準備できるNAPLEX問題解答は無料更新されて100%試験合格保証 [2022]
問題集リアルなNABP NAPLEX試験問題 [更新されたのは2022年]
質問 82
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.
It is recommended to monitor complete blood count in patients on chronic metformin because of what reason?
- A. Metformin may decrease vitamin B12 levels
- B. Metformin may decrease platelet count
- C. Metformin may cause leukocytosis
- D. Metformin may decrease erythropoietin level
- E. Metformin may decrease iron absorption
正解: A
解説:
Explanation
Metformin may impair the absorption of vitamin B12, especially in those with inadequate vitamin b12 or calcium intake/absorption. Vitamin b12 deficiency can be treated with discontinuation of therapy or supplementation. Vitamin b12 serum concentrations should be monitored periodically with long-term therapy.
質問 83
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 84
When does the newer chronic kidney disease (CKD) guidelines recommend stopping metformin?
- A. when creatinine clearance <30 ml/min
- B. when estimated glomerular filtration (eGFR) is <50 mL/min/1.73 m2
- C. when serum creatinine is <1.8 mg/dL
- D. when the estimated glomerular filtration (eGFR) is <30 mL/min/1.73 m2
- E. when creatinine clearance <50 ml/min
正解: D
解説:
Metformin should be stopped when eGFR falls below 30. This is the only cutoff that is recommended for absolute discontinuing. If the eGFR falls between 30-44 while ontherapy, benefits and risks of discontinuing should be evaluated. New initiation is only recommended when eGFR >45.
質問 85
A 51-year-old patient, who takes a calcium channel blocker (CCB), reports that he is experiencing constipation. Which CCB is the patient most likely to be taking?
- A. Amlodipine
- B. Diltiazem
- C. Verapamil
- D. Nifedipine
正解: C
解説:
Explanation
Non-dihydropyridine calcium channel blockers - which are diltiazem and verapamil - are statistically more likely to cause constipation. Of these two, verapamil has a higher probability of causing this side effect.
質問 86
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:
Explanation
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 87
WM did not receive influenza vaccine prior to the start of this season, it's now December. He did get influenza vaccine last year. Which of the following is correct course of action?
- A. Skip influenza vaccine for this year since it's too late.
- B. Skip influenza vaccine for this year since he received vaccine last year.
- C. Vaccinate him with influenza vaccine since influenza season lasts until March in your community.
- D. Start Amantadine 200mg daily
- E. Start WM on Tamiflu to prevent him from getting influenza.
正解: C
解説:
Explanation
Influenza vaccine is recommended annually, thus, WM should not skip it this year, and B is incorrect. Also, per the CDC, seasonal influenza outbreaks can occur as early as October, however, most activity peaks in January or later. Thus, it is not too late for WM to receive his vaccine in December, thus A is incorrect. Lastly, antiviral medications such as Tamiflu are an important adjunct to vaccinations. They are recommended as early as possible for any patient with confirmed or suspected influenza who, is 1) Hospitalized, 2) has severe, complicated, or progressive illness or 3) is at higher risk for influenza complications. Thus, WM is not a candidate with the given information and C is incorrect. Starting Tamiflu or Amantadine is not recommended for prevention. It has indication for treatment and prophylaxis.
質問 88
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 89
Injectable Sulfamethoxazole/Trimethoprim comes as 400mg/80mg/5ml. Physician requests you to dose a Sulfamethoxazole/Trimethoprim intravenously for PCP. You know the dose is 15mg/kg/day (based on TMP component) divided q6h.
How many milliliters of Sulfamethoxazole/Trimethoprim of 400mg/80mg/5ml would you need for single dose? Patient weighs 80kg.
- A. 75 mL
- B. 50 mL
- C. 16.5 mL
- D. 15 mL
- E. 18.75 mL
正解: E
解説:
Explanation
80kg person = 15mg/kg/day = 1200mg/day 80mg /5ml = 1200mg/X X= 75mL/day / 4 doses = 18.75 mL per dose
質問 90
A 49-year-old's blood test results have come back from the lab. Their chloride level currently measures 99 mEq/L. How should you interpret this result?
- A. Very high, requires immediate treatment
- B. Very low, requires immediate treatment
- C. Within the normal range
- D. Slightly below normal
正解: C
解説:
Explanation
Serum chloride levels should ideally fall between 96-106 mEq/L. For this reason, the patient's chloride level has come back as normal.
質問 91
The rate that an outcome will occur given a particular exposure, compared to the rate of the outcome occurring in the absence of that exposure is definition of which of the following?
