[2022年更新]合格できるNAPLEX試験にはリアルな問題解答
NAPLEX試験問題ゲット最新[2022]と正解回答
質問 54
JT is a 58-year-old women who is on vancomycin empirically for pyomyositis confirmed by MRI. Surgical debridement has successfully removed infected tissue and pus. C&S of the infected tissue comes back MSSA sensitive to everything on the panel. JT is allergic to PCN (rash), she has had cephalosporin for her UTI in the past with no problem.
What would be the most appropriate antibiotics to switch to while JT is still in the hospital?
- A. Oxacillin
- B. Ceftaroline
- C. Daptomycin
- D. Doxycycline
- E. Cefazolin
正解: E
解説:
Explanation
Cefazolin or an antistaphylococcal penicillin (oxacillin or nafcillin) is recommended for this patient because the C&S results indicate MSSA. Since the patient develops a rash to penicillins, it would be acceptable to use cefazolin in this case.
質問 55
JK is a 67 years old African American man who presents to your clinic for his blood pressure management. His past medical history includes Peptic ulcer disease and hypertension. His two BP readings are 160/98, 159/96 and HR 85. He says he has been adherent to his medication and lifestyle. He currently takes 12.5mg Chlorthalidone and Prilosec 20mg daily.
Which of the following is the best strategy to manage his blood pressure?
- A. Increase chlorthalidone to 25mg daily
- B. Add Lisinopril 20mg daily
- C. Add Norvasc 2.5 daily
- D. Add Lisinopril 5mg daily
- E. Add hydrochlorothiazide 25mg daily
正解: C
解説:
As the patient is over the age of 60 and he does not have CKD or diabetes, his goal BP should be SBP < 150 mmHg or DBP < 90 mmHg, and he is not currently at this goal with his medication regimen. Options are to maximize the current medication dosage (option A), or to add a second agent. Since calcium channel blockers like Norvasc are recommended as initial treatment options in African Americans, choosing Norvasc over lisinopril would probably be the more effective option.
Reference:
http://jamanetwork.com/journals/jama/fullarticle/1791497
質問 56
A 50-year-old female has been receiving a diuretic for the treatment of essential hypertension. This drug acts by increasing the calcium content of urine and is the drug of choice for reducing acute pulmonary edema in congestive heart failure. Its side effects include ototoxicity and hyperuricemia. What is the most likely mechanism of action of this drug?
- A. Blocking of the NACL cotransporter
- B. Inhibition of the Na/K/2Cl cotransporter
- C. Aldosterone receptor antagonist
- D. Acts as osmotic diuretic
- E. Inhibition of carbonic anhydrase
正解: B
解説:
B: Loop diuretics inhibit the Na/K/2Cl cotransporter of the luminal membrane in the ascending limb of the loop of Henle. Therefore, reabsorption of Na, K, and CL is decreased. The loop diuretics are the most efficacious of the diuretic drugs because the ascending limb accounts for the reabsorption of 25-30 % of filtered NaCl and downstream sites are not able to compensate for this increased Na load. Loop diuretics are the drugs of choice for reducing acute pulmonary edema in congestive heart failure. Loop diuretics act promptly, even among patients who have poor function or who have not responded to thiazides or other diuretics. Adverse side effects include ototoxicity, particularly when used in conjunction with the aminoglycoside antibiotics. Furosemide and ethacrynic acid compete with uric acid for the renal and biliary secretary system, thus blocking its secretion, and thereby causing or exacerbating gouty attacks. A: Aldosterone receptor antagonist is incorrect.
Spironolactone is a synthetic aldosterone antagonist that competes with aldosterone for intracellular cytoplasmic receptor sites. Because spironolactone chemically resembles some of the sex steroids, it does have minimal hormonal activity and may induce gynecomastia in males and menstrual irregularities in females.
