Pre-Predictor exam review Exam Questions And 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. 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: - 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: - 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: - 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? - 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.
A child with Type 1 diabetes mellitus brings in a glucose diary indicating consistent morning
hyperglycemia. How can the nurse practitioner differentiate the Somogyi effect from dawn
phenomenon? - Instruct the parent to monitor the blood glucose at 3:00 am.
Dawn phenomenon is an early morning rise in plasma glucose. It indicates a need for increased
insulin. The Somogyi effect is a rise in plasma glucose in response to hypoglycemia. It is usually
accompanied by weight gain and hunger and is corrected by decreasing the evening insulin dose. A
series of 3 early morning measurements of blood glucose will help differentiate between the 2
conditions.
Of the following signs and symptoms of heart failure (HF), the earliest clinical manifestation is: -
weight gain.
The earliest and most sensitive clinical indicator of HF is weight gain. A patient with HF should be
instructed to weigh himself daily to note changes in his weight. The best time of day to weigh is early
morning. The other clinical manifestations listed will present after the weight gain. Another early,
clinical manifestation of CHF not listed above is fatigue.
The mother of a 6-month-old infant asks about the use of an infant walker. The most appropriate
response is to: - discourage the use of walkers and encourage parental holding and floor play.
Baby walkers are a significant cause of injuries in young children. Their use should be discouraged
and parental holding and floor play should be encouraged instead.
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. 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: - 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: - 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: - 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? - 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.
A child with Type 1 diabetes mellitus brings in a glucose diary indicating consistent morning
hyperglycemia. How can the nurse practitioner differentiate the Somogyi effect from dawn
phenomenon? - Instruct the parent to monitor the blood glucose at 3:00 am.
Dawn phenomenon is an early morning rise in plasma glucose. It indicates a need for increased
insulin. The Somogyi effect is a rise in plasma glucose in response to hypoglycemia. It is usually
accompanied by weight gain and hunger and is corrected by decreasing the evening insulin dose. A
series of 3 early morning measurements of blood glucose will help differentiate between the 2
conditions.
Of the following signs and symptoms of heart failure (HF), the earliest clinical manifestation is: -
weight gain.
The earliest and most sensitive clinical indicator of HF is weight gain. A patient with HF should be
instructed to weigh himself daily to note changes in his weight. The best time of day to weigh is early
morning. The other clinical manifestations listed will present after the weight gain. Another early,
clinical manifestation of CHF not listed above is fatigue.
The mother of a 6-month-old infant asks about the use of an infant walker. The most appropriate
response is to: - discourage the use of walkers and encourage parental holding and floor play.
Baby walkers are a significant cause of injuries in young children. Their use should be discouraged
and parental holding and floor play should be encouraged instead.
