nr 603 week 4 apea predictor exam 2024prepredictor
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NR 603 WEEK 4 APEA PREDICTOR EXAM 2024-PRE-PREDICTOR
TESTBANK (WITH COMPLETE SOLUTIONS AND RATIONALES)
• A 15 years old high school student with a mild sore throat and low-grade fever
that haspersisted 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?
• Palpate the lymph nodes and spleen
• Examine the posterior oropharynx for petechiae
• d. Obtain an urinalyses and serum for LFTs and amylase
• Obtain a CBC, throat culture, and heterophil antibody test.
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 maculopapularor 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.
• 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 tractinfections. The initial treatment should be:
a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-
10 dayb. ciprofloxacin (Cipro) for 3-5 days
c. Trimethoprim-Sulfamethoxazole for 3
daysd. 750 mg ciprofloxacin as a one-
time dose
Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n appropriate medication
totreat 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
• Which agent is most effective for the treatment of nodulocystic acne?
• Benzoyl peroxide (Benzac)
• Retinoic acid (Retin A)
• Topical tetracycline
,d. Isotretinoin)
Explanation: Isotretinoin (Accutane) is a systemic agent indicated for treatment with
severe inflammatory acne. Guidelines for its use must be clearly understood by the
patient. A womanof childbearing age must use an effective method of contraception
because isotretinoin is teratogenic. There are many restrictions in prescribing this
medication because of the teratogenic effects is given during pregnancy. Therefore, it is a
pregnancy category X.
• An 18 y/o woman is taking a combined hormonal oral contraceptive. She
shouldbe instructed to use a backup method for the prevention of pregnancy a.
b. If prescribed topiramate (Topamax) for the treatment of migraines.
Throughout the week of placebo pills
• If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection
• if she forgets to take a single dose of the contraceptive
Explanation: Anticonvulsant including phenytoin (Dilantin), carbamazepine (Tegretol),
primidone (Mysoline), topiramate (Topamax) and oxcarbazepine (Trileptal) reduce the
effectiveness of contraceptives. Depo-medroxyprogesterone acetate injections or
levonorgestrelreleasing intrauterine devices would be a better method of contraceptive
forpatients taking anticonvulsants. Most commonly used antibiotics have not been proven
to
reduce the effectiveness of contraceptives. Rifampin is an exception, and additional …. Be
usedby women taking this drug and using oral contraceptives, transdermal, or vaginal ring
preparations. Additional backup contraception should be used if taking antifungal agents.
No additional protection is needed thought the week of placebo pills. Missing one single
dose of contraceptive does not require additional protection, missing more than one
doses does.
• A 44 years 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 (65 mmol/L), and
triglycerides= 344mg/dL (8.94 mmol/L). What agent have the greatest effect on
improving her lipid profile andreducing morbidity and mortality associates with
dyslipidemia? a. Niacin (Niaspan)
b. Atorvastatin
• Omega 3 fatty acids
• Fenofibrates
Explanation: First and foremost, it is essential to educate individuals on a heart-healthy
lifestyle. LDL-C is one of the major culprits in the development of atherosclerotic heart
, disease.The target level of LDL-C is between 50 to 70mg/dl to prevent plaque formation in
the blood vessels. Guidelines strongly 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.
• 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 isan example of
• Failure of diligence
• Professional liability
• Negligence
• 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 camewith sings and symptoms indicating appendicitis and the NP failed to refer
the patient..
• A NP has recently been hired to work in a fast track facility. The NP employer asked
if shehas “a problem prescribing medications for emergency contraception.” The NP
replies affirmatively. This is:
b. An ethical dilemma for the NP
a. Grounds for dismissal
• Illegal according to the standards of nursing
• 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 neither against the law nor a violation of the
standards of practice
• A patient presents with pruritic lesions on both knees. There are visible silver scales.
HowShould this condition be managed?
• Topical antifungal cream or ointment
• c. Topical corticosteroids cream
• Oral antibiotics
d. Topical anti-fungal/ steroid cream
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 alsobe ordered.
• Antidepressant discontinuation syndrome is less likely if the patient
• Is male
• Is less than 35 y/o
• Has taken an SSRI with a short half life
• Gradually tapers SSRI use
Explanation: Antidepressant discontinuation syndrome is most often seen in the primary
careoffice 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.
• Patient with benign prostatic hyperplasia (BPH) should be taught to avoid which one
of thefollowing drug classes?
• Alpha adrenergic antagonist
• Anti-androgen agents
• Tricyclic antidepressant (TCA)
• Sulfonamides
Explanation: tricyclic antidepressant should not be used by men with benign prostatic
hyperplasia because of the increased risk of urinary retention secondary to the
anticholigergiceffects of TCAs.
• Which of the following is the best response to a woman who has just admitted
she is avictim of spousal abuse?
• What was if you did to make him angry?
• You must seek refuge immediately
• I am concerned about your safety
• I am going to call a shelter for you
Explanation: The first step is to establish trust in the therapeutic relationship. without
trust future collaboration, intervention and client outcome cannot be accomplished to
facilitate appropriate and safe behavior. The experience of abuse is a traumatic
psychological crisis thatmust be addressed as such. The healthcare providers must
emphasize the fact that the victim has not done anything wrong and they must also
emphasize the fact that the victim's life and the lives of their children can be in danger if
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