NABP NABP-NAPLEX Online Practice Questions and Exam Preparation

NABP NABP-NAPLEX Online Questions & Answers

• Question 1:

  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 low, requires immediate treatment
  B. Slightly below normal
  C. Within the normal range
  D. Very high, requires immediate treatment
  C. Within the normal range

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  Serum chloride levels should ideally fall between 96-106 mEq/L. For this reason, the patient's chloride level has come back as normal.

• Question 2:

  According to the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to ReduceAtherosclerotic Cardiovascular Risk in Adults, which of the following LDL cholesterol thresholds is an indication for high-intensity statin therapy?

  A. 100 mg/dL
  B. 130 mg/dL
  C. 190 mg/dL
  D. 200 mg/dL
  E. 150 mg/dL
  C. 190 mg/dL

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• Question 3:

  Which of the following medication may increase LDL?

  A. Amiodarone
  B. Lisinopril
  C. Hydrochlorothiazide
  D. Acetaminophen
  E. Cyclosporine
  E. Cyclosporine

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  LDL can be elevated by diuretics, cyclosporine, glucocorticoids, and amiodarone.

  http://circ.ahajournals.org/content/129/25_suppl_2/S1

• Question 4:

  Select the class of Anti-diabetic medication that works in the specified organ to prevent hyperglycemia. Select all that applies. Pancreases (A)

  A. Sulfonylureas
  B. Alpha- Glucosidase Inhibitors
  C. DPP4 Inhibitors
  D. Glucagon-like peptide-1 receptor agonists
  E. Thiazolidinediones
  F. Biguanide
  G. SGLT2 inhibitors
  D. Glucagon-like peptide-1 receptor agonists

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  (A) Sulfonylureas, (C) 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 peptide1 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 skeletaland 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.

• Question 5:

  Which of the following is/are a risk factor for myopathy with statin therapy?

  A. Hypothyroidism
  B. Vitamin D deficiency
  C. Renal impairment
  D. Hepatic dysfunction
  E. Vitamin C deficiency
  D. Hepatic dysfunction

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  Risk factors for myopathy are hypothyroidism, reduced renal or hepatic function, rheumatologic disorders such as polymyalgia rheumatica, steroid myopathy, vitamin D deficiency, or primary muscle diseases.

• Question 6:

  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 60mg ER po daily and morphine 15mg po q6h prn breakthrough pain
  C. Morphine 30mg ER po q6hr and morphine 5mg q6h prn for breakthrough pain
  D. Morphine 15mg ER po q12hr and morphine 15mg po q6h prn for breakthrough pain
  E. Morphine 15mg ER po q12hr and morphine 5mg po q6h prn breakthrough pain
  E. Morphine 15mg ER po q12hr and morphine 5mg po q6h prn breakthrough pain

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  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.

• Question 7:

  What is the Osmolarity in mOsm/L of 40mEq of KCl in 100ml sterile water? (Molecular weight of KCl is 74.5gm/mol.)?

  A. 400mOsm/L
  B. 800mOsm/L
  C. 80mOsm/L
  D. 200mOsm/L
  E. 1600mOsm/L
  B. 800mOsm/L

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• Question 8:

  In Normal distribution, what percentage of the sample is found within 2 standard deviation of the mean?

  A. 68%
  B. 95%
  C. 99%
  D. 100%
  E. 72%
  B. 95%

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  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.

  http://www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one

• Question 9:

  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. Nifedipine
  B. Amlodipine
  C. Verapamil
  D. Diltiazem
  C. Verapamil

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  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.

• Question 10:

  A 7-year-old boy has been suffering from influenza and had been given a drug by his father to decrease his high fever. A few hours later, his father brought him to the emergency room in a comatose state with a papulovesicular rash all over the body, moderate hepatomegaly, and asterixis. Laboratory studies reveal elevated levels of blood ammonia, AST, ALT, and PT. CT scan findings are suggestive for generalized cerebral edema.

  The drug the father gave his son is most likely which of the following drugs?

  A. Aspirin
  B. Acetaminophen
  C. Indomethacin
  D. Mefenamic acid
  E. Diclofenac
  A. Aspirin

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  A: The syndrome is an acute noninflammatory encephalopathy with hepatic failure. Although the etiology of Reye's syndrome is unknown, the condition typically follows viral illness, particularly upper respiratory tract infection (URTI), influenza, varicella, or gastroenteritis, and is associated with aspirin use during the illness. A dramatic decrease in aspirin use in children has made Reye's syndrome rare. High index of suspicion is critical for diagnosis. Consider Reye's syndrome in any child with vomiting and altered mental status. Pathogenesis is unclear, but it typically involves mitochondrial dysfunction in a viral-infected, sensitized host, usually with exposure to mitochondrial toxins (e.g., salicylates, in >80% of cases). Individuals with low levels of urea cycle enzymes are also at increased risk. Mortality has fallen from 50% to less than 20% as a result of earlier diagnosis, recognition of milder cases, and more aggressive therapy. Signs and symptoms of Reye's syndrome include protracted vomiting, with or without significant dehydration, encephalopathy in afebrile patients with minimal or absent jaundice, and hepatomegaly in 50% of patients. Antiemetics may mask early symptoms. Liver function tests reveal elevation of ammonia levels to as much as 1.5 times normal (up to 1200g/dL) 24-48 hours after the onset of mental status changes; this is the most frequent laboratory abnormality. Transaminases (ALT and AST) increase to 3 times normal. Histologic changes include: hepatocyte cytoplasmic fatty vacuolization, astrocyte edema, loss of neurons, and edema and fatty degeneration in proximal lobules. The American Academy of Pediatrics Committee on Infectious Disease recommends that salicylate not be given to children with chicken pox or influenza B. B: Acetaminophen is incorrect. Acetaminophen acts by prostaglandin synthesis in the CNS, and this explain its antipyretic and analgesic properties, which account for its weak anti-inflammatory activity. Acetaminophen is a suitable substitute for the analgesic and antipyretic effects of aspirin in those patients with gastric complaints and to avoid Reye's syndrome in children. C: Indomethacin is incorrect. Indomethacin is more potent than aspirin as an anti-inflammatory agent (NSAID), but it is inferior to the salicylates at doses tolerated by rheumatoid arthritis patients. D: Mefenamic acid is incorrect. Mefenamic acid has no advantage over the other NSAIDS as anti-inflammatory agents. The side effects of mefenamic acid, such as diarrhea, can be severe and associated with inflammation of the bowel. E: Diclofenac is incorrect. Diclofenac is approved for long-term use in the treatment of rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis.