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APEA Predictor Exam APEA Predictor Exam



NSG 6440 Week 4 APEA Predictor Exam – Pre- a.
b.
Throughout the week of placebo pills
If prescribed topiramate (Topamax) for the treatment of migraines.

Predictor Test latest
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

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
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 woman of
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.

4. An 18 y/o woman is taking a combined hormonal oral contraceptive. She should be
instructed to use a backup method for the prevention of pregnancy
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, APEA Predictor Exam APEA Predictor Exam




c. If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection c. Illegal according to the standards of nursing
d. if she forgets to take a single dose of the contraceptive d. Patient abandonment.
Explanation: in this instance, the NP has a difference of opinion with her employer based on her
Explanation: Anticonvulsant including phenytoin (Dilantin), carbamazepine (Tegretol), religious or moral belief about providing emergency contraception. This situation is an example
primidone (Mysoline), topiramate (Topamax) and oxcarbazepine (Trileptal) reduce the of an ethical dilemma. Failure to participate in the provision of care to the patient based on the
effectiveness of contraceptives. Depo-medroxyprogesterone acetate injections or levonorgestrel- NP’s beliefs is neither against the law nor a violation of the standards of practice
releasing intrauterine devices would be a better method of contraceptive for patients taking
anticonvulsants. Most commonly used antibiotics have not been proven to reduce the 8. A patient presents with pruritic lesions on both knees. There are visible silver scales. How
effectiveness of contraceptives. Rifampin is an exception, and additional …. Be used by women Should this condition be managed?
taking this drug and using oral contraceptives, transdermal, or vaginal ring preparations. a. Topical antifungal cream or ointment
Additional backup contraception should be used if taking antifungal agents. No additional b. Oral antibiotics
protection is needed thought the week of placebo pills. Missing one single dose of contraceptive c. Topical corticosteroids cream
does not require additional protection, missing more than one doses does. d. Topical anti-fungal/ steroid cream

5. A 44 years old female patient has diabetes. Her total cholesterol (TC) is 250 mg/dl (6.5 Explanation: Psoriasis is characterized by erythematous papules, as well as itchy, red, precisely
mmol/L), LDL= 190 mg/dL (4.94 mmol/L), HDL= 25 mg/dL (65 mmol/L), and triglycerides= defined plaques with silvery scales. Auspitz sings is another common finding. Topical agents
344 mg/dL (8.94 mmol/L). What agent have the greatest effect on improving her lipid profile and containing tar and salicylic acid may be used. Topical steroids, such as betamethasone, may also
reducing morbidity and mortality associates with dyslipidemia? be ordered.
a. Niacin (Niaspan)
b. Atorvastatin 9. Antidepressant discontinuation syndrome is less likely if the patient
c. Omega 3 fatty acids a. Is male
d. Fenofibrates b. Is less than 35 y/o
Explanation: First and foremost, it is essential to educate individuals on a heart-healthy c. Has taken an SSRI with a short half life
lifestyle. LDL-C is one of the major culprits in the development of atherosclerotic heart disease. d. Gradually tapers SSRI use
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 Explanation: Antidepressant discontinuation syndrome is most often seen in the primary care
levels, but they also have the secondary effects of lowering triglyceride and increasing HDL-C office in association with SSRI discontinuation, because SSRIs are the most commonly
levels. prescribed class of antidepressant medications. Interruption of treatment with an anti-depressant
medication is sometimes associated with an antidepressant discontinuation syndrome; in early
6. A 30 years old female comes into a clinic with classic signs and symptoms of appendicitis. reports it was referred to as a “withdrawal reaction. Symptoms of antidepressant discontinuation
The NP fails to refer the patient to a surgeon. The appendix ruptures and the woman die. This is syndrome can include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances,
an example of and hyperarousal. Tapering is recommended by experts.
a. Failure of diligence
b. Professional liability 10. Patient with benign prostatic hyperplasia (BPH) should be taught to avoid which one of the
c. Negligence following drug classes?
d. Malpractice a. Alpha adrenergic antagonist
b. Anti-androgen agents
Explanation: malpractice, a negligence tort, occurs when a health care professional’s actions fall c. Tricyclic antidepressant (TCA)
bellow the appropriate standard of care and hurts the patient. In this case the patient came with d. Sulfonamides
sings and symptoms indicating appendicitis and the NP failed to refer the patient.. Explanation: tricyclic antidepressant should not be used by men with benign prostatic
hyperplasia because of the increased risk of urinary retention secondary to the anticholigergic
7. A NP has recently been hired to work in a fast track facility. The NP employer asked if effects of TCAs.
she has “a problem prescribing medications for emergency contraception.” The NP replies
affirmatively. This is: 11. Which of the following is the best response to a woman who has just admitted she is a
a. Grounds for dismissal victim of spousal abuse?
b. An ethical dilemma for the NP a. What was if you did to make him angry?

