PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A., Exams of Nursing

Download PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. and more Exams Nursing in PDF only on Docsity! PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 1. A patient recovering from a recent stroke is starting anticoagulant therapy. The nurse practitioner should teach the patient to avoid all of the following EXCEPT: a. b. milk and milk products 2. A patient presents with periorbital erythema and edema, fever, and nasal drainage. The nurse practitioner should a. start aggressive antibiotic therapy 3. A positive drawer sign support a diagnosis of a. cruciate ligament injury 4. A 50-year-old patient with diabetes complains of pain bilaterally in her lower legs while walking. The pain disappears at rest. What else would you expect to identify on her lower extremities. b. peripheral artery insufficiency 5. A 16-year-old athlete complains of pain underneath his heel every time he walks. There is a verrucous surface level with the skin of the heel. What pharmacologic interventions should the nurse practitioner prescribe for this patient? a. salicylic acid plasters 6. A -year-old with Type I diabetes has had itching and burning lesions between her toes for 6 months. Scrapings of the lesion confirm the diagnosis of tinea pedis. What is the best treatment option for this PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. patient? a. prescribe an anti-fungal powder for application between her toes and in her shoes and a topical prescription strength anti-fungal cream for other affected areas. Monitor for a secondary bacterial infection. c. Prescribe an oral anti-fungal for 4 to 12 weeks. Monitor liver enzymes, BUN and creatinine at one week, 2 weeks, and every month thereafter. PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 13. A 35-year-old male presents with a severe unilateral headache over his left eye. He says it started about one hour ago and has rapidly gotten worse. He gives a history of similar headaches over the past 2 years. Physical examination is negative except for left eye lacrimation. What is the most likely diagnosis? c. Cluster headache d. Classic migraine headache 14. A 16-year-old sexually active female present to the clinic. She has never had vaccination for hepatitis A or B, she has had one MMR immunization, and her last tetanus vaccination was 4 years ago. Which vaccination would be contraindicated without further testing? c. MMR 15. A 15-year-old male presents with abdominal pain that began in the peri-umbilical area then localized to the right lower quadrant. He complains of nausea, vomiting, anorexia, and low-grade fever. A complete blood count (CBC) reveals moderate leukocytosis. What is the most likely diagnosis? d. Acute appendicitis 16. A 25-year-old hypertensive patient has a BMI of 16. His blood pressure is 165/100. There is an audible bruit in his left upper abdominal quadrant. He probably has: a. Essential hypertension b. Secondary hypertension 17. Which of the following is the most common presenting sign of substance abuse in adolescents? d. changes in behavior 18. Therapeutic international normalized ratio (INR) for a patient takein warfarin (Coumadin) for chronic PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. atrial fibrillation is expected to be a. increased 19. A 199-year-old female reports that she is having “panic attacks.” The NP knows that panic attacks are characterized by d. sudden onset of intense fear or terror 20. A 25-year-old complains of fever and throat pain. The tonsils have exudate bilaterally. The patient describes having an anaphylactic reaction to penicillin in the past. What antibiotic should the NP prescribe if she believes the causative agent is bacterial? a. amoxicillin (Amoxil) b. erythromycin 21. A diagnostic finding of Hodgkin’s lymphoma is the presence of b. Reed-Sternberg cells 22. With a history of ankle sprain, the nurse practitioner would most likely elicit a history of d. ankle inversion PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 23. Certification for nurse practitioners is offered through: c. national certifying organizations 24. Simple cases of impetigo and folliculitis are usually successfully treated with: a. systemic antibiotics b. topical antibiotics 25. A 43-year-old has chronic gout. He comes to the clinic for the 3rd time in as many months for treatment of an exacerbation. Dietary counseling should include avoidance of all of the following EXCEPT: c. green, leafy vegetables  A 37-year-old female patient with a history of a single episode of depression and frequent complaints of PMS is being treated for hypothyroidism. Today she complains of poor concentration and fatigue. Initially, the NP should: a. Question her further  Which of the following is an example of secondary prevention? a. Annual influenza vaccination 26. A 57-year-old patient presents for an annual physical exam. He reports having 3 attacks of acute gout during the past year. He does not take any medication except NSAIDs during the attacks which help “a little bit.” The NP would appropriately recommend c. avoidance of dietary purine sources 27. A 43-year-old male presents with a large and painful furuncle, the 3rd one in the past 6 months. The NP should _?_ all of the following EXCEPT: b. prescription of a prophylactic antibiotic PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. d. Td and HBV 49.Which of the following patients is most likely to have a diagnosis of Type 2 diabetes mellitus? b. A 49-year-old male with impotence and HbAIC 10.0% 50. Which of the following findings is consistent with otitis externa? d. pain 51. The most effective primary prevention of skin cancer is to educate the public about: d. limiting exposure to natural solar radiation 52. Which of the following is NOT a symptom of irritable bowel syndrome? d. Weight loss 53. An 18-year-old woman is taking a combined hormonal oral contraceptive. She should be instructed to use a backup method for the prevention of pregnancy: b. if prescribed topiramate (Topamax) for the treatment of migraines PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 54. A 50-year old patient has abnormal vaginal bleeding with heavy periods and intermenstrual watery discharge with a small amount of blood. What is the most likely diagnosis? a. uterine fibroids b. normal peri-menopause c. endometrial cancer d. cervical cancer 55. Which agent is most effective for the treatment of nodulocystic acne? d. isotretinoin (Accutane) 56. Which of the following signs and symptoms is typical of hyperthyroidism? a. heat intolerance 57. An 83-year-old man has a resting hand tremor. What disease process is this type of tremor is most commonly associated with? a. Multiple sclerosis (MS) b. Parkinson’s disease c. diabetic neuropathy 58. A young female reports onset of right flank pain 2 days ago that is now severe. Last night she discovered a “burning rash” in the same area. The NP identifies popular fluid-filled lesions that are confluent and follow a linear distribution along the T-8 dermatome. The NP would appropriately order: c. an oral antiviral d. a topical steroid cream 59. Expected spirometry redings when the patient has chronic emphysema include: d. increased total lung capacity (TLC) 60. Right-sided heart failure is characterized by all of the following clinical findings EXCEPT: Answer: a 4th heart sound PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 61. Moderate weight loss, particularly of visceral adipose tissue, in patients with Type 2 diabetes mellitus may have all of the following beneficial effects EXCEPT: c. increased lean muscle mass d 62. Nurse practitioner services are filed with Medicare for reimbursement a. and paid by Medicare Part B 63. Which of the following drugs has a beneficial effect on benign prostatic hyperplasia? a. doxazosin (Cardura) 64. A 46-year-old female has hypertension and is well managed with propranolol (Inderal). Which of the following is a beneficial secondary effect of this drug? d. migraine prophylaxis 65. The finding which is most consistent with a diagnosis of benign prostatic hyperplasia is digital palpation of a prostate gland that is: a. enlarged, symmetrical, semi-firm, and non-tender b. enlarged, symmetrical, boggy, and exquisitely tender PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. d. confidentiality 77. A 43-year-old female patient complains of dull ache around both ankles after a day’s work as a cashier. Her symptoms are relieved by sitting and elevating her legs. She reports ankle edema at the end of the day. What is the most likely cause of these problems? a. varicose veins 78. Which of the following are characteristic of patients with Type 2 diabetes mellitus? 