C: Inhibition of carbonic anhydrase is incorrect. Acetazolamide inhibits carbonic anhydrase, which is located intracellulary and on the apical membrane of the proximal tubular epithelium. The decreased ability to exchange NA for H in the presence of acetazolamide results in a mild diuresis. The adverse side effects of acetazolamide include metabolic acidosis (mild), potassium depletion, renal stone formation, drowsiness, and paresthesia. D: Acts as osmotic diuretic is incorrect. A number of simple, hydrophilic, chemical substances that are filtered through the glomerulus, such as mannitol and urea, result in some degree of diuresis. This is due to their ability to carry water with them into tubular fluid. Osmotic diuretics are a mainstay of treatment for patients with increased intracranial pressure or acute renal failure due to shock, drug toxicities, or trauma. E: Blocking of the NaCl cotransporter is incorrect. The thiazide derivatives act mainly in the distal tubule to decrease the reabsorption of Na by inhibition of an Na/Cl cotransporter on the luminal membrane. As a result, these drugs increase the concentration of NA and CL in the tubular fluid. Hypokalemia is the most frequent problem encountered with the thiazide diuretics and can predispose patients on digitalis to ventricular arrhythmias.
Thiazides increase serum uric acid by decreasing the amount of acid excreted by the organic acid secretory system. The thiazides inhibit the secretion of calcium, sometimes leading to elevated levels of Ca in the blood.
質問 57
You get an order for 5% amino acid 15% dextrose premixed parenteral nutrition solution, 2 L at 83mls/hr.
Your pharmacy technician tells you there is manufacture's backorder on those. How many ml of 20% dextrose would you need to provide the same amount of dextrose in 24 hrs?
- A. 1000ml
- B. 200ml
- C. 1500ml
- D. 2500ml
- E. 1400ml
正解: C
解説:
Explanation
15% dextrose = 15gm/100ml = 300gm/2000ml. Patient needs 300gm. 300gm/Xml = 20gm/100ml = 1500ml
質問 58
Which of the following antidiabetic medication may cause cyanocobalamin deficiency?
- A. Metformin
- B. Saxagliptin
- C. Glimepiride
- D. Canagliflozin
- E. Pioglitazone
正解: A
解説:
Metformin is associated with vitamin B12 deficiency because it affects the calcium dependent membrane uptake of it. All other drug classes are not associated with this.
質問 59
In the US Nurses' Health Study (NHS) cohort study, where they looked at association of regular aspirin use (≥two 325 mg tablets/week) and colorectal cancer in 82,911 women found (RR, 0.77; 95% CI, 0.67-0.88) over
20 years of follow-up.
In an another analysis of the NHS, regular aspirin use, investigator also found (hazard ratio [HR]=0.72, 95% CI
0.56-0.92), what does this say about the mortality from colorectal cancer? How can this data best be interpreted?
- A. Those who takes aspirin ≥2 times/week have 23% reduction in death from colorectal cancer
- B. Those who takes aspirin ≥2 times/week have 23% lower risk of colorectal cancer
- C. Those who takes aspirin ≥2 times/week have 0.77% lower risk of colorectal cancer
- D. Those who takes aspirin ≥2 times/week have 28% lower risk of colorectal cancer
- E. None of the above is correct
正解: B
解説:
Explanation/Reference:
Explanation:
Relative risk can be stated as 0.77 times as likely or 0.77 times the risk, but it could also be illustrated as a relative risk reduction and stated as a 23% risk reduction or 23% lower risk by taking the medication.
Reference:
https://www.ncbi.nlm.nih.gov/books/NBK63647/
質問 60
Your patient is a 43-year-old male who is experiencing post-operative voiding difficulty after an elective inguinal hernia repair. His post void residual volume was 280 cc.
Which of the following medications is the most appropriate choice of therapy for this patient?
