[2022年02月最新リリース]NAPLEX問題集でNAPLEX Certification認証
最新の完璧なNAPLEX問題集問題と解答で100%パスさせます
NABP NAPLEX 認定試験の出題範囲：
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質問 17
Which of the following medication should be avoided if a patient is on lithium to avoid lithium toxicity?
- A. Amiodarone
- B. Naproxen
- C. Lisinopril
- D. Warfarin
- E. Furosemide
正解: B
解説:
Explanation
ACE-inhibitors (such as lisinopril), NSAIDs (such as naproxen) and loop diuretics (furosemide) can all increase the risk of lithium toxicity.
質問 18
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 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/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. The bioavailability of levothyroxine is roughly 50%.
The physician requests you for a dose recommendation to convert her home dose of 75mcg po daily to intravenous.
What would be the appropriate intravenous dose?
- A. 37.5mg
- B. 37.5mcg
- C. 75mcg
- D. 150mcg
- E. 75mg
正解: B
解説:
Explanation
Since the bioavailability of levothyroxine is roughly 50% (given in the question). To convert the home dose to intravenous, it would be 50% of the oral dose. So 50% of oral 75 mcg would be 37.5 mcg intravenously.
質問 19
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 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with
20K at 125mls/hour and Hydromorphone PCA at 0.2mg/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.
What is LN's creatinine clearance using Cockcroft and Gault equation based on IBW?
- A. 63 mls/min
- B. 53 mls/min
- C. 43 mls/min
- D. 33 mls/min
- E. 23 mls/min
正解: D
解説:
Explanation/Reference:
Explanation:
ABW = 85 kg IBW = 50 kg + 2.3 kg (4) = 59.2 kg 85/59.2 = 1.44 AdjBW = 59.2 kg + 0.4(85 kg-59.2 kg) = 69.52 kg CrCl (IBW) = [(140-84) 59.2]/(72 × 1.4) = 32.8 CrCl (AdjBW) = [(140-84) 69.52]/(72 × 1.4) = 38.6
質問 20
Which of the following would be most appropriate to treat stenotrophomonas maltophilia?
- A. Ciprofloxacin
- B. Cefepime
- C. Vancomycin
- D. Sulfamethoxazole/trimethoprim
- E. Meropenem
正解: D
解説:
Explanation
Primary treatment for stenotrophomonas maltophilia is SMX-TMP. Meropenem, ciprofloxacin, and vancomycin have no coverage.
質問 21
A 67-year-old female presents to your clinic complaining of fatigue, diarrhea, headaches and a loss of appetite.
Upon examination you find that she is having some cognitive difficulty. Laboratory results reveal: MCV: 109fL; Hgb: 9g/dL; MMA and homocystine are both elevated. Shilling test is positive.
What is the next best step in the management of this patient?
- A. Give corticosteroids and iron supplementation
- B. Lifelong Vitamin B12 supplementation
- C. Iron supplementation for 4-6 months
- D. Lifelong folic acid supplementation
- E. Obtain a Coomb's test
正解: B
解説:
Lifelong Vitamin B12 supplementation. Vitamin B12 (cyanocobalamin) deficiency generally presents in patients as fatigue, diarrhea and headaches but can also be the cause of cognitive changes (difficulty concentrating, even mild dementia). Pernicious anemia is a macrocytic anemia, therefore laboratory findings indicate an increased mean corpuscular volume (MCV), with a decreased hemoglobin. A positive Schilling test indicates that the B12 deficiency is due to a lack of intrinsic factor. Lifelong cyanocobalamin supplementation (either orally or via injections) is needed to treat pernicious anemia. A is incorrect. Folic acid deficiency anemia is another common type of macrocytic anemia. However, cognitive deficits are not typically seen with folic acid deficiency. Furthermore, a schilling test would be negative and the methylmalonic acid (MMA) would be normal, rather than elevated. C is incorrect. Iron deficiency anemia causes a microcytic anemia, characterized by a decreased MCV. D is incorrect. A Coomb's test is used to detect autoimmune hemolysis that may be suspected in patients with normocytic anemia (anemia with an MCV in the normal range). E is incorrect.
Corticosteroids and iron supplementation are indicated as treatment in hemolytic anemia.
質問 22
You receive an order for 40mg/kg/dose of Amoxicillin every 12 hours. Pt's weight is 18 lbs. You have
250mg/5ml of amoxicillin suspension.
Calculate the total amount in milliliters needed for 10-day supply. Round up your answer to the nearest 1.