1. Beta cell destruction 2. High body mass 3. Central obesity 4. Unexplained weight loss a. 1,2,3 b. 2,3 c. 1,4 79. The sexual partner of a symptomatic male patient with gonorrhea should be empirically treated: c. with ceftriaxone and doxycycline (Vibramycin) 80. A patient on oral contraceptives complains of breast fullness, tenderness, and some nausea. The patient is concerned. How should the NP manage this? b. change the pill to one containing less estrogen 81. A 62-year-old with Type 2 diabetes mellitus complains of increased nocturia, fatigue, and weakness. His fasting blood glucose is 110 mg/dL (6.2 mmol/L), he is slightly anemic and his serum creatinine level is slightly elevated. All other laboratory tests and physical examination are within normal limits. What is the most likely diagnosis? d. renal insufficiency 82. A 23-year-old female presents with scaly hypo-pigmented macular lesions on her trunk, shoulders, and upper arms. The lesions fluoresce under Wood’s lamp. Appropriate treatment for this condition is: a. Apply selenium sulfide (Versel) lotion and allow to dry for 10 minutes, then rinse off 83. The goals of treatment for patients with alcohol abuse disorder are: PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. c. abstinence or reduction in sue, relapse prevention and rehabilitation d. marital satisfaction, improvement in family functioning, and reduction in psychiatric impairment 84. Which of the following drug classes may potentiate hyperkalemia in a patient taking a potassium- sparing supplement? a. thiazide diuretic b. angiotensin-converting enzyme inhibitor 85. A patient has laboratory studies performed which demonstrate increased TSH, decreased free T4, and T3. Which symptoms might she complain of? d. hair loss 86. The anatomical site currently believed to be the best location for subcutaneous insulin administration is the c. abdomen PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 87. Following the finding of prostate gland abnormalities on DRE, the nurse practitioner orders appropriate labs. When preparing to review lab reports with the patient, the NP know all of the following are true EXCEPT: a. normal PSA is 10 mg/ml or less 88. An obese 43-year-old has recurrent superficial fungal skin infections over the past 2 years. Today, she presents with intertriginous candida. Her skin is macerated from frequent rubbing and scratching. The plan of care for this patient should include: a. recommended screening for diabetes mellitus and HIV infection 89. Which statement is true regarding dental health? a. a diet high in sugar has no effect on dental caries b. individuals with dentures should visit the dentist every 2 years 90. A 51-year-old post-menopausal female, requests guidance regarding osteoporosis risk. The NP would be correct to recommend all of the following EXCEPT: d. weight loss 91. When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action? a. order abdominal x-rays b. order abdominal ultrasound 92. Which of the following is NOT an appropriate treatment for chronic bacterial prostatitis (CBP) d. nitrofurantoin (Macrobid) 93. The first step when taking a patient history is the c. introductory information PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 104. A characteristic of delirium that is typically absent in dementia is: a. acute onset of confusion in a previously alert and oriented patient b. gradual loss of short-term memory c. loss of language skills d. long-term memory gaps filled in with confabulation 105. A 48-year-old female presents with a chief complaint of insomnia. On further investigation, she reports fatigue, nervousness and agitation during the daytime, and feeling hot most of the time. Which of the following would NOT be included in the differential diagnosis? d. Parkinson’s disease 106. The nurse practitioner correctly diagnoses iron deficiency anemia in a female patient whose lab report reveals a. an increased reticulocyte count b. a mean corpuscular volume (MCV >100) c. hemoglobin (Hgb) 14.0 d. an increase total iron binding capacity (TIBC) PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 107. A 16-year-old sexually active student presents with complaints of a greenish-gray frothy vaginal discharge and vaginal itching. The nurse practitioner should suspect: a. bacterial vaginosis (BV) b. trichomoniasis c. syphilis d. gonorrhea 108. A 37-year-old female is found to have a negative rubella titer. How long after immunization should she avoid pregnancy? a. 28 days 109. A 60-year-old male diabetic presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which has resolved. His temperature is 102 degrees F and pulse is 100 bpm. The nurse practitioner’s most appropriate initial action is to: a. start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days b. order mandibular x-rays and question the patient about physical abuse c. start an oral antibiotic, mouth swishes with an oral anti-infectives, and an analgesic d. initiate an IM/IV antibiotic and consider hospital admission 110. A 44-year-old male Caucasian patient’s blood pressures are consistently 170 mm Hg systolic and 100-119 mm Hg diastolic. He has no significant medical history and is of normal weight. His lab tests and EKG are normal. What is the most appropriate action at this time? d. Prescribe and ACE inhibitor and a low dose thiazide diuretic 111. A 65-year old diabetic patient has periorbital cellulitis secondary to a sinus infections, What course of action should the nurse practitioner take? PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. d. Consider collaboration with a physician regarding antibiotic treatment, culture and subsequent action 112. A 15- year-old swim team member presents with mild “swimmer’s ear.” Vital signs are normal. What is the most appropriate therapy for this patient? a. Oral amoxicillin-clavulanate (Augmentin) b. Oral cefaclor (Ceclor) c. Keep the ear canals dry at all times until the condition resolves on its own d. hydrocortisone-bacitracin-polymyxin B (Corisporin) otic suspension 113. Which of the following is true concerning sensitivity and specificity? a. Assessment techniques must be highly sensitive and highly specific to be useful b. Sensitivity relates to the reliability of a technique to give a positive result when the finding is present. Specificity relates to the reliability of a technique to successfully rule out a finding. PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. c. lower triglyceride d. prevent coronary heart disease (CAD) 121. An elderly patient presents with a gray-white ring around the periphery of the iris. This is probably a. indicative of underlying atherosclerotic disease b. a normal variant associated with the aging process 122. A patient complains of “stomach pains” on and off for the past month. In distinguishing between a gastric and duodenal ulcer, what question is least important to ask? a. Have you been out of the country in the past several months? b. Have you had dark, tarry or bloody stools? 