- A. Imipramine
- B. Bethanechol
- C. Finasteride
- D. Phenylephrine
- E. Oxybutynin
正解: B
解説:
The patient is experiencing a common complication of low abdominal surgery. Post-operative urinary retention occurs in almost 25% of patients after low abdominal surgical procedures. A normal post-void residual volume is less than 50 cc or urine. The effects of anesthesia and analgesia both contribute to bladder distension, decreased micturition reflex, reduction of contractility of the detrusor muscle of the bladder, and incomplete voiding. The detrusor muscle of the bladder is stimulated to contract by muscarinic cholinergic agonists.
Bethanechol is a muscarinic agonist and is frequently used in this setting to improve bladder emptying.
Finasteride is a drug that is a 5 alpha reductase inhibitor indicated for use in patients with bladder outlet obstruction as a result of prostatic hypertrophy. The inhibition of 5 alpha reductase decreases local conversion of testosterone to dihydrotestosterone in the prostate gland, which results in gradual shrinkage over a period of six to twelve months. Phenylephrine is an alpha-adrenergic agonist that is selective for alpha-1 receptors.
Activation of the alpha 1 receptors in the bladder results in contraction of the trigone muscle and sphincter.
This promotes urinary retention. Oxybutynin is an antimuscarinic agent that is useful for treatment of urge incontinence, and would have a detrimental effect on this patient's bladder disorder. Imipramine is a medication with anticholinergic properties that would also cause worsening of the patient's condition. Take home message:
Post-operative urinary retention with concomitant incomplete voiding is a complication that results from a decreased micturition reflex, increased vesical sphincter tone, or decreased contractility of the detrusor muscle of the bladder. It can be successfully treated with a muscarinic agonist, such as bethanechol, or with an alpha-
1 adrenergic antagonist.
質問 61
Proportion of people in a population who have a particular disease at a specified point in time or over a specified period of time is definition as which of the following?
- A. Incidence rate
- B. Relative risk
- C. Prevalence rate
- D. Mortality rate
- E. Odds ratio
正解: C
解説:
Incidence rate = New reported cases / summed person-years of observation (avg population during time interval) Prevalence = Cases in a population in a given time period / total population at that time.
Reference:
https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson3/section2.html
http://www.healthknowledge.org.uk/public-health-textbook/research-methods/1a-epidemiology/numerators- denominators-populations
質問 62
TM is a 78 YOW with a history of hypertension, hypercholesterolemia and arthritis was admitted for proximal arterial fibrillation.
While in the hospital she was placed on diltiazem drip and eventually, converted to oral diltiazem 240mg. Pt's home medication includes Simvastatin 40mg po daily , hydrochlorothiazide 25mg po daily , Lisinopril 20mg daily and Acetaminophen. Her LDL-C is 100mg /dL.
What would be the most appropriate change to make on her therapy?
- A. Keep Simvastatin at 40mg po daily
- B. Increase Simvastatin to 80mg po daily
- C. Change Simvastatin 40mg to Atorvastatin 40mg po daily
- D. Discontinue Statins.
- E. Change Simvastatin to Lovastatin 20mg po daily
正解: C
解説:
Diltiazem has a major drug interaction with Simvastatin. Diltiazem is a CYP3A4 inhibitor, and since Simvastatin is metabolized by CYP3A4, its level can build up and the risk of myopathy increases. It is recommended to switch to a non-CYP3A inhibitor such as Pitavastatin, Pravastatin, or Rosuvastatin, and if Simvastatin is to be kept on it should not exceed 10 mg/day. The same interaction also exists with lovastatin, and the recommendation is to not exceed a total dose of 20 mg/day po of Lovastatin. Given the current options, the best choice is to change to Atorvstatin 40 mg po daily.
Reference:
http://www.fda.gov/Drugs/DrugSafety/ucm256581.htm
http://circ.ahajournals.org/content/129/25_suppl_2/S1
質問 63
A 50-year-old female has been receiving a diuretic for the treatment of essential hypertension. This drug acts by increasing the calcium content of urine and is the drug of choice for reducing acute pulmonary edema in congestive heart failure. Its side effects include ototoxicity and hyperuricemia. What is the most likely mechanism of action of this drug?
