protozoan) is a frothy, greenish-gray discharge
with a fishy odor. The vagina may be very edematous and red.
The cervix may be friable with petechiae ("strawberry cervix").
A 16 year-old has been diagnosed with Lyme disease. Which
drug should be used to treat him? Correct Answers Doxycycline
Doxycycline is frequently chosen first line to treat Lyme
Disease. However, numerous studies have demonstrated that
amoxicillin and cefuroxime have equal efficacy as doxycycline
in treatment of early Lyme Disease. These drugs are
recommended in patients who exhibit erythema migrans.
Doxycycline is not recommended in children less than 9 years of
age.
A 17-year-old female presents with painful vesicular lesions on
her vulva. Which of the following would be the most definitive
diagnostic test? Correct Answers Tzanck prep
Tzanck prep is the only test in this list which is diagnostic for
herpes simplex. KOH prep is used to diagnose candidal and
bacterial vaginosis. Gram stain is used to help distinguish Gram
positive and Gram negative organisms. The Papanicolaou (Pap)
smear is used to screen for cervical dysplasia and cancer.
,A 2-year-old female presents with a 3 day history of high fever,
followed by abrupt resolution and development of a pink,
maculopapular rash today. What pharmacological
intervention(s) should the nurse practitioner consider? Correct
Answers No pharmacologic intervention is needed, but fluids
should be encouraged
This 2 year old has roseola, a human herpes virus. Since the
fever has resolved and the rash will last another day or 2, no
pharmacologic intervention is needed. Fluids should be
encouraged because there may be some residual dehydration
from the 3 days of fever.
A 28 year-old has a Grade 3 murmur. Which characteristic
indicates a need for referral? Correct Answers A fixed split
A split is created because of closure of valves. For example, an
S2 is created by closure of the aortic and pulmonic valves.
Normally these split with inspiration and almost never with
expiration. Splits should never be fixed. This indicates some
pathology like an atrial septal defect, pulmonic stenosis, or
possibly mitral regurgitation. In any event, this patient needs
initial evaluation with an echocardiogram because fixed splits
are always considered abnormal.
A 3 year-old female had a fever of 102 degrees F for 3 days.
Today she woke up from a nap and is afebrile. She has a
maculopapular rash. Which statement is true? Correct Answers
The rash will blanch.
, This describes a patient with roseola or exanthem subitum. This
is a common viral exanthem found in young children caused by
the Human Herpes Virus 6B. It is characterized by high fever for
3 days followed by the abrupt cessation of fever and the
appearance of a maculopapular rash. This usually resolves in a
few days. The child may return to school or daycare when he
has been fever free for 24 hours.
A 32 year-old patient is a newly diagnosed diabetic. She has
developed a sinus infection. Her symptoms have persisted for 10
days. Six weeks ago she was treated with amoxicillin for an
upper respiratory infection. It cleared without incident. What
should be recommended today? Correct Answers Prescribe
amoxicillin-clavulanate today.
Amoxicillin is no longer indicated for initial treatment in adults
who have acute bacterial sinusitis. A bacterial cause can be
assumed since she's had symptoms for 10 days. A viral infection
likely would have run its course by now. After 10 days of
persistent symptoms, treatment is reasonable with an antibiotic;
especially since this patient is diabetic. She may be having blood
sugar elevations that facilitate growth of the causative organism
of the sinus infection. A decongestant could be added depending
on her blood pressure and personal history of using
decongestants.
A 32-year-old female patient presents with fever, chills, right
flank pain, right costovertebral angle tenderness, and hematuria.
Her urinalysis is positive for leukocytes and red blood cells. The
nurse practitioner diagnoses pyelonephritis. The most