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, APEA Predictor Exam APEA Predictor Exam




b. You must seek refuge immediately Explanation: Herpangina is a viral infection common in toddlers and young children caused by
c. I am concerned about your safety Coxsackie virus. The clinical findings of numerous, small (1-2 mm) ulcerations on the tonsils
d. I am going to call a shelter for you and uvula are typical of herpangina. The ulcerations can be very painful but usually resolve in 7
Explanation: The first step is to establish trust in the therapeutic relationship. without trust to 10 days. Treatment is symptomatic.
future collaboration, intervention and client outcome cannot be accomplished to facilitate
appropriate and safe behavior. The experience of abuse is a traumatic psychological crisis that 15. A patient has Kawasaki syndrome. Which characteristics would be UNUSUAL?
must be addressed as such. The healthcare providers must emphasize the fact that the victim has a. Age > 15 years
not done anything wrong and they must also emphasize the fact that the victim's life and the lives b. Fever > 101 F (38.3 C)
of their children can be in danger if the abuse is not addressed. It will not disappear with a lack c. Exudative pharyngitis
of action. An order of protection against the perpetrator is often recommended. 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
12. For which patient group does the US Preventive Services Task Force recommend routine by damaging the coronary arteries is most prevalent in children of Asian ethnicity. Diagnosis of
screening for asymptomatic bacteriuria Kawasaki disease requires presentation of fever and 4 of the following criteria: bilateral bulbar
a. pregnant woman conjunctival injection, oral mucous membrane changes, peripheral extremity changes,
b. Children polymorphous rash, and cervical lymphadenopathy.
c. Patients with diabetes
d. patients over the age of 70 16. According to the JNC 8 guideline hypertension in a 40 y/o can be diagnosed when blood
Explanation: an increased incidence of bacteriuria is found in all the population listed. However, pressure exceeds
bacteriuria in pregnant women increases the mother…..Also increased is the risk of a pre-term a. 140/90
delivery, which then increases perinatal and fetal morbidity and mortality. The recommended b. 130/90
it…. c. 125/85
d. 150/100
13. What diabetic complications result from hyperglycemia? Explanation: According to JNC 8 guidelines, hypertension is a sustained elevation of systolic
1. Retinopathy BP greater than or equal to 140 mmHg or diastolic BP greater or equal than 90mmHg, taken
2. Hypertension resistant to treatment from 2 or more readings on 2 different occasions after an initial screening.
3. Peripheral neuropathy
4. Accelerated atherosclerosis 17. A 48 y/o female complains of pain and stiffness in her right hip and knee that is mild on
a. 1,2,3 awakening in the morning, get worse as the day progresses and is relived with hot baths and
b. 2,3,4 ibuprofen. Crepitus is palpated on range of motion of the knee. Signs of inflammation are
c. 1,3,4 notably absent. What is the most likely diagnosis?
d. 1,2,4 a. Rheumatoid arthritis (RA)
explanation: Complications of untreated or uncontrolled hyperglycemia over a prolonged period b. Gout
of time include: c. Osteoarthritis (OA)
Microvascular complications: Retinopathy, Nephropathy, Neuropathy d. Osteoporosis
Macrovascular complications: Coronary artery disease, Cerebrovascular disease, Peripheral Explanation: Rheumatoid arthritis is characterized by several joint deformities, usually
vascular disease 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
14. A 6 y/o presents w/ complaints of sore throat and fever for 2 days. He has multiple purine metabolism, increased uric acid production, or decreased uric acid excretion.
vesiculated ulcerations on his tonsils and uvula. There are no other remarkable findings. What is
the most likely diagnosis? 18. A 7-year old female patient presents with severe injuries that are inconsistent with the
a. Viral pharyngitis explanation given for them. The nurse practitioner questions the mother about abuse. She admits
b. Herpangina that her husband, the child’s father, beat the child. How should the nurse practitioner proceed?
c. Epiglottitis a. Inform the mother that the abuse must be reported to child protection authorities.
d. Tonsillitis b. Counsel the mother that if it happens again it will be reported to child protection service.
c. Ask the child what she did to cause the punishment

