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Topics based on an exam taken that needed to be answered based on how to assess, diagnose, evaluate, mediations used, and interventions.
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NURS 682L-A
APEA Pre-Predictor Examination Grading:
A passing score is considered 70% or above. The awarded grade in the in the grade book is
based using the following point conversion system:
≥ 70 = 400 points
65 – 69 = 300 points
60 – 64 = 200 points
0 – 59 = 0 points
APEA Pre-Predictor Examination Remediation:
Remediation is available for students who score less than 70% on the exam. Remediation
Assignment instructions may be found in the Week 3 module. If needed, the remediation plan
should be started immediately and be submitted no later than Monday of Week 8 of the course.
Students who score less than 70% on the Pre-Predictor Exam will have an opportunity to earn up
to 400 points by thoroughly completing the remediation assignment. Students may not be
awarded more than 400 total points in the gradebook for the Pre-Predictor Exam.
Remediation Point Scale:
≥ 70 = encouraged to remediate weak areas – maximum points earned
65 – 69 = can earn 100 points – total test score cannot be greater than 400 points
60 – 64 = can earn 200 points – total test score cannot be greater than 400 points
0 – 59 = can earn 300 points – total test score cannot be greater than 400 points
You can choose not to remediate – and you will keep your current score. If you choose to
remediate – you must do all questions missed, as you are provided with all points or none for
remediation, partial points will not be awarded.
Students who complete the remediation assignment may qualify to re-take the APEA PrePredictor Examination at their own expense. The examination may be re-attempted only once
(1-time). Student is required to make a formal exam-re-take request with approval granted by
program Faculty/Assistant Dean/Dean. The second and final attempt must be completed
on/before Thursday, 11:59 pm (PST) of Week 8 of the course. This is optional – and will not
affect your grade in 682L-A – this is simply for your own benefit and practice.
How to do remediation:
Students who earned less than 70 percent on the Pre-Predictor exam will be allowed to earn back
points, not exceeding the total of 400 points for the assignment by creating a remediation assignment
related to the missed questions on the Summary Report.
1. To review the Pre-Predictor Exam Summary Report: APEA OTCLinks to an external site..
2. Expand all categories by clicking “Expand All” to see all categories under the topic areas.
3. Create a Word Document with headings that correlate with the missed “Knowledge
Area”, “Question” Topic, and Domain on the Pre-Predictor Exam Summary Report. (See
Diagram 1 below).
4. Use resources such as your textbook, or a reputable standard of care website, such as
the American College of Cardiology, etc. to remediate. Summarize the missed content
topic in 2-3 paragraphs (6 sentences minimum) and include a hyperlink to the reference.
5. All missed questions must be addressed to earn all points.
6. Remediation should begin as soon as possible.
7. Submit in Week 8: Pre-Predictor Exam Remediation
Pre-Predictor Exam Remediation Assignment Example
(SAMPLE)
Student Name
West Coast University
NURS 682L-A
Instructor’s Name
Date
Cardiovascular
Advanced Heart Failure: Assessment
Heart failure stages are defined by New York Heart Association (NYHA) functional class or by the
American Heart Association. Patients considered to be in advanced heart failure or categorized as a class
III or IV and listed as stage D. Those patients in class III have symptoms with less than ordinary activity
while in stage IV they have symptoms at rest or with minimal activity. Advanced heart failure patients
are candidates for transplant, mechanical circulatory support or palliative care depending on how
advanced the disease is. Frequently they require recurrent hospitalizations and careful medical
management. Identifying patients who are categorized or soon to be categorized as advanced heart
failure is important for prognosis. Criteria used to identify patients with advanced heart failure include
the following inotrope dependence, left ventricular ejection fraction less than or equal to 25% greater
than or equal to two hospitalization or emergency departments for decompensated heart failure in 12
months, persistent NYHA class III or IV symptoms, high risk biomarker profiles which include
hyponatremia and elevated natriuric peptides, requiring higher doses of diuretics or persistent edema
despite diuretic dose, progressive renal failure, recurrent atrial fibrillation, cardiac cachexia, and the
need to discontinue ace inhibitors/ARBs/ARNI because of hypotension or renal intolerance are