123. Which of the following is a microcytic hypochromic anemia? a. Folic acid deficiency anemia b. Iron deficiency anemia 124. What information should a 42- year old patient with newly diagnosed diabetes receive about exercise? c. Snack before exercise 125. A 14-year-old female cheerleader reports gradual and progressive dull anterior knee pain, exacerbated by kneeling. She also complains of a “sore lump on my knee.” The nurse practitioner notes swelling and point tenderness at the tibial tuberositiy X-ray is negative. What is the most likely diagnosis? c. Osgood-Schlatter disease 126. The obesity associated with Type 2 diabetes mellitus is: d. a truncal (android distribution) PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 127. Which of the following patients would appropriately be diagnosed with isolated systolic hypertension (ISH)? a. a 69-year old male with BP 156/86 128. An adolescent goes to Colorado for a ski trip. He is unaccustomed to the high altitude and very dry air. He develops nose bleeds and visits the nurse practitioner. What intervention is LEAST effective? d. Drink adequate water to promote hydration of the nares 129. The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is a. psychotherapy b. electroconvulsive therapy (ECT) 131. A person with 20/80 vision: d. has poorer vision than someone with 20/40 vision 132. Which of the following is considered a non-inflammatory disease process? a. Osteoarthritis (OA) PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 133. A 49 – year-old Hispanic female has a blood pressure of 145/95. mmHg during a routine annual evaluation. She no history of hypertension. She takes a statin for dyslipidemia. How should the NP proceed with this patient? a. The patient’s blood pressure should be checked in about 2-4 weeks 134. With a diagnosis of syphilis, which of the following tests remains positive for the patient’s lifetime? b. RPR c. FTA-Abs or MHA-TP 135. Stress urinary incontinence is: a. associated with the normal aging process b. may be caused by anticholinergic or antidepressant medication c. due to detrusor muscle instability d. may be aggravated by caffeine or alcohol 136. Which of the following accurately describes the appropriate use of influenza vaccine? a. Influenza vaccine is recommended on a one-time only basis for all 65 yrs. or older and to persons 6 months or older who are in chronic care facilities or who suffer cardiopulmonary disorders, metabolic diseases, hemoglobinopathies, or immunosuppression. a. Influenza vaccine should be given annually to all persons 65 yrs. or older and to persons 6 months or older who are in chronic care facilities or who suffer cardiopulmonary disorders, metabolic diseases, hemoglobinopathies, or immunosuppression. a. Influenza vaccine should be administered to all persons born after 1956 who lack evidence of immunity to influenza. a. Influenza vaccine should be administered to all young adults not previously immunized and also to susceptible adults in high risk groups including homosexual men, injecting drug users, and PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 146. Tricyclic antidepressants should be avoided in elderly patients because they have potentially disabling side effects. Which of the following is least likely to be a side effect of TCAs? d. potentiation of seizures 147. Of the following, the patient who should be referred for periodic colonoscopy is the patient with: a. diverticulitis resistant to traditional medical management b. extensive ulcerative colitis of long duration c. irritable bowel syndrome (IBS) complicated by psychiatric illness d. lactose intolerance 148. What is the most frequent cause of death in patients with anorexia nervosa? d. cardiac arrest 149. All patients with renal calculi should be taught that the best prevention is: a. increased fluid intake 150. In order to decrease deaths from lung cancer: PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. d. patients should be counseled to quit smoking OTHER PRE-TEST QUESTIONS 2. Which of the following physical findings is consistent with a diagnosis of beta-thalassemia major? a. Bronze skin color 4. Weber test with lateralization to right ear Conduction problem in the right ear 5. Yesterday, a patient got sand in his eye during a volleyball game at the beach. Today, he presents with an exquisitely painful left eye, photophobia, and constant tearing. The nurse practitioner removes a tiny spec of sand from under the lid and notes vertical corneal abrasion. The treatment of choice is: a. patching the injured eye only; no medication is needed b. an ophthalmic steroid to reduce swelling, inflammation, and pain c. an ophthalmic antibiotic ointment, eye patch, and ibuprofen d. normal saline drops only, eye-patching is not necessary 6. A critically ill patient states “my family is well provided for. The nurse practitioner must interpret this as meaning the patient a. is suicidal b. wishes to discuss the topic of death 7. The patient who has iron deficiency anemia should be advised that food high in iron content include: a. bananas, apples, and oranges b. yellow vegetables c. organ meats, and dark, leafy vegetables 8. Microalbuminuria is a measure of: d. protein lost into the urine PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 9. Appropriate therapy for peptic ulcer disease (PUD) is: a. primarily by eradication of infection b. based on etiology 10. All of the following are medical emergencies which may be attributed to acute cocaine intoxication EXCEPT: d. decreased heart rate and vasodilation leading to hypersomnia 11. The treatment of choice for chronic bacterial prostatitis (CBP) is: c. a flouroquinolone twice daily for 3 weeks to 4 months PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 27. Pre-diabetes is: a. the result of insulin resistance and hyperinsulinemia 29. The nurse practitioner suspects a TMJ disorder. As the patient slowly opens and closes the lower jaw, the nurse practitioner palpates the temporomandibular joint (TMJ) bilaterally: a. anterior to the mastoid process b. anterior to the tragus 30. A patient newly diagnosed with Type 2 diabetes referred to a diabetes nurse educator and complete the initial educational program. The need for further education is indicated when the patient says which of the following? b. “I may notice some weight loss as my diabetes gets under better control” 31. A 44-year-old patient complains of stiffness and soreness in his hands, hips, and knees. There is noticeable PIP and DIP joint enlargement in his hands. The nurse practitioner suspects arthritis. All of the following questions are helpful in differentiation between rheumatoid arthritis (RA) and osteoarthritis(OA) EXCEPT: d. Have you notice decreased joint movement or flexibility? 32. Changes in pulmonary air flow associated with asthma exacerbations and remissions is best assessed by monitoring: c. peak expiratory flow rate (PEFR) as measured by a peak flowmeter 33. The most effective intervention to prevent stroke is (are): d. smoking cessation and treatment of hypertension 35. A patient recovering from a recent stroke is starting anticoagulant therapy. The nurse practitioner should teach the patient to avoid all of the following EXCEPT: PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. b. milk and milk products 36. What is the most common chronic condition in the elder population in the United States? b. arthritis 38. It is imperative that the nurse practitioner teach patients taking oral contraceptives to report any of the danger signs of complications. Which of the following, would be of LEAST concern to the nurse practitioner? d. weight gain 41. A patient reports to the nurse practitioner that he was diagnosed with hepatitis B one year ago and has not seen a health care provider since then. What information should this patient be given? b. About 10% of affected persons become carriers, and are at increased risk for hepatocellular carcinoma 42. An active 82-year-old male in good health complains “I don’t see as well as I used to and my eyes are very sensitive to glare.” His near-distant visual acuity is diminished, and he has a bilateral white pupillary reflex. The most likely diagnosis is: c. cataracts PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 43. A female patient asks “How do I calculate my ideal body weight?” The nurse practitioner appropriately answers: a. Start with 100 pounds, and add 5 pounds for every inch in height over five feet 44. What assessment findings are NOT typical of the patient with psoriasis? d. Satellite lesions 45. A patient presents to the nurse practitioner with complaints of diarrhea and malaise which started at 2:00 am the morning of the visit. After history and examination, the nurse practitioner advises the patient that the problem should be self-limiting. If the diarrhea does not resolve, when should the nurse practitioner