- A. Incidence rate
- B. Prevelance rate
- C. Odds ratio
- D. Relative risk
- E. Confidence Interval
正解: D
解説:
Explanation
RR = rate of an outcome occurring in an exposed group (treatment group/intervention group) divided by the rate of an outcome occurring in an unexposed group (control group) Ex: Relative Risk = Rate of UTI in patients taking drug XYZ / rate of UTI in patients not on drug XYZ
質問 92
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. 1400ml
- B. 200ml
- C. 1000ml
- D. 2500ml
- E. 1500ml
正解: E
解説:
Explanation
15% dextrose = 15gm/100ml = 300gm/2000ml. Patient needs 300gm. 300gm/Xml = 20gm/100ml = 1500ml
質問 93
Your patient, a 25-year-old G1P0 female at 26 weeks gestation presents due to an abnormal glucose tolerance test. One week prior, she was given 50 g of oral glucose and demonstrate a venous plasma glucose level of 156 mg/dL one hour later.
Which of the following is the most appropriate next step of management?
- A. Administer an oral, 3-hour 100 g glucose dose
- B. Advise the patient to follow an American Diabetic Association diet plan
- C. Begin insulin treatment
- D. Repeat the 50 g oral glucose challenge
- E. Order a fetal ultrasound examination
正解: A
解説:
Explanation
Gestational diabetes is typically asymptomatic but identified via a 1-hour 50g oral glucose challenge administered at 24-28 weeks of gestation. A venous plasma glucose blood level of > 140 mg/dL is suggestive, and must be confirmed with a 3-hour 100g oral glucose tolerance test. After administration of the 100g glucose challenge, at least two of the following are required for diagnosis: (1) fasting glucose > 95 mg/dL, (2) one-hour glucose >180 mg/dL, (3) two hour glucose >155 mg/dL, and (4) three hour glucose > 140 mg/dL.
Choice A -
To diagnose gestational diabetes, a positive 1-hour 50g oral glucose challenge must be followed up by a three-hour 100g oral glucose challenge. The diagnosis is only confirmed after both challenges are completed and the thresholds are met. Choice C - Following the diagnosis of gestational diabetes, the first step is strict glycemic control (fasting glucose).
質問 94
Which of the following would you use for aspiration pneumonia with an intention to cover anaerobes?
- A. Piperacillin-Tazobactam
- B. Levofloxacin
- C. Cefepime
- D. Ampicillin-sulbactam
- E. Cefazolin
正解: D
解説:
Cefepime, levofloxacin, cefazolin does not provide good coverage of anaerobes. Ampicillin-sulbactam and piperacillin-tazobactam provide anaerobic coverage.
質問 95
Which of the following illnesses is an example of a type III hypersensitivity reaction?
- A. Allergic rhinitis
- B. Lupus
- C. Graves disease
- D. Myasthenia gravis
- E. Hashiomoto's thyroiditis
正解: B
解説:
Explanation
A type III hypersensitivity reaction is mediated by immune complex deposition. In lupus, auto-antibodies are formed and these complexes are deposited in other tissues, especially in the kidneys, skin, and joints. Graves disease and myasthenia gravis are examples of type II but in some classification systems they are called type V reactions. The auto-antibodies created in Graves attack TSH receptors in the thyroid, whereas in Myasthenia the target is the acetylcholine receptor. Hashimoto's thyroiditis is usually considered an example of a combination of type II and IV reactions, as T cells are directed at thyroid antigens and antibodies are also produced. Allergic rhinitis is a classic example of a type I, IgE mediated reaction.
質問 96
How many kcal per gram does IV dextrose provide?
- A. 3.4 kcal/g
- B. 0.9 kcal/g
- C. 1.2 kcal/g
- D. 1.5 kcal/g
正解: A
解説:
Explanation
IV dextrose provides 3.4 kcal/g.
質問 97
Which of the following would be most appropriate to treat infections associated with stenotrophomonas maltophilia?
- A. Ciprofloxacin
- B. Ampicillin
- C. Vancomycin
- D. Sulfamethoxazole/trimethoprim
- E. Meropenem
正解: D
解説:
Primary treatment for stenotrophomonas maltophilia is SMX-TMP. Meropenem, ciprofloxacin, Ampicillin and vancomycin have no coverage.
質問 98
If a patient takes 0.5mg of intravenous hydromorphone every 4hrs what would be the equivalent orals total daily dose? Hydromorphone oral to parenteral ratio 7.5:1.5.
- A. 7.5mg
- B. 15mg
- C. 5mg
- D. 10mg
- E. 20mg
正解: B
解説:
Explanation
To determine the dose conversion IV to PO, the ratio of PO to IV needs to be determined, this is 7.5 / 1.5 which is 5. This number means that the PO dose is 5 times more than the IV dose to get the same amount of drug into the bloodstream. If the patient is taking 0.5 mg IV then the PO dose would be 0.5 mg multiplied by
5, which is 2.5 mg. Since the patient is taking the medication every 4 hours the patient is receiving 6 doses,
24hrs/4hrs = 6. Since the patient is receiving 2.5 mg every dose and is receiving 6 doses a day, the patient is receiving 15 mg, 2.5 mg multiplied by 6 doses.
