1. Prescriptive authority:: may be exercised by giving a verbal medication order toa
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hi pharmacist.
An example of exercising prescriptive authority is giving a verbal order to a pharma-cist
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or writing an order for a prescription medication.Prescriptive authority rules
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andregulations vary from state to state. Prescriptive authority is granted only to
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hi those APRNs who meet the requirements of the governing body for the state in which
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theAPRN practices.
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2. When examining a pregnant patient, where should the fundal height be
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hi at22 weeks?: Above the umbilicus
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Between 18 and 32 weeks, there is good correlation between fundal height and
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hi gestational age of the fetus.The expected heights are: 10-12 weeks: fundus
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hi hi
,hi slightlyabove the symphysis pubis 16 weeks:fundus midway between the symphysis
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pubisand umbilicus 20 weeks: fundus at the level of umbilicus 28 weeks: fundus 3
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hi fingerbreadths above the umbilicus 36 weeks:fundus just below the xiphoid process
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3. What intervention does the American College of Rheumatology recommendas
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i
hi first-line therapy for osteoarthritis?: Exercise and weight loss
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Exercise, weight loss, and rest are recommended by the American College of
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hi Rheumatologyguidelines forthe initial management of osteoarthritis (OA).Given
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theadverse effects of medications used to treat OA, it is best to minimize dosage and
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hi delay use as long as possible.An extensive diagnostic workup is not
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recommendedunless the presentation is in question. Patients who have severe
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hi degenerative
joint disease (DJD), joint fusion, or whose pain severity is not relieved by more
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hi conservative therapies may be candidates for joint replacement. Acetaminophen
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hi isrecommended as a first-line medication.
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4. A 63-year-old male retired accountant complains of pain and stiffness in his
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hi hi
,hi feet and hands of several years duration. He reports that the pain and
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hi stiffness become worse with activity. On examination, he is noted to have
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hi Heberden's nodes but no other bony deformities.Which of the following is
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themost probable diagnosis?: Osteoarthritis (OA)
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Although his vocation involved sedentary activity, this patient is not at great risk for
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hi osteoarthritis. Rheumatoid arthritis is characterized by several joint
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hi deformities,usually bilaterally symmetrical. RA is characterized by inflammatory
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hi processes, while OA is not. RA and OA are chronic conditions. Gout is characterized
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hi by
acute exacerbations related to a defect in purine metabolism, increased uric
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hi acidproduction, or decreased uric acid excretion.
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hi hi
, 5. The family of a 78-year-old man moved him into an assisted living center
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hi because he can no longer be left at home alone. He is unable to toilet when
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hi asked to do so and he has had several episodes of incontinence. He has
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hi walked out of the facility twice and been unable to find his way back from 3
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hi blocks away. On examination,he is pleasant but mildly confused.Which of
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hihismedications is LEAST likely contributing to his behavior?: ramipril (Altace)
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Tricyclic antidepressants, like amitriptyline, have anticholinergic side effects which
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hi are especiallyproblematic in the elderlybecause theycontribute to urinary
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retention.Hydrochlorothiazide is a diuretic and may contribute to his incontinence.
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Cimetidineis well known to produce adverse reactions such as confusion in elders.
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hi Ramipril, an ACE inhibitor, is unlikely to contribute to this patient's incontinence or
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hi confusion.Toileting may be a complicated by the anticholinergic medication and/or the
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hidiureticcausing diuresis, urge incontinence, and inability to void at will.
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6. A patient with no significant medical history has varicose veins. She com-
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hi hi
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