- A. Blocking of the NACL cotransporter
- B. Inhibition of the Na/K/2Cl cotransporter
- C. Aldosterone receptor antagonist
- D. Acts as osmotic diuretic
- E. Inhibition of carbonic anhydrase
正解: B
解説:
Explanation
B: Loop diuretics inhibit the Na/K/2Cl cotransporter of the luminal membrane in the ascending limb of the loop of Henle. Therefore, reabsorption of Na, K, and CL is decreased. The loop diuretics are the most efficacious of the diuretic drugs because the ascending limb accounts for the reabsorption of 25-30 % of filtered NaCl and downstream sites are not able to compensate for this increased Na load. Loop diuretics are the drugs of choice for reducing acute pulmonary edema in congestive heart failure. Loop diuretics act promptly, even among patients who have poor function or who have not responded to thiazides or other diuretics. Adverse side effects include ototoxicity, particularly when used in conjunction with the aminoglycoside antibiotics.
Furosemide and ethacrynic acid compete with uric acid for the renal and biliary secretary system, thus blocking its secretion, and thereby causing or exacerbating gouty attacks. A: Aldosterone receptor antagonist is incorrect. Spironolactone is a synthetic aldosterone antagonist that competes with aldosterone for intracellular cytoplasmic receptor sites. Because spironolactone chemically resembles some of the sex steroids, it does have minimal hormonal activity and may induce gynecomastia in males and menstrual irregularities in females. C: Inhibition of carbonic anhydrase is incorrect. Acetazolamide inhibits carbonic anhydrase, which is located intracellulary and on the apical membrane of the proximal tubular epithelium. The decreased ability to exchange NA for H in the presence of acetazolamide results in a mild diuresis. The adverse side effects of acetazolamide include metabolic acidosis (mild), potassium depletion, renal stone formation, drowsiness, and paresthesia. D: Acts as osmotic diuretic is incorrect. A number of simple, hydrophilic, chemical substances that are filtered through the glomerulus, such as mannitol and urea, result in some degree of diuresis. This is due to their ability to carry water with them into tubular fluid. Osmotic diuretics are a mainstay of treatment for patients with increased intracranial pressure or acute renal failure due to shock, drug toxicities, or trauma. E: Blocking of the NaCl cotransporter is incorrect. The thiazide derivatives act mainly in the distal tubule to decrease the reabsorption of Na by inhibition of an Na/Cl cotransporter on the luminal membrane. As a result, these drugs increase the concentration of NA and CL in the tubular fluid.
Hypokalemia is the most frequent problem encountered with the thiazide diuretics and can predispose patients on digitalis to ventricular arrhythmias. Thiazides increase serum uric acid by decreasing the amount of acid excreted by the organic acid secretory system. The thiazides inhibit the secretion of calcium, sometimes leading to elevated levels of Ca in the blood.
質問 64
CJ is a 69-year-old male with a history of diabetes, hypertension and hypercholesterolemia. His fasting lipid profile is TC 530 mg/dL; LDL-C 125; HDL-C 48 mg/dL; and TG 640 mg/dL. His A1c 8.1, calculate creatinine clearance is 65mls/hr, BP 135/80 mm Hg, HR 70 beats /min.
His current medications include metformin 1000mg po bid, lisinopril 20mg daily, sitagliptin 50mg bid and atorvastatin 40mg daily.
What is the best pharmacological agent to initiate on CJ?
- A. Fish oil 500mg twice daily
- B. Fenofibrate 162mg daily
- C. Increase atorvastatin to 80mg
- D. Niacin 500mg twice daily
- E. Gemfibrozil 600mg twice daily
正解: B
解説:
Explanation
It is reasonable to add triglyceride-lowering medications such as fibrates or niacin to prevent pancreatitis in those with triglyceride levels >500 mg/dL, which applies to this patient as his TG level is 640 mg/dL.
