Pre-Predictor exam review
1. 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.
2. 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
3. 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.
4. 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
, Pre-Predictor exam review
characterized by acute exacerbations related to a defect in purine metabolism,
increased uric acid production, or decreased uric acid excretion.
5. 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.
6. 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.
7. 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.
8. 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
, Pre-Predictor exam review
aware when the patient is taking any herbal supplement to avoid risk of drug
interactions.
9. 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.
10. 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.
11. 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.
12. 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.
, Pre-Predictor exam review
13. 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.
14. 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.
15. 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.
16. 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.
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