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APEA PRE-PREDICTOR NP EXAM
- Prescriptive authority:: may be exercised by giving a verbal medication order toa pharmacist. An example of exercising prescriptive authority is giving a verbal order to a pharma-cist or writing an order for a prescription medication. Prescriptive authority rules andregulations 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 theAPRN 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
slightlyabove the symphysis pubis 16 weeks: fundus midway between the symphysis pubisand 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 recommendas 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 theadverse 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 recommendedunless the presentation is in question. Patients who have severe degenerative joint disease (DJD), joint fusion, or whose pain severity is not relieved by more
- 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 hismedications 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. Cimetidineis 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 diureticcausing diuresis, urge
incontinence, and inability to void at will.
- A patient with no significant medical history has varicose veins. She com-plains of "aching legs". The intervention that will provide the greatest relief forher 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 outof 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 alcoholdecreases sphincter control. Anticholinergic and
A cataract opacity is seen as a dark disruption of the red reflex on ophthalmoscopicexam.
- A 72 year old female patient reports a 6 month history of progressively more swollen and painful distal interphalangeal (DIP) joints of one hand. Thereare no systemic symptoms but the erythrocyte sedimentation rate (ESR), anti-nuclear 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 testswithout evidence of systemic inflammation can lead to
misdiagnosis.
- The nurse practitioner is evaluating a 35 - year-old female nurse. She has ahistory of hospitalization for hepatitis B infection 2 years ago. Her laboratorytests 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 withhepatitis B. Lab studies indicating a positive surface antigen on 2 separate occasionsat 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:: childrenunder 2 years-of-age.
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 medica-tion such as prochlorperazine (Compazine) and provide oral fluid and electrolyte replacement instruction. Enterocolitis is the most common clinical presentation of salmonellosis. Diagnosis ismade 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 shouldbe 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 differenti-ate the Somogyi effect from dawn phenomenon?: Instruct the parent to monitorthe 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 tohypoglycemia. 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 earliestclinical manifestation is:: weight gain. The earliest and most sensitive clinical indicator of HF is weight gain. A patient withHF 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.
Corn syrup acts as an osmotic agent to increase water concentration in fecalmaterial, stimulating peristalsis and, thus, a bowel movement.
- A patient presents with an inflamed upper eyelid margin. The conjunctivais red and there is particulate matter along the upper eyelid. The patient complains of a sensation that "there is something in my eye." What is the diagnosis and how should it be treated?: Blepharitis; treat with warm compressesand gentle debridement with a cotton swab Blepharitis is an inflammation of the eyelid and can be caused by bacteria or a seborrheic process. Treatment includes lid scrubs and a topical antibiotic if the causeis bacterial.
- Initial treatment of a child presenting with a severe head injury is:: aimedat resuscitation, then maintenance of oxygenation and blood flow.
A head-injured patient requires that all related injuries be identified and treated, butthe most immediate need is airway resuscitation, maintenance of oxygenation, andmaintenance of blood flow. Cerebral edema, a major complication of head injury, ismanaged with adequate oxygenation, elevation of the head and trunk to facilitate venous return from the head, isotonic intravenous fluid administration maintaining low central venous pressure, and maintenance of normal body temperature.
- Eligibility requirements for the ANP or FNP exam include all of the follow-ing EXCEPT:: a masters degree in nursing or an area. Today, NP students are prepared at the graduate level. There are nurse practitionerswho have completed an accredited or approved non-graduate level educational program prior to implementation of graduate level education requirements. Most states have "grandfathered" these NPs into practice.
- A 12-year-old presents with ear pain of 36 hours duration. The nurse
- An appropriate initial treatment for external genital warts caused by humanpapilloma virus (HPV) in a non-pregnant patient is:: topical trichloroacetic acid (TCA). Appropriate initial treatment of external genital warts caused by HPV includes cryotherapy with liquid nitrogen or cryoprobe, self-treatment with podofilox 0.5% solution, podophyllin 10%-25%, trichloroacetic acid (TCA), or electrodesiccation orelectrocautery. 5 - fluorouracil cream has not been evaluated in controlled studies andis not recommended for treatment of genital warts. Intralesional interferon is used for treatment of persistent and recurrent genital warts, but is not recommended by the CDC. Topical acyclovir is not indicated for treatment of genital warts.
- A 6-year-old presents with complaints of sore throat and fever for 2 days. He has multiple vesiculated ulcerations on his tonsils and uvula. There are no other remarkable findings. What is the most likely
diagnosis?: Herpangina Herpangina is a viral infection common in toddlers and young children caused by Coxsackie virus. The clinical findings of numerous, small (1-2 mm) ulcerations on the tonsils and uvula are typical of herpangina. The ulcerations can be very painfulbut usually resolve in 7 to 10 days. Treatment is symptomatic.
- The daughter of a 75 - year-old patient reports that her mother roams thehouse at night saying she cannot fall asleep. She has fallen twice. Of the following choices, which would be the most appropriate to treat her insom-nia?: doxepin (Sinequan) Low dose doxepin (Sinequan) has been proven efficacious in the therapy of transientinsomnia, producing improvements in wake after sleep onset, total sleep time and sleep-onset latency. Since this patient is having difficulty falling
Clarithromycin is an antibiotic recommended by the American Thoracic Society for treatment of community acquired pneumonia (CAP) in young adults without co-mor- bid conditions. Clarithromycin provides antimicrobial activity against Streptococcus pneumoniae, the most common causative organism in CAP, and provides coverage for other less common pathogens, including Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophlia
27. All of the following are associated with erectile dysfunction (ED) EXCEPT:- : NSAIDs and oral hypoglycemic agents Neither NSAIDs nor hypoglycemic agents are associated with erectile dysfunction (ED). Male diabetics frequently have ED, but it is due to the disease, not the medications used to treat diabetes. Erectile dysfunction may also be caused by diuretics, spironolactone, anti-depressants, peripheral
neuropathy, and spinal injuryat S2 to S4 or higher.
- The nurse practitioner suspects migraine in a 6 year old male with a 2 month history of recurrent headache. What finding would support a diagnosisof migraine headache?: Family history of migraine headache The most common recurrent headache in children is migraine. There is a positivefamily history 75% of cases.
- A 49 year old man sees the nurse practitioner for evaluation of a 2 millime-ter macular lesion on his back. The lesion is brown with regular borders. Themost appropriate action for the nurse practitioner is to:: reassure the patient that this lesion is not suspicious for pathology. Lesions that are less than 5 millimeters, flat, with regular borders and even color,are not suspicious for malignancy. This patient should be reassured.
- A 45 year old with Type 1 diabetes mellitus has had itching and
