NSG 6998 Pre-Predictor Exam
Questions With Correct Answers
Prescriptive authority:
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?
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?
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?
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?
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:
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:
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?
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?
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?
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.
Questions With Correct Answers
Prescriptive authority:
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?
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?
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?
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?
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:
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:
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?
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?
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?
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.
