NSG 6440 Predictor Test

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

a. Throughout the week of placebo pills

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b. If prescribed topiramate (Topamax) for the treatment of migraines.

c. If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection

d. 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 for patients taking

anticonvulsants. Most commonly used antibiotics have not been proven to reduce the

effectiveness of contraceptives. Rifampin is an exception, and additional …. Be used by 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.

5) 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=

344 mg/dL (8.94 mmol/L). What agent have the greatest effect on improving her lipid profile

and reducing morbidity and mortality associates with dyslipidemia?

a. Niacin (Niaspan)

b. Atorvastatin

c. Omega 3 fatty acids

d. 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.

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

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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 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

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 because of the increased risk of urinary retention secondary to the anticholigergic

effects of TCAs.

11) Which of the following is the best response to a woman who has just admitted she is a

victim of spousal abuse?

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a. What was if you did to make him angry?

b. You must seek refuge immediately

c. I am concerned about your safety

d. 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 that

must 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 the abuse is not addressed. It will not disappear with a lack

of action. An order of protection against the perpetrator is often recommended.

12) For which patient group does the US Preventive Services Task Force recommend routine

screening for asymptomatic bacteriuria

a. pregnant woman

b. Children

c. Patients with diabetes

d. patients over the age of 70

Explanation: an increased incidence of bacteriuria is found in all the population listed.

However, bacteriuria in pregnant women increases the mother…..Also increased is the risk of a

pre-term delivery, which then increases perinatal and fetal morbidity and mortality. The

recommended it….