Pre-Predictor exam review Questions with Solutions
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.
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.