advise the patient to return? c. 3 days 46. The nurse practitioner diagnoses epididymitis in a 24-year-old sexually active male patient. The drug of choice for treatment of this patient is: b. oral doxycycline (Vibramycin) plus intramuscular ceftriaxone 47. A 75-year-old patient is well controlled on timolol maleate (Timoptic) for chronic open-angle glaucoma. Prescribing propranolol (Inderal) for this patient may precipitate: c. bradycardia 48. What intervention does the American College of Rheumatology recommend as first-line therapy for osteoarthritis? d. Exercise and weight loss 50. Electrocardiogram markers of hypokalemia include all of the following EXCEPT: c. peaked T waves 52. Which of the following drugs classes would be most effective in decreasing elevated triglyceride levels (650 md/dL)? PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 71. An adult patient has an S4 heart sound and the PMI is located at the 5th left ICS, left of the MCL. What are these findings associated with? c. hypertension 72. Which of the following is an appropriate drug for initial treatment of gastroesophageal reflux disease (GERD) in adults? a. famotidine (Pepcid) 73. The cornerstone of treatment for stress fracture of the femur or metatarsal stress fracture is: a. absolute rest from activities which may further stress the bone 75. What diabetic complications result from hyperglycemia? 1. Retinopathy 2. Hypertension resistant to treatment 3. Peripheral neuropathy 4. Accelerated atherogenesis c. 1,3,4 76. A 66-year-old patient exhibits sudden onset of fluctuating restlessness, agitation, confusion, and impaired attention. This is accompanied by visual hallucinations and sleep disturbance. What is the most likely cause of this behavior? b. delirium PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 77. The preferred therapeutic regimen for an 18-year-old pregnant patient diagnosed with Chlamydia trachomatis infection is: d. a single dose of azithromycin (Zithromax) one gram orally 78. An 80-year-old Caucasian female has heart failure (HF). Which symptom below is an early indication of failure? a. Weight gain 79. What is the most common cause of Cushing’s syndrome? b. Administration of a glucocorticoid or ACTH 81. A 45-year-old male is diagnosed with hypertension. The blood pressures have been gradually increasing over time, with a reading today of 152/98. Diagnostic studies are normal. The most likely diagnosis for this patient is: b. essential hypertension 82. A patient with hepatic cirrhosis presents with pedal edema. He reports that his iwfe prepares the same lunch for him every day: a ham and cheese sandwich on white bread with mustard, a bowl of fresh vegetable soup, a fresh orange, banana or grapes, and sweetened iced tea. He denies adding salt to his food. The food that is most likely causing his edema is the: b. ham and cheese 83. A depressed patient has been treated and has had relief of symptoms while on medication for depression. Which patient statements is a correct understanding of depression? b. I must remain on medication for about 6 months since this is my first episode of depression 84. A 16-year-old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be the LEAST appropriate to prescribe? d. doxycycline 85. An 87-year-old patient was placed on low dose amlodipine (Norvasc) for treatment of hypertensionadn angina. She takes no other medications. What side effects might be expected PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. from amlodipine? b. orthostatic hypotension 86. Patients diagnosed with polycystic ovarian disease are at increased risk of developing: a. diabetes mellitus 87. A patient present with an inflamed upper eyelid margin. The conjunctiva is 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? c. Blepharitis, treat with warm compresses and gentle debridement with a cotton swab 88. What disease process are Bouchard’s nodes most commonly associated with? c. osteoarthritis (OA) 89. An adult female presents with a hordeolum. A topical antibiotic is prescribed. Which of the following instructions is NOT appropriate advice for the nurse practitioner to give the patient? a. Apply warm, moist compresses several times per day b. Do not use soap near the affected eyelid c. Do not wear eye makeup and discard all use eye makeup d. Do not rub your eyes PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 106. A mother has been breastfeeding her infant since giving birth 6 weeks ago. Her right breast is engorged, erythematous, hot to touch, and very painful. She says the problem began 48 hours earlier. She has been feeding exclusively with the left breast. The nurse practitioner diagnosis acute mastitis and recommends all of the following EXCEPT: d. discontinue breastfeeding from the affected breast and wearing a bra until the pain and engorgement have resolved. 107. Which murmur is associated with radiation to the neck? b. aortic stenosis 108. A 50-year-old nonsmoker with no comorbidities presents to the clinic and is diagnosed with community-acquired pneumonia. His vitals are normal except for temperature 101.6 F. A sputum specimen is collected and sent for culture and sensitivity. What action does the nurse practitioner take today? a. b. Start clarithromycin (Biaxin) 500 mg BID for 5 days 111. correct answer is fenofibrate 112. A 24-year-old female insists on having a screening mammogram. Upon further questioning, the nurse practitioner discovers the patient is concerned about breast cancer because her mother has fibrocystic breast disease. The nurse practitioner would be accurate if she tells patient that a major risk factor for development of breast cancer in women is: c. first full term pregnancy after 30 years of age 113. A 44-year-old female patient has diabetes. Her total cholesterol (TC) is 250 mg/dL (6.5 mmol/L), LDL=190 mg/dL (4.94 mmol/L), HDL = 25 mg/dL (6.5 mmol/L), and triglycerides = 344 mg/dL (8.94 mmol/L). What agent would have the greatest effect on improving her lipid profile and reducing morbidity and mortality associated with dyslipidemia? b. Atorvastatin PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 114. In which of the following presentation is further diagnostic testing NOT warranted? b. Bilateral gynecomastia in a 13-year-old male wit normal testicular size and volume 115. A 65-year-old presents with a past medical history of coronary artery disease, temperature 101 degrees F, tachypnea 24 breaths per minute, and consolidation in the left lower lobe. A chest x-ray confirms left lower lobe pneumonia. What antimicrobial agent(s) should the nurse practitioner prescribe? b. levofloxacin (Levaquin) 117. A 17-year-old female is diagnosed with secondary amenorrhea. Findings in her history which may account for the cessation of menses include all of the following EXCEPT she: c. frequently uses the designer drug ecstasy or smoke marijuana on the weekends with friends 119. Atenolol (Tenormin) should be avoided in: a. a 643-year old female with asthma 120. The correct treatment for ankle sprain during the first 48 hours after injury include: c. rest, elevation, compression, ice, and pain relief 122. Medical interventions that have proven most successful in the initial treatment of bulimia nervosa are: c. antidepressant medication and cognitive therapy that focuses on behavior PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 123. Prescriptive authority for APRNs is: a. legislated and regulated at the state level b. uniform for all states c. governed by the state medical board d. regulated by federal and state laws 124. What diagnosis is associated with an elevated serum amylase? c. pancreatitis 126. A very active 35-year-old male has painful hemorrhoids, but he does not want hemorrhoid surgery at this time. His diet has been indiscriminate as his job requires frequent travel. The most appropriate recommendation is for him to select foods that are: c. high in fiber such as bran, complex carbohydrates, and fresh fruit 127. An 18-year-old patient is diagnosed with classic migraine headache. Her headaches are frequent and debilitating. She is offered an abortive therapy, but say she would rather take a medication for prophylaxis. The nurse practitioner