Exam (elaborations)
Pre-Predictor exam review
- Course
- Institution
Pre-Predictor exam review
[Show more]
Content preview
PRE-PREDICTOR EXAM BEST REVIEWCOMPLETE DETAILED CASE STUDY
u 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 uprevention uof uskin ucancer uincludes ulimiting usun uexposure, uavoiding utanning ufacilities, uand
uapplying usunscreen. uExamining uthe uskin uand urecognizing umelanoma uare uboth usecondary uprevention
umeasures.
A upatient uhas uexperienced unausea uand uvomiting, uheadache, umalaise, ulow-grade ufever, uabdominal
ucramps, uand udiarrhea ufor u32 uhours. uThe uwhite ucount uis uslightly uelevated uwith ua ushift uto uthe uleft.
uHe uis urequesting umedication ufor udiarrhea. uWhat uis uthe umost uappropriate uresponse? u- uOffer uan
uanti-emetic umedication usuch uas uprochlorperazine u(Compazine®) uand uprovide uoral ufluid uand
uelectrolyte ureplacement uinstruction.
Enterocolitis uis uthe umost ucommon uclinical upresentation uof usalmonellosis. uDiagnosis uis umade uby
uclinical upresentation, uand ucan ube uconfirmed uonly uwith ustool uor ublood ucultures. uMost uhealthy
uadults uhave ua ucourse uthat uis uself-limiting uto u72 uhours. uAntibiotics ushould ube uused uvery
udiscriminantly uas uresistance uapproaches u50%. uAnti-diarrheal uagents upotentially uincrease
ucomplications uand upredispose uthe upatient uto ubacteremia.
A uchild uwith uType u1 udiabetes umellitus ubrings uin ua uglucose udiary uindicating uconsistent umorning
uhyperglycemia. uHow ucan uthe unurse upractitioner udifferentiate uthe uSomogyi ueffect ufrom udawn
uphenomenon? u- uInstruct uthe uparent uto umonitor uthe ublood uglucose uat u3:00 uam.
Dawn uphenomenon uis uan uearly umorning urise uin uplasma uglucose. uIt uindicates ua uneed ufor uincreased
uinsulin. uThe uSomogyi ueffect uis ua urise uin uplasma uglucose uin uresponse uto uhypoglycemia. uIt uis uusually
uaccompanied uby uweight ugain uand uhunger uand uis ucorrected uby udecreasing uthe uevening uinsulin udose.
uA useries uof u3 uearly umorning umeasurements uof ublood uglucose uwill uhelp udifferentiate ubetween uthe u2
uconditions.
Of uthe ufollowing usigns uand usymptoms uof uheart ufailure u(HF), uthe uearliest uclinical umanifestation uis: u-
uweight ugain.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller knowledgeNest. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
75323 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now