significant clues. The mnemonic I – NEED – HELP is one way to help remember the clinical clues for
advanced heart failure. I = inotropes, N= NYHA class/natriuretic peptide, E = end organ dysfunction, E=
LVEF1 hospitalization in 12 mo. E= edema/escalating diuretics, L=low
blood pressure, P= prognostic medications (Morris et al., 2021)
Link: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001016
Advanced Heart Failure: Planning and Intervention
As there is no cure for heart failure, interventions are aimed at treatment to relieve symptoms and slow
further damage. First and foremost, lifestyle changes which advise patients to avoid salt and caffeine
and, in some cases, limit their fluid intake. Medication management in heart failure includes
vasodilators, diuretics, aldosterone inhibitors, ace inhibitors, cardiac glycosides to strengthen
contractions, anticoagulants, and beta blockers. Some patients may require surgery to bypass or open
blocked arteries, replace poor functioning valves, implantation of pacemakers and or cardio
defibrillators. Some patients will require ventricular assist device is as a bridge to heart transplantation
or as a treatment in lieu of transplant for patients who are not considered candidates (Nishikawa, et al.,
2020). Determining if a patient is a candidate for transplant is of key importance in determining what
type of treatment or therapy is appropriate for each patient. Depending on patients having other
comorbidities, transplant may not be an option. It is also important to assess the social support system
of the patient and include caregivers in the plan of care. Secondly, patient education is of great
importance. Patients must be educated how to manage their disease and their medication’s and when
to contact their provider.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045766/
Chronic Venous Insufficiency: Diagnosis
Chronic venous insufficiency usually affects the lower extremities and includes patient
complaints of increasing leg pain and heaviness with prolong standing, varicose torturous veins,
progressive skin changes, venous stasis dermatitis and ulcerations, and lipodermatosclerosis. Diagnosing
chronic venous insufficiency begins with a thorough history and physical exam followed by a Doppler
ultrasound. Additional testing might include CT venography or magnetic resonance venography.
Link: https://www.uptodate.com/contents/diagnostic-evaluation-of-lower-extremity-chronicvenous-insufficiency
Congenital Structural Heart Defect: Assessment
The most common tests done to evaluate for structural heart defects are ECG and
echocardiogram. Some defects are not detected until adulthood when patients may present with
fatigue, palpations, or atypical chest pain. An atrial shunt might be discovered during an echocardiogram
when evaluating a patient for an arrhythmia. A chest x-ray might show an enlarged right atrium, right
ventricle, or pulmonary trunk with certain defects. However, echocardiography is the diagnostic tool
most often used for interatrial communications. If the transthoracic echo is in adequate a
transesophageal echo may be necessary. Cardiac MRI may reveal ventricular septal defects. Congenital
heart disease can result in various ECG changes that might be related to atrial or ventricular overload or
enlargement. The defects most found include atrial septal defect, ventricular septal defect, patent
ductus arteriosus, pulmonary stenosis, aortic cortication, and AV canal defect (Pierpont, et al., 2018).
Link: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000606
Dyslipidemia: Assessment
Dyslipidemia is elevated plasma lipids such as cholesterol, triglycerides, or both. Most
individuals diagnosed with dyslipidemia have a predisposition with secondary factors such as obesity or
type II diabetes. The clinical approach to assessing a patient’s need for intervention begins with
assessing their ASCVD risk. Having increased LDL and increased triglycerides usually warrants treatment.
Link: https://academic.oup.com/edrv/article/43/4/611/6408399
Hypertension: Pharmacology
Hypertension can be treated with many different pharmacologic agents. Thiazide diuretics are
recommended first line for most patients however initial selection of agent depends on underlying
patient diseases. ACE inhibitors or ARBs should be considered in patients with diabetes, proteinuria,
heart failure, but avoided in pregnancy. Beta blockers are no longer the first line drug for patients with
uncomplicated hypertension but should be considered for patients with heart failure, ischemic heart
disease, and migraines. Calcium channel blockers are encouraged for patients with isolated systolic
hypertension, asthma, and migraines. If a patient is in stage two hypertension, two different drugs
should be considered. In pregnant patients we can treat hypertension with vasodilators, beta blockers,
and methyldopa (Hollier et al., 2011).