would recommend: c. a beta-adrenergic blocking agent 128. Which of the following set of symptoms should raise suspicion of a brain tumor? d. holocranial headaches present in the morning and accompanied by projectile vomiting without nausea 129. A patient with a history of alcohol abuse presents with acute nausea vomiting, and severe retrosternal pain which radiates to the . Based on the most probable diagnosis, the nurse practitioner would appropriately order a CBC, chemistry profle, and: a. serum amylase and lipase, and liver function studies 130. A 65-year-old male patient presents with a history of alcoholism, hemoglobin of 10 g/dL, and mean PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 150. According to Erikson, the developmental task of the elderly adult is: a. b. ego integrity vs despair c. PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. Typed Pre-Predictor 1) A 15 years old high school student with a mild sore throat and low-grade fever that has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite. The NP suspects mononucleosis. Which of the following is the LEAST appropriate intervention? a. Palpate the lymph nodes and spleen b. Examine the posterior oropharynx for petechiae c. Obtain a CBC, throat culture, and heterophil antibody test. d. Obtain an urinalyses and serum for LFTs and amylase Explanation: mononucleosis is a symptomatic infection caused by the Epstein-Bar virus. Common is people 15-24 years of age. Common signs and symptoms following incubation period (1-2 months) include fatigue, chills, malaise, anorexia, white tonsillar exudates and lymphadenopathy or posterior cervical region. Splenomegaly can be present. A maculopapular or occasionally a petechial rash occurs in less than 15% of patients. A diagnosis is usually made using the Monospot. In addition, neutropenia and lymphocytosis are usually detected in the CBC. 2) A 32 years old male patient complaint of urinary frequency and burning on urination for 3 days. Urinalyses reveals bacteriuria and positive nitrites. He denies any past hx. Of urinary tract infections. The initial treatment should be: a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day b. ciprofloxacin (Cipro) for 3-5 days c. Trimethoprim-Sulfamethoxazole for 3 days d. 750 mg ciprofloxacin as a one-time dose PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n appropriate medication to treat urinary tract infections in most patients. In the case of community resistance to TMPS >20%^, another medication should be substituted. In men, the appropriate length of time is 7-10 days. Women may be treated for 3 days for uncomplicated UTI 3) Which agent is most effective for the treatment of nodulocystic acne? a. Benzoyl peroxide (Benzac) b. Retinoic acid (Retin A) c. Topical tetracycline PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. recommend statin therapy because they primarily lower LDL-C levels, but they also have the secondary effects of lowering triglyceride and increasing HDL-C levels. 6) A 30 years old female comes into a clinic with classic signs and symptoms of appendicitis. The NP fails to refer the patient to a surgeon. The appendix ruptures and the woman die. This is an example of a. Failure of diligence b. Professional liability c. Negligence d. Malpractice Explanation: malpractice, a negligence tort, occurs when a health care professional’s actions fall bellow the appropriate standard of care and hurts the patient. In this case the patient came with sings and symptoms indicating appendicitis and the NP failed to refer the patient.. 7) A NP has recently been hired to work in a fast track facility. The NP employer asked if she has “a problem prescribing medications for emergency contraception.” The NP replies affirmatively. This is: a. Grounds for dismissal b. An ethical dilemma for the NP c. Illegal according to the standards of nursing d. Patient abandonment. Explanation: in this instance, the NP has a difference of opinion with her employer based on her religious or moral belief about providing emergency contraception. This situation is an example of an ethical dilemma. Failure to participate in the provision of care to the patient based on the NP’s beliefs is PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. neither against the law nor a violation of the standards of practice 8) A patient presents with pruritic lesions on both knees. There are visible silver scales. How Should this condition be managed? a. Topical antifungal cream or ointment b. Oral antibiotics c. Topical corticosteroids cream d. Topical anti-fungal/ steroid cream PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. Explanation: Psoriasis is characterized by erythematous papules, as well as itchy, red, precisely defined plaques with silvery scales. Auspitz sings is another common finding. Topical agents containing tar and salicylic acid may be used. Topical steroids, such as betamethasone, may also be ordered. 9) Antidepressant discontinuation syndrome is less likely if the patient a. Is male b. Is less than 35 y/o c. Has taken an SSRI with a short half life d. Gradually tapers SSRI use Explanation: Antidepressant discontinuation syndrome is most often seen in the primary care office in association with SSRI discontinuation, because SSRIs are the most commonly prescribed class of antidepressant medications. Interruption of treatment with an anti-depressant medication is sometimes associated with an antidepressant discontinuation syndrome; in early reports it was referred to as a “withdrawal reaction. Symptoms of antidepressant discontinuation syndrome can include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. Tapering is recommended by experts. 10) Patient with benign prostatic hyperplasia (BPH) should be taught to avoid which one of the following drug classes? a. Alpha adrenergic antagonist b. Anti-androgen agents c. Tricyclic antidepressant (TCA) d. Sulfonamides Explanation: tricyclic antidepressant should not be used by men with benign prostatic hyperplasia PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. explanation: Complications of untreated or uncontrolled hyperglycemia over a prolonged period of time include: Microvascular complications: Retinopathy, Nephropathy, Neuropathy Macrovascular complications: Coronary artery disease, Cerebrovascular disease, Peripheral vascular disease 14) A 6 y/o presents w/ 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? a. Viral pharyngitis b. Herpangina c. Epiglottitis PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. d. Tonsillitis Explanation: 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 painful but usually resolve in 7 to 10 days. Treatment is symptomatic. 15) A patient has Kawasaki syndrome. Which characteristics would be UNUSUAL? a. Age > 15 years b. Fever > 101 F (38.3 C) c. Exudative pharyngitis d. Painful rash explanation: Kawasaki disease is an acute febrile vasculitis syndrome that evolves inflammation of the blood vessels. This condition often causes cardiac complication in children by damaging the coronary arteries is most prevalent in children of Asian ethnicity. Diagnosis of Kawasaki disease requires presentation of fever and 4 of the following criteria: bilateral bulbar conjunctival injection, oral mucous membrane changes, peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy. 16) According to the JNC 8 guideline hypertension in a 40 y/o can be diagnosed when blood pressure exceeds a. 140/90 b. 130/90 c. 125/85 d. 150/100 Explanation: According to JNC 8 guidelines, hypertension is a sustained elevation of systolic BP greater PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. than or equal to 140 mmHg or diastolic BP greater or equal than 90mmHg, taken from 2 or more readings on 2 different occasions after an initial screening. 