- A. 96 mls
- B. 14 mls
- C. 132 mls
- D. 36 mls
- E. 86 mls
正解: C
解説:
Explanation
If 40mg of amoxicillin are needed per kg of body weight, then the dose of amoxicillin is 40mg multiplied by the patient's body weight. This patient weighs 18 lbs, based on the conversion of 2.2 lbs = 1 kg, the patient weighs
8.2 kg. 40 mg multiplied by 8.2 kg is equal to 328 mg, this is one dose of amoxicillin. If the amoxicillin comes in 250 mg/5 mL, then it needs to be determined how many mLs it will take to get 328 mg of amoxicillin. In order to do this 328 mg needs to be divided by 250 mg to get a ratio. This comes out to be 1.312. This ratio can be multiplied by the number of mLs it takes to make up 250 mg, which is 5 mLs. 1.312 multiplied by 5 mLs is 6.56 mL, this is how many mLs it will take to have 328 mg. This volume is for 1 single dose of amoxicillin. The patient is receiving 2 doses per day and for a total of 10 days, this means the patient will be receiving 20 doses. 20 doses multiplied by 6.56 mL doses equals the total volume the patient will be receiving, which is
131.2 mL.
質問 23
Which of the following is/are ordinal data?
- A. Alive or Dead
- B. Grade of breast cancer
- C. Sex
- D. Improvement Yes/No
- E. NYHA I-IV
正解: B
解説:
Explanation/Reference:
Explanation:
Categorical data includes ordinal (ordered categories) and nominal (unordered categories). NYHA I-IV and grade of breast cancer are considered ordinal data because the categories for the answer choice are in order, you can have NYHA class I, II, III, or IV. Grade of breast cancers are also in order, grade 1, 2, or 3. Sex, Improvemnet Yes/No, Alive or Dead is considered nominal, unordered data because the answer choices are female or male, and do not have a set order.
Reference:
http://www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one
質問 24
Which of these medicines is well-known to cause a positive direct Coombs test?
- A. Methyldopa
- B. Labetalol
- C. Hydralazine
- D. Nifedipine
正解: A
解説:
Explanation
The direct Coombs test is used to test for autoimmune hemolyticanemia - a condition in which the body attacks red blood cells, leading to anemia. Some drugs can cause a positive direct Coombs test - methyldopa being one of the most well-known (via IgG-mediated type II hypersensitivity reaction). Other drugs that can cause this effect include quinidine (IgM-mediated activation) and penicillins (at very high doses).
質問 25
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 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with
20K at 125mls/hour and Hydromorphone PCA at 0.2mg/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. The bioavailability of levothyroxine is roughly 50%.
The physician requests you for a dose recommendation to convert her home dose of 75mcg po daily to intravenous.
What would be the appropriate intravenous dose?
- A. 37.5mg
- B. 37.5mcg
- C. 75mcg
- D. 150mcg
- E. 75mg
正解: B
解説:
Since the bioavailability of levothyroxine is roughly 50% (given in the question). To convert the home dose to intravenous, it would be 50% of the oral dose. So 50% of oral 75 mcg would be 37.5 mcg intravenously.
質問 26
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 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/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.
What is the reason for holding metformin in patients with reduced renal function?
- A. Metformin can cause acute renal failure
- B. Metformin can build up neurotoxin
- C. Metformin can cause hyperkalemia
- D. Metformin can cause hyperglycemia
- E. Metformin can cause lactic acidosis
正解: E
解説:
Explanation
Metformin is held in patients with reduced renal function due to an increased risk of lactic acidosis. Metformin has a Boxed Warning for lactic acidosis, which is a rare but serious metabolic complication. Lactic acidosis can occurs due to an accumulation of metformin (5 mcg/mL or more). It is fatal in about 50% of cases. Lactic acidosis has also been reported to occur in those with diabetes who have significant renal function impairment.
Lactic acidosis occurs when there are elevated blood lactate levels of 5 mmol/L or more, decreased blood pH, electrolyte disturbances with an increased anion gap, and an increased lactate/pyruvate ratio. Normal lactic acid level <2.0 mmol/L.
質問 27
A physician orders 300gms of albumin post paracentesis, how many milliliters of 25% albumin do you need to give 300gms?
- A. 1200ml
- B. 300ml
- C. 25ml
- D. 1000ml
- E. 100ml
正解: A
解説:
Explanation
25g/100ml = 300g/Xml Xml = 1200mL
質問 28
What is the Osmolarity in mOsm/L of 40mEq of KCl in 100ml sterile water? (Molecular weight of KCl is
74.5gm/ mol.)?
