NSG 6440
PREDICTOR EXAM.
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
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
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