17) A 48 y/o female complains of pain and stiffness in her right hip and knee that is mild on awakening in the morning, get worse as the day progresses and is relived with hot baths and ibuprofen. Crepitus is palpated on range of motion of the knee. Signs of inflammation are notably absent. What is the most likely diagnosis? a. Rheumatoid arthritis (RA) b. Gout c. Osteoarthritis (OA) d. Osteoporosis PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. prior surgery. Volvulus occurs more frequently in middle-aged and elderly men. Cronos’s is most often diagnosed between 13 – 30 years of age. 20) A middle-aged female complains of insomnia, night sweats, feeling intensely hot, emotional lability, extreme nervousness and impatience. The LEAST likely cause of her symptoms is a. Thyrotoxicosis b. Menopausal vasomotor instability c. Alcohol or another drug withdrawal d. New onset type 2 diabetes mellitus Explanation: New onset diabetes produces elevated serum glucose levels less than 200 mg/dL (7.0 mmol/L) and usually no clinical signs or symptoms. At higher levels, the patient may report lethargy, fatigue, weakness, weight loss, and polydipsia, polyuria, and/or polyphagia. Complaints of insomnia, night sweats, feeling intensely hot, emotional lability, and extreme nervousness may be caused by thyroxine excess, menopausal instability, or withdrawal from alcohol or other drugs of addiction. 21) Which of the following indicated need for further evaluation? a. A 7 y/o girl with vaginal bleeding b. A 7 years old girl with no true pubic hair c. A 12 years old boy with sparse, slightly pigmented pubic hair d. A 12-year-old girl with breast buds explanation: In newborn girls, withdrawal bleeding may occur as a normal response to maternal estrogen leaving the infant’s uterine lining. Vaginal bleeding after the first few weeks of life and before puberty is PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. considered abnormal. Early vaginal bleeding can indicate trauma, foreign bodies (toilet paper is the most common), vulvovaginitis, hemangiomas, benign polyps, precocious puberty, or sexual abuse. 22) A young couple is being seen by the NP for preconception counseling. They express a wish for pregnancy within the next 3 month and are very eager to know what they can do now to “make the baby as healthy as possible”. Which of the following should the NP encourage to decrease the chance of neural tube defect in the fetus? a. Maternal alpha-fetoprotein level b. Folic acid 0.4 mg daily c. Rubella vaccine today PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. d. Vitamin E 400 IU daily Explanation: Supplementation with folic acid decreases the development of neural tube defects, such as spina bifida and anencephaly. Folic acid plays an essential role in neural tube closure. Neural tube development/closure takes place in the fist 4 weeks of embryonic life (6 weeks’ gestation). U.S. Public Health Service and the CDC recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent tube defects. 23) A patient with a past history of documented coronary arterial blockage less than 70% complains of chest pain several time p…. which is relived with nitroglycerin. Which is the most appropriate initial action for the NP? a. Refer to a cardiologist as soon as possible b. Prescribe long-acting nitroglycerin c. Order treadmill stress test d. Prescribe an ACE inhibitor and re-evaluate in 24 to 48 hours Explanation: The patient has at least a 70% occlusion of a major coronary artery. For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery). 24) A 3 y/o has enlarged, warm, tender cervical lymph nodes, indicating: a. Infection proximal to the nodes b. A possible cancer diagnosis c. Shorty nodes, a common normal variant in children d. An infectious process distal to the nodes PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. limits recommended by the manufacturer 28) A 13 y/o pt. complains that he fell while running during football practice. Now his knee hurts and sometimes “lucks”. The NP conducts McMurrays test. Which of the following is TRUE about this test? a. An audible or palpated “click” is positive for a torn meniscus b. A various stress is applied to the flexed knee c. The straight leg is internally rotated with the patient supine and flat d. The knee is grasped with the examiner’s fingers placed laterally. Explanation: Mac Murray’s test is conducted while the patient is in the supine position. The NP places the distal hand on the foot and raises the knee slowly, keeping the foot and knee externally rotated with the proximal hand resting on the join line. The knee is flexed and then quickly straightened. If an audible or palpable click occurs during the this test, the outcome is positive for medial meniscal injury. PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 29) A 20 y/o male patient complains of “scrotal swelling”. He states his scrotum feels heavy but denies pain. On examination, the NP notes transillumination of the scrotum. What is the most likely diagnosis? a. Hydrocele b. Orchitis c. Testicular torsion d. Indirect inguinal hernia Explanation: Hydrocele is common in newborns and usually disappears without treatment within the first year. Older men can develop hydroceles, sometimes due to inflammation or injury. Hydroceles are usually painless, but may become large and inconvenient. An ultrasound may be needed to diagnose the condition. 30) A 15 y/o male has a hx of cryptorchidism which was surgically repaired. Because of this information, it is essential for the NP to teach him about a. Testicular self-examination b. Protection of the testes during sports activities c. Risk of testicular torsion d. Practicing safer sex Explanation: Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer. 31) A pt. present with classic symptoms of gastroesophageal reflux diseases’ (GERD). He is instructed in PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. lifestyle modification, and drug initialed. Two month later, he returns and report that he still has symptoms. The next steps are to. a) Refer for surgical interventions such as partial or complete fundoplication. b) Refer for endoscopy, namometry, and/or PH testing c) Repeat the 8*-week course of drug therapy while continuing lifestyles modifications. d) Review proper proton pump inhibitor dosing time and adherence with the patient. Explanation: poor adherence is an importance cause of inadequate acid suppression and refractory GERD. Determining adherence to proton pump inhibitor (PPI) therapy and superficially timing in relation to meals, should be sought first alarm features such as iron deficiency anemia, unexplained weight loss, and persistent vomiting would precipitate the need for further diagnostic testing. Diagnostic testing procedures should proceed any surgical intervention like fundoplication. 32) A 51 –year- old post-menopausal female, request guidance regarding osteoporosis risk. The NP would be correct to recommend all of the following EXCEPT PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 34) Moderate weight loss, particularly of visceral adipose tissue in patients with type 2 diabetes mellitus may have all of the following beneficial effects EXCEPT: a. Improved insulin sensitivity b. Increased glucose uptake and utilization by the cells c. Increase lean muscle mass’ d. Improved lipid profile Explanation: Regular, consistent exercise is an essential part of diabetes and prediabetes management. The ADA recommends that people with diabetes perform at least 30 minutes, 5 days/wk of a moderate- intensity aerobic physical activity. The ADA also encourages people with type 2 diabetes to perform resistance training 3Xwk in the absence of contraindications. Exercise contributes to weight loss, which further decreases insulin resistance. The therapeutic benefits of regular physical activity may result in a decreased need for diabetes medications to reach target blood glucose goals. Regular exercise may also help reduce triglyceride and low-density lipoprotein (LDL) cholesterol levels, increase high-density lipoprotein (HDL), reduce BP, and improve circulation. Patients who use insulin, sulfonylureas, or meglitinides are at increased risk for hypoglycemia when they increase physical activity. 