質問 99
Select the class of Anti-diabetic medication that works in the specified organ to prevent hyperglycemia. Select all that applies. Alpha cells in pancreases
- A. Alpha- Glucosidase Inhibitors
- B. Thiazolidinediones
- C. Biguanide
- D. DPP4 Inhibitors
- E. Sulfonylureas
- F. SGLT2 inhibitors
- G. Glucagon-like peptide-1 receptor agonists
正解: D
解説:
Explanation
DPP4 Inhibitors, D Glucagon-like peptide-1 receptor agonists Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha-Glucosidase Inhibitors stop -glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body.
Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion; (iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia. Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in skeletal and cardiac muscle, liver, and adipose tissue. It ameliorates insulin resistance, decreases visceral fat. Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.
質問 100
Which of the following class of antidiabetic medication may cause fluid retention?
- A. Alpha-glucosidase inhibitor
- B. SGLT2 Inhibitor
- C. GLP-1 agonist
- D. Bile acid sequestrant
- E. Thiazolidinediones
正解: E
解説:
Explanation
Thiazolidinediones may cause fluid retention through proposed mechanism of increasing reabsorption in the collecting duct of the kidney and increasing vascular permeability in adipose tissue. Bile acid sequestrants work in the intestine to bind bile acids which doesn't affect fluid retention. GLP-1 receptor agonists work to activate these receptors to secrete insulin from beta pancreatic cells/decrease glucagon secretion/ increase satiety and doesn't affect fluid retention. SGLT2 inhibitors actually cause increase of fluid elimination through the kidneys. Alpha-glucosidase inhibitors work in the gut to decrease carb absorption/digestion and have no affect on fluid retention.
質問 101
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:
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 Reference:
http://www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one
質問 102
Which of the following statements is true regarding Drug-receptor bonds?
- A. Covalent bonds of drugs with receptors are strong and mostly reversible
- B. Hydrophobic bonds are weak bonds and they are important in the interactions of highly water soluble drugs with the lipids of cell membranes
- C. Bond formation of between the acetyl group of aspirin and cyclo-oxygenase enzyme is a covalent bond
- D. Covalent bonding is much more common than electrostatic bonding in drug-receptor interactions
- E. Electrostatic bonds are stronger than covalent bonds
正解: C
解説:
Drugs mainly interact with the receptors by means of chemical forces or bonds. There are three major types of drug receptor bonds: - Covalent - Electrostatic - Hydrophobic Covalent bonds are very strong bonds and in most of the cases they are irreversible under biologic conditions. For example, the covalent bond between the acetyl group of aspirin and cyclo-oxygenase enzyme (target enzyme present on the platelets) does not breaks easily. The platelet aggregation effect of aspirin lasts long after free acetyl-salicylic acid has disappeared from the blood (about 15 minutes) and it is reversed only by the synthesis of new cyclo-oxygenase enzyme in new platelets which takes a long time. Hence the effect of aspirin is seen after the drug is stopped. Among the drug receptor interactions, electrostatic bond is much more commonly found than covalent bond. The electrostatic bonds vary from relatively strong linkages between permanently charged ionic molecules to weaker hydrogen bonds and very weak induced dipole interactions such as van der Waals force. The electrostatic bonds are weaker than covalent bonds. Hydrophobic bonds are usually very weak bonds and probably important in the interactions of highly lipid soluble drugs with the lipids of cell membranes and perhaps in the interactions of the drugs with the internal walls of receptor "pockets".
質問 103
Alteplase is ordered for a 72 YOM who weighs 68kg for Ischemic stroke. The ER physician would like you to dose. As an ER pharmacist you know the dose is 0.9 mg/kg IV (not to exceed 90 mg); give 10% of the total dose as an IV bolus over 1 minute, then give the remaining 90% as an IV infusion over 60 minutes. After reconstitution, the concentration of Altaplace is 1mg/ml. How many ml is needed for the bolus and how many ml is needed for the infusion? Round to the nearest ml.
- A. 4ml IV bolus, followed by 57mL IV over 60 minutes
- B. 3ml IV bolus, followed by 58mL IV over 60 minutes
- C. 9ml IV bolus, followed by 82mL IV over 60 minutes
- D. 8ml IV bolus, followed by 52mL IV over 60 minutes
- E. 6ml IV bolus, followed by 55mL IV over 60 minutes
正解: E
解説:
Explanation
68kg * 0.9mg/kg = 61.2mg dose * 1mg/mL = 61.2mL 61.2mg * 0.1 = 6mL IV bolus 61.2mg * 0.9 = 55mL IV over 60 minutes
質問 104
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 105
When does the newer chronic kidney disease (CKD) guidelines recommend stopping metformin?
- A. when creatinine clearance <30 ml/min
- B. when estimated glomerular filtration (eGFR) is <50 mL/min/1.73 m2
- C. when serum creatinine is <1.8 mg/dL
- D. when the estimated glomerular filtration (eGFR) is <30 mL/min/1.73 m2
- E. when creatinine clearance <50 ml/min
正解: D
解説:
Explanation
Metformin should be stopped when eGFR falls below 30. This is the only cutoff that is recommended for absolute discontinuing. If the eGFR falls between 30-44 while ontherapy, benefits and risks of discontinuing should be evaluated. New initiation is only recommended when eGFR >45.
質問 106
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