- A. 80mOsm/L
- B. 1600mOsm/L
- C. 800mOsm/L
- D. 200mOsm/L
- E. 400mOsm/L
正解: C
解説:
Explanation
40mEq * 1equiv/1000mEq * 74.5g/1equiv = 2.98 gm of KCl in 100ml. Calculate: mOsm/L. 2.98g/100ml *
1mol/74.5g * 2Osm/1mol * 1000mOsm/ Osm * 1000ml/1L = 800mOsm/L
質問 29
Number of new cases per population at risk in a given time period is a definition of which of the following?
- A. Odds ratio
- B. Incidence rate
- C. Confidence Interval
- D. Prevalence rate
- E. Mortality rate
正解: B
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 Mortality rate
= deaths during specified time interval / population size at risk for death.
Reference:
https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson3/section2.html
質問 30
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 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/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.
LN used 5 on-demand bolus doses from the hydromorphone PCA, how much hydromorphone did the patient get in 24 hours?
- A. 5.3mg
- B. 0.5mg
- C. 4.8mg
- D. 52.8mg
- E. 10mg
正解: A
解説:
Explanation
0.2 mg/hour basal rate = 0.2mg/hour (24 hours) = 4.8 mg Demand dose of 0.1 mg * 5 = 0.5 mg 4.8 mg + 0.5 mg = 5.3 mg
質問 31
What is the Osmolarity in mOsm/L of 40mEq of KCl in 100ml sterile water? (Molecular weight of KCl is 74.5gm/ mol.)?
- A. 80mOsm/L
- B. 1600mOsm/L
- C. 800mOsm/L
- D. 200mOsm/L
- E. 400mOsm/L
正解: C
解説:
40mEq × 1equiv/1000mEq × 74.5g/1equiv = 2.98 gm of KCl in 100ml. Calculate: mOsm/L. 2.98g/100ml ×
1mol/74.5g × 2Osm/1mol × 1000mOsm/ Osm × 1000ml/1L = 800mOsm/L
質問 32
All of the following may increase triglycerides except:
- A. Fish oil
- B. Bile acid sequestrants
- C. Protease inhibitor
- D. Glucocorticoids
- E. Oral estrogens
正解: A
解説:
Explanation
Agents that can cause elevated triglycerides: oral estrogens, glucocorticoids, bile acid sequestrants, protease inhibitors, retinoic acid, anabolic steroids, sirolimus, raloxifene, tamoxifen, beta blockers (not carvedilol), and thiazides.
質問 33
In Normal distribution, what percentage of the sample is found within 2 standard deviation of the mean?
- A. 100%
- B. 68%
- C. 99%
- D. 72%
- E. 95%
正解: E
解説:
Explanation
In a normal distribution sample, within 1 standard deviation 68% of the sample falls within 1 standard deviation, 95% within 2 standard deviations, and 99.7% within 3 standard deviations of the mean.
質問 34
You prescribe doxepin to a 37-year-old woman to treat neurotic excoriations on her arms. The patient is concerned about the side effects of this drug. Which of the following is not a side effect of doxepin:
- A. Urinary retention
- B. Liver toxicity
- C. Constipation
- D. Somnolence
- E. Xerostomia
正解: B
解説:
Explanation
A,C,D,E - False - Doxepin is a tricyclic antidepressant with H1 and H2 antihistamine activity. Side effects include sedation and anticholinergic effects (dry mouth, urinary retention, and constipation). Although extensively metabolized by the liver and excreted by the kidney, liver toxicity is very rare. Nephrotoxicity, on the other hand, is a well-known serious adverse effect of long term doxepin use.
質問 35
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 8 mg iv q6h with taper dosing, Ondansetron 4 mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10 mg po daily, Citalopram 20 mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10 mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10 mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20 K at
125 mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6 min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K
5.0 mmol/L, Na 135 mmol/L.
Which of the following medication may cause tardive dyskinesia when given at a higher dose and for a long duration?
- A. Metoclopramide
- B. Hydromorphone
- C. Lisinopril
- D. Famotidine
- E. Dexamethasone
正解: A
解説:
Metoclopramide may cause tardive dyskinesia when given at a higher dose and for a long duration of time of more than 3 months. Tardive dyskinesia is also listed as a Boxed Warning for metoclopramide. Tardive dyskinesia is a serious movement disorder that is irreversible. The risk increases with duration of treatment and the total cumulative dose. If signs or symptoms of tardive dyskinesia develop, then metoclopramide should be discontinued. There is currently no known treatment for it, but symptoms can lessen or resolve after metoclopramide is stopped. Treatment should not be more than 12 weeks unless the benefits outweigh the risks of developing tardive dyskinesia.