35) A 12 y/o presents with eat pain or 36 hours duration. The NP diagnoses acute otitis media because the a. Tympanic membrane is bulging and glossy with tiny bubbles visible posteriorly b. Tympanic membrane is retracted against boy landmarks c. Bony landmarks are obscured, and the tympanic membrane is mildly erythematous, dulls and immobile. d. Canal is narrowed, erythematous, and exquisitely tender with speculum contact Explanation: Serous otitis media typically presents with a flat or bulging and tympanic membrane with a PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. fluid line and/or tiny bubbles visible posteriorly. The tympanic membrane may be immobile and retracted against the bony landmarks when the eustachian tube is swollen or congested as with the common cold or allergies. Narrowing of the external canal with erythema and extreme tenderness of the canal wall is indicative of otitis externa. 36) The NP should instruct the mother of an infant with thrush to: a. Take oral nystatin since she is breastfeeding b. Stop breast feeding until the thrush has resolved c. administer antifungal medication to the infant prior to feeding d. sterilized pacifiers and bottle nipples PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. explanation: Most bouts of oral thrush occur for no apparent reason. However, regularly sterilization of pacifiers, bottles-feed and other mouth toys used by the baby may help to prevent some bouts. 37) A 26 y/o patient, 18 weeks pregnant with twins, has been healthy and has followed recommendations of her nurse midwife. She is in the office to discuss results of her maternal serum alpha-fetoprotein (MSAFP) test. which show elevation in this particular pregnancy? a. Elevated MSAFPO is an indicator of Down Syndrome b. Low MSAFP is expected at 18 weeks’ gestation c. Neural tube defects are highly probable d. Elevated MSAFP is an expected finding Explanation: elevated maternal serum alfa Protein is expected when a woman is pregnant with twins. An elevation can also be an indication of a miscalculated due date. Low levels can indicate Down Syndrome 38) The hallmark of neurofibromatosis (von Recklinghousen disease) present in almost 100% of patients is: a. Acoustic neuroma b. Astrocytoma of the retina c. Distinctive osseous lesion d. Café au lait spots PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. c. Acute pancreatitis d. Myocarditis Explanation: The “typical” patient with chronic cholecystitis is “female, fat, fertile, and (over) 40” years of age. Myocarditis produces retrosternal pain that is not related to diet. The pain of pancreatitis radiates to the back. The pain of hepatitis is non-specific upper quadrant pain. 42) A 16 y/o male presents w/ mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechia. With for this patient, what drug would be the LEAST appropriate to prescribe? a. Ibuprofen b. Erythromycin c. Ampicillin d. Doxycycline Explanation: Mono can be managed with supportive care, including NSAIDs, and warm sailing gargles. patients with strep throat should be prescribed penny ceiling or every throw myosin PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. instead of amoxicillin or ampicillin because amoxicillin and ampicillin often cause a rash in mono patients. 43) A characteristic of delirium that is typically absent in dementia is a. Acute onset of confusion in a previously alert and oriented patient b. Gradual loss of short-term memory c. Loss of language skills d. Long term memory gaps filled in with confabulation Explanation: Delirium is acute confusional state, is potentially a reversible cognitive impairment that often has a physiological cause; physiological causes include electrolyte imbalances, cerebral anoxia (an absence of oxygen); hypoglycemia; medication effects; tumors; subdural hematoma; and cerebral infection, infarction, or hemorrhage. Dementia is a generalized impairment of intellectual functioning that interferes with social and occupational functioning. It is an umbrella term that includes Alzheimer's disease, Lewy body disease, frontal-temporal dementia, and vascular dementia. 44) It is imperative that the NP teach patients taking oral contraceptives to report any of the danger signs of complications. Which of the following would be the LEAST concern to the NP? a. Lower leg pain b. Upper abdominal pain c. Chest pain d. Weight gain Explanation: Common side effects of OCP includes: bleeding between periods, nausea, breast tenderness, headaches and weight gain. The symptoms often subside after a few months of use. Lower Leg pain can be indicative of- DVT. Other major complication can include the liver, gallbladder or the cardiac organ. PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 45) Which of the following oral medications should be avoided in a child under 8 years of age? a. Cephalexin (Keflex) b. Tetracycline c. Rifampin d. Metronidazole (flaggyl) Explanation: Children younger than 8 years old should not take tetracycline. Deposition in the bone and primary dentition occurs during calcification in growing children. This causes discoloration and hypoplasia of the teeth and a temporary stunting of growth. 46) Which of the following descriptions of Denver II Developmental Screening Test is most accurate? a. Applicable to children from birth to 2 years; evaluates four major categories of development: motor, intellectual, emotional, and language to determine whether a child is within normal range for various behaviors or is developmentally delayed PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. an important role in elderly patients with diabetes, as long as patients are selected appropriately to avoid the risk of lactic acidosis. 49) the components of the Denver II Developmental screening test are: a. Personal/social, fine motor, gross motor, language b. Intelligence, motor performance, language development c. Vocabulary, clarity of speech, abstract thinking d. Problem-solving, speech, gross motor, fine motor Explanation: The Denver II Developmental Screening Test is the most widely used tool to assess early childhood development and rates the categories of personal–social, fine motor–adaptive, language, and gross motor skills. The nurse should explain to the parent before administering the test that this test does not measure intelligence but of the child's level of development or ability to perform age-appropriate tasks. DDST II Assesses: Gross motor function Language development Fine motor-adaptive skills Personal-social skills 50) A patient has been taking fluoxetine (prozar) since being diagnosed with major depression 7 month ago. She reports considerable empowerment in her symptoms and her intention to discontinue the medication what should be the NP’s recommendation? PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. a. Advice the patient to stop the antidepressant medication b. Question the patient to determine if the self-assessment is correct before advising her to discontinue the medication c. Recommend that the patient continue the antidepressant medication for at least 4 more month d. Discuss with the patient that need to take the antidepressant medication indefinitely Explanation: Anxiety Treatment Clinical guidelines for managing MDD also recommend that patients should maintain antidepressant use for at least 6–9 months after full symptom remission and that patients with some risk factors. 51) for the general adult population, total dietary fat intake should be no more than what percent of total calories? a) 10% b) 20% c) 30% PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. d)40% Explanation: Clinical trials suggest that heart disease mortality rates un the US could be lowered by 5 to 20% if all Americans restricted their fat intake to less than 30% of total daily calories, 7% from saturated fat. 52) A 30 y/o female patient is being seen by the NP for the first time. She is seeking advice from the NP about becoming pregnant. She is currently taking an oral contraceptive. She gives a hx of having hydatidiform molar pregnancy 2 years ago. An appropriate plan of care for this a. patient should include b. Delaying pregnancy for 1 more year c. Measuring serum chorionic gonadotropin level d. Discontinuing oral contraceptive e. Recommending permanent sterilization Explanation: A Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole. Pregnancy raises hCG levels which increases the risk for choriocarcinoma. 