[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
質問 32
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 33
JM is a 32-year-old women who comes to your diabetic clinic with complain of several episodes of hypoglycemia. She is on Insulin NPH/regular 70/30, 22 units twice a day with breakfast and dinner. 8 units with lunch.
After discussing with physician you decide to decrease the total daily insulin by 10% and change to insulin glargine once a day and Insulin Lispro three time a day at ratio of 50:50 - 50 % of long and 50 % of short acting insulin.
What is her new insulin regimen? Round down to the nearest 1 unit.
- A. 16 units of insulin glargine once daily, Insulin Lispro 4 units 3 times a day with meals
- B. 18 units of insulin glargine once daily, Insulin Lispro 6 units 3 times a day with meals
- C. 15 units of insulin glargine once daily, Insulin Lispro 5 units 3 times a day with meals
- D. 23 units of insulin glargine once daily, Insulin Lispro 7 units 3 times a day with meals
- E. 30 units of insulin glargine once daily, Insulin Lispro 6 units 3 times a day with meals
正解: D
解説:
Explanation
22 * 2 + 7 = 51 units of total insulin per day. Decrease by 10% 51 units * 0.9 = 45.9 units per day round up to
46 units. 46 units * 0.50 = 23 units, administer 23 units of insulin glargine once daily. 46 units * 0.50 = 23 units total Insulin Lispro. Round down, divided by three times a day, 7 units 3 times a day with meals.
質問 34
Before use, which of the following products should be used to clean surfaces of a laminar flow hood?
- A. 70% isopropyl alcohol
- B. 95% ethyl alcohol
- C. Purified water
- D. Purified WFI
正解: A
解説:
Explanation
Before each use, 70% isopropyl alcohol should be used to clean surfaces of a laminar flow hood.
質問 35
After talking to the patient you find out LT has been incompliant with her three times a day Valproic acid, level came back at 35 mmol/L.
What is the most appropriate course of action?
- A. Valproic acid level is within normal limit, no adjustment is needed.
- B. Notify the physician to increse the dose of Valproic acid.
- C. Albumin needs to be obtained to calculate corrected Valproic acid level
- D. Notify the physician to decrease the dose of Valproic acid.
正解: A
解説:
Explanation
The delayed-release action of divalproex allows for less frequent dosing than valproic acid in some patients.
Divalproex sodium contains sodium valproate and valproic acid in a 1:1 molar stable co-ordination compound.
Valproic acid, sodium valproate, and divalproex share the same pharmacology; however, there are pharmacokinetic differences among products.
質問 36
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. Add Lisinopril 5mg daily
- B. Add Lisinopril 20mg daily
- C. Add hydrochlorothiazide 25mg daily
- D. Add Norvasc 2.5 daily
- E. Increase chlorthalidone to 25mg daily
正解: D
解説:
Explanation
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.
質問 37
Which of the following beta-blocker is NOT proven to reduce mortality in patients with Systolic CHF?
- A. Bisoprolol
- B. Carvedilol
- C. Nadolol
- D. Metoprolol Tartrate
- E. Metoprolol succinate
正解: D
解説:
Explanation
Nadolol is not proven to reduce mortality in patients with systolic CHF. The efficacy of nadolol in HF has not been determined. For patients taking nadolol, it should be used with caution in those with compensated heart failure and patients should be monitored for a worsening of the condition. Bisoprolol, carvedilol, and sustained- release metoprolol succinate are the beta-blockers that have been proven to reduce mortality in patients with systolic CHF. These 3 beta-blockers have been effective in reducing the risk of death in patients with chronic HFrEF. Other beta-blockers were found to be less effective. Bucindolol did not exhibit uniform effectiveness across different populations. Metoprolol tartrate was found to be less effective in HF clinical trials.
質問 38
FT is a 23-year-old newly diagnosed type I diabetes admitted to the hospital due to diabetes ketoacidosis. 2 days after being on insulin drip, anion gap is closed. Physician would like your help in transitioning her to subcutaneous insulin. She suggests using insulin glargine once a day and Insulin lispro three time a day at ratio of 70:30. 70 % of long and 30 % of short acting insulin. FT received average of 70 units of insulin in
24hrs.
Which of the following would be the best insulin regimen?
- A. 52 units of Insulin Glargine subcutaneous daily and 6 units of Insulin Lispro subcutaneous three times a day with meals
- B. 40 units of Insulin Glargine subcutaneous daily and 10 units of Insulin Lispro subcutaneous three times a day with meals
- C. 25 units of Insulin Glargine subcutaneous daily and 15 units of Insulin Lispro subcutaneous three times a day with meals
- D. 46 units of Insulin Glargine subcutaneous daily and 8 units of Insulin Lispro subcutaneous three times a day with meals
- E. 49 units of Insulin Glargine subcutaneous daily and 7 units of Insulin Lispro subcutaneous three times a day with meals
正解: E
解説:
70% of 70 units = 49 units of Insulin Glargine daily 30% of 70 units = 21 units of Insulin Lispro daily. Dived in 3 doses would be 7 units three times a day. FT's Insulin regimen should be 49 units of Insulin Glargine subcutaneous daily and 7 units of Insulin Lispro subcutaneous three times a day with meals
質問 39
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. Daptomycin
- B. Oxacillin
- C. Ceftaroline
- D. Cefazolin
- E. Doxycycline
正解: D
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 40
Which of the following is dichotomous variable?