質問 36
A Physician orders Dobutamine HCl IV infusion at 5 mcg/kg/min. Dobutamine HCl is available as 500 mg in
250 mL of D5W. The patient weighs 68 kg. Calculate the infusion rate in mL/hr.
- A. 22.4mls/hr
- B. 0.17mls/hr
- C. 340mls/hr
- D. 5.2mls/hr
- E. 10.2mls/hr
正解: E
解説:
Explanation
68 kg * [5 mcg/kg/min] = 340 mcg/min Bag concentration = 2 mg/ml or 2000 mcg/ml 340 mcg * [1 mL/2000 mcg] = 0.17 mL/min 60 in * [0.17 mL/min] = 10.2 mLs in one hour
質問 37
Which of the following class of antidiabetic medications can increase triglycerides?
- A. Thiazolidinediones
- B. Alpha-glucosidase inhibitors
- C. Bile acid sequestrant
- D. SGLT2 Inhibitor
- E. GLP-1 agonist
正解: C
解説:
Explanation
The only bile acid sequestrant, colesevelam (Welchol), has been shown to increase triglycerides through mechanism of: activation of phosphatidic acid phosphatase with promotes triglyceride synthesis. GLP-1 agonists work on GLP 1 receptors to increase insulin secretion, decrease glucagon secretion, and increase satiety. Thiazolidinediones activate nuclear transcription factor PPAR gamma to increase insulin sensitivity.
SGLT2 inhibitors inhibit glucose reabsorption in the kidney. Alpha-glucosidase inhibitors slow down digestion and absorptions of carbs in the gut.
質問 38
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 28% lower risk of colorectal cancer
- B. Those who takes aspirin ≥2 times/week have 0.77% lower risk of colorectal cancer
- C. Those who takes aspirin ≥2 times/week have 23% reduction in death from colorectal cancer
- D. None of the above is correct
- E. Those who takes aspirin ≥2 times/week have 23% lower risk of colorectal cancer
正解: E
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 39
An order is received for 0.03 units /min of vasopressin for Sepsis to maintain MAP >65. The standard mixed in your hospital for vasopressin is 40 units in 100ml NS.
What is the rate in mLs/hr should the vasopressin be infused at?
- A. 4.5ml/hr
- B. 4.9ml/hr
- C. 6ml/hr
- D. 3.5ml/hr
- E. 4.0 ml/hr
正解: A
解説:
Explanation
Rate of infusion: 100mL/40U * 0.03U/min * 60min/1 hr = 4.5mL/hr
質問 40
RL is a 54 YOM who's calculated 10-year atherosclerotic cardiovascular disease (ASCVD) risk is 18 %.
Which of the following is the most appropriate pharmacotherapy recommendation for CR?
- A. Rosuvastatin 10 mg PO QHS
- B. Atorvastatin 20mg PO QHS
- C. Pravastatin 20 mg PO QHS
- D. Lovastatin 10 mg PO QHS
- E. Atorvastatin 80 mg PO QHS
正解: E
解説:
Explanation
This patient belongs in one of the four statin benefit groups because his estimated 10-year ASCVD risk is over
7.5%. Adults 40 to 75 years of age with LDL-C 70 to 189 mg/dL, with an estimated 10-year ASCVD risk
7.5% and without clinical ASCVD or diabetes should receive either a moderate-intensity or high-intensity statin. Since the extent of reducing the risk of ASCVD is proportionally related to the degree of LDL-C reduction, risk could be reduced more so with a high intensity statin. Considering the given options, Atorvastatin 80 mg PO QHS is the best choice.
質問 41
A physician needs your help to calculate the protamine dose on a patient who started hemorrhaging while on heparin. Patient has been receiving heparin at a dose of 13mls/hr for 2 hrs when the physician decides to use protamine to reverse the heparin. Heparin bag says concentration of 50 units/ml. The half-life of heparin is 60 minutes. 1 mg of protamine reverses 100 units of heparin.
How much protamine should be given to this patient?
- A. 13mg
- B. 7mg
- C. 5mg
- D. 10mg
- E. 9.7mg
正解: E
解説:
Explanation
1st hour: 13mL/hr * 1 hr = 13mL 50U/mL = XU/13mL 650U Heparin given in hours since the half-life of protamine is 60 min 2nd hour 650/2 =325 units 650 units + 325 units = 975 units needs to be reversed.
**1mg of protamine reverses 100U of Heparin (1mg protamine/100U Heparin) = (x mg protamine/975U Heparin given) = x = 9.7mg protamine
質問 42
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