NABP NABP Certifications NAPLEX Questions & Answers

• Question 121:

  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. lockout 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. 10mg

  B. 5.3mg

  C. 4.8mg

  D. 0.5mg

  E. 52.8mg

  Correct Answer: B

  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

• Question 122:

  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. lockout 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 erythropoietin level

  B. Metformin may decrease platelet count

  C. Metformin may decrease vitamin B12 levels

  D. Metformin may cause leukocytosis

  E. Metformin may decrease iron absorption

  Correct Answer: C

  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.

• Question 123:

  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. lockout 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 cause lactic acidosis

  C. Metformin can build up neurotoxin

  D. Metformin can cause hyperglycemia

  E. Metformin can cause hyperkalemia

  Correct Answer: B

  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 andlt;2.0 mmol/L.

• Question 124:

  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 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 10mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10 mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20K at 125 mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6min, 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 increase LN's potassium?

  A. Ondansetron

  B. Metoclopramide

  C. Metformin

  D. Lisinopril

  E. Hydromorphone

  Correct Answer: D

  Lisinopril may increase LN's potassium. One of the warnings/precautions of lisinopril is hyperkalemia. ACE inhibitors block the formation of circulating angiotensin II, which can lead to a decrease in aldosterone secretion that can result in an increase in potassium. Risk factors for hyperkalemia while taking lisinopril include renal impairment, diabetes, and concomitant use of potassium-sparing diuretics, potassium supplements and/or potassium containing salts. Potassium should be monitored closely when taking any of the other agents listed. Hyperkalemia is not listed in the warnings/precautions section for the other medications.

• Question 125:

  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 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 10mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20K at 125 mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6min, 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/s should LN be on to prevent the most common side effect of hydromorphone?

  A. Ondansetron for N/V

  B. Dexamethasone for N/V

  C. Insulin Sliding scale for hyperglycemia

  D. Docusate sodium / Senna for Constipation

  E. Docusate sodium / Senna for Constipation and ondansetron for N/V

  Correct Answer: E

  LN should be on docusate sodium/Senna for constipation and ondansetron for N/V. Dexamethasone has

  an off label use for N/V that is chemotherapy-associated. It is mostly used as an anti-inflammatory or

  immunosuppressant agent.

  Hydromorphone does not cause hyperglycemia. The most common side effects of opioids are nausea,

  vomiting and constipation.

• Question 126:

  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 20K at 125mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6min, 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 significantly cause QT prolongation?

  A. Lisinopril

  B. Levothyroxine

  C. Metformin

  D. Hydromorphone

  E. Citalopram

  Correct Answer: E

  Celexa causes dose-dependent QT interval prolongation, which can cause Torsades de Pointes, ventricular tachycardia, and sudden death. Celexa is not recommended for use at doses greater than 40 mg per day because such doses cause too large an effect on the QT interval and confer no additional benefit. Celexa should be discontinued in patients found to have persistent QTc measurements greater than 500 ms. Ondansetron and Famotidine may cause QT prolongation. Ondansetron may cause QT prolongation. However, this would be dose-dependent. Doses greater than 16 mg of Ondansetron IV are no longer recommended due to an increased risk of QT prolongation. Famotidine may prolong the QT interval; this has been reported in those with renal dysfunction. There have also been reports of torsade de pointes. Use of all three medications may result in an arrhythmia occurring since both have the potential to prolong the QT interval. Therefore, close monitoring is recommended or discontinuation of one medication. The other medications listed do not have this warning/precaution.

• Question 127:

  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. Lisinopril

  B. Dexamethasone

  C. Famotidine

  D. Metoclopramide

  E. Hydromorphone

  Correct Answer: B

  Dexamethasone is associated with psychiatric disturbances. Corticosteroids may exacerbate pre-existing psychiatric conditions.

• Question 128:

  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. Lisinopril

  B. Dexamethasone

  C. Famotidine

  D. Metoclopramide

  E. Hydromorphone

  Correct Answer: D

  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.

• Question 129:

  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 increase LN's Blood glucose?

  A. Lisinopril

  B. Dexamethasone

  C. Famotidine

  D. Metoclopramide

  E. Hydromorphone

  Correct Answer: B

  Dexamethasone can increase LN's blood glucose. All glucocorticosteroids are known to increase blood glucose. Blood glucose would need to be monitored while LN is being treated with dexamethasone.

• Question 130:

  A 54-year-old male with a long history of mild persistent asthma on daily fluticasone therapy has been using his albuterol inhaler every day for the past month, and presents requesting a refill. What changes should be made to his current regimen?

  A. Add ciclesonide to current regimen

  B. Add salmeterol to current regimen

  C. Discontinue fluticasone and instead use salmeterol

  D. Add cromolyn to current regimen

  E. Discontinue fluticasone and add ipratropium to current regimen

  Correct Answer: B

  Add salmeterol to the current regimen. This patient had mild persistent asthma but was using his albuterol daily, which indicates that a step up in therapy is warranted. The preferred first line treatment regimen for moderate persistent asthma are low to medium dose inhaled corticosteroids plus a long acting beta2 agonist, as well as a short acting beta2 agonist as needed. A is incorrect. Ciclesonide is an inhaled corticosteroid. The patient in the case is already using fluticasone, so adding ciclesonide would be therapeutic duplication. C is incorrect. Long-acting beta2 agonists should only be used as adjunctive therapy in patients who are currently receiving but not adequately controlled on an inhaled corticosteroid. These medications should not be used as monotherapy, due to an increased risk of asthma related deaths. D is incorrect. Cromolyn prevents the release of vasoactive mediators from mast cell and is primarily used for exercise-induced asthma, it is not indicated as an alternative agent in patients with moderate persistent asthma. E is incorrect. Ipratropium is a short-acting anticholinergic, which is often used in COPD or in asthma exacerbations. It is not indicated for maintenance treatment of moderate persistent asthma.