- A. Pain yes/ Pain no
- B. alive / dead
- C. Sex
- D. NYHA I-IV
- E. Grade of Breast Cancer
正解: B
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 41
Which of the following side effects should LT be made aware of while on Divalproex Sodium?
- A. Oligomenorrhea
- B. Gingival hyperplasia
- C. Gynecomastia
- D. Alopecia
- E. Weight gain
正解: D
解説:
Explanation
Common GI side effects of Valproic Acid and Divalproex Sodium are Weight gain, Nausea, Vomiting, Diarrhea, abdominal pain, dyspepsia. Divalproex sodium or valproic acid affects reproductive endocrine function in women. Menstrual irregularities defined as amenorrhea, oligomenorrhea, and prolonged cycles were common. Gynecomastia is not a side effect of Divalproex Sodium. For list of drugs that causes gynecomastia refer the reference. Gingival hyperplasia is a well-known side effect of phenytoin.
質問 42
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 43
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 4mg iv q6h prn for N/V, Levothyroxine 0.075 mg 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 135 mmol/L.
Which of the following medication may cause psychotic episode such as emotional lability, hallucinations, mania, mood swings and schizophrenic reasons?
- A. Metoclopramide
- B. Dexamethasone
- C. Hydromorphone
- D. Lisinopril
- E. Famotidine
正解: B
解説:
Dexamethasone is associated with psychiatric disturbances. Corticosteroids may exacerbate pre-existing psychiatric conditions.
質問 44
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:
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 45
Which of the following is/are nominal data?
- A. Race
- B. Stages of breast cancer
- C. Sex
- D. NYHA stages I-IV
- E. Blood Group
正解: E
解説:
Explanation
Nominal data is considered unordered categories. Sex answers fall into male or female which is unordered.
Race can be multiple answers such as Caucasian, African American, Asian, etc which is unordered. Blood group can only have blood type O, A, B, or AB which is also unordered. Ordered, or ordinal data would have categories that are in some sort of order
質問 46
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. 22.4mls/hr
- B. 14.29mls/hr
- C. 0.17mls/hr
- D. 5.2mls/hr
- E. 10.2mls/hr
正解: B
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 47
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 4mg iv q6h prn for N/V, Levothyroxine 0.075 mg 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 135 mmol/L.
Which of the following medication may cause psychotic episode such as emotional lability, hallucinations, mania, mood swings and schizophrenic reasons?
- A. Metoclopramide
- B. Dexamethasone
- C. Hydromorphone
- D. Lisinopril
- E. Famotidine
正解: B
解説:
Explanation
Dexamethasone is associated with psychiatric disturbances. Corticosteroids may exacerbate pre-existing psychiatric conditions.
質問 48
Octreotide 50mcg/hr is ordered for a patient with esophageal varices, nurses prepared by mixing 1ml of concentration 0.5mg/ml of octreotide in 50mls NS. What rate should the bag be infused?
- A. 0.5ml/min
- B. 7ml/hr
- C. 50ml/hr
- D. 5ml/min
- E. 5ml/hr
正解: E
解説:
The concentration is the first thing to calculate, using 1 mL of octreotide solution containing a concentration of
0.5mg/mL is really using 0.5mg of octreotide. If this is placed in 50 mL NS then it is 0.5mg/50mL which is
0.01mg/mL or 10 mcg/mL. If the patient needs 50 mcg of octreotide per hour then the patient will need 5, 10 mcg/mL doses or 5 mLs. So the rate for this patient would be 5 mL/hr.
質問 49
The administration of dapsone gel for the topical treatment of acne vulgaris in patients with G6PD deficiency may produce which of these?
- A. Hemolysis
- B. Immunosuppression
- C. Anaphylaxis
- D. Fungal infections
正解: A
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 50
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:
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 51
Which of the following medication may increase LDL?
- A. Amlodipine
- B. Diltiazem
- C. Lisinopril
- D. Metoprolol
- E. Hydrochlorothiazide
正解: E
解説:
LDL can be elevated by diuretics, cyclosporine, glucocorticoids, and amiodarone.
質問 52
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 53
MT is 47-year-old man who presents to the ER with painful, red, swollen area on his left leg. His temperature is 38.4, respiratory rate 30 and heart rate 95. He has been taking cephalexin day 4 today, as prescribed by his primary care physician. His CMP is normal a CBC shows elevated WBC of 16,000/mm3.
What would be the most appropriate antibiotic/s to initiate on MT empirically?
- A. Vancomycin IV.
- B. Nafcillin
- C. IV Doxycycline and Ceftazidime
- D. Ceftriaxone
- E. Vancomycin IV and Piperacillin/Tazobactam
正解: E
解説:
Explanation
This patient is displaying signs of a severe case of cellulitis. Severe cellulitis is defined as having one of the following: failed oral antibiotic treatment, immunocompromised, clinical signs of deeper infection, or meeting the SIRS criteria. Based on this patient's presentation they have failed antibiotic treatment and meet SIRS criteria. For severe cellulitis, IDSA SSTI guidelines recommend using Vancomycin along with Zosyn.
質問 54
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