C is wrong because gemfibrozil should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms and rhabdomyolysis. Fenofibrate may be considered concomitantly with a low- or moderate- intensity statin when triglycerides are above 500 mg/dL,2, however he is on a high intensity statin therapy. For niacin, the IR dose should start at 100 mg TID2 and niacin does not lower triglyceride levels as much as fibrate do.4 Fenofibrates are dose adjusted for renal function lower than 60 mL/min to 54 mg/mL, so this dose is appropriate for this patient because of his renal function being above 60 mL/min. The best option is fenofibrate 162 mg daily, but this needs to be monitored for any symptoms of muscle pain exhibited by the patient, especially as the patient is at a higher risk due to being a diabetic. Fish oil is not a first line agent to treat hypertriglyceridemia.
質問 65
A 27-year-old female with ovarian cancer is undergoing chemotherapy. She develops subsequent renal failure.
Which of the following drugs is most likely responsible for this?
- A. Cyclophosphamide
- B. Vinblastine
- C. Bleomycin
- D. Vincristine
- E. Cisplatin
正解: E
解説:
Explanation
Cisplatin. All chemotherapeutics have similar generalized side effects related to their effects on rapidly growing cells. These include hair loss, nausea, and fatigue. However, many chemotherapeutics have unique toxicities as well which are often tested. Cisplatin (C) is notable for its nephrotoxicity and ototoxicity.
Cyclophosphamide
(A) is known to cause hemorrhagic cystitis. This is a distinct process from nephrotoxicity. The most noteworthy side effect of bleomycin (B) is pulmonary toxicity that can lead to pulmonary fibrosis. Vinblastine (D) is known for bone marrow suppression. Vincristine (E) causes neuropathy.
質問 66
LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.
His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN's medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram
20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125 mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1mg.
lock-out every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/ dl, K 5.0mmol/L, Na 135mmol/L. Day 3 post-operation LN's pain was much better and only used
3 mg of hydromorphone in the 24hrs.
Physician wants to change to oral morphine. What would be your best recommendation?
- A. Morphine SR 10mg po daily and morphine 5mg po q6h prn for breakthrough pain
- B. Morphine 30mg ER po q6hr and morphine 5mg q6h prn for breakthrough pain
- C. Morphine 15mg ER po q12hr and morphine 5mg po q6h prn breakthrough pain
- D. Morphine 60mg ER po daily and morphine 15mg po q6h prn breakthrough pain
- E. Morphine 15mg ER po q12hr and morphine 15mg po q6h prn for breakthrough pain
正解: C
解説:
Explanation
Since LN used 3 mg of hydromorphone, this would be equivalent to a total of morphine 60 mg po daily. Since you would start with 70-80% of that dose, Morphine 15mg ER po q12hr and morphine 5mg po q6h prn breakthrough pain would be appropriate regimen.
質問 67
A physician orders 300gms of albumin post paracentesis, how many milliliters of 25% albumin do you need to give 300gms?
- A. 1000ml
- B. 300ml
- C. 1200ml
- D. 25ml
- E. 100ml
正解: C
解説:
25g/100ml = 300g/Xml Xml = 1200mL
質問 68
A physician orders Dopamine 5 mcg/kg/min. The concentration of the Dopamine IV bag is 400 mg in 250 D5W.
The patient's weight is 168 lbs. Calculate the infusion rate in mL/hr.
- A. 10.2mls/hr
- B. 22.4mls/hr
- C. 5.2mls/hr
- D. 14.29mls/hr
- E. 0.17mls/hr
正解: D
解説:
Pt's weight in Kg 76.4. 76.4 × [5 mcg/kg/min] = 381.18 mcg/min Concentration of the bag [400 mg/250 mL]
1.6 mg/ml or 1600mcg 381.18 mcg × [1 mL/1600 mcg] = 0.2382 mL/ml 60 in × [0.0.2382 mL/min] = 14.29 mL in one hour
質問 69
A 22-year-old woman adopted a cat. Shortly thereafter, she developed itchy eyes and persistent rhinorrhea.