In patients with BP >20/10mmHg above target range, two drug therapy, either as a single pill
combination or two separate pills should be started. Avoid combining any two drugs of the following
classes: ACE inhibitor, or ARB/direct renin inhibitor. And in patients with atrial fibrillation, ARBs are
preferred. In patients with aortic disease, beta blockers are preferred. Patients with heart failure should
be prescribed diuretics. Chlorthalidone is the preferred thiazide diuretic for treatment of hypertension
in African-Americans (Flack, et al., 2020).
Link: https://www.sciencedirect.com/science/article/pii/S1050173819300684
Inferior STEMI: Planning and Intervention:
Are inferior STEMI is usually caused by occlusion of the right coronary artery and less commonly by
occlusion of the left circumflex artery. ECG analysis of an inferior STEMI displays ST elevation in leads II,
III, and aVF. STEMI patients should receive aspirin immediately regardless of fibrinolytic therapy. Patient
presenting with STEMI may have bradycardia and or hypotension requiring administration of IV fluids, a
vasopressor agent and/or atropine. Patient should also receive anti-platelet aggregation inhibitor such
as Plavix. Patient might also receive heparin or Lovenox. The preferred treatment for patients with
STEMI is PCI reperfusion therapy if performed within 90 minutes of first medical contact and within 12
hours of symptom onset. Door to needle goal is fibrinolytic therapy delivered within 30 minutes of
hospital arrival or door to balloon time within 90 minutes. ACE inhibitors should be started within 24
hours of all STEMI patients unless contraindicated. Secondary prevention medication’s that will be
prescribed to the patient may include a statin, beta blocker, and an ACEI/ARB (Whalen, et al., 2019).
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443514/
References
Barkley, T. (2021). Adult Gerontology Acute Care Nurse Practitioner Certification Review: Clinical
Update Continuing Education Course. Barkley & Associates.
Ferri, F. F. (2021). Ferri’s Clinical Advisor 2021: 5 books in 1. Elsevier.
Flack, J. M., & Adekola, B. (2020). Blood pressure and the new ACC/AHA Hypertension
Guidelines. Trends in Cardiovascular Medicine, 30(3), 160–164.
https://doi.org/10.1016/j.tcm.2019.05.003
Hasan, T. F., Hasan, H., & Kelley, R. E. (2021). Overview of Acute Ischemic Stroke
Evaluation and Management. Biomedicines, 9(10), 1486.
https://doi.org/10.3390/biomedicines9101486
Hollier, A., & Hensley, R. (2011). Hypertension. In Clinical guidelines in primary care: A
reference and review book (pp. 5–21). essay, Advanced Practice Education Associates.
McGilton, K. S., Haslam-Larmer, L., Wills, A., Krassikova, A., Babineau, J., Robert, B., Heer,
C., McAiney, C., Dobell, G., Bethell, J., Kay, K., Keatings, M., Kaasalainen, S., Feldman, S., Sidani,
S., & Martin-Misener, R. (2023). Nurse practitioner/physician collaborative models of care: a
scoping review protocol. BMC geriatrics, 23(1), 98. https://doi.org/10.1186/s12877-023-037981
Morris, A. A., Khazanie, P., Drazner, M. H., Albert, N. M., Breathett, K., Cooper, L. B.,
Eisen, H. J., O’Gara, P., & Russell, S. D. (2021). Guidance for timely and appropriate referral of
patients with advanced heart failure: A scientific statement from the American Heart
Association. Circulation, 144(15). https://doi.org/10.1161/cir.0000000000001016
Nishikawa, Y., Hiroyama, N., Fukahori, H., Ota, E., Mizuno, A., Miyashita, M., Yoneoka, D., &
Kwong, J. S. (2020). Advance Care Planning for Adults with Heart Failure. The Cochrane
Database of Systematic Reviews. 2(2), CD013022.
https://doi.org/10.1002/14651858.CD013022.pub2
Papadakis, M. A., McPhee, S. J., & Rabow, M. W. (2023). Current Medical Diagnosis &
Treatment. McGraw-Hill Education.