53) which of the following is NOT a goal for treatment for the patient with cystic fibrosis? a. Prevent intestinal obstruction b. Provide adequate nutrition c. Promote clearance of secretions d. Replace water soluble vitamins Explanation: most patients with cystic fibrosis have insufficient release of pancreatic enzymes. This results in malabsorption of the fat-soluble vitamins….meconium ileus , resembles appendicitis in these patients PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 58) a 16 y/o sexually active female presents to the clinic. She has never had vaccinations for hepatitis A or B. She has had one MMR immunization, and her last tetanus vaccination was 4 years ago. which vaccination would be contraindicated without further testing? a. Hepatitis B b. Hepatitis A c. MMR d. Tetanus Explanation: Patient should have a pregnancy test before MMR vaccine. The MMR vaccine is contraindicated during pregnancy because it contains live, attenuated viruses that pose a theoretical risk to the fetus 59) following the finding of prostate gland abnormalities on DRE, The NP orders appropriate labs. When preparing to review with the patient, the NP knows all of the following are true EXCEPT a. Normal PSA is 10 mg/ml or less b. PSA is elevated in the presence of malignant prostate epithelium PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. c. PSA is elevated in the presence of BPH d. Positive serum acid phosphatase reflects malignancy of the prostate gland with bone metastasis. Explanation: The effect of digital rectal examination (DRE) on serum PSA levels is still debatable. ... Although, there was a statistically significant increase in serum PSA levels 30 min after DRE, the clinical significance of this increase in PSA values with a mean difference of 0.4 ng/ml remains to be clarified. 60) in which of the following presentations is further diagnostic testing NOT warranted? a. Bilateral gynecomastia in a prepubertal male of average weight; Tanner stage 1 b. Bilateral gynecomastia in a 13 y/o male with normal testicular size and volume c. Recent onset gynecomastia in a 20-year-old male with breast tenderness d. Unilateral breast mass which is 5 centimeters in diameter Explanation: Gynecomastia is the benign enlargement of male breast glandular tissue and is the most common breast condition in males. Pubertal gynecomastia usually begins at age 10-12-years-old and peaks at ages 13-14.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987263/ 61) a 59 years old post-menopausal woman has atrophic vaginitis. She has a hx. Of breast cancer at age 40 years. What is the appropriate initial treatment for this patient? a. Oran conjugated estrogens b. Oral medroxyprogesterone aetate c. Topical medroxyprogesterone aetate d. Topical conjugate estrogen cream Explanation: PREMARIN (conjugated estrogens) Vaginal Cream is a mixture of estrogens indicated for: Treatment of Atrophic Vaginitis and Kraurosis Vulvae Treatment of Moderate to Severe Dyspareunia, a Symptom of Vulvar and Vaginal Atrophy, due to Menopause. https://www.pfizermedicalinformation.com/en-us/premarin-vaginal-cream PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. 62) Advances in obstetric and neonatal care have a. Helped to identify the cause of cerebral palsy b. Demonstrated the cerebral palsy is a direct result of birth asphyxia c. Has no effect on the incident of cerebral palsy d. Resulted in a dramatic decrease in the incidence of cerebral palsy Explanation: Cerebral palsy is a common, non-progressive, encephalopathy that is believed to be from a defect in the developing brain. Improvements in perinatal care have not affected the incidence. 63) which of the following physical modalities recommended for treatment of rheumatic arthritis provides the most effective long-term pain relief? a. Superficial and deep heat b. Application of cold c. Transcutaneous electrical nerve stimulation (TENS) d. Exercise PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. d. An imaginary friend Explanation: The parents need to understand that the child's behavior is not uncommon. Imaginary friends are common in the preschool-age child. The child's behavior is not abnormal. The child does not have a deep-set psychological need. The child is not at risk for social isolation. 68) A 44 y/o patient complains of stuffiness and soreness in his hands, hips and knees. There is noticeable PIP and DIP joint enlargement in his hands.. The NP suspects arthritis. All of the following questions are helpful in differentiation between rheumatoid arthritis (RA) and osteoarthritis (OA) EXCEPT a. on the joint of your fingers never feel particularly warm or hot? b. tell me about your usual energy level c. does the soreness and stiffness get better or worse as the day progresses? d. Have you noticed decreased joint movement or flexibility? Explanation: Limited range of joint motion is characteristic of both types of arthritis. The soreness and stiffness associated with OA improves as the day progresses and joint range of motion improves with the performance of daily activities. Joint pain and stiffness associated with RA worsens with use. Loss of energy, malaise, and easy fatigability are constitutional symptoms associated with RA. RA is an inflammatory disease of the joints and flare-ups are characterized by very warm and erythematous joints relieved by anti-inflammatory medications such as NSAIDs and glucocorticosteroids 69) An adult presents w/ tinea corpus. What comment by the patient would be the LEAST likely explanation of how he acquired this disease? a. "I trap animals" b. "my wife has this also" c. "I have diabetes" d. "I live in the Northern US" Explanation: A ringworm infection can be spread in many direct and indirect ways, including: Person to person, Pet/animal to person, Inanimate item to person: It’s possible to get ringworm through indirect contact with objects, including hair of an infected person, bedding, clothing, shower stalls, and floors, Soil PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. to person, having a weak immune system. https://www.healthline.com/health/tinea-corporis 70) Acute rheumatic fever is diagnosed using the modified Jones criteria. Which is NOT a major criterion in the Jones System? a. Jaundice b. Carditis c. Polyarthritis d. Subcutaneous nodules Explanation: One of the major criteria for diagnosis of acute rheumatic fever using the Jones System is polyarthritis, the most common finding. This usually responds to aspirin therapy within 48 hours. Another common finding is carditis. Other major criteria which are far less common include erythema marginatum and subcutaneous nodules. 71) A pt is taking an ACE inhibitor for the blood pressure control. The NP decides to add a diuretic which of the following is the best choice? a. a thiazide diuretic b. a loop diuretic c. a potassium-sparing diuretic PREDICTOR LATEST UPDATE STUDY GUIDE QUESTIONS AND ANSWERS GRADED A DOWNLOAD TO SCORE A. d. Fitness bar Explanation: A ringworm infection can be spread in many direct and indirect ways, including: Person to person, Pet/animal to person, Inanimate item to person: It’s possible to get ringworm through indirect contact with objects, including hair of an infected person, bedding, clothing, shower stalls, and floors, Soil to person, having a weak immune system. 70) Acute rheumatic fever is diagnosed using the modified Jones criteria. Which is NOT a major criterion in the Jones System? e. Jaundice f. Carditis g. Polyarthritis h. Subcutaneous nodules Explanation: One of the major criteria for diagnosis of acute rheumatic fever using the Jones System is polyarthritis, the most common finding. This usually responds to aspirin therapy within 48 hours. Another common finding is carditis. Other major criteria which are far less common include erythema marginatum and subcutaneous nodules. 71) A pt is taking an ACE inhibitor for the blood pressure control. The NP decides to add a diuretic which of the following is the best choice? e. a thiazide diuretic f. a loop diuretic g. a potassium-sparing diuretic h. Fitness bar Explanation: First-line and later-line treatments should now be limited to 4 classes of medications: thiazide-type diuretics, calcium channel blockers (CCBs), ACE inhibitors, and ARBs. 72) which of the following drugs classes would be most effective in decreasing elevated triglycerides levels (650 mg/dL)?