She was clearly allergic to the pet, but desperately wanted to keep it. She tried taking diphenhydramine, but it had intolerable side effects.
Which of the following is a common effect of this type of medication?
- A. Xerostomia
- B. Decreased intraocular pressure
- C. Bradycardia
- D. Excessive sweating
- E. Diarrhea
正解: A
解説:
Diphenhydramine possesses anticholinergic properties. Xerostomia, or dry mouth, is a common side effect of anti-cholinergic medications, due to anti-muscarinic, parasympatholytic effects. Other adverse reactions may include: * Mydriasis with blurred vision, photophobia * Urinary retention * Constipation * Anhidrosis * Hyperthermia * Tachycardia * Altered mental status A commonly referenced mnemonic for anti-cholinergic toxicity is "mad as a hatter, red as a beet, dry as a bone, hot as a hare, blind as a bat" to reflect confusion, flushing, dry mouth, hyperthermia and mydriasis, respectively.
質問 70
The administration of dapsone gel for the topical treatment of acne vulgaris in patients with G6PD deficiency may produce which of these?
- A. Anaphylaxis
- B. Fungal infections
- C. Hemolysis
- D. Immunosuppression
正解: C
解説:
Explanation
Dapsone treatment has produced dose-related hemolysis and hemolytic anemia. Individuals with glucose-6- phosphate dehydrogenase (G6PD) deficiency are more prone to hemolysis.
質問 71
Which of the following is dichotomous variable?
- A. Grade of Breast Cancer
- B. NYHA I-IV
- C. alive / dead
- D. Sex
- E. Pain yes/ Pain no
正解: C
解説:
Explanation
Dichotomous data is considered categorical data that only has two categories, or two answer choices. All 3 answer choices have only 2 categories: sex has male or female, pain is yes or no, and alive or dead is only two options also.
質問 72
A 23-year-old female presents to your clinic complaining of intermittent throbbing headaches that usually last for several hours and are made worse by the presence of light. She endorses occasional nausea without vomiting during the most severe episodes. Physical examination is unrevealing, and she has no significant past medical history.
Which of the following treatments is considered an abortive therapy for this patient's underlying condition?
- A. Diltiazam
- B. Propranolol
- C. Gabapentin
- D. Sumatriptan
- E. Amitriptyline
正解: D
解説:
Correct:
A. Migraine headaches typically affect females more often than males, and patients most frequently present in their early 20s. Classic symptoms of migraine include throbbing headaches lasting between 2-24 hours in duration, with triggers such as red wine, fasting, stress, and menses. Primary prevention is aimed at the identification and avoidance of triggers. Over the counter NSAIDS can be used if symptoms persist. Failing this, PRN abortive therapy is indicated, including the triptans (e.g. - sumatriptan) and metoclopramide. Choice B - Gabapentin is an anticonvulsant that is considered to be a second-line, prophylactic treatment for recurrent migraine headaches. Its utility is limited by its lengthy side effect profile. Choice C - Amitriptyline, a tricyclic antidepressant, can also be utilized for migraine prophylaxis. However, it will not abort a migraine currently in progress, and extensive side effects limit its use. Choices D + E - Propranolol and diltiazam are beta-blockers and calcium channel blockers, respectively. As with the anticonvulsants and tricyclic antidepressants, these are considered migraine prophylaxis and will not interrupt a migraine once it has begun.
質問 73
Which of the following would be most appropriate to treat infections associated with stenotrophomonas maltophilia?
- A. Ampicillin
- B. Meropenem
- C. Vancomycin
- D. Sulfamethoxazole/trimethoprim
- E. Ciprofloxacin
正解: D
解説:
Primary treatment for stenotrophomonas maltophilia is SMX-TMP. Meropenem, ciprofloxacin, Ampicillin and vancomycin have no coverage.
質問 74
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NABP NAPLEX 認定試験の出題範囲：
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