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, APEA Predictor Exam APEA Predictor Exam




d. Refer the family to the National Domestic Violence hotline. be caused by thyroxine excess, menopausal instability, or withdrawal from alcohol or other drugs
Explanation: An awareness of all the unique presentations of child abuse, subjective or of addiction.
objective, physical, sexual, or neglect, is essential for NPs. Objective findings, such as broken
bones, burns, and bruises, may be as a result of an intentional injury from physical abuse or from 21. Which of the following indicated need for further evaluation?
an unintentional injury as a result of neglect. Both must be considered. Repeated visits to the a. A 7 y/o girl with vaginal bleeding
emergency department, frequent or suspicious injuries, or bilateral or multiple healing fractures b. A 7 years old girl with no true pubic hair
are often indicators of physical abuse. Once the diagnosis of child abuse has been made, the c. A 12 years old boy with sparse, slightly pigmented pubic hair
primary role of the NP is to ensure the child is safe. If the NP suspect that a child is undergoing d. A 12-year-old girl with breast buds
abuse, it’s critical to report it—and to continue reporting each separate incidence if it continues explanation: In newborn girls, withdrawal bleeding may occur as a normal response to maternal
to recur. estrogen leaving the infant’s uterine lining. Vaginal bleeding after the first few weeks of life and
before puberty is considered abnormal. Early vaginal bleeding can indicate trauma, foreign
19. A 1-month-old presents with reported recurrent diarrhea, screaming, and drawing up of the bodies (toilet paper is the most common), vulvovaginitis, hemangiomas, benign polyps,
legs followed by periods of lethargy. On physical examination, a “sausage-like” mass in the precocious puberty, or sexual abuse.
upper right quadrant of the distended abdomen. Which of the following is the most likely
diagnosis? 22. A young couple is being seen by the NP for preconception counseling. They express a wish
a. Intussusception for pregnancy within the next 3 month and are very eager to know what they can do now to
b. Volvulus “make the baby as healthy as possible”. Which of the following should the NP encourage to
c. Crohn’s disease decrease the chance of neural tube defect in the fetus?
d. Foreign body in the GI tract a. Maternal alpha-fetoprotein level
explanation: Intussusception is one of the most common causes of abdominal obstruction in b. Folic acid 0.4 mg daily
children prior 2 years of age; is best described as a portion of the intestine which telescopes into c. Rubella vaccine today
a more distal intestinal segment. The classic triad of intussusception include crampy d. Vitamin E 400 IU daily
(intermittent, also known as colicky) abdominal pain, vomiting, and bloody stools. The patient Explanation: Supplementation with folic acid decreases the development of neural tube defects,
may pull up his knees with crying. The patient may develop vomiting with bilious emesis. such as spina bifida and anencephaly. Folic acid plays an essential role in neural tube closure.
Progressive lethargy/altered level of consciousness and pallor is common. The etiology of this Neural tube development/closure takes place in the fist 4 weeks of embryonic life (6 weeks’
lethargic presentation is not known, but it tends to occur in younger infants. As intussusception gestation). U.S. Public Health Service and the CDC recommend that all women of childbearing
progresses, a palpable, sausage-shape mass may develop. Some hypothesize that this is due to age consume 0.4 mg of folic acid daily to prevent tube defects.
release of endogenous opioids or endotoxins released from ischemic bowel. Intussusception in a
child presenting with lethargy is often difficult to diagnose since other causes of lethargy such as 23. A patient with a past history of documented coronary arterial blockage less than 70%
dehydration, hypoglycemia, sepsis, toxic ingestion, post-ictal state, etc., must also be considered. complains of chest pain several time p…. which is relived with nitroglycerin. Which is the most
Ultrasound is the preferred diagnostic test. Enemas is considered the first line of treatment prior appropriate initial action for the NP?
surgery. Volvulus occurs more frequently in middle-aged and elderly men. Cronos’s is most often a. Refer to a cardiologist as soon as possible
diagnosed between 13 – 30 years of age. b. Prescribe long-acting nitroglycerin
c. Order treadmill stress test
d. Prescribe an ACE inhibitor and re-evaluate in 24 to 48 hours
20. A middle-aged female complains of insomnia, night sweats, feeling intensely hot, emotional Explanation: The patient has at least a 70% occlusion of a major coronary artery.
lability, extreme nervousness and impatience. The LEAST likely cause of her symptoms is For a patient to be considered for CABG, the coronary arteries to be bypassed must have
a. Thyrotoxicosis approximately a 70% occlusion (60% if in the left main coronary artery).
b. Menopausal vasomotor instability
c. Alcohol or another drug withdrawal 24. A 3 y/o has enlarged, warm, tender cervical lymph nodes, indicating:
d. New onset type 2 diabetes mellitus a. Infection proximal to the nodes
b. A possible cancer diagnosis
Explanation: New onset diabetes produces elevated serum glucose levels less than 200 mg/dL c. Shorty nodes, a common normal variant in children
(7.0 mmol/L) and usually no clinical signs or symptoms. At higher levels, the patient may report d. An infectious process distal to the nodes
lethargy, fatigue, weakness, weight loss, and polydipsia, polyuria, and/or polyphagia. Complaints explanation: size of lymph nodes is important. Nodes > 1 cm are significant and should be asses
of insomnia, night sweats, feeling intensely hot, emotional lability, and extreme nervousness may carefully. Nodes > 5 cm are almost always neoplastic. Tenderness of a node usually suggest

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