Papadakis, M. A., McPhee, S. J., Rabow, M. W., Raj, K., Williams, N., & DeBattista, C.
(2021). Psychiatric Disorders. In Current Medical Diagnosis & Treatment 2021 (pp. 1107–1119).
essay, McGraw-Hill Education.
Pierpont, M. E., Brueckner, M., Chung, W. K., Garg, V., Lacro, R. V., McGuire, A. L., Mital,
S., Priest, J. R., Pu, W. T., Roberts, A., Ware, S. M., Gelb, B. D., Russell, M. W., & American Heart
Association Council on Cardiovascular Disease in the Young; Council on Cardiovascular and
Stroke Nursing; and Council on Genomic and Precision Medicine (2018). Genetic Basis for
Congenital Heart Disease: Revisited: A Scientific Statement From the American Heart
Association. Circulation, 138(21), e653–e711. https://doi.org/10.1161/CIR.0000000000000606
NURS 682L-A
Pre-Predictor Examination Announcement
Students in the APRN Program are required to take diagnostic exams to test their knowledge and
readiness for the national board certification exam. The exams are offered through a nurse
practitioner board certification exam preparation specialist called Advanced Practice Education
Associates (APEA). In accordance with the WCU Academic Honor Code and Student Code of
Conduct, these exams are proctored to ensure academic integrity and security in the completion
of examinations through distance learning technology. A proctored exam is a supervised exam.
All online delivery courses at WCU must meet the same rigorous standards as on-ground or
blended delivery courses.
Students should plan to take exams within the time allowed. This will help to prepare the student
for the actual national board exam.
The University is responsible for the initial testing and proctoring fees such as the 3Ps Predictor
Exam, Pre-Predictor Exam, and Exit Exam. Students are responsible for subsequent testing and
proctoring fees.
Additional information and a Q & A opportunity will be provided during the collaborative
session scheduled in week 1 of the course.
APEA Pre-Predictor Examination Grading:
A passing score is considered 70% or above. The awarded grade in the in the grade book is
based using the following point conversion system:
≥ 70 = 400 points
65 – 69 = 300 points
60 – 64 = 200 points
0 – 59 = 0 points
APEA Pre-Predictor Examination Remediation:
Remediation is available for students who score less than 70% on the exam. Remediation
Assignment instructions may be found in the Week 3 module. If needed, the remediation plan
should be started immediately and be submitted no later than Monday of Week 8 of the course.
Students who score less than 70% on the Pre-Predictor Exam will have an opportunity to earn
points by thoroughly completing the remediation assignment. Students may not be awarded more
than 400 total points in the gradebook for the Pre-Predictor Exam.
Remediation Point Scale:
≥ 70 = encouraged to remediate weak areas – maximum points earned
65 – 69 = with remediation can earn up to 100 points
60 – 64 = with remediation can earn up to 200 points
0 – 59 = with remediation can earn up to 300 points
Students who complete the remediation assignment may qualify to re-take the APEA PrePredictor Examination at their own expense. The examination may be re-attempted only once
(1-time). Student is required to make a formal exam-re-take request with approval granted by
program Faculty/Assistant Dean/Dean. The second and final attempt must be completed
on/before Thursday, 11:59 pm (PST) of Week 8 of the course.
Pre-Predictor Exam Remediation Rubric
Criteria
Complete Pre-Predictor
Remediation Documentation
Ratings
Point
1 point
0 point
Remediation Complete
Remediation Not Complete
All missed question topics in the
knowledge areas are thoroughly
addressed in the remediation
document. Adequately uses and
provides resources for each question
topic missed. Remediation of each
question topic is addressed in a 2 – 3
paragraph summary.
All missed question topics in the
knowledge areas are not thoroughly
addressed in the remediation
document to include a 2 – 3
paragraph summary. Adequate
resource(s) are not provided for
each question topic missed.